Browsing by Author "Hirst, Sandra"

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    Effectiveness of a community program for older adults with type 2 diabetes and multimorbidity: a pragmatic randomized controlled trial
    (2020-05-13) Miklavcic, John J; Fraser, Kimberly D; Ploeg, Jenny; Markle-Reid, Maureen; Fisher, Kathryn; Gafni, Amiram; Griffith, Lauren E; Hirst, Sandra; Sadowski, Cheryl A; Thabane, Lehana; Triscott, Jean A C; Upshur, Ross
    Abstract Background Type II diabetes mellitus (T2DM) affects upwards of 25% of Canadian older adults and is associated with high comorbidity and burden. Studies show that lifestyle factors and self-management are associated with improved health outcomes, but many studies lack rigour or exclude older adults, particularly those with multimorbidity. More evidence is needed on the effectiveness of community-based self-management programs in older adults with T2DM and multimorbidity. The study purpose is to evaluate the effect of a community-based intervention versus usual care on physical functioning, mental health, depressive symptoms, anxiety, self-efficacy, self-management, and healthcare costs in older adults with T2DM and 2 or more comorbidities. Methods Community-living older adults with T2DM and two or more chronic conditions were recruited from three Primary Care Networks (PCNs) in Alberta, Canada. Participants were randomly allocated to the intervention or control group in this pragmatic randomized controlled trial comparing the intervention to usual care. The intervention involved up to three in-home visits, a monthly group wellness program, monthly case conferencing, and care coordination. The primary outcome was physical functioning. Secondary outcomes included mental functioning, anxiety, depressive symptoms, self-efficacy, self-management, and the cost of healthcare service use. Intention-to-treat analysis was performed using ANCOVA modeling. Results Of 132 enrolled participants (70-Intervention, 62-Control), 42% were 75 years or older, 55% were female, and over 75% had at least six chronic conditions (in addition to T2DM). No significant group differences were seen for the baseline to six-month change in physical functioning (mean difference: -0.74; 95% CI: − 3.22, 1.74; p-value: 0.56), mental functioning (mean difference: 1.24; 95% CI: − 1.12, 3.60; p-value: 0.30), or other secondary outcomes.. Conclusion No significant group differences were seen for the primary outcome, physical functioning (PCS). Program implementation, baseline differences between study arms and chronic disease management services that are part of usual care may have contributed to the modest study results. Fruitful areas for future research include capturing clinical outcome measures and exploring the impact of varying the type and intensity of key intervention components such as exercise and diet. Trial registration NCT02158741 Date of registration: June 9, 2014.
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    A Grounded Theory of South Asian Older Men Who Have Hypertension
    (2019-07-26) Singh, Shaminder; Hirst, Sandra; Raffin Bouchal, Shelley; Mather, Charles; Venturato, Lorrraine; Hunter, Kathleen
    Hypertension is a widespread but rarely symptomatic chronic condition characterized by raised blood pressure over a lengthy period of time that causes serious vascular damage. South Asians are nearly three times more susceptible to hypertension than European Whites. As compared to South Asian women, men are more prone to hypertension risk factors such as alcohol and tobacco consumption, remain less compliant with antihypertensive medications, and experience more cardiovascular events and mortality. Age is also a known risk factor of hypertension. How South Asian older men managed their hypertension was a knowledge gap. The current grounded theory revealed the four-stage processes of Savvy the Self for hypertension management in South Asian men aged 55 years and older in a Canadian context: (1) self-care, (2) self-protection, (3) making sense, and (4) equipping self. Findings exposed the links between South Asian men’s masculine identity, cultural beliefs, and disequilibrium in their self-care and developmental needs that emerged with a diagnosis of hypertension. The disequilibrium eventually evoked awakening for South Asian men that mobilized the processes of Savvy the Self leading to their hypertension management. This grounded theory provided insights into South Asian culture and revealed new nursing knowledge to assess, plan, and deliver nursing care for older South Asian men with hypertension. Findings may be useful for health education and services, cultural and faith-based community organizational services, and future research related to professionals’ cultural competency for serving a diverse group of people.
