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St Louis J, Benzies K, Raffin-Bouchal S, Sinclair S. Describing Nurses' Work and Educational Needs in Providing Neonatal Palliative Care: A Narrative Review. Neonatal Netw 2024; 43:35-49. [PMID: 38267086 DOI: 10.1891/nn-2023-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
Nurses in NICUs report insufficient education as a persistent barrier to providing quality neonatal palliative care (NPC). Since existing literature on educational interventions in NPC is limited, this review aimed to identify and narratively synthesize literature both about nurses' attitudes toward NPC and the NPC education received by nurses. We conducted a nonsystematic narrative literature review. Four themes were identified from the 28 articles included in this review. These were as follows: (a) nursing work in NPC, (b) NICU nurses' experiences and perceptions of NPC, (c) facilitators and barriers to nursing work in NPC, and (d) educational interventions in NPC. This literature review identified studies about NICU nurses' experiences and education in providing NPC. NICU nurses both desired and lacked education in NPC. This literature review identifies the importance of developing and evaluating NPC education for nurses.
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St Louis J, Raffin-Bouchal S, Benzies K, Sinclair S. Qualitative Study of Nurses' Experiences as They Learned to Provide Neonatal Palliative Care. J Obstet Gynecol Neonatal Nurs 2023:S0884-2175(23)00295-2. [PMID: 38161057 DOI: 10.1016/j.jogn.2023.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/08/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE To describe the experiences of nurses as they learned to provide palliative care in the NICU. DESIGN Interpretive description. SETTING Four NICUs in three Canadian provinces, including one rural center and three tertiary centers. PARTICIPANTS Nine NICU nurses with 3 to 21 years of experience who provided neonatal palliative care. METHODS We collected data using online interviews that we recorded and transcribed. We analyzed data using immersion, inductive coding, reflective memoing, and thematic analysis. RESULTS Participants received little or no formal education in neonatal palliative care and instead learned to provide this care through observation and experience. Participants said it was important to find meaning in their work, which contributed to their motivation to learn to provide high-quality neonatal palliative care. Participants described challenges, including unit cultures in which early palliative care was not embraced. We identified three overarching themes that represented the participants' experiences: Meaning-Making in Neonatal Palliative Care, Challenges in Providing Neonatal Palliative Care, and Ill-Prepared to Provide Neonatal Palliative Care. CONCLUSION Standardized education may improve the quality of care and nurses' experiences with neonatal palliative care. We recommend designing and evaluating a standardized curriculum on neonatal palliative care.
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Abou Mehrem A, Toye J, Aziz K, Benzies K, Alshaikh B, Johnson D, Faris P, Soraisham A, McNeil D, Al Hamarneh YN, Foss K, Foulston C, Johns C, Zimmermann GL, Zein H, Hendson L, Kumaran K, Price D, Singhal N, Shah PS. Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI) Trial: a protocol for a multicentre, stepped-wedge cluster randomized trial. CMAJ Open 2023; 11:E397-E403. [PMID: 37130608 PMCID: PMC10158756 DOI: 10.9778/cmajo.20220177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Evidence-based Practice for Improving Quality (EPIQ) is a collaborative quality improvement method adopted by the Canadian Neonatal Network that led to decreased mortality and morbidity in very preterm neonates. The Alberta Collaborative Quality Improvement Strategies to Improve Outcomes of Moderate and Late Preterm Infants (ABC-QI) Trial aims to evaluate the impact of EPIQ collaborative quality improvement strategies in moderate and late preterm neonates in Alberta, Canada. METHODS In a 4-year, multicentre, stepped-wedge cluster randomized trial involving 12 neonatal intensive care units (NICUs), we will collect baseline data with the current practices in the first year (all NICUs in the control arm). Four NICUs will transition to the intervention arm at the end of each year, with 1 year of follow-up after the last group transitions to the intervention arm. Neonates born at 32 + 0 to 36 + 6 weeks' gestation with primary admission to NICUs or postpartum units will be included. The intervention includes implementation of respiratory and nutritional care bundles using EPIQ strategies, including quality improvement team building, quality improvement education, bundle implementation, quality improvement mentoring and collaborative networking. The primary outcome is length of hospital stay; secondary outcomes include health care costs and short-term clinical outcomes. Neonatal intensive care unit staff will complete a survey in the first year to assess quality improvement culture in each unit, and a sample will be interviewed 1 year after implementation in each unit to evaluate the implementation process. INTERPRETATION The ABC-QI Trial will assess whether collaborative quality improvement strategies affect length of stay in moderate and late preterm neonates. It will provide detailed population-based data to support future research, benchmarking and quality improvement. TRIAL REGISTRATION ClinicalTrials.gov, no. NCT05231200.
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Affiliation(s)
- Ayman Abou Mehrem
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont.
| | - Jennifer Toye
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Khalid Aziz
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Karen Benzies
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Belal Alshaikh
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - David Johnson
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Peter Faris
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Amuchou Soraisham
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Deborah McNeil
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Yazid N Al Hamarneh
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Karen Foss
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Charlotte Foulston
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Christine Johns
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Gabrielle L Zimmermann
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Hussein Zein
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Leonora Hendson
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Kumar Kumaran
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Dana Price
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Nalini Singhal
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
| | - Prakesh S Shah
- Department of Pediatrics (Abou Mehrem, Alshaikh, Johnson, Soraisham, Foulston, Zein, Hendson, Price, Singhal), Cumming School of Medicine and Alberta Children's Hospital Research Institute (Abou Mehrem, Benzies, Alshaikh, Johnson, Soraisham, McNeil, Hendson, Singhal), University of Calgary, Calgary, Alta.; Department of Pediatrics (Toye, Kumaran) and Office of Lifelong Learning (Aziz), Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alta.; Faculty of Nursing (Benzies), University of Calgary, Calgary, Alta.; Alberta Health Services (Faris, Foss, Foulston, Johns), Edmonton, Alta.; Community Health Sciences (Faris, McNeil, Zimmermann), Cumming School of Medicine, University of Calgary, Calgary, Alta.; Alberta SPOR SUPPORT Unit (Al Hamarneh, Zimmermann); Department of Pharmacology (Al Hamarneh), Faculty of Medicine and Dentistry, University of Alberta; Covenant Health (Foss), Edmonton, Alta.; Department of Pediatrics (Shah), Mount Sinai Hospital; Department of Pediatrics (Shah), University of Toronto, Toronto, Ont
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Wollny K, McNeil D, Moss SJ, Sajobi T, Parsons SJ, Benzies K, Metcalfe A. Unplanned Extubations Requiring Reintubation in Pediatric Critical Care: An Epidemiological Study. Pediatr Crit Care Med 2023; 24:311-321. [PMID: 37026721 DOI: 10.1097/pcc.0000000000003167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVES Unplanned extubations are an infrequent but life-threatening adverse event in pediatric critical care. Due to the rarity of these events, previous studies have been small, limiting the generalizability of findings and the ability to detect associations. Our objectives were to describe unplanned extubations and explore predictors of unplanned extubation requiring reintubation in PICUs. DESIGN Retrospective observational study and multilevel regression model. SETTING PICUs participating in Virtual Pediatric Systems (LLC). PATIENTS Patients (≤ 18 yr) who had an unplanned extubation in PICU (2012-2020). INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS We developed and trained a multilevel least absolute shrinkage and selection operator (LASSO) logistic regression model in the 2012-2016 sample that accounted for between-PICU variations as a random effect to predict reintubation after unplanned extubation. The remaining sample (2017-2020) was used to externally validate the model. Predictors included age, weight, sex, primary diagnosis, admission type, and readmission status. Model calibration and discriminatory performance were evaluated using Hosmer-Lemeshow goodness-of-fit (HL-GOF) and area under the receiver operating characteristic curve (AUROC), respectively. Of the 5,703 patients included, 1,661 (29.1%) required reintubation. Variables associated with increased risk of reintubation were age (< 2 yr; odds ratio [OR], 1.5; 95% CI, 1.1-1.9) and diagnosis (respiratory; OR, 1.3; 95% CI, 1.1-1.6). Scheduled admission was associated with decreased risk of reintubation (OR, 0.7; 95% CI, 0.6-0.9). With LASSO (lambda = 0.011), remaining variables were age, weight, diagnosis, and scheduled admission. The predictors resulted in AUROC of 0.59 (95% CI, 0.57-0.61); HL-GOF showed the model was well calibrated (p = 0.88). The model performed similarly in external validation (AUROC, 0.58; 95% CI, 0.56-0.61). CONCLUSIONS Predictors associated with increased risk of reintubation included age and respiratory primary diagnosis. Including clinical factors (e.g., oxygen and ventilatory requirements at the time of unplanned extubation) in the model may increase predictive ability.
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Affiliation(s)
- Krista Wollny
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Alberta Children's Hospital, PICU, Calgary, AB, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Deborah McNeil
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, AB, Canada
| | - Stephana J Moss
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tolulope Sajobi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Karen Benzies
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, Calgary, AB, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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5
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Wasylak T, Benzies K, McNeil D, Zanoni P, Osiowy K, Mullie T, Chuck A. Creating Value Through Learning Health Systems: The Alberta Strategic Clinical Network Experience. Nurs Adm Q 2023; 47:20-30. [PMID: 36469371 PMCID: PMC9746610 DOI: 10.1097/naq.0000000000000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Design, implementation, and evaluation of effective multicomponent interventions typically take decades before value is realized even when value can be measured. Value-based health care, an approach to improving patient and health system outcomes, is a way of organizing health systems to transform outcomes and achieve the highest quality of care and the best possible outcomes with the lowest cost. We describe 2 case studies of value-based health care optimized through a learning health system framework that includes Strategic Clinical Networks. Both cases demonstrate the acceleration of evidence to practice through scientific, financial, structural administrative supports and partnerships. Clinical practice interventions in both cases, one in perioperative services and the other in neonatal intensive care, were implemented across multiple hospital sites. The practical application of using an innovation pipeline as a structural process is described and applied to these cases. A value for money improvement calculator using a benefits realization approach is presented as a mechanism/tool for attributing value to improvement initiatives that takes advantage of available system data, customizing and making the data usable for frontline managers and decision makers. Health care leaders will find value in the descriptions and practical information provided.
