This research study seeks to better understand the experience of South Asian immigrant women in the Neonatal Intensive Care Unit (NICU). The information gathered cannot be generalized to all South Asian and other immigrant populations nor is it the intent of this study. Instead, by examining the individual NICU experiences and challenges faced during this experience, themes emerge that can prompt neonatal nurses to examine their own practice with immigrant families. The main, overall theme identified in all participant responses was, Fear of the Unknown. Three subthemes that emerged from discussions regarding how participants experience nursing care were Trust, Teaching and Advocating. In terms of what participants identified as their most critical concerns while their infant was in the NICU, the three subthemes that arose were Language Barriers, Lack of Knowledge about the NICU and A More Comfortable NICU. On a broader scale, it is hoped that this research study will inspire all nurses to examine their interactions with all immigrant families in order to provide care that is holistic and individualized to the needs of their immigrant patient. / Graduate

In recent years, mental illness in pregnant and postpartum women has become a public health concern. Untreated and undertreated maternal mental illness has a significant negative impact on not only the mother, but also on the baby and family. Further, many women do not seek help or access mental health care due to stigma surrounding mental illness, the unrealistic social expectations of motherhood, and the fear of being judged or rejected. An interpretive descriptive study informed by a feminist perspective was conducted with six postpartum women who sought maternal mental health care services. Semi-structured interviews provided an opportunity to explore women’s experiences of having a maternal mental illness, accessing care, and the role of stigma. Analysis focused on the bio-psycho-social dimensions of their experiences. A shared experience and meaning emerged: self stigma and expectations of motherhood, stigma and infertility, factors influencing self stigma, level of self-efficacy, and treatment satisfaction, engagement and outcome. Findings are discussed with reference to the current literature on maternal mental illness, stigma, and infertility. Findings are conceptualized using Brown’s (2006) Shame Resilience Theory, implications for practice are presented including women’s advice to other women, and recommendations for future research are made.

The purpose of this research was to learn about the needs of young adults living with newly diagnosed cancer and undergoing chemotherapy and/or radiation treatment in order to enhance oncology care providers’ understanding of these needs. This was a qualitative investigation of the perspectives of young adults with cancer using interpretation description methodology (Thorne, 2008). Semi-structured interviews were conducted with seven individuals to gain a deeper insight into the subjective experience of being a young adult with cancer with consideration of quality of life issues. Eight interpretive themes were revealed from the data: It Is Hard Being a Parent with Cancer, Symptom Management Is a Challenge, Social Support is Imperative, Information Access is Essential, Fear of Recurrence and Mortality, Trusting Relationships with Health Care Professionals Make a Difference, Financial Worries, and Follow Up Care. These concepts represent a critical analysis which can serve to guide oncology care and oncology nursing practice.

The H1N1/09 (sub-type A) virus was declared to be a pandemic influenza on June 11th, 2009. In response, Canadian public health agencies planned mass vaccination clinics to protect the public. However, little information existed to aid in the planning of mass vaccination clinics, as they had not been used in previous pandemic flu outbreaks. This was further complicated by fear of a limited vaccine supply and nurse shortages. Public health nurses (PHNs), as the largest group of public health professionals were pivotal in implementing the mass vaccination clinics. Yet, the available evidence indicated that PHNs involvement in H1N1/09 response planning was limited and their experiences on the frontline in the mass vaccination clinics were not well understood. The purpose of this study was to give PHNs’ a voice to describe their experiences in the H1N1/09 mass vaccination clinics. A framework based on Foucault’s concepts of knowledge, power, and resistance was developed as the theoretical lens to guide the research. Using an interpretive descriptive methodology, a purposeful sample of 23 PHNs (16 front-line immunizers, seven clinic supervisors) participated in semi-structured interviews. Four pandemic planning documents containing policies in place during the pandemic outbreak were also reviewed to provide context to participants’ experiences. Interpretive descriptive analysis was used to analyze the interviews and pandemic documents. Guba and Lincoln’s (1994) trustworthiness framework was implemented to evaluate the rigour of the study’s findings. Two overall core themes emerged to describe participants’ experiences. The core theme ‘the necessity of knowledge’, illustrated participants’ feelings of unpreparedness entering into the H1N1/09 clinics. Limited notice of the pandemic response, uncertainties regarding the clinics’ anticipated timeframe, and a lack of knowledge on vaccination and clinic management, contributed to a loss of power in the participants’ role. In the second core theme ‘essential supports in protecting the population’, many perceived a lack of agency support when they tried to exercise power in their clinical practice. Although participants did not refuse to immunize in, or supervise, the mass vaccination clinics, participants at times did display subtle resistance. Insights gained from participants’ experiences have implications in terms of public health nursing administration, practice, research, and education. A key recommendation is to involve PHNs in future pandemic planning to optimize mass vaccination clinics’ operations. If this cannot happen, PHNs should at least be informed of the disciplinary discourse utilized to guide clinical decisions. This will help nurses be supported in their own pandemic roles and contribute to the provision of quality population care.

