PRISM :: Browsing by Author "Estefan, Andrew"

Browsing by Author "Estefan, Andrew"

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Open Access
A Narrative Inquiry Exploring All-Terrain Vehicle Injury Survivors' Experiences
(2023-06) Grossi, Marissa; dela Cruz, Añiela; Estefan, Andrew; Raffin Bouchal, Shelley
All-terrain vehicle (ATV) use in Canada, has led to significant morbidity and mortality. Children under 18 years old are more prone to ATV injuries. Despite the increasing number of ATV-related injuries and fatalities, there has been limited research about ATV use conducted in Alberta. There is limited academic knowledge about ATV riding behavior. There have been no known qualitative studies that have researched the experiences of ATV injury survivors. Given the unique nature of ATVs as a recreation vehicle and as farming equipment, the increasing rate and severity of injuries, and the perceived lack of protective equipment used while operating an ATV, it is important to research and understand the experiences of people who have sustained ATV injuries during childhood. The purpose of this narrative inquiry was to understand the experiences of emerging adult ATV injury survivors (ages 18 to 29 years old), who sustained childhood ATV-related injuries, and how their experiences with injury survival shaped their self-identity. Clandinin and Connelly’s (2000) form of narrative inquiry methodology was used to explore the experiences of two emerging adults who had childhood ATV-related injuries. Data was generated through field texts which included in-depth conversational interviews with each participant and field journal writing. This study yielded in-depth narratives which described ATV experience as being strongly anchored within the social spaces of family and community. Two narrative threads that resonated across narrative accounts include: ATV use as a shared experience, and stories to live by (narrative forms of identity) - how ATV-related injury shapes emerging adults over time. This thesis concludes with a discussion of the personal, social, and practical significance of this work, with implications for nursing practice, social policy, health education, and future research.
Open Access
A Narrative Inquiry into Learning Experiences that Shape Becoming a Paramedic
(2014-09-05) Donelon, Becky; Mannion, Cynthia; Bohac Clarke, Veronika; Estefan, Andrew; Reilly, Sandra
In this narrative inquiry, I explored 5 paramedics’ experiences of learning within a technical education program grounded in a behaviourist paradigm. I focused on understanding the learning experiences that shaped participants’ knowledge constructs in readiness for the complexities of practice. This research puzzle began with my first experiences as a novice paramedic learning to do practice. My interest in this study evolved through reflection upon my experiences as a student, practitioner, and educator. Story is an important way paramedics can interpret how their experiences shape them. The meanings embedded in paramedic learning experiences can be understood and shared through stories, which can provide insight for future paramedics. I negotiated a relational inquiry space called the field with each of the participants where we shared our stories. Individual audiotaped conversations were guided by the research puzzle. Conversations occurred over a 6-month period. I developed field texts from the recorded conversations and my session notes. Research texts were co-constructed iteratively over time with participants while attending to a 3-dimensional narrative inquiry space (temporality, sociality, and place). As a narrative inquirer coming into relation with participants in order to conduct this inquiry, I brought Dewey’s (1938) experiential theory based on continuity and transaction as central to my understanding of teaching and learning experiences. I interpreted the stories through my postmodernist lens, which shapes my telling as well as my thinking with others’ stories. In this way, I framed this inquiry within the theoretical framework of a humanist, constructivist lens. Participants’ stories form the basis for learning to practice narratives. I honoured participants’ voices as the authority of their particular experiences. The narratives that emerged from the stories revealed what participants found meaningful during their student experiences and how this shaped their knowledge constructs. The narratives illuminated the ii iii complexities, tensions, and possibilities embedded within experiences of learning to become a paramedic. Narratives that arose from thinking with the stories that shape learning for practice feature (a) relational ethics, (b) developing identity, and (c) tacit knowledge. I discuss the personal, practical, and social implications of this inquiry make recommendations for further research and practice.
