Browsing by Author "Ducey, Ariel"

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    A 'controversial' decision: multiple sclerosis patients, online medical knowledge and the ccsvi procedure
    (2012) Kelly, Jeanine Erin; Ducey, Ariel
    This thesis examines how people with multiple sclerosis (MS) used internet resources, including personal narratives on patient-based websites and medical information, to learn about a new and 'controversial' treatment based on the theory that MS is caused by chronic cerebrospinal venous insufficiency (CCSVI). In-depth asynchronous or telephone interviews were conducted with 49 people with MS. Findings are that people with MS have used internet resources to develop reflexive communities and sometimes challenge the authority and knowledge of medical practitioners. Also examined is how study participants view the use of the internet to make the theory of CCSVI indispensable. Finally, the thesis shows that while MS patients use internet resources to become informed, the decision to undergo the CCSVI procedure was subjective and based on how each participant viewed the progression of their disease and the chances that CCSVI could reconnect them with their sense of self.
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    Achieving Publicly Funded Midwifery in Alberta: A Case Study of the Changing Nature of Midwifery Work
    (2018-06-28) Field, Diane; Langford, Tom; Ducey, Ariel; Nelson, Fiona; Malacrida, Claudia; Schneider, Barbara; De Vries, Raymond G.
    From 1994 to 2008, Alberta midwives were in the unique position among the provinces of Canada of being provincially regulated but unable to obtain public funding for their care work. With the achievement of government funding for midwifery services in 2009, midwifery’s place as an equal but autonomous health care profession within this province’s health care system was secured. My dissertation investigates how and why Alberta midwives undertake particular work practices to mediate the effects of public funding on their daily work lives. I also interrogate the midwives’ ability to maintain their work practices within the core principles of the midwifery model of care, in ways that are distinct from the influence of public funding. In this pursuit, I undertake a case study in a midwifery clinic in southern Alberta that includes: observation of midwife-client appointments over an 8-month period; in-depth, semi-structured interviews with both midwives and clients; and gathering of documents pertaining to both the work of the clinic midwives and the broader political-economic and institutional contexts. My contributions to an understanding of midwives’ work practices include: • Although the daily work of Alberta midwives rests primarily on the enactment of the core principles of the Canadian midwifery model of care, I find midwives are confronted with a paradoxical struggle to maintain their core principles in light of the diverse nature of clients, as a direct consequence of public funding. • I argue that midwives employ strategies that reflect an initial “gatekeeping” to determine the suitability of clients for their care that intermittently results in tensions between their philosophical foundations and their day-to-day work practices. • I contend that midwives establish caring connections in individual appointments with their clients by, initially, creating conditions that support the building up of these relationships and, later, by consolidating and fortifying these relationships through an increased emphasis on partnership aspects of care. • With the achievement of public funding and the substantial increase in the number of women seeking their care, I document how these midwives develop alternative group approaches to individual appointments that go some way to alleviate increased tensions and work stresses. As well, I conclude this style of care has the potential to continue to foster intimate and trusting relationships. • I assert that midwives’ work involved in promoting and facilitating breastfeeding is effective due to the continued strengthening of deep and intimate relationships between themselves and their clients, although they occasionally adopt but also struggle to resist the role of “expert” if clients choose other methods of feeding.
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    Caring for People on the Margins: An Institutional Ethnographic Exploration of Community Palliative Care Work for People who are Precariously Housed
    (2023-09-15) Petruik, Courtney Rae; Ducey, Ariel; McCoy, Liza ( Associate Professor Emerita); Milaney, Katrina; Tezli, Annette; Marshall, Zachary; Stajduhar, Kelli
    People experiencing homelessness have more barriers accessing healthcare than the general population. Challenges are worsened when people become ill and require end-of-life care (EOLC). Some barriers to EOLC for this population include discrimination, service providers who lack knowledge about homelessness, and fewer opportunities to voice care preferences. As part of a developing palliative equity movement, small teams have been created to provide better EOLC for people experiencing homelessness. While much research explores homelessness and healthcare, to date, none investigates the social organization of these teams amidst the mainstream system. This research addresses this gap by exploring how one of these small teams, the Community Allied Mobile Palliative Partnership (CAMPP), interacts with clients, structures their work, hooks into the mainstream healthcare system, and is institutionally accountable to a broader philanthropic funding structure in Calgary, Canada. This project uses institutional ethnography (IE) as its guiding mode of inquiry. From the standpoint of CAMPP clients, IE promotes understanding of how this team’s work is put together, produced, legitimized, and challenged while operating in the interstices of the mainstream healthcare system. With over 100 hours of observations, document reviews, and 21 client and service provider interviews, this research recasts the reader’s view from taken for granted medical models of palliative care toward the social realities of people at society’s margins and how the CAMPP team embeds these needs into their care model. Grounded in client accounts, this project illustrates how the mainstream system is structured to create challenges for people facing economic marginalization warranting a service like the CAMPP team. Paying close attention to language, this study shows how CAMPP is shaped by and reshapes the palliative care discourse to include social factors, mobilizing the widely recognized model of “harm reduction”. Lastly, this project describes how the CAMPP team is funded and their perceptions of the sustainability of their program. This study has implications for policymakers, community programs, researchers, and people experiencing homelessness by making visible how teams like CAMPP provide care “at the margins” of dissolution while caring for people “at the margins” of society.
