Hydrocephalus is a common pediatric neurosurgical condition affecting the body’s ability to regulate cerebral spinal fluid. Treatment commonly involves insertion of a ventriculoperitoneal (VP) shunt re-establishing cerebral spinal fluid flow. Shunts are prone to malfunction, with headache being a common symptom. Headache has predominantly been recognized as a sign of shunt malfunction and not seen as a pain event. While headache is common in pediatric hydrocephalus patients with an apparently functional shunt, it has not been rigorously investigated putting them at risk for the consequences of unresolved pain. Researchers have not addressed headache within this patient population outside of shunt functioning or the impact of headache from the child and adolescent perspective. Drawing on the Gate Control Theory, the Neuromatrix Theory of Pain and the International Headache Societies Headache Classification system, a mixed methods study design was undertaken to (a) determine the prevalence, frequency and nature of headaches, (b) describe potential child factors associated with headaches and (c) evaluate the impact of headaches on the child’s and adolescent’s’ school, social and family life. Sixty six percent of children and adolescents reported headache within a one month period. Based on the modified International Headache Society’s criteria, 13.0% of headaches were tension-like, 13.2% were unclassifiable 33.5% were migraine-like and 38.8% were mixed. Etiology was significant with children diagnosed with tumour and congenital without myelomeningocele having a decreased tendency to report headache compared to children diagnosed with congenital with myelomeningocele. Children and adolescents described hidden emotions and missing out on many of their school, social and family activities. The main themes from the qualitative analysis were invisibility, normalcy and control/out of control. Etiology and multiple psychosocial and psychological factors potentially influence the headache experience in children and adolescents with shunted hydrocephalus. Future studies are required to further explore and delineate factors impacting headache within this study population.

A growing body of research has drawn attention to the hierarchical and bureaucratic nature of the hospital organizational environment in which nurses seek to resolve ethical problems related to patient care, whereas other studies have focused on the impact of nurses’ personal or professional qualities on those nurses’ ethical problem solving. This qualitative investigation sought to elucidate the extent to which nurses perceived their personal or professional qualities, as well as organizational characteristics, as influencing their ethical decision making. This investigator interviewed 10 registered nurses in 2 acute-care hospitals that were different in size, location, and type. A relational ethics lens assisted in the analysis of the data, emphasizing ways in which the nurses’ ethical problem solving was socially situated within a complex of relationships with others, including patients, families, physicians, and coworkers. Data analysis revealed key themes, including the nurses’ concern for patients, professional experience, layered relationships with others, interactions within the organization, and situational analysis of contexts and relationships. Subthemes included the nurses’ relationships with patients, physicians, patients’ families, and coworkers. This study revealed a range of ethical problems. Nurses saw their patients as their greatest concern; the nurses worked within a social context of multilayered and complex relationships within a hierarchical, bureaucratic organization with the desire to bring about the best outcomes for patients. The participants described ethical concerns related to the actions or decisions of physicians, patients’ family members, and nurses’ coworkers. The nurses’ deliberation to resolve these ethical problems considered risks and benefits for patients, nurses, and others. The nurses seemed to carry out a contextual assessment, analyzing the presence of mutual respect, the extent of relational engagement, and the potential for opening relational space in order to work together with others to resolve the ethical problem for the patient’s best outcome. The nurses’ ethical actions were socially situated within this complex interpersonal context. This thesis discusses implications of these findings for nursing research, education, and practice.

Nurse empowerment is a well-researched area of nursing practice yet the quality of work environments continue to be eroded, and interactions between nurses and nurse managers continue to be fragile. Power is integral to empowerment, yet the exercise of power between nurses and their managers have been under-investigated in the nurse empowerment literature. To advance our knowledge in the empowerment literature, the study explored the process of how power is exercised in nurse-manager relationships in the hospital setting. Strauss and Corbin’s (1998) grounded theory methodology informed the study. Multiple qualitative fieldwork methods were utilized to collect data on staff nurses about how the manager’s role affected their ability to do their work. The researcher conducted semi-structured interviews and participant observations with 26 participants on three units within a tertiary hospital in Western Canada. Seeking connectivity was the basic social process in which nurses strive to connect with their manager to create a workable partnership in the provision of quality patient care while responding to the demands in the organizational context. Conditions, actions, and consequences formed the theory of seeking connectivity as an extension of nurse empowerment theory. The overarching finding is that the manager plays a critical role in modifying the work environment for nurses and as such, nurses seek connection with their manager to accomplish their work. Institutional policies and practices combined in various ways to influence nurses’ thinking and shaped their actions. The first pattern of the process was characterized by the absence of meaningful engagement with the manager. Power was held over nurses restricting discussions with the manager, and nurses employed a variety of resistance strategies. In the second pattern of the process when managers provided guidance, advocated for nurses, and engaged nurses as collaborators, nurses were better able to problem solve and make decisions with the manager to positively influence patient outcomes. The theory of seeking connectivity is the explanatory framework emerging from the study that reveals how power is exercised in social relations between nurses and managers. Seeking connectivity is a recursive process that continues to evolve. The results of this study advance nurse empowerment primarily from a structural perspective and secondarily from a critical social perspective, suggesting nurses’ perceptions and abilities shape their work role and are foundational to promoting change through collective action. Study implications for research, practice and policy are addressed.

