Browsing by Author "Raffin-Bouchal, Shelley"
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Item Open Access A scoping review of the globally available tools for assessing health research partnership outcomes and impacts(2023-12-22) Mrklas, Kelly J.; Boyd, Jamie M.; Shergill, Sumair; Merali, Sera; Khan, Masood; Moser, Cheryl; Nowell, Lorelli; Goertzen, Amelia; Swain, Liam; Pfadenhauer, Lisa M.; Sibley, Kathryn M.; Vis-Dunbar, Mathew; Hill, Michael D.; Raffin-Bouchal, Shelley; Tonelli, Marcello; Graham, Ian D.Abstract Background Health research partnership approaches have grown in popularity over the past decade, but the systematic evaluation of their outcomes and impacts has not kept equal pace. Identifying partnership assessment tools and key partnership characteristics is needed to advance partnerships, partnership measurement, and the assessment of their outcomes and impacts through systematic study. Objective To locate and identify globally available tools for assessing the outcomes and impacts of health research partnerships. Methods We searched four electronic databases (Ovid MEDLINE, Embase, CINAHL + , PsychINFO) with an a priori strategy from inception to June 2021, without limits. We screened studies independently and in duplicate, keeping only those involving a health research partnership and the development, use and/or assessment of tools to evaluate partnership outcomes and impacts. Reviewer disagreements were resolved by consensus. Study, tool and partnership characteristics, and emerging research questions, gaps and key recommendations were synthesized using descriptive statistics and thematic analysis. Results We screened 36 027 de-duplicated citations, reviewed 2784 papers in full text, and kept 166 studies and three companion reports. Most studies originated in North America and were published in English after 2015. Most of the 205 tools we identified were questionnaires and surveys targeting researchers, patients and public/community members. While tools were comprehensive and usable, most were designed for single use and lacked validity or reliability evidence. Challenges associated with the interchange and definition of terms (i.e., outcomes, impacts, tool type) were common and may obscure partnership measurement and comparison. Very few of the tools identified in this study overlapped with tools identified by other, similar reviews. Partnership tool development, refinement and evaluation, including tool measurement and optimization, are key areas for future tools-related research. Conclusion This large scoping review identified numerous, single-use tools that require further development and testing to improve their psychometric and scientific qualities. The review also confirmed that the health partnership research domain and its measurement tools are still nascent and actively evolving. Dedicated efforts and resources are required to better understand health research partnerships, partnership optimization and partnership measurement and evaluation using valid, reliable and practical tools that meet partners’ needs.Item Open Access Assessing the credibility and transferability of the patient compassion model in non-cancer palliative populations(2018-09-13) Sinclair, Shane; Jaggi, Priya; Hack, Thomas F.; McClement, Susan E.; Raffin-Bouchal, Shelley; Singh, PavneetAbstract Background A lack of evidence and psychometrically sound measures of compassion necessitated the development of the first known, empirically derived, theoretical Patient Compassion Model (PCM) generated from qualitative interviews with advanced cancer inpatients. We aimed to assess the credibility and transferability of the PCM across diverse palliative populations and settings. Methods Semi-structured, audio-recorded qualitative interviews were conducted with 20 patients with life-limiting diagnoses, recruited from 4 settings (acute care, homecare, residential care, and hospice). Participants were first asked to share their understandings and experiences of compassion. They were then presented with an overview of the PCM and asked to determine whether: 1) the model resonated with their understanding and experiences of compassion; 2) the model required any modification(s); 3) they had further insights on the model’s domains and/or themes. Members of the research team analyzed the qualitative data using constant comparative analysis. Results Both patients’ personal perspectives of compassion prior to viewing the model and their specific feedback after being provided an overview of the model confirmed the credibility and transferability of the PCM. While new codes were incorporated into the original coding schema, no new domains or themes emerged from this study sample. These additional codes provided a more comprehensive understanding of the nuances within the domains and themes of the PCM that will aid in the generation of items for an ongoing study to develop a patient reported measure of compassion. Conclusions A diverse palliative patient population confirmed the credibility and transferability of the PCM within palliative care, extending the