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Affiliation(s)
- Tracy Wasylak
- Alberta Health Services, Edmonton, Alberta, Canada (Ms Wasylak, Dr McNeil, and Messrs Osiowy and Mullie); Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada (Mss Wasylak and Zanoni and Drs Benzies and McNeil); and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (Dr Chuck)
| | - Karen Benzies
- Alberta Health Services, Edmonton, Alberta, Canada (Ms Wasylak, Dr McNeil, and Messrs Osiowy and Mullie); Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada (Mss Wasylak and Zanoni and Drs Benzies and McNeil); and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (Dr Chuck)
| | - Deborah McNeil
- Alberta Health Services, Edmonton, Alberta, Canada (Ms Wasylak, Dr McNeil, and Messrs Osiowy and Mullie); Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada (Mss Wasylak and Zanoni and Drs Benzies and McNeil); and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (Dr Chuck)
| | - Pilar Zanoni
- Alberta Health Services, Edmonton, Alberta, Canada (Ms Wasylak, Dr McNeil, and Messrs Osiowy and Mullie); Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada (Mss Wasylak and Zanoni and Drs Benzies and McNeil); and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (Dr Chuck)
| | - Kevin Osiowy
- Alberta Health Services, Edmonton, Alberta, Canada (Ms Wasylak, Dr McNeil, and Messrs Osiowy and Mullie); Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada (Mss Wasylak and Zanoni and Drs Benzies and McNeil); and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (Dr Chuck)
| | - Thomas Mullie
- Alberta Health Services, Edmonton, Alberta, Canada (Ms Wasylak, Dr McNeil, and Messrs Osiowy and Mullie); Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada (Mss Wasylak and Zanoni and Drs Benzies and McNeil); and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (Dr Chuck)
| | - Anderson Chuck
- Alberta Health Services, Edmonton, Alberta, Canada (Ms Wasylak, Dr McNeil, and Messrs Osiowy and Mullie); Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada (Mss Wasylak and Zanoni and Drs Benzies and McNeil); and Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (Dr Chuck)
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6
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Aylsworth L, Manca T, Dubé È, Labbé F, Driedger SM, Benzies K, MacDonald N, Graham J, MacDonald SE. A qualitative investigation of facilitators and barriers to accessing COVID-19 vaccines among Racialized and Indigenous Peoples in Canada. Hum Vaccin Immunother 2022; 18:2129827. [PMID: 36218335 DOI: 10.1080/21645515.2022.2129827] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Structural and systemic inequalities can contribute to susceptibility to COVID-19 disease and limited access to vaccines. Recognizing that Racialized and Indigenous Peoples may experience unique barriers to COVID-19 vaccination, this study explored early COVID-19 vaccine accessibility, including barriers and potential solutions to vaccine access, for these communities in Canada. We conducted semi-structured interviews about challenges to accessing COVID-19 vaccination with Racialized and Indigenous Peoples, including linguistic minorities and newcomers, in Spring 2021, just as COVID-19 vaccines were becoming more widely available in Canada. Participants were purposely selected from respondents to a Canadian national online survey. Three researchers analyzed the interviews for emergent themes using a descriptive content analysis approach in NVivo. At the time of the interview, interview participants (N = 27) intended to receive (n = 15) or had received (n = 11) at least one vaccine dose, or did not state their status (n = 1). Participants described multiple barriers to COVID-19 vaccination that they personally experienced and/or anticipated they or others could experience - including technology requirements, language barriers, lack of identification documentation, and travel challenges - as well as related solutions. These were organized into three broad categories: 1) COVID-19 disease and vaccination information, 2) vaccination booking procedures, and 3) vaccination sites. These structural and systemic barriers during the initial months of vaccine rollout substantially restricted participants' COVID-19 vaccination access, even when they were eager to get vaccinated, and should be addressed early in vaccine rollouts to facilitate optimal uptake for everyone everywhere.
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Affiliation(s)
- Laura Aylsworth
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Terra Manca
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Ève Dubé
- Direction des risques biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Québec, Quebec, Canada
| | - Fabienne Labbé
- Direction des risques biologiques et de la Santé au travail, Institut National de Santé Publique du Québec, Québec, Quebec, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.,Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, Calgary, Alberta, Canada
| | - Noni MacDonald
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janice Graham
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Technoscience & Regulation Research Unit, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shannon E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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7
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Shafey A, Benzies K, Amin R, Stelfox HT, Shah V. Fathers' Experiences in Alberta Family Integrated Care: A Qualitative Study. J Perinat Neonatal Nurs 2022; 36:371-379. [PMID: 36288445 DOI: 10.1097/jpn.0000000000000684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Family Integrated Care (FICare) program adapted for Alberta (AB) level II neonatal intensive care units (NICUs) aims to increase parental involvement and support during their NICU stay. The experience of fathers of preterm infants in a FICare program is currently unknown. PURPOSE To describe the experiences of fathers of preterm infants born at 320/7 to 346/7 weeks' gestational age with AB FICare. METHODS A qualitative substudy of a multicenter prospective cluster randomized controlled trial of FICare in 10 level II NICUs across Alberta. Fathers of preterm infants participated in a semistructured interview after discharge when their infants were at least 2 months' corrected gestational age. Journal entries written by fathers while in the NICU from the FICare intervention sites were also collected. Data were analyzed thematically and the interview and journal data were triangulated. FINDINGS Thirteen fathers (9 from the FICare intervention and 4 from standard care) participated in semistructured interviews and there were 24 journals collected. Seven themes emerged: fear of the unknown, mental preparation, identifying the father's role, parenting with supervision, effective communication, postneonatal intensive care transition, and family life. Fathers enrolled in AB FICare attributed their level of confidence and positive neonatal intensive care experience that continued postdischarge to the care and attention they received during hospitalization. CONCLUSION AB FICare may improve experiences for fathers of preterm infants in the NICU with continuation postdischarge. Future research should include designing and evaluating father-specific NICU programs.
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Affiliation(s)
- Amy Shafey
- Department of Pediatrics, University of Alberta, Edmonton, Canada (Dr Shafey); Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada (Dr Benzies); Department of Pediatrics, University of Toronto, Toronto, Canada (Drs Amin and Shah); and Department of Critical Care Medicine, University of Calgary, Calgary, Canada (Dr Stelfox)
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8
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Reifferscheid L, Marfo E, Assi A, Dubé E, MacDonald NE, Meyer SB, Bettinger JA, Driedger SM, Robinson J, Sadarangani M, Wilson SE, Benzies K, Lemaire-Paquette S, Gagneur A, MacDonald SE. COVID-19 vaccine uptake and intention during pregnancy in Canada. Can J Public Health 2022; 113:547-558. [PMID: 35476258 PMCID: PMC9045023 DOI: 10.17269/s41997-022-00641-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 04/04/2022] [Indexed: 01/27/2023]
Abstract
Objective To investigate COVID-19 vaccine uptake and intent among pregnant people in Canada, and determine associated factors. Methods We conducted a national cross-sectional survey among pregnant people from May 28 through June 7, 2021 (n = 193). Respondents completed a questionnaire to determine COVID-19 vaccine acceptance (defined as either received or intend to receive a COVID-19 vaccine during pregnancy), factors associated with vaccine acceptance, and rationale for accepting/not accepting the vaccine. Results Of 193 respondents, 57.5% (n = 111) reported COVID-19 vaccine acceptance. Among those who did not accept the vaccine, concern over vaccine safety was the most commonly cited reason (90.1%, n = 73), and 81.7% (n = 67) disagreed with receiving a vaccine that had not been tested in pregnant people. Confidence in COVID-19 vaccine safety (aOR 16.72, 95% CI: 7.22, 42.39), Indigenous self-identification (aOR 11.59, 95% CI: 1.77, 117.18), and employment in an occupation at high risk for COVID-19 exposure excluding healthcare (aOR 4.76, 95% CI: 1.32, 18.60) were associated with vaccine acceptance. Perceived personal risk of COVID-19 disease was not associated with vaccine acceptance in the multivariate model. Conclusion Vaccine safety is a primary concern for this population. Safety information should be communicated to this population as it emerges, along with clear messaging on the benefits of vaccination, as disease risk is either poorly understood or poorly valued in this population.
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Affiliation(s)
| | - Emmanuel Marfo
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Ali Assi
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Eve Dubé
- Institut national de santé publique du Québec, Québec City, QC, Canada.,Department of Anthropology, Université Laval, Québec City, QC, Canada
| | - Noni E MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Samantha B Meyer
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Julie A Bettinger
- Vaccine Evaluation Centre, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - S Michelle Driedger
- Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Joan Robinson
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Centre, BC Children's Hospital Research Institute, University of British Columbia, Vancouver, BC, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Sarah E Wilson
- ICES, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Public Health Ontario, Toronto, ON, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | | | - Arnaud Gagneur
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada.,Department of Pediatrics, Université de Sherbrooke, Sherbrooke, QC, Canada
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9
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Dunn S, Campbell D, Beall R, Spackman E, Lipscombe L, Benzies K, McCormack G, Olstad D. A Healthy Food Prescription Incentive Program for Adults With Type 2 Diabetes Who Are Experiencing Food Insecurity: Protocol for a Longitudinal Qualitative Study. Curr Dev Nutr 2022. [DOI: 10.1093/cdn/nzac072.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Food insecurity is inadequate or insecure access to food due to financial constraints. Individuals experiencing food insecurity tend to have poorer diet quality compared to their food secure peers. Given the importance of maintaining healthful dietary patterns for optimal glycemic control, food insecurity is a considerable barrier to managing type 2 diabetes (T2DM). Healthy food prescription incentive programs aim to reduce such barriers by providing financial incentives to purchase healthy foods. The purpose of this study is to conduct longitudinal qualitative shop-along interviews among adults with T2DM who are experiencing food insecurity. We will explore experiences of redeeming healthy food incentives and factors influencing food purchasing patterns during participation in a healthy food prescription program in Alberta, Canada.
Methods
The healthy food prescription incentive program consists of two core elements: 1) A one-time healthy food prescription pamphlet outlining an evidence-based healthy dietary pattern; and 2) A healthy food incentive of $1.50/day/household member to purchase healthy foods in participating supermarkets for 6 months. Thirty participants aged 18–85 years will be purposefully recruited from primary care clinics. At baseline and 6-month follow-up, participants will take part in supermarket-based shop-along qualitative interviews. Participants will be asked to complete a usual grocery shop alongside a researcher. Using think-aloud principles, they will be asked to verbalize their thought processes for the shop's duration. Researchers will also collect naturalistic observations of participants, such as consulting nutrition labels. A post-shop interview will be completed to discuss experiences, decision-making rationale, and potential barriers and facilitators to food purchasing. Data will be analyzed iteratively and inductively at each time point. Further, a longitudinal analysis will compare emerging themes and identify changes occurring over time.
Results
N/A
Conclusions
This study will generate key data regarding if, how, and why such programs may address barriers to maintaining healthful dietary patterns. These findings will help to understand experiences of participating in healthy food incentive programs that can be used to improve future programs.
Funding Sources
Alberta Innovates.
