Construction of identity in individuals with inflammatory bowel disease across the lifespan.

Inflammatory bowel disease (IBD) is a chronic illness that affects 10 million individuals worldwide; however, Canada has the highest rates of IBD per capita in the world. Presently, 0.7% of Canadians are diagnosed with IBD, which is expected to rise to 1% by 2030. Disease onset is typically between the ages of 15-45 years old. This is a crucial period for identity development and growth; however, IBD symptoms often disrupt these processes and cause individuals to abandon or reconstruct parts of their identity. As a result, changes in individuals' life plans and health status may cause them to grieve their former pre-IBD identities. In this qualitative narrative study, we captured the lived experiences of IBD, with a focus on what individuals have lost, gained, or accomplished across various avenues (e.g. relationships, education, and future scripts). Thirteen participants constructed IBD narratives using a holistic-form narrative approach, a method that captures various plot formulations and discourses that emerge through storytelling. We found three main plotlines: The 'journey to acceptance', which detailed a route to acceptance wherein individuals integrated IBD into their identity, 'the ambivalent story', which exemplified individuals who were unsure of IBD and the resulting impacts of the diagnosis on their identity, and 'the grief story', which outlined grief and loss surrounding one's pre-IBD self. These results illuminate the role of narrative in shaping meaning-making and identity processes over the life course. We urge future researchers to explore narrative inquiry as a route to further understand the integration of IBD into one's life story/identity.

One-year follow-up of hospital nurses' work experiences during the COVID-19 pandemic: A qualitative study.

AIM: To follow up on the experiences of Registered Nurses (RNs) working after 1 year of the COVID-19 pandemic in Canadian and American hospitals. DESIGN: Semi-structured interviews were conducted, and transcripts were analysed through a reflexive thematic analysis (RTA). METHODS: RNs (n = 19) first interviewed in the spring of 2020 were re-interviewed 1 year after their original interviews (May 25, 2021-June 25, 2021). Participants consisted of nurses residing in Canada and working in Ontario (n = 12) or American hospitals (n = 7), i.e., both local and cross-border nurses. RESULTS: Five themes were identified: (1) "You call us heroes, but you forgot us": Nurses described experiences of disrespect and stigma from their communities, their government, and their workplaces. (2) "A whole new level of busy": Nurses reported stressors both at home and at work that had increased exponentially throughout the pandemic. (3) "Running on empty": Nurses described burnout and mental health struggles including depression, irritation, and suicidal ideation; they coped using both adaptive and maladaptive strategies. (4) "The job of nursing is painful": Ongoing pandemic issues led nurses to re-evaluate their commitments to their units, their hospitals and the profession itself. (5) "Surviving an un-survivable day": Nurses shared positive moments at work and home that helped give them the strength to carry on. CONCLUSION: Significant investments will be required from hospital organizations and governments to ensure that healthcare systems continue to function safely for patients, their families and nurses. IMPACT: The purpose of this study was to understand and describe nurses' experiences after 1 year of working during the COVID-19 pandemic. Nurses reported feeling disrespected, overwhelmed, and burned out; many were looking to leave the profession. These findings will be of interest to nurses working on the frontline of the pandemic as well as hospital managers and policy makers. NO PATIENT OR PUBLIC CONTRIBUTION: In this investigation, nurses were the participants.

"I Called us the Sacrificial Lambs": Experiences of Nurses Working in Border City Hospitals During the First Wave of the COVID-19 Pandemic.

BACKGROUND: The first wave of the COVID-19 pandemic had a significant impact on the personal and professional lives of frontline nurses. PURPOSE: The purpose of this descriptive phenomenological study was to explore the experiences of Canadian Registered Nurses (RNs) working in Ontario or United States hospitals during the first wave of the COVID-19 pandemic. METHODS: Semi-structured interviews were conducted with 36 RNs living in Ontario and employed either at an Ontario or United States hospital. Three main themes were identified across both healthcare contexts. RESULTS: 1) The Initial Response to the pandemic included a rapid onset of chaos and confusion, with significant changes in structure and patient care, often exacerbated by hospital management. Ethical concerns arose (e.g., redeployment, allocation of resources) and participants described negative emotional reactions. 2) Nurses described Managing the Pandemic by finding new ways to nurse and enhanced teamwork/camaraderie; they reported both struggle and resiliency while trying to maintain work and home life balance. Community responses were met with both appreciation and stigma. 3) Participants said they were Looking Forward to a "new normal", taking pride in patient improvements, accomplishments, and silver linings, with tempered optimism about the future. Many expressed a reaffirmation of their identities as nurses. Differences between participants working in the US and those working in Ontario were noted in several areas (e.g., initial levels of chaos, ethical concerns, community stigma). CONCLUSIONS: The COVID-19 pandemic has been very difficult for nursing as a profession. Close attention to post-pandemic issues is warranted.

