Browsing by Author "Bouchal, Shelley Raffin"

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    Compassion: a scoping review of the healthcare literature
    (2016-07) Sinclair, Shane; Norris, Jill M.; McConnell, Shelagh J.; Chochinov, Harvey Max; Hack, Thomas F.; Hagen, Neil A.; McClement, Susan; Bouchal, Shelley Raffin
    Recent concerns about suboptimal patient care and a lack of compassion have prompted policymakers to question the preparedness of clinicians for the challenging environment in which they practice. Compassionate care is expected by patients and is a professional obligation of clinicians; however, little is known about the state of research on clinical compassion. The purpose of this scoping review was to map the literature on compassion in clinical healthcare.
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    Compassion: a scoping review of the healthcare literature
    (BMC Palliative Care, 2016-01-19) Sinclair, Shane; Norris, Jill M.; McConnell, Shelagh J.; Chochinov, Harvey M.; Hack, Thomas F.; Hagen, Neil A.; McClement, Susan; Bouchal, Shelley Raffin
    Background Recent concerns about suboptimal patient care and a lack of compassion have prompted policymakers to question the preparedness of clinicians for the challenging environment in which they practice. Compassionate care is expected by patients and is a professional obligation of clinicians; however, little is known about the state of research on clinical compassion. The purpose of this scoping review was to map the literature on compassion in clinical healthcare. Methods Searches of eight electronic databases and the grey literature were conducted to identify empirical studies published over the last 25 years. Eligible studies explored perceptions or interventions of compassionate care in clinical populations, healthcare professionals, and healthcare students. Following the title and abstract review, two reviewers independently screened full-texts articles, and extracted study data. A narrative approach to synthesizing and mapping the literature was used. Results and discussion Of 36,637 records, 648 studies were retrieved and 44 studies were included in the review. Less than one third of studies included patients. Six themes emerged from studies that explored perceptions of compassionate care: nature of compassion, development of compassion, interpersonal factors related to compassion, action and practical compassion, barriers and enablers of compassion, and outcomes of compassion. Intervention studies included two compassionate care trials with patients and eight educational programs that aimed to improve compassionate care in clinicians and students. Conclusions This review identifies the limited empirical understanding of compassion in healthcare, highlighting the lack of patient and family voices in compassion research. A deeper understanding of the key behaviors and attitudes that lead to improved patient-reported outcomes through compassionate care is necessary.
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    Conceptualizations of Children with Disabilities among the Bulsa of Northern Ghana
    (2019-07-19) Achuroa, David Akanpentiba; Mather, Charles M.; Gerlach, S. Craig; Bouchal, Shelley Raffin
    Across the world, people meet their healthcare needs using a variety of approaches. The Bulsa located in Northern Ghana are no different. They have historically relied on both contemporary healthcare and traditional healthcare to address their health-related problems. This research explores how children with disabilities (CWDs) are conceptualized in Bulsa traditional healthcare, in the context of a system that many anthropologists have studied with reference to shrines. The shrine system, which encompasses governance, illnesses, belongingness, health in general, and inheritance in some African societies, has long been a subject of anthropological investigation (Mather 2003, Kirby 1993, Rattray 1932, Fortes 1967). As valuable as these studies have been, the investigation of disability in the context of the shrine system has at best only been treated in a peripheral way. As a way to uncover what CWDs signify in the shrine system, the research entailed interviewing fifty informants and conducting five household group discussions. Some individuals interviewed were parents of CWDs. The thesis research was also informed by my own lived experience with disability in Bulsa society. The investigations found that the role of the shrine system in disability and illness management in Bulsa society included two dimensions: ingestion of herbs and drugs; and reverence for invisible agencies, such as wen, jadok, and their associated processes. Moreover, we observed that people mostly use the term kikiruk in the context of CWDs and the term jadok for some adult acquired disability. Both terms carry with them a certain degree of humiliation and discrimination with respect to their victims, but the kikiruk term carries the greatest consequence for CWDs and their families.