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10
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Perry R, Ginn C, Donnelly C, Benzies K. Assessing resiliency in Canadians experiencing social vulnerability: Psychometric properties of the CUPS Resiliency Interview Schedule and Resiliency Questionnaire. Health Soc Care Community 2022; 30:799-807. [PMID: 33094488 DOI: 10.1111/hsc.13202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/18/2020] [Accepted: 09/28/2020] [Indexed: 06/11/2023]
Abstract
Deficit models of care for clients experiencing social vulnerability have become increasingly unsustainable; and there is a shift towards models of care that promote and protect resiliency for lifelong health. We defined clients as socially vulnerable if they were living with poverty, mental health problems and addictions, disability, and social isolation. Scales to measure outcomes of resiliency-focused programming have limited reliability and have not been validated with vulnerable populations. The aim of this study was to develop and conduct preliminary psychometric assessment of two measures: CUPS (formerly Calgary Urban Project Society) Resiliency Interview Schedule (RIS) and Resiliency Questionnaire (RQ) for adults experiencing social vulnerability. To engage clients who were seeking integrated services at a social services agency, we developed the RIS and accessed data collected between April 2017 and December 2018. In a structured intake interview, the client and staff prioritised goals and identified resiliency in three domains: (a) economic, (b) social-emotional, and (c) health. On average, clients (N = 545) who completed the CUPS-RIS were 45.9 years old (SD = 12.62). For the CUPS-RIS, Cronbach's alphas at intake and outcome assessments were 0.80. Exploratory factor analysis demonstrated a four-factor solution with two unexpected results: executive functioning/self-regulation loaded with mental and physical health, and client education failed to load on any factor. We found significant improvements between client intake and outcome measurement points on eight of 12 sub-domains. As a brief self-report measure of resiliency, we developed the CUPS-RQ and accessed data collected between November 2018 and May 2019. Clients (N = 29) who completed the CUPS-RQ concurrently with the Resilience Research Centre-Adult Resilience Measure (RRC-ARM) were, on average, 42.46 years old (SD = 12.87). The CUPS-RQ was correlated with RRC-ARM, r = 0.819. In preliminary psychometric assessment, the CUPS-RIS and CUPS-RQ demonstrated satisfactory reliability and validity and show promise as measures of resiliency for agencies serving clients experiencing social vulnerability.
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Affiliation(s)
| | - Carla Ginn
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
| | | | - Karen Benzies
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
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11
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Murphy M, Shah V, Benzies K. Effectiveness of Alberta Family-Integrated Care on Neonatal Outcomes: A Cluster Randomized Controlled Trial. J Clin Med 2021; 10:jcm10245871. [PMID: 34945163 PMCID: PMC8708302 DOI: 10.3390/jcm10245871] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/11/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
Family-Integrated Care (FICare) empowers parents to play an active role as a caregiver for their infant in the neonatal intensive care unit (NICU). This model of care is associated with improved neonatal outcomes, such as improved weight gain and higher breastfeeding rates at discharge in infants admitted to level III NICUs; however, its effectiveness in level II NICUs remains unproven. The objective of this study was to evaluate the effectiveness of the model on neonatal outcomes in a cluster randomized controlled trial conducted in 10 level II NICUs randomized to Alberta FICare or standard care. Mothers and their preterm infants born between 32+0 and 34+6 weeks' gestational age were included. The primary outcome was the proportion of infants who regained their birth weight (BW) after 14 days of life. The analysis included 353 infants/308 mothers at Alberta FICare sites and 365 infants/306 mothers at standard care sites. There was no difference in the proportion of infants who had regained their BW by 14 days between the groups. A lack of perceived improved weight gain trajectory for those in the FICare group is attributed to a shorter length of hospital stay and infants being discharged prior to regaining BW.
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Affiliation(s)
- Madeleine Murphy
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (M.M.); (V.S.)
| | - Vibhuti Shah
- Department of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5, Canada; (M.M.); (V.S.)
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada
- Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, 3300 University Drive NW, Calgary, AB T2N 4N1, Canada
- Correspondence:
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Brockway ML, Keys E, Bright KS, Ginn C, Conlon L, Doane S, Wilson J, Tomfohr-Madsen L, Benzies K. Top 10 (plus 1) research priorities for expectant families and those with children to age 24 months in Alberta, Canada: results from the Family Research Agenda Initiative Setting (FRAISE) priority setting partnership project. BMJ Open 2021; 11:e047919. [PMID: 34887269 PMCID: PMC8663105 DOI: 10.1136/bmjopen-2020-047919] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The study objective was to identify the top 10 research priorities for expectant parents and caregivers of children up to age 24 months. DESIGN A priority setting partnership using a modified James Lind Alliance approach was implemented. First, a core steering committee was formed, consisting of 17 parents, clinicians and community agency representatives. Second, through in-person collaboration with steering committee members, we developed and distributed a survey to identify research priorities across 12 topics. In total, 596 participants consented and 480 completed the survey. Survey responses were grouped and themed into codes during a consensus-building workshop with steering committee members (n=18). Research and practice experts were consulted to provide feedback on which themes had already been researched. An in-person (n=21) workshop was used to establish the top 34 priorities, which were circulated to the broader steering committee (n=25) via an online survey. Finally, the core steering committee members (n=18) met to determine and rank a top 10 (plus 1) list of research priorities. SETTING This study was conducted in Alberta, Canada. PARTICIPANTS Expectant parents and caregivers of children up to age 24 months. RESULTS Survey results provided 3232 responses, with 202 unique priorities. After expert feedback and steering committee consensus, a list of 34 priorities was moved forward for final consideration. The final top 10 (plus 1) research priorities included three priorities on mental health/relationships, two priorities on each of access to information, immunity and child development, and one priority on each of sleep, pregnancy/labour and feeding. Selecting 11 instead of 10 priorities was based on steering committee consensus. CONCLUSIONS The findings will direct future maternal-child research, ensuring it is rooted in parent-identified priorities that represent contemporary needs. To provide meaningful outcomes, research in these priority areas must consider diverse socioeconomic backgrounds and experiences.
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Affiliation(s)
- Meredith Lee Brockway
- Pediatrics and Child Health, University of Manitoba Faculty of Health Sciences, Winnipeg, Manitoba, Canada
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Elizabeth Keys
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- School of Nursing, Faculty of Health and Social Development, The University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Katherine Stuart Bright
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Outpatient Psychiatry, Alberta Health Services, Calgary, Alberta, Canada
| | - Carla Ginn
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Leslie Conlon
- FRAISE Steering Committee, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Doane
- FRAISE Steering Committee, Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | | | - Lianne Tomfohr-Madsen
- Psychology, Faculty of Arts, University of Calgary, Calgary, Alberta, Canada
- Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Paediatrics and Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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13
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Zanoni P, Scime NV, Benzies K, McNeil DA, Mrklas K. Facilitators and barriers to implementation of Alberta family integrated care (FICare) in level II neonatal intensive care units: a qualitative process evaluation substudy of a multicentre cluster-randomised controlled trial using the consolidated framework for implementation research. BMJ Open 2021; 11:e054938. [PMID: 34663673 PMCID: PMC8524282 DOI: 10.1136/bmjopen-2021-054938] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To evaluate the barriers and facilitators to implementing Alberta Family Integrated Care (AB-FICare [2019 Benzies]), a model of care for integrating parents into level II neonatal intensive care units (NICUs) care teams, from the perspective of healthcare providers (HCP) and hospital administrators. DESIGN Qualitative process evaluation substudy. SETTING Ten level II NICUs in six cities across Alberta, Canada. PARTICIPANTS HCP and hospital administrators (n=32) who were involved in the cluster-randomised controlled trial of AB-FICare in level II NICUs. METHODS Post-implementation semi-structured interviews were conducted via phone or in-person. The Consolidated Framework for Implementation Research was used to develop interview guides, code transcripts and analyse data. RESULTS Key facilitators to implementation of AB-FICare included (1) a receptive implementation climate, (2) compatibility of the intervention with individual and organisational practices, (3) available resources and access to knowledge and information for HCP and hospital administrators, (4) engagement of key stakeholders across the organisation, (5) engagement of and outcomes for intervention participants, and (6) reflecting and evaluating on implementation progress and patient and family outcomes. Barriers were (1) design quality and packaging of the intervention, (2) relative priority of AB-FICare in relation to other initiatives, and (3) learning climate within the organisation. Mixed influences on implementation depending on contextual factors were coded to eight constructs: intervention source, cost, peer pressure, external policy and incentives, staff needs and resources, structural characteristics, organisational incentives and rewards, and knowledge, beliefs and attitudes. CONCLUSIONS The characteristics of an organisation and the implementation process had largely positive influences, which can be leveraged for implementation of AB-FICare in the NICU. We recommend site-specific consultations to mitigate barriers and assess how swing factors might impact implementation given the local context, with the goal that strategies can be put in place to manage their influence on implementation. TRIAL REGISTRATION NUMBER NCT02879799.
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Affiliation(s)
- Pilar Zanoni
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Natalie V Scime
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Paediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Deborah A McNeil
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Maternal Newborn Child and Youth Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Kelly Mrklas
- Community Health Sciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
- Provincial Clinical Excellence, Alberta Health Services, Calgary, Alberta, Canada
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14
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MacKay L, Benzies K, Raffin Bouchal S, Barnard C. Parental and Health Care Professionals' Experiences Caring for Medically Fragile Infants on Pediatric Inpatient Units. Children's Health Care 2021. [DOI: 10.1080/02739615.2021.1973900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Lyndsay MacKay
- Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Karen Benzies
- Nursing, University of Calgary, Calgary, Alberta, Canada
| | | | - Chantelle Barnard
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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15
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Wollny K, Metcalfe A, McNeil D, Benzies K, Sajobi T, Parsons S. 465Simplifying the Differences between Causal and Prediction Analyses. Int J Epidemiol 2021. [DOI: 10.1093/ije/dyab168.716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Focus of Presentation
Multivariable regression models can be used to answer a variety of clinical questions. The two main objectives of regression models are to either 1) understand an association between one or more exposures and an outcome; or 2) predict future outcomes based on certain exposures or variables. To simplify this, we will consider the former causal analysis, and the latter prediction analysis. This presentation will explain the steps in model development and assessment using a clinical case study, highlighting the similarities and differences. This presentation is aimed at trainees.
Findings
The key differences between causal and prediction models include: the purpose and research questions, power calculations, variable selection, model specification, testing model fit, and the desired outcome of each model. The case study demonstrates these differences, while working through a causal and prediction model with similar clinical questions.
Conclusions/Implications
It is important for researchers to consider the purpose of their research question and to tailor the model accordingly. This will guide the model development and interpretation, which are different for causal and prediction analyses.
Key messages
A thorough understanding of the types of models available, their assumptions, and the process of model development and assessment is essential to conducting research that is valid and applicable to the clinical environment, enabling knowledge translation.
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Affiliation(s)
| | - Amy Metcalfe
- University Of Calgary, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | - Deborah McNeil
- University Of Calgary, Calgary, Canada
- Alberta Health Services, Calgary, Canada
| | - Karen Benzies
- University Of Calgary, Calgary, Canada
- Alberta Health Services, Calgary, Canada
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Dewell S, Ginn C, Benzies K, Seneviratne C. Nursing student and faculty attitudes about a potential genomics-informed undergraduate curriculum. Int J Nurs Educ Scholarsh 2021; 18:ijnes-2020-0109. [PMID: 34380187 DOI: 10.1515/ijnes-2020-0109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 07/21/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore attitudes about adding genomic content to an undergraduate nursing curriculum. Genomic knowledge is essential to nursing education, but challenges exist for curriculum innovation. Few countries have guiding documents from national nursing organizations on genomic competencies for practice or education. Information on attitudes about genomics may provide guidance for curriculum development. METHODS Nineteen undergraduate nursing students and two faculty from a school of nursing with two sites in western Canada participated. Five focus groups and four interviews were conducted using a semi-structured focus group guide. Data were analysed using thematic analysis. Coding was inductive. RESULTS Characteristics of participants, eight key themes, and four future focal areas were identified to guide future research and curriculum development. CONCLUSIONS Global development of genomics-informed curricula will require a focus on increasing knowledge, defining scope and role, increasing visibility of role models, and preparing to implement precision health.
