Double-duty caregivers enduring COVID-19 pandemic to endemic: "It's just wearing me down".

The COVID-19 pandemic has considerably strained health care providers and family caregivers. Double-duty caregivers give unpaid care at home and are employed as care providers. This sequential mixed-method study, a survey followed by qualitative interviews, aimed to comprehensively understand the experiences of these Canadian double-duty caregivers amidst the pandemic and the transition to the endemic phase. The multi-section survey included standardized assessments such as the Double-duty Caregiver Scale and the State Anxiety Scale, along with demographic, employment-related, and care work questions. Data analysis employed descriptive and linear regression modeling statistics, and content analysis of the qualitative data. Out of the 415 respondents, the majority were female (92.5%) and married (77.3%), with 54.9% aged 35 to 54 years and 29.2% 55 to 64 years. 68.9% reported mental health decline over the past year, while 60.7% noted physical health deteriorated. 75.9% of participants self-rated their anxiety as moderate to high. The final regression model explained 36.8% of the variance in participants' anxiety levels. Factors contributing to lower anxiety included more personal supports, awareness of limits, younger age, and fewer weekly employment hours. Increased anxiety was linked to poorer self-rated health, and both perceptions and consequences of blurred boundaries. The eighteen interviewees highlighted the stress of managing additional work and home care during the pandemic. They highlighted the difficulty navigating systems and coordinating care. Double-duty caregivers form a significant portion of the healthcare workforce. Despite the spotlight on care and caregiving during the COVID-19 pandemic, the vital contributions and well-being of double-duty caregivers and family caregivers have remained unnoticed. Prioritizing their welfare is crucial for health systems as they make up the largest care workforce, particularly evident during the ongoing healthcare workforce shortage.

Newcomer Women's Experiences with Perinatal Care During the Three-Month Health Insurance Waiting Period in Ontario, Canada.

BACKGROUND: The three-month health insurance waiting period in Ontario reinforces health inequities for newcomer women and their babies. Little is known about the systemic factors that shape newcomer women's experiences during the OHIP waiting period. PURPOSE: To examine the factors that shaped newcomer women's experiences with perinatal care during the three-month health insurance waiting period in Ontario, Canada. METHODS: This qualitative study was informed by an intersectional framework, and guided by a critical ethnographic method. Individual interviews were conducted with four newcomer women and three perinatal healthcare professionals. Participant observations at recruitment and interview sites were integral to the study design. RESULTS: The key systemic factors that shaped newcomer women's experiences with perinatal care included social identity, migration, and the healthcare system. Social identities related to gender, race, and socio-economic status intersected to form a social location, which converged with newcomer women's experiences of social isolation and exclusion. These experiences, in turn, intersected with Ontario's problematic perinatal health services. Together, these factors form systems of oppression for newcomer women in the perinatal period. CONCLUSIONS: Given the health inequities that can result from these systems of oppression, it is important to adopt an upstream approach that is informed by the Human Rights Code of Ontario to improve accessibility to and the experiences of perinatal care for newcomer women.

Equity, diversity, and inclusion in open educational resources: An interpretive description of students' perspectives.

BACKGROUND: Although often assumed as objective, texts in nursing education are value-laden artifacts. Not unlike many educational materials, nursing texts are socially situated and often reflect dominant discourses of white supremacy, patriarchy, colonialism, cis/heteronormativity, gender binaries, and ableism. In addition to conveying what institutions and educators value, the discourses that are mediated through text socialize students in their ways of thinking and acting. There is a collective responsibility to critically examine how and why particular discourses persistently permeate texts used in nursing education. Open educational resources, as one type of text in nursing, are often touted as symbols of social justice because they are accessible for use by diverse learners and can be adapted to suit educators' needs. OBJECTIVES: With a focus on better understanding how equity, diversity, and inclusion can inform the design and production of open education resources, our guiding research question was: How do students perceive and envision equity, diversity, and inclusion in nursing-related open educational resources? DESIGN: Guided by a social justice framework, we used interpretive description methodology informed by participatory action research values to answer this question. SETTING, PARTICIPANT AND METHODS: Sixteen students participated from a post-secondary year-one nursing course in two focus groups and thirty-three students completed an open-ended survey. RESULTS: Data analysis yielded four themes: representation, learning, identities, and self. CONCLUSION: Nurse educators have the opportunity to design open educational resources in ways that empower students and elevate social justice. Thus, a more nuanced and critical approach towards social justice is needed to better integrate diversity in nursing-related resources.