The purpose of this study was to understand undergraduate students’ attitudes about search data privacy in academic libraries and their preferences for how librarians should handle information about what students search for, borrow, and download. This is an important area of study due to the increasingly data-driven nature of evaluation, accountability, and improvement in higher education, along with libraries’ professional commitment to privacy, which has historically limited the amount of data collected about student use. Using a qualitative approach through the lens of interpretive description, I used the constant comparative method of data collection and analysis to conduct semi-structured interviews with 27 undergraduate students at a large, urban public research institution. Through inductive coding, I organized the data into interpretive themes and subthemes to describe students’ attitudes, and developed a conceptual/thematic description that illustrates how they are formed. Students revealed that a variety of life experiences and influences shaped their views on search data privacy in academic libraries. They viewed academic library search data as less personally revealing than internet search data. As a result, students were generally comfortable with libraries collecting search data so long as it is used for their benefit. They were comfortable with data being used to improve library collections and services, but were more ambivalent about use of search data for personalized search results and for learning analytics-based assessment. Most students expressed a desire for de-identification and user control of data. Some students expressed concern about search data being used in ways that reflect bias or favoritism. Participants had moderate concern about their library search data privacy being used by government agencies to protect public safety. Although some disagreed with the practice in concept, most did not feel that the search data would be useful, nor would it reveal much about their personal interests or selves. Students who were not comfortable with the idea of search data collection in academic libraries often held their convictions more strongly than peers who found the practice acceptable. The results of this study suggest that academic libraries should further explore student perspectives about search data collection in academic libraries to consider how and if they might adjust their data collection practices to be respectful of student preferences for privacy, while still meeting evaluation and improvement objectives. This study achieved the intended purpose of contributing a foundational body of knowledge about student attitudes regarding search data privacy in academic libraries. It positions librarian-researchers to develop studies that further this line of inquiry in an area that has significant implications for both user privacy and libraries’ practices for assessment and evaluation. Limitations of this study include its limited generalizability as a result of the qualitative research design, and the fact that it relied primarily on a convenience sampling method.

Nurses working in acute care psychiatry experience high rates of violence perpetrated by patients and their perspectives on these experiences are essential to understand this phenomenon. The purpose of this study was to explore psychiatric nurses’ experiences of patient violence in acute care inpatient psychiatric settings. In this interpretive descriptive study, a purposeful sample of 12 nurses were interviewed to understand how they define patient violence and understand their experiences of abuse within the workplace. Using thematic content analysis, a problem, needs and practice analysis was also conducted. Experiencing patient violence had many perceived negative impacts on nurses, patients and the organization. It was often considered to be part of the job and some nurses struggled with the role conflict between one’s duty to care and one’s duty to self when needing to provide care following a critical incident. Power, control and stigma also influenced nurses’ perceptions and responses to patient violence. In their practice, nurses used a wide variety of interventions to stay safe as well as prevent and manage patient violence. Nurses recommended increased education, support and debriefing, and an improved working environment. Future research should explore a consistent definition of violence, barriers to incident reporting and the creation of best practice guidelines specifically related to patient violence. Understanding the perspectives and experiences of nurses in acute inpatient psychiatry leads to greater knowledge of the phenomenon of patient violence and helps to inform the development of future nursing interventions to prevent and to respond to patient violence, as well as support nurses working within the acute care setting. / Thesis / Master of Science in Nursing (MSN)

