Daphne Cockwell School of Nursing 3 rd Annual Nursing Research Day: Advancing Research for Health in our Global Community

Transcription

1 Daphne Cockwell School of Nursing 3 rd Annual Nursing Research Day: Advancing Research for Health in our Global Community Monday, June 7, 2010 Ryerson University

2 Daphne Cockwell School of Nursing 3rd Annual Nursing Research Day: Advancing Research for Health in our Global Community Program Committee Elizabeth McCay, Chair Committee Members Krista Abramovic Heather Beanlands Cristina Catallo Faith Donald Sherry Espin Suzanne Fredericks Sepali Guruge Jennifer Lapum Nancy Purdy Elaine Santa Mina Lori Schindel Martin Souraya Sidani Mandana Vahabi

3 8:00-8:30 Room :30-8:45 Room Conference Overview: Continental Breakfast and Registration Introductory Remarks Dr. Elizabeth McCay, Associate Director of Scholarly, Research, and Creative Activities, Daphne Cockwell School of Nursing, Ryerson University Welcome Dr. Karen Spalding, Director, Daphne Cockwell School of Nursing Dr. Usha George, Dean, Faculty of Community Services, Ryerson University 8:45-9:45 Room Keynote Address Introduction: Dr. Judy Mill, Associate Dean, Global Health, Faculty of Nursing, University of Alberta Director for PAHO/WHO Collaborating Centre for Nursing and Mental Health Drifting at Sea or Swimming in Formation : Developing a Global Health Research Program 9:45-10:00 Room Coffee 10:00-11:00 Concurrent Sessions Room Socioeconomic Determinants of Health Room Health Systems and Policy Room Health Systems and Policy: Worklife Room Patient-Provider Relationships 11:00-11:45 Room :45-12:45 Room :45-1:45 Room Poster viewing Presenters available at Posters Lunch Afternoon Panel Moderator: Dr. Judy Mill The Local-Global Connection in Research: Migration as a Global Health Issue Dr. Denise Gastaldo, Associate Professor, Associate Director, Centre for Critical Qualitative Health Research Lawrence S. Bloomberg Faculty of Nursing, University of Toronto Local to Global, Global to Local: Developing a Program of Research on Violence against Women throughout the Migration Process Dr. Sepali Guruge, Associate Professor, CIHR New Investigator Daphne Cockwell School of Nursing, Ryerson University 1

4 2:00-3:00 Concurrent Sessions Room Public and Population Health: Heart Disease Room Public and Population Health: Community-based Strategies Room Health Systems and Policy: Worklife Room Gender, Sexuality and Health: Women s Health 3:00-3:15 Room Coffee and Poster Viewing 3:15-3:55 Concurrent Sessions Room Health Systems and Policy: Errors Room Educational Initiatives (A) Room Educational Initiatives (B) Room Gender, Sexuality and Health: HIV Room Socioeconomic Determinants of Health 4:00-4:30 Room Closing Reflections of the Day Dr. Judy Mill, Associate Dean, Global Health, Faculty of Nursing, University of Alberta Director for PAHO/WHO Collaborating Centre for Nursing and Mental Health Dr. Denise Gastaldo, Associate Professor, Associate Director, Centre for Critical Qualitative Health Research Lawrence S. Bloomberg Faculty of Nursing, University of Toronto Dr. Sepali Guruge, Associate Professor, CIHR New Investigator Daphne Cockwell School of Nursing, Ryerson University Closing Remarks Dr. Elizabeth McCay, Associate Director Scholarly, Research and Creative Activities Daphne Cockwell School of Nursing, Ryerson University Dr. Karen Spalding, Director Daphne Cockwell School of Nursing, Ryerson University 2

5 Keynote Address (8:45-9:45) - Room TRS Drifting at Sea or Swimming in Formation : Developing a Global Health Research Program Dr. Judy Mill, Associate Dean, Global Health, Faculty of Nursing, University of Alberta, Director for PAHO/WHO Collaborating Centre for Nursing and Mental Health In this presentation, I will argue that global health research is a critical component of nursing research programs. I will provide an overview of several concepts that are relevant to and inform global health research, including internationalization, global citizenship, and global social responsibility. Opportunities and challenges in global health research will be discussed in order to highlight strategies for successful global health research programs. Finally, I will provide an overview of my program of research Vulnerability and Empowerment: Studies in HIV and AIDS as an example of a global health research program. Judy Mill, RN, PhD, is an Associate Professor in the Faculty of Nursing, at the University of Alberta. Her research program focuses on understanding the broad social, economic and cultural factors that influence the vulnerability of individuals and communities to HIV infection in both Canadian and international settings. In addition to Judy s public health nursing and research experience in Canada, she has lived in Malawi, Zambia, Zimbabwe, and Ghana for more than 7 years working on clinical and research projects. Judy is the Director of the PAHO/WHO Collaborating Centre for Nursing and Midwifery and the Associate Dean, Global Health in her Faculty. Afternoon Panel (12:45-1:45) - Room TRS The Local-Global Connection in Research: Migration as a Global Health Issue Dr. Denise Gastaldo, Associate Professor, Bloomberg Faculty of Nursing, University of Toronto In this presentation, I will explore how I have conceptualized migration as a global health issue, rather than a context-specific subject. By adopting a global health perspective in studies I conducted in Toronto, I have been able to capture transnational health practices and immigrants mobile subjectivities. I have embraced the localglobal connection utilizing a research strategy traditionally considered a local-focused one, community-based research. Finally, I will refer to how a congruent theory-methodology articulation supports such approach. Denise Gastaldo RN, PhD is an Associate Professor at the Bloomberg Faculty of Nursing, University of Toronto and cross-appointed to the Dalla Lana School of Public Health, University of Toronto and to the Faculty of Nursing and Physiotherapy, University of Balearic Islands, Spain. Her research focuses on the social determinants of health, health promotion and global health. Currently, she is developing projects in Canada and Spain in the area of gender and migration. She is also involved in graduate educational projects in several countries. She is the faculty coordinator and co-creator of the International Nursing PhD Collaboration, which aims at increasing nurses capacity to participate in global health and international nursing research. Nursing faculties from Canada, Spain, Mexico, Finland, Brazil and Australia participate in this Collaboration. She is also a member of the Primary Health Care Nursing Leadership and Capacity Building project, a partnership between the Brazilian Ministry of Health and the Bloomberg Faculty of Nursing, University of Toronto. Dr. Gastaldo is an Associate Director at the Centre for Critical Qualitative Health Research, University of Toronto, which oversees an integrated series of methodology graduate courses for students from all health sciences disciplines. Her areas of interest in qualitative research are participatory and community-based methodologies and knowledge translation for the community. 3

