Understanding the Experience of Miscarriage in the Emergency Department.

INTRODUCTION: Up to 20% of pregnancies end in miscarriage, which can be a significant life event for women with psychological implications. Because the only preventative measure for a miscarriage is risk factor modification, the treatment focuses on confirming the miscarriage has occurred and medical management of symptoms. Although women experiencing a miscarriage are frequently directed to seek medical care in emergency departments, the patients are often triaged as nonemergent patients unless they are unstable, which exposes women to potentially prolonged wait times. Research about miscarriages and emergency departments predominantly focus on medical management with little understanding of how emergency care shapes the experience of miscarriage for women. METHODS: Seeking to describe the experiences of women coming to the emergency department for care while having a miscarriage, interpretive phenomenology-a form of qualitative research-guided this study. Eight women were recruited to participate in semi-structured face-to-face interviews of 60 to 90 minutes in length. Data were analyzed using hermeneutics and thematic analysis. RESULTS: Five themes emerged: "Pregnant/Life: Miscarriage/Death"; "Deciding to go to the emergency department: Something's wrong"; "Not an illness: A different kind of trauma"; "Need for acknowledgement"; and "Leaving the emergency department: What now?". Participants believed their losses were not acknowledged but instead dismissed. These experiences, combined with a perceived lack of discharge education and clarity regarding follow-up, created experiences of marginalization. DISCUSSION: This study describes the experience of miscarrying in emergency departments and provides insights regarding how nursing and physician care may affect patient perceptions of marginalization.

Referral pathways to early intervention services for psychosis and their influence on perceptions of care: An interpretive phenomenological analysis.

AIM: Most young adults experiencing psychosis enter early intervention services (EIS) via inpatient and emergency departments. These experiences are suggested to negatively impact their views of treatment and engagement in EIS. However, limited research has examined the impact of young adults' prior help-seeking experiences on these outcomes. The present study aimed to explore how young adults engaged in EIS have experienced initial help-seeking and make sense of these experiences in the context of their current treatment. METHODS: Using an interpretative phenomenological analysis approach, semi-structured interviews were conducted with 12 young adults (mean age = 24.83) within their first 3-12 months of treatment in EIS. Interviews aimed to examine their experiences of help-seeking and referral to EIS as well as the impact of these experiences on their subsequent perception of, and engagement with EIS. RESULTS: 3 superordinate themes emerged: (1) Navigating the Maze of Healthcare (2) Dignity and (3) Impact of Help-Seeking and Referral Experiences. Participants with referral pathways involving urgent care services described more adversity during their referral pathway and tended to describe help-seeking experiences as contributing to negative views towards EIS and diminished engagement in treatment. CONCLUSIONS: The impact of early negative experiences with healthcare on views towards EIS and engagement is evident in participants' accounts. Sense making was further contextualized by participants' illness insight, degree of recovery, and social support throughout experiences. Emergent themes highlight the need for psychiatric services to emphasize service users' dignity and for EIS to provide opportunities for patients to process past negative mental healthcare experiences to strengthen engagement.

Prescribing trends of antipsychotics in youth receiving income assistance: results from a retrospective population database study.

BACKGROUND: Prescribing of antipsychotics (AP) to young people has increased in the last decade internationally. We aimed to characterize AP prescribing in a population of low-income youth in Nova Scotia, Canada. METHODS: We conducted a population database study of AP prescription claims and health services utilization by young people aged 25 years and younger receiving drug benefits through the publicly funded Pharmacare program between October 1, 2000 to September 30, 2007. RESULTS: Four percent (1715/43888) of youth receiving Pharmacare benefits filled AP prescriptions. The use of second generation antipsychotics (SGAs) significantly increased (p < 0.0001) in all age groups except 0-5 year olds, whereas first generation antipsychotic use significantly decreased. Pharmacare beneficiaries aged 21-25 years represented 45.2% of AP users. The majority (66%) of youth filling AP prescriptions had 2 or more psychiatric diagnoses. Most youth (76%) filled prescriptions for only one type of AP during the study period. Psychotic disorders were the most common indication for AP use except with risperidone, in which ADHD was the most likely reason for use. Co-prescribing of psychotropics was prevalent with antidepressants and mood stabilizers prescribed in 42% and 27% of AP users, respectively. General practitioners (GPs) prescribed incident APs most often (72%) followed by psychiatrists (16%). The age- and gender-adjusted rate of death was higher in AP users as compared to the age-matched general population of Nova Scotia. CONCLUSIONS: SGA use increased significantly over seven years in a cohort of 0 to 25 years olds receiving Pharmacare benefits. Off-label use of APs was prevalent with ADHD and other non-psychotic disorders being common reasons for AP use. GPs initiated most AP prescriptions. Co-prescribing of other psychotropics, especially antidepressants and mood stabilizers, was prevalent even in younger age strata. This study raises further questions about AP prescribing in those 25 years of age and under, especially given the range of diagnoses and psychotropic co-prescribing.