rigour and applicability of the PCM that was originally developed within an advanced cancer population. The views of a diverse palliative patient population on compassion helped to validate previous codes and supplement the existing coding schema, informing the development of a guiding framework for the generation of a patient-reported measure of compassion.Item Open Access Can Self-Compassion Promote Healthcare Provider Well-Being and Compassionate Care to Others? Results of a Systematic Review(Wiley, 2017-04) Sinclair, Shane; Kondejewski, Jane; Raffin-Bouchal, Shelley; King-Shier, Kathryn M; Singh, PavneetBackground This meta-narrative review, conducted according to the RAMESES (Realist And Meta-narrative Evidence Syntheses: Evolving Standards) standards, critically examines the construct of self-compassion to determine if it is an accurate target variable to mitigate work-related stress and promote compassionate caregiving in healthcare providers. Methods PubMed, Medline, CINAHL, PsycINFO, and Web of Science databases were searched. Studies were coded as referring to: (1) conceptualisation of self-compassion; (2) measures of self-compassion; (3) self-compassion and affect; and (4) self-compassion interventions. A narrative approach was used to evaluate self-compassion as a paradigm. Results Sixty-nine studies were included. The construct of self-compassion in healthcare has significant limitations. Self-compassion has been related to the definition of compassion, but includes limited facets of compassion and adds elements of uncompassionate behavior. Empirical studies use the Self-Compassion Scale, which is criticised for its psychometric and theoretical validity. Therapeutic interventions purported to cultivate self-compassion may have a broader effect on general affective states. An alleged outcome of self-compassion is compassionate care; however, we found no studies that included patient reports on this primary outcome. Conclusion We critically examine and delineate self-compassion in healthcare providers as a composite of common facets of self-care, healthy self-attitude, and self-awareness rather than a construct in and of itself.Item Open Access Clinical Decision Making by Fourth-Year Pharmacy Students: Understanding Their Uncertainty(2020-12) Charrois, Theresa L.; Sewell, Douglas; Locke, Jennifer; Raffin-Bouchal, ShelleyClinical decision making is a critical process underpinning much of a pharmacist’s daily activities. Pharmacists in Alberta have a scope of practice that includes prescribing medications, and prescribing includes clinical decision making. Ensuring pharmacy education actively prepares students for clinical decision making is therefore a priority. While it is known that pharmacists hesitate to make decisions, it remains unclear whether pharmacy students experience similar hesitancy. Clinical decision making is dependent on many factors, such as knowledge and experience, that need to be considered when investigating hesitancy and uncertainty in decision making by pharmacy students. Adult learning theories of experiential education and reflective practice are applicable to the pedagogy of decision making given that experience is considered a critical influencer in clinical decision making. This study was designed from a social constructivist paradigm using case study methodology. The purpose was to investigate issues related to hesitancy in clinical decision making by fourth-year pharmacy students. Data was collected through observation of students engaging in simulations, post-simulation interviews, and written reflections. Data analysis included multiple stages of coding, followed by pattern identification and discovery of interrelationships. The primary themes relating to issues in pharmacy student clinical decision making were relational factors, teaching and learning, degree of certainty, and personal characteristics. These themes represent elements that affected decision making before the final stage where the students were either willing or unwilling to make a decision. Pharmacy students construct their decision making primarily by using the patient care process, through repeated practice, and by observing role models. Students felt facilitated in their decision making when there were positive relationships with patients and physicians, practise in the skills lab, and development of comfort with ambiguity. Students discussed that strategies for responsible decision making were complex and related to many of the previously mentioned themes. Students struggled with responsibility taking for decisions both throughout the curriculum and in experiential education. Future research plans include investigating how Albertan students compare with those in other jurisdictions and investigating the training of preceptors to include building student comfort with ambiguity by creating education underpinned by adult learning theories of experiential learning.Item Open Access Clinical Leadership Development Workshops for Licensed Practical Nurses in Supported Living in Alberta: An Exploratory Qualitative