"My problems aren't severe enough to seek help": Stress levels and use of mental health supports by Canadian hospital employees during the COVID-19 pandemic.

Due to the unique set of stressors associated with the COVID-19 pandemic, healthcare workers in acute care settings may be facing elevated rates of mental health symptomatology. The purpose of this study was to assess levels of depression, anxiety, and stress in a sample of healthcare employees working in hospitals and their use of formal and informal mental health supports. Data was gathered over a three-week period in December 2020 as COVID cases began to rise sharply in Ontario, Canada. Results from an online survey of 650 healthcare employees suggested that overall levels of depression, anxiety, and stress were mild. However, a significant minority of participants reported severe or extremely severe levels of depression (14.4%), anxiety (21.8%), and stress (13.5%). Levels of distress were higher among women, younger participants, those who did not work directly with COVID+ patients, and those who were redeployed. Use of formal mental health supports (e.g., Employee Assistance Plans, teletherapy) was very low (<10%), with the most frequently-reported reason for not using supports being "problems not severe enough to require this service". Implications are considered for healthcare policy decisions as hospital systems attempt to address the mental health needs of their employees.

Practical strategies and the need for psychological support: recommendations from nurses working in hospitals during the COVID-19 pandemic.

PURPOSE: Nurses working during the coronavirus disease 2019 (COVID-19) pandemic have reported elevated levels of anxiety, burnout and sleep disruption. Hospital administrators are in a unique position to mitigate or exacerbate stressful working conditions. The goal of this study was to capture the recommendations of nurses providing frontline care during the pandemic. DESIGN/METHODOLOGY/APPROACH: Semi-structured interviews were conducted during the first wave of the COVID-19 pandemic, with 36 nurses living in Canada and working in Canada or the United States. FINDINGS: The following recommendations were identified from reflexive thematic analysis of interview transcripts: (1) The nurses emphasized the need for a leadership style that embodied visibility, availability and careful planning. (2) Information overload contributed to stress, and participants appealed for clear, consistent and transparent communication. (3) A more resilient healthcare supply chain was required to safeguard the distribution of equipment, supplies and medications. (4) Clear communication of policies related to sick leave, pay equity and workload was necessary. (5) Equity should be considered, particularly with regard to redeployment. (6) Nurses wanted psychological support offered by trusted providers, managers and peers. PRACTICAL IMPLICATIONS: Over-reliance on employee assistance programmes and other individualized approaches to virtual care were not well-received. An integrative systems-based approach is needed to address the multifaceted mental health outcomes and reduce the deleterious impact of the COVID-19 pandemic on the nursing workforce. ORIGINALITY/VALUE: Results of this study capture the recommendations made by nurses during in-depth interviews conducted early in the COVID-19 pandemic.

Meaning in Life Mediates the Association between Environmental Engagement and Loneliness.

Although the positive outcomes of human-environment interactions have been established, research examining the motivation between engagement in pro-environmental activities and psychological well-being is limited. In this mixed-methods study, the relationship between pro-environmental engagement, meaning in life, and well-being, including loneliness and depression, were investigated in a sample of 112 young adults in Canada. It was found that engaging in pro-environmental activities was negatively associated with loneliness. This association was mediated by meaning in life (e.g., an intrinsic motive of caring for future generations). In addition, qualitative analyses explored how engaging in pro-environmental activities has a meaningful impact on meaning in life, and on well-being. A thematic analysis generated three unique themes: (1) responsibility to teach the next generation about the environment, (2) deep appreciation for and connection to nature, and (3) renewed agency through self-directed learning. Overall, findings suggest that meaning in life is a core motive that underlies the association between environmental engagement and loneliness. The present study enriched the relationship between pro-environmentalism and well-being with a mixed-methods perspective.

