The mission of the Chronicity Areas of Excellence (AoE) is to advance and disseminate knowledge and to influence public policy related to living well with chronic health concerns.
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  1. Study protocol: Living with hope: Developing a psychosocial supportive program for rural women caregivers of persons with advanced cancer [Download]

    Title: Study protocol: Living with hope: Developing a psychosocial supportive program for rural women caregivers of persons with advanced cancer
    Creator: Duggleby, W.
    Description: Background: Hope is defined by caregivers as the inner strength to achieve future good and to continue care giving. Pilot test findings of a Living with Hope Program (LWHP) suggested it is an acceptable and feasible intervention for use by family caregivers. Although it shows promise in potentially increasing hope and quality of life, further testing and development is needed. Questions remain as to: a) what are the mechanisms through which the LWHP affects outcomes and b) how long it is effective? The overall purpose of this time series mixed method study is the further development and testing of the LWHP by: a. Determining the mechanisms of the LWHP by testing a LWHP conceptual model in which self-efficacy, and loss/grief are hypothesized intermediary variables for changes in hope, and subsequently quality of life among rural women caring for persons with advanced cancer, and; b. Exploring the longitudinal effects of the LWHP on hope, quality of life and health services utilization among rural women caring for persons with advanced cancer. Methods/Design: Using a time-series embedded mixed method design, data will be collected from 200 rural women caregivers. Following the collection of baseline and outcome variables, the intervention (LWHP) is applied to all subjects. Subjects are followed over time with repeated measures of outcome variables (1 wk, 2 wk, 3, 6 and 12 months). The journals that are completed as part of the LWHP comprise the qualitative data. Health services utilization data will be collected from the Saskatchewan Health Administrative Database for all subjects one year prior and one year after study enrolment. Path analysis will be used to test the model post LWHP, at 1 and 2 weeks. Two-factor ANCOVA will determine patterns over time and Cortazzi’s narrative analysis will be used to analyze subjects journals completed as part of the LWHP. Discussion: Data Collection began January 2009 and is expected to be completed within 2 years time. Monthly meetings with data collectors and site collaborators have been instrumental in revisions to the original study protocol such as identifying and adding additional study sites.
    Subjects: Rural women, Support programs, Caregivers, Psychosocial support, Cancer patients
    Date Created: 2010
  2. Influence of interpersonal violence on maternal anxiety, depression, stress and parenting morale in the early postpartum: A community based pregnancy cohort study. [Download]

    Title: Influence of interpersonal violence on maternal anxiety, depression, stress and parenting morale in the early postpartum: A community based pregnancy cohort study.
    Creator: Malta, L. A.
    Description: Background Research has shown that exposure to interpersonal violence is associated with poorer mental health outcomes. Understanding the impact of interpersonal violence on mental health in the early postpartum period has important implications for parenting, child development, and delivery of health services. The objective of the present study was to determine the impact of interpersonal violence on depression, anxiety, stress, and parenting morale in the early postpartum. Methods Women participating in a community-based prospective cohort study (n = 1319) completed questionnaires prior to 25 weeks gestation, between 34–36 weeks gestation, and at 4 months postpartum. Women were asked about current and past abuse at the late pregnancy data collection time point. Postpartum depression, anxiety, stress, and parenting morale were assessed at 4 months postpartum using the Edinburgh Postnatal Depression Scale, the Spielberger State Anxiety Index, the Cohen Perceived Stress Scale, and the Parenting Morale Index, respectively. The relationship between interpersonal violence and postpartum psychosocial health status was examined using Chi-square analysis (p 
    Subjects: postpartum mental health, pregnancy cohort, interpersonal violence, parenting morale
    Date Created: 2012
  3. Determinants of hospital nurse intention to remain employed: Broadening our understanding. [Download]