study(2020-03-27) Enghiad, Parivash; Venturato, Lorraine; Ewashen, Carol J.; King-Shier, Kathryn M.; Raffin-Bouchal, ShelleyAim: This study had three aims: 1) to develop and deliver a clinical leadership development (CLD) workshop for licensed practical nurses (LPNs) who work in supported living (SL) contexts; 2) to explore LPN participants’ experiences, as well as the influence of the workshop on their attitudes, knowledge, and skills; and 3) to explore the feasibility of implementing a work-based CLD workshop for LPNs working in SL in Alberta. Background: Effective clinical leaders create an efficient and caring work environment, resulting in quality care for patients that attend to both their physical (e.g., safety) and psychological (e.g., autonomy) needs. In SL in Alberta, nursing care is primarily undertaken by LPNs, who work with both registered nurses (RN) and health care aides (HCA) in delivering quality care to older adults. As a result, LPNs are required to undertake clinical leadership (CL) roles that they are often under-prepared for. CL requires the development of a new set of skills for LPNs. To date, few resources have been devoted to developing educational programs to teach these skills, particularly in relation to work-based learning. This program addressed the issue of improving LPNs’ CL skills by developing and delivering a work-based CLD workshop. Design: An exploratory qualitative design was used, incorporating multiple data collection methods, including individual and focus group interviews, a demographic questionnaire, and a knowledge questionnaire. Interview data were analyzed using thematic description and the knowledge questionnaire data were statistically analyzed using a Wilcoxon signed-rank test. Result: The themes were captured in the findings: exploring and raising awareness of the LPNs role as a clinical leader; a sense of empowerment for LPNs in their role as clinical leader; the influence of the CLD workshop on teamwork and communication; and feasibility’s facilitators and challenges. The data affirmed the need for developing a program to help LPNs improve their CL skills, and understand and undertake their CL roles and responsibilities. The effectiveness of the CLD workshop was demonstrated through the LPN participants’ increased confidence, autonomy, and perceived control over decision-making. Following the workshop, the participants expressed a sense of empowerment, which resulted in changed attitudes about their capacity and their role. Conclusion: This study has shown the importance of LPNs understanding their role as a clinical leader, developing effective communication skills, and establishing a working relationship with and among their staff; it has also shown the significance of empowering LPNs. Limitations of the study included challenges arranging and scheduling the necessary time for LPNs to attend CLD workshop, availability and sustainability of the CL training for new staff, and refresher training for the existing staff.Item Open Access Compassion in Health Care: An Empirical Model(2016-02) Sinclair, Shane; McClement, Susan; Raffin-Bouchal, Shelley; Hack, Thomas F.; Hagen, Jack A.; McConnell, Shelagh; Chochinov, Harvey MaxCompassion is frequently referenced as a hallmark of quality care by patients, health care providers, health care administrators, and policy makers. Despite its putative centrality, including its institution in recent health care reform, an empirical understanding based on the perspectives of patients, the recipients of compassion, is lacking -making compassion one of the most referenced yet poorly understood elements of quality care.Item Open Access Compassion training in healthcare: what are patients' perspectives on training healthcare providers?(BioMed Central, 2016) Sinclair, Shane; Torres, Mia-Bernadine; Raffin-Bouchal, Shelley; Hack, Thomas F; McClement, Susan; Hagen, Neil A; Chochinov, Harvey MBackground: The purpose of this qualitative study was to investigate advanced cancer patients’ perspectives on the importance, feasibility, teaching methods, and issues associated with training healthcare providers in compassionate care. Methods: This study utilized grounded theory, a qualitative research method, to develop an empirical understanding of compassion education rooted in direct patient reports. Audio-recorded semi-structured interviews were conducted to obtain an in-depth understanding of compassion training from the perspectives of hospitalized advanced cancer patients (n = 53). Data were analyzed in accordance with grounded theory to determine the key elements of the underlying theory. Results: Three overarching categories and associated themes emerged from the data: compassion aptitude, cultivating compassion, and training methods. Participants spoke of compassion as an innate quality embedded in the character of learners prior to their healthcare training, which could be nurtured through experiential learning and reflective practices. Patients felt that the innate qualities that learners possessed at baseline were further fashioned by personal and practice experiences, and vocational