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    Continuing the Dance: A Constructivist Grounded Theory of Understanding Transitions of Rural Couples with Parkinson's Disease
    (2020-09-14) Robinson, Tanis Arlene La Rose; Venturato, Lorraine; Bouchal, Shelley Raffin; Green, Theresa L.
    Parkinson’s disease (PD) is a complex chronic debilitating neurological disease characterized by muscle stiffness, rigidity, tremors, and postural imbalances – making it the second most common neurological disorder in Canada after Alzheimer’s disease. PD affects more men than women, diagnosis occurs around age 60, no known cause or cure exists, and rural living has been linked as a known risk factor. Little extant research helps us understand the rural couple’s experience and the processes used to adapt and transition to living with PD. As a result, adaptations and transitions of couples living in rural areas and implications to accessing health care services were explored. Constructivist grounded theory methodology guided this study. Purposeful sampling was used to recruit five couples and one additional participant living in rural areas, in which one spouse was diagnosed with PD, for a total of 11 participants. Five open-ended intensive joint interviews and one single intensive interview were conducted and transcribed verbatim. Charmaz’s constructivist grounded theory analysis steps were used to guide analysis of the data. Participants described their experience of living with PD in rural areas as an innate process of adapting, planning, and managing PD that allowed them to transition together, as a couple. Their main concern was learning how to negotiate the adaptations and transitions together – continuing a dance they began together many years ago. Through “negotiating the dance” together, couples “choreographed the dance,” “danced together,” and experienced “Adagio–Changing the Tempo.” As a result, they “continue the dance” every day. Recommendations for further research on rural couples with PD and the broader Parkinson’s community are also made.
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    The Experiences of Individuals Re-engaging in Sexual Relationships Following a Bone Marrow Transplant
    (2019-07-19) Shartau, Kristi; King-Shier, Kathryn M.; Booker, Reanne; Bouchal, Shelley Raffin
    More than 50,000 individuals worldwide receive a bone marrow transplant annually, and this incidence is increasing. Sexual function is a common long-term concern after a bone marrow transplant (BMT). Studies have demonstrated though important to patients, healthcare providers are often remiss in addressing these concerns. Thus, Straussian Grounded Theory was used to seek a deeper understanding of the process BMT patients undergo to reintegrate their sexual relationships following a bone marrow transplant. Qualitative themes that emerged included: identifying importance, taking responsibility, seeking resources, and navigating the partnered-relationship. Gender permeated each of these themes. These events occurred in a non-linear process of seeking a new normal and could apply at any time point during the treatment trajectory. The core category of seeking a new normal’ refers to the process participants will go through while searching for ‘normalization’ and trying to get back to the condition they were in before diagnosis. Gaining an understanding of the process patients go through when integrating back into their sexual lives post-transplant will facilitate awareness about the impact a transplant can have on a patient’s sexual health.
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    Feeding and Readiness: The Transition from Hospital-to-Home with a Late-Preterm Infant
    (2020-01) Shillington, Jessica; McNeil, Deborah; Bouchal, Shelley Raffin; Scotland, Jeanne; Premji, Shahirose Sadrudin J.E.
    In comparison to full-term infants, late-preterm infants (34 0/7 and 36 6/7 weeks’ gestation) have a greater likelihood of morbidity and a three-fold increased risk for mortality. Parents of late-preterm infants have identified inadequate preparation to manage their newborn’s unique needs at home, yet little is known about their hospital discharge experience. This study aims to describe the perspectives of parents surrounding their transition from hospital-to-home with their late-preterm infant. Twelve parents, nine mothers and three fathers, were recruited from Calgary, Alberta, and shared their experiences through in-person interviews and one focus group. Interpretative description was used to guide the study, and data were analyzed through interpretive thematic analysis and description. Key themes from the parents’ experiences were revealed to be "Fed is best" and "Feeling ready". These two themes support parents’ “Transition from hospital-to-home with their late-preterm infant” and are influenced by contextual attributes, including "Previous parenting experience" and the "Discharge care setting". Parents described verbal approval from healthcare professionals, early community follow-up, and discharge teaching specific to the unique characteristics of a late-preterm infant to increase their feelings of readiness to transition home. Parents found the care of their late-preterm infant to be normalized, particularly on the postpartum unit. Feeding was found to be the most significant challenge parents’ experienced, and the parent participants expressed a “fed is best” stance indicating that breastmilk is nutritionally superior, yet they feel the most important thing for their newborn is to feed and grow. Mothers and fathers of late-preterm infants need support from healthcare providers to take care of themselves and to choose a feeding method that works best for them and their infant. In hopes of reducing feeding challenges, parents need education on the characteristics of their late-preterm infant before leaving hospital and to have teaching reinforced in the community.