    Title: Determinants of hospital nurse intention to remain employed: Broadening our understanding.
    Creator: Tourangeau A. E.
    Description: Aim.  This paper is a report of a study to identify nurse reported determinants of intention to remain employed and to develop a model explaining determinants of hospital nurse intention to remain employed. Background.  A worsening shortage of nurses globally suggests that efforts must be made to promote retention of nurses. However, effective retention promotion strategies depend on understanding the factors influencing nurse retention. Methods.  A descriptive study using focus group methodology was implemented. Thirteen focus groups including 78 nurses were carried out in two Canadian provinces in 2007. Thematic analysis strategies were incorporated to analyse the data. Findings.  Eight thematic categories reflecting factors nurses described as influencing their intentions to remain employed emerged from focus groups: (1) relationships with co-workers, (2) condition of the work environment, (3) relationship with and support from one’s manager, (4) work rewards, (5) organizational support and practices, (6) physical and psychological responses to work, (7) patient relationships and other job content, and (8) external factors. A model of determinants of hospital nurse intention to remain employed is hypothesized. Conclusion.  Findings were both similar to and different from previous research. The overriding concept of job satisfaction was not found. Rather, nurse assessments of satisfaction within eight thematic categories were found to influence intentions to remain employed. Further testing of the hypothesized model is required to determine its global utility. Understanding determinants of intention to remain employed can lead to development of strategies that strengthen nurse retention. Incorporation of this knowledge in nurse education programmes is essential.
    Subjects: nursing workforce, theory development, focus groups, employment, work environments, hospital nurses
    Date Created: 2010
  4. Identifying signals of suffering by linking verbal and facial cues. [Download]

    Title: Identifying signals of suffering by linking verbal and facial cues.
    Creator: Morse, J.
    Description: Here, the authors describe microanalytically the two main behavioral states in suffering (enduring and emotional suffering) so that in subsequent research, appropriate comforting responses to ease and relieve suffering can be identified for each behavioral state. Their objectives were to describe the facial expressions of enduring and emotional suffering, and to link them with verbal narrative and thus develop a microanalytic description of each behavioral state. Using Ekman's modified EMFACS, they videotaped interviews with 19 participants and coded co-occurring verbal text and expressions. They also documented differences between each behavioral state and the transitions from enduring to emotional suffering. Enduring and emotional suffering are distinct and identifiable behaviors. These formerly implicit behavioral cues can be used in clinical assessment and research.
    Subjects: enduring, facial expression, suffering
    Date Created: 2003
  5. Stories of chronic kidney disease: Listening for the unsayable. [Download]

    Title: Stories of chronic kidney disease: Listening for the unsayable.
    Creator: Makaroff, K. L.
    Description: Aims: To explore individuals’ stories of chronic kidney disease, particularly those aspects of experience that are difficult to discuss using language (i.e., unsayable). Background: Chronic kidney disease is continuous, but it is also life-threatening and sometimes people ask difficult questions about life and death that can be challenging and for some, impossible to discuss. These ‘unsayables’ are the focus of this article. The unsayable may reside both within and beyond language. Careful analysis of narratives of illness for sayable and unsayable aspects of the experience can help illuminate new areas of concern for people with chronic kidney disease. Design: Narrative inquiry, located in a social constructionist framework, guided this study. Methods: Secondary data analysis was conducted with 46 in-depth interviews (collected between 2008-2011) with 14 people living with chronic kidney disease. Findings: Through narrative thematic analysis, we identify that the unsayable includes the following five themes: living with death, embodied experiences that were difficult to language, that which was unthinkable, unknowable mystery and that which was untold/unheard. Whereas the first four themes attend to that which is unsayable for people living with chronic kidney disease, the last theme acknowledges that which is unsayable to people living with chronic kidney disease. Conclusion: Not all experiences of illness can be explicitly articulated in language. Listening for both the sayable and unsayable aspects of life with chronic and life-threatening illness is an important nursing role.
    Subjects: narrative, communication, chronic illness, renal nursing
    Date Created: 2013
  6. The lived experience of family caregivers who provided end-of-life care to persons with advanced dementia. [Download]