motivators. Participants also provided recommendations for compassion training, including developing an interpersonal relationship with patients, seeing the patient as a person, and developing a human connection. Teaching methods that patients suggested in compassion training included patient-centered communication, self-reflection exercises, and compassionate role modeling. Conclusions: This study provides insight on compassion training for both current and future healthcare providers, from the perspectives of the end recipients of healthcare provider training – patients. Developing a theoretical base for patient centred, evidence-informed, compassion training is a crucial initial step toward the further development of this core healthcare competency.Item Open Access Compassion training in healthcare: what are patients' perspectives on training healthcare providers?(2016-07) Sinclair, Shane; Torres, Mia-Bernadine; Raffin-Bouchal, Shelley; Hack, Thomas F.; McClement, Susan; Hagen, Neil A.; Chochinov, Harvey M.The purpose of this qualitative study was to investigate advanced cancer patients’ perspectives on the importance, feasibility, teaching methods, and issues associated with training healthcare providers in compassionate careItem Open Access Designing and Implementing an Ambulatory Oncology Nursing Peer Preceptorship Program: Using Grounded Theory Research to Guide Program Development(2012-05-09) Watson, Linda C.; Raffin-Bouchal, Shelley; Melnick, Amy; Whyte, DarleneHaving enough staff to provide high-quality care to cancer patients will become a growing issue across Canada over the next decades. Statistical predictions indicate that both the number of new diagnoses and the prevalence of cancer will increase dramatically in the next two decades. When combining these trends with the simultaneous trend toward health human resource shortage in Canada, the urgency of assuring we have adequate staff to deliver cancer care becomes clear. This research study focuses directly on oncology nurses. Guided by the grounded theory methodology, this research study aims to formulate a strategic, proactive peer preceptorship program through a four-phased research process. The goal of this research is to develop a program that will support experienced staff members to fully implement their role as a preceptor to new staff, to facilitate effective knowledge transfer between experienced staff to the new staff members, and to assure new staff members are carefully transitioned and integrated into the complex ambulatory cancer care workplaces. In this article, the data from the first phase of the research project will be explored specifically as it relates to establishing the foundation for the development of a provincial ambulatory oncology nursing peer preceptorship program.Item Open Access The Educational Needs of Professional Hospice Staff: An Ethnographic Inquiry(2021-08-26) Mason, Andrea; Raffin-Bouchal, Shelley; Sinclair, Shane; Ginn, Carla; Venturato, LorraineHospice care delivered by an interdisciplinary team of professional staff includes care of those individuals with a life-limiting illness and a prognosis of days to a few months. It serves a variety of individuals with a combination of multiple diseases and co-morbidities and provides support for their families. A skilled health workforce is needed to deliver quality hospice and palliative care services. Inconsistencies in hospice staff knowledge and provided education have been identified locally in Alberta and across Canada. In previous studies, hospice nurses have identified knowledge deficits in pain and symptom management, psychological and spiritual care, and communication with dying patients. This research, engaging a focused ethnographic methodology, occurred at a local 26-bed hospice. I immersed myself in the hospice culture and in the research process to understand ways that the culture of hospice care can shape the educational needs of professional hospice staff. Data consisted of semi-structured interviews of hospice staff key participants, observations of interdisciplinary hospice professionals during their daily work, examination of hospice cultural documents and artifacts, and the writing of field notes over three months. The study findings suggest that at the core of the hospice staff educational needs lies three primary themes: communication as an essential foundation of quality care; interdisciplinary collaboration is vital for team cohesiveness and lastly, the central care philosophy utilized by the hospice interdisciplinary team is person/resident and family-centered care. These findings offer suggestions for hospice education and further research. Relational care is foundational for this philosophy, with trusting relationships at the forefront of care.Item 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, LorraineDecision-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.Item Open Access Exploring Undergraduate Nursing Students' Experiences of End-of-Life Conversations(2022-10-18) D'Souza, Cheryl; Laing, Catherine; Raffin-Bouchal, Shelley; Moules, NancyNurses report that