Open Access
Adoption of Innovation: Exploring the Design and Implementation of a Cardiovascular Registry Project
(2023-03-30) King, Melanie; Lock, Jennifer; Estefan, Andrew; Kawalilak, Colleen
Advanced data technologies are permeating the healthcare environment, yet little is known about the role of learning in these change events. Literature on advances of data science for use in healthcare predominantly focuses on the computational and analytic methods, barriers and benefits, as well as the potential impact on the industry and professional roles. Few studies have explored health professionals’ experiences and perspectives on the integration of data science technologies in practice. In this qualitative, descriptive case study, I explored the experiences of 16 health professionals who had a role in a change event related to a cardiac registry project in western Canada. Study participants included project team members, clinicians, research collaborators, and academic and clinical institution staff and leaders. Semi-structured interviews were used to explore the experiences of participants to better understand the conditions that shaped the change event, the learning strategies employed, and the factors that contributed to the successful adoption of innovation. Findings from the study revealed that people play a central role in the success of a change event and project implementation. While three additional themes emerged from the data, namely the environment, learning, and innovation, it was the individuals, teams, and relationships that function within those elements that were critical to the success of the registry project. The results of this work provided insight into the necessary conditions to support successful adoption of advanced data technologies and guided recommendations for future change events.
Open Access
Artistry in Social Science Research
(2016-01-06) Dam, Shirley Cassandra; Rusted, Brian; Einsiedel, Edna; McCoy, Liza; Estefan, Andrew; Pink, Sarah
This interpretive research study is an inquiry into social science researchers’ aesthetic practices in relation with photographic-based research practices. Specifically, it is an hermeneutic study that probes their experiences of practice careers and trajectories of practitioners in relation to expectations, traditions, and conventions of visual research communities. I explore through my conversations with five visual researchers from diverse social science disciplines the relevancy of aesthetics in evolving photographic research practices guided by philosophical hermeneutics and practice theory. Participants demonstrate that photographic-based research practices are messy, interdisciplinary, and complex because of the shared, entwined histories of photography, disciplinary traditions, and emerging aesthetic practices. The inquiry explores changing practices over time and space, creating a possible trajectory of aesthetic practice in photographic-based research practices. This trajectory is based on participants’ recollections of practice careers and literature about photography’s emergence into multiple histories across disciplines and fields and its ultimate establishment as a legitimate social science approach to data collection, analysis, and dissemination. It probes participants’ expectations, traditions, desires, and values of photographic-based research practices and relationships with aesthetic practices as their visual research careers evolved over time and space. Visual researchers face increasing complexity and challenges in their individual practices because of evolving shared practices. This includes their place(s) within visual research and disciplinary communities, borrowing from other disciplines, challenges to traditional expectations of collective practices, and their own desires to innovate and contribute to visual research methods. Aesthetic practices further complicate both individual and community practices, as aesthetics is still viewed by some practitioners as the domain of the arts and irrelevant to social science while others explore social worlds with aesthetic experience and expressions.
Open Access
Being Uncertain: Rural Living Cardiac Patients' Experience of Accessing Healthcare
(2020-01-06) Lowe, Erin; King-Shier, Kathryn M.; Banner-Lukaris, Davina; Estefan, Andrew
Cardiovascular disease is a leading cause of morbidity and mortality worldwide and secondary prevention strategies such as physical activity, diet and weight management, stress management, emotional health, and education are necessary to reduce disease progression to heart failure. Although cardiac rehabilitation has also been demonstrated to improve quality of life and well-being, services tend to be underutilized worldwide, particularly in rural populations. Thus, Straussian Grounded Theory was used to seek a deeper understanding of the process that rural cardiac patients go through to access healthcare and cardiac rehabilitation following myocardial infarction. In-depth interviews with eleven participants were untaken resulting in emergence of several themes. Qualitative themes that emerged included comfort with health information, relationship with healthcare providers, social support, taking ownership, and availability of/for cardiac rehabilitation. These events occurred throughout a linear timeline progressing from hospital discharge to maintaining health. The core category of ‘being uncertain’ refers to the process rural cardiac participants will go through while accessing care after their myocardial infarction. Gaining an understanding of the process rural patient go through to access care after their myocardial infarction will assist in identifying ways to improve access and address uncertainty stemming from a lack of perceived information at and post-discharge.
Open Access
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.