    Title: The lived experience of family caregivers who provided end-of-life care to persons with advanced dementia.
    Creator: Peacock, S.
    Description: Objective: Dementia is a terminal illness, and family caregivers play a vital role in providing end-of-life care to their relative. The present study begins to address the paucity of research regarding end-of-life caregiving experience with dementia. Method: This study utilized Munhall's methodology for interpretive phenomenology. Seven women and four men were interviewed two to three times within a year of their relative's death; interviews were transcribed verbatim and hermeneutically analyzed. Results: Findings reveal two essential aspects of end-of-life dementia caregiving: being-with and being-there. Further findings are organized according to the existential life worlds. Examination of the life worlds demonstrates that 1) spatiality provided a sense or lack of feeling welcome to provide end-of-life care; 2) temporality was an eternity or time melting away quickly, or the right or wrong time to die; 3) corporeality revealed feelings of exhaustion; and 4) relationality was felt as a closeness to others or in tension-filled relationships. Significance of results: An understanding from bereaved caregivers’ perspectives will help healthcare practitioners better support and empathize with family caregivers. Further research is warranted that focuses on other places of death and differences in experience based on gender or relationship to the care receiver.
    Subjects: phenomenology, family caregivers, dementia, end-of-life care
    Date Created: 2013
  7. Mobility of Vulnerable Elders (MOVE): Study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities [Download]

    Title: Mobility of Vulnerable Elders (MOVE): Study protocol to evaluate the implementation and outcomes of a mobility intervention in long-term care facilities
    Creator: Slaughter, S.
    Description: Background: Almost 90% of residents living in long-term care facilities have limited mobility which is associated with a loss of ability in activities of daily living, falls, increased risk of serious medical problems such as pressure ulcers, incontinence and a significant decline in health-related quality of life. For health workers caring for residents it may also increase the risk of injury. The effectiveness of rehabilitation to facilitate mobility has been studied with dedicated research assistants or extensively trained staff caregivers; however, few investigators have examined the effectiveness of techniques to encourage mobility by usual caregivers in long-term care facilities. Methods/Design: This longitudinal, quasi-experimental study is designed to demonstrate the effect of the sit-tostand activity carried out by residents in the context of daily care with health care aides. In three intervention facilities health care aides will prompt residents to repeat the sit-to-stand action on two separate occasions during each day and each evening shift as part of daily care routines. In three control facilities residents will receive usual care. Intervention and control facilities are matched on the ownership model (public, private for-profit, voluntary not-for-profit) and facility size. The dose of the mobility intervention is assessed through the use of daily documentation flowsheets in the health record. Resident outcome measures include: 1) the 30-second sit-to-stand test; 2) the Functional Independence Measure; 3) the Health Utilities Index Mark 2 and 3; and, 4) the Quality of Life - Alzheimer’s Disease. Discussion: There are several compelling reasons for this study: the widespread prevalence of limited mobility in this population; the rapid decline in mobility after admission to a long-term care facility; the importance of mobility to quality of life; the increased time (and therefore cost) required to care for residents with limited mobility; and, the increased risk of injury for health workers caring for residents who are unable to stand. The importance of these issues is magnified when considering the increasing number of people living in long-term care facilities and an aging population.
    Subjects: Mobility Limitation, Quality of Life psychology, Homes for the Aged standards, Activities of Daily Living psychology, Nursing Homes standards
    Date Created: 2011
  8. Conservative management for postprostatectomy urinary incontinence [Download]