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Affiliation(s)
- Sarah Dewell
- School of Nursing, University of Northern British Columbia, Prince George, BC, Canada
| | - Carla Ginn
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
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Abstract
Introduction Extensive evidence indicates that the quality of parent-child attachment is related to later socio-emotional and physical health outcomes. Yet, despite its clinical relevance, the parent-child attachment concept has been inconsistently applied across the disciplines of nursing, medicine and psychology and is often conflated with parent-child bonding in nursing literature. Objectives To provide readers with a critical analysis of the concept of parent-child attachment. Using a principle-based concept analysis, we clarify how parent-child attachment is understood from a multidisciplinary perspective to advance the use of this concept in nursing practice. Concept Description: Attachment is an affectionate, mutually satisfying relationship between a child and a caregiver that serves the purpose of making the child feel safe, secure, and protected. Discussion In this principle-based concept analysis, each definitional (i.e., epistemological, pragmatic, linguistic, and logical) principle contributes to an understanding of the strengths and limitations of the state of science about this concept. The discussion highlights how applying the concept of parent-child attachment security may offer exciting and promising opportunities for nursing clinical work with families. Conclusion The understanding of the concept of parent-child attachment differs among disciplines of nursing, medicine and psychology and offers exciting and promising opportunities for clarity and collaborative, multi-disciplinary work.
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Affiliation(s)
- E Ali
- University of Calgary, Calgary, Alberta, Canada
| | | | - K Benzies
- University of Calgary, Calgary, Alberta, Canada
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18
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Dewell S, Benzies K, Ginn C, Seneviratne C. Assessing knowledge of genomic concepts among Canadian nursing students and faculty. Int J Nurs Educ Scholarsh 2020; 17:/j/ijnes.2020.17.issue-1/ijnes-2020-0058/ijnes-2020-0058.xml. [DOI: 10.1515/ijnes-2020-0058] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/04/2020] [Indexed: 01/27/2023]
Abstract
Abstract
Objectives
Contemporary nurses require genomic literacy to engage in genomics-informed health care. Little is known about the genomic literacy of undergraduate nursing students and faculty in many countries. Concept inventories can be used to assess levels of knowledge and inform curriculum development.
Methods
The 31-item Genomic Nursing Concept Inventory (GNCI) was administered to undergraduate nursing students (n=207) and faculty (n=13) in a school of nursing with two sites in western Canada.
Results
Scores on the GNCI were low and comparable to those of US students and faculty. Six student characteristics were associated with total score on the GNCI.
Conclusions
Both students and faculty need to increase their knowledge of genomics. Mandates from national nursing organizations and international collaboration are needed to develop and implement foundational genomics content for undergraduate curricula to enable graduates to engage in genomics-informed health care.
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Affiliation(s)
- Sarah Dewell
- Faculty of Nursing , University of Calgary , Calgary , AB , Canada
| | - Karen Benzies
- Faculty of Nursing , University of Calgary , Calgary , AB , Canada
| | - Carla Ginn
- Faculty of Nursing , University of Calgary , Calgary , AB , Canada
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Abstract
Precision health is the integration of personal genomic data with biological, environmental, behavioral, and other information relevant to the care of a patient. Genetics and genomics are essential components of precision health. Genetics is the study of the effects of individual genes, and genomics is the study of all the components of the genome and interactions between genes, environmental factors, and other psychosocial and cultural factors. Knowledge about the role of genetics and genomics on health outcomes has increased substantially since the completion of the human genome project in 2003. Insights about genetics and genomics obtained from bench science are now having positive clinical implications on patient health outcomes. Nurses have the potential to make distinct contributions to precision health due to their unique role in the health care system. In this article, we discuss gaps in the development of precision health in nursing and how nursing can expand the definition of precision health to actualize its potential. Precision health plays a role in nursing practice. Understanding this connection positions nurses to incorporate genetic and genomic knowledge into their nursing practice.
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Affiliation(s)
- Sarah Dewell
- Faculty of Nursing, University of Calgary, Canada
| | | | - Carla Ginn
- Faculty of Nursing, University of Calgary, Canada
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MacKay L, Benzies K, Barnard C, Raffin Bouchal S. Parental Experiences Caring for Their Hospitalized Medically Fragile Infants: A Description of Grief, Stress, and Coping. Can J Nurs Res 2020; 53:191-201. [PMID: 32847405 DOI: 10.1177/0844562120954125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Advances in care have increased survival and improved outcomes of infants with complex and chronic diseases. These medically fragile infants require long-term hospitalization and depend on technology for survival. Parents of these infants experience stress and difficulties adapting to their parental role. PURPOSE To present an account of parental experiences as they provided care for their hospitalized medically fragile infant. METHODS This study was part of a larger constructivist grounded theory study to provide a holistic understanding of the processes of care for medically fragile infants. For this sub-study, 21 parents of hospitalized medically fragile infants were recruited from a pediatric hospital in Western Canada. Parents participated in face-to-face, semi-structured interviews, which were transcribed and analyzed using initial and focused coding. RESULTS Parents of hospitalized medically fragile infants grieved the loss of parenting a healthy infant, and they experienced multiple stressors. Parents utilized various coping strategies to manage their grief and stressors. Some parents were unable to cope, which exacted a heavy toll on their physical and mental health. Parents recommended psychological support, access to physical activity, primary nursing, and health system navigators. CONCLUSIONS Parental recommendations can inform the design of interventions for parents of hospitalized medically fragile infants.
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Affiliation(s)
- Lyndsay MacKay
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada.,Departments of Pediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chantelle Barnard
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Hunter A, Cunningham KS, Yuen C, Jensen K, Afzal A, Benzies K. Effect of a Nurse-Led Protocol on Time to Treatment of Partial Occlusions in Central Venous Access Devices in Pediatric Oncology. J Pediatr Oncol Nurs 2020; 37:305-312. [PMID: 32639196 DOI: 10.1177/1043454220938349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Central venous access devices (CVADs) are the standard of care in pediatric oncology. Occlusion is a common complication that can lead to delays in therapy, readmission, and CVAD removal and reinsertion. Early treatment of partial occlusions using a standardized protocol may restore patency and increase life span of CVADs. The objective of this study was to develop and evaluate a nurse-led protocol to manage partial CVAD occlusions in pediatric oncology and autologous bone marrow transplant patients. The protocol enabled nurses to manage partially occluded CVADs by administering thrombolytic therapy following an algorithm and patient-specific standing order. The primary outcome was time from recognition of the partial occlusion to instillation of a thrombolytic. Secondary outcomes were thrombolytic dwell time, number of complete occlusions, and CVAD life span. We used a quasi-experimental, after-only, nonequivalent control group design to compare patients not exposed (retrospective cohort, n = 137) and patients exposed (prospective cohort, n = 101) to the nurse-led protocol. Mann-Whitney U tests were used to compare time to treatment, dwell time, and CVAD life span between cohorts, and χ2 was used to compare the proportion of occlusions classified as complete. Time to treatment was significantly lower in the prospective cohort (M = 99.9 minutes) versus the retrospective cohort (M = 483.7 minutes), U = 1366.50, p < .01, as was thrombolytic dwell time, U = 282.50, p < .01. Proportion of complete occlusions and CVAD life span did not differ between cohorts. The nurse-led protocol was effective to manage partial CVAD occlusions in pediatric oncology patients.
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Affiliation(s)
- Allison Hunter
- Alberta Children's Hospital, Alberta Health Services, Calgary, Alberta, Canada.,University of Calgary, Calgary, Alberta, Canada
| | | | - Carol Yuen
- Alberta Children's Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | | | - Arfan Afzal
- University of Calgary, Calgary, Alberta, Canada
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Mackay L, Benzies K, Barnard C, Raffin Bouchal S. Health Care Professionals' Experiences of Providing Care to Hospitalized Medically Fragile Infants and Their Parents. J Pediatr Nurs 2020; 53:14-21. [PMID: 32339972 DOI: 10.1016/j.pedn.2020.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To understand contemporary experiences of pediatric health care professionals' (HCPs) caring for hospitalized Medically Fragile Infants (MFI) and their parents. DESIGN AND METHODS Convenience sampling was adopted to recruit 26 HCPs who provided care to MFI and their parents on inpatient units at a large tertiary pediatric hospital in Western Canada. Participants participated in either a focus group or individual face-to-face interview. Themes and concepts emerged during open and focused coding. FINDINGS HCPs encountered barriers to establishing relationships with parents, including: (a) intricate nature of MFI, (b) lack of social supports, (c) inconsistency, (d) moral distress, (e) burnout, and (f) struggle to gain control. HCPs utilized strategies to establish relationships with parents, including: (a) normalizing and building parental confidence, (b) tailoring care and being flexible, (c) providing parent care, and (d) optimizing communication. CONCLUSION HCPs aimed to establish relationships built on trust with parents of MFI to empower and enable parents to care for their infants. The relationship was the vehicle to enhance the care provided and well-being of MFI. HCPs encountered barriers to establishing trusting relationships and utilized strategies to establish such relationships. PRACTICE IMPLICATIONS It is valuable to understand the importance that the parent-HCPs relationship plays in the care provided to hospitalized MFI and how lack thereof can lead to moral distress and burnout among HCPs. Increasing HCPs' awareness of barriers and strategies to the establishment of a trusting relationship with parents could help improve the collaborative relationship between parents and HCPs.
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Affiliation(s)
- Lyndsay Mackay
- Faculty of Nursing, University of Calgary,, Alberta, Canada.
| | - Karen Benzies
- Faculty of Nursing, Departments of Paediatrics and Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.
| | - Chantelle Barnard
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Alberta, Canada.
