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Item Open Access Strategies for Addressing Needle Debris Study (SANDS): A Content Analysis of Media Reports about Needle Debris and Discarded Drug Paraphernalia in Alberta, Canada(University of Calgary, 2024) Ferreira, Carla; Gadimova, Farida; Neufeld, Kyle; Chapdelaine, Jeremy; Guan, Cally; Aslan Nergiz, Aygul; Elliot, Jessie; Khan, Nayab; Raval, Aum; Stokes, Graeme; Lockerbie, Stacy Lee; Jackson, JenniferObjectives: Media reports are known to influence public perceptions of mental health and harm reduction services. The purpose of this study was to analyze media reporting about needle debris and discarded drug paraphernalia, as they related to support for harm reduction services. Methods: We conducted a structured search of media outlets in Alberta, Canada, from March 2015 to February 2022. We conducted content analysis of the text from the media reports. Results: We identified a total of 112 articles from 6 outlets. Government officials and SCS employees were represented most often, at 27% each. About half of media reports included views associating needle debris and supervised consumption sites (52%), with beliefs that the sites produced needle debris, rather than mitigated it. Conclusion: Media reports presented mixed views of needle debris and community impact from harm reduction. Advocates can consider different messaging for each group, based on these views.Item Open Access Perspectives of Acute Care Healthcare Professionals on Harm Reduction Strategies: A Scoping Review Protocol(2023) Boring, Teressa; Lee, Marika; Watkins, Sarah; Jackson, Jennifer; Ens-Giesbrecht, TwylaObjective: The objective of this scoping review is to investigate the perspectives of acute care healthcare professionals on harm reduction strategies. Introduction: Patients with substance use disorders (SUD) are more likely to leave hospitals against medical advice (AMA), which results in untreated health conditions, comorbidities, and increased hospital readmissions. Current research suggests that perceived stigma around addictions may increase the risk of leaving AMA. Harm reduction strategies can enhance patient care and reduce AMA departures; however, implementing these strategies can be challenging if healthcare professionals are opposed to harm reduction. This scoping review will investigate the current literature to understand the perspectives of acute care healthcare professionals on harm reduction strategies. Inclusion criteria: This scoping review will include studies that discuss the perspectives of regulated healthcare professionals working in acute care settings regarding harm reduction strategies. Literature on harm reduction education will be excluded, as well as harm reduction interventions not targeted at patients who use alcohol, illicit drugs, or abuse prescription drugs. Methods: This scoping review protocol follows the Joanna Briggs Institute (JBI) guidelines for developing a protocol (Peters et al., 2022). The searched databases will include MEDLINE(R) (Ovid), APA PsycInfo (Ovid), EMBASE (Ovid), and CINAHL Plus with Full Text (EBSCO). The search will use subject headings and keywords identified during the analysis of seed articles. To make the search more comprehensive, handsearching reference lists and citation tracing will be utilized. Studies will be limited to the English language. Data extraction will use articles from the search that discuss perspectives of harm reduction strategies in acute care. The data extracted will include the author, year of publication, title, setting, study design, participants, aim or questions, methods, and themes or outcomes. The proposed scoping review will follow the JBI methodology for scoping reviews (Peters et al., 2020).Item Open Access Factors that Influence Adequacy of Bowel Preparation in Inpatients Undergoing Colonoscopy: A Scoping Review Protocol(2023-07-12) Marchildon, Marianne; Jackson, Jennifer; Hayden, Alix; Rankin, JanetObjective: The objective of this scoping review is to examine the extent and type of research related to the rate of adequate bowel preparation in adult inpatients undergoing colonoscopy. Our intent is to establish an understanding the factors, both modifiable and non-modifiable, that influence the rate of adequate bowel preparation hospitalized patients undergoing colonoscopy. Introduction: Adequate bowel cleansing is necessary to perform successful colonoscopies, detect adenomas, and identify sources of gastrointestinal bleeding. Inpatients, however, experience a higher-than-average rate of inadequate bowel preparation leading to cancelled procedures, increased stress for the patient, increased time in hospital, and increased cost to the healthcare system. Inclusion criteria: This scoping review will consider all studies examining factors that influence the adequacy of bowel preparation in adult inpatients 18 years and older undergoing colonoscopy who have been admitted to hospital as inpatients. Studies published