Advance care planning for older people: The influence of ethnicity, religiosity, spirituality and health literacy.

In this discussion paper we consider the influence of ethnicity, religiosity, spirituality and health literacy on Advance Care Planning for older people. Older people from cultural and ethnic minorities have low access to palliative or end-of-life care and there is poor uptake of advance care planning by this group across a number of countries where advance care planning is promoted. For many, religiosity, spirituality and health literacy are significant factors that influence how they make end-of-life decisions. Health literacy issues have been identified as one of the main reasons for a communication gaps between physicians and their patients in discussing end-of-life care, where poor health literacy, particularly specific difficulty with written and oral communication often limits their understanding of clinical terms such as diagnoses and prognoses. This then contributes to health inequalities given it impacts on their ability to use their moral agency to make appropriate decisions about end-of-life care and complete their Advance Care Plans. Currently, strategies to promote advance care planning seem to overlook engagement with religious communities. Consequently, policy makers, nurses, medical professions, social workers and even educators continue to shape advance care planning programmes within the context of a medical model. The ethical principle of justice is a useful approach to responding to inequities and to promote older peoples' ability to enact moral agency in making such decisions.

"I was pretty sure I had the 'flu": qualitative description of confirmed-influenza symptoms.

Influenza is a common infectious disease, yet its diagnosis is rarely confirmed, rather is presumed in the presence of non-specific clinical symptoms. Public health organisations enlist the lay person in the diagnostic process, as infection containment initiatives focus on encouraging individuals with influenza-like illness to stay at home, seeking medical attention only in the presence of complications. While lay self-diagnosis of influenza has been confirmed to be neither specific nor sensitive, little is known about how people with confirmed-influenza infection describe their illness. In this article we report the descriptions of influenza by 21 individuals with rapid antigen test-kit confirmation of influenza A or B and we discuss their recommendations for management of future influenza infection. Semi-structured interviews reveal that the variability in symptoms and severity of disease makes a standard description of influenza elusive. Almost all participants had a cough, sweats, runny nose and muscle aches, but the prominence of these symptoms varied significantly between participants. Most participants were preoccupied with diagnostic certainty, and would seek medical attention in a future similar illness episode. This study underlined a conditioned recourse to medical authority for confirmation of diagnosis which challenges current public health strategies and should be further explored in order to determine its wider impact.

Primary healthcare NZ nurses' experiences of advance directives: understanding their potential role.

Advance directives are one aspect of advance care planning designed to improve end of life care. The New Zealand Nurses Organisation released their first mission statement in 2010 concerning advance directives suggesting an increase in the use of these. A burgeoning older population, expected to rise over the next few years, places the primary healthcare nurse in a pivotal role to address the challenges in constructing advance directives. While literature supports the role for primary healthcare nurses in promoting advance directives, no research was found on this role in the New Zealand context. This paper presents results of a qualitative study conducted in New Zealand with 13 senior primary healthcare nurses with respect to their knowledge, attitudes, and experiences of advance directives. Results of the analysis revealed a dynamic process involving participants coming to understand their potential role in this area. This process included reflection on personal experience with advance directives; values and ethics related to end of life issues; and professional actions.

Responding to adolescent women's reproductive health concerns: empowering clients through health literacy.

Adolescents have particular needs in health care that are often not met. Health care providers can help overcome barriers that hinder adolescents' effective use of health services by incorporating health literacy strategies that are developmentally and contextually appropriate, and that actively involve adolescents in their own learning. Based on extensive practice and research experience in Canada with rural and urban high school adolescent women, we offer suggestions for how health care providers can respond to adolescent women's reproductive health concerns by teaching these young women how to increase their skills in functional, communicative/interactive, and critical health literacy.

Challenges and opportunities in graduate nursing education by distributed learning in Canada and Brazil / Desafios e oportunidades na educação de pós-graduação em enfermagem por aprendizagem distribuída no Canadá e Brasil / Retos y oportunidades en la educación de postgrado en enfermería por aprendizaje distribuido en Canadá y Brasil

In this paper, the authors share their experience related to graduate nursing programs offered by distributed learning (DL) in Canada and Brazil. Although degrees offered by DL are often the subject of criticism, the authors’ experience has been that learning outcomes have been very good. Nevertheless, a number of challenges and opportunities have been encountered including those associated with flexibility of the program, delivering practice courses at a distance, facilitating interaction, faculty workload and preparation and student support, Newer technologies that may assist in this effort are identified. Despite the challenges encountered, students rate the program highly and ongoing efforts are underway to ensure excellence of such flexible innovative graduate programs in nursing. The authors argue that despite the challenges, DL programs offer high quality graduate education that meets the needs of many nurses.

