Service Providers' Perspectives: Reducing Intimate Partner Violence in Rural and Northern Regions of Canada.

BACKGROUND: Intimate partner violence (IPV) persists as a serious challenge, globally, with regions in Central and Northern Canada reporting the highest rates of shelter use to escape abuse, of sexual assault, and of IPV in the country. Despite research into IPV, barriers and gaps exist in understanding what an effective response to IPV in rural and northern communities should look like. METHODS: To enhance this understanding, qualitative interviews and focus groups with a total of 55 participants were conducted with service providers, including shelter services, victims services, the Royal Canadian Mounted Police, counselors, and others (e.g., psychologists). A grounded theory approach was used to analyze data, with findings illustrated in a schematic that conceptualize the challenges service providers experience. RESULTS: The findings reveal how an IPV environment, characterized by oppression, abuse, and illness, requires transformation into an IPV-free environment, characterized by empowerment, positive social connections, and wellness. As service providers work to influence this transition, they become experts in understanding the sociocultural context, formal services, and informal supports accessible or not for women experiencing IPV. Service providers encourage social media use into service delivery to improve communication; lobby for rural-specific IPV specialists; and recognize isolation as a barrier to seeking out safe shelter and housing, transportation, and economic assistance. CONCLUSION: In order to reduce rates of IPV, the results suggest we must support service providers, document service gaps, and maximize policy change and community action based on IPV as it is experienced in rural and northern regions of Canada.

A Web of Disheartenment With Hope on the Horizon: Intimate Partner Violence in Rural and Northern Communities.

Intimate partner violence (IPV) has become a worldwide epidemic, yet little is known about the experiences of women survivors living in rural and Northern Canadian communities. Existing statistics suggest that women living in rural areas of the Canadian Prairie Provinces and Northwest Territories (NWT) are at a significantly higher risk of experiencing IPV. To better understand the experiences of IPV in these regions, qualitative interviews were conducted with service providers, including the Royal Canadian Mounted Police (RCMP), Victims Services, Shelter Services, counselors, and others (e.g., physicians). In total, 122 participants were interviewed. These interviews were analyzed using a grounded theory approach where the data/results were transformed into a pictorial matrix that documents the struggles that service providers endure. The matrix/results highlight how social issues, such as isolation and poverty, contribute to social oppressions, such as lack of resources, transportation, and/or services. As service providers struggle against these forces, they begin to develop feelings of disheartenment. Yet, they continue to fight because there are opposing forces, such as Emergency Intervention Orders, police transportation, and Victim Services, that demonstrate how societal response is improving the lives and increasing safety in rural and Northern communities. Ultimately, the results suggest that to reduce the incidences of IPV, we must go beyond the violent acts and deal with the social contexts in which IPV resides.

Exploring health services accessibility by indigenous women in Asia and identifying actions to improve it: a scoping review.

Objectives: The aim of this scoping review was to uncover and summarize what is known in the literature about the experiences of Indigenous women in Asia regarding access to health services. Design: The study was informed by the scoping review methodology proposed by Arksey and O'Malley [2005. "Scoping Studies: Towards a Methodological Framework." International Journal of Social Research Methodology 8 (1): 19-32. doi:10.1080/1364557032000119616]. A comprehensive search of the databases for peer-reviewed studies and grey literature was conducted between January 2000 and December 2016. The data of selected papers and abstracts were analysed by three independent researchers through a protocol of data charting, descriptive numerical summary, and thematic analysis. Results: Sixteen articles and two abstracts met the inclusion criteria for this scoping review. These 18 peer-reviewed documents consisted of eight qualitative studies, seven quantitative studies, and three mixed-method studies, which included the peer-reviewed poster and oral presentation abstracts from international conferences. The findings were sorted and grouped under the following themes: health care access for Indigenous women in Asia, facilitators to accessing healthcare services, barriers to accessing healthcare services, and cultural contexts impacting health and access. Conclusion: There is limited information about the experiences, facilitators, barriers, and cultural contexts faced by Indigenous women in Asia related to health services accessibility, and even less information related to improving health services accessibility and health outcomes. This scoping review in particular highlights the dearth of literature relating to Indigenous women's postpartum health and access to postnatal supports and services. Generally, it indicates that Indigenous women in Asia are more vulnerable to poor health in comparison to non-Indigenous women, and continue to face challenges and barriers in accessing quality and equitable health services. The barriers identified in this review are useful in explaining why inequities in health and access to health care for Indigenous women living in Asia continue to exist. Recommendations for future research directions are described.