in English between 2000 and 2023 will be included. Methods: An initial search of MEDLINE, CINAHL, SCOPUS, and EMBASE was undertaken to identify seed articles, followed by a systematic search using keywords and subject headings. Study abstracts will be independently screened by two reviewers against inclusion criteria. Discrepancies will be resolved by consensus. Data extraction will be performed in tabular form and include data related to modifiable and non-modifiable factors that influence bowel preparation in adult inpatients.Item Open Access Understanding Movement Strategies in Adults Post Sternotomy: A Scoping Review Protocol(2022-11-13) Wiens, Karen; Hayden, K. Alix; King-Shier, KathrynObjective: This scoping review will identify, map, and synthesize the available evidence for movement strategies in adults post sternotomy within the first 12 weeks postoperatively. Introduction: It is essential to identify safe movement strategies for adults post sternotomy that supports a safe, independent return to daily activity. In addition, there needs to be an evidence-informed approach to guide clinical practice that balances sternal healing while supporting proper movement strategies for the individual. A review of the evidence within this field is warranted to guide healthcare professionals in best practice as novel movement strategies have emerged. Inclusion criteria: This scoping review will include published, peer-reviewed studies (experimental, non-experimental, and qualitative) focusing on upper body movement strategies to resume activity post sternotomy within the first 12 weeks postoperatively. Systematic, descriptive, and narrative reviews that meet the inclusion criteria will also be considered. Additionally, case reports that focus on this topic will be included. Methods: The electronic databases to be searched include MEDLINE, Embase, CINAHL, PEDro, Sport Discus, Scopus, and the Cochrane Library. The search will be restricted to studies in English, with no date limit. Two independent reviewers will assess titles, abstracts, and full-text articles against the inclusion criteria. The reviewers will develop a data extraction tool; one reviewer will complete the data extraction, which the second reviewer will verify. The results of the data analysis will be presented in tabular and narrative form.Item Open Access Teaching and learning with technology for the design and launch of a first-in-Canada blended Master of Nursing program.(2019-11-07) Stawnychko, Leda; Porter, Amber; Marei, Nedal; Hafez, AyaOral presentation and workshop facilitation at the Symposium on Scholarship of Teaching and Learning held in Banff, Alberta on November 7- 9, 2019.Item Open Access Strategies for Addressing Needle Debris: Scoping Review Protocol(2022-08) Tung, Megan; Jackson, Jennifer; Ferreira, Carla; Hayden, K. Alix; Ens, TwylaObjective: The objective of this scoping review is to explore the literature about needle debris associated with drug use in a community setting. Introduction: Needle debris in the community poses a public health concern. Needle debris and discarded drug paraphernalia could contribute to perceived social disorder associated with harm reduction services, like supervised consumption sites. Discarded needles represent a public safety risk for both people who use drugs and other community members. Currently, the existing research on this topic is scattered and has yet to be consolidated and reviewed. Addressing needle debris may decrease perceived community impact from harm reduction services, and increase support for these services among area residents, business owners, and others. This scoping review will be undertaken to inform a program of research around needle debris, to review available literature on the topic. Inclusion criteria: Studies that focus on strategies to address needle debris will be included, when referring to discarded needles and drug paraphernalia in the community. Exclusion criteria include strategies for people who use needles, who may generate needle waste inside homes and private property. Needle exchange programs and supervised consumption sites will be excluded when their primary purpose is to provide sterile supplies to prevent HIV/Hepatitis C transmission, and prevent and manage drug poisonings and overdoses, rather than prevent needles being discarded in the community. Methods: This scoping review protocol was established following the Joanna Briggs Institute (JBI) guidelines for developing a protocol (Peters et al., 2022). The databases that will be searched are MEDLINE(R) and Epub Ahead of Print, In-Process, In-Data-Review & Other Non-Indexed Citations and Daily (Ovid), CINAHL Plus with Full Text (EBSCO), APA PsycInfo (Ovid), EMBASE (Ovid), and Social Services Abstracts (ProQuest). The search will be conducted using subject headings and relevant keywords identified from analyzing seed articles. Studies will be limited to the English language. Data extraction will be completed using articles