ABSTRACT Background. A wealth of data highlights the health disparities and barriers to health care experienced by Aboriginal women and children when compared to non-Aboriginal women and children. The first thousand days time period, from conception to the age of two, is an opportunity for health professionals to positively impact the health of Aboriginal children with effects lasting into adulthood. Cultural safety has been reported to improve access to health care for Aboriginal Canadians, but little is known about the significance of cultural safety from the perspective of Aboriginal women during the first thousand days. Methodology. An interpretive descriptive design and a postcolonial perspective guided this study. In-depth interviews were conducted with six Aboriginal women at a community health centre located in the inner-city of Regina, Saskatchewan, between June and July of 2015. Data was analyzed using principles of interpretive description to determine themes. Findings. Culturally safe and unsafe care was experienced during the first thousand days. Three themes common to participants included: the importance of being able to trust that they are safe when accessing health care, the overwhelming impact of poverty on their ability to achieve or maintain good health, and finally, the experience of worry related to the first thousand days including the worry about being worthy of respectful, culturally safe treatment by all employed in health environments. Discussion. The perception of culturally safe care was significant in affecting access to health care for this group of participants. Findings of this study suggest that more attention needs to be paid to the development of trust in health care encounters, and future research could explore the concept of trust for Aboriginal peoples. Emphasis on awareness of the social determinants of health, including colonialism and racism, should be included in educational programming for health professionals locally.

Autoimmune diseases (ADs) are a classification of chronic of illnesses in which the immune system mistakes healthy cells for foreign invaders and attacks the body’s own tissues or organs. They are unique in that the diagnosis of one AD makes the individual more susceptible to developing other ADs, and the symptoms of one AD, influence the disease activity of the others. Disease activity may also be influenced by a mind-body connection due to the relationship between stress and the immune system. The purpose of this study was to provide empirical evidence to generate new knowledge and expand our understanding of how individuals diagnosed with multiple ADs are living well. The methodology of interpretive description guided analysis. Five women with their ages ranging from early twenties to late seventies who were diagnosed with two or more ADs participated. The participants’ experiences were illuminated through semi-structured interviews. Four major interconnected themes and 13 sub-themes emerged. They discussed their challenges and successes, their attitudes towards their illnesses, and how they managed living with multiple ADs. The knowledge of the importance of a holistic lens through which to view healthcare provides important insights for those working in physical or mental health settings.

The purpose of this study was to explore the knowledge and attitudes of hospital postpartum and public health nurses towards postpartum depression (PPD) using interpretive description. Postpartum depression is the leading complication after childbirth and impacts negatively on the health of the mother and her child. The nurses in this study participated in focus groups and/or participant observation. The five patterns that describe participants experiences related to PPD were: “Nurses understand PPD in different ways”, “Nurses recognize that women need support”, “Nurses reported that teaching about PPD makes a difference”, “Strong relationships with a primary care provider is essential in the post partum period”, and “a key role of the nurse is to listen”. The nurses in this study revealed a rich understanding of PPD leading to recommendations for practice by hospital and public health nurses related to PPD contributing to better care for women experiencing PPD.

Stigma prevents individuals with serious mental illness from seeking assistance (Fung et al., 2007; Vogel et al., 2006). Self-Determination Theory (SDT) seeks to explain how individuals are motivated by environmental factors and how these elements affect their well-being (Deci & Ryan, 1985). Limited information is available about how young adults with mental illness experience stigma, and how this affects their self-determination and ability to recover. This study explores factors that facilitated recovery and thriving behaviors in nine young adults (ages 18-25) with psychosis, by using a combination of interviews and questionnaires. Findings suggest that having a variety of supports and a determination to recover facilitates high self-determination and thriving behavior in these individuals. By identifying factors that assist these individuals ability to thrive, it is anticipated that professionals will intervene with young adults experiencing psychosis more effectively.

