Psychological Distress and Unmanaged Negative Emotions: Examining Resilience Among Nurses Working on COVID-19 Designated Inpatient Units.

Anecdotal evidence suggests nurses are engaging in resilience-based strategies to mitigate increased levels of psychological distress and unmanaged negative emotions they have been experiencing. Nurses' levels of resilience during the coronavirus disease 2019 (COVID-19) pandemic have not been clearly articulated, specifically in relation to psychological distress and negative emotions. The purpose of the current mixed-methods non-experimental descriptive study was to examine nurses' resilience during the pandemic. Sixty RNs working in acute care hospitals on inpatient units designated to care for patients with COVID-19 completed the study survey and 20 of these RNs completed an interview. Findings indicate moderate levels of resilience among participants, with the need to increase resources and support emerging as a common theme among the qualitative data. Suggestions for integration of resilience-based strategies into the clinical setting, such as creation of a dedicated space for nurses to engage in mindfulness, relaxation, and meditation, were put forward. [Journal of Psychosocial Nursing and Mental Health Services, 60(9), 24-28.].

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.

Women's Experiences of Intimate Relationships While Living With Irritable Bowel Syndrome.

Irritable bowel syndrome is a chronic digestive disorder that commonly affects women. Research has shown that the illness experience of irritable bowel syndrome can disrupt social relationships. However, the area of intimate relationships has yet to be explored despite the deep involvement that intimate partners often have in the experience of living with chronic illness. Using a critical feminist lens, a narrative methodology was employed to explore women's experiences of intimate relationships while living with irritable bowel syndrome. Data collection methods included semistructured interviews and an arts-informed activity. The women's narrative accounts and artistic pieces reflected the emotional, physical, and interpersonal aspects of intimacy while living with irritable bowel syndrome. The findings indicated that women's experiences were deeply emotional and involved laborious and gendered emotion work. Their body concept complicated their relationship experiences. Women's emotional and social well-being was fostered by their partners' provision of acceptance, understanding, and support. The findings highlighted the need to implement and further explore the inclusion of emotional support and counselling as well as dyadic and gendered approaches to irritable bowel syndrome management.

Facilitators and Barriers of Heart Surgery Discharge: Patients' and Nurses' Narrative Accounts.

BACKGROUND: Optimal patient recovery from open-heart surgery relies on effective discharge planning and education. However, the nature of the discharge experience has not been clearly described. OBJECTIVE: The study purpose is to explore patients' and nurses' narrative accounts of the facilitators and barriers of heart surgery discharge. METHODS: A qualitative study was employed using a narrative methodology that elicited and analyzed stories. This research was conducted in a large, urban hospital in Ontario, Canada. A total of 17 patients and nurses were recruited. Five female and 5 male patients were recruited from a preoperative clinic. Ages ranged from 37 to 80 years. Seven nurses were recruited from inpatient cardiovascular units. They had 2 to 19 years of cardiovascular nursing experience. Semistructured, narrative-based interviews were conducted. Two interviews were conducted with each patient at 1 week after discharge and at 4 to 6 weeks. One interview was conducted with each nurse. RESULTS: Findings indicate that although the preoperative period was identified as an effective time for discharge preparation, the patient's cognitive capacity was limited during the postoperative phase of surgery. Both nurses and patients also found that insufficient time impeded the discharge process and limited individualized discussions. The structured and standardized delivery of discharge information affected patients' capacity to apply it to the particularities in their own lives and homes. The fostering of therapeutic relationships created a space where patients felt comfortable sharing their concerns and nurses learned more about patients and thus could better tailor the discharge approach. CONCLUSIONS: Study recommendations include group and scenario-based education in which patients and nurses brainstorm about how to apply the discharge information to the particularities of patients' lives and homes. Provision of support needs to be bolstered during the home period, where patients have timely opportunities to discuss their concerns and questions with practitioners or possibly peers.

Dance for Individuals With Dementia.

The movement and music associated with dance plays an important role in many individuals' lives and can become imprinted upon the body and mind. Dance is thus closely associated with memory because of these deep connections. Without conscious thought, dance has the potential to be initiated as individuals age. In the current article, the authors share narrative reflections about their experiences with, and the potential of, dance as an intervention for aging populations diagnosed with dementia-related diseases. They draw upon their experiences in working with the aging population and a dance program currently being developed by Canada's National Ballet School and Baycrest Health Sciences for individuals with dementia-related diseases in long-term care. The current article is structured as dialogue between the authors because it mimics dance as a dialogical encounter between movement and music, and/or between individuals.