6 Afternoon Panel (12:45-1:45) - Room TRS Local to Global, Global to Local: Developing a Program of Research on Violence against Women Throughout the Migration Process Dr. Sepali Guruge, Associate Professor, Daphne Cockwell School of Nursing, Ryerson University Violence against women is a global health issue. My program of research on violence against women began with a specific focus on intimate partner violence (one form of violence against women) among immigrant women in Canada. Findings of my studies show a strong link between what takes place post-migration, and pre-migration and border-crossing contexts. As a result, I extended my work to a number of other countries. This work also showed that partner violence cannot be researched in isolation and that other forms of violence against women need to be studied to gain a comprehensive understanding of the phenomenon. My studies in other immigrantreceiving countries such as the U.S. and England led me back to research with a number of additional immigrant communities in Canada. I will talk about my plans to learn about the common elements across groups and countries while paying particular attention to the unique contextual factors in order to ensure that knowledge gained on this global health issue is locally relevant, and provides a basis for culturally and linguisticallyappropriate and context-specific care. Sepali Guruge, RN, PhD is an Associate Professor in the Daphne Cockwell School of Nursing at Ryerson University. Her research focuses on violence against women throughout the migration process (i.e., premigration, border-crossing, and post-migration contexts). She leads Ryerson s Global Health Team, and she coleads the Nursing Centre for Research and Education on Violence Against Women and Children at Ryerson. Presently, Dr. Guruge is engaged in community-based health research on violence against women with colleagues in Canada, the United States, Sri Lanka, Ethiopia, Brazil, Belgium, Italy, and the United Kingdom. Her program of research is supported by a CIHR New Investigator Award. She supervises graduate students in Nursing, Early Childhood Studies, Public Health, and Immigration and Settlement Studies in a number of different countries. Dr. Guruge has published in nursing and interdisciplinary refereed journals and books, and presented papers at national and international conferences. She is also editor (along with Dr. Enid Collins) of the book, Working with Immigrant Women: Issues and Strategies for Mental Health Professionals (published by the Centre for Addiction and Mental Health, Toronto, 2008). 4

7 Daphne Cockwell School of Nursing 3rd Annual Nursing Research Day: Advancing Research for Health in our Global Community Monday, June 7, 2010, 8:00-5:00pm, Ryerson University Ted Rogers School of Management, 55 Dundas St West, 7 th Floor, Toronto, ON CONTINENTAL BREAKFAST & REGISTRATION 8:00-8:30 (1-148) WELCOME & KEYNOTE 8:30-9: Welcome and Introductory Remarks Drifting at sea or swimming in formation : Developing a global health research program Dr. Judy Mill, Associate Dean, Global Health, Faculty of Nursing, University of Alberta, Director for PAHO/WHO Collaborating Centre for Nursing and Mental Health COFFEE 9:45-10: Concurrent Sessions (10:00-11:00) Socioeconomic Determinants of Health Chair: Josephine Wong 10:00-10:20 Food Insecurity among Latin American recent immigrants in Toronto Mandana Vahabi 10:20-10:40 Sustaining Health Sustaining Housing: An evaluation of a supported housing program for people living with HIV/AIDS Amrita Ahluwalia 10:40-11:00 Excavating the Environment within the Nursing Metaparadigm and its relationship with health, nursing, person. Aroha Page Health Systems and Policy Chair: Elaine Santa Mina A Systematic Review of the Factors that Influence the Use of Health System Information in Policy Making Cristina Catallo Firearm Death and Injury in Canada: Twenty years after the Montreal Massacre Wendy Cukier The Meaning of Changing Expectations: A qualitativedescriptive study. Karen Thomas & Ross Riggs Health Systems and Policy: Worklife Chair: Nancy Purdy Effects of Work Environments on Nurse Outcomes Nancy Purdy Compassion Satisfaction, Compassion Fatigue, Worklife Conditions, and Burnout among Frontline Mental Health Staff Susan L Ray Novice Nurses' Lived Experience of Family Nursing Viola Fast Braun Patient-Provider Relationships Chair: Sherry Espin Patient Experiences with Visiting a Nurse Practitioner for Primary Health Care in New Brunswick Trudy Hahn Support and Housing Priorities for Persons with Serious Mental Illness in Northern and Rural Ontario: Q methodology Patricia Bailey & Sharolyn Mossey Nurse client decisionmaking: Concept analysis, model, and middle-range descriptive theory Susan E. Bishop 5