Neste trabalho, os autores partilham suas experiências na pós-graduação em Enfermagem no Canadá e Brasil oferecidas por meio de aprendizagem distribuída (AD). Embora a AD seja freqüentemente objeto de críticas, a experiência dos autores tem sido de resultados positivos. No entanto, uma série de desafios e oportunidades é discutida, incluindo: flexibilidade do programa, possibilidade de oferecimento de cursos práticos à distância, necessidade de facilitar a interação professor/alunos, sobrecargade trabalho dos docentes, preparo dos docentes para este tipo de atividade e apoio aos estudantes. Novas tecnologias que podem apoiar o desenvolvimento da AD são apresentadas. Apesar dos desafios identificados, os estudantes avaliam positivamente a AD e esforços tem sido feitos para assegurar, de modo inovativo e flexível, a excelência de programas de pós-graduação em enfermagem. Os autores argumentam que apesar dos desafios existentes, os programas de AD oferecem alta qualidade para o ensino de pós-graduação na área de enfermagem e atendem às necessidades de muitos enfermeiros.

En este artículo, los autores comparten sus experiencias de programas de postgrado de enfermería, ofrecidos en Canadá y Brasil, el aprendizaje distribuido (AD). Aunque el AD sea objeto de críticas, la experiencia de los autores ha demostrado resultados positivos del aprendizaje. Sin embargo, se han encontrado algunos retos y oportunidades: los relacionados con laflexibilidad del programa, la posibilidad de ofrecimiento de cursos prácticos a distancia, la necesidad de facilitar la interacción profesor/estudiante y apoyo a los estudiantes, la sobrecarga de trabajo del profesor y la necesidad de su preparación para esta actividad, Nuevas tecnologías que pueden apoyar el desarrollo del AD son presentadas. A pesar de los desafíos identificados, los estudiantes evaluaron positivamente el AD y se esforzaron para asegurar, de manera innovadora y flexible, la excelencia de postgrado en enfermería. Los autores sostienen que a pesar de los desafíos, los programas de postgrado con el AD ofrecen educación de alta calidad y cumple las necesidades de muchas enfermeras.

Challenges and opportunities in graduate nursing education by distributed learning in Canada and Brazil.

In this paper, the authors share their experience related to graduate nursing programs offered by distributed learning (DL) in Canada and Brazil. Although degrees offered by DL are often the subject of criticism, the authors' experience has been that learning outcomes have been very good. Nevertheless, a number of challenges and opportunities have been encountered including those associated with flexibility of the program, delivering practice courses at a distance, facilitating interaction, faculty workload and preparation and student support, Newer technologies that may assist in this effort are identified. Despite the challenges encountered, students rate the program highly and ongoing efforts are underway to ensure excellence of such flexible innovative graduate programs in nursing. The authors argue that despite the challenges, DL programs offer high quality graduate education that meets the needs of many nurses.

Learning about Aboriginal contexts: the reading circle approach.

As more opportunities arise for nursing students to obtain experience in community sites, they will be called on to practice in culturally appropriate ways more often. Although nurses remain challenged by the range of populations needing differentiated approaches, Aboriginal cultural contexts deserve special attention. Nurse educators must help students increase their understanding of Aboriginal life and ways of knowing. One way to facilitate this understanding is through a learning approach called reading circles. Reading circles offer a structure in the classroom for students to interact about ideas or readings. The reading circle process is congruent with Aboriginal ways of learning, which emphasize working in circle, with each member having a role and an equal chance to be heard. Aboriginal students in the class may be particularly comfortable with this learning method. This article describes specific steps for incorporating the reading circle approach into the nurse education classroom.

Victimization and Relational Aggression in Adolescent Romantic Relationships: The Influence of Parental and Peer Behaviors, and Individual Adjustment.

Consistent with the view that adolescent relationships are established in the context of important characteristics of their social networks, we examined the effects of adolescents' experiences of parenting (psychological control and positive monitoring) and of peer aggression and victimization, on their self reports of dating victimization and aggression. We also examined the effects of individual differences in emotional and behavioral problems. We used questionnaire data from a population-based sample of youth 12-18 years old who were in dating relationships (n = 149). Parental monitoring emerged as a protective factor in reducing both dating victimization and relational aggression. Our findings also point to a significant transfer of aggression in peer relationships to relational aggression in dating relationships.

Building strengths through practice-research-policy collaborations.

Solving long-standing, sensitive social problems through community-based, collaborative partnerships requires more than rushed policies and program efforts that react to sudden crises. Efforts to support resilient trajectories in children dealing with adversities like peer victimization or adolescents' searching for engagements and identities in communities struggling with a dramatic change in its economic base requires a sustained and coordinated effort based on the best knowledge that we have. But action must not only be knowledge based, it must also be relevant, and the "buy-in" of or "pull from" those who are affected by the action as recipients or as implementers needs to be secured. Collaboration of policy makers, practitioners, and researchers can advance this agenda. Involving decision-makers and knowledge users in the formulation of knowledge has been highlighted as the best predictor for the application of research knowledge. Community-based research can ensure that research results are relevant to a wider audience and thus hasten adoption beyond the immediate communities.