"I'm No Superman": Understanding Diabetic Men, Masculinity, and Cardiac Rehabilitation.

Exercise-based cardiac rehabilitation (CR) programs help patients with coronary heart disease (CHD) reduce their risk of recurrent cardiac illness, disability, and death. However, men with CHD and Type 2 diabetes mellitus (T2DM) demonstrate lower attendance and completion of CR despite having a poor prognosis. Drawing on gender and masculinity theory, we report on a qualitative study of 16 Canadian diabetic men recently enrolled in CR. Major findings reflect two discursive positions men assumed to regain a sense of competency lost in illness: (a) working with the experts, or (b) rejection of biomedical knowledge. These positions underscore the varied and sometimes contradictory responses of seriously ill men to health guidance. Findings emphasize the priority given to the rehabilitation of a positive masculine identity. The analysis argues that gender, age, and employment status are powerful mechanisms of variable CR participation.

Examining the effect of patient-centred care on outcomes.

Within patient-centered care (PCC), the individual is viewed as an active member of the healthcare team. While there has been recent interest in conducting systematic reviews to examine the effectiveness of PCC interventions, various studies fall short in explaining the type of intervention most effective in producing significant changes to desired outcomes. The purpose of this systematic review was to determine the characteristics of PCC interventions that have demonstrated effectiveness in enhancing the quality of care and performance of self-care behaviours. A systematic review of 40 studies that addressed PCC interventions, included samples over the age of 18 years, and were published between 1995 and 2014 was performed. Descriptive statistics were used to delineate study, participant, and intervention characteristics. Results suggest PCC-based interventions are not effective when delivered to individuals living with chronic illnesses.

The experience of developing a faculty research cluster using the creativity of the narrative reflective process.

Faculty development that builds research capacity is a significant yet challenging expectation in academia. The School of Nursing faculty at Ryerson University established several research clusters to support research collaborations and productivity. This article explicates one cluster's development process, and specifically, its adoption of the narrative reflective process (NRP). Engaging in NRP permitted the group to creatively enter into critical dialogue, address both individual and collective needs, and establish a supportive environment that nurtures the creative process--all of which ultimately enhances scholarship and academic productivity.

"Treat Me Like a Person": Unveiling Healthcare Narratives of Muslim Women who Wear Islamic Head Coverings Through a Poststructural Narrative Study.

BACKGROUND: In Canada, the healthcare experiences and needs of Muslim women who wear Islamic head coverings are conflated with the larger Muslim community who do not wear Islamic head coverings. Understanding their specific and unique preferences and challenges is essential for tailoring care and improving healthcare encounters. PURPOSE: The study purpose is to explore the healthcare encounters of Muslim women wearing Islamic head coverings in Canada, focusing on how discourse influences their narratives. METHODS: A postructuralist narrative methodology was used to understand how power, knowledge, language, and discourse impacted their experiences. Semi-structured interviews were conducted with eight Muslim women. Narrative analysis was used to dissect stories and the way these stories were told. RESULTS: Five themes were identified, including: The Fingerprint: Highlights the importance of recognizing individual identities to provide personalized care.The Membrane: Examines how societal biases and assumptions permeate healthcare professionals and impacts care.The Heartbeat: Reveals the immediate emotional and physical responses that reflect systemic challenges within healthcare encounters.Unseen: Emphasizes the lack of acknowledgement experienced by Muslim women related to their healthcare preferences and/or needs.Heard: Encompasses instances where Muslim women feel recognized by their healthcare provider; contrasts Theme #4. CONCLUSION: This research emphasizes the diverse experiences of Muslim woman who wear an Islamic head covering and the need for healthcare professionals to move away from a one-size-fits-all approach and instead, provide care that respects the unique preferences amongst this diverse group.

Theoretical framing of high-fidelity simulation with Carper's fundamental patterns of knowing in nursing.

Many nursing programs integrate high-fidelity simulation(HFS) into the curriculum. The manikins used are modeled to resemble humans and are programmed to talk and reproduce physiological functions via computer interfaces.When HFS design negates a theoretical framework consistent with the interpersonal and relational nature of nursing,it can problematically focus simulation on psychomotor skills and the physical body. This article highlights a theorized approach to HFS design informed by Carper's seminal work on the fundamental patterns of knowing in nursing(i.e., empirics, esthetics, personal knowing, and ethics). It also describes how a team of Canadian nurse educators adopted these patterns of knowing as a theoretical lens to frame scenarios, learning objectives, and debriefing probes in the context of maternal and newborn assessment. Institutions and practitioners can draw on Carper's work to facilitate focusing on the whole person and expanding the epistemological underpinnings of HFS in nursing and other disciplines.