communicating with patients and families about End of Life (EOL) issues is one of the most challenging aspects of providing EOL care. Many nurses enter practice not feeling prepared or confident to talk about death and dying, and research related to how student nurses encounter EOL conversations in their practicums is lacking. We investigated final year undergraduate nursing students’ experiences of having EOL conversations with patients and family members in their clinical settings. Semi-structured interviews were conducted and analysed using Braun and Clark’s (2006) framework of thematic analysis (TA). A total of five participant interviews were conducted and analysed to yield the following four themes: attitudes towards death and death talk; nursing students’ inner world during EOL conversations; recognizing, communicating, and responding to patients; and the student nurse role in EOL conversations. For nursing students, engaging in EOL conversations with patients and their families is experienced as a complex intellectual and emotional process. Students often fear saying the wrong thing and feel uncertain in knowing how to navigate these conversations. Implications for practice include addressing the gaps in EOL communication content and training in the nursing programs.Item Open Access Healthcare providers perspectives on compassion training: a grounded theory study(2020-08-05) Sinclair, Shane; Hack, Thomas F; McClement, Susan; Raffin-Bouchal, Shelley; Chochinov, Harvey M; Hagen, Neil AAbstract Background There is little concrete guidance on how to train current and future healthcare providers (HCPs) in the core competency of compassion. This study was undertaken using Straussian grounded theory to address the question: “What are healthcare providers’ perspectives on training current and future HCPs in compassion?” Methods Fifty-seven HCPs working in palliative care participated in this study, beginning with focus groups with frontline HCPs (n = 35), followed by one-on-one interviews with HCPs who were considered by their peers to be skilled in providing compassion (n = 15, three of whom also participated in the initial focus groups), and end of study focus groups with study participants (n = 5) and knowledge users (n = 10). Results Study participants largely agreed that compassionate behaviours can be taught, and these behaviours are distinct from the emotional response of compassion. They noted that while learners can develop greater compassion through training, their ability to do so varies depending on the innate qualities they possess prior to training. Participants identified three facets of an effective compassion training program: self-awareness, experiential learning and effective and affective communication skills. Participants also noted that healthcare faculties, facilities and organizations play an important role in creating compassionate practice settings and sustaining HCPs in their delivery of compassion. Conclusions Providing compassion has become a core expectation of healthcare and a hallmark of quality palliative care. This study provides guidance on the importance, core components and teaching methods of compassion training from the perspectives of those who aim to provide it—Healthcare Providers—serving as a foundation for future evidence based educational interventions.Item Open Access How are health research partnerships assessed? A systematic review of outcomes, impacts, terminology and the use of theories, models and frameworks(2022-12-14) Mrklas, Kelly J.; Merali, Sera; Khan, Masood; Shergill, Sumair; Boyd, Jamie M.; Nowell, Lorelli; Pfadenhauer, Lisa M.; Paul, Kevin; Goertzen, Amelia; Swain, Liam; Sibley, Kathryn M.; Vis-Dunbar, Mathew; Hill, Michael D.; Raffin-Bouchal, Shelley; Tonelli, Marcello; Graham, Ian D.Abstract Background Accurate, consistent assessment of outcomes and impacts is challenging in the health research partnerships domain. Increased focus on tool quality, including conceptual, psychometric and pragmatic characteristics, could improve the quantification, measurement and reporting partnership outcomes and impacts. This cascading review was undertaken as part of a coordinated, multicentre effort to identify, synthesize and assess a vast body of health research partnership literature. Objective To systematically assess the outcomes and impacts of health research partnerships, relevant terminology and the type/use of theories, models and frameworks (TMF) arising from studies using partnership assessment tools with known conceptual, psychometric and pragmatic characteristics. Methods Four electronic databases were searched (MEDLINE, Embase, CINAHL Plus and PsycINFO) from inception to 2 June 2021. We retained studies containing partnership evaluation tools with (1) conceptual foundations (reference to TMF), (2) empirical, quantitative psychometric evidence (evidence of validity and reliability, at minimum) and (3) one or more pragmatic characteristics. Outcomes, impacts, terminology, definitions and TMF type/use were abstracted verbatim from eligible studies using a hybrid (independent