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    Nurse-Client Situated Interaction (NCSI): A Constructivist Grounded Theory of the Indicators and Clinical Reasoning Processes that Registered Nurses Use to Recognize Delirium in Older Adults in Acute Care Settings
    (2015-01-12) EL HUSSEIN, MOHAMED; Hirst, Sandra
    Delirium is an acute disorder of attention and cognition in older adults. It affects half of the older adults admitted to acute care settings and is a major cause of increasing mortality and healthcare costs. Delirium is preventable in 30–40% of cases and its early recognition is crucial to improve prognosis. Registered Nurses’ (RNs) prolonged interactions with older adults place them in an advantageous position to recognize delirium. Regrettably, RNs often fail to recognize delirium in older adults. The goal of this research was to identify the indicators and clinical reasoning processes that RNs use to recognize delirium in older adults in acute care settings. Purposive and theoretical sampling techniques were used to recruit 17 RNs for this study. Data gathering and analysis from participants’ interviews was done concurrently using Constructivist Grounded Theory. The logic of constant comparison and memo-writing facilitated the transitioning from initial to focused coding. Coding for processes culminated in the emergence of the Nurse-Client Situated Interaction (NCSI) as the core category of the substantive grounded theory. NCSI refers to the main strategies that RNs used to resolve concerns of delirium recognition in older adults in acute care settings. NCSI consists of 3 subcategories that emerged from data. Each subcategory is rooted in several properties that were derived directly from the rich descriptions provided by the participants in the interviews. The subcategories and their respective properties in relation to the current state of the science are discussed in this thesis. Discussions of the recommendations that are relevant to the practices of RNs are included. Finally, limitations of the study and the agenda for future research (concatenation) are discussed.
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    Obtaining a Definition of Accountability in Medical-Surgical Nursing Practice
    (2013-01-04) Sommerville, Kimberley; Hirst, Sandra
    Accountability in nursing practice is not a new concept. Although the term is found extensively in nursing literature and regulatory documents, there has been no agreed upon definition. A review of the literature did not produce any definition from a nursing perspective. The purpose of this qualitative study was to obtain how the cultural group of registered nurses defined accountability. Interviews were conducted with 7 individual medical/surgical nurses and by analyzing their language through the ethnoscience methodology, a taxonomy evolved and a definition of accountability was developed. The three categories of the taxonomy of accountability were intent, process, and outcome. Together they help clarify and promote understanding for accountability in nursing practice.
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    Recognition and Assessment of Geriatric Depression in Residential Care Facilities in Alberta: A Mixed Methods Study of Perspectives and Practices of Regulated Nursing Staff
    (2016) Azulai, Anna; Hall, Barry; Walsh, Christine; Hirst, Sandra; Konnert, Candace; Seneviratne, Cydnee; McCleary, Lynn
    Geriatric depression is under-detected in residential care facilities. There is a paucity of Canadian and Alberta-specific research on how this mental health condition is recognized and assessed in residential care settings. The purpose of this exploratory study was to learn about the perspectives and practices of regulated nurse professionals on the recognition of geriatric depression in long-term care (LTC) and designated supportive living (DSL) facilities in Alberta. The research questions focused on: 1) relevant knowledge, beliefs, and education of participants; 2) the relationship between the level of knowledge and types of facilities; 3) depression assessment process and methods; 4) barriers to the recognition and assessment; and 5) perceived strategies for the effective detection of depression. The study employed a convergent parallel mixed methods design, including a survey (N = 635) and qualitative interviews (N = 14). Findings suggested a risk for social exclusion of residents with geriatric depression from mental health services in Alberta. While considering the assessment of depression important, participants reported multiple challenges to its identification in facilities. One of the main challenges included specific socio-cultural beliefs about geriatric depression among staff, residents, and public, such as ageism, the normalization and the stigmatization of geriatric depression. Other challenges related to a less than optimal clinical knowledge of participants about geriatric depression, scarcity of resources, complicated and unclear assessment protocols, inconsistent use of assessment methods, poor communication between all stakeholders, and marginalized priority of the mental health care in facilities. These inter-connected structural and agential barriers on micro, mezzo, and macro levels served as constraining conditions in the depression assessment process. The perceived improvement strategies targeted addressing this complex constellation of barriers to enable successful detection. Recommendations included actions to alter views about geriatric depression, such as public awareness campaigns and enhancing depression-specific education, as well as increasing resources, elevating the priority of mental health in facilities, and advocating for the legislative changes to support effective regulations and policies for mental health provision in these care settings.