Open Access
Composing and Recomposing Self as Lesbian Birth Mother: A Narrative Inquiry
(2022-12-21) Mansell, Deborah; Estefan, Andrew; dela Cruz, Aniela; Nelson, Fiona
Motherhood and mothering are dynamic experiences, yet they are often framed within and by heterosexual contexts, positioning lesbian birth mothers as outside “typical” mothering experiences. Most pregnant women in Canada, including lesbian birth mothers receive some formalized prenatal care and give birth in an acute care setting. Despite this, little is known about the experiences of lesbian birth mothers as they interact with healthcare providers and the maternity health and social care systems. Narrative inquiry research is a way to study experience through story and is a way to generate meaningful insights into the experiences of lesbian birth mothers as they negotiate maternity care. Narrative inquiry is a relational, iterative process in which the research data collection and reporting are negotiated with participants and alongside a response community of advisors and experts. In this narrative inquiry, together with three (3) lesbian birth mothers, I explored their experiences with maternity health and social services, family, institutions, and community in the greater Calgary, Alberta area. Three co-composed narrative accounts of the experiences of being a lesbian birth mother are presented, followed by the narrative threads of (1) Lesbian Maternal Wisdom, (2) Functional Infertility or Free to Decide? (3) Shades of Grey; and (4) Whose Space is this Space? In the final chapter, implications and recommendations for practice, research, and policy are made.
Open Access
Consequence Delimiting: A Grounded Theory of Healthcare Leader Decision Making in the Context of Adverse Events
(2018-05-22) McRae, Leonard Glenn; White, Deborah Elizabeth; Estefan, Andrew; Raffin Bouchal, Shelley; Reilly, Sandra Muir; Sheps, Samuel Barry
Adverse events (AEs) remain a central focus of North American healthcare leaders (HLs) since the release of the Institute of Medicine’s (IOM) report: “To Err is Human” in 1999 (Institute of Medicine, 1999). The IOM reported that as many as 98,000 people died from preventable deaths every year in the United States as a result of errors in the delivery of healthcare. Studies in other healthcare systems report comparable rates of harm (Baker et al., 2004; Thomas et al., 2000; Vincent, Neale, & Woloshynowych, 2001). The high incidence of AEs coupled with healthcare leaders’ fiduciary and regulatory responsibilities to manage these events result in its central import for healthcare leaders. The aim of this study was to discover a general substantive theory on how HLs approach accountability in the context of adverse events (AEs). The research findings were that the main concern of HLs was determining how to respond to each AE. Consequence Delimiting emerged as the core category of this classic grounded theory (CGT). The theory was conceptualized as a stage theory where multiple phases proceed sequentially and each produces a product that is built upon by subsequent stages to ultimately produce an outcome. Consequence Delimiting begins at the time that the HL accountable for managing the AE; the accountable leader (AL) becomes aware of the AE and proceeds through the interrelated categories of apprehending, story constructing, expectation navigating and truth promoting to an event disposition. The emergent theory takes particular cognizance of the role that context and discretion play in determining the disposition of an AE. It highlights the influence of organizational and leadership culture, constraints and the role of pathways in influencing the disposition. Consequence Delimiting has implications for regulators and healthcare leaders interested in better understanding and improving patient safety in their organizations.
Embargo
Difference is the Greatest Influence: An Autoethnographic Exploration of Transcultural Sexual Fluidity
(2016) Francis, Roger; Kawalilak, Colleen; Estefan, Andrew; Winchester, Ian; Alderson, Kevin; Mizzi, Robert
The lived experiences of transcultural sexually fluid identities (TSFI) within Canada’s diverse transnational communities remain an unexplored area of individuality and difference. TSFI fits within the general referencing of non-heteronormative sexual identities. In spite of Canada’s projected diversity and accommodating laws for human differences, there is still a stigma attached to non-traditional sexual expressions. Across the diverse Canadian landscape, there are numerous interpretations and understandings of same gender sex (SGS) engagement. In this study, interpretations of TSFI are viewed through a blended theoretical lens of borderland theory (Anzaldúa, 1993) and liminality theory (Turner, 1969). This fused theoretical lens informs a deeper understanding of TSFI and allows for an examination of the many identities that exist within the spectrum of non-heteronormative sexual identities. The non-heteronormative sexual identity context is a fluid spectrum of diversity consisting of various sexual identity labels residing in a space that are referenced in this research as fluidsexuality. Fluidsexuality is a term created for this research and refers to the range of sexual identities present between the binary constructs of heterosexuality and homosexuality. The combined poles of these binary concepts are premised by another term created for this research henceforth referenced as binarysexuality. Within the span of these opposite poles, lies an array of same-gender-sex (SGS) sexually fluid labels. In examining the plethora of emerging SGS labels, this research was guided by autoethnographic methodology through which I explored TSFI identities across Canada. This study investigated the lived experiences of TSFIs and how their lives can inform knowledge development that may result in a rejuvenated adult learning pedagogy focused on diversity and difference.