identified from the search that have substantial discussion on needle debris and the concept of disposal, retrieval, collection, prevention, and/or education. For a more comprehensive search, hand searching of reference lists and citation tracing will also be included. The proposed scoping review will be conducted in accordance with the JBI methodology for scoping reviews (Peters et al., 2020).Item Open Access Neonatal Intensive Care Unit Design and its Effect on Infant Health and Development and Parent Psychosocial Health(2022-04-21) Clapperton, Michelle; Benzies, Karen; McNeil, Debbie; Hayden, K. AlixBACKGROUND: In the past four decades, there has been an increasing interest in designing neonatal intensive care units (NICUs) to create a healing environment with beneficial effects on the caregiving process, health and development of infants, and family comfort. However, the effects of single-family rooms (SFRs) on infant and parental outcomes, parental involvement, and hospital length of stay remain unclear. METHODS: We conducted a systematic review comparing NICU design and its influence on infants’ health and development up to 2 years of age. We searched MEDLINE, CINAHL, Embase, Cochrane Central, Scopus, Web of Science with English language limitations and no time limit. In addition, we conducted a review of reviews. RESULTS: SFRs were associated with increased parental presence, earlier initiation and longer duration of skin-to-skin care, more frequent infant caregiving activities, greater sustained exclusive breastfeeding up to 4 months corrected age, and reduced overall direct care costs. Infants had earlier experience with their mother's milk and oral feeding. Differences in infant rate of weight gain and weight at discharge were mediated by increased maternal involvement and developmental support. In SFRs, parents reported more privacy, greater comfort, satisfaction with family centered care, and a sense of control/ownership. Increased opportunity to participate in rounds and shared decision made them feel more emotionally supported. Parental stress results were mixed; however, parents reported less stress related to sights and sounds with SFRs. In SFRs versus open designs, length of stay ranged from 4 days longer to 3.4 to 15 days shorter. Regardless of NICU design, infant stress, pain, medical procedures, and infant attention were mediated by increased maternal involvement. Maternal involvement and greater human milk feeding were associated with a decreased length of stay irrespective of NICU design. Skin to skin care and maternal care, but not NICU design, were the most significant predictors of neurodevelopmental at 18 months. CONCLUSION: NICU designs and policies that facilitate parental presence benefit everyone. Consistent with family integrated care, parents need to feel welcomed and supported to be present. An environment that addresses the medical, developmental, educational, emotional, and social needs of the infants, families, and staff is essential for improved outcomes.Item Open Access What Influences Use of Nonpharmacological Treatments for Seniors with Mild or Moderate Dementia: An Integrative Review Protocol(2022-04-02) Hwang, Jasmine; Donnelly, Tam Truong; Davidson, Sandra; Raffin, ShelleyAim: The aim of this integrative review is to explore the extent and nature of evidence concerning factors that influence use of nonpharmacological treatment interventions for community-dwelling seniors with mild-to-moderate dementia. Background: Despite the significance of nonpharmacological interventions in optimal management of mild-to-moderate dementia, it is unclear in the literature how seniors with mild or moderate dementia view, understand, and access nonpharmacological interventions. To our knowledge, no review has been conducted on factors influencing the use of nonpharmacological interventions for seniors with mild-to-moderate dementia. Design: An integrative review method will be used to meet the review objective. Review method: We will perform a systematic literature search from five electronic databases to locate relevant empirical and theoretical research evidence on the topic. Eligible studies include empirical research, both qualitative and quantitative methods, and theoretical studies published since 2000 in English, that explored factors influencing use of community-based nonpharmacological interventions for seniors with mild or moderate dementia. Eligibility criteria are studies that included community-dwelling seniors (≥ 65) with mild-to-moderate dementia, their care partners, or health care practitioners and that explored the use of community-based nonpharmacological dementia treatments. We will extract the data by creating matrices on quality appraisal, key methodological features, and key findings. Data analysis will include constant comparison of extracted data, examining relationships between concepts, overall strengths and weaknesses of the literature, and gaps in knowledge. Findings will