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Ginn C, Mughal MK, Pruett MK, Pruett K, Perry RL, Benzies K. Engaging From Both Sides: Facilitating a Canadian Two-Generation Prenatal-to-Three Program for Families Experiencing Vulnerability. Can J Nurs Res 2020; 52:117-128. [PMID: 32046505 DOI: 10.1177/0844562120905710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Young children living in families experiencing social vulnerability, including low income, mental illness, addictions, social isolation, and/or homelessness, are at risk of developmental delay. Two-generation programs can improve outcomes for preschool children, but underlying mechanisms and outcomes for younger children remain unclear. PURPOSE We explored program facilitation and identified developmental benefits of a two-generation program beginning prenatally. METHODS In our convergent, concurrent mixed methods study, we interviewed agency staff (n = 10) and held focus groups with parents (n = 14). We compared child (N = 100) development between program intake and exit as measured by the Ages and Stages Questionnaires 3rd edition. RESULTS Our core category, Engaging From Both Sides, included (a) Mitigating Adversity (focused codes Developing Trust, Letting Go of Fear, and Putting in the Effort); (b) Continual Learning (focused codes Staying Connected, and Taking it to the Community); (c) Fostering Families (focused codes Cultivating Optimism, and Happiness and Love); (d) Unravelling Cycles of Crisis (focused codes Advocating, and Helping Parents' Parent); and (e) Becoming Mainstream (focused codes Knowing Someone Has Your Back, and Managing Stress, Anxiety, and Anger). We found significant improvements in child Fine Motor, Problem-Solving, and Personal-Social domains between program intake and exit. CONCLUSIONS Our study adds to existing literature regarding mechanisms of two-generation programs beginning prenatally. Mitigating effects of intergenerational adversity was the primary motivation for interaction and engagement of staff and parents in two-generation programming, which improved child development.
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Affiliation(s)
- Carla Ginn
- Faculty of Nursing, University of Calgary, AB, Canada
| | | | | | | | | | - Karen Benzies
- Faculty of Nursing, University of Calgary, AB, Canada
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24
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Anis L, Letourneau N, Benzies K, Ewashen C, Hart MJ. Effect of the Attachment and Child Health Parent Training Program on Parent-Child Interaction Quality and Child Development. Can J Nurs Res 2020; 52:157-168. [PMID: 32000509 DOI: 10.1177/0844562119899004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Exposure to chronic stressors (poverty, addiction, family violence) in early life can derail children's development. Interventions focused on parental reflective function may promote parents' abilities to regulate their feelings and behaviors toward their children and buffer the impact of chronic stressors on children's development by nurturing high-quality parent-child interaction. PURPOSE To test the effectiveness of parental reflective function-focused intervention entitled Attachment and Child Health on parent-child interaction and child development. METHODS We conducted two pilots with vulnerable mothers and children <36 months. Randomized controlled trial (n = 20) and quasi-experimental (n = 10) methods tested the effect of Attachment and Child Health on parent-child interaction via Parent-Child Interaction Teaching Scale (PCITS) and on child development via Ages and Stages Questionnaire (ASQ-3) and Ages and Stages Questionnaire-Social Emotional (ASQSE). We employed analysis of covariance and t-tests to examine the outcomes. RESULTS For randomized controlled trial, we found significant improvements in PCITS parent total, combined total, and cognitive growth fostering scores, and ASQ-3 personal-social scores post-intervention. For quasi-experimental study, we found significant improvements in PCITS combined total, sensitivity to cues, response to child's distress, and responsiveness to caregiver scores. CONCLUSION Incorporating Attachment and Child Health contributed to effective programming for vulnerable families with young children.
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Affiliation(s)
- Lubna Anis
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Nicole Letourneau
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Departments of Pediatrics and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Carol Ewashen
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Martha J Hart
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Departments of Pediatrics and Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Ali E, Letourneau N, Benzies K, Ntanda H, Dewey D, Campbell T, Giesbrecht G. Maternal Prenatal Anxiety and Children’s Externalizing and Internalizing Behavioral Problems: The Moderating Roles of Maternal-Child Attachment Security and Child Sex. Can J Nurs Res 2019; 52:88-99. [DOI: 10.1177/0844562119894184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background Prenatal anxiety is associated with child behavioral problems. Prenatal anxiety is predictive of postnatal anxiety which can interfere with the security of maternal-child attachment and further raise the risk of child behavior problems. Secure maternal-child attachment is essential for optimal emotional health. Sex influences the type of behavior problem experienced. There is a gap in understanding whether attachment security and the sex of the child can moderate association between prenatal anxiety and children’s behavioral problems. Purpose To examine the association between prenatal anxiety and child behavioral problems and to test the moderating effects of attachment security and child sex on the association between prenatal anxiety and child behavioral problems. Methods Secondary analysis of data from 182 mothers and their children, enrolled in the Alberta Pregnancy Outcomes and Nutrition Study using Hayes' (2013) conditional process modeling. Results Prenatal anxiety was associated with both externalizing ( b = −0.53; standard error ( SE) = 0.20; p = 0.009) and internalizing ( b = −0.32; SE = 0.13; p = 0.01) behaviors only in children with an insecure style of attachment. Child sex did not moderate the association between prenatal anxiety and children's behavioral problems. Conclusions Attachment security moderated the association between prenatal anxiety and children’s externalizing and internalizing behavioral problems.
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Affiliation(s)
- Elena Ali
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Nicole Letourneau
- Faculty of Nursing, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Henry Ntanda
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Deborah Dewey
- Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tavis Campbell
- Faculty of Arts, University of Calgary, Calgary, AB, Canada
| | - Gerry Giesbrecht
- Faculty of Pediatrics, University of Calgary, Calgary, AB, Canada
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Keys E, Benzies K, Kirk V, Duffett-Leger L. Effectiveness of play2sleep with mothers and fathers of infants aged 5 months: a mixed methods study examining the effect of an intervention designed to improve parent-child interaction on infant sleep. Sleep Med 2019. [DOI: 10.1016/j.sleep.2019.11.531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lasiuk GC, Penner J, Benzies K, Jubinville J, Hegadoren K, van Manen M. Evaluation of a Storybook Resource for Parents in the Neonatal Intensive Care Unit. J Perinat Educ 2019; 27:220-232. [PMID: 31073268 DOI: 10.1891/1058-1243.27.4.220] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This project evaluates the acceptability and utilityof a storybook, entitled Unexpected: Parents' Experience of Preterm Birth, as an educational resource for parents in the neonatal intensive care unit (NICU). Forty-nine parents were recruited from Level II and Level III NICUs and completed several questionnaires; a subset of 11 parents also participated in focused qualitative interviews. Almost all parents experienced the characters as believable and agreed/strongly agreed that the stories accurately portray what it is like to be a parent in the NICU. The multiple narrators offer different perspectives of the NICU experience, which helped to normalize their experience and reminded them that they were not alone. Participants reported learning something new from the storybook and would recommend it to others.
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Mughal MK, Giallo R, Arnold PD, Kehler H, Bright K, Benzies K, Wajid A, Kingston D. Trajectories of maternal distress and risk of child developmental delays: Findings from the All Our Families (AOF) pregnancy cohort. J Affect Disord 2019; 248:1-12. [PMID: 30690110 DOI: 10.1016/j.jad.2018.12.132] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 12/19/2018] [Accepted: 12/26/2018] [Indexed: 01/11/2023]
Abstract
BACKGROUND Existing literature on the impact of the course of maternal distress symptoms in the perinatal period and beyond has mainly focused on one source of distress (e.g., anxiety or depression) and only selected aspects of child development. This study examined the relative impact of trajectories of maternal depression, anxiety, and stress symptoms from mid-pregnancy to early childhood on child communication, gross motor, fine motor, problem solving, and personal social development at three years of age. METHODS Data were analyzed from 1983 mother-child dyads who participated in the three-year follow-up of the All Our Families (AOF) study. Maternal distress and child development across five domains were measured using validated tools. Latent class analysis (LCA) was conducted to identify trajectories of maternal distress over time. Multivariable logistic regression was used to explore the relationship between the trajectories and child development while adjusting for the covariates. RESULTS At age three years, 5.2% of children were at risk communication delay; 12.7% for gross motor delay; 15.4% for fine motor delay; 11.2 for problem solving delay; and 5.6% for personal-social delay on ASQ-3 domains. Multivariable analysis showed children born to mothers with persistent high anxiety symptoms from pregnancy to 3-years postpartum had an increased risk of delays in communication and personal-social domains. LIMITATIONS The use of self-reported maternal mental health symptoms and maternal reported child development are the study limitations. CONCLUSIONS The impact of high levels of maternal anxiety symptoms on the increased risk of child developmental delay in communication and personal-social domains highlights the importance of early intervention and addressing maternal anxiety from pregnancy through early childhood.
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Affiliation(s)
- Muhammad Kashif Mughal
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, Alberta T2N 1N4, Canada.
| | - Rebecca Giallo
- Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia.
| | - Paul D Arnold
- Mathison Center for Mental Health Research & Education, Cumming Schol of Medicine, University of Calgary, 3280 Hospital Dr. N.W., Calgary, Alberta T2N 4Z6, Canada.
| | - Heather Kehler
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, Alberta T2N 1N4, Canada.
| | - Katherine Bright
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, Alberta T2N 1N4, Canada.
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, Alberta T2N 1N4, Canada.
| | - Abdul Wajid
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, Alberta T2N 1N4, Canada.
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, 2500 University Dr. N.W, Calgary, Alberta T2N 1N4, Canada.
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McDonald SW, Madigan S, Racine N, Benzies K, Tomfohr L, Tough S. Maternal adverse childhood experiences, mental health, and child behaviour at age 3: The all our families community cohort study. Prev Med 2019; 118:286-294. [PMID: 30468793 DOI: 10.1016/j.ypmed.2018.11.013] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 11/01/2018] [Accepted: 11/19/2018] [Indexed: 01/05/2023]
Abstract
Links between adverse childhood experiences (ACEs) and threats to health and well-being later in life are well established. The current study extends those findings into younger populations of pregnant women and their children; investigating how ACEs relates to maternal postpartum well-being, coping, and parenting, as well as child outcomes. Participants included 1994 mothers and children from the All Our Families community-based cohort in Alberta, Canada, followed from pregnancy (from 2008 to 2011) until child age 3 years. The sample is representative of the pregnant population in an urban Canadian centre. Mothers completed questionnaires on ACEs, postpartum mental health, as well as parenting morale, efficacy, coping, and personality. Child outcomes included internalizing and externalizing behavior, as well as temperament. Approximately 62% of participants experienced at least one ACE; 25% experienced 3 or more ACEs. The presence of 3 or more ACEs was associated with postpartum smoking, binge drinking, depressive and anxiety symptoms, lower optimism and higher neuroticism, and lower reported parenting morale. In children, 3 or more maternal ACEs was associated with higher levels of internalizing (e.g., anxiety) and externalizing difficulties (aggression and hyperactivity), as well as temperament (surgency and negative affectivity). Cumulative maternal ACEs are associated with postpartum mental health and parenting morale, as well as maladaptive coping strategies. The demonstrated downstream consequences of maternal ACEs for child outcomes suggests that early intervention strategies and community resources to improve life course outcomes for parents and children are critical for breaking intergenerational continuities of risk.