Healthcare Access Experiences Among Indigenous Women in Northern Rural Thailand: A Focused Ethnographic Study.

INTRODUCTION: Persistent inequities in health and access to healthcare services for indigenous women living in Thailand remain a significant challenge. This study provides narrative accounts of Indigenous women's experiences accessing healthcare in northern and rural Thailand and explores the complexity of culture and its interaction with multiple intersecting influences on health behaviours. METHODS: A focused ethnographic study was conducted to understand and describe the culture of health behaviors and other cultural phenomena. We recruited 21 female participants aged 20-41 years between March and April of 2017. In-depth semi-structured interviews conducted in Thai were used to explore the experiences of the participants living in a northern rural village. Data analysis was informed and guided by Roper and Shapira's framework for ethnographic analysis. RESULTS: Seven themes presented across three phases of experience (pre-access, making choices, and encountering difficulties) revealed an in-depth understanding of the Indigenous women's lives, the broader sociocultural context in which they lived, and the challenges they faced when accessing healthcare. Analysis of data showed that the participants did not have equal access to healthcare and often disproportionately experienced discriminatory practices and negative attitudes of mainstream healthcare providers. CONCLUSIONS: This is the only study to date that discusses healthcare access challenges experienced by Indigenous women living in a northern rural Thai village. There is an urgent need to focus on citizenship, employment, and general health conditions; gender, familial, and labor roles; specific health conditions, wellness, and cultural practices; the seeking of healthcare services; healthcare provider relationships; the ability to access needed care; and optimization of self-care. Future efforts to improve healthcare access and reduce disease burden might benefit from these findings and allow for the development of more effective strategies, programs, and policies.

An exploration of addiction in adults experiencing early-life stress: a metasynthesis.

OBJECTIVE: to review and synthesize qualitative research on the links between early-life stress and addiction behaviours in adulthood. METHOD: metasynthesis to review qualitative research findings based on procedures that outline how to identify themes or constructs across studies in a specific area. Comprehensive searches of multiple electronic databases were performed. The initial search yielded 1050 articles and the titles and abstracts were screened for inclusion based on predetermined criteria. Thirty-eight full text, peer-reviewed articles were retrieved and assessed by three independent reviewers. Twelve articles were eligible for full review and appraised using the Critical Appraisal Skills Programme (CASP) tools. RESULTS: the findings revealed that clear associations exist between early-life stress and addictive behaviours in adulthood, such as between trauma in childhood, violence, and addictive behaviours. A common theme in the findings indicates that participants turn to addictive substances as a way of strategically coping with stressful childhood experiences, regardless of the harmful side effects or detrimental social outcomes. CONCLUSION: it can be inferred that addiction may be viewed as a way to deal with adversity in childhood and that there is an interrelationship between addiction, domestic violence and crime.

An exploration of addiction in adults experiencing early-life stress: a metasynthesis / Uma investigação sobre o vício em adultos com estresse no início da vida: uma metassíntese / Una exploración de la adicción en adultos que han sufrido estrés durante los primeros años de su vida: una metasíntesis

ABSTRACT Objective: to review and synthesize qualitative research on the links between early-life stress and addiction behaviours in adulthood. Method: metasynthesis to review qualitative research findings based on procedures that outline how to identify themes or constructs across studies in a specific area. Comprehensive searches of multiple electronic databases were performed. The initial search yielded 1050 articles and the titles and abstracts were screened for inclusion based on predetermined criteria. Thirty-eight full text, peer-reviewed articles were retrieved and assessed by three independent reviewers. Twelve articles were eligible for full review and appraised using the Critical Appraisal Skills Programme (CASP) tools. Results: the findings revealed that clear associations exist between early-life stress and addictive behaviours in adulthood, such as between trauma in childhood, violence, and addictive behaviours. A common theme in the findings indicates that participants turn to addictive substances as a way of strategically coping with stressful childhood experiences, regardless of the harmful side effects or detrimental social outcomes. Conclusion: it can be inferred that addiction may be viewed as a way to deal with adversity in childhood and that there is an interrelationship between addiction, domestic violence and crime.