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    Cycling Through Intersections: Regimes of Velomobility in Calgary and Amsterdam
    (2017) Ponto, Jason; Ducey, Ariel; Miller, Byron; Langford, Tom; Monteyne, David; Patterson, Matt; McCann, Eugene
    Studying mobilities means paying attention to practices, subjectivities, materialities, sociospatially co-constituted spaces, and the complex social, political, and economic milieus in which planners, policy makers, and mobile subjects operate. When the complexities and interplays of these aspects of mobility are considered together, we can describe regimes of mobility. This dissertation focuses on a specific form of mobility: velomobility (mobility by bicycle). It presents a comparative analysis of the regimes of velomobility in two cities: Calgary, Canada, and Amsterdam, Netherlands. It draws from a wide range of evidence, including 102 semi-structured interviews conducted with cyclists, 24 interviews conducted with policy makers, document analysis (including a visual content and thematic analysis of print advertisements), and ethnographic research (including ethnographic photography). By comparing and contrasting these two regimes of velomobility, this dissertation seeks to de-naturalize velomobility by highlighting the ways that politics and policies affect mobile subjectivities and associated practices by enabling or constraining urban forms, by influencing the design and development of transportation infrastructure, and by encouraging or restricting automobility. Drawing on notions of governmentality, sociospatial theory, risk, class habitus, and the performance of identity, this research project sits at the intersections of several theoretical frameworks as it explores the intersections through which cyclists move.
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    Dangerous balancing acts: the politics and ethics of the Alberta mental health act
    (2011) Barron, Gary Robert Shane; Ducey, Ariel
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    Decision-making in Practice: Surgical Actionability and Consent in Pelvic Floor Medicine
    (2014-05-27) Nikoo, Shoghi W; Ducey, Ariel
    In this thesis I explore how patients’ problems are made surgically actionable so that decisions regarding and consent to surgery may be produced. I employ ethnographic observations of the material and semiotic practices in which surgeons and patients are engaged. Surgical actionability arises in a cascade of practices that produce diseases such that they meet conditions of actionability. Disagreement between realities of a problem, or uncertainty regarding surgical outcomes, may produce disruptive turbulence in these cascades. Surgeons manage turbulence by shifting sites of decision onto ‘patient choice’ – if a patient decides she is bothered enough to justify the risks, surgery may go forward. However, patients’ decisions rarely take on this ‘rational’ character; instead, they appear to be non-formal and centre on issues other than risks and benefits. I question the value of ‘respect for autonomy’ and propose that policy based in care, with a focus on the particularities of disease and decision production, may serve patients better.
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    Harm Reduction in Canadian Health Care: A Qualitative Study of Caring and Compassion in a Supervised Consumption Clinic
    (2020-05-15) Van Dyke, Jessica Lauren; Ducey, Ariel; Rittenbach, Katherine K.; Lightman, Naomi; Haines-Saah, Rebecca J.