be visually categorized and narratively summarized. Discussion: This integrative review will identify and synthesize enablers and barriers that influence use of nonpharmacological interventions by seniors with mild-to-moderate dementia, identify knowledge gaps, and inform future research studies and literature reviews.Item Open Access Parenting Stress, Maternal Perception, and Child Development in Families Experiencing Adversity(2020-11-08) Mughal, Muhammad Kashif; Ginn, Carla S.; Syed, Hafsa; Donnelly, Carlene; Benzies, Karen MarieThe objective of this study was to examine the association between maternal parenting stress and child development in families living with low income, mental illness, addiction, and/or social isolation on intake to an inner-city two-generation preschool program. Our sample included 88 children (age 2.5-5 years) and their mothers entering the preceding inner-city two-generation preschool program. We administered the Parenting Stress Index – Short Form (PSI-SF) and the Battelle Developmental Inventory- Screening Test 2nd ed. (BDI-ST). Bivariate analysis demonstrated associations between PSI-SF sub-scale scores and BDI-ST personal-social and adaptive domains, and we performed two multivariable logistic regression models to investigate associations. Increased parenting stress related to maternal perception of difficult child was associated with delays in children’s development in adaptive and personal-social domains. When designing two-generation early interventions with whole-family approaches for families experiencing adversity, mindfulness of the effects of maternal stress and maternal perception of having a difficult child is essential. In families experiencing adversity, where mothers experience parenting stress due to perceptions of having a difficult child, additional support and resources for both mothers and children may mitigate the risk of children’s developmental delay. Consideration of intergenerational effects of adversity includes increasing societal contributions to environments decreasing parenting stress.Item Open Access Institutional Partnerships for the Design and Launch of Four Blended Online Graduate Nursing Programs(2019-11-15) Stawnychko, Leda; Porter, Amber; Marei, Nedal N.; Hafez, AyaA collaborative partnership between healthcare leaders, students, alumni and university scholars resulted in the design and launch of four blended online graduate nursing programs. The programs, consisting of one-year certificates leading to a Master of Nursing degree, are the first in Canada to be offered in a technology intensive format. They meet the accessibility needs of healthcare professionals whose work and other responsibilities prevent them from pursuing graduate education. The certificates are available in four specialization areas: contemporary topics in aging; addiction and mental health; innovations in teaching and learning; and leadership for health system transformation. Each graduate certificate can be earned alone or combined for credit towards the MN degree. The impact of the program on educators and students is significant. Student access in the graduate programs of the Faculty of Nursing, University of Calgary will increase by 300%. Teaching in the new technology intensive program requires educators to critically examine their teaching and learning practice; adopt blended T&L technologies; and closely consider SoTL principles to support student learning. Student admissions are currently underway for the first cohort to join the program in Fall 2019. We will share lessons learned from program design including partnerships with AHS, the UCalgary’s Taylor Institute for Teaching and Learning, the Faculty of Social Work, Werklund School of Education, Haskayne School of Business and the department of Continuing Education.Item Open Access Selecting a Grounded Theory Approach for Nursing Research(2018-10) Singh, Shaminder; Estefan, AndrewGrounded theory is a commonly used research methodology. There are three primary approaches to grounded theory in nursing research: those espoused by Glaser, Strauss and Corbin, and Charmaz. All three approaches use similar procedures, yet there are important differences among them, which implies that researchers need to make careful choices when using grounded theory. Researchers new to grounded theory need to find the most appropriate approach that fits their research field, topic, and researcher position. In this article, we compare the three grounded theory approaches. Choices of a grounded theory approach will depend on the researcher's understanding of the philosophical underpinnings of all three approaches. Practical aspects of grounded theory approaches should match the information processing styles and analytical abilities of the researcher and the intended use of the theory. We illustrate key aspects of decision making about which method to select by drawing upon the first author's experiences in his doctoral research.Item Open Access Exploring