Open Access
Disclosure of Sexual Orientation in Primary Health Care: Gay Men's Stories of Coming Out
(2018-09-20) Cashen, Daniel Steven; Estefan, Andrew; Venturato, Lorraine; Dela Cruz, Añiela Marie; Ginn, Carla S.; Then, Karen L.
Access to primary health care is important for maintenance of health and well-being and the timely treatment of illness. Primary health carers address many dimensions of people’s health and social welfare. The literature suggests that experiences of primary health care might be problematic for gay men. For many reasons, it can be difficult for gay men to discuss their sexual orientation with primary providers. The health literature offers little guidance about how gay men experience primary health care. The health care literature about gay men is dominated by studies about the transfer and prevention of sexually transmitted diseases, and there is little exploration of patient-practitioner relationships in the context of primary health care. This study is a narrative inquiry into three gay men’s experiences of “coming out,” or disclosure of their sexual orientation in primary health care. Three narrative accounts form the basis for the development and discussion of three narrative threads: Disclosure and Connections, Opportunities Taken and Lost, and Making Maps for Connections. Recommendations for nursing practice, research, and policy development are made.
Open Access
Emergency Department Staff Knowledge and Practice of Caring for Individuals with Intellectual Disabilities Seeking Mental Health Care
(2020-09-21) Aboumrad, Mona; Lashewicz, Bonnie M.; Hughson, E. Anne; Haines-Saah, Rebecca J.; Lashewicz, Bonnie M.; Hughson, E. Anne; Haines-Saah, Rebecca J.; Estefan, Andrew; Dewey, Deborah
Individuals with intellectual disabilities have limited access to out-patient community-based mental health care. Emergency departments have become a fundamental entry for patients with intellectual disabilities to receive mental health care, leaving patients with intellectual disabilities being frequent users of the emergency department when compared to those without intellectual disabilities. The purpose of this study is to examine and unpack the knowledge, practice, and professional experience of emergency department staff regarding patients with intellectual disabilities seeking mental health care. The study aims to contribute to understandings about the ways in which emergency department staff utilize the emergency department space, time, and resources, and how this utilization impacts how responsive and supportive care is provided to patients with intellectual disabilities. Semi-structured face-to-face and phone interviews were conducted with seven emergency department social workers, registered nurses, and physicians from four emergency departments in Calgary, Canada. A qualitative descriptive study design was employed to collect, analyze, and describe and interpret findings. Emergency department staff described: the emergency department standard practice and procedures, environment, conflicting demands, professional and personal experience in the emergency department, and the ways these descriptions helped or hindered their ability to provide responsive and supportive care to patients with intellectual disabilities. Guided by a critical disability theoretical framing and the author’s experience as a disability service professional, the author has unpacked descriptive findings to illuminate that: the emergency department is not the place for any patient with or without an intellectual disability to receive adequate mental health care, the emergency department prioritizes physical health over mental health, emergency department staff do not have adequate time, space, resources, and academic or clinical training to provide responsive and supportive care, further illuminating how the knowledge, practice, and professional experience of emergency department staff additionally contribute to the marginalization of individuals with intellectual disabilities in various systems and practices, particularly the emergency department.