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Affiliation(s)
- S W McDonald
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - S Madigan
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - N Racine
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - K Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - L Tomfohr
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - S Tough
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Bright KS, Ginn C, Keys EM, Brockway ML, Tomfohr-Madsen L, Doane S, Benzies K. Study Protocol: Determining Research Priorities of Young Albertan Families (The Family Research Agenda Initiative Setting Project-FRAISE)-Participatory Action Research. Front Public Health 2018; 6:228. [PMID: 30211143 PMCID: PMC6121170 DOI: 10.3389/fpubh.2018.00228] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 07/26/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Pregnancy and childrearing can be an exciting and stressful time for new parents. The maternal-child health landscape has changed dramatically over the last few decades and research priorities need to address these rapid changes. There have been limited attempts to engage and collaborate with members of the public to develop research priorities for families who are expecting or parenting an infant to age 24 months. The work that has been completed has attempted to identify parental preference for information delivery and barriers to uptake of parenting programs but has not investigated parental research priorities. Methods: In collaboration with provincial research units and strategic clinical networks (SCN), we will use principles of participatory action research (PAR) as our theoretical framework/method, and a modified James Lind Alliance priority setting approach to prioritize a list of research questions that parents/knowledge users believe will support the health of their families. This will result in a top 10 list of parent/knowledge user-identified research priorities. This project will consist of three phases. In the first phase, we developed a steering committee of parents/knowledge users, healthcare providers, community agencies, and researchers to design a survey about health priorities for families. In the second phase, we will distribute the survey to diverse groups of parents/knowledge users/providers and hold a series of meetings to identify and prioritize potential questions from new parents about health issues from conception to age 24 months. In the third phase, we will collaboratively disseminate and translate findings. Discussion: This study will highlight parental health concerns and recommend parent-identified research priorities to inform future research projects needed to support the health of families between conception to age 24 months. Understanding the health research priorities of families in the community will help ensure future research contributes to meaningful changes in the health of young children, parents/knowledge users, and families. Ethics: This study and protocol have received ethical approved from the Conjoint Health Research Ethics Board at the University of Calgary (REB17-0014). Dissemination: The top 10 research priorities will be published and additional findings from the study will be distributed through pamphlets and newsletters.
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Affiliation(s)
| | - Carla Ginn
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | | | | | | | - Stephanie Doane
- FRAISE Steering Committee, University of Calgary, AB, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
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Mughal MK, Giallo R, Arnold P, Benzies K, Kehler H, Bright K, Kingston D. Trajectories of maternal stress and anxiety from pregnancy to three years and child development at 3 years of age: Findings from the All Our Families (AOF) pregnancy cohort. J Affect Disord 2018; 234:318-326. [PMID: 29604550 DOI: 10.1016/j.jad.2018.02.095] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 02/27/2018] [Accepted: 02/28/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Existing literature on maternal distress has focused on stress and anxiety during the pregnancy or postnatally and their relationship with child development. However, few studies have investigated the association between maternal stress and anxiety symptoms over time and child development in preschool children. The aim of this study was to examine the association between trajectories of maternal stress and anxiety symptoms from mid-pregnancy to three years postpartum and child development at age three years. METHODS Data were analyzed from 1983 mother-child dyads who participated in the three year follow-up of the All Our Families (AOF) study. Latent class analysis (LCA) was conducted to identify trajectories of women's stress and anxiety across from mid-pregnancy to three years postpartum. Multivariate logistic regression was used to explore the relationship between the stress and anxiety trajectories and child developmental delays while adjusting for the covariates. RESULTS LCA identified three distinct trajectories of maternal stress and anxiety symptoms over time. Multivariate analysis showed mothers assigned to the high anxiety symptoms class had an increased risk (adjusted OR 2.80, 95% CI 2.80 (1.42 ─ 5.51), p = 0.003) of having a child with developmental delays at 3 years. LIMITATIONS The use of self-reported maternal mental health symptoms and no data on fathers' mental health are our study's limitations. CONCLUSIONS The findings from a population-based Canadian sample provide empirical support for a relationship between maternal anxiety overtime and risk of child developmental delays. Identifying and supporting mothers experiencing high anxiety symptoms in the perinatal period may mitigate the risk of these delays in children.
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Affiliation(s)
| | - Rebecca Giallo
- Murdoch Children's Research Institute, Flemington Road, Parkville, Victoria, Australia
| | - Paul Arnold
- Mathison Centre for Mental Health Research & Education, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Heather Kehler
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Katherine Bright
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Dawn Kingston
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
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Kingston D, Kehler H, Austin MP, Mughal MK, Wajid A, Vermeyden L, Benzies K, Brown S, Stuart S, Giallo R. Trajectories of maternal depressive symptoms during pregnancy and the first 12 months postpartum and child externalizing and internalizing behavior at three years. PLoS One 2018; 13:e0195365. [PMID: 29652937 PMCID: PMC5898728 DOI: 10.1371/journal.pone.0195365] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 03/17/2018] [Indexed: 02/03/2023] Open
Abstract
Background Most evidence of the association between maternal depression and children’s development is limited by being cross-sectional. To date, few studies have modelled trajectories of maternal depressive symptoms from pregnancy through the early postpartum years and examined their association with social emotional and behavior functioning in preschool children. The objectives of this study were to: 1) identify distinct groups of women defined by their trajectories of depressive symptoms across four time points from mid-pregnancy to one year postpartum; and 2) examine the associations between these trajectories and child internalizing and externalizing behaviors. Methods We analyzed data from the All Our Families (AOF) study, a large, population based pregnancy cohort of mother-child dyads in Alberta, Canada. The AOF study is an ongoing pregnancy cohort study designed to investigate relationships between the prenatal and early life period and outcomes for children and mothers. Maternal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale. Children’s behavioral functioning at age 3 was assessed using the Behavior Scales developed for the Canadian National Longitudinal Survey of Children and Youth. Longitudinal latent class analysis was conducted to identify trajectories of women’s depressive symptoms across four time points from pregnancy to 1 year postpartum. We used multivariable logistic regression to assess the relationship between trajectories of maternal depressive symptoms and children’s behavior, while adjusting for other significant maternal, child and psychosocial factors. Results 1983 participants met eligibility criteria. We identified four distinct trajectories of maternal depressive symptoms: low level (64.7%); early postpartum (10.9%); subclinical (18.8%); and persistent high (5.6%). In multivariable models, the proportion of children with elevated behavior symptoms was highest for children whose mothers had persistent high depressive symptoms, followed by mothers with moderate symptoms (early postpartum and subclinical trajectories) and lowest for minimal symptoms. After accounting for demographic, child and psychosocial factors, the relationships between depression trajectories and child hyperactivity/inattention, physical aggression (subclinical trajectory only) and separation anxiety symptoms remained significant. Conclusion These findings suggest both externalizing and internalizing children’s behaviors are associated with prolonged maternal depressive symptoms. There is a good case for the need to move beyond overly simplistic clinical cutoff approaches of depressed/not depressed in screening for perinatal depression. Women with elevated depressive symptoms at clinical and subclinical levels need to be identified, provided with evidence-based treatment, and monitored with repeat screening to improve maternal mental health outcomes and reduce the risk of associated negative outcomes on children’s early social-emotional and behavior development.
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Affiliation(s)
- Dawn Kingston
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
| | - Heather Kehler
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Marie-Paule Austin
- St John of God Health Care, Burwood, Australia
- University of New South Wales, Sydney, Australia
| | | | - Abdul Wajid
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Lydia Vermeyden
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Stephanie Brown
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
| | - Scott Stuart
- Department of Obstetrics and Gynecology, University of Iowa, Iowa City, Iowa, United States of Amreica
| | - Rebecca Giallo
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia
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Dewell S, Slater D, Benzies K, McDonald S, Tough S. Relationship Between Psychosocial Distress in Pregnancy and Two Genes Associated With Human Social Interaction: A Pilot Study. SAGE Open Nurs 2018; 4:2377960818765272. [PMID: 33415193 PMCID: PMC7774440 DOI: 10.1177/2377960818765272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 02/02/2018] [Accepted: 02/18/2018] [Indexed: 11/17/2022] Open
Abstract
Background Prenatal depression, anxiety, and stress (prenatal psychosocial distress) are common, and several environmental risk factors have been implicated in their development. Variation in genes, specifically single nucleotide polymorphisms (SNPs), may explain why some women develop maternal mental health concerns while others do not. Purpose The purpose of this pilot study was to determine the feasibility of completing SNP analyses using whole blood collected prenatally between 2008 and 2011. We examined the association between SNPs in two genes (FKBP5 and OXTR) among women with low and high prenatal psychosocial distress. Methods A subset (N = 50, 25 high and 25 low prenatal psychosocial distress) of participants was selected from the All Our Families pregnancy cohort. DNA was extracted from maternal blood and used for selected SNP analysis. Participants’ scores on the Edinburgh Prenatal Depression Scale, Spielberger State Anxiety Inventory, and Perceived Stress Scale were used along with demographic variables. Results Genotype distribution was not significantly different between the low and high prenatal psychosocial distress groups for either the FKBP5 or the OXTR SNP (p = .699 and p = .125). After controlling for maternal age and income, women with the GG genotype at the OXTR SNP (rs237885) were statistically less likely to be in the high prenatal psychosocial distress group (p = .037). Conclusion OXTR SNP rs237885, maternal age, and lower income were associated with prenatal psychosocial distress. This pilot study demonstrated the feasibility of continuing to a larger study that incorporates additional environmental and genetic information.
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Affiliation(s)
- Sarah Dewell
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Donna Slater
- Departments of Physiology & Pharmacology and Obstetrics & Gynaecology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Sheila McDonald
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Suzanne Tough
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Bayrampour H, McNeil DA, Benzies K, Salmon C, Gelb K, Tough S. A qualitative inquiry on pregnant women's preferences for mental health screening. BMC Pregnancy Childbirth 2017; 17:339. [PMID: 28974195 PMCID: PMC5627476 DOI: 10.1186/s12884-017-1512-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 09/15/2017] [Indexed: 01/23/2023] Open
Abstract
Background Approaches to screening can influence the acceptance of and comfort with mental health screening. Qualitative evidence on pregnant women’s comfort with different screening approaches and disclosure of mental health concerns is scant. The purpose of this study was to understand women’s perspectives of different mental health screening approaches and the perceived barriers to the communication and disclosure of their mental health concerns during pregnancy. Methods A qualitative descriptive study was undertaken. Fifteen women, with a singleton pregnancy, were recruited from a community maternity clinic and a mental health clinic in Calgary, Canada. Semi-structured interviews were conducted during both the 2nd and 3rd trimesters. Data were analyzed using thematic analysis. Results Preferences for mental health screening approaches varied. Most women with a known mental health issue preferred a communicative approach, while women without a known mental health history who struggled with emotional problems were inclined towards less interactive approaches and reported a reluctance to share their concerns. Barriers to communicating mental health concerns included a lack of emotional literacy (i.e., not recognizing the symptoms, not understanding the emotions), fear of disclosure outcomes (i.e., fear of being judged, fear of the consequences), feeling uncomfortable to be seen vulnerable, perception about the role of prenatal care provider (internal barriers); the lack of continuity of care, depersonalized care, lack of feedback, and unfamiliarity with/uncertainty about the availability of support (structural barriers). Conclusions The overlaps between some themes identified for the reasons behind a preferred screening approach and barriers reported by women to communicate mental health concerns suggest that having options may help women overcome some of the current disclosure barriers and enable them to engage in the process. Furthermore, the continuity of care, clarity around the outcomes of disclosing mental health concerns, and availability of immediate support can help women move from providing “the best answer” to providing an authentic answer.