Children and adolescents with cerebral palsy (CP) often receive botulinum toxin (BoNT-A) to manage spasticity. Our 2014 study developed an inventory of parents’ goals for BoNT-A treatment, but reasons for selecting these goals were unclear. The current study aimed to describe and categorize the effects of BoNT-A that parents observed according to WHO’s International Classification of Functioning, Disability and Health (ICF) framework. This qualitative study used interpretive description. Fifteen parents of non-ambulatory young people with CP (mean age 10.2 years, SD 3.9, 7 males) who received BoNT-A were recruited through McMaster Children’s Hospital’s Spasticity Management Clinic. Interviews were conducted in-person or by telephone for 20-60 minutes. The research team read the initial transcript, identified codes, and finalized the coding framework. Member checking was conducted to enhance trustworthiness. The key theme was that parents needed to find the right path to do what is best for their child. Parents described how they learned about both positive and negative effects of BoNT-A treatment: some parents emphasized the child’s pain during BoNT-A injections (negative), but also felt that BoNT-A was helpful for their child (positive). Most effects of BoNT-A were coded at the ICF activity level, such as dressing These observations helped inform parents’ decision to continue with BoNT-A and identify future goals. This study provides insight into parents’ journey of learning about BoNT-A and goal-setting for their child. Parents’ perspectives will be used to refine the 2014 inventory of goals to facilitate collaborative goal-setting for BoNT-A treatment. / Thesis / Master of Science (MSc) / Children diagnosed with cerebral palsy (CP) receive botulinum toxin (BoNT-A) as a treatment to reduce muscle tone. Current research on the use of BoNT-A injections in non-ambulatory children with CP is scarce and may not incorporate the perspectives of the family about their goals for treatment. This study interviewed parents to ask about the effects that they observed in their child after BoNT-A treatment. Fifteen parents were interviewed and all parents spoke about their journey of “finding the right path to do what is best for my child” as they learned about the possible effects of BoNT-A treatment for their child. By learning about parents’ journey, informational resources can be developed and shared with other parents about the effects of BoNT-A treatment. It is important to help parents understand these effects, which would allow them to discuss and identify appropriate goals with healthcare professionals in future BoNT-A treatment sessions.