    This autoethnographic research explores my lived experiences within Calgary’s only supervised consumption site, Safeworks, and those of program, staff and clients. In this thesis I am attentive to the everyday, the minute, and the details of lives lived within real time, in specific moments, and in actual situations. Drawing on several months of participatory observations within the supervised consumption site and 21 in-depth interviews with program staff and clients, I discuss how supervised consumption services offer more than a reduction in drug related harms; rather, these services fulfill an essential social void in the lives of people who use drugs – that of interpersonal recognition and respect. I offer consideration into caring relationships as they are cultivated at Safeworks – exploring the difficulties and tensions of caring for a population that is regularly publicly denounced and denied. Further, I offer a reflection of the ethical dilemmas present in the course of providing care; what may be felt to be intuitively just by some staff is seldom shared by all those involved in the delivery of supervised consumption services. What moral predicaments arise when clients present at Safeworks with more needs than staff can ever hope to meet? The burdens borne by staff, I argue, exist because they are not shared. In the absence of a collective vision of mutual recognition and resemblance with persons who use substances, care providers at Safeworks must work overtime: supporting clients to feel less stigmatized and less isolated, above attending to their daily needs in states of dependency, despair, and overdose, while simultaneously extending their reach to cover gaps in service delivery that manifest in societies indifferent to the plight of those overwhelmed by addictions.
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    How Legal Problems Affect Health and the Role of Medical Legal Partnership in Canada
    (2021-09) van Olm, Alexander; Ducey, Ariel; McCoy, Ted; Hardcastle, Lorian; Banerjee, Pallavi
    At the moment, there is little research involving the connection between legal issues and an individual’s overall health. It makes sense that non-individual factors go into determining one’s health, such as physical environment, housing, and education. These factors are typically referred to as the Social Determinants of Health (SDOH) (Mikkonen and Raphael 2012). However, at times, individuals experience issues that are legal in nature, which can in many ways affect one’s health. It is this recognition that has sparked the creation of medical-legal partnerships throughout the United States, and more recently in Canada. The health benefits of medical-legal partnerships are well documented in the United States and have created a network of medical-legal organizations, in addition to new practices in both legal and medical education (Theiss 2017; Tobin-Tyler 2011). This research explores the establishment of one of Canada’s first Medical-Legal Partnerships (MLP) between The University of Calgary’s Student Legal Assistance (SLA) and Calgary’s downtown community health center (CUPS). This research explores how legal supports included alongside healthcare service provision can work to address structural inequalities that exist in our social environment and are created or exacerbated by one’s “legal wellbeing". Interviews with healthcare and social service providers working alongside the CUPS and SLA MLP provides novel insight into the various ways legal issues can disrupt access to healthcare, interrupt health-seeking behaviours, or create unique health crises all on their own. The idea behind this is to prove that legal wellbeing is a distinct social determinant of health. The following research aims to establish a foundation for the further development of Medical-Legal Partnership throughout Canada and challenges readers to ask, what does access to justice really look like?
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    How Mental Health Care Workers Meet Client Needs for Care in Organizational Contexts
    (2020-04-29) Stefulic, Daniel Dorian; Ducey, Ariel; Tézli, Annette; Milaney, Katrina J.
    Modern community-based mental health care is delivered by an assemblage of services that attempts to meet the diverse needs of the population. Frontline mental health staff deliver these services directly to clients in ways that reflect their personal and professional orientations to treatment. However, the delivery of mental health services by these workers cannot be understood without taking into account the organizational contexts in which they practice. Twelve participants who work in the mental health field for a variety of organizations were recruited for semi-structured interviews. Their responses were analyzed to uncover the experiences and attitudes that underpin the relationships that they develop with clients, the interactions between organizations and providers, and the processes that affect all of these stakeholders. These relationships influence client experiences as providers assist them in their journey to connect with services that aim to be useful to their mental health needs. As services are delivered, various performance measures are collected, analyzed, and utilized to improve those services at the client-facing level and for organization-wide reporting. Ultimately, resource constraints prompt organizations to make allocative decisions when implementing their programs, and providers work within those constraints to provide client care. This is not a straightforward process, as practitioners navigate the tensions between what they perceive to be ideal care and what is possible, while simultaneously using discretion on an individualized basis, working within organizational policies, and attempting to optimize the use of resources toward the goal of offering optimal care.
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    Job Control in Professional Practice: A Study on the Implications for Well-Being
    (2019-04-26) Davis, Amanda Lynne; Wallace, Jean Elizabeth; Ducey, Ariel; Langford, Tom
    This thesis examines the relationships between job control and well-being using survey data from 354 male and female veterinarians in Alberta. It also explores whether men and women in veterinary practice experience different levels of job control, job demands and well-being and whether the effects of job control on well-being vary by gender. Job control is measured in terms of autonomy (i.e., task autonomy and control over work hours) and authority (i.e., job position and supervisor status). The results indicate that job control can be both beneficial and detrimental for well-being. Greater autonomy via more control over personal work hours has a positive effect on well-being whereas greater authority through practice ownership has a negative effect on well-being. The results also suggest that men and women experience significantly different levels of job control and well-being. Interestingly, the relationships between job control and well-being are relatively similar for men and women. Several avenues for further research are discussed from the findings of this study.