RESUMO Objetivo: revisar e sintetizar pesquisas qualitativas sobre os vínculos entre o estresse no início da vida e os comportamentos de dependência na idade adulta. Método: metassíntese para revisar resultados de pesquisa qualitativa com base em procedimentos que descrevem como identificar temas ou construtos através de estudos em uma área específica. Foram realizadas pesquisas abrangentes em múltiplas bases de dados eletrônicas. A pesquisa inicial produziu 1.050 artigos, cujos títulos e resumos foram selecionados para inclusão com base em critérios predeterminados. Trinta e oito textos completos de artigos revisados por pares foram recuperados e avaliados por três revisores independentes. Doze artigos foram elegíveis para revisão completa e avaliados usando as ferramentas do Programa de Competências de Avaliação Crítica (Critical Appraisal Skills Programme, CASP). Resultados: os achados revelaram que existem associações claras entre o estresse no início da vida e comportamentos aditivos na idade adulta, como entre trauma na infância, violência e comportamentos aditivos. Um tema comum nas descobertas indica que os participantes se voltam para substâncias aditivas como uma maneira de lidar estrategicamente com experiências estressantes da infância, independentemente dos efeitos colaterais deletérios ou resultados sociais prejudiciais. Conclusão: pode-se inferir que o vício pode ser visto como uma forma de lidar com a adversidade na infância e que existe uma inter-relação entre vício, violência doméstica e crime.

RESUMEN Objetivo: revisar y sintetizar la investigación cualitativa referida a la relación entre el estrés durante la infancia y las conductas adictivas en la adultez. Método: metasíntesis que examina los resultados de investigaciones cualitativas basadas en procedimientos orientados a identificar temas o constructos en diferentes estudios en un área específica. Se realizaron búsquedas exhaustivas en múltiples bases de datos electrónicas. La búsqueda inicial arrojó 1.050 artículos. Sus títulos y resúmenes fueron analizados para determinar si debían incluirse en este estudio en base a criterios predeterminados. Se obtuvieron treinta y ocho artículos completos revisados por expertos que fueron evaluados por tres revisores independientes. Entre ellos, doce fueron seleccionados para una revisión detallada y evaluados mediante las herramientas del Programa de Habilidades de Evaluación Crítica (CASP por sus siglas en inglés). Resultados: los resultados revelaron que existe una asociación clara entre el estrés de la infancia y las conductas adictivas en la edad adulta, al igual que entre los traumas infantiles, la violencia y las conductas adictivas. Un aspecto común encontrado en los resultados es que los participantes recurren a las sustancias adictivas como una estrategia para lidiar con experiencias estresantes de su niñez, independientemente de sus efectos secundarios dañinos o de sus resultados sociales perjudiciales. Conclusión: se concluye que la adicción puede ser vista como una forma de lidiar con la adversidad en la niñez y que existe una interrelación entre la adicción, la violencia doméstica y la delincuencia.

Nursing Students Achieving Community Health Competencies through Undergraduate Clinical Experiences: A Gap Analysis.

In Canada, it is widely believed that nursing practice and health care will move from acute care into the community. At the same time, increasing numbers of nursing students are engaged in non-traditional clinical experiences for their community health rotation. These clinical experiences occur at agencies not organizationally affiliated with the health care system and typically do not employ registered nurses (RNs). What has yet to be established is the degree to which nursing students are actually being prepared for community health nursing roles through their community health clinical rotations. In this paper we report the findings of a mixed method study that explored the gap between desired and observed levels of competence in community health of senior nursing students and new graduates. The gap was quantified and then the nature of the gap further explored through focus groups.

Disconnects in pedagogy and practice in community health nursing clinical experiences: Qualitative findings of a mixed method study.

BACKGROUND: Many baccalaureate schools of nursing are using non-traditional placements for undergraduate community health clinical rotations. These placements occur at agencies not organizationally affiliated with the health care system and they typically do not employ registered nurses (RNs). OBJECTIVES AND DESIGN: In this paper, we describe the qualitative findings of a mixed method study that explored these gaps as they relate to pre-registration nursing students' preparation for community health roles. RESULTS: While non-traditional community health placements offer unique opportunities for learning through carefully crafted service learning pedagogy, these placements also present challenges for student preparation for practice in community health roles. The theory-practice gap and the gap between the expected and actual performance of new graduates are accentuated through the use of non-traditional community clinical experiences. These gaps are not necessarily due to poor pedagogy, but rather due to the perceptions and values of the stakeholders involved: nursing students, community health nursing faculty, and community health nurses. CONCLUSIONS: New ways must be developed between academe and community health practice areas to provide students with opportunities to develop competence for practice.

Baccalaureate nursing education: has it delivered? A retrospective critique.

Despite political support for the baccalaureate degree as entry to practice, historical concerns over nursing education - the value of education versus service, professional versus vocational identity and theoretical versus practical knowledge - persist. The authors challenge the notion of a "two-tiered" nursing system and call for a nationwide curriculum review to help the profession adapt to the changing needs of the Canadian healthcare system.