Background: In the face of overwhelming need and increasingly scarce resources, the humanitarian charge of “saving lives and alleviating suffering” is often reduced to simply saving lives. In 2014, World Health Assembly Resolution 67.19 called for the strengthening of palliative care as a key component of comprehensive care. However, even when palliative care is the only available option (ie. 2014-2015 Ebola Crisis), there is little evidence showing it is available in the field. More research is needed to understand this dissonance between policy and practice, and to ensure that humanitarians are providing ethical and contextually appropriate care. Methodology: Twelve individual, in-depth, semi-structured interviews were conducted in English and French with humanitarian healthcare policy makers from North America, Europe, and the Middle East, average 10+ years of experience representing various international organizations. Interviews were transcribed and coded using NVivo11 and an interpretive description framework. Findings: Participant comments suggested the existence of an institutionalized rescue culture, characterized by the fear of failure, equating of death with failure of the humanitarian healthcare professional, and a resultant systemic devaluation of palliative- type care in disaster contexts. The indoctrination of this culture may begin as early as medical school, and manifests clearly in the lack of consistent nomenclature and awareness of palliative care, treatment of palliative-triaged individuals, and resources allocated to palliative care in humanitarian contexts. Palliative care provision is a moral obligation as a final bastion of the human right to dignity and to health. Discussion & Conclusion: In order for palliative care to be integrated into the humanitarian mandate, a significant cultural shift must first take place. The findings of this thesis and the larger Humanitarian Health Ethics study will provide key guidance for the adoption and adaptation of policies that help humanitarians maintain the dignity of individuals in their most vulnerable moments. / Thesis / Master of Science (MSc)

Background & Purpose: Sustaining an acquired brain injury (ABI) can often lead to admission to an inpatient rehabilitation program. The purpose of inpatient rehabilitation is to provide individualized, patient-centered therapy in order to facilitate community re-integration. Considering the patient perspective is beneficial for informing patient-centered care because clinicians and program administrators may develop greater awareness and understanding of patient needs and preferences. There is a lack of qualitative research investigating patient experiences and perspectives of ABI inpatient rehabilitation, and the majority of existing research was conducted in non-Canadian contexts. The present study was thus designed to describe and interpret patient experiences of an ABI inpatient rehabilitation program in urban Ontario. The purpose was to contribute to a patient lens that inpatient rehabilitation staff could consider in their work. Methods: An interpretive description approach was adopted for this qualitative study. Twelve participants were purposively sampled from a regional ABI rehabilitation program. They completed semi-structured interviews about their experiences. Interviews were transcribed, coded, and analyzed to identify major themes. Results: Three major themes were identified from the analysis and arranged around three time points. At the time point prior to admission to inpatient rehabilitation, the theme was “Life Rerouted,” where participants described their lives being diverted from what was “normal” after sustaining an ABI. Inpatient rehabilitation was seen as a way to return to their pre-injury life. The second theme described experiences within inpatient rehabilitation and was entitled, “Autonomy within Rehab.” Under this theme, participants emphasized the importance of personal autonomy over their choices and abilities while in rehabilitation, with three related sub-themes: interactions with clinicians, perceptions of institutional policy, and the involvement of family members. Under a minor theme, not directly related to aspects of autonomy, entitled “social comparisons,” participants also made comparisons of their recovery progress to other patients. The third and final theme reflected participants experiences just after discharge and was entitled, “Life (and Recovery) Go On.” Under this theme, participants described an ongoing recovery process leading to sentiments of both frustration and hope for the future. Discussion: An overarching key message was developed from these themes: “re-establishing personal identity is important to the recovery process.” Two theories (biographical disruption and relational autonomy) are used to interpret this message and describe the strategies and perspectives adopted by patients during inpatient rehabilitation as they attempted to cope with the psychosocial impacts of ABI on their lives. Conclusions: The findings of this study provide knowledge and a theoretical lens in which program staff can view and understand patients’ experiences, needs and preferences. These findings may enhance patient-centered care within the context of ABI inpatient rehabilitation. / Thesis / Master of Science (MSc)