"I can't just follow any particular textbook": immigrants in cardiac rehabilitation.

AIM: The study purpose was to examine how and under what circumstances immigrants combine diabetes self-care with cardiac rehabilitation recommendations. BACKGROUND: Cardiac rehabilitation can improve and lengthen life in people with coronary heart disease as it promotes healthy physical and psychosocial behaviours and outcomes. This study is the first to examine the convergence of two common issues on participation: (1) the problems posed when cardiac rehabilitation patients must also contend with type II diabetes and (2) the experiences of immigrants in cardiac rehabilitation. DESIGN: A critical ethnographic approach was employed. METHODS: Two in depth interviews were conducted with 18 immigrants (eight men, ten women) enrolled in cardiac rehabilitation. Data were collected from 2008-2010. FINDINGS: Threaded throughout immigrant participants' descriptions were biographical accounts of crossing geographical borders, establishing a sense of belonging in their adopted country and trying to feel 'at home' in cardiac rehabilitation. Participants described creative hybridization of transnationally informed knowledges and particularized practices to manage diabetes self-care and to reduce cardiac risk. Participants judiciously considered, assessed and blended knowledges from cardiac rehabilitation, experience with their own bodies and general 'wisdoms' passed on within their own and other immigrant communities. CONCLUSION: These findings suggest that migration constitutes an important social positioning that contextualizes individual efforts to activate diabetes self-care and cardiac rehabilitation. Support to immigrants may improve when nurses recognize the significance of such experiences. Efforts are needed in practice and research to recognize and explore immigrants' creative efforts to engage in cardiac rehabilitation.

A cyborg ontology in health care: traversing into the liminal space between technology and person-centred practice.

Person-centred practice indubitably seems to be the antithesis of technology. The ostensible polarity of technology and person-centred practice is an easy road to travel down and in their various forms has been probably travelled for decades if not centuries. By forging ahead or enduring these dualisms, we continue to approach and recede, but never encounter the elusive and the liminal space between technology and person-centred practice. Inspired by Haraway's work, we argue that healthcare practitioners who critically consider their cyborg ontology may begin the process to initiate and complicate the liminal and sought after space between technology and person-centred practice. In this paper, we draw upon Haraway's idea that we are all materially and ontologically cyborgs. Cyborgs, the hybridity of machine and human, are part of our social reality and embedded in our everyday existence. By considering our cyborg ontology, we suggest that person-centred practice can be actualized in the contextualized, embodied and relational spaces of technology. It is not a question of espousing technology or person-centred practice. Such dualisms have been historically produced and reproduced over many decades and prevented us from recognizing our own cyborg ontology. Rather, it is salient that we take notice of our own cyborg ontology and how technological, habitual ways of being may prevent (and facilitate) us to recognize the embodied and contextualized experiences of patients. A disruption and engagement with the habitual can ensure we are not governed by technology in our logics and practices of care and can move us to a conscious and critical integration of person-centred practice in the technologized care environments. By acknowledging ourselves as cyborgs, we can recapture and preserve our humanness as caregivers, as well as thrive as we proceed in our technological way of being.

A performative and poetical narrative of critical social theory in nursing education: an ending and threshold of social justice.

In this article, a poetical and performative narrative is shared to examine how the use of stories to critically self-reflect on oppression facilitates an understanding of critical social theory in nursing education and impacts social justice. A fusion of prose with a poetical narrative is employed; the latter is reserved to capture the immediacy of personal, emotive, and embodied storied experiences. This deeply intimate and dialogical story begins with a pedagogical experiment created to facilitate nursing students' understanding of critical social theory. Drawing upon Paulo Freire's work, the nursing teacher in a professional development course attempted to deconstruct power relations and cultivate an open and safe learning environment by sharing a poem that depicts her oppression. Students then anonymously wrote a word/statement about their oppression. The teacher created a composite poem from students' words and shared it with the class; it was a powerful moment that highlighted their shared humanity. As a way to further explore stories and consider how to preserve these words, a small group of students and the teacher formed the 'the oppression group'. Towards the end, we conclude an unfinished story by realizing that the chains of oppression are loosening and humanity is surfacing. There is still a camouflaging of an authentic self. There are still stories to be told. The group is not yet certain if a social representation of an authentic self is possible and if all stories can be told. It has become apparent that the personal can play out in social justice as enacted in the classroom between teacher and students and provides an entry point into the development of the capacity to be social agents in nursing. The group simultaneously concludes the story with both an ending and a threshold of social justice.