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Affiliation(s)
- Hamideh Bayrampour
- Department of Family Practice, Midwifery Program, University of British Columbia, 3rd Floor David Strangway Building, 320-5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada.
| | - Deborah A McNeil
- Alberta Health Services and Associate Professor in Faculty of Nursing and Department of Community Health Sciences Cumming School of Medicine, University of Calgary, Calgary, T2W 3N2, Canada
| | - Karen Benzies
- Professor in Faculty of Nursing, University of Calgary, Calgary, T2N 1N4, Canada
| | - Charleen Salmon
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, T2N 1N4, Canada
| | - Karen Gelb
- Midwifery Program, Department of Family Practice, Faculty of Medicine, University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Suzanne Tough
- Alberta Innovates Health Solutions Health Scholar and Professor in Department of Pediatrics and Community Health Sciences, University of Calgary, Calgary, T3B 6A8, Canada
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Abstract
BACKGROUND Maternal breastfeeding self-efficacy (BSE) is reflective of a mother's confidence in breastfeeding and is a modifiable factor that may improve breastfeeding rates. Breastfeeding self-efficacy theory purports that women with higher BSE will have better breastfeeding outcomes. Research aim: The aim of this systematic review was to explore the theoretical link between BSE and breastfeeding outcomes by investigating (a) if interventions to improve BSE were successful and (b) if improvements in BSE resulted in improved breastfeeding rates. METHODS The authors performed a systematic search of 10 databases for studies that investigated the effect of interventions for mothers of full-term infants on BSE and breastfeeding rates. They used an inverse-variance, random-effects meta-analysis. RESULTS Of 1,366 titles and abstracts identified, 58 full-text articles were screened and 11 met the study criteria. Compared with mothers in control groups, mothers in intervention groups had significantly higher BSE, scoring 4.86 points higher, 95% confidence interval [3.11, 6.61], at 2 months postpartum. Mothers in the intervention groups were 1.56 and 1.66 times more likely to be breastfeeding at 1 month and 2 months postpartum, respectively. Interventions that were implemented in the postpartum period, used combined delivery settings, or were informed by BSE theory had the greatest influence on breastfeeding outcomes. Meta-regression indicated that for each 1-point increase in the mean BSE score between the intervention and control groups, the odds of exclusive breastfeeding increased by 10% in the intervention group. CONCLUSION Breastfeeding self-efficacy is a modifiable factor that practitioners can target to improve breastfeeding rates in mothers of full-term infants.
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Affiliation(s)
| | - Karen Benzies
- 1 Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - K Alix Hayden
- 2 Libraries and Cultural Resources, University of Calgary, Calgary, AB, Canada
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Pazderka H, Prinz RJ, Heidebrecht T, Wiebe S, Benzies K, Hosan N, Hoglund W, Rinaldi C, Easton D, Preston T, Tough S, Embry DD. Testing the PAX Good Behavior Game with and without school-based parenting support: study description and practical challenges. International Journal of Mental Health Promotion 2017. [DOI: 10.1080/14623730.2017.1347515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hannah Pazderka
- PolicyWise for Children & Families, Edmonton, Canada
- Department of Psychiatry, University of Alberta, Edmonton, Canada
| | - Ronald J. Prinz
- Parenting & Family Research Center, Department of Psychology, University of South Carolina, Columbia, SC, USA
| | | | - Sandra Wiebe
- Department of Psychology, University of Alberta, Edmonton, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Canada
| | - Naheed Hosan
- Department of Psychology, University of Alberta, Edmonton, Canada
| | - Wendy Hoglund
- Department of Psychology, University of Alberta, Edmonton, Canada
| | - Christina Rinaldi
- Department of Educational Psychology, University of Alberta, Edmonton, Canada
| | | | - Tara Preston
- PolicyWise for Children & Families, Edmonton, Canada
| | - Suzanne Tough
- PolicyWise for Children & Families, Edmonton, Canada
- Department of Paediatrics, Community Health Sciences, University of Calgary, Calgary, Canada
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Nowell L, White DE, Benzies K, Rosenau P. Exploring mentorship programs and components in nursing academia: A qualitative study. ACTA ACUST UNITED AC 2017. [DOI: 10.5430/jnep.v7n9p42] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: Nursing education institutions globally have issued calls for mentorship to address the nursing faculty shortage; however, little is known about the current state of mentorship for faculty members in Canadian schools of nursing. The purpose of this study is to describe the current state of mentorship in Canadian schools of nursing and explore definitions and goals of mentorship programs, mentorship models and components, and mentorship evaluation.Methods: A qualitative descriptive study was conducted. Within the Canadian Association of Schools of Nursing there are 81 English-speaking schools of nursing and 2,284 permanent faculty members spread over four regions. Participants were recruited from the 81 schools of nursing through the CASN newsletter list serve and publically accessible email addresses. Inclusion was limited to English speaking faculty. Purposive sampling aimed to capture variation across rank and tenure, school, size and areas within Canada. Semi-structured interviews were utilized to explore the participant’s (n = 48) perspectives and involvement with mentorship. Interviews were audio-recorded and transcribed verbatim. NVivo was used to code and analyze the data for significant statements and phrases, which were organized into themes and sub-themes.Results: Mentorship remains largely informal in nursing academia without common definitions or goals. Current mentorship in nursing academia employed dyad, peer, group, constellation, and distance mentorship models. Common mentorship program components included guidelines, training, professional development workshops, purposeful linking of mentors and mentees, and mentorship coordinators. Evaluation of mentorship in nursing academia, where it exists, remains mostly descriptive, anecdotal, and lacks common evaluative metrics.Conclusions: Our results confirm mentorship in Canadian schools of nursing remains largely informal. In developing mentorship programs, academic leaders need to consider the mentorship models and components to meet their specific needs. Further rigorous evaluation of mentorship programs and components is needed to identify if mentorship programs are achieving specified goals.
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Tough SC, McDonald SW, Collisson BA, Graham SA, Kehler H, Kingston D, Benzies K. Cohort Profile: The All Our Babies pregnancy cohort (AOB). Int J Epidemiol 2017; 46:1389-1390k. [DOI: 10.1093/ije/dyw363] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 11/15/2022] Open
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Montgomery L, Benzies K, Barnard C. Effects of an Educational Workshop on Pediatric Nurses' Attitudes and Beliefs About Family-Centered Bedside Rounds. J Pediatr Nurs 2016; 31:e73-82. [PMID: 26614612 DOI: 10.1016/j.pedn.2015.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Revised: 09/22/2015] [Accepted: 10/12/2015] [Indexed: 11/26/2022]
Abstract
This pilot study evaluated the effects of an educational workshop on nurses' (N=36) attitudes and beliefs toward family-centered bedside rounds (FBR) using a single group, pretest/posttest design on two pediatric inpatient units at an academic tertiary-care center in Western Canada. The theory of planned behavior was used to develop the Nurses Attitudes and Behaviors about Rounds (NABAR) questionnaire. There were statistically significant increases between pretest and posttest scores on nurses' intentions, subjective norms and perceived behavioral control related to FBR, and on providing education to families about FBR. A brief, educational workshop can positively affect nurses' attitudes and beliefs about FBR. Future research should include additional psychometric evaluation of the NABAR.
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Affiliation(s)
- Lara Montgomery
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
| | - Chantelle Barnard
- Department of Paediatrics, University of Calgary, Calgary, AB, Canada
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Bayrampour H, Ali E, McNeil DA, Benzies K, MacQueen G, Tough S. Pregnancy-related anxiety: A concept analysis. Int J Nurs Stud 2016; 55:115-30. [DOI: 10.1016/j.ijnurstu.2015.10.023] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 10/11/2015] [Accepted: 10/22/2015] [Indexed: 12/20/2022]
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Ballantyne M, Benzies K, Rosenbaum P, Lodha A. Mothers' and health care providers' perspectives of the barriers and facilitators to attendance at Canadian neonatal follow-up programs. Child Care Health Dev 2015; 41:722-33. [PMID: 25272331 DOI: 10.1111/cch.12202] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/31/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite the benefits of Neonatal Follow-Up (NFU) programs for infants at risk for developmental problems subsequent to preterm birth, non-attendance continues to be a problem within Canada and beyond. This study investigated the barriers and facilitators to attendance at Canadian NFU programs from mothers' and health care providers' (HCP) perspectives. METHODS In this multi-site qualitative descriptive study, we conducted semi-structured individual interviews with 12 mothers, six from each of two NFU programs; and focus groups with 20 HCPs from nine NFU programs. Interviews were audio-recorded and transcribed and then subjected to thematic analysis. RESULTS The predominant barriers represented a complex interplay of cumulative factors: mothers' isolation and feeling overwhelmed, with limited support, experiencing difficulty attending because of limited resources, who viewed NFU as not needed until problems arose for their child. Other barriers included vulnerability and fear of bad news. Mothers reported the need to protect their vulnerable child from risks, whereas HCPs reported creating vulnerability by monitoring the child's development over time. HCPs perceived fear of bad news as a barrier, whereas mothers viewed that impending bad news increased their need to attend to address the issue. The predominant facilitators were support, family centred-care and mothers with adequate resources. CONCLUSIONS Attendance is most problematic for mothers with limited support, capacity and resources. First and foremost, targeted approaches to NFU service provision are needed to address the cumulative barriers and improve experiences for mothers who find it difficult to attend NFU. A continuous relationship with a single point of contact is needed and merits further investigation - a provider who works across the traditional silos of neonatal intensive care, NFU and community services, minimizes duplication and navigates transitions.
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Affiliation(s)
- M Ballantyne
- School of Nursing, Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - K Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada
| | - P Rosenbaum
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - A Lodha
- Department of Paediatrics, University of Calgary, Calgary, AB, Canada
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Benzies K, Mychasiuk R, Tough S. What patterns of postpartum psychological distress are associated with maternal concerns about their children's emotional and behavioural problems at the age of three years? Early Child Dev Care 2015; 185:1-16. [PMID: 25544794 PMCID: PMC4270423 DOI: 10.1080/03004430.2014.899592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 02/26/2014] [Indexed: 06/04/2023]
Abstract
Mothers experiencing psychological distress in the postpartum period may have difficulties parenting their children. Inconsistent and unresponsive parenting may increase the risk of later emotional and behavioural problems in children. The purpose of this study was to identify how maternal psychological characteristics cluster at eight weeks postpartum, and whether these clusters were associated with maternal-reported child emotional and behavioural problems at the age of three years, as measured by the Parents' Evaluation of Developmental Status (PEDS) questionnaire. In a longitudinal pregnancy cohort (N = 647), three clusters of postpartum psychological characteristics were identified. Contrary to expectations, mothers with the greatest psychological distress did not report concerns about their child's emotional and behavioural problems; rather, they reported concerns about global developmental delay. These findings suggest that infants of mothers experiencing postpartum psychological distress should receive additional follow-up to reduce the risk for global developmental delay.