8 Poster Viewing 11:00-11: Presenters available at posters. LUNCH 11:45-12: AFTERNOON PANEL 12:45-1: Moderator: Dr. Judy Mill The local-global connection in research: Migration as a global health issue Dr. Denise Gastaldo, Associate Professor, Bloomberg Faculty of Nursing, University of Toronto Local to global, Global to local: Developing a program of research on violence against women throughout the migration process Dr. Sepali Guruge, Associate Professor, Daphne Cockwell School of Nursing, Ryerson University Concurrent Sessions (2:00-3:00) Public and Population Health: Heart Disease Chair: Heather Beanlands 2:00-2:20 An Examination of the Difference in the Type and Number of Self-Care Behaviours Performed among White and Non- White Patients Following Bypass Surgery Joyce Lo Public and Population Health: Communitybased Strategies Chair: Cristina Catallo Best Practices: Healthy Workplace, Professionalism, and Client Centered Care through a Smoke Free/Tobacco Initiative Helen Kirkpatrick Health Systems and Policy: Worklife Chair: Faith Donald Confidence in Critical Care Nursing Helen Kelly and Jeanne Evans Gender, Sexuality and Health: Women s Health Chair: Lori Schindel Martin Health Care Professionals Response to Women Experiencing Partner Violence: Findings from A Study in Iran Maryam Chinichian 2:20-2:40 When the heart fails: South Asian immigrant women speak about their experiences Jasna K. Schwind Effectiveness of an Educational Intervention on Reducing Sugar Sweetened Beverage Consumption in Rural Adolescents in the Upper Peninsula of Michigan Melissa Romero & Sheri Giordana Why Men Enter Nursing: Development of a Recruitment and Retention Strategy John Stone Knowledge of Breast Cancer and Screening Practices Among Iranian Immigrant Women in Toronto Mandana Vahabi 6

9 2:40-3:00 Arts-informed Inquiry: Poetically and Visually Dwelling in Stories of Heart Surgery and Recovery Jennifer Lapum Report on Findings, Survey of UV Awareness Activities and UV Protection Policies in Ontario Public Health Units, George Thomas Kapelos & Cheryl Rosen Exploring Worklife Issues in Correctional Settings Sue Bookey-Bassett Towards an emerging theory of gender, emotion, and knowledge: Implications for nursing Margaret M. Malone COFFEE AND POSTER VIEWING 3:00-3: Concurrent Sessions (3:15-3:55) Health Systems and Policy: Errors Chair: Lori Schindel Martin Educational Initiatives (A) Chair: Jennifer Lapum Educational Initiatives (B) Chair: Linda Cooper Gender, Sexuality and Health: HIV Chair: Sue Edwards Socioeconomic Determinants of Health Chair: Elizabeth McCay 3:15-3:35 Near Misses in Mental Health Settings: An Exploratory Study Don Rose The Global Need for Evidence-Based Pedagogy to Teach Undergraduate Statistics to Nurses: A Descriptive Study Explores Nurses Perspectives Regarding their Education and Application of Baccalaureate- Level Statistics Elaine Santa Mina An International Partnership: Understanding Educational Capital in Determining Global Health Barbara J. Astle An exploratory study on the sexual practices of racialized young men from Toronto's disadvantaged neighbourhoods Josephine Pui-Hing Wong Between a Rock and a Hard Place: Narrative of Displaced Iranian Immigrants and Refugees Fay Mahdieh Dastjerdi 3:35-3:55 See next page for the next session papers. 7

10 Concurrent Sessions (3:35-3:55) Health Systems and Policy: Errors Chair: Lori Schindel Martin Educational Initiatives (A) Chair: Jennifer Lapum Educational Initiatives (B) Chair: Linda Cooper Gender, Sexuality and Health: HIV Chair: Sue Edwards Socioeconomic Determinants of Health Chair: Elizabeth McCay 3:35-3:55 Fourth Year Nursing Students Perceptions of Error and Error Reporting Diana Tasikas Development and Test of an Instrument to Assess and Recognize Degree Equivalence: A Local Response to the Needs of Global Nursing Community Elaine Santa Mina Gaining cultural competence through Community Health Nursing Placements in the Dominican Republic Sylvia Loewen & Margot Underwood Correlates of HIV Stigma in HIV- Positive Women Anne C. Wagner Community Health Professionals' Perspectives on the Needs of Low Income Clients Living with Type 2 Diabetes: Health and Social Policy Implications F. Beryl Pilkington CLOSING 4:00-4:30 (1-067) Reflections of the Day Book Draw Closing Remarks For a full listing of authors and abstracts for concurrent sessions and poster presentations, please see Abstracts, pages