The literature suggests that mentoring is an important factor in the development of nurse leaders. Preliminary evidence suggests that self-efficacy may provide the conceptual link between receipt of mentoring functions and leadership performance. The purpose of this study was to contribute to the scientific knowledge base that informs nursing administration by examining the contribution of mentoring to development of leadership self-efficacy (LSE) among nurses. The conceptual framework that guided the study integrated theoretical perspectives from mentoring, leadership, and self-efficacy theories. A prospective, repeated measures design was used. One hundred Registered Nurses completed measures of LSE at the beginning and conclusion of leadership training and three months following training, and mentoring just prior to the final LSE measurement. Hierarchical regression analysis was used to assess the effect of mentoring on self-efficacy for each of five leadership practices. The change in LSE levels over the course of the leadership training intervention was included as a control for the effect of training. Participant administrative experience and professional education were included as controls. Study results did not support the proposition that protégé exposure to career and psychosocial mentoring would lead to higher levels of LSE. Mentorship did not predict self-efficacy for any of the leadership practices. The impact of participants’ mentoring experiences prior to the study, low statistical power due to a small sample size, homogeneity of respondents with respect to their mentorship experiences, and the possibility of a ceiling effect for LSE are possible explanations for these results. Results did suggest that mentored nurses were able to enhance their LSE during leadership training, and to sustain this increase upon return to their home organizations. Findings also provided insight into the prevalence of mentoring among nurses who are actively pursuing leadership development. Nearly two-thirds of the respondents were mentored during the study period, and these nurses reported that their mentoring relationships were active and positive. Mentoring continues to be advanced as an important contributor to leadership development among nurses. This study reinforces the need for further exploration of this relationship to inform and guide developmental interventions and allocation of resources.

Hydrocephalus is a common pediatric neurosurgical condition affecting the body’s ability to regulate cerebral spinal fluid. Treatment commonly involves insertion of a ventriculoperitoneal (VP) shunt re-establishing cerebral spinal fluid flow. Shunts are prone to malfunction, with headache being a common symptom. Headache has predominantly been recognized as a sign of shunt malfunction and not seen as a pain event. While headache is common in pediatric hydrocephalus patients with an apparently functional shunt, it has not been rigorously investigated putting them at risk for the consequences of unresolved pain. Researchers have not addressed headache within this patient population outside of shunt functioning or the impact of headache from the child and adolescent perspective. Drawing on the Gate Control Theory, the Neuromatrix Theory of Pain and the International Headache Societies Headache Classification system, a mixed methods study design was undertaken to (a) determine the prevalence, frequency and nature of headaches, (b) describe potential child factors associated with headaches and (c) evaluate the impact of headaches on the child’s and adolescent’s’ school, social and family life. Sixty six percent of children and adolescents reported headache within a one month period. Based on the modified International Headache Society’s criteria, 13.0% of headaches were tension-like, 13.2% were unclassifiable 33.5% were migraine-like and 38.8% were mixed. Etiology was significant with children diagnosed with tumour and congenital without myelomeningocele having a decreased tendency to report headache compared to children diagnosed with congenital with myelomeningocele. Children and adolescents described hidden emotions and missing out on many of their school, social and family activities. The main themes from the qualitative analysis were invisibility, normalcy and control/out of control. Etiology and multiple psychosocial and psychological factors potentially influence the headache experience in children and adolescents with shunted hydrocephalus. Future studies are required to further explore and delineate factors impacting headache within this study population.