Nurse-Family Partnership is a targeted public health intervention program designed to improve child and maternal health through nurse home visiting. Adolescent girls and young women who are pregnant or living in situations of social and economic disadvantage are at increased risk for poor health. Rural living may compound marginalization and create additional challenges for young mothers. In the context of a large-scale process evaluation, I posed the question: “In what ways do Canadian public health nurses explain their experiences with delivering this program across different geographical environments?” This thesis represents a purposeful attempt to examine the experiences of public health nurses as they deliver the Nurse-Family Partnership program across different geographical settings in British Columbia, Canada. The qualitative methodology of interpretive description guided study decisions and data were collected through focus groups and semi-structured interviews with public health nurses delivering the Nurse-Family Partnership program and their supervisors. Consisting of three studies linked by their focus of evaluating Nurse-Family Partnership in British Columbia, this thesis explores influences on program delivery across the rural-urban continuum, including issues related to nurse recruitment, retention, and turnover. Overall, the findings from these analyses suggest that the nature of clients’ place and their associated social and physical geography emphasizes that geography has a significant impact on program delivery for clients who were living with multiple forms of oppression and it worked to reinforce disadvantage. In manuscript one, exploration and description of factors that contribute to recruitment, retention, and turnover of public health nurses delivering Nurse-Family Partnership in British Columbia, Canada are presented. Then manuscript two reflects the factors and challenges of providing the NFP program in rural communities. The final manuscript applies an intersectional lens to reveal how the nature of clients’ place and their associated social and physical geography emphasizes inadequacies of organizational and support structures that create health inequities for clients. The collective work of this thesis emphasises the importance of location as a factor affecting home visitation programs. In rural environments, public health nurses are resourceful and can provide insight into important considerations for program delivery. These may include enhanced use of technology for communicating with supervisors, nurses, or clients through cell phone/videoconferencing or experiencing rugged terrain and extreme weather conditions. Public health nurses practicing in urban areas also have geographical considerations that are location specific, including precariously housed clients whose locations are transient and providing care to clients living in unsafe conditions. Across all environments, time was a valued commodity and effective communication was essential. Supporting nurses as they deliver Nurse-Family Partnership in Canadian communities can help nurse retention in a program with many positive attributes. Working with vulnerable populations, building relationships with clients, regular reflective supervision and team meetings were among the top reasons public health nurses enjoyed being involved in Nurse-Family Partnership. Reasons leading to turnover are also discussed. / Dissertation / Doctor of Philosophy (PhD) / Living in social or economic disadvantage is associated with negative health outcomes for Canadian families. Young mothers and their children are one such group at risk for suboptimal health outcomes, creating a significant public health concern. The Nurse-Family Partnership is a targeted public health intervention program designed to improve child and maternal health through nurse home visiting. As this program is evaluated for uptake in Canada, this thesis examines the delivery within the context of Canadian geography. Factors that influence program delivery for public health nurses in Canada are explored.

Public health concerns were prominent during the COVID-19 pandemic, particularly regarding rising cases of anxiety and depression among adults. U.S. healthcare providers were especially affected by the unrelenting demands on their time and service. Psychiatric Mental Health Nurse Practitioners (PMHNPs) provided patient care during the pandemic to meet the increasing need for mental health services as people began experiencing mood disturbances such as anxiety, depression, and grief. The purpose of this qualitative study was to explore the perceived effect of the COVID-19 pandemic on the mental health of PMHNPs. A qualitative design using the interpretive description method allows researchers to use pre-existing knowledge to inform their research and actively participate in knowledge synthesis, focusing on variations in data. Individual interviews with 18 PMHNPs were conducted via video teleconferencing, and their data were evaluated and interpreted for meaning. After a thorough analysis of the interview transcripts, nine themes were identified: adaptive coping, improved access, support, self-care, work strain, complications, maladaptive coping, pandemic strain, and polarization. This study illuminated the challenges PMHNPs faced during the pandemic and the strategies they employed to cope with difficulties and will inform future research and practice in mental health care.

Background: Adolescents are more likely to be dissatisfied with perinatal care than adults. Adolescents’ perspectives of their perinatal care experiences have been explored; however, there are few studies exploring adolescent-friendly inpatient care from nurses’ perspectives. Purpose: To explore adolescent-friendly care from the perspective of hospital-based adolescent-friendly perinatal nurses. Research Questions: (1) How and why do perinatal nurses in inpatient settings adapt their practice when caring for adolescents? (2) What are the individual nursing behaviours and organizational characteristics of adolescent-friendly care in inpatient perinatal settings, from the perspective of perinatal nurses? Methods: I report the qualitative component of a mixed methods study. Open-ended interviews were conducted with twenty-seven purposively-sampled expert nurses. Data were analyzed using Interpretive Description. Findings: Nurses described being mother-friendly to adolescents by being nonjudgmental, forming connections, individualizing care, and employing behavioural strategies that facilitate relationship-building. Implications: These findings will inform the development of interventions to facilitate connections between nurses and adolescent mothers.