11 Floor Map 9

12 Concurrent Session (10:00-11:00) - Socioeconomic Determinants of Health - Room TRS Food Insecurity among Latin American Recent Immigrants in Toronto Mandana Vahabi, Daphne Cockwell School of Nursing, Ryerson University; Cynthia Damba, Independent Data Consultant/Epidemiologist; Cecilia Rocha, School of Nutrition, Ryerson University; Elizabeth Cristina Montoya, The Meighen Health Centre Background: Food security is an important social determinant of health. Food insecurity is more prevalent in low income households and those formed by recent immigrants. Exploration of the extent and correlates of food insecurity among recent Latin Americans (LA) immigrants is essential considering they encompasses an increasing number of young immigrants, many of whom, despite relatively high education, are unemployed or have low wage positions. This study examines the extent of food insecurity and its correlates among recent Latin American (LA) immigrants in Toronto. Methods: A cross-sectional study was conducted with a convenience sample of 70 adult LA recent immigrants. Participants were recruited from selected community health centres across Toronto using snow ball sampling. Data were collected using questionnaires in face-to-face interviews with primary household care givers. Results: A considerably high rate of food insecurity (56%) was found among participants. Household food insecurity was highly related to: being on social assistance; limited proficiency in English; and the use of foodbanks. Discussion: Our findings indicate that the primary determinant of a household's food security status is income, which suggests the need for strategies to improve the financial power of new immigrants to purchase sufficient, nutritious, and culturally acceptable food. Enhancing the employability of new immigrants, reforming the income structure for working adults beyond social assistance, and providing more subsidized English language and housing programs is also required. Concurrent Session (10:00-11:00) - Socioeconomic Determinants of Health - Room TRS Sustaining Health Sustaining Housing: An Evaluation of a Supported Housing Program for People Living with HIV/AIDS Amrita Ahluwalia 1; James Watson 2; Sue Ferrier 1; Sepali Guruge 3 1-Fife House Foundation; 2-Ontario HIV Treatment Network; 3-Ryerson University Background: HIV/AIDS is a global health issue. Despite considerable advances made in certain areas such as treatment of people living with HIV/AIDS (PHAs), limited information is available on certain social determinants of health in the context of HIV/AIDS. In particular, a review of literature from various countries shows limited research on the housing needs and services for PHAs. Study Purpose: A mixed methods study was conducted to investigate the influence of housing needs and related services on overall health of PHAs accessing these services. Methods and Description: Thirty five residents participated in a quantitative survey. Qualitative data were collected through three focus groups (n=15) conducted with the residents of a housing program for PHAs. Quantitative data analysis included univariate analysis and qualitative data were analyzed using thematic analysis. This presentation will primarily focus on the themes that emerged from the qualitative data, supported by the quantitative findings. Results: The main themes that emerged included: the centrality of neighborhood for sense of belonging; competing concepts of community; HIV as barrier or link to community engagement; the link between stable housing in improving health; support services and their role in enhancing security, reducing social isolation and increasing community engagement. 10

13 Conclusions and Recommendations: Based on the findings we will propose a number of services/practice recommendations including: strengthening and streamlining dissemination of information to offset the gaps in communication; reinforcing community networks with a focus on mental health and employment reintegration services, and enhancing programs and services for the aging population. Concurrent Session (10:00-11:00) - Socioeconomic Determinants of Health - Room TRS Excavating the Environment Within the Nursing Metaparadigm and its Relationship with Health, Nursing, Person. Aroha Page, Nipissing University Methods and Description: This descriptive study employed combined methodologies of visual ethnography and grounded theory, for unearthing the meanings that English speaking Hispanic elderly women (HEW) held in relation to their subjective-well-being (SWB).Participants were recruited as a convenience, purposive sample. Data harvested from their semi-structured interviews and photographs provided a meaning structure of their respective possessions, which was developed from the elicited categories, properties and dimensions and typologies, (eg:-ecologic, aesthetic). Results: The emergent substantive theory generated from the data Possessions-as environmental-synthesizers for SWB, reflected the dynamic capacity for the identified typologies to shift and fluctuate in response to the participants respective meanings attached to their selected possessions. Meanings were found further, to be shaped by two dominant orientations-intrinsic and extrinsic perspectives that framed the essence of the respective HEW meanings. Conclusion and Implications: This study incrementally adds to the body of nursing knowledge concerning its espoused metaparadigm within both symbolic and concrete dimensions. However, as the study reflects, nursing epistemology has barely scratched the surface of its stated terrain for the practice arena, there is much to be explored and developed for future needs. An example of the utility of the theory for practice application will be described. 11