abstraction–validation) approach and synthesized using summary statistics (quantitative), inductive thematic analysis and deductive categories (qualitative). Methodological quality was assessed using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD). Results Application of inclusion criteria yielded 37 eligible studies. Study quality scores were high (mean 80%, standard deviation 0.11%) but revealed needed improvements (i.e. methodological, reporting, user involvement in research design). Only 14 (38%) studies reported 48 partnership outcomes and 55 impacts; most were positive effects (43, 90% and 47, 89%, respectively). Most outcomes were positive personal, functional, structural and contextual effects; most impacts were personal, functional and contextual in nature. Most terms described outcomes (39, 89%), and 30 of 44 outcomes/impacts terms were unique, but few were explicitly defined (9, 20%). Terms were complex and mixed on one or more dimensions (e.g. type, temporality, stage, perspective). Most studies made explicit use of study-related TMF (34, 92%). There were 138 unique TMF sources, and these informed tool construct type/choice and hypothesis testing in almost all cases (36, 97%). Conclusion This study synthesized partnership outcomes and impacts, deconstructed term complexities and evolved our understanding of TMF use in tool development, testing and refinement studies. Renewed attention to basic concepts is necessary to advance partnership measurement and research innovation in the field. Systematic review protocol registration: PROSPERO protocol registration: CRD42021137932 https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=137932 .Item Open Access The Influence of Risk Perception on Health Behaviour in Adults with Cardiovascular Disease: A Constructivist Grounded Theory Study(2021-01-05) Helms, Kailee Corrine; Donnelly, Tam Truong; Raffin-Bouchal, Shelley; Ginn, Carla S.Cardiovascular disease (CVD) is recognized as a significant contributing factor to the global burden of chronic illness. Fortunately, CVD is a largely preventable disease; the challenge may lie in identifying accurate perception or understanding of personal CVD risk to increase the likelihood that an individual is engaged in preventative behaviours. The purpose of this study was to gain an understanding of how perceptions of risk factors influence preventative health behaviour in adults living with CVD. Using the theory of planned behaviour (TPB) as the guiding theoretical framework and constructivist grounded theory methodology, I interviewed nine participants from a Cardiovascular Rehabilitation facility in Calgary, Alberta, Canada, to explore their experience following an acute cardiovascular event. I analyzed the data using coding, memo-writing, theoretical sampling, and constant-comparative processes. This analysis led to the co-construction of the theory An Inner Struggle of Finding Self-Acceptance after a Cardiovascular Event. Encompassed within this theory is the core variable and basic social process, an inner struggle, and three interrelated categories each with defining sub-categories and properties. Findings from this study suggest that the key to supporting and empowering individuals to make preventative lifestyle changes is in acknowledging and understanding the unique and contextual experience of each individual to foster a multidimensional approach to health. Keywords: Cardiovascular disease, prevention, perception of risk, health behaviour, constructivist grounded theory, theory of planned behaviour.Item Open Access NICU Nurses’ Experiences of Learning to Provide Palliative Care: An Interpretive Description(2023-04-17) St Louis, Julia; Sinclair, Shane; Benzies, Karen; Raffin-Bouchal, ShelleyAbstract Background: More children die in the neonatal period than any other period of childhood. These infants often live their short lives in the neonatal intensive care unit (NICU) and receive palliative care. NICU nurses who provide quality, family-centred palliative care can help alleviate family and patient suffering. Nurses have identified insufficient education as a barrier to providing palliative care in the NICU. No known studies have explored how NICU nurses learn to provide palliative care without formal educational resources. It is important to identify and assess how nurses learn to provide palliative care in the NICU. Research Aim: The purpose of this study is to describe the experiences of nurses in learning to provide palliative care in the NICU. The research questions for this study were: (a) What are NICU nurses' experiences of learning to provide neonatal palliative care?; and (b) What learning experiences do NICU nurses want to provide optimal neonatal palliative care? Methods: A qualitative study was conducted using interpretive description. Participants were purposively recruited through social media and nursing associations. Inclusion criteria were NICU nurses with one year’s experience who had provided palliative care to at least one infant. Data were collected using semi-structured interviews. Data analysis occurred inductively through