Toward decolonizing nursing: the colonization of nursing and strategies for increasing the counter-narrative.

Although there are notable exceptions, examination of nursing's participation in colonizing processes and practices has not taken hold in nursing's consciousness or political agenda. Critical analyses, based on the examination of politics and power of the structural determinants of health, continue to be marginalized in the profession. The goals of this discussion article are to underscore the urgent need to further articulate postcolonial theory in nursing and to contribute to nursing knowledge about paths to work toward decolonizing the profession. The authors begin with a description of unifying themes in postcolonial theory, with an emphasis on colonized subjectivities and imperialism; the application of a critical social science perspective, including postcolonial feminist theory; and the project of working toward decolonization. Processes involved in the colonization of nursing are described in detail, including colonization of nursing's intellectual development and the white privilege and racism that sustain colonizing thinking and action in nursing. The authors conclude with strategies to increase the counter-narrative to continued colonization, with a focus on critical social justice, human rights and the structural determinants of health.

Competence and competency-based nursing education: finding our way through the issues.

The language of competence is widely utilized in both the regulation of nursing practice and curricular design in nursing education. The notion of competence defines what it means to be a professional, although it is not the only way of describing nursing practice. Unfortunately, there is much confusion about the concepts of competence, competency, and competency-based education. As well, the notion of competence, despite its global popularity, has flaws. In this paper we will disentangle these terms and critique the use of competence frameworks in nursing education.

Creating interprofessional clinical learning units: developing an acute-care model.

In exploring innovative approaches to enhanced patient care, an acute care interprofessional clinical learning unit (IPCLU) was established in a medical unit of a large metropolitan hospital in Edmonton, Alberta, Canada. Part of a larger, community based, participatory mixed method research project, this acute-care model involved several post-secondary institution health science faculties, students, academics, and other post-secondary institutions partnering with the hospital to coordinate and enhance student clinical learning and improve patient care. Pre-implementation data collected from the existing acute-care unit patient-care team, students, and faculty identified areas of strength and enhancement opportunities in interprofessional education (IPE). Interested members of several professions from the patient-care units and students constituted the working group that developed the model. This paper discusses clinical IPE and its relevance in nursing education, explains the processes and mechanisms in creating the IPCLU, details the initiatives that were developed to facilitate enhanced interprofessional care, and offers considerations in advancing IPE in an acute-care setting. The work plan included initiatives that enhance interprofessional teaching and learning culture, increase awareness surrounding interprofessional teamwork and professional roles, promote interprofessional communication and decision-making strategies, and further develop clinical reflection. Insights regarding sustainability are offered.

Exploring ethics in practice: creating moral community in healthcare one place at a time.

Examining everyday ethical situations in clinical practice is a vital but often overlooked activity for nursing leaders and practitioners, as well as most other healthcare professionals. In this paper, we share how a series of practitioner-led Ethics in Practice sessions (EIPs), which originated within a busy urban teaching hospital, were adapted and translated, first into home care and more recently, into an EIP session for public health nurses. The success of EIP sessions rests with their focus on issues that are selected by practitioners. The aims of EIPs are to foster ethical leadership within communities of practice, create safe places to share concerns, use relevant research evidence and other literature to support informed discussion, and generate stories that deepen our understanding of the ethical situations we encounter in our work. We hope our experience inspires nursing leaders, nursing colleagues and fellow healthcare professionals to consider using the EIP approach to build moral community and the idea of moral imagination with their clinical colleagues, one place at a time.

Using narrative inquiry to elicit diabetes self-care experience in an Aboriginal population.

A narrative inquiry approach was used to explore the experience of Aboriginal people living with type 2 diabetes mellitus in a rural community. Narrative inquiry based on hermeneutic phenomenological philosophy was the methodology used to guide the research. A purposive sample of 4 persons of Nuxalk ancestry living in Bella Coola, Canada, were selected for their ability to present rich life narratives and to reveal meaning in their particular diabetes stories. Three key insights or overarching analytical interpretations emerged and could contribute broadly to Aboriginal health research. The focus of the article is the expansion of our understanding of diabetes within a specific cultural context. The discussion connects various philosophical, epistemological, and methodological orientations to research with Aboriginal people living with diabetes.

Discovering the literature on Aboriginal diabetes in Canada: a focus on holistic methodologies.