Brief report: youth pathways out of homelessness - preliminary findings.

While there exists an extensive body of knowledge regarding the risks associated with youth homelessness, very little work has addressed the process of exiting street contexts. This paper reports baseline findings from an ongoing longitudinal study assessing factors associated with a successful transition out of homelessness. Fifty-one formerly homeless youth who obtained stable housing in the past 2 months to 2 years participated in this study which took place in two Canadian urban centres. Findings include poorer functioning across all domains for youth residing in housing contexts without supports, a lack of relationship between psychological and behavioural aspects of community integration, and the central role of self-concept in mental health and quality of life. These findings suggest the need for ongoing support for youth exiting street spaces and social contexts, with attention to the importance of self-concept and psychological aspects of community integration.

Mothers and infants exposed to intimate partner violence compensate.

Reasons for the developmental variability in children exposed to intimate partner violence (IPV) are unclear and under studied. This article presents exploratory findings on (a) the potential impact of IPV on mother-child relationships and child development and (b) the association between these maternal-child relationship impacts and child development. The fit of findings with compensatory, spillover, and compartmentalization hypotheses was explored. Participants were 49 mothers and 51 children younger than 3 years of age affected by IPV. Data were collected on maternal-child interactions, child development, social support, difficult life circumstances, family functioning, child temperament, and parental depression. The findings suggested developmental impacts on children in the sample, along with children's high sensitivity and responsiveness to their caregivers. Although some spillover effects were observed, the predominant observation was of mothers and infants compensating for exposure to IPV in their interactions.

Women's Experiences Regarding Physical Activity during the Postpartum Period: A Feminist Poststructuralist Study.

Although recovery after birth can be promoted through bodily movement, many women do not engage in regular postpartum physical activity. While research studies have identified some of the reasons behind their decisions, including a lack of time, only a limited number of studies have been carried out to explore how postpartum physical activity is socially and institutionally constructed. Thus, the present study aimed to investigate the experiences of women regarding postpartum physical activity in Nova Scotia. Six postpartum mothers participated in semi-structured, virtual, in-depth interviews. Women's experiences of postpartum physical activity were examined through a discourse analysis guided by feminist poststructuralism. The following themes were identified: (a) socialization in different ways; (b) social support; (c) mental and emotional health; and (d) being a good role model for their children. The findings indicated that all women perceived postpartum exercise as a positive behavior that can promote mental health, although some postpartum mothers experienced social isolation and a lack of support. Furthermore, social discourses about motherhood caused the personal needs of mothers to be disregarded. The results showed that collaboration among health care providers, mothers, investigators, and community groups is necessary to promote and support mothers' engagement in postpartum physical activity.

Implications of understanding the undergraduate nursing students' learning styles: A discussion paper.

The article aims to present and critique the literature exploring nursing students' learning styles and to discuss the implications of understanding nursing students' learning styles for nurse educators, nursing students, and nursing academic programs. Learning style refers to the way an individual prefers to learn. Learning styles are shaped by several factors and change with different contexts. The learning styles vary among students in nursing programs and other health professions, with no one dominant style. Despite inconsistent evidence, educators believe that matching their teaching methods with students' learning styles can promote academic performance. The authors share a teaching experience that incorporates offering several teaching methods for the same content to meet the different learning styles of nursing students. The teaching experience resulted in students' satisfaction and improvement in their performance. The paper proposes assisting nursing students to develop their learning styles to enable them to master the skillset required by nursing as a profession. These nursing students are future nurses who would have developed the necessary learning style and skills to provide safe and competent nursing care.

A first voice perspective of people experiencing homelessness on preferences for the end-of-life and end-of-life care during the COVID-19 pandemic.