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    Patient and healthcare perspectives on the importance and efficacy of addressing spiritual issues within an interdisciplinary bone marrow transplant clinic: a qualitative study
    (2016-07) Sinclair, Shane; McConnell, Shelagh; Bouchal, Shelley Raffin; Ager, Naree; Booker, Reanne; Enns, Bert; Fung, Tak
    The purpose of this study was to use a qualitative approach to better understand the importance and efficacy of addressing spiritual issues within an interdisciplinary bone marrow transplant clinic from the perspectives of patients and healthcare providers. Participants were recruited from the bone marrow transplant clinic of a large urban outpatient cancer care centre in western Canada. Focus groups were conducted with patients (n=7) and healthcare providers (n=9) to explore the importance of addressing spiritual issues across the treatment trajectory and to identify factors associated with effectively addressing these needs.
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    Sympathy, empathy, and compassion: A grounded theory study of palliative care patients' understandings, experiences, and preferences
    (Sage, 2016) Sinclair, Shane; Beamer, Kate; Hack, Thomas F; McClement, Susan; Bouchal, Shelley Raffin; Chochinov, Harvey M; Hagen, Neil A
    Background: Compassion is considered an essential element in quality patient care. One of the conceptual challenges in healthcare literature is that compassion is often confused with sympathy and empathy. Studies comparing and contrasting patients’ perspectives of sympathy, empathy, and compassion are largely absent. Aim: The aim of this study was to investigate advanced cancer patients’ understandings, experiences, and preferences of “sympathy,” “empathy,” and “compassion” in order to develop conceptual clarity for future research and to inform clinical practice. Design: Data were collected via semi-structured interviews and then independently analyzed by the research team using the three stages and principles of Straussian grounded theory. Setting/participants: Data were collected from 53 advanced cancer inpatients in a large urban hospital. Results: Constructs of sympathy, empathy, and compassion contain distinct themes and sub-themes. Sympathy was described as an unwanted, pity-based response to a distressing situation, characterized by a lack of understanding and self-preservation of the observer. Empathy was experienced as an affective response that acknowledges and attempts to understand individual’s suffering through emotional resonance. Compassion enhanced the key facets of empathy while adding distinct features of being motivated by love, the altruistic role of the responder, action, and small, supererogatory acts of kindness. Patients reported that unlike sympathy, empathy and compassion were beneficial, with compassion being the most preferred and impactful. Conclusion: Although sympathy, empathy, and compassion are used interchangeably and frequently conflated in healthcare literature, patients distinguish and experience them uniquely. Understanding patients’ perspectives is important and can guide practice, policy reform, and future research.
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    Transitioning Fractured Identities: A Grounded Theory Study of Operational Stress Injuries from Veterans’ Perspectives
    (2019-07-31) Smith-MacDonald, Lorraine Alison; Sinclair, Shane; Bouchal, Shelley Raffin; Reay, Gudrun; Ewashen, Carol J.; Konnert, Candace A.