Though patient participation is recognized as an important element of rehabilitation, few studies have used a qualitative lens to specifically examine factors influencing patient-participation in stroke rehabilitation. Thus, the purpose of this work was to explore factors perceived by service users to influence their participation in hospital-based stroke rehabilitation activities and to use this information to generate knowledge relevant for the clinical context of stroke rehabilitation. The following research gaps provided rationale for this work: 1) no published studies from the patients’ perspective on influencers of participating in hospital-based stroke rehabilitation programs, and 2) limited studies about influences on participation in hospital-based stroke rehabilitation. The first manuscript (chapter two) was designed to specifically address these gaps while the second manuscript (chapter three) was developed to highlight important findings surrounding rehabilitation intensity from chapter two. This thesis has discussed a number of patient-perceived barriers and facilitators to participating in stroke rehabilitation, which the final chapter conceptualizes into a framework of personalized rehabilitation representing a patient-centred approach to providing rehabilitation that encourages patient participation. Together, this thesis contributes knowledge about: 1) patient perspectives on factors affecting participation in stroke rehabilitation, 2) promoting patient participation, 3) shortcomings in closing the evidence-to-practice gap with respect to therapy intensity during inpatient stroke rehabilitation, and 4) insights into an exploratory framework of personalized rehabilitation developed from service users’ perspectives of stroke rehabilitation. In addition, this work emphasizes a call to action for the delivery of user-centered stroke care, specifically in regard to rehabilitation intensity during inpatient stroke rehabilitation. The implications of this work are directed at stroke rehabilitation providers as well as policy makers and stroke health system planners in order to develop appropriate and effective services and strategies for optimal recovery and successful implementation of best practice recommendations. / Thesis / Master of Science (MSc) / Rehabilitation is a crucial part of recovery after stroke and patient participation is recognized as an important element of rehabilitation. A less explored perspective is patients’ experiences participating in stroke rehabilitation and barriers/facilitators to participation. This study interviewed individuals who participated in stroke rehabilitation to ask about factors influencing their participation. Eleven individuals were interviewed, and four key themes were identified as barriers and/or facilitators to patient-participation in stroke rehabilitation: 1) environmental factors, 2) components of therapy, 3) physical and emotional well-being, and 4) personal motivators. A sub-theme, amount of therapy, was explored further and this work draws attention to the rehabilitation intensity evidence-to-practice gap apparent as a prevalent issue in Canada and elsewhere. This exploration of patients’ experiences and factors perceived as influencing participation can help to shape the development of strategies to facilitate participation in rehabilitation and improve implementation of existing recommendations to maximize recovery after stroke.