Mothers Caring for Adult Children With Substance Use Disorder: Understanding Lived Experience.

BACKGROUND: Most persons with substance use disorder (SUD) live in family settings. In the absence of adequate mental health services, mothers are often called upon to provide care for their adult children with SUD. Despite positive outcomes such as decreased rates of hospitalization associated with family involvement, mothers are often stigmatized within the health care systems as contributors to trauma and/or family dysfunction. PURPOSE: The purpose of this study is to explore mothers' lived experience of caring for adult children with SUD. METHOD: Guided by critical feminist theory, this study used interpretive descriptive qualitative research design to identify patterns within mothers' experiences for practical relevance and application to service provision. RESULTS: The findings yielded in this study identified mothers' experiences as: longing for wellness, identity as loving mother, loss, anticipatory grief, shame and blame and feeling excluded from services. Ultimately, the findings from this study extend the limited research to date on mothers' experiences of stigma, especially when they are blamed for their child's illness. CONCLUSIONS: Findings from this study advocate for family-centered approaches that attend to mothers' unique experience, from their standpoint, and offer recommendations for change to service provision.

The COVID-19 Mask: Toward an Understanding of Social Meanings and Responses.

The COVID-19 pandemic has imposed unprecedented restrictions on everyday life. Unlike lockdown or shelter-in-place measures, the facemask has emerged as an empowering response to the public spread of the virus, permitting some degree of return to prepandemic life-such as school or work-by disrupting transmission that would otherwise occur. And yet, this utilitarian tool has attracted considerable controversy and polarized opinions. This article uses Blumer's adaptation of symbolic interactionism as a theoretical roadmap to examine the various meanings ascribed to the facemask and its usage. We discuss how it is socially perceived and consider implications for health care providers within the Canadian social context.

User Engagement Using an Etextbook: A Descriptive Study.

Engagement is an integral pedagogical component underpinning effective educational activities and is of importance for educators using online platforms. Carefully designed, technology-enabled learning resources can increase student engagement. We developed an open educational resource etextbook on vital sign measurement using an interactive and multimodal platform to facilitate student learning. The etextbook design was informed by experiential teaching-learning theory. Students progressed through the etextbook at their own pace, following pedagogy informed by the iterative process of read, observe, practice, and test, commonly used in nursing education. The etextbook was introduced as a required reading in a first-year health assessment course at one university and two colleges. In this project, we explored the level of engagement experienced by users of the etextbook. We conducted a descriptive study using the User Engagement Scale to measure students' degree of engagement using the etextbook. Results from participants (N = 455) who used the etextbook in the study indicated a high level of engagement. The responses to an open-ended item on the survey provided context to the results and shed light on effective design practices. Several recommendations for best practices in developing etextbooks are identified for educators to consider.

Curricular uptake of virtual gaming simulation in nursing education.

In nursing education, virtual simulations are used to augment in-person simulation and prepare and supplement students for clinical placements. More recently, as a result of the COVID-19 pandemic, virtual simulations are being used to replace clinical hours. Many virtual simulations require the user to make decisions that affect the outcome of the simulated experience. In this article, we provide a historical account of the virtual gaming simulations that members of our team developed and the processes that led to successful uptake into curriculum. In addition, we share lessons learned from our experiences in terms of maximizing curricular uptake. We found engagement of the teaching team is essential when using VGS in a course. In addition, when using VGS, it is important to follow the process of prebrief, enactment, debrief and evaluation. Educators can build on and grow from our lessons learned so that the path to embedding virtual gaming simulation in curriculum becomes clear.