Body- and symptom-related concerns in women diagnosed with polycystic ovary syndrome: A gap in symptom management.

Polycystic ovary syndrome is the most common endocrine disorder among women aged from 18 to 40 years. Its debilitating menstrual/obesity-related symptoms challenge conceptions of femininity. To date, age-related differences in women's body esteem and physicians' symptom management recommendations have not been investigated. Age moderated the relationships between symptom concerns and both sexual attractiveness and physical condition, but only for midlife, not for emerging adult women. Midlife women received holistic management information from physicians, while emerging adult women received weight management information. This study highlights the need for physician training to manage women's health and age-targeted body acceptance interventions for women diagnosed with polycystic ovary syndrome.

The Diagnostic Experiences of Women With Polycystic Ovary Syndrome (PCOS) in Ontario, Canada.

Polycystic ovary syndrome (PCOS) is the most common endocrine syndrome that disproportionally affects women of childbearing age (~8% to 13% of women worldwide). If unmanaged, it can lead to chronic, lifelong complications. Over the past decade, improvements in diagnostic guidelines have not produced an expected reduction in the diagnostic timeframe. We examined the potential reasons underlying this diagnosis delay. Participants first constructed a diagnostic timeline and then charted and reflected on their diagnosis journeys. Through a reflexive thematic analysis, five themes represented the most common diagnostic trajectory: (a) dismissal of adolescents' early symptoms, (b) negative diagnostic encounters, (c) wariness of treatment options, (d) uncertainty for the future, and (e) self-education and advocacy. Our findings lead us to argue for education of physicians and allied professionals to strengthen patient-centered care delivery to women with a focus on building in training supports that include critically informed, social justice foundations.

The codevelopment of community involvement and generative concern pathways in emerging and young adulthood.

In this longitudinal Canadian study, we investigated the relationship between the developmental trajectories of community involvement and generative concern measured at ages 23, 26, and 32. Participants completed a questionnaire on youth involvement, the Youth Involvement Inventory (YII), and the Loyola Generativity Scale (LGS) at all 3 ages. A latent growth model (LGM) of community involvement predicting time-specific variance in the LGS revealed that: (a) higher levels of community involvement at age 23 predicted greater generative concern at ages 23 and 26, but not at age 32; (b) there were 3 specific indirect paths linking age 23 community involvement to age 32 generativity through earlier assessments of age 23 and age 26 generative concern; and finally (c) a more positive slope of community involvement over time predicted higher levels of generative concern at age 32. These findings suggest that early involvement in community commitments, and increases in community involvement across emerging adulthood, may lead individuals down a path toward a more generative personality in young adulthood. (PsycINFO Database Record

The mediating role of cultural coping behaviours on the relationships between academic stress and positive psychosocial well-being outcomes.

While culture's effect on the coping process has long been acknowledged in the stress-coping literature conceptually, empirical evidence and attempts to discern the specific relationship between culture and coping remain very scarce. Against this backdrop, the present study applied the Cultural Transactional Theory (Chun, Moos, & Cronkite, 2006) to examine the mediating role of cultural coping behaviours (Collective, Engagement and Avoidance Coping) on the relationship between academic stress (AS) and two positive psychosocial well-being outcome measures: Collective Self-esteem (CSE) and Subjective Well-being (SWB). Responses from a sample of undergraduate students in Canada (N = 328) were analysed to test a theory-driven, hypothesised model of coping using structural equation modelling (SEM). As hypothesised, the SEM results showed that: (a) the proposed cultural coping model fit the data well; (b) Engagement Coping and Collective Coping partially mediated the association between AS and the outcomes and (c) the path relationships among the constructs were in the hypothesised directions. A set of preliminary exploratory analyses indicated that Collective Coping was most strongly endorsed by the African/Black and the Middle Eastern cultural groups as compared to other ethnic groups. Implications of the study's findings for future research and practice concerning culture, stress, and coping are discussed.