A community of practice approach for Aboriginal girls' sexual health education.

INTRODUCTION: There is a paucity of intervention programs for Aboriginal girls and many of those that exist are delivered in culturally inappropriate ways. METHODS: In this paper, we provide an overview of recent research that focused on delivering a sexual health mentorship program that enhanced the voices of Aboriginal youth and was culturally relevant and appropriate to indigenous youth. RESULTS: Our program served to enhance social connection and reinforced a sense of belonging and relational mutuality among group members. CONCLUSION: The purpose of this article is to illustrate how a mentorship program that used a community of practice approach empowered Aboriginal youth to become successful border crossers and helped to align them with the wider community.

Using curriculum design principles to improve health education for adolescent girls.

Learning and teaching are main concepts within health contexts, but curriculum theory is generally overlooked in the design of health education. In this paper, we describe the curriculum development component of a health research study designed to develop and present educational interventions for adolescent girls. Through the use of these interventions, we encouraged the girls to recognize and address potential health compromises in their dating relationships. By blending our disciplinary approaches of nursing and education to address the challenges of this research, we developed a curriculum that would effectively meet the needs of the participants. To do this, we assessed humanistic, social reconstructionist, technological, and academic curriculum approaches to determine that our approach is one of social reconstruction. We then considered teacher-centered, learner-centered, and problem-centered curriculum designs, choosing both learner and problem centered, and analyzed six dimensions of these designs. We describe these approaches, designs, and dimensions of curriculum considering pedagogical issues, criteria for evaluation, and appropriateness to educational health intervention programs.

Beyond talking groups: strategies for improving adolescent health education.

In a study that focused on adolescent girls' health issues within their dating relationships, we found that nonstructured focus group conversation can be augmented with structured strategies to generate a nonthreatening environment in which participants are enabled to co-create an understanding of their experiences. The use of free writing, role playing, and body tracing helped raise participants' awareness and understanding of some of their health behaviors. We suggest that these strategies can be used in health care and educational contexts to promote the health of adolescents. By sharing strategies between education and health care professionals, both professions will benefit.

The tyranny of consensus: implications for nursing education.

The egalitarian appeal of decision making based on consensus has been valued as a strong alternative to other decision making approaches such as voting. In this paper, we identify some of the challenges inherent in this view, and suggest consideration of alternative decision making approaches needed at times to help nurse educators in their work with students and colleagues. As nurse educators, we have a responsibility to educate students about the meanings of consensus, to encourage open discussion about implicit values underlying behaviors, and help them appreciate the importance of dissent in a democratic society. Our challenge is to ensure that we are using, and teaching, the best decision making process for the circumstance.

"Like, what am I supposed to do?": adolescent girls' health concerns in their dating relationships.

This ethnographic study explored the health-related concerns, within dating relationships, of 40 female adolescents aged 15 and 16. The results reveal a complex interaction of male/female relational dynamics and socialization processes in these relationships. To avoid behaviours risky to their health, participants had to negotiate power relationships with partners and peers; yet, paradoxically, any increase in their power could increase the threat of violent confrontation, loss of power, and further health compromises. The girls' desire to have a dating partner outweighed their desire to avoid health threats such as substance abuse and violence. This dynamic can be understood in terms of patriarchal power imbalances. These findings point to the gravity of adolescent girls' health issues and the need for interventions that challenge mainstream culture and that foster empowerment among female adolescents.

Data collection strategies for accessing adolescent women's worlds.

A two-year study was initiated in 1999 to investigate adolescent women's health concerns pertaining to their relationships. Data were obtained from four groups of girls (ages 14-19; N = 31) that met for approximately 18 weeks each. To help equalize power in the groups and facilitate a respectful and caring environment, we encouraged each group to use a variety of strategies, including those based on feminist principles. Data collection procedures based on feminist values can enable researchers to gain rich descriptions on the lived experience of adolescent women. Such procedures can help create an environment in which individuals can articulate their concerns and collectively co-construct the meanings of life events in health-promoting and consciousness-raising ways.

Considerations for research ethics boards in evaluating qualitative studies: lessons from an ethnographic study with adolescent females.

Research ethics boards (REBs) have traditionally been required to evaluate quantitative research proposals. They are, however, increasingly facing the need to evaluate the ethical implications of proposals involving qualitative research. This article discusses one form of qualitative research, ethnography, in light of possible ethical concerns. It suggests ways in which ethical issues may be addressed, and provides examples drawn from an ethnographic study of adolescent girls' health concerns in their dating relationships. Recommendations for REBs are included.