Introduction: La répartition de la main-d'oeuvre dentaire à travers le Canada est fortement balancée en faveur des zones urbaines, une situation qui favorise les disparités dans l'accès aux soins de santé buccodentaire. En engageant des professionnels de la santé buccodentaire dans la pratique dentaire en milieu rural, il faut d’abord comprendre leurs opinions personnelles et professionnelles, ainsi que les obstacles et les facteurs motivant leur choix de pratique. Cependant, il existe un manque des connaissances sur la perception des étudiants de soins de santé buccodentaire à l'égard de la pratique rurale. Par conséquent, nous avons voulu vérifier comment les étudiantes en médecine dentaire perçoivent la pratique dentaire en milieu rural. Méthodes: Nous avons effectué une recherche qualitative dans deux grandes facultés de médecine dentaire au Québec. Un échantillonnage intentionnel et la technique boule de neige ont été utilisé pour recruter des étudiants finissants et des résidents en médecine dentaire en tant que participants à l'étude. Des enregistrements sonores des entrevues, d’une durée de 60 à 90 minutes, semi-structurées et face à face ont été colligés jusqu’à atteinte de la saturation. Nous avons procédé à une analyse thématique pour dégager les enjeux. Cela a inclus un compte-rendu des entrevues, l’encodage des transcriptions, la présentation des données et leur interprétation. Résultats: Dix-sept entretiens (10 F et 7 M, âge: 22 à 39) ont été réalisées. Cinq grands thèmes ont émergé des entrevues: niveau des connaissances sur les inégalités de la santé buccodentaire en milieu rural, image de la ruralité, image de la pratique dentaire en milieu rural, obstacles perçus et facteurs mobilisateurs. Les étudiants ont exprimé que l'éducation dentaire, les avantages financiers, le professionnalisme, le soutien professionnel, et les médias sociaux peuvent influencer positivement leur intérêt à l’égard de la pratique dentaire en milieu rural. Conclusion : Les résultats de cette étude soutiennent la mise en place de stratégies connues pour augmenter la connaissance et la motivation des étudiants en médecine dentaire pour choisir leur profession dans une région rurale. Les acteurs des politiques éducatives ont un rôle essentiel dans la promotion de ces politiques et stratégies facilitantes. / Introduction: The distribution of dental workforce across Canada is highly skewed toward urban areas, a situation which favours disparities in oral health care access. Engaging oral health care professionals in rural dental practice necessitates understanding the personal and professional points of view of these professionals, as well as barriers and motivators in regard to the choice of practice. However, little research exists on how dental students perceive working in rural and remote areas. Therefore, this study aimed to explore the knowledge and perspectives of future Quebec dentists in regard to rural dental practice. Methods: We conducted a qualitative interpretive descriptive research study in two major Faculties of Dental Medicine in Quebec. A purposeful sampling and snowball technique were used to recruit fourth-year dental students and dental residents as study participants. Audio-recorded, 60–90 minute, face-to-face and semi-semi-structured interviews were conducted, with the number of interviews being determined by saturation. Qualitative data were analyzed using a thematic approach including interview debriefing, transcript coding, data display, and interpretation. Results: Seventeen interviews (10 F and 7 M, age: 22–39) were carried out. Five major themes emerged from the interviews: awareness on rural oral health care access, image of rurality, image of rural dental practice, perceived barriers and enablers in regard to rural dental practice. Students expressed that undergraduate dental education, financial rewards, professionalism, professional support, and social media can positively affect their perspectives on rural dental practice.Conclusion: The results of this study support the implementation of strategies that are known to increase the knowledge and motivation of dental students toward rural dental practice. Educational policy maker have an essential role in encouraging these facilitating policies and strategies.

To meet learning needs of current undergraduate nursing students, and respond to mandates for bettered prepared graduates, nurse educators must restructure curricula and teaching strategies. One strategy garnering increased attention is the flipped classroom model (FCM). This form of instruction requires students to have access to and be accountable for lecture material on their own time, and then use face-to-face classroom time for interactive learning that can include discussion, case study analysis, or application of pre-class lecture content. Although the FCM has gained popularity, few researchers have fully studied this strategy or considered experiences of faculty who implement the model. Nurse educators, in particular, do not have enough evidence-based information to support use of the FCM. The purpose of this study was to explore and describe undergraduate nurse educators’ experiences associated with the FCM and to elucidate factors which enhance and hinder its implementation. With the analytical approach of interpretive description (ID), the researcher sought to highlight what it is like for educators to teach undergraduate nursing students using the FCM and to offer interpretation of what occurs with transition from traditional lecture to this strategy. Three overarching themes emerged from the data: 1) What We Are Doing Is Not Working: “There’s a Big Disconnect”, 2) Charting a Different Course: Experimenting with the FCM, and 3) Reflections of the Journey thus Far. These themes revealed participants’ motivation for transition to the FCM, their patterns of thinking as they restructured coursework, roles and relationships, and considerations regarding use of this model. Results from this study offer implications for future research and provide undergraduate educators footing for continued evidence-based teaching practice.

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.