published_or_final_version / Public Health / Master / Master of Public Health

published_or_final_version / Public Health / Master / Master of Public Health

The relief of pain is an essential element of nursing practice. Nursing has begun to successfully use art to assess and reduce pain among hospitalized children, surgical patients, and oncology patients. Structured art projects have been used to provide distraction from pain and patient drawings have allowed nurses to assess pain. This project employed grounded theory and thematic analysis to uncover significant concepts in the artists' statements. The Roy adaptation model and Saunders' total pain theory provided the project theoretical framework. The artistic statements and the art of chronic pain patients were examined using thematic analysis to identify recurrent themes. This project explored the insights to chronic pain in the adult patient as evidenced in the posted work. The project also considered how the content of the posted artistic statements informed individual nursing practice and facilitated the reduction of pain in the adult patient suffering from chronic pain. Emergent concepts were used to develop artistic nursing interventions. Suggested modification of nursing practice included drawing as a tool in pain assessment, exploring the meaning of color choices, encouraging mask making, providing distraction, and using art to identify spiritual distress. The proposed nursing actions will allow more effective communication of pain, provide meaningful distraction, intervene in spiritual distress, and encourage creation of an artistic product. Expected outcomes include more effective pain control, greater patient autonomy, and reduced healthcare costs. The application of this new knowledge and skill will make a difference in the lives of chronic pain patients and will therefore promote positive social change.

Chronic pain is estimated to affect approximately 29% of the Canadian population and causes far-reaching lifestyle changes and difficulties that have personal, social, and economic impact. Managing pain is a complex task that recently has been recognized as requiring a multidisciplinary approach. Significant amounts of research have been conducted to understand the biological and cognitive bases of pain; and yet, spiritual aspects of chronic pain have received less attention. Despite this, spirituality remains an important coping strategy as reported by individuals managing chronic health conditions. Some interventions in use today have spiritual roots; however, western medical treatments of pain often do not recognize or utilize spirituality on a regular basis. Utilizing one such intervention, namely mindfulness meditation (MM), this study attempted to understand the role that MM plays in the management of chronic pain and the development of spirituality. This study measured self-reported pain, anxiety, depression, and spirituality in individuals engaged in an 8-week group process in which individuals were provided chronic pain related psycho-education either with MM or without. A repeated measures model was utilized to measure changes that occurred in reported pain experiences (using the McGill Pain Questionnaire) and in spirituality (using the Spiritual Assessment Scale ) to determine if changes could be associated with the teaching of MM. Differences in Affective pain ratings were observed and correlations between pain ratings and spirituality discussed. Reasons for the lack of significant findings, including sample size, power, and measures are discussed.

This qualitative descriptive study explores a parent’s sense of meaning and understanding in relation to the parenting of their children who are living with type 1diabetes. A collective case study design was used and ten interviews were conducted with parents of children living with type 1 diabetes. Recruitment took place through the Winnipeg Diabetes Education and Resource for Children and Adolescents and the Juvenile Diabetes Research Foundation. Nine categories are identified using qualitative content analysis and are interpreted according to an ecological framework (Bronfenbrenner, 1979). Data was triangulated through references to field notes and to the existing literature in this area. Implications regarding training and education for children and families have been discussed.