    Title: Conservative management for postprostatectomy urinary incontinence
    Creator: Hunter, K.F.
    Description: Background Urinary incontinence is common after both radical prostatectomy (RP) and transurethral resection of the prostate (TURP).Conservative management includes pelvic floor muscle training (PFMT) with or without biofeedback, electrical stimulation, compression devices (penile clamps), lifestyle changes, extra-corporeal magnetic innervation or a combination of methods. Objectives To assess the effects of conservative management for urinary incontinence after prostatectomy. Search methods We searched the Cochrane Incontinence Group Specialised Trials Register (searched 23 January 2006), MEDLINE (January 1966 to January 2006), EMBASE (January 1988 to January 2006), CINAHL (January 1982 to January 2006), PsycLIT (January 1984 to January 2006), ERIC (January 1984 to January 2006), the reference lists of relevant articles, handsearched conference proceedings and contacted investigators to locate studies. Selection criteria Randomised or quasi-randomised controlled trials evaluating conservative interventions for urinary continence after prostatectomy. Data collection and analysis At least two review authors assessed the methodological quality of trials and abstracted data. Main results Seventeen trials met the inclusion criteria, fifteen trials amongst men after radical prostatectomy (RP), one trial after transurethral resection of the prostate (TURP) and one trial after either operation. There was considerable variation in the interventions, populations and outcome measures. The majority of trials in this area continue to be of moderate quality, although more recent studies have been of higher quality in terms of both randomisation and blinding. Data were not available in all the trials for many of the pre-stated outcomes. Confidence intervals have tended to be wide except for the more recent studies, and it continues to be difficult to reliably identify or rule out a useful effect. There were several important variations in the populations being studied. Therefore the decision was made by the review authors to separate in the analysis the men having the intervention as prevention (whether administered before or after operation, to all men having surgery) or as treatment (postoperatively to those men who did have urinary incontinence), as well as separating those treated with TURP or RP. Amongst seven treatment trials of postoperative PFMT for urinary incontinence after RP, one trial suggested benefits, whereas the estimates from the others were consistent with no effect. There was clinical and statistical heterogeneity, precluding meta-analysis. There was no clear reason for this heterogeneity. Trials of preventative PFMT started pre or post-operatively also showed heterogeneity: only one large trial favoured PFMT but the data from the others were conflicting. Analysis of other conservative interventions such as transcutaneous electrical nerve stimulation and anal electrical stimulation, or combinations of these interventions were inconclusive. There were too few data to determine treatment effects on incontinence after TURP. The findings should continue to be treated with caution, as most studies were of poor to moderate quality. With respect to other management, men in one trial reported a preference for one type of external compression device compared to two others or no treatment. The effect of other conservative interventions such as lifestyle changes remains undetermined as no trials involving these interventions were identified. Men’s symptoms tended to improve over time, irrespective of management. Authors’ conclusions The value of the various approaches to conservative management of postprostatectomy incontinence remains uncertain. Long-term incontinence may be managed by external penile clamp, but there are safety problems. P L A I N L A N G U A G E S U M M A R Y Conservative management for men with urinary incontinence after prostate surgery The prostate is a male sex gland that surrounds the outlet of the bladder. Two main diseases of the prostate (cancer of the prostate, or benign prostatic enlargement) can be treated by surgery but some men suffer leakage of urine (urinary incontinence) afterwards. Conservative treatment of the leakage, such as pelvic floor muscle training with or without biofeedback or anal electrical stimulation are thought to help men control this leakage. The review of trials found that there was conflicting information about the benefit of pelvic floor muscle training for either prevention or treatment of urine leakage after prostate surgery, whether for cancer or benign (non cancerous) enlargement of the prostate (endoscopic resection). Of three external compression devices tested, one type seemed to be better than the others but needs to be used cautiously because of safety risks. More research of better quality is needed to assess conservative managements.
    Subjects: Urinary incontinence (etiology; therapy), Prostatectomy (adverse effects), Biofeedback, Psychology, Exercise therapy, Randomized controlled trials on topic
    Date Created: 2007
  9. Reducing depression in older home care clients: Design of a prospective study of a nurse-led interprofessional mental health promotion intervention [Download]