Promoting culturally competent care for diabetes is critical to addressing the health inequities of indigenous peoples. Based on a review of studies published between 1995 and 2007, the author presents a descriptive analysis of Aboriginal diabetes knowledge guiding the involvement of advanced practice nurses in programs of care. While the literature review is not systematic, it is sufficiently comprehensive to provide a theoretical backdrop to Aboriginal diabetes programs of practice and research. In terms of a particular area of Aboriginal diabetes literature, it also provides a snapshot of community-based diabetes research focused on holistic methodologies historically used in the Canadian context. The Aboriginal diabetes literature is found to be a source of rich information. Analysis of holistic methodologies, however, reveals underdevelopment of research and limited use of key holistic guidelines for Aboriginal policy research.

Aboriginal healing: regaining balance and culture.

This ethnographic study explored the question, How do urban-based First Nations peoples use healing traditions to address their health issues? The objectives were to examine how Aboriginal traditions addressed health issues and explore the link between such traditions and holism in nursing practice. Data collection consisted of individual interviews, participant observations, and field notes. Three major categories that emerged from the data analysis were: following a cultural path, gaining balance, and sharing in the circle of life. The global theme of healing holistically included following a cultural path by regaining culture through the use of healing traditions; gaining balance in the four realms of spiritual, emotional, mental, and physical health; and sharing in the circle of life by cultural interactions between Aboriginal peoples and non-Aboriginal health professionals. Implications for practice include incorporating the concepts of balance, holism, and cultural healing into the health care services for diverse Aboriginal peoples.

The diabetes experiences of Aboriginal people living in a rural Canadian community.

OBJECTIVE: To optimise participation with Aboriginal people by sharing experiences of living with the challenges of diabetes in rural south-western Canada, and how these could be addressed. DESIGN: Qualitative content analysis of semi-structured and conversational interviews. SETTING: Diabetes health services in the Bella Coola Valley, British Columbia, Canada. SUBJECTS: Eight Nuxalk Nation participants, five women and three men, living with type 2 diabetes, were interviewed. Four of these participants, three women and one man, were engaged in six follow-up conversational interviews. MAIN OUTCOME MEASURES: The descriptive research explored experiences of Nuxalk people living with the challenges of diabetes, and how these could inform diabetes health services in culturally specific ways. RESULTS: Challenges included understanding the connections between (i) diabetes and western or traditional medicines; (ii) dietary changes, exercise and weight loss; (iii) how health professionals communicate and the relevance of what is said; (iv) having many life choices and the responsibility to choose; and (v) a belief in living day by day and an awareness of life cycles that may need to be broken. CONCLUSION: The study substantiated the fundamental necessity for diabetes health services to be inclusive of Aboriginal perspectives.

Linking aboriginal healing traditions to holistic nursing practice.

With a phenomenal expected growth in the Canadian Aboriginal population and the fact that less than 1% of Canadian health professionals are of Aboriginal ancestry, there is an increased need for culturally competent health professionals. This article explains diverse healing traditions and links those traditions to holistic nursing practice. Respect for culturally sensitive care is necessary for understanding Aboriginal peoples in different contexts. We suggest that nursing practice, which takes into consideration the understanding of Aboriginal healing traditions, strengthens the intention of nurses to be holistic. Holism in nursing allows the profession to be on the fore-front of understanding Aboriginal healing traditions; the linking of holistic nursing practice with Aboriginal healing traditions offers a foundation on which to build culturally competent care.

Narrative inquiry: Locating Aboriginal epistemology in a relational methodology.

BACKGROUND: This methodology utilizes narrative analysis and the elicitation of life stories as understood through dimensions of interaction, continuity, and situation. It is congruent with Aboriginal epistemology formulated by oral narratives through representation, connection, storytelling and art. Needed for culturally competent scholarship is an experience of research whereby inquiry into epiphanies, ritual, routines, metaphors and everyday experience creates a process of reflexive thinking for multiple ways of knowing. Based on the sharing of perspectives, narrative inquiry allows for experimentation into creating new forms of knowledge by contextualizing diabetes from the experience of a researcher overlapped with experiences of participants--a reflective practice in itself. AIM: The aim of this paper is to present narrative inquiry as a relational methodology and to analyse critically its appropriateness as an innovative research approach for exploring Aboriginal people's experience living with diabetes. NURSING APPLICATION: Narrative inquiry represents an alternative culture of research for nursing science to generate understanding and explanation of Aboriginal people's 'diabetic self' stories, and to coax open a window for co-constructing a narrative about diabetes as a chronic illness. The ability to adapt a methodology for use in a cultural context, preserve the perspectives of Aboriginal peoples, maintain the holistic nature of social problems, and value co-participation in respectful ways are strengths of an inquiry partial to a responsive and embodied scholarship.