OBJECTIVE: People experiencing homelessness often encounter progressive illness(es) earlier and are at increased risk of mortality compared to the housed population. There are limited resources available to serve this population at the end-of-life (EOL). The purpose of this study was to gain insight into preferences for the EOL and end-of-life care for people experiencing homelessness. Utilizing an interpretive phenomenology methodology and the theoretical lens of critical social theory, we present results from 3 participants interviewed from August to October 2020, with current or previous experience of homelessness and a diagnosis of advanced disease/progressive life-threatening illness. RESULTS: A key finding focused on the existential struggle experienced by the participants in that they did not care if they lived or died. The participants described dying alone as a bad or undignified way to die and instead valued an EOL experience that was without suffering, surrounded by those who love them, and in a familiar place, wherever that may be. This study serves to highlight the need for improvements to meet the health care and social justice needs of people experiencing homelessness by ensuring equitable, humanistic health and end-of-life care, particularly during the context of the COVID-19 pandemic.

Supporting mothering: service providers' perspectives of mothers and young children affected by intimate partner violence.

Although negative outcomes from intimate partner violence (IPV) are not inevitable, IPV is recognized to have profound negative effects on child development. We conducted a qualitative descriptive study of service providers' understandings of the impact of IPV on mothers, young children (birth to 36 months), and mother-infant/child relationships, and of the support needs of these mothers and young children. Service providers suggested that IPV negatively influenced caregiving and identified a pressing need for information and strategies to help mothers promote and protect their young children's development. Although service providers struggled to articulate ideal forms of assistance to promote maternal-infant/child relationships, they agreed that mothers and young children experiencing IPV required more support than is currently available.

An Exploration of Facilitators and Challenges to Young Adult Engagement in a Community-Based Program for Mental Health Promotion.

Adolescence and young adulthood can be particularly daunting for those with mental health concerns. In one Canadian city, a community-based drop-in psychosocial mental health center (Center) was designed specifically for youth who self-identified as struggling with mental health issues. The purpose of this study was to identify the features of the program that promoted or discouraged engagement. Narrative inquiry was used to guide the project. One-on-one interviews were conducted with 10 Center users. Four major categories were identified: (a) Reasons for Coming: Motivated to Work on Goals; (b) Facilitators of Engagement and Beyond; (c) Challenges to Engagement; and (d) Benefits of Engaging: Finding My Way. These categories were further delineated into themes. All participants had experienced trauma, and the Center assisted them in their coping. The researchers believe that to aid recovery, agencies working with this population need to use trauma-informed and healing-centered engagement.

"You have to be okay with okay": experiences of flourishing among university students transitioning directly from high school.

Mental health is central to overall wellbeing and, for students attending university, mental health is critical for learning and academic success. A wealth of research has focused on young people who experience psychosocial declines during academic and developmental transitions, but little is known about how young people flourish in this transition. The first to explore the experiences of flourishing among first-year Canadian university students making the transition directly from high school, this study sought to develop an understanding of: 1) the factors that promote flourishing amidst this academic and developmental transition, and 2) how first-year students define and experience flourishing. An interpretive phenomenological approach underpinned by Gadamerian hermeneutic philosophy was used to explore experiences of flourishing, using semi-structured interviews, in a sample of nine full-time, first-year university students, ages 18-20 years. What it meant to flourish amidst this developmental and academic transition and how participants defined flourishing offer new understandings of the concept associated with: 1) personal/individual aspects of flourishing, 2) contextual nature of flourishing, 3) temporality of flourishing, 4) dialectic aspects of flourishing. Implications for practice, policy, and research in light of these new understandings are discussed.

Claymation art therapy in early phase psychosis: A qualitative study to explore participants' experiences with the program and identify outcome effects.

AIM: Art therapy is a complex intervention that has mixed evidence for people with schizophrenia and scant research in early phase psychosis. Benefits appear to depend on level of engagement and more qualitative studies are needed to elucidate how it works and what outcomes to measure. The purpose of this study was to determine the feasibility of a 13-week Claymation art therapy group intervention for young adults with early phase psychosis, and to explore participants' experiences with the program and to identify outcome effects. METHODS: Thirteen participants completed the intervention in two cohorts. The participants' experiences were explored through qualitative thematic analysis of individual interviews postintervention and at 3-month follow-up. RESULTS: The program had a 62% retention rate and an 80% attendance rate. Qualitative analysis of postintervention and 3-month follow-up interviews identified six themes that described program elements: (a) Claymation valued; (b) film screening fostered support; (c) getting to know each other through art; (d) connecting with others with lived experience; (e) opportunity to build skills; and (f) supportive facilitators. Five themes were identified as outcome effects from both time points: (a) stress relief; (b) self-discovery; (c) pride in art; (d) confidence and hope; and (e) engagement in meaningful activity postintervention. Two themes were unique to the 3-month follow-up interviews: (a) Claymation was enabling and (b) showing my film. CONCLUSIONS: This group Claymation art therapy intervention effectively engaged people with early phase psychosis and the qualitative analysis identified program elements and outcome effects that can be evaluated in future studies.

