Browsing by Author "Caine, Vera"

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    Beyond "Meeting Them Where They Are At" : How Nursing Students Conceptualize Harm Reduction In Their Practice With People Who Use Drugs
    (2022-01-04) Denis-Lalonde, Dominique B.; Estefan, Andrew; Dela Cruz, Aniela; Caine, Vera
    This thesis presents findings from a qualitative study that explored how final year nursing students conceptualized harm reduction as a part of their practice with people who use drugs. The research was conducted using a critical social theory lens informed by the work of Habermas (1972; 1984). Data were collected in semi-structured interviews with 11 undergraduate nursing students from a western Canadian university. Data analysis was undertaken using the thematic analysis method developed by Braun and Clarke (2006). Three themes and nine sub-themes demonstrate the complex influences involved in the conceptualization of harm reduction among the participants. Participants expressed that harm reduction was congruent with nursing practice and that conceptually, harm reduction was inherent to their understanding of the profession. While participants seemed to have integrated the concept of harm reduction with their practice, their diverse experiences and identities influenced their perspectives. Contextually, these perspectives caused continued tensions for participants as they navigated questions about drug use stigma, the nature of drug use, the scope of the nurse, and the real-world application of their nursing education. These interconnected influences occurred against a backdrop of critical societal and systemic issues. Participants were negotiating oppressive systems and systemic norms, which affected their perspectives towards harm reduction and the care of people who use drugs. Participants enthusiastically perceived nurses as capable advocates and agents of change, yet they focused on individual contributions and abilities rather than collective efforts and progress. This study’s findings, reflected in four recommendations, contribute to the evidence required for educators to critically explore and prioritize educational approaches that support HR as nursing practice.
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    The Alberta Neonatal Abstinence Syndrome Mother-Baby Care ImprovEmeNT (NASCENT) program: protocol for a stepped wedge cluster randomized trial of a hospital-level Neonatal Abstinence Syndrome rooming-in intervention
    (2023-05-06) Wine, Osnat; McNeil, Deborah; Kromm, Seija K.; Foss, Karen; Caine, Vera; Clarke, Denise; Day, Nathaniel; Johnson, David W.; Rittenbach, Katherine; Wood, Stephen; Hicks, Matt
    Abstract Background Neonatal Abstinence Syndrome (NAS), a problem common in newborns exposed to substances in-utero, is an emerging health concern. In traditional models of care, infants with NAS are routinely separated from their mothers and admitted to the Neonatal Intensive Care Unit (NICU) with long, expensive length of stay (LOS). Research shows a rooming-in approach (keeping mothers and infants together in hospital) with referral support is a safe and effective model of care in managing NAS. The model’s key components are facilitating 24-h care by mothers on post-partum or pediatric units with support for breastfeeding, transition home, and access to Opioid Dependency Programs (ODP). This study will implement the rooming-in approach at eight hospitals across one Canadian Province; support practice and culture shift; identify and test the essential elements for effective implementation; and assess the implementation’s impact/outcomes. Methods A stepped wedge cluster randomized trial will be used to evaluate the implementation of an evidence-based rooming-in approach in the postpartum period for infants born to mothers who report opioid use during pregnancy. Baseline data will be collected and compared to post-implementation data. Six-month assessment of maternal and child health and an economic evaluation of cost savings will be conducted. Additionally, barriers and facilitators of the rooming-in model of care within the unique context of each site and across sites will be explored pre-, during, and post-implementation using theory-informed surveys, interviews, and focus groups with care teams and parents. A formative evaluation will examine the complex contextual factors and conditions that influence readiness and sustainability and inform the design of tailored interventions to facilitate capacity building for effective implementation. Discussion The primary expected outcome is reduced NICU LOS. Secondary expected outcomes include decreased rates of pharmacological management of NAS and child apprehension, increased maternal ODP participation, and improved 6-month outcomes for mothers and infants. Moreover, the NASCENT program will generate the detailed, multi-site evidence needed to accelerate the uptake, scale, and spread of this evidence-based intervention throughout Alberta, leading to more appropriate and effective care and use of healthcare resources. Trial registration ClinicalTrials.gov, NCT0522662. Registered February 4th, 2022.
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    Unable To Feed My Hungry Child: A Narrative Inquiry into the Experience of Caring for a Child with Prader Willi Syndrome
    (2022-12-22) Currie, Margaret Genevieve; Estefan, Andrew; Estefan, Andrew; Caine, Vera; Moules, Nancy; Dimitropoulos, Georgina; Bengezen, Viviane
    Prader-Willi syndrome is a genetic disorder that causes insatiable hunger and overeating. It poses both significant health risks and complex social challenges for families. The experiences of mothers caring for a child with Prader Willi syndrome and managing the hyperphagia and anxiety are not well known. Researchers have studied the biological make up of Prader Willi syndrome but few have explored mothers’ experiences in managing the physical and mental health issues of caring for a child with hyperphagia, anxiety, and insatiation. This study is a narrative inquiry into the experiences of four mothers caring for their children with Prader Willi syndrome. Narrative inquiry is the study of experience using storied accounts and attends to the dimensions of temporality, place, and sociality. Four narrative accounts were co-composed with participants and highlight the complex political and social landscapes for families. The narrative accounts revealed two narrative threads, engaging in (extra)ordinary care practices, and navigating tensions called forth by coherent and incoherent stories. Recommendations for practice, policy, and theory are also presented after inquiring into mothers’ experiences.