the Use of Social Media: Implications for Participatory Design with Undergraduate Students(Proceedings of the 30th Australian Computer-Human Interaction Conference Proceedings, 2018-12-06) Duffett-Leger, Linda A.; Beck, Amy J.This paper presents our experience of working with young adults, using Participatory Design (PD), to develop a wearable technology to reduce back injury among nurses. We reflect on how participation was enacted with Nursing Students (NS) throughout the study and examine research activities that either promoted or hindered meaningful participation. We propose social media as an opportunity to foster participation in young adults.Item Open Access Nurse educators' reflections on their current multiple choice exam practices and their vision for the future(2017-03-24) O'Rae, Amanda; Mannion, Cynthia A.; Hnatyshyn, Tammy; Beck, Amy J.; Patel, ShrutiItem Open Access Nurse Educators and Multiple Choice Examination Practices(2018-09-12) Mannion, Cynthia A.; Hnatyshyn, Tammy; O'Rae, Amanda; Beck, Amy J.; Patel, ShrutiItem 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.Item Open Access Conducting Analysis in Institutional Ethnography: Analytical Work Prior to Commencing Data Collection(SAGE, 2017-10-30) Rankin, JanetInstitutional ethnography (IE) is an innovative approach to research that requires a significant shift in researchers’ ordinary habits of thinking. There is a growing body of methodological resources for IE researchers however advice about how to proceed with analysis remains somewhat scattered and cryptic. The purpose of the first of a two-paper series is to contribute to publications focused exclusively on analysis. The aim is to provide practical tips to support researchers to shift their ordinary habits of thinking. This first paper outlines how this must happen at the outset of the research design. Analysis of the phenomenon under study commences as the research is being formulated. The approaches to analytical thinking outlined in this paper are based on my own IE research and also my experience working with graduate students since 2008. In this first volume of the two-paper set I provide a brief background to the method and direct readers to important IE resources. I outline three core methodological concepts: standpoint, problematic and ruling relations. I discuss how these concepts guide the early analytical thinking that is embedded in the research design and the critical analysis of the literature that is part of the process of analysis in IE. The second paper provides practical advice for working with data.Item Open Access Conducting Analysis in Institutional Ethnography(SAGE, 2017-12-01) Rankin, JanetInstitutional ethnography (IE) is being taken up by researchers across diverse disciplines, many who do not have a background in sociology and the antecedents and influences that underpin Dorothy Smith’s distinctive IE method. Novice IEers, who often work with advisors who have not studied or conducted an IE, are at risk of straying from IE’s core epistemology and ontology. This second of a two-volume set provides a broad overview to approaching analysis once the IE design and fieldwork are well under way. The purpose of two-volume series is to offer practical guidance and cautions that have been generated from my experiences of supervising graduate students and my involvement in reviewing and examining IE work that has gone “off track.” With a particular focus on the practicalities of conducting analysis, the paper includes examples of the application of IE’s theoretical framework with techniques for approaching and managing data: mapping, indexing, and building preliminary accounts/“analytic chunks.” I suggest these techniques are useful tactics to work with data and to refine the formulation of the research problematic(s) to be explicated.Item Open Access Focusing elementary students with active classrooms: exploring teachers’ perceptions of self-initiated practices(IEJEE, 2017-10-01) Foran, Christine A; Mannion, Cynthia; Rutherford, GayleThe aim of our study was to explore the perceptions of elementary teachers who routinely prioritized physical activity in their classrooms. Researchers are reporting improved student academic test results following physical activity sessions, however, classroom teachers are challenged in balancing curricular and other expectations. Hence, teachers who voluntarily implement physical activity have views that are unique and important for promoting the practice to others. We interviewed seven teachers from grades 1-6, using the qualitative constructivist approach to grounded theory qualitative research. Teachers valued physical activity because it enhanced their students’ focus on classroom activities. Common attributes amongst the teachers were active lifestyles, previous employment experiences using physical activity, and a pedagogical approach prioritizing physical activity throughout the day. Additionally, the teachers perceived that belonging to