Beyond instrumental support: Mobile application use by family caregivers of persons living with dementia.

In recent years, there has been a rapid increase in technology use in dementia caregiving, particularly the use of mobile applications (apps) which are highly accessible, cost-effective and intuitive. Yet, little is known about the experiences of family caregivers of persons living with dementia who use apps to support caregiving activities. This is of particular concern given that limited understandings of the user experience in designing technology have often led to end-users experiencing barriers in technology adoption and use. Using a qualitative descriptive approach, the purpose of the study was to explore the experiences of family caregivers of persons living with dementia on using apps in their caregiving roles. A purposive sample of five family caregivers in Ontario, Canada participated in two interviews each, with the second interview informed by photo-elicitation methods. Thematic analysis of the collected data revealed a central overarching theme, Connecting to support through apps in my, your and our lives, which explicated how apps played an important role in the lives of the caregiver, the care recipient and both together as a dyad. Three core themes also emerged: Adapting apps to meet individual needs of the dyad, Minimising the impact of the condition on the person and the family and Determining the effectiveness of apps. The findings highlighted that the value of apps extends beyond their mere functionality and their ability to help with care provision as they are also able to promote richer interpersonal connections, enhance personhood and sustain family routines. This research advances our understanding of the impact of app use in caregiving and provides direction for future research, policy, education, practice and app development.

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.

"Goodbye Through a Glass Door": Emotional Experiences of Working in COVID-19 Acute Care Hospital Environments.

BACKGROUND: The severity of the COVID-19 health crisis has placed acute care nurses in dire work environments in which they have had to deal with uncertainty, loss, and death on a constant basis. It is necessary to gain a better understanding of nurses' experiences to develop interventions supportive of their emotional well-being. PURPOSE: The purpose of this study is to explore how nurses are emotionally affected working in COVID-19 acute care hospital environments. The research question is: What is the emotional experience of nurses working in COVID-19 acute care hospital environments? METHODS: We employed a narrative methodology that focused on participants' stories. Twenty registered nurses, who worked in six hospitals in the Greater Toronto Area in Canada, participated in interviews. A narrative analysis was conducted with a focus on content and form of stories. RESULTS: We identified three themes about working in COVID-19 acute care hospital environments: the emotional experience, the agency of emotions, and how emotions shape nursing and practice. CONCLUSION: In moving forth with pandemic preparations, healthcare leaders and governments need to make sure that a nurse's sacrifice is not all-encompassing. Supporting nurses' emotional well-being and resilience is necessary to counterbalance the loss and trauma nurses go through.

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.

Focus group reactions to an arts-based educational exhibit on menopausal hot flashes.

OBJECTIVE: To assess public reactions to an arts-based educational exhibit designed to immerse and engage people in scientific facts to increase their conceptual understanding of hot flashes. Our ultimate goals were to stimulate learning and conversations about menopausal hot flashes to change interactions between menopausal women and providers, and menopausal women and other people (family, friends, etc). Focus groups reacted to the concept art (graphics, miniaturized model); and a questionnaire for quickly assessing reactions. METHODS: Using a qualitative descriptive methodology, six focus groups of diverse people (n = 50) aged 13 to 64 years described their reactions to the art and questionnaire. Recruitment methods were word of mouth, advertisements on university websites, and a university-based participant registry. Data were analyzed using qualitative content analysis and inductively derived codes. RESULTS: Reactions to the concept art were generally favorable. Participants remarked on appealing and less appealing aspects and age appropriateness. Appealing aspects were resonance with women's experiences, clear information, use of symbolism, and overall design. Less appealing aspects lacked resonance, contained confusing information, or unappealing design elements. Participants felt the exhibit should be open to all ages. The final questionnaire reflected participants' descriptions of the art's ability to stimulate learning, dispel myths, spur dialog, and increase empathy. CONCLUSIONS: The concept art is an appropriate tool for improving knowledge and communication about hot flashes. Displaying the concept art and/or future full-scale exhibit in healthcare settings or public venues may facilitate learning and communication among three groups-menopausal women, healthcare providers, and others.