Globally tobacco use and exposure to tobacco smoke represent some of the greatest risk factors for mortality. Best practice guidelines and standards of practice support nurses' provision of smoking cessation interventions. Nurses employed in primary health care settings interact with large numbers of people who smoke, and have the potential to significantly reduce tobacco use in the population. Evidence shows that nurses do not consistently implement smoking cessation interventions. The purpose of this cross-sectional study was to describe nurses' perceptions of factors that influence their intentions related to providing smoking cessation interventions in primary health care settings. A conceptual framework derived from the Theory of Planned Behavior and relevant empirical literature guided the study. A questionnaire measuring the concepts of interest was mailed to a random sample of Registered Nurses and Nurse Practitioners in Ontario. Responses of 237 eligible participants were available for analysis. Multiple regression analyses were used to examine the hypothesized relationships between nurses' attitudes, subjective norms and perceived behavioural control, and their intention to implement smoking cessation interventions, and the association between intention and practice related to smoking cessation. The Theory of Planned Behavior concepts explained up to 48.5% of variance in behavioural intention. Perceived behavioural control was most strongly associated with intention to provide smoking cessation interventions. Behavioural intention was correlated with smoking cessation practice. Analysis of responses to open-ended questions identified factors that facilitated (wish to improve patients' health, organizational support, access to resources, a perception of patient readiness to quit, and training in smoking cessation) and hindered (lack of time, lack of patient readiness, lack of support and resources, and lack of knowledge) nurses' provision of smoking cessation interventions. Overall, the study results suggest that nursing intention to engage in smoking cessation practices in primary health care settings was associated with organizational factors. Further research is required to explore how primary health care organizations can support nurses so that they fully realize their role in reducing the impact of tobacco use on the health of the people in Ontario.

Improved success of paediatric cardiac transplantation has resulted in increased survival of recipients into young adulthood (19 to 29 years of age). Young adults who received a heart transplant during childhood have experienced multiple life sustaining procedures. As survival and longevity increase, it is clear that transplant recipients experience negative physiological, psychological and social sequelae. With heart transplant offering individuals a chance to extend life into young adulthood, recipients need lifelong care and at age 18 they will transition from paediatric to adult healthcare facilities. The study addressed young adults circumstances of existence and their competing interests within various social environments. This research project applied Pierre Bourdieu’s theoretical concepts of habitus, field and capital, to conceptualize and engage with empirical knowledge production about young adults who have received a heart transplant during childhood. Using visual methodology, focused open-ended interviews were conducted with 12 young adults who had a heart transplant during childhood. Bourdieu’s work provided a theoretical framework to investigate transplant recipients’ identities and social repositioning in relation to dominant discourses of organ transplant and shifting relationships with health services providers. This study involved an iterative process to identify recipients’ encounters and new compositions in relation with others, in order to answer the research objective. These findings highlight that young adult transplant recipients struggle with relational dispositions that excludes them from various fields of social engagement; their struggle and exclusion from various fields is symbolic and is embedded in the structure of the dominant social order of the field from where they become excluded; the social order is taken up and embodied, leading young transplant recipients to practices of accommodation and “normalization”. Changes in healthcare practices, attuned to person implications and peer relationships can begin to address young transplant recipients’ contradictory social positions. Such an approach can potentially lead to improvement in ongoing care and services for young adults who require a lifetime of care. At the same time, it will allow nurses to better prepare and counsel young individuals who are preparing for a heart transplant.

Improved success of paediatric cardiac transplantation has resulted in increased survival of recipients into young adulthood (19 to 29 years of age). Young adults who received a heart transplant during childhood have experienced multiple life sustaining procedures. As survival and longevity increase, it is clear that transplant recipients experience negative physiological, psychological and social sequelae. With heart transplant offering individuals a chance to extend life into young adulthood, recipients need lifelong care and at age 18 they will transition from paediatric to adult healthcare facilities. The study addressed young adults circumstances of existence and their competing interests within various social environments. This research project applied Pierre Bourdieu’s theoretical concepts of habitus, field and capital, to conceptualize and engage with empirical knowledge production about young adults who have received a heart transplant during childhood. Using visual methodology, focused open-ended interviews were conducted with 12 young adults who had a heart transplant during childhood. Bourdieu’s work provided a theoretical framework to investigate transplant recipients’ identities and social repositioning in relation to dominant discourses of organ transplant and shifting relationships with health services providers. This study involved an iterative process to identify recipients’ encounters and new compositions in relation with others, in order to answer the research objective. These findings highlight that young adult transplant recipients struggle with relational dispositions that excludes them from various fields of social engagement; their struggle and exclusion from various fields is symbolic and is embedded in the structure of the dominant social order of the field from where they become excluded; the social order is taken up and embodied, leading young transplant recipients to practices of accommodation and “normalization”. Changes in healthcare practices, attuned to person implications and peer relationships can begin to address young transplant recipients’ contradictory social positions. Such an approach can potentially lead to improvement in ongoing care and services for young adults who require a lifetime of care. At the same time, it will allow nurses to better prepare and counsel young individuals who are preparing for a heart transplant.