Unpacking the hidden curriculum in nursing education: clinical placements abroad.

Many Canadian nursing programs endorse clinical placements abroad. We critically examined the hidden curriculum embedded in clinical placements seeking to provide a 'global' experience. Using purposeful sampling, we interviewed a total of 18 participants, including eight faculty, eight students and two placement coordinators. Data were analyzed using initial and focused coding, supported by NVivo. After generating themes from the coded data, we adapted Hafferty's (1998) framework to further analyze the theme of the hidden curriculum. The findings illuminate how policies sustained international experience as a privileged endeavour, with restricted access based on grades. Placements incorporated little evaluation of benefits for local communities. Few resources were allocated to students for such placements, as many students paid for their placement. The institutional terms 'international and global experience' denoted interactions with cultural "Others". We recommend that nursing programs attend to hidden practices that sustain clinical placements abroad as prestigious, commodified experiences.

Client or Volunteer? Understanding Neoliberalism and Neocolonialism Within International Volunteer Health Work.

As international volunteer health work increases globally, research pertaining to the social organizations that coordinate the volunteer experience in the Global South has severely lagged. The purpose of this ethnographic study was to critically examine the social organizations within Canadian NGOs in the provision of health work in Tanzania. Multiple, concurrent data collection methods, including text analysis, participant observation and in-depth interviews were utilized. Data collection occurred in Tanzania and Canada. Neoliberalism and neocolonialism were pervasive in international volunteer health work. In this study, the social relations-"volunteer as client," "experience as commodity," and "free market evaluation"-coordinated the volunteer experience, whereby the volunteers became "the client" over the local community and resulting in an asymmetrical relationship. These findings illuminate the need to generate additional awareness and response related to social inequities embedded in international volunteer health work.

Evaluating dementia home care practices: The reification of care norms.

This critical ethnographic study examined how power relations shape the nature and enactment of caregivers' evaluation of home-based dementia care practices. As the home care sector continues to evolve and prepare itself as a key element in caring for people living with dementia and their families, this study grounds our understanding of how dementia home care practices are enacted and evaluated, particularly at the interface of formal and familial caregiving. The critical finding from our data is that not all evaluations of care practices were considered equally meaningful or relevant, and, moreover, their significance depended on whether the evaluation was made by someone in a position of power. Renewed awareness of and attention to power relations, such as class and gender, are implicated in the evaluation of care practices. Consequently, challenging how power is enacted in ways that (re)produces and reifies care norms is vital in order to foster equitable and supportive partnerships in home-based dementia care.

Virtual Gaming Simulation in Nursing Education: A Focus Group Study.

BACKGROUND: The use of serious gaming in a virtual world is a novel pedagogical approach in nursing education. A virtual gaming simulation was implemented in a health assessment class that focused on mental health and interpersonal violence. The study's purpose was to explore students' experiences of the virtual gaming simulation. METHOD: Three focus groups were conducted with a convenience sample of 20 first-year nursing students after they completed the virtual gaming simulation. RESULTS: Analysis yielded five themes: (a) Experiential Learning, (b) The Learning Process, (c) Personal Versus Professional, (d) Self-Efficacy, and (e) Knowledge. CONCLUSION: Virtual gaming simulation can provide experiential learning opportunities that promote engagement and allow learners to acquire and apply new knowledge while practicing skills in a safe and realistic environment. [J Nurs Educ. 2017;56(5):274-280.].

Nurses negotiating professional-familial care boundaries: striving for balance within double duty caregiving.