Open Access
Emerging Adult Women with Chronic Pain: A Narrative Inquiry
(2022-03) Finlay, Jenise; dela Cruz, Añiela; Estefan, Andrew; McCaffrey, Graham
Women are disproportionately affected by chronic pain, yet women’s pain is frequently discounted or underestimated by medical professionals. Emerging adult women are at higher risk for insufficient pain management and face unique challenges navigating chronic illness, dating, body image, college, careers, establishing independence from family, and bearing children at an age where youth is equated to being healthy. An increasing prevalence in chronic pain has been observed across all age groups in Canada, most notably among those aged 20 to 29 with no other health conditions, yet few qualitative studies examine chronic pain exclusively in women under 30. The purpose of this narrative inquiry was to understand how the experience of living with chronic pain affects the identity of emerging adult women aged 18 to 29. Clandinin and Connelly’s (2000) form of narrative inquiry was used to explore the lived and told stories of two emerging adult women living with chronic pain, gaining a deeper understanding of how their experiences shape, and are shaped by, social, cultural, familial, and institutional narratives. Data were generated through composition of field texts that included in-depth conversational interviews and field journal writing. Participant artwork, poetry, and writing were also used for data generation and data analysis. Transitioning from field texts to research texts, narrative accounts were then co-composed with research participants. Narrative threads that resonated across narrative accounts include: silenced, invisible, and locating self with pain; pain experiences storied through relationships; and resisting the singular stories of people living with chronic pain. Personal, practical, and social significance of this work are discussed with implications for nursing practice, health education, research, and policy before concluding with final reflections.
Open Access
Enacting Strategic Memory: A Grounded Theory of Critical Care Nurse Decision Making in Crises
(2019-01-14) MacDougall, Gordon; Estefan, Andrew; Reay, Gudrun; Raffin-Bouchal, Shelley; Venturato, Lorraine
Decision-making is a key component of registered nurse practice. The decisions registered nurses make in practice have important consequences for healthcare provision and patient outcomes. In critical care, nurses make decisions in complex circumstances, including crisis events in which nurses and others must respond quickly and effectively. The ways that nurses in critical care environments make decisions during crises has not been well studied. Within the nursing and other literature there are numerous theories, conceptualizations, and expert opinions about what constitutes decision-making but few of these describe what is happening when nurses make decisions in their practice contexts. This study was a classical grounded theory study to explain how critical care nurses make decision in crises. Data were collected from ten participants and analyzed using constant comparative analysis. The theory Enacting Strategic Memory accounts for the data provided by participants and explains how nurses make decisions. Findings showed that nurses engage in decision-making through the strategic use of cognitive and physical resources by recognizing triggers, negotiating past and present, and telling stories. The theory is discussed in light of extant literature and recommendations for practice, research, and policy are made.
Open Access
Examining Causes for Readmission in the Internal Medicine Population from the Patient Perspective
(2021-12) de Boer, Shelley; Estefan, Andrew; Seneviratne, Cydnee; Swart, Ruth
A significant number of internal medicine patients discharged from acute care require readmission within 30 days. Current readmission rates create a significant burden to the healthcare system. Identifying causes of readmission can inform health care practice to mitigate factors associated with readmission and improve care and outcomes for patients and families. A literature review reveals a wealth of quantitative research from the perspective of healthcare practitioners. Less is known about the perspectives of internal medicine patients, particularly in Canada. As such, understanding why readmissions occur within 30 days of discharge within this patient population is limited. Avoiding readmission needs to be guided by strategic discharge practices that are informed by relevant research studies. Specifically, further research into patient perspectives on why they are readmitted warrants further qualitative investigation. This study is a qualitative, thematic analysis, designed to explore internal medicine patients’ perspectives about readmission to hospital. Knowledge from this study can inform healthcare practice by informing upstream, proactive, pre-emptive measures to address patients’ and health system needs.
Open Access
Examining the Experiences of Punjabi Women in Alberta Accessing Mental Health Services
(2023-01-02) Thind, Rajneek K.; Nicholas, David B; Jamal, Aamir; Estefan, Andrew
This study explores lived experience related to mental health service utilization among Punjabi women living in Alberta. The Punjabi diaspora has roots connecting to the state of Punjab in India, which has witnessed significant historical trauma. The Punjabi population in Alberta is increasing with immigration and migration from other areas in Canada. Punjabi women face challenges seeking appropriate support for their mental health. There are significant gaps in the literature in this area, warranting further exploration to better understand and support mental health service delivery for this population. Based on an Interpretive Description methodology, seven Punjabi women living in Alberta participated in semi-structured interviews to share their mental health service access experiences. Findings convey a range of challenges related to mental health service utilization. Recommendations are offered to inform mental health support for this population.