schools with a culture of movement was important. Teachers view physical activity as a teaching asset when they perceive a positive impact on their students’ ability to focus. Specific teacher attributes and a school environment that embraces physical activity may predispose teachers to these views, and represent areas that should be further explored. Pre-service courses could be one way to provide teachers with experience and a repertoire of easy physical activities.Item Open Access A qualitative study: Mothers of late preterm infants relate their experiences of community-based care(PloS ONE, 2017-03) Premji, Shahirose; Currie, Genevieve; Reilly, Sandra; Dosani, Aliyah; May Oliver, Lynette; Lodha, Abhay K; Young, MarilynPurpose In Alberta, the high occurrence of late preterm infants and early hospital discharge of mother-infant dyads has implications for postpartum care in the community. Shortened hospital stay and complexities surrounding the care of biologically and developmentally immature late preterm infants heighten anxiety and fears. Our descriptive phenomenological study explores mothers’ experience of caring for their late preterm infants in the community. Methods Eleven mothers were interviewed using a semi-structured interview guide. Interview transcripts were analysed using an interpretive thematic approach. Findings The mothers’ hospital experience informed their perspective that being a late preterm infant was not a “big deal,” and they tended to treat their infant as normal. “Feeding was really problem,” especially the variability in feeding effectiveness, which was not anticipated. Failing to recognize late preterm infants’ feeding distress exemplified lack of knowledge of feeding cues and tendencies to either rationalize or minimize feeding concerns. Public health nurses represent a source of informational support for managing neonatal morbidities associated with being late preterm; however, maternal experiences with public health nurses varied. Some nurses used a directive style that overwhelmed certain mothers. Seeing multiple public health nurses and care providers was not always effective, given inconsistent and contradictory guidance to care. These new and changing situations increased maternal anxiety and stress and influenced maternal confidence in care. Fathers, family, and friends were important sources of emotional support. Conclusion After discharge, mothers report their lack of preparation to meet the special needs of their late preterm infants. Current approaches to community-based care can threaten maternal confidence in care. New models and pathways of care for late preterm infants and their families need to be responsive to the spectrum of feeding issues encountered, limit duplication of services, and ensure consistent and effective care that parents will accept.Item Open Access Growing the science of Family Systems Nursing: Family health intervention research focused on illness suffering and family healing(Chenelière Éducation, 2015) Bell, Janice M.The purpose of this book chapter is to review the current science of Family Systems Nursing (FSN) and describe programs of family health intervention research that have contributed unique knowledge about FSN nursing interventions with families experiencing illness. All of these programs of FSN intervention research have boldly challenged the predominant belief within “good science” that before intervention research can be designed and conducted, there first must be a thorough understanding of the phenomenon, i.e., an in-depth knowledge of the variables that mediate families’ response to health and illness. Since the early 1980’s, FSN researchers have been courageously immersed in actual nursing practice with families experiencing illness while researching, mentoring, supervising, examining, and evaluating advanced nursing practice with families. They felt called to answer two central questions: “What are nurses actually doing and saying that is helpful to families in their experience of illness suffering?” and “How can FSN knowledge be implemented by practicing nurses in health care settings?” In the process, they uncovered a circular interactional relationship between practice and research with each informing and enhancing the other. This chapter offers exemplars of programs of FSN intervention research from around the world that used “going inside FSN interventions” to describe and evaluate the nursing actions that diminish or soften illness suffering in families. Programs of FSN intervention research have also focused on “translating FSN interventions” in practice settings. Recommendations for future research are offered that include an even greater commitment to research focused on actual nursing practice with families and a broader, larger systems focus that uses knowledge translation methodology to examine multisystemic variables that influence how FSN knowledge can be better translated and sustained in the practice of health care with families.