    Soldiers who are deployed to military operations are often exposed to unique occupational stressors, particularly when deployed to combat environments. Research has predominantly focused on soldiers’ exposure and experiences of traumatic stress or events which results in the diagnosis of posttraumatic stress disorder. More recently epidemiological research with post 9-11 veterans (those who served in Afghanistan and Iraq) has illustrated that these veterans are experiencing not only posttraumatic stress disorder, but a variety of physiological injures, psychiatric illnesses, and psychosocial challenges. In response, the umbrella term operational stress injuries was introduced to try and capture all injuries and harm, caused by serving within military occupations, regardless of the domain of health. Central to the change of operational stress injuries is not only the language, but also the recognition that there may be injurious components of military service that are currently unidentified or under-researched- including those which may transcend into the spiritual or existential elements of military service. The purpose of this doctoral research was to determine Canadian combat veterans’ perspectives regarding what elements of operational stress injuries they deemed to be most problematic and why. Initial broad searches of military trauma literature indicated that research was predominately focused on the psychological domain of health; (i.e., the development of psychiatric illness from traumatic or stressful experiences), with less understanding of potentially harmful spiritual and existential aspects of soldiers’ experiences. As a result, a systematic review was conducted to synthesize and critically evaluate the relationship between spirituality and mental well-being in post-deployment veterans. Next, a theoretical manuscript was written to discuss points of convergence and divergence when integrating the classical grounded theory method within a patient-oriented research framework. Finally, a patient-oriented research informed classical Grounded Theory study was designed and conducted to create a systematic mid-range theory of operational stress injuries from veterans’ perspectives. Findings from this doctoral research demonstrate that while traumatic stress outcomes such as post-traumatic stress disorder were problematic, most injurious to veterans were what they termed “fracturing experiences” and “limboizing.” Fracturing experiences were largely synonymous with the current classification of moral injury, while limboizing referred to the military-to-civilian transition. Participants identified that from their perspective unresolved morally injurious experiences were the cause of their mental health symptoms, which frequently resulted in formal psychiatric diagnosis and being medically released from the military. More, upon being released, participants struggled to successfully transition to the civilian world which further compounded their psychological, social, and spiritual challenges. Ongoing work to further examine how moral injury may influence veterans’ mental health and their ability to successfully navigate the military-to-civilian transition is crucial, as successfully addressing these injurious components may allow veterans to thrive and not simply survive in their new life.
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    Water Birth: The Experiences and Perceptions of Childbirth Health Care Professionals in Alberta Hospitals
    (2020-01-15) Mercredi, Ashleigh; Goldsworthy, Sandra; Snell, Diana; Reilly, Sandra M.; Bouchal, Shelley Raffin
    The differences between the medical and midwifery models of childbirth challenge whether the medical model of childbirth represents the best standard of care for women. The introduction and progression of increased access of midwifery services in Alberta has led to water birth becoming more accessible. Water birth, is currently taking place in hospitals in Alberta with claims from midwifery clinics that over 70% of their mothers have given birth in water (Birth Partnership Midwives, n. d.). Although several studies have been conducted regarding patient perspectives surrounding this practice, very little research has been carried out to investigate the perceptions and experiences of childbirth health care professionals (HCPs) who either actively participate in water birth or are exposed to water birth in their work site. A quantitative, nonexperimental, descriptive research study design in the form of a cross-sectional online survey was used to gain a better understanding of the level of support that exists for this practice within the province and explore the overall perceptions and experiences of childbirth HCPs in terms of perceived benefits, risks and barriers toward water birth. Respondents comprised 214 registered nurses, 38 registered midwives, 41 physicians, and 11 obstetricians (N=304). Results showed that childbirth HCPs had a positive level of support for water birth as a practice in Alberta. A significant difference in support levels between the different HCP groups was noted, except for the physician-obstetrician pair. Childbirth HCPs generally perceived high benefits, but also high barriers, high maternal risk, and high other risk associated with water birth. Attitudes toward neonatal risk were more ambiguous. More research is needed to better understand what underlying factors impact the perception of water birth benefits, risks, and barriers to skew either more negatively or more positively. The future of water birth depends not only on more research, but on the beliefs and experiences of the people involved in the birthing process, which includes not only all varieties of childbirth HCPs and women experiencing childbirth, but also other roles within the health care system that impact the delivery of patient care (i.e., administrators, patients, and policy makers).