The purpose of this sequential, two-phase mixed-methods study was to examine the health of male and female nurses who provided care to older relatives (i.e., double duty caregivers). We explored the experiences of 32 double duty caregivers, which led to the development of an emergent grounded theory, Negotiating Professional-Familial Care Boundaries with two broad dialectical processes: professionalizing familial care and striving for balance. This article examines striving for balance, which is the process that responds to familial care expectations in the midst of available resources and reflects the health experiences of double duty caregivers. Two subprocesses of striving for balance, reaping the benefits and taking a toll, are presented in three composite vignettes, each representing specific double duty caregiving (DDC) prototypes (making it work, working to manage, living on the edge). This emergent theory extends current thinking of family caregiving that will inform the development and refinement of practices and policies relevant to DDC.

Professionalizing familial care: examining nurses' unpaid family care work.

An emergent grounded theory was used to examine Professionalizing Familial Care, the processes by which registered nurses enact professional care work within the familial care domain. A sample of registered nurses (n = 32) were interviewed by telephone at multiple time points over a 6- to 12-month period. The findings revealed that the professionalization of care work was often reinforced by societal, familial, and self-expectations. Setting Limits and Making Connections were the dialectical overarching processes shaping the professionalizing of care while 6 interdependent substrategies emerged: assessing, advising, advocating, collaborating, coordinating, and consulting. These findings will help inform refinement of policies and practices for nurses who provide care for an older relative.

Making care decisions in home-based dementia care: why context matters.

The hours of unpaid elder care by family members are projected to triple by 2038. Because living with dementia can inhibit decision-making abilities, family members are often besought to assist in this process. In this ethnographic study, relationships within home-based dementia care were critically examined through face-to-face interviews and participant observations with clients, family caregivers, and home care providers (n = 51). The findings revealed how the formalized home care system contextually imposes decisions, and revealed three themes: (1) accommodating clinically defined competence/incompetence, (2) making untimely decisions, and (3) reinforcing exclusion in decision making. These themes shed light on how cultural values (competency), beliefs (immutability of the system), and practices (timing of decisions) of the home care system are ultimately deterministic in decision making for persons with dementia and caregivers. Additional attention to the collaborative and inclusive practices of all family members in dementia home care is imperative in order to optimize health.

Dementia home care resources: how are we managing?

With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1) finite formal care-inexhaustible familial care, (2) accessible resources rhetoric-Iinaccessible resources reality, and (3) diminishing care resources-increasing care needs. The development of policies and practices that provide available, accessible, and appropriate resources, ensuring equitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future.

Predictors of pneumococcal vaccination among older adults with pneumonia: findings from the Community Acquired Pneumonia Impact Study.

BACKGROUND: The incidence of community-acquired pneumonia (CAP) almost triples for older adults aged 65 years or older. In Canada, CAP is a leading cause of hospital admissions and mortality. Although CAP is very prevalent, complications due to CAP may be reduced with the pneumococcal polysaccharide vaccine (PPV). The purpose of this study was to identify predictors of pneumococcal vaccination among community-dwelling older adults with clinically diagnosed CAP. METHODS: A telephone survey was used to collect detailed information from adults aged 60 years and older with clinically diagnosed CAP. This was a community wide study with participants being recruited from all radiology clinics in one Ontario community. RESULTS: The most important predictors of pneumococcal vaccination among older adults included: getting an influenza vaccine within the past year (OR 14.5, 95% CI 4.27 to 49.0); at least weekly contact with a friend (OR 3.97, 95% CI 1.71 to 9.24); having one or more co-morbidities/chronic conditions (OR 3.64, 95% CI 1.60 to 8.28); being 70 years of age or older (OR 2.56, 95% CI 1.21 to 5.40); having health problems that limited physical activities (OR 5.37, 95% CI 1.49 to 19.3); having little or no bodily pain (OR 2.90, 95% CI 1.25 to 6.73); and reporting having spiritual values or religious faith (OR 3.47, 95% CI 1.03 to 11.67). CONCLUSIONS: A wide range of factors, including demographic, co-morbidity, quality of life, social support and lifestyle were found to be associated with pneumococcal vaccination status among older adults with clinically diagnosed CAP. The findings from this study could inform future pneumococcal immunization strategies by identifying individuals who are least likely to receive the PPV.