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    Multiple constraints compromise decision-making about implantable medical devices for individual patients: qualitative interviews with physicians
    (2017-12-22) Gagliardi, Anna R; Ducey, Ariel; Lehoux, Pascale; Turgeon, Thomas; Kolbunik, Jeremy; Ross, Sue; Trbovich, Patricia; Easty, Anthony; Bell, Chaim; Urbach, David R
    Abstract Background Little research has examined how physicians choose medical devices for treating individual patients to reveal if interventions are needed to support decision-making and reduce device-associated morbidity and mortality. This study explored factors that influence choice of implantable device from among available options. Methods A descriptive qualitative approach was used. Physicians who implant orthopedic and cardiovascular devices were identified in publicly available directories and web sites. They were asked how they decided what device to use in a given patient, sources of information they consulted, and how patients were engaged in decision-making. Sampling was concurrent with data collection and analysis to achieve thematic saturation. Data were analyzed using constant comparative technique by all members of the research team. Results Twenty-two physicians from five Canadian provinces (10 cardiovascular, 12 orthopedic; 8, 10 and 4 early, mid and late career, respectively) were interviewed. Responses did not differ by specialty, geographic region or career stage. Five major categories of themes emerged that all influence decision-making about a range of devices, and often compromise choice of the most suitable device for a given patient, potentially leading to sub-optimal clinical outcomes: lack of evidence on device performance, patient factors, physician factors, organizational and health system factors, and device and device market factors. In the absence of evidence from research or device registries, tacit knowledge from trusted colleagues and less-trusted industry representatives informed device choice. Patients were rarely engaged in decision-making. Physician preference for particular devices was a barrier to acquiring competency in devices potentially more suitable for patients. Access to suitable devices was further limited to the number of comparable devices on the market, local inventory and purchasing contract specifications. Conclusions This study revealed that decision-making about devices is complex, cognitively challenging and constrained by several factors limiting access to and use of devices that could optimize patient outcomes. Further research is needed to assess the impact of these constraints on clinical outcomes, and develop interventions that optimize decision-making about device choice for treating given patients.
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    Psy-Knowledge and the Problem of ‘Pain Without Lesion’
    (2022-12-16) Knox, Erin; Ducey, Ariel; McLean, Scott; Stahnisch, Frank
    This thesis examines the two most significant responses to the problem of pain without lesion by the Western psy-complex in the last 150 years. Through a close reading of disciplinary discourses, it specifically examines the differential techniques and vocabularies deployed by expert practitioners of psychoanalytic psychiatry (1895 – 1961) and cognitive psychology (1963 – 1995) in their efforts to render pain without lesion, a definitionally intangible and subjective phenomenon, into an identifiable, knowable, and workable entity. In doing so, I examine the way that the mind was brought into the question of pain by influential psychiatrists and psychologists: Freud, H.S. Sullivan, and Szasz in psychiatry, and Ellis, Beck, and M.J. Sullivan in cognitive psychology. In psychoanalytic psychiatry, pain without lesion was understood as a symptom of hysteria, which was caused by the unconscious conversion of emotional suffering into physical pain. The goal of psychoanalytic treatment was to increase patients’ self-knowledge and help them experience a broader range of emotions. Addressing chronic pain, cognitive psychology focussed instead on “pain cognitions,” peoples’ mental and emotive reactions to pain. The goal of their treatment was to teach patients how to monitor their thoughts so that they could identify and change cognitions that made pain worse. In this thesis, I consider the implication of these discourses in shaping the range of possible experience for those in pain, the assumptions they reveal about human nature and responsibility, and the degree to which they do and do not consider those in pain as socially positioned. I argue that the cognitive approach to pain without lesion is less equipped to consider aspects of the patient’s lifeworld that were once important in psychoanalytic considerations of pain, and that revisiting psychoanalytic ideas regarding the relationships between mind, pain, and the lifeworld may benefit contemporary pain researchers.