14 Concurrent Session (10:00-11:00) - Health Systems and Policy - Room TRS A Systematic Review of the Factors that Influence the Use of Health System Information in Policy Making Cristina Catallo 1,2,3,4 John N Lavis 2,3,4, 5 Moriah Ellen 2,3,4 for the BRIDGE team. 1. Daphne Cockwell School of Nursing, Ryerson University 2. European Observatory for Health Systems and Policies 3. Centre for Health Economics and Policy Analysis, McMaster University 4. Department of Clinical Epidemiology and Biostatistics, McMaster University 5. Department of Political Science, McMaster University. Background: Optimal governance of health systems necessitates well-informed decision making. On many occasions, health policy decisions are made without utilizing varied sources of high quality evidence. The purpose of this systematic review is to examine the contextual factors that influence the use of health-related research evidence for public policy making. Methods: This review was conducted in 2001 with an update up to July 2009 with multiple databases searched relevant to health sciences and policy. A multi-stage, iterative approach was used with at least two reviewers for all stages of the review. Included articles were assigned a quality score and data related to factors that potentially increased, decreased or had no effect on information use for policy decisions was abstracted. Results: Electronic databases yielded 50, 766 citations and the final review included 126 articles. Four articles were found to be of high quality, 30 moderate quality and the remaining of low quality. Across strong and moderate quality studies, prospects for health systems information increased when there were ongoing linkages between researchers and policy makers and when the evidence supported pre-existing values, beliefs and political goals. Findings demonstrated great variability across studies in research, design, methods for analysis and final results. As a result these results should be interpreted with caution. Implications: The results of this systematic review on information use in health policy decision making can offer new learning regarding the contextual factors that influence how new and existing knowledge is used in the health policy making process. Concurrent Session (10:00-11:00) - Health Systems and Policy - Room TRS Firearm Death and Injury in Canada: Twenty Years after the Montreal Massacre Wendy Cukier, Ted Rogers School of Management, Ryerson University Background: The murder of 14 young women at Montreal s l Ecole Polytechnique on December 6, 1989, drew attention to the problem of firearm death and injury in Canada. What began as a response to the murder of 14 young women, shifted to a focus on reducing firearms deaths and injury. The health effects of firearms extended beyond death and physical injury. Public health, injury prevention, suicide prevention, nursing and physician's organizations joined with victims, police, labour, and women s organizations to mobilize for policy change. As a result, two pieces of legislation Bill C-17 (1991) and Bill C-68 (1995) became law. Discussion: Using well-established models in injury prevention, this presentation will examine data on the problem of firearm death and injury in Canada, the contributing factors, interventions and their impacts. For example, disaggregated show differential effects on males and females and specific forms of injury. For example, rates of suicide involving firearms, particularly among youth, have plummeted (while rates of non-firearm suicide have not). Murders of women with firearms have decreased dramatically (while rates of murder of women without firearms have not). In 2005, 818 Canadians were killed in homicides, suicides or accidents with firearms compared to 1444 in The session will also discuss the process of advocating for firearms policy changes and the role of nursing organizations including NENA, CFNU as well as provincial associations. 12

15 Concurrent Session (10:00-11:00) - Health Systems and Policy - Room TRS The Meaning of Changing Expectations: A Qualitative-descriptive Study. Karen Thomas, Toronto General Hospital, University Health Network; Ross Riggs, Nursing Information Systems, University Health Network Introduction: This research study explores the phenomenon of changing expectations for patients and their families who experience unexpected cancellation of surgery. The aim was to gain an understanding of the meaning of this experience with the results having the potential to positively affect nursing practice by influencing policy and protocol development. Method: Parse s human becoming theory guided this qualitative-descriptive study. Twenty-seven participants discussed their experience of surgical cancellation in semi-structured interviews. Results: Findings have been insightful, moving, and meaningful. Understanding what patients have gone through to be ready for surgery and hearing their stories is a humbling experience. In gaining a fuller understanding we have the ability to focus on what the participants say is helpful or not helpful when they experience surgical cancellation. Conclusion: This is of interest to nurses, allied health, and hospital administrators as the development of practices designed to improve patients experiences is of great importance. Our research has had phenomenal impact on key stakeholders. Through this knowledge transfer the development of policy and procedures that better address the needs of the patient and their families was achieved. We have seen great improvement in both patient and staff satisfaction. Our research and the associated awareness of issues surrounding surgical cancellation has also influenced other procedural areas. The results of this study are relevant not only to other Canadian hospitals, but also globally. 13

16 Concurrent Session (10:00-11:00) - Health Systems and Policy: Worklife - Room TRS Effects of Work Environments on Nurse Outcomes Nancy Purdy, Daphne Cockwell School of Nursing, Ryerson University; Heather Laschinger, Arthur Labatt Family School of Nursing; Joan Finegan, Department of Psychology; Fernando Olivera, Ivey School of Business, University of Western Ontario Background: Nurses are leaving the profession due to high levels of job dissatisfaction arising from current working conditions. Empowering work environments for nurses have the potential to enhance the individual nurse s engagement in empowering behaviours that lead to quality care for patients and job satisfaction for nurses. Methods and Analysis: To test these hypotheses, a multi-site cross-sectional design was employed using a sample of nurses (n=697) from 61 medical-surgical units in 21 hospitals across Ontario. Self-report surveys were completed using standardized instruments. Multilevel structural equation modeling was used for the data analysis. Results: This report is part of a larger study investigating the relationship between work environments and nursing and patient outcomes. Group-level structurally empowered work environments exerted a promising although non-significant effect on individual-level psychological empowerment. Nurses who viewed their workplace to be psychologically empowering were significantly more likely to engage in empowered behaviors (β=.47), that in turn, predicted higher levels of job satisfaction (β=.15) and quality patient care (β=.08). Direct effects of psychological empowerment on these outcomes were also evident (β=.39 and.22, p<.001 respectively). Discussion and Implications: Theoretical contributions include extending Kanter s theory of structural empowerment to include an emergent group-level construct with promising cross-level effects on psychological empowerment. Empowered behaviour as a consequence of feeling empowered suggests a mechanism through which job satisfaction and nurses evaluations of patient care are achieved. Strategies for change at the unit and organization levels will be proposed to promote proactive nursing behaviour, job satisfaction and quality patient care. Concurrent Session (10:00-11:00) - Health Systems and Policy: Worklife - Room TRS Novice Nurses' Lived Experience of Family Nursing Viola Fast Braun, School of Health Studies, Brandon University; Cathy Foster, School of Health Studies, Brandon University Background: This presentation will present preliminary findings of a study exploring the lived experience of family nursing for novice registered nurses. In the last decades there has been an increased emphasis on family content in Canadian nursing education curricula. However, literature on family nursing is ambiguous about differentiating what aspects of family nursing are appropriate for all nurses (generalists) and what aspects are appropriate at the specialist level and acknowledges that there is a blurring of lines between generalist and specialist practice. Segaric & Hall (2005) advocate for research that investigates nurses' understanding of family nursing in general clinical settings. Methods: The study utilized a phenomenological approach to examine how nurses with two years or less in practice experience family nursing in a variety of settings. Following ethical approval, invitations were sent to all nurses employed in two health authorities, who met the study criteria. Five nurses were interviewed using a semi structured interview. Participants shared how they practice family nursing in the current nursing situation of shortages and constraints. 14