    Title: Reducing depression in older home care clients: Design of a prospective study of a nurse-led interprofessional mental health promotion intervention
    Creator: Markle-Reid, M.
    Description: Background: Very little research has been conducted in the area of depression among older home care clients using personal support services. These older adults are particularly vulnerable to depression because of decreased cognition, comorbid chronic conditions, functional limitations, lack of social support, and reduced access to health services. To date, research has focused on collaborative, nurse-led depression care programs among older adults in primary care settings. Optimal management of depression among older home care clients is not currently known. The objective of this study is to evaluate the feasibility, acceptability and effectiveness of a 6-month nurse-led, interprofessional mental health promotion intervention aimed at older home care clients with depressive symptoms using personal support services. Methods/Design: This one-group pre-test post-test study aims to recruit a total of 250 long-stay (> 60 days) home care clients, 70 years or older, with depressive symptoms who are receiving personal support services through a home care program in Ontario, Canada. The nurse-led intervention is a multi-faceted 6-month program led by a Registered Nurse that involves regular home visits, monthly case conferences, and evidence-based assessment and management of depression using an interprofessional approach. The primary outcome is the change in severity of depressive symptoms from baseline to 6 months using the Centre for Epidemiological Studies in Depression Scale. Secondary outcomes include changes in the prevalence of depressive symptoms and anxiety, health-related quality of life, cognitive function, and the rate and appropriateness of depression treatment from baseline to 12 months. Changes in the costs of use of health services will be assessed from a societal perspective. Descriptive and qualitative data will be collected to examine the feasibility and acceptability of the intervention and identify barriers and facilitators to implementation. Discussion: Data collection began in May 2010 and is expected to be completed by July 2012. A collaborative nurse-led strategy may provide a feasible, acceptable and effective means for improving the health of older home care clients by improving the prevention, recognition, and management of depression in this vulnerable population. The challenges involved in designing a practical, transferable and sustainable nurse-led intervention in home care are also discussed.
    Subjects: Ageing, Depression, Chronic illness, Nurse-led interventions, Home care, Clinical effectiveness, Mental health promotion
    Date Created: 2011
  10. Evolving the theory and praxis of knowledge translation through social interaction: A social phenomenological study [Download]

    Title: Evolving the theory and praxis of knowledge translation through social interaction: A social phenomenological study
    Creator: McWilliam, C.
    Description: Background: As an inherently human process fraught with subjectivity, dynamic interaction, and change, social interaction knowledge translation (KT) invites implementation scientists to explore what might be learned from adopting the academic tradition of social constructivism and an interpretive research approach. This paper presents phenomenological investigation of the second cycle of a participatory action KT intervention in the home care sector to answer the question: What is the nature of the process of implementing KT through social interaction? Methods: Social phenomenology was selected to capture how the social processes of the KT intervention were experienced, with the aim of representing these as typical socially-constituted patterns. Participants ( n = 203), including service providers, case managers, administrators, and researchers organized into nine geographically-determined multidisciplinary action groups, purposefully selected and audiotaped three meetings per group to capture their enactment of the KT process at early, middle, and end-of-cycle timeframes. Data, comprised of 36 hours of transcribed audiotapes augmented by researchers' field notes, were analyzed using social phenomenology strategies and authenticated through member checking and peer review. Results: Four patterns of social interaction representing organization, team, and individual interests were identified: overcoming barriers and optimizing facilitators; integrating 'science push' and 'demand pull' approaches within the social interaction process; synthesizing the research evidence with tacit professional craft and experiential knowledge; and integrating knowledge creation, transfer, and uptake throughout everyday work. Achieved through relational transformative leadership constituted simultaneously by both structure and agency, in keeping with social phenomenology analysis approaches, these four patterns are represented holistically in a typical construction, specifically, a participatory action KT ( PAKT) model. Conclusion: Study findings suggest the relevance of principles and foci from the field of process evaluation related to intervention implementation, further illuminating KT as a structuration process facilitated by evolving transformative leadership in an active and integrated context. The model provides guidance for proactively constructing a 'fit' between content, context, and facilitation in the translation of evidence informing professional craft knowledge.
    Subjects: Implementation, Interventions, Transdisciplinarity, Randomized controlled-trial, Participatory action research, Conceptual framework, Health care, Evidence based medicine, Innovations, Clinical Practice
    Date Created: 2009