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    Sensing Someone Else's Pain: Ethical Historical Traces of Disciplined Interactions in Medical Care
    (International Society of the Learning Sciences, 2022-06) Dutta, Santanu; Sengupta, Pratim; Ducey, Ariel
    This paper highlights the ethical and moral dimensions of relational work and dignity in technoscientific spaces which are elusive in normative disciplinary practices. Using the lenses of ethical perceptions and embodied actions, we locate how microinteractions within physician-patient interactions during pain diagnosis and care are intertwined with interpersonal dignity, racialized emotions and historicized violence on Indigenous people. We discuss the implications of our work in light of dismantling normative views of disciplinary authenticity that underlie technoscience education.
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    Under the Neoliberal Blanket: Maternal Strategies in the Resettlement of Yazidi Refugees in Calgary
    (2020-04-30) Saheb Javaher, Negin; Banerjee, Pallavi; Ducey, Ariel; Maghbouleh, Neda
    The Islamic State (or Daesh) led genocide against the Yazidi people - a religious cultural minority population in Northern Iraq - left thousands of Yazidis fleeing and in need of refuge. The majority of those forcefully displaced vanished in-between borders far from the “developed world”. About 1200 of the displaced refugees were initially selected to be resettled in Canada under the Survivors of Daesh program, out of whom about 265 were settled in Calgary, Canada. As they arrived in a cold foreign land, they found themselves wrapped around by services that although warming, surfaced a structure that pushed them to quickly become “economic” and “independent”. The scarcity of services provided and the expiration date on Yazidi refugee families’ federal income assistance, and most importantly the unfulfilled promise of family reunification put mental burdens on the already traumatized Yazidi community in Calgary. My thesis is based on qualitative analysis of in-depth interview data with 66 adult Yazidi women and 7 key resettlement agency women staff, and observational and indirect data on women as Family Host volunteers (83% of all Family Hosts) who closely work with the Yazidi families. My analysis shows that what fills the gaps created due to insufficient budgets, delayed child support benefits, unfamiliar “mental support,” and confusing Canadian laws are what I call maternal strategies that Yazidi mothers, the service provider staff, and Family Host volunteers utilize to enable resettlement. The pressures from the Canadian neoliberal approach towards social services have been absorbed by Yazidi refugee women/mothers who have regularly been trying to smoothen the resettlement process for their families. The resettlement agency’s staff as well as the Family Host volunteers who are by majority women, also employ their own set of maternal strategies. By going above and beyond their duty descriptions and forming personal relationships that resemble familial connections and caregiving, these actors have played a significant role in moving the resettlement wheel for the Yazidi refugee families. Maternal strategies get woven into the larger Canadian institutional resettlement practice and discourse and are often overlooked. Nonetheless, these efforts are what have made the resettlement of Yazidi refugees possible in Calgary, Canada.
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    “We Are Bridging That Gap”: Insights from Indigenous Hospital Liaisons for Improving Health Care for Indigenous Patients in Alberta
    (2020-06-30) Link, Claire MacKinnon; Voyageur, Cora Jane; Ducey, Ariel; Barnabé, Cheryl Carmelle Marie
    This thesis explores the insights of five Indigenous Hospital Liaisons working in Alberta Health Services hospitals to improve health care for Indigenous patients. Indigenous people in Canada often encounter difficulties and obstacles when accessing health care. Previous studies have described the negative experiences that many Indigenous people encounter within hospitals and other health care facilities. Limited research in Alberta prevents an understanding of context-specific barriers that may exist. Additionally, the insights of Indigenous Hospital Liaisons are a new area of research. These frontline employees work directly with Indigenous patients to help them navigate barriers and ultimately improve their hospital experiences. This research uses a strength-based approach to highlight the dedication that Indigenous Hospital Liaisons have to Indigenous patients and provide a more positive image of Indigenous people. In addition to pointing out barriers they believe are commonly encountered by Indigenous people in Alberta, the Indigenous Hospital Liaisons in this research highlight existing resources that can benefit Indigenous patients. They also share their suggestions for changes that may improve hospital experiences for Indigenous people. The findings of this research provide a welcome contrast to the mass of negative and often deficit-based research that dominates the Indigenous health literature and suggest a more positive and optimistic view of the future of health care for Indigenous people in Alberta. Specific recommendations are provided based upon the findings and suggestions for future research involving Indigenous Hospital Liaisons are discussed.