Globally tobacco use and exposure to tobacco smoke represent some of the greatest risk factors for mortality. Best practice guidelines and standards of practice support nurses' provision of smoking cessation interventions. Nurses employed in primary health care settings interact with large numbers of people who smoke, and have the potential to significantly reduce tobacco use in the population. Evidence shows that nurses do not consistently implement smoking cessation interventions. The purpose of this cross-sectional study was to describe nurses' perceptions of factors that influence their intentions related to providing smoking cessation interventions in primary health care settings. A conceptual framework derived from the Theory of Planned Behavior and relevant empirical literature guided the study. A questionnaire measuring the concepts of interest was mailed to a random sample of Registered Nurses and Nurse Practitioners in Ontario. Responses of 237 eligible participants were available for analysis. Multiple regression analyses were used to examine the hypothesized relationships between nurses' attitudes, subjective norms and perceived behavioural control, and their intention to implement smoking cessation interventions, and the association between intention and practice related to smoking cessation. The Theory of Planned Behavior concepts explained up to 48.5% of variance in behavioural intention. Perceived behavioural control was most strongly associated with intention to provide smoking cessation interventions. Behavioural intention was correlated with smoking cessation practice. Analysis of responses to open-ended questions identified factors that facilitated (wish to improve patients' health, organizational support, access to resources, a perception of patient readiness to quit, and training in smoking cessation) and hindered (lack of time, lack of patient readiness, lack of support and resources, and lack of knowledge) nurses' provision of smoking cessation interventions. Overall, the study results suggest that nursing intention to engage in smoking cessation practices in primary health care settings was associated with organizational factors. Further research is required to explore how primary health care organizations can support nurses so that they fully realize their role in reducing the impact of tobacco use on the health of the people in Ontario.

It is widely accepted that breast milk is the optimal source of infant nutrition. Despite the World Health Organization (WHO) recommendation of exclusive breastfeeding for the first 6 months of infant life, many women discontinue breastfeeding as a result of perceived difficulties. Nipple pain is a highly prevalent, significant reason for breastfeeding cessation. Among the numerous interventions for nipple pain, the application of lanolin is commonly recommended, with endorsement by Health Canada, The La Leche League, and International Board Certified Lactation Consultants. The few studies that have evaluated the effectiveness of lanolin on nipple pain have lacked methodologic rigor, and are thus not reliable or generalizable. As such, the purpose of this trial was to rigourously evaluate the effect of lanolin for the treatment of nipple pain among breastfeeding women. This single-site randomized controlled trial (RCT) compared the application of lanolin (treatment) to usual postpartum care (not applying lanolin) for the treatment of nipple pain. The primary outcome for this trial was the effect on pain severity, as measured by a numeric rating scale (NRS) at 4 days post-randomization. Of 186 participants, 93 were randomized to the treatment group and 93 to the usual care group. At 4 and 7 days post-randomization there were no statistically significant differences in pain scores between groups. It is noteworthy that by 7 days post-randomization there were clinically relevant decreases in nipple pain in both groups. However, there were no statistically significant differences between groups for other outcomes, including pain measured with the short-form McGill Pain Questionnaire, breastfeeding duration, breastfeeding exclusivity, and breastfeeding self-efficacy. Despite these findings, women in the treatment group were significantly more satisfied receiving lanolin for their nipple pain than those receiving usual care. Since the use of lanolin is no more effective than applying nothing to the nipples for the management of nipple pain, the widespread use of lanolin is questionable. Further research is required on the role of interventions to prevent nipple pain and damage, and the effect of anticipatory guidance on improving breastfeeding outcomes for those experiencing nipple pain in the early postpartum period.