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Affiliation(s)
- Karen Benzies
- Faculty of Nursing and Department of Pediatrics, University of Calgary, PF2222 – 2500 University Drive, Calgary, Alberta, CanadaT2N 1N4
| | - Richelle Mychasiuk
- Faculty of Medicine, University of Calgary, 2500 University Drive NW, Calgary, CanadaAB T2N 1N4
| | - Suzanne Tough
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Suite 200, 3820 – 24th Avenue NW, Calgary, CanadaAB T3B 2X9
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Benzies K, Clarke D, Barker L, Mychasiuk R. UpStart parent survey: a new psychometrically valid tool for the evaluation of prevention-focused parenting programs. Matern Child Health J 2014; 17:1452-8. [PMID: 23054456 PMCID: PMC3785186 DOI: 10.1007/s10995-012-1152-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Parents are the most significant influence on the growth and development of young children. All parents can increase their knowledge of developmental milestones and parenting practices by participating in effective programs that offer information and support. However, there is limited outcome evaluation of programs offering these services. Prevention-focused parenting programs (P-FPPs) are key frontline services designed to educate parents and improve the overall well-being of children. Evaluation of these programs is currently weak; this is not to say they are ineffective, rather that their effectiveness has been poorly evaluated. Rigorous evaluation of P-FPPs would support informed funding and evidence-based policy decisions. The purpose of this study was to conduct a preliminary psychometric analysis of the UpStart Parent Survey (USPS)-a tool developed specifically for evaluating this type of program. Preliminary analysis revealed uni-dimensionality of each scale, strong internal consistency and temporal stability, as well as strong concurrent validity on 9 of the 11 items examined with an urban Canadian population. In its first round of psychometric evaluation, the USPS demonstrated promise as a brief, easy to administer, scientifically rigorous tool for the evaluation of prevention-focused parenting programs.
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Affiliation(s)
- Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada,
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Benzies K, Yates M. The benefits of child obesity prevention programs. Can Nurse 2013; 109:13. [PMID: 23556348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Zucchi FCR, Yao Y, Ward ID, Ilnytskyy Y, Olson DM, Benzies K, Kovalchuk I, Kovalchuk O, Metz GAS. Maternal stress induces epigenetic signatures of psychiatric and neurological diseases in the offspring. PLoS One 2013; 8:e56967. [PMID: 23451123 PMCID: PMC3579944 DOI: 10.1371/journal.pone.0056967] [Citation(s) in RCA: 134] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Accepted: 01/18/2013] [Indexed: 12/21/2022] Open
Abstract
The gestational state is a period of particular vulnerability to diseases that affect maternal and fetal health. Stress during gestation may represent a powerful influence on maternal mental health and offspring brain plasticity and development. Here we show that the fetal transcriptome, through microRNA (miRNA) regulation, responds to prenatal stress in association with epigenetic signatures of psychiatric and neurological diseases. Pregnant Long-Evans rats were assigned to stress from gestational days 12 to 18 while others served as handled controls. Gestational stress in the dam disrupted parturient maternal behaviour and was accompanied by characteristic brain miRNA profiles in the mother and her offspring, and altered transcriptomic brain profiles in the offspring. In the offspring brains, prenatal stress upregulated miR-103, which is involved in brain pathologies, and downregulated its potential gene target Ptplb. Prenatal stress downregulated miR-145, a marker of multiple sclerosis in humans. Prenatal stress also upregulated miR-323 and miR-98, which may alter inflammatory responses in the brain. Furthermore, prenatal stress upregulated miR-219, which targets the gene Dazap1. Both miR-219 and Dazap1 are putative markers of schizophrenia and bipolar affective disorder in humans. Offspring transcriptomic changes included genes related to development, axonal guidance and neuropathology. These findings indicate that prenatal stress modifies epigenetic signatures linked to disease during critical periods of fetal brain development. These observations provide a new mechanistic association between environmental and genetic risk factors in psychiatric and neurological disease.
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Affiliation(s)
- Fabiola C. R. Zucchi
- Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
- Department of Biological Sciences, University of Mato Grosso State, Caceres, Mato Grosso, Brazil
| | - Youli Yao
- Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
- Department of Biological Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Isaac D. Ward
- Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Yaroslav Ilnytskyy
- Department of Biological Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - David M. Olson
- Departments of Obstetrics and Gynecology, Pediatrics and Physiology, University of Alberta, Edmonton, Alberta, Canada
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Igor Kovalchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Olga Kovalchuk
- Department of Biological Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
| | - Gerlinde A. S. Metz
- Department of Neuroscience, University of Lethbridge, Lethbridge, Alberta, Canada
- * E-mail:
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Ward ID, Zucchi FCR, Robbins JC, Falkenberg EA, Olson DM, Benzies K, Metz GA. Transgenerational programming of maternal behaviour by prenatal stress. BMC Pregnancy Childbirth 2013; 13 Suppl 1:S9. [PMID: 23446000 PMCID: PMC3561190 DOI: 10.1186/1471-2393-13-s1-s9] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Peripartum events hold the potential to have dramatic effects in the programming of physiology and behaviour of offspring and possibly subsequent generations. Here we have characterized transgenerational changes in rat maternal behaviour as a function of gestational and prenatal stress. Pregnant dams of the parental generation were exposed to stress from days 12-18 (F0-S). Their daughters and grand-daughters were either stressed (F1-SS, F2-SSS) or non-stressed (F1-SN, F2-SNN). Maternal antepartum behaviours were analyzed at a time when pregnant dams usually show a high frequency of tail chasing behaviours. F1-SS, F2-SNN and F2-SSS groups showed a significant reduction in tail chasing behaviours when compared with controls. The effects of multigenerational stress (SSS) slightly exceeded those of transgenerational stress (SNN) and resulted in absence of tail chasing behaviour. These findings suggest that antepartum maternal behaviour in rats is programmed by transgenerational inheritance of stress responses. Thus, altered antepartum maternal behaviour may serve as an indicator of an activated stress response during gestation.
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Affiliation(s)
- Isaac D Ward
- Canadian Centre for Behavioural Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB, Canada T1K3M4
| | - Fabíola C R Zucchi
- Canadian Centre for Behavioural Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB, Canada T1K3M4
| | - Jerrah C Robbins
- Canadian Centre for Behavioural Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB, Canada T1K3M4
| | - Erin A Falkenberg
- Canadian Centre for Behavioural Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB, Canada T1K3M4
| | - David M Olson
- Departments of Obstetrics & Gynecology, Pediatrics and Physiology, University of Alberta, 227 HMRC, University of Alberta, Edmonton, AB, Canada T6G2S2
| | - Karen Benzies
- Faculty of Nursing, University of Calgary, 2500 University Dr. NW, Calgary, AB, Canada T2N1N4
| | - Gerlinde A Metz
- Canadian Centre for Behavioural Neuroscience, University of Lethbridge, 4401 University Drive, Lethbridge, AB, Canada T1K3M4
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Abstract
Purpose: To solve large complex health-related problems, there has been a progressive movement towards interdisciplinary research teams; however, there has been minimal investigation into the attributes of successful teams. The purpose of this literature review was to examine the attributes that are important for the effective functioning of these teams.
Method: Literature from medicine, nursing and psychology databases, published between 1990 and 2010, was reviewed.
Principal findings: Thematic organization of the findings identified seven attributes important to effective interdisciplinary research teams: team purpose, goals, leadership, communication, cohesion, mutual respect and reflection. These attributes are described in depth.
Conclusion: Identification of these attributes could form the basis of a new measure to monitor interdisciplinary research team effectiveness, identify weaknesses and promote team development.
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Lakhani J, Benzies K, Hayden KA. Attributes of interdisciplinary research teams: a comprehensive review of the literature. CLIN INVEST MED 2012; 35:E226. [PMID: 23043705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Indexed: 06/01/2023]
Abstract
PURPOSE To solve large complex health-related problems, there has been a progressive movement towards interdisciplinary research teams; however, there has been minimal investigation into the attributes of successful teams. The purpose of this literature review was to examine the attributes that are important for the effective functioning of these teams. METHOD Literature from medicine, nursing and psychology databases, published between 1990 and 2010, was reviewed. PRINCIPAL FINDINGS Thematic organization of the findings identified seven attributes important to effective interdisciplinary research teams: team purpose, goals, leadership, communication, cohesion, mutual respect and reflection. These attributes are described in depth. CONCLUSION Identification of these attributes could form the basis of a new measure to monitor interdisciplinary research team effectiveness, identify weaknesses and promote team development.
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Devolin M, Phelps D, Duhaney T, Benzies K, Hildebrandt C, Rikhy S, Churchill J. Information and Support Needs among Parents of Young Children in a Region of Canada: A Cross-Sectional Survey. Public Health Nurs 2012; 30:193-201. [DOI: 10.1111/phn.12002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Maureen Devolin
- Sexual and Reproductive Health; Health Promotion, Disease and Injury Prevention; Population and Public Health; Alberta Health Services; Calgary; Alberta
| | - Dawn Phelps
- Early Childhood, Health Promotion, Disease and Injury Prevention; Population and Public Health; Alberta Health Services; Calgary; Alberta
| | - Tara Duhaney
- Sexual and Reproductive Health; Health Promotion, Disease and Injury Prevention; Population and Public Health; Alberta Health Services; Calgary; Alberta
| | - Karen Benzies
- Faculty of Nursing; University of Calgary; Calgary; Alberta
| | - Clare Hildebrandt
- Decision Support Strategies; Public Health Innovation and Decision Support, Surveillance and Health Assessment; Population and Public Health; Alberta Health Services; Calgary; Alberta
| | - Shivani Rikhy
- Alberta Children's Hospital; Alberta Health Services; Calgary; Alberta
| | - Jocelyn Churchill
- Best Beginning, Healthy Moms/Healthy Babies, and Antenatal Community Care Program; Public Health, Calgary Zone; Alberta Health Services; Calgary; Alberta
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Abstract
BACKGROUND Facebook is currently one of the world's most visited websites, and home to millions of users who access their accounts on a regular basis. Owing to the website's ease of accessibility and free service, demographic characteristics of users span all domains. As such, Facebook may be a valuable tool for locating and communicating with participants in longitudinal research studies. This article outlines the benefit gained in a longitudinal follow-up study, of an intervention programme for at-risk families, through the use of Facebook as a search engine. RESULTS Using Facebook as a resource, we were able to locate 19 participants that were otherwise 'lost' to follow-up, decreasing attrition in our study by 16%. Additionally, analysis indicated that hard-to-reach participants located with Facebook differed significantly on measures of receptive language and self-esteem when compared to their easier-to-locate counterparts. CONCLUSIONS These results suggest that Facebook is an effective means of improving participant retention in a longitudinal intervention study and may help improve study validity by reaching participants that contribute differing results.
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Affiliation(s)
- R Mychasiuk
- Faculty of Nursing, University of Calgary, AB, Canada.
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