Open Access
Exploring How Alberta Health Services Nurses are Making Sense of Their Role in Relation to the Recent Changes to the Mental Health Act of Alberta
(2024-04-30) Mustapha, Wafa; Smith, Jacqueline; Estefan, Andrew; Dimitropoulos, Gina; McCaffrey, Graham
The purpose of this qualitative study is to explore how Alberta Health Services nurses are making sense of their role in relation to the recent changes to the Mental Health Act of Alberta. The Mental Health Act (MHA) of Alberta was enacted to protect and ensure the rights of people suffering from mental disorders. The most recent MHA amendment, which was enacted in September 2020, includes expanded duties required of the hospital and health care providers. Social Constructivism, Carper’s Ways of Knowing theory, and Uncertainty theory will provide the theoretical framework for this study. A Thematic Analysis method was utilized to elicit responses using a semi-structured interview tool. Data analysis will be conducted using the six-step thematic analysis as introduced by Braun and Clarke (2006). The way nurses make sense of their role contributes to the composition of ethically informed, safe, and effective care within the scope of professional practice and current legislation. This study helps address this gap in the context of mental health nursing practice in Alberta.
Open Access
Exploring the Experiences of Graduate Nurses with Horizontal Violence
(2018-08-13) Krut, Breanne Alyse; Laing, Catherine M.; Moules, Nancy J.; Estefan, Andrew
Horizontal violence (HV) is a familiar term used within the nursing profession. Certain populations of nurses are more susceptible to HV than others. Graduate nurses (GNs), nurses within their first 12 months of practice, are widely considered a vulnerable population within the profession, and thus more at risk for HV. A common thread found in the literature is that the damage from HV is at all levels of healthcare. The purpose of this research was to explore how HV affects GNs. Interviews were conducted to collect data and analyze the data using thematic analysis. Participants included eight GNs or RNs, all of whom had experience with HV in their first 12 months of practice. The two main themes that were found in this study are Toxic Nursing Culture and Fear. Horizontal violence poses a serious challenge for GNs entering the nursing profession. It is essential to have an understanding of the challenges that GNs are facing today when they enter the workforce in order to promote change and advocate for safe workplace environments.
Open Access
Facilitating Reflection-in-Action During High-Fidelity Simulation
(2021-10-29) Mulli, Jessica Marie; Nowell, Lorelli; Estefan, Andrew; Swart, Ruth; Grant, Kimberley
Background: High-fidelity simulation has become common practice in undergraduate nursing education and highly skilled educators are needed to facilitate these complex learning opportunities. Reflective practice is considered an essential step to learning in simulation, starting with reflection-before-action through prebriefing, and ending with reflection-on-action, through debriefing. However, reflection-in-action may be the hallmark of artistry or mastery of a subject. Therefore, undergraduate nursing simulation facilitators need to develop skills to identify and support learners to reflect-in-action. Methods: I conducted a concept analysis to develop an understanding of the phenomena of reflection-in-action during high-fidelity simulation. I then conducted a descriptive phenomenology study with 11 undergraduate nursing simulation facilitators from eight colleges and universities across Alberta. Participants underwent a semi-structured interview, and Colazzi’s seven step process for analysis was utilized to understand the phenomenon of reflection-in-action as experienced by undergraduate nursing simulation facilitators during high-fidelity simulation. Results: Through the concept analysis, I identified four defining attributes of reflection-in-action: (a) reflection-in-action occurs during simulation scenarios; (b) a critical learning juncture occurs and is identified by the learners; (c) a pause in student action occurs; and (d) knowledge sharing through discussion. The experiences of the participants aligned with the findings from the concept analysis. Participants in the study were experienced simulation facilitators. Despite this, they had little formal training regarding reflection-in-action. Participants were able to identify reflection-in-action during high-fidelity simulation when students paused, collaborated, shared their thinking aloud, and changed their course of action. Barriers to reflection-in-action included learner fear and anxiety, poor simulation design, and inadequate preparation. Participants supported reflection-in-action through prebriefing, remaining curious, and providing cues, prompts, or facilitated paused. The benefits of reflection-in-action include collaborative learning, building confidence, critical thinking, and embedding reflection into practice. Conclusions: Phenomenological exploration of experiences of participants was able to add insights to enhance understanding of a poorly defined subject. The insights from this work may enhance simulation facilitator’s ability to effectively support reflection-in-action within high-fidelity simulation. These findings may contribute to theory development, checklists, and decision trees to support the facilitation of reflection-in-action during high-fidelity simulation. Keywords: nursing, education, simulation, reflection, reflection-in-action