data immersion, inductive coding, reflective memoing and thematic analysis. Findings: The nine participants in this study received little or no formal education in neonatal palliative care. They learned to provide neonatal palliative care largely through observation and experience. Three themes emerged from the data: meaning-making in neonatal palliative care, challenges in learning and providing neonatal palliative care, and learning to provide neonatal palliative care. Discussion: Most positive learning experiences identified in this study resulted from nurses being in the right place at the right time to observe a skilled colleague providing neonatal palliative care. A standardized curriculum on neonatal palliative care is recommended, as well as evaluating practice and knowledge outcomes in research assessing future education. Keywords: neonatal, NICU, palliative care, nursing educationItem Open Access Understanding Cultural Competence from the Perspective of Registered Nurses Working in Community Health Care Settings(2019-09-19) Anokye-Owusu, Evelyn Addai; Donnelly, Tam Truong; Raffin-Bouchal, Shelley; Phillips, Georgina AnnCanada’s immigrant population has been growing steadily for decades, and, as a result, the health care system is attending to increasing numbers of patients from ethnically diverse backgrounds. With increased migration, culturally competent care from nurses has become an expectation to prevent cultural impositions and to foster respect for national diversity when providing effective patient care. Using descriptive phenomenology methodology, the purpose of this research is to describe the essence of cultural competence by exploring the strengths, challenges, and barriers that public health nurses face in community healthcare settings. The primary research question is: What are the lived experiences of nurses with respect to cultural competence? Individual in-depth interviews were conducted with seven nurses who work in community health clinics. This study suggests that there are inherent challenges to working with culturally and ethnically diverse populations. These include language barriers, limited cultural knowledge, and lack of organizational support which hinders the nurse-patient relationship. Cultural competence education for nurses working with ethnically diverse patient populations is neither mandatory nor readily available; as a result, nurses working in cross-cultural settings often have insufficient cultural knowledge and lack the cultural skills required to work cross-cultural situations. Professional development in the form of workshops and seminars is required on an on-going basis for nurses to develop their cultural awareness and skills. Cultural competence education should be a required aspect of the undergraduate nursing curriculum, as well as the in the workplace.Item Open Access What are healthcare providers' understandings and experiences of compassion? The healthcare compassion model: a grounded theory study of healthcare providers in Canada(British Medical Journal, 2018-03-14) Sinclair, Shane; Hack, Thomas F; Raffin-Bouchal, Shelley; McClement, Susan; Stajduhar, Kelli; Singh, Pavneet; Hagen, Neil A; Sinnarajah, Aynharan; Chochinov, Harvey MaxBackground Healthcare providers are considered the primary conduit of compassion in healthcare. Although most healthcare providers desire to provide compassion, and patients and families expect to receive it, an evidence-based understanding of the construct and its associated dimensions from the perspective of healthcare providers is needed. Objectives The aim of this study was to investigate healthcare providers’ perspectives and experiences of compassion in order to generate an empirically derived, clinically informed model. Design Data were collected via focus groups with frontline healthcare providers and interviews with peer-nominated exemplary compassionate healthcare providers. Data were independently and collectively analysed by the research team in accordance with Straussian grounded theory. Setting and participants 57 healthcare providers were recruited from urban and rural palliative care services spanning hospice, home care, hospital-based consult teams, and a dedicated inpatient unit within Alberta, Canada. Results Five categories and 13 associated themes were identified, illustrated in the Healthcare Provider Compassion Model depicting the dimensions of compassion and their relationship to one another. Compassion was conceptualised as—a virtuous and intentional response to know a person, to discern their needs and ameliorate their suffering through relational understanding and action. Conclusions An empirical foundation of healthcare providers’ perspectives on providing compassionate care was generated. While the dimensions of the Healthcare Provider Compassion Model were congruent with the previously developed Patient Model, further insight into compassion is now evident. The Healthcare Provider Compassion Model provides a model to guide clinical practice and research focused on developing interventions, measures and resources to improve it.