Background Falls in older people result in harm for individuals and are a major public health problem, but there is little published data on the recording and incidence of falls seen in primary care, with which to consider the implications of recent policy initiatives. A range of factors contribute to falls risk. Amongst these, the role of some medications is well established, but the evidence base regarding the effects of some of the most commonly prescribed medications remains meagre and inconsistent. Aims The project aims to quantify the overall incidence and distribution of recorded falls among older people in primary care in the UK, and the associated risk of death. The falls risk profile of more recently introduced serotonin noradrenalin reuptake inhibitors (SNRls) is explored to assess whether it is more favourable than that of selective serotonin reuptake inhibitors (SSRls). Similarly, prescribing of subclasses of antihypertensive medication is explored to establish whether any of them modify risk of falling. Finally, other classes or sub-classes of medication prescribed in primary care are identified whose apparent falls risk warrants further investigation. Methods Analysis of falls and prescribing history in the electronic records of patients aged 60 years and over from The Health Improvement Network (THIN) using cohort, survival, case-control and case series study designs. Results Amongst people aged >60 years the overall crude incidence rate of recorded falls was 3.58/100 person-years (3.56-3.61), higher in older age groups, in women and least advantaged social groups, and was constant in the period 2003-2006. Fallers experienced a substantial increase in mortality (two-fold increase for recurrent fallers, and more than five-fold for those aged 60-74 years). This increase is independent of fractures recorded at the time of the fall or subsequently. People who fall have an increased rate of subsequent fracture (approximately three-fold and, for recurrent fallers aged 60-74 years more than eight-fold). There was an increased risk of current prescribing of SNRls (adjusted OR 1.79, 1.42 - 2.25) in first fall cases compared with controls. This was similar in magnitude to that seen with tricyclic antidepressants and SSRls. The increase in risk was apparent within the first 28 days after first prescription. The effects were also apparent in the self-controlled case series analysis: the incidence risk ratio for the period 1-28 days after initiation of treatment compared with unexposed periods was 1.49 (1.15 - 1.93). There was an increased risk of current prescribing of thiazides (adjusted OR 1.28, 1.16-1.42). At 3 weeks after first prescribing the adjusted risk remained 4.28 (1.19-15.42). In the case series analysis the incidence risk ratio for the period 21 days after first prescription was 2.80 (1.7 - 4.57). We found a reduced risk for current prescribing of beta blockers (adjusted OR 0.90; 0.85- 0.96), but a weakly positive effect in the case series analysis for the corresponding period IRR 1.23 (1.02-1.48). Taken together, the case-control and case series analyses of other subclasses of antihypertensives provided weak or no evidence for an effect on falls. In the hypothesis generating case-control analysis of other medication classes, unadjusted odds ratios of greater than 1.7 were found in a number of classes of medication including: laxatives, antifungals, corticosteroids, insulin, antibiotics for mild to moderate acne, and vaccines for influenza and other infections. Conclusions Older people with a recorded fall represent a group who are at increased risk of death, irrespective of whether they have a subsequent fracture. Nevertheless the incidence of falls recorded in primary care suggests that guidance about asking patients if they have fallen in the last year appears not to have been followed during the study period. The fact that the incidence rate of falls is strongly associated with social disadvantage suggests the need to target the design and delivery of interventions accordingly. The falls risk profile of SNRls, which is similar to that of SSRls and TCAs, suggests that clinicians initiating prescribing of SNRls should be alert to the increased risk of falls. Similarly, clinicians initiating prescribing of thiazides in older people, which has generally been considered a 'safe' option for older patients, should be alert to the possibility of an increased risk of falls in the first three weeks of prescribing. Case series analysis of recurrent periodic exposures can elucidate bias in classis case-control analysis of the same data, and will be useful in assessing the falls risk profile of other medications such as insulin. Given the small size of sources of detailed data about older people who fall and the imprecision in their measurement of exposure to medications and potential confounders, case-control and case series analysis of first falls in THIN represents a valuable source of new evidence about medication risk factors.

No description available.

Chronic pain is estimated to affect approximately 29% of the Canadian population and causes far-reaching lifestyle changes and difficulties that have personal, social, and economic impact. Managing pain is a complex task that recently has been recognized as requiring a multidisciplinary approach. Significant amounts of research have been conducted to understand the biological and cognitive bases of pain; and yet, spiritual aspects of chronic pain have received less attention. Despite this, spirituality remains an important coping strategy as reported by individuals managing chronic health conditions. Some interventions in use today have spiritual roots; however, western medical treatments of pain often do not recognize or utilize spirituality on a regular basis. Utilizing one such intervention, namely mindfulness meditation (MM), this study attempted to understand the role that MM plays in the management of chronic pain and the development of spirituality. This study measured self-reported pain, anxiety, depression, and spirituality in individuals engaged in an 8-week group process in which individuals were provided chronic pain related psycho-education either with MM or without. A repeated measures model was utilized to measure changes that occurred in reported pain experiences (using the McGill Pain Questionnaire) and in spirituality (using the Spiritual Assessment Scale ) to determine if changes could be associated with the teaching of MM. Differences in Affective pain ratings were observed and correlations between pain ratings and spirituality discussed. Reasons for the lack of significant findings, including sample size, power, and measures are discussed.

This qualitative descriptive study explores a parent’s sense of meaning and understanding in relation to the parenting of their children who are living with type 1diabetes. A collective case study design was used and ten interviews were conducted with parents of children living with type 1 diabetes. Recruitment took place through the Winnipeg Diabetes Education and Resource for Children and Adolescents and the Juvenile Diabetes Research Foundation. Nine categories are identified using qualitative content analysis and are interpreted according to an ecological framework (Bronfenbrenner, 1979). Data was triangulated through references to field notes and to the existing literature in this area. Implications regarding training and education for children and families have been discussed.

No description available.