Open Access
Families Journeying Together: Exploring Resilience in Families with Adolescents with ADHD
(2019-01-24) McMenemy, Therese Claire; Nicholas, David Bruce; Nicholas, David Bruce; Enns, Richard A.; Estefan, Andrew
There is increasing attention given to the ways that children and adolescents with ADHD experience resilience and factors that help them to thrive. Research in this area is particularly needed for the relatively understudied group, emerging adolescents, who are experiencing a key transitional stage of life and are at risk for developing significant comorbidities. The purpose of this study was to explore the experience of resilience among emerging adolescents and their families. Using a qualitative, constructivist grounded theory approach, 21 interviews were conducted with parents and primary caregivers of emerging adolescents with ADHD, adolescents with ADHD and supportive professionals who work directly with this population. Participants were from three Canadian cities. A resilience-promoting process emerged of Families Journeying Together. It comprised three parts of experiencing constant challenge, building family consciousness, and moving forward. The findings underlined the key role that parents play in the lives of emerging adolescents with ADHD, and the need to include a family systems perspective when exploring resilience in ADHD. Participants affirmed the relevance of an ecological approach to understanding and supporting resilience for emerging adolescents with ADHD and their families. Findings suggest future research and policy/program development that focuses upon ecological factors to nurture resilience and well-being.
Open Access
Female Genital Cutting and African Women's Migration to Canada: Toward a Postcolonial Feminist Decolonizing Methodology
(2020-11-23) Werunga, Jane Nasipwondi; Ewashen, Carol J.; Reimer-Kirkham, Sheryl; Estefan, Andrew
The discourse on the cultural practice of FGC has captured a lot of attention over the last several decades, and with international migration propelling what was once a private cultural practice onto the global stage, FGC has become a fixture in the international human rights and global health arenas. FGC is a sensitive topic and the debates around it remain politically and culturally contentious. A lot of resources have been poured into eradication endeavors with multiple multinational organizations including the WHO spearheading the effort, the non-negotiable endpoint being the wellbeing, safety, and security of young girls and women. The purpose of this qualitative interpretive description study informed by decolonizing perspectives was to critically examine how immigrant and refugee women who have experienced FGC make sense of and explain the practice for themselves and for younger generations; and to explore the sociopolitical contexts sustaining and perpetuating FGC in the lives of affected younger and older women including their perceptions of as well as interactions with health services in diasporic locations. Participants’ understandings and agency-in-practice were analyzed through the themes of Experiencing, Explaining, Migrating, and Mitigating FGC. A decolonizing interpretation of research findings surfaced the intersections of social, political, economic, and cultural barriers manifesting through racialized and gendered axes of exclusion and marginalization to affect the health and wellbeing of FGC-affected immigrant and refugee women in a globalized milieu. This study highlights the importance of historical and cultural contexts in understanding and researching FGC-affected women as well as the relevance of decolonizing universal norms including in research, in order to effectively do this. This study offers an alternative way of conceptualizing FGC in a transnational setting and has implications for nursing research, health services, nursing education, as well as leadership and policy. Immigrant and refugee women affected by FGC deserve equitable, socially just, culturally responsive, and trauma-informed health services. This is in keeping with the nursing mandate of fostering health equity and social justice for all individuals. This study opens avenues for considering alternative ways of conceptualizing FGC and in doing so lives up to the interpretive description design logic.