17 Implications: This study adds to our understanding of what happens at a beginning level of family nursing. The interviews provide insight into how nurses understand and experience caring for families in the everyday enactment of their professional role, and barriers and facilitators to including family in nursing care. The findings provide important information for nurse educators in grounding the teaching of family nursing in the real world of nurses. Concurrent Session (10:00-11:00) - Health Systems and Policy: Worklife - Room TRS Compassion Satisfaction, Compassion Fatigue, Worklife Conditions, and Burnout among Frontline Mental Health Staff Susan L Ray, School of Nursing, University of Western Ontario; Carol Wong, School of Nursing, University of Western Ontario; Dawn White, Masters of Health Sciences, London Mental Health Crisis Service (LMHCS) & Canadian Mental Health Assoc. (CMHA-LM) Background: Frontline mental health care professionals (FMHPs) are often required to provide a high degree of support and long-term therapy to their clients. This degree of intensive involvement may, over time, result in physical and psychological effects often referred to as compassion fatigue (CF) or vicarious traumatization (VT). The overall aim of this study was to determine the relationships among compassion satisfaction (CS), compassion fatigue (CF), work life conditions and burnout among FMHPs. Method: A non experimental, predictive survey design was used for this study. The survey questionnaire was mailed to a convenience sample of 430 FMHPs at two community hosoitals, one outpatient and one inpatient. Hierarchical multiple regression was used to test the study hypothesis while controlling for years of experience in respondents respective professions as there was a significant negative correlation between years in profession and emotional exhaustion. Results: 195 FMHPs completed the questionnaire (a 45% response rate ). The combination of compassion satisfaction, trauma, and areas of work life were all significant predictors of emotional exhaustion. Consistent with our hypothesis, higher levels of compassion satisfaction, lower levels of compassion fatigue/trauma, and higher overall degree of fit in the six areas of work life are predictive of lower burnout in mental health professionals. Conclusion: Studies are needed to determine ways to mitigate the effects of CF to eventually reduce the financial costs to the organizations. It is important to investigate the mental health of FMHPs as ultimately improving their mental health will enhance clients quality of care. 15

18 Concurrent Session (10:00-11:00) - Patient-Provider Relationships - Room TRS Patient Experiences with Visiting a Nurse Practitioner for Primary Health Care in New Brunswick Trudy Hahn, University of New Brunswick Background: In June, 2002, the New Brunswick government in Canada gave royal assent to the implementation of the role of nurse practitioner. Since that time, several nurse practitioners have been hired to work in different areas of the province in collaborative care settings like Community Health Centers or hospital Outpatient Departments. The people of New Brunswick have been suffering with a shortage of family doctors for the past 8-10 years. The people of New Brunswick had never been exposed to the role of nurse practitioner for primary health care. This study examined patients responses to this new role in New Brunswick. Methods: The study was conducted using the qualitative method of interpretive description. Results: Patients who had been visiting a nurse practitioner for primary health care for a period of at least six months were interviewed and findings showed that patients identified knowledge, partnership and respect as the concepts that were inherent in the relationships established with nurse practitioners. Conclusion and Implications: The information gained from this study provides a framework for further investigation into the scope of the nurse practitioner role. Patient responses have been shown to be a key factor in determining the quality of health services. The results of this study can be instrumental to government Departments of Health as they make further decisions regarding the allocation of funding for primary health care providers. The findings are also of interest to all nurse practitioners as qualitative research in the area of patient responses to their services is sparse. Concurrent Session (10:00-11:00) - Patient-Provider Relationships - Room TRS Support and Housing Priorities for Persons with Serious Mental Illness in Northern and Rural Ontario: Q Methodology Phyllis Montgomery, School of Nursing, Laurentian University; Patricia Bailey, School of Nursing, Laurentian University; Sharolyn Mossey, School of Nursing, Laurentian University; Don Rose, Daphne Cockwell School of Nursing, Ryerson University; Cheryl Forchuk, School of Nursing, University of Western Ontario Background: Housing persons living with serious mental illness is a complex phenomenon constituted by service users and service providers perceptions, values, attitudes, opinions and expectations. Securing housing is further challenged by the context of northern and rural poverty, lack of quality and range of housing. Purpose: The purpose of this study was to describe consumers and community mental health service providers viewpoints about support and housing priorities. Method: Q methodology is an approach that focuses on participants ranking of views within a predetermined response format. A total of 96 service users and service providers sorted 39 support and housing statements generated from qualitative data gathered in an earlier stage of the study. Centroid factor analysis and varimax rotation yielded six independent factors. Findings: The six factors were: establish, enact and enforce housing and formal support standards and policy; create private refuges; create spaces for fellowship; assemble resources for personalized support; actualize self through integration; and finally, respond to service crises. Discussion: A number of policy recommendations will be discussed, together with the requirements for a comprehensive social safety net in northern and rural communities. 16

