Background: Children continue to experience pain in hospital. Few studies examine pediatric pain management in the rural context. Objectives: 1) To explore nurses’ experiences providing pain care to pediatric inpatients in Northern Ontario. 2) To identify institutional resources to support nurses’ pain care practices. Method: Across methods approach. Study I used qualitative description completed with 10 nurses using semi-structured interviews. Data were analyzed using inductive content analysis. Study II was an exploratory descriptive online survey using a study-specific questionnaire that was completed by 8 hospital administrators. Data were analyzed using descriptive statistics and narrative synthesis was used for open-ended questions. Findings: Pediatric pain management presents challenges in Northern Ontario, including competing priorities, gaps in pain knowledge, unclear policies, and resource constraints. Potential facilitators include nurses’ motivation to improve pain management, leveraging local resources, and an increase in context specific standards. Conclusion: Context specific strategies need to be designed and implemented to support nurses’ practices in delivering recommended pediatric pain management to their patients.

Submitted by Erika Demachki (erikademachki@gmail.com) on 2018-07-03T18:02:31Z No. of bitstreams: 2 Dissertação - Júlio Cury Hoffmann - 2018.pdf: 1219488 bytes, checksum: 20fea8e1513a899e8a9f32df5739d99a (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2018-07-04T12:29:08Z (GMT) No. of bitstreams: 2 Dissertação - Júlio Cury Hoffmann - 2018.pdf: 1219488 bytes, checksum: 20fea8e1513a899e8a9f32df5739d99a (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2018-07-04T12:29:08Z (GMT). No. of bitstreams: 2 Dissertação - Júlio Cury Hoffmann - 2018.pdf: 1219488 bytes, checksum: 20fea8e1513a899e8a9f32df5739d99a (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2018-04-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / There are several problems on the analysis of biological communities with sparse data, resulting from gradients with high beta diversity. I used four strategies to solve this problem (Beals smoothing, Swan, Shortest Path and Extended Dissimilarity). I randomly removed from 1% to 50% of the individuals in empirical and simulated matrices. I then performed PCoA and nMDS ordinations and used Procrustes correlation of the original two dimensional ordination with the ordination obtained using the degraded matrices. For the simulated data set, I also correlated the ordenation in two dimensions with the coordinates of the samples in the two-dimensional simulated gradients. Finally, I analyzed how robustness to degradation, quantified as Procrustean correlation, was related to the matrix properties. Different from the expected, in the comparison of the degraded and original ordinations, the uncorrected data with a traditional dissimilarity index (Bray-Curtis) produced higher fit than the four methods evaluated. In relation to the coordinates of the simulated two-dimensional gradients, the evaluated methods were slightly better than the raw data. Overall, the simulated data were more robust to the degradation than the empirical ones and the data of abundance were more robust than matrices of presence and absence. Matrices with small proportion of zeros were more robust to degradation. I conclude that the correction methods evaluated distorted the pattern on the original data. Also, data with low beta diversity (few zeros) are robust to degradation and sufficient to reconstruct the original gradient. / Existem vários problemas nas análises de comunidades em Ecologia decorrentes da grande quantidade de zeros na matriz de espécies por locais (dados esparsos), principalmente em situações em que a diversidade beta é alta. Usando quatro estratégias para resolver estes problemas (Beals, Swan, Menor Caminho e Dissimilaridade estendida) retirei aleatoriamente de 1 ate 50 % dos indivíduos de matrizes empíricas e simuladas (degradação das matizes). Realizei ordenações PCoA e nMDS e, com correlações de Procrustes, relacionei a ordenação original em duas dimensões com a ordenação obtida pelas matrizes degradadas. Com dados simulados relacionei a ordenação em duas dimensões também com as coordenadas das amostras no gradiente bidimensional simulado. Além disso, analisei como a robustez à degradação, medida como correlação Procrustes, está relacionada às características da matriz. Diferente do esperado, na comparação das ordenações de matrizes degradadas com a ordenação da matriz original, os dados utilizados sem correções e com índice de dissimilaridade tradicional (Bray-Curtis) tiveram maior ajuste que os quatro métodos avaliados. Em relação às coordenadas, os métodos aplicados tiveram desempenho um pouco melhor do que os dados sem correções quando a diversidade beta foi maior. Em geral, os dados simulados foram mais robustos à degradação que os empíricos e os dados de abundância foram mais robustos que de presença e ausência. Matrizes com menor proporção de zeros foram mais robustas à degradação. Concluo que os métodos de correção distorceram o padrão dos dados originais. Ainda, dados com baixa diversidade beta (poucos zeros na matrix) são robustos à degradação e são suficientes para reconstruir o gradiente original.