Does moving from a high-poverty to lower-poverty neighborhood improve mental health? A realist review of 'Moving to Opportunity'.

Ray Pawson's realist review method was used to analyse 22 evaluations/reviews of the Moving to Opportunity (MTO) housing intervention. MTO was a randomized controlled trial that moved families from high-poverty to low-poverty neighborhoods in five US cities between 1994 and 2006. This realist review focussed on mental health outcomes of families who moved, as well as the mechanisms through which moving influenced mental health. It identified and assessed the effectiveness of the underlying theory driving MTO, and suggests revising the existing theory. This realist review suggests that, even when moves are voluntary, there are potentially negative mental health outcomes from these types of social interventions. Directing resources towards the improvement of existing communities is one way of improving health outcomes for all community residents.

Supporting Parents' Pain Care Involvement With Their Children With Acute Lymphoblastic Leukemia: A Qualitative Interpretive Description.

Children with acute lymphoblastic leukemia experience pain from the disease, treatment, and procedures. Parents can be effective in managing their child's pain, but little is systematically known about how they do this. Appreciative inquiry was used to frame the study within a strengths-based lens and interpretive descriptive methods were used to describe pain sources, parents' pain care role, and key structures supporting parents pain care involvement. Eight paediatric oncology clinic nurses and 10 parents participated. Six key themes per group were identified. Parent themes included establishing therapeutic relationships, relearning how to care for my child, overcoming challenges and recognizing pain, learning parent specific strategies, empowering to take active pain care role, and maintaining relationships. Nurse themes included establishing therapeutic relationships, preparing parents to care for their child, facilitating pain assessment, teaching parents best pain care, empowering parents, and maintaining relationships. These findings can be used to guide clinical practice and future research.

Older male sexual partner as a marker for sexual risk-taking in adolescent females in Nova Scotia.

PURPOSE: To examine age differences between Nova Scotia women aged 15-19 and their male sexual partners, and to determine if those adolescents with older partners were more likely to have engaged in sexual risk-taking behaviours. METHODS: A cross-sectional survey (response rate=91%) administered in May 2003 assessed the following sexual risk behaviours: (a) not using condom/hormonal contraception at last vaginal intercourse; (b) having unplanned vaginal intercourse while using alcohol or drugs; (c) having more than one partner in the previous year; (d) vaginal intercourse before age 15; and (e) ever having anal intercourse. Univariate analysis was carried out to determine associations of sexual risk behaviours with partner age difference. Logistic regression was then used to examine behaviours associated with partner age (p < 0.15) in univariate analysis. RESULTS: Of the young women surveyed, 520 (47.7%) had had vaginal intercourse in the previous year; 515 of these provided information on their last partner's age. Over 10% had partners four or more years older. In multivariate analysis, having a partner > or =4 years older was associated with not using a condom at last intercourse (OR 2.15; 95% Cl 1.10-4.20), having more than one partner in the previous year (OR 21.9; 95% Cl 1.13-4.28) and having unplanned vaginal intercourse while using alcohol or drugs (OR 2.66; 95% Cl 1.34-5.28). CONCLUSIONS: A significant number of female adolescents have older male sexual partners, and such relationships are markers for high-risk sexual behaviours. Partner age is an important consideration for health professionals providing sexual health advice to young women.

System struggles and substitutes: A qualitative study of general practitioner and psychiatrist experiences of prescribing antipsychotics to children and adolescents.

There are significant controversies regarding rising antipsychotic prescription trends in children and adolescents. Many pharmacoepidemiology trend studies have been published, and interpretations of these data are helpful in explaining what is happening in prescribing practices, but not why these patterns exist. There is a lack of qualitative data in this area, and the experience of prescribing antipsychotics to children and adolescents has not been adequately researched. We conducted a qualitative study using an interpretive phenomenological analysis of physicians' experiences of antipsychotic prescribing to children and adolescents. Prescribers participated in individual interviews and a focus group. We used a staged approach for data analysis of transcriptions. In all, 11 physicians including psychiatrists and general practitioners participated in our study. We identified themes related to context, role and identity, and decision-making and filtering Struggles with health system gaps were significant leading to the use of antipsychotics as substitutes for other treatments. Physicians prescribed antipsychotics to youth for a range of indications and had significant concerns regarding adverse effects. Our results provide knowledge regarding the prescribers' experience of antipsychotics for children and adolescents. Important gaps exist within the health system that are creating opportunities for the initiation and continued use of these agents.