19 Concurrent Session (10:00-11:00) - Patient-Provider Relationships - Room TRS Nurse client Decision-making: Concept Analysis, Model, and Middle-range Descriptive Theory Susan E. Bishop, Daphne Cockwell School of Nursing, Ryerson University Background: Nurse client decision-making is embedded in nursing practice and is thus an important, globally relevant concept. However, the meaning of nurse client decision-making is inconsistent and unclear in nursing literature. Purpose: To describe, explain, and give meaning to nurse client decision-making. Method: I use Walker and Avant s (2005) model to clarify the concept of nurse client decision-making. Discussion: After analyzing the concept, I derive a middle-range descriptive theory and a model. The model brings together three sets of essential components: attributes, antecedents, and consequences. The concept s defining attributes form the middle of the model. Nurse and client each bring antecedents to the encounter, antecedents that pave the way for a collaborative relationship. Arising from nurse client decision-making are positive and negative consequences for client and nurse. Conclusions: Because nurse client decision-making is embedded in nursing practice, it is a very important concept with global relevance. The proposed middle-range descriptive theory and model of nurse client decision-making provide new insights into this concept. Clarifying this concept will give nurses opportunities to discuss, challenge, and critique it. Implications for Nursing: Staff nurses and nursing administrators can use this concept analysis to enhance nurse client decision-making. It could be incorporated into nursing courses. Further research can expand the theory, empirically testing theoretical links between the model s components, testing whether they exist in actual clinical settings, and operationalizing the concept of nurse client decision-making. 17

20 Concurrent Session (2:00-3:00) - Public and Population Health: Heart Disease - Room TRS An Examination of the Difference in the Type and Number of Self-Care Behaviours Performed among White and Non-White Patients Following Bypass Surgery Suzanne Fredericks, Daphne Cockwell School of Nursing, Ryerson University; Joyce Lo, Daphne Cockwell School of Nursing, Ryerson University; Jennifer Leung, St. Michael s Hospital; Sarah Ibrahim, Daphne Cockwell School of Nursing, Ryerson University Background: The cultural profile of patients who have had Coronary Artery Bypass Graft (CABG) surgery has changed significantly from mainly English (white) to Indian and Chinese (non-white). Patient education is provided to those undergoing CABG to improve the performance of self-care behaviours following hospital discharge. However, such education has mostly been designed and tested using white, homogenous samples. The number and types of self-care behaviours performed by persons of Indian and Chinese origin has not been investigated. Purpose: The purpose of this study was to examine the difference in the number and type of self-care behaviours performed between white and non-white patients following CABG surgery. Methods: This descriptive study included a convenience sample of 99 participants of English, Irish, Scottish, Indian, and Chinese backgrounds. As there was an unequal distribution across cultural groups, the groups were collapsed into White and Non-White clusters. Analysis: Descriptive data were used to describe the sample and identify specific self-care behaviours performed. Findings: No statistically significant differences were noted between white and non-white groups hours pre-hospital discharge (p > 0.05). However, statistically significant differences were noted between white and non-white groups related to the use of incentive spirometer, deep breathing and coughing exercises, and activity modification at 1 week following hospital discharge." Implications: Continued examination is required into the influence of culture on behaviour performance. A larger, more diverse sample is needed, as well as the inclusion of non-english speaking study participants to obtain a more comprehensive understanding of culture and its effect on behaviour. Concurrent Session (2:00-3:00) - Public and Population Health: Heart Disease - Room TRS When the Heart Fails: South Asian Immigrant Women Speak about their Experiences Jasna K. Schwind, Daphne Cockwell School of Nursing, Ryerson University; Sepali Guruge, Daphne Cockwell School of Nursing, Ryerson University; Suzanne Fredericks, Daphne Cockwell School of Nursing, Ryerson University; Victoria Gaudite; Kateryna Aksenchuk, Daphne Cockwell School of Nursing, Ryerson University; Anuradha Sinha, South Asian Women's Center Background and Purpose: Heart disease is a serious global health concem. Studies show that South Asians (SA) are more likely to die earlier from heart disease. However, limited health research has focused on this topic within Canadian SA communities. A qualitative study was conducted to explore SA immigrant women's experiences of living with heart disease. Methods: This narrative inquiry involved 4 senior SA immigrant women living with heart disease for over ten years. The participants engaged in a guided narrative reflective process that encompassed storytelling, metaphors, writing and drawing. This was followed by semi-structured narrative-based interviews. Collected narrative data were deconstructed into key themes and significant narrative threads. Following critical narrative reflection, stories were reconstructed, incorporating the newly uncovered meanings and significance of the experiences. 18