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    Residents’ Interpretation of Their Experience of Care in Relation to Particular Workplace Culture Social Interaction Patterns
    (2015-12-22) Taylor, Deanne, Catherine; Wolbring, Gregor; Hirst, Sandra; Thurston, Wilfreda
    Social and professional relationships are an integral component of the daily care and work experience within residential care (long-term care), yet little is known about how these relationships influence residents’ perceptions of care and quality of life. The purpose of this two phased, mixed method study was to explore residents’ perspectives of workers’ peer interactions and identify if workers’ peer social interactions had an influence on residents’ experience of care and if so, how. Drawing upon workplace culture theory and using narrative reality methods, residents’ perspectives of workers’ peer relationships within four residential care facilities located in a large health authority in British Columbia, Canada were examined. In phase one, contextual data was gathered by administering a worker survey and collecting field observations focused on workers’ peer social interactions and residents’ behaviours in public areas (e.g., dining rooms, lounges). In phase two, lengthier field observations were conducted and interviews with residents who were asked about their observations of how workers interacted with peers and if, and how, this affected their care experiences. The final analysis resulted in producing three themes characterizing workers’ peer social interactions: shaming, blaming, and collegiality. Shaming and blaming peer interactions impacted negatively on residents’ quality of care by reducing workers’ team interactions, work capacity, and care coordination; and on residents’ quality of life by producing an oppressed environment, reduced resident social engagement, and emphasized resident vulnerability. Conversely, collegial workers’ peer social interactions impacted positively on residents’ quality of care through increased communication, seamless teamwork, and improved safety practices; and on quality of life by residents’ increased enjoyment and security, and creation of positive environments. The results underscore the quality of workers’ peer relationships as influential to residents’ perceptions of quality of care and life, and add to the literature about the relational features of residential care. Recommendations arising from this study include promoting common collegial language and practices, fostering relational leadership, formalizing workplace relational processes and engaging in more research about residential care at a daily level, including residents with dementia and family perspectives of workers’ peer interactions on quality of care and the care environment.
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    Understanding Pre-Registration Employment and Transition to Practice for the Newly Graduated Nurse
    (2017) Reimche, Ruthanne; Hirst, Sandra; Seneviratne, Cydnee; Walsh, Christine; Premji, Shahirose
    Background Transition from nursing student to a registered nurse is fraught with difficulties such as gaining acceptance and knowledge on the unit, and obtaining comfort and confidence. Approximately 20% of newly graduated nurses (NGNs) leave the profession in the first year often due to difficulties in the transition phase. The focus of this research was understanding direct paid pre-registration employment and transition to practice for the NGN. Methods A study with a descriptive qualitative design was conducted. Nine participants, between three months and one year after completing their nursing program, were interviewed. Thematic analysis was conducted on the data. Findings The main themes emerging from the data were support, vulnerability, de-stress, becoming comfortable, and gaining confidence. Contribution to Nursing Practice Interviewing NGNs with paid pre-registration employment will assist employees’ understanding of the transition experience of new graduates, which may assist with retention of new hires.
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    Understanding the experience of exiting homelessness among women without children
    (2009) Osuji, Joseph; Hirst, Sandra
    The issue of homelessness has come to the fore front of social ills plaguing the Canadian society. There is an overwhelming consensus among researchers and social scientists that the numbers of the homeless are on the increase, their average age is dropping, and more women and family units are becoming part of this population. Although it has been observed that women experience homelessness in ways that are vastly different from men, they are generally underrepresented in published literature on homelessness. The few studies that have focused on homeless women often study those with children and rarely explore the meaning of the exiting experience from homelessness among them, especially those without children. The purpose of this study was to explore the meaning of the lived experience of exiting homelessness among women without children. Convenience and snow ball sampling techniques were used to recruit 12 women exiting homelessness in Calgary and who lived in transitional type accommodations. The texts resulting from audio-taped interviews, participant observations, and reflective journal entries by the researcher constituted data for analysis. Gadamerian hermeneutics informed the interpretive method used for data analysis. An overall meaning of the experience of exiting homelessness among women without children that emerged from the study was that the experience represented a journey through loosing oneself, self discovery, and hopefulness. The findings yielded 5 subthemes that supported the overall meaning and described the journey through exiting homelessness; (1) loss of self at home: the trigger, (2) Non-feeling of 'at-homeness': dissociation, (3) Disconnection and aloneness: homelessness, (4) Simulating home, transitional shelter living, and (5) Finding oneself: hopefulness. These findings suggest that exiting homelessness for women was not a journey in search of a house; rather it was a journey in search of hope, and connection with the self and others. The study is significant in that it validated narratives and literature indicating that exiting the homelessness situation is not just about finding a home, it is about assisting the homeless reconnect with themselves, rediscover personal identities, and find hope. This perspective suggests a new approach for nursing practice, and possibilities for further research, and public policy reviews.