Socio-economic factors and adolescent sexual activity and behaviour in Nova Scotia.

PURPOSE: Little is known about associations of adolescents' socio-economic status (SES) and their sexual activity and risk behaviours. This study examined these associations in Nova Scotia adolescents aged 15-19. METHODS: Students at four high schools in northern Nova Scotia completed surveys examining relationships of family SES factors and: 1) sexual activity (having had vaginal or anal intercourse, intercourse before age 15 (early intercourse)); and 2) risk behaviours (use of contraception/condoms, number of partners and unplanned intercourse after substance use). RESULTS: Of students present when the survey was administered, 2,135 (91%) responded. Almost half (49%) had had vaginal intercourse, and 7% anal intercourse. In univariate analysis for young women, non-intact family structure and lower parental education were associated with having vaginal, anal and early intercourse. Female risk behaviours showed no significant univariate associations with SES. Young men had univariate associations of family structure, lower maternal education and paternal unemployment with early intercourse, and lower paternal education with anal intercourse. Condom use was higher for young men with employed fathers; those living with both parents less often had >1 sexual partner. In multivariate analysis, most SES associations with females' sexual activities held, while most for males did not, and few associations of SES and risk behaviours were seen for females. CONCLUSIONS: Indicators of lower SES are associated with sexual activity in young women. Sexual risk behaviours are not often associated with SES in females, though they are more so in males. These findings have implications for sexual health promotion and health services.

A Qualitative Study of Antipsychotic Medication Experiences of Youth.

OBJECTIVE: To explore the lived experience of youth who are prescribed antipsychotics. METHODS: We conducted an interpretive phenomenology study of young people with recent experience of taking antipsychotics. Youth were interviewed and a staged approach was used for data analysis of transcriptions. We collected approximately 13 hours of audio from 18 youth aged 13 to 26 years between January and August of 2010. RESULTS: Ambivalence was significant and antipsychotic adverse effects frequently tempered benefits. Both illness and antipsychotics had significant impacts on physical and mental wellbeing with adverse effects on relationships and functioning in various contexts (e.g., school). Stigma related to both antipsychotics and illness was also prominent. Participants' limited knowledge about their antipsychotics and pressure to conform within their youth culture and context affected decisions on starting, adhering to, and persisting with treatment. CONCLUSIONS: The lived experience of youth taking antipsychotics is complex and the benefits (e.g., symptom improvement) and consequences (e.g., adverse effects) associated with antipsychotics affect all facets of life. More research is needed to better understand youth priorities in treatment decisions and whether youth who demonstrate substantive gaps in their knowledge about antipsychotics are truly given the opportunity to be informed and engage in management decisions including whether to initiate, persist with, and discontinue treatments.

OBJECTIF: Explorer l'expérience vécue d'adolescents à qui on a prescrit des antipsychotiques. MÉTHODES: Nous avons mené une étude interprétative phénoménologique auprès de jeunes gens qui ont récemment fait l'expérience de prendre des antipsychotiques. Les jeunes ont été interviewés et une approche graduelle a servi à l'analyse des données des transcriptions. Nous avons recueilli environ 13 heures d'enregistrement audio auprès de 18 jeunes de 13 à 26 ans, entre janvier et août 2010. RÉSULTATS: L'ambivalence était significative et les effets indésirables des antipsychotiques en ont souvent modéré les avantages. Tant la maladie que les antipsychotiques avaient des effets significatifs sur le bien-être physique et mental, et des effets indésirables sur les relations et le fonctionnement dans divers contextes (p. ex., l'école). Les stigmates liés à la maladie et aux antipsychotiques étaient également proéminents. Les connaissances limitées des participants de leurs antipsychotiques et la pression de se conformer à la culture et au contexte des jeunes influaient sur leur décision de commencer le traitement, de l'observer et d'y persister. CONCLUSIONS: L'expérience vécue de jeunes qui prennent des antipsychotiques est complexe et les avantages (p. ex., l'amélioration des symptômes) et conséquences (p. ex., les effets indésirables) associés aux antipsychotiques affectent toutes les facettes de la vie. Il faut plus de recherche pour mieux comprendre les priorités des jeunes dans les décisions liées au traitement, et pour déterminer si l'on donne réellement aux jeunes qui démontrent des lacunes substantielles dans leurs connaissances des antipsychotiques l'occasion d'être informés et de prendre des décisions quant à la prise en charge, notamment commencer le traitement, persister et abandonner.