21 Results: Narrative data analysis brought to the surface the immigrant experience as it revealed itself through the stories of the failed heart. Tensions often associated with post-migration experiences became evident: pastpresent; belonging-loneliness; generativity-rejection; and self-sacriflce-self-care. Narrative threads interwove the two main stories, the "Immigrant and the "Family-, and included such sub-themes as: illness is associated with hard life; acquiescence to treatment; a sense of rejection, and ensuing isolation and loneliness. Implications: An increased understanding of how SA immigrant women experience heart disease, allows healthcare professionals an opportunity to consider more effective ways to provide care to these patients, including meaningful engagement and education on self-care and symptom-management. as well as ways in which care is accessed and received. Further quantitative research is planned to more fully understand this phenomenon. Concurrent Session (2:00-3:00) - Public and Population Health: Heart Disease - Room TRS Arts-informed Inquiry: Poetically and Visually Dwelling in Stories of Heart Surgery and Recovery Jennifer Lapum, Daphne Cockwell School of Nursing, Ryerson University; Kathryn Church, School of Disability, Ryerson University; Alison Matthews David, School of Fashion, Ryerson University Background: Various research methodologies contribute to the dimensions of nursing in our global communities. There has been intensified focus on humanistic nursing practices, which may be attributed to increasing technologization in health care. Alongside of this, arts-informed research has emerged as a way to engage aesthetic ways of knowing that access emotive and embodied senses and highlight humanistic dimensions of nursing. The purpose of this presentation is to engage poetical and visual senses with an artsinformed narrative inquiry of patients experiences of heart surgery. Poetry and photographic images will be shared that were composed based on participants stories. Methods: Narrative emplotment was the theoretical foundation, which framed the research around temporal and contextual acts of storytelling. Interviews were completed with sixteen individuals 2-4 days following surgery and 4-6 weeks following discharge. The analysis involved aesthetic immersion in which researchers became emotionally, morally and cognitively attuned to stories. Researchers attended to the narrative flow and linguistic components of stories including characters, events and outcomes. Results: Study results indicated that participants struggled with: a) balancing possibilities of death with positive probabilities of life; b) protective mechanism of relinquishing control and becoming passive and non-agential; c) cared for in ways that were technologically competent, but neglected personal engagement; and d) anxiety and fear about unfamiliar body sensations and uncertain pathways of recovery. Implications: Evidence-based practice involves critical consideration of enhancing the balance between humanistic- and technological-based practices of care. Arts-informed methodologies can prompt an understanding of this balance and enhance aesthetic ways of knowing. 19

22 Concurrent Session (2:00-3:00) - Public and Population Health: Community-Based Strategies - Room TRS Best Practices: Healthy Workplace, Professionalism, and Client Centered Care through a Smoke Free/Tobacco Initiative Helen Kirkpatrick, St. Joseph s Healthcare Hamilton, McMaster University; Mary-Lou Martin, St. Joseph s Healthcare Hamilton, McMaster University; Colleen Stang, St. Joseph s Healthcare Hamilton; Dr. Hugh Fuller, St. Joseph s Healthcare Hamilton; Sean Kidd, Centre for Addiction and Mental Health; Jan Johnston, Hamilton Public Health Services Background: This study will describe the experiences of individuals with mental illness and their healthcare providers with the Best Practice Guidelines (BPGs): Healthy Workplace-Professionalism in Nursing, and Client- Centered Care through the pre and post implementation of a Smoke Free/Tobacco Initiative. Objectives include: 1) describe the experiences and perspectives of individuals with mental illness and their healthcare providers about the Smoke Free/Tobacco Initiative (SFTI); 2) explore knowledge issues with individuals with mental illness and their health care providers where the implementation of the SFTI is in process; 3) identify the issues in collaborating with the team during the SFTI implementation; 4) describe the ethical issues raised by patients and healthcare providers about SFTI; and 5) advance knowledge that facilitates the implementation of the BPGs. Methods: This narrative case study is taking place at a mental health setting. Multiple sources of data include: interviews, focus groups and questionnaires, documents, artifacts and environmental context. In-patients (~n=90) and healthcare providers (~n=105) from 11 wards have been asked to participate in a 60 minute audiorecorded interview or focus group pre and post implementation of the BPGs. Data has been collected for pre implementation and is on-going. Results: Thematic analysis of the interviews and the focus groups will be available for the pre-implementation phase. Conclusions and Implications for Nursing: It is hoped that the findings will help improve the delivery and sustainability of best practices in Professionalism, Smoking Cessation and Client-centered Care for individuals with mental illness and their healthcare providers in mental health settings. Narrative research includes: 1) people with major mental illnesses who have been homeless and who get permanent housing with supports, 2) harm reduction for individuals who have been chronically homeless and alcoholic and 3) a WEB-based study of people who have attempted suicide and decided to go on living. Case study research includes: 1) Implementation and Evaluation of the RNAO Prevention of Falls and Fall Injuries Best Practice Guideline, and 2) Implementing the Healthy Workplace BPG, Professionalism in Nursing, Through a Smoke Free/Tobacco Initiative and Client-Centred Care in a Mental Health Setting. This study is funded by the Canadian Nurses Foundation. Concurrent Session (2:00-3:00) - Public and Population Health: Community-Based Strategies - Room TRS Effectiveness of an Educational Intervention on Reducing Sugar Sweetened Beverage Consumption in Rural Adolescents in the Upper Peninsula of Michigan Melissa Romero, Northern Michigan University; Sheri Giordana, Northern Michigan University; Helen Wedin, Northern Michigan University; Terry Delpier, Northern Michigan University Background and Purpose:The purpose of the study was to determine the effectiveness of an educational intervention on decreasing sugar sweetened beverage (SSB) consumption in rural adolescents in the Upper Peninsula of Michigan. 20