Writing activities and the hidden curriculum in nursing education.

Nursing programs are complex systems that articulate values of relationality and holism, while developing curriculums that privilege metric-driven competency-based pedagogies. This study used an interpretive approach to analyze interviews from 20 nursing students at two Canadian Baccalaureate programs to understand how nursing's educational context, including its hidden curriculums, impacted student writing activities. We viewed this qualitative data through the lens of activity theory. Students spoke about navigating a rigid writing context. This resulted in a hyper-focus on "figuring out" the teacher with minimal focus on the act of writing. Students used a form of behavioral "code-switching" to maximize their grade while considering how their "valuing" of the assignment fit within their writing motives. Hidden curriculum messages taught students that academic success was assured whether their writing mirrored instructor preferences. Instructional practices of rigidity reinforced unequal social conditions for some minority students. Faculty can counteract the impact of the hidden curriculum through encouragement of choice and independent thinking about writing activities. Acknowledging power relationships and their influence on how students navigate writing assignments and nursing discourse may relieve pressures on students who fear penalties for countering norms and result in a more flexible learning environment.

Ethical and moral considerations of (patient) centredness in nursing and healthcare: Navigating uncharted waters.

This discussion paper aims to explore potential ethical and moral implications of (patient) centredness in nursing and healthcare. Healthcare is experiencing a philosophical shift from a perspective where the health professional is positioned as the expert to one that re-centres care and service provision central to the needs and desires of the persons served. This centred approach to healthcare delivery has gained a moral authority as the right thing to do. However, little attention has been given to its moral and ethical theoretical grounding and potential implications for nurses, persons served and the healthcare system. Based upon a review of academic and grey literature, centredness is proposed as a value-laden concept in nursing inquiry. Potential moral and ethical implications of centredness on nurses/healthcare providers, persons served and the healthcare system are discussed. These challenges are then considered within the context of normative and relational ethical theories. These perspectives may offer guidance relative to how one should act in those circumstances as well as an understanding as to how interdependency and engagement with the other person(s) can help navigate the challenges of a centred care approach. Viewing centredness through an ethical theoretical lens provides a valuable discourse to nursing in efforts to expand the knowledge base and integrate centred approaches into practice and policy.

Understanding access to healthcare among Indigenous peoples: A comparative analysis of biomedical and postcolonial perspectives.

As nursing professionals, we believe access to healthcare is fundamental to health and that it is a determinant of health. Therefore, evidence suggesting access to healthcare is problematic for many Indigenous peoples is concerning. While biomedical perspectives underlie our current understanding of access, considering alternate perspectives could expand our awareness of and ability to address this issue. In this paper, we critique how access to healthcare is understood through a biomedical lens, how a postcolonial theoretical lens can extend that understanding, and the subsequent implications this alternative view raises for the nursing profession. Drawing on peer-reviewed published and gray literature concerning healthcare access and Indigenous peoples to inform this critique, we focus on the underlying theoretical lens shaping our current understanding of access. A postcolonial analysis provides a way of understanding healthcare as a social space and social relationship, presenting a unique perspective on access to healthcare. The novelty of this finding is of particular importance for the profession of nursing, as we are well situated to influence these social aspects, improving access to healthcare services broadly, and among Indigenous peoples specifically.

Evaluating patient satisfaction on an acute leukemia/bone marrow transplant day/night treatment unit: A pilot project.

The transition from hospital to home following hematopoietic stem cell transplantation increases the vulnerability for treatment challenges in patients, often resulting in unscheduled and costly hospital re-admissions. Two Acute Leukemia/ Bone Marrow Transplant Day/Night (ALBMT) inpatient beds were established in 2011 at one tertiary care hospital to support successful transition from inpatient cancer treatment to home. This pilot study aimed to investigate patient satisfaction feedback on information provision, treatment, and emotional support on this care innovation. Fourteen former unit patients participated. Survey responses indicated positive satisfaction for treatment and emotional support, and opportunities for information provision enhancement. Findings of this preliminary study exploring satisfaction of this novel inpatient initiative provide important insights into the patient experience, informing future research and practice.

Psychosocial adaptation: an evolutionary concept analysis exploring a common multidisciplinary language.

AIMS: To provide the first known concept analysis of psychosocial adaptation, exploring its evolution from the concept adaptation. We also determine how psychosocial adaptation is conceptualized across nursing, health, sociobehavioural and education disciplines. BACKGROUND: Psychosocial adaptation is an important conceptual term that is poorly defined in nursing and other health, sociobehavioural and education disciplines. A thorough understanding of the concept's application in nursing and across disciplines can help to clarify its meaning, facilitate a more effective common language between disciplines and inform future psychosocial adaptation research. DESIGN: Rodger's evolutionary view guided this concept analysis. DATA SOURCES: Peer-reviewed English and Spanish manuscripts published between 2011-2013 were retrieved from the following databases: CINAHL, Psych INFO, PubMed, Scopus and LILACS. REVIEW METHODS: Eighty-nine articles related to psychosocial adaptation were included in the analysis. Findings identify key attributes, antecedents and consequences associated with the use of the concept. Findings were compared vis-a-vis reported characteristics of adaptation. RESULTS: The attributes characterizing psychosocial adaptation are: change, process, continuity, interaction and influence. In psychosocial adaptation, new life conditions serve as antecedents, while consequences are good or bad outcomes. Important features of the evolution of this concept include its broad appropriation across the reviewed disciplines. The attributes of psychosocial adaptation, have some similarities to those of general adaptation. Both concepts include an aspect of change, but unlike adaptation, psychosocial adaptation has branched away from biological descriptors, such as homeostasis and tends to focus on relational characteristics, such as interaction and influences.

The Role of the Cardiac Surgery Patient in Pain Management: The Patient Perspective.

One and a half million cardiac surgeries are completed worldwide each year where undertreated postoperative pain increases the risk of patient morbidity and mortality. Patient-centered pain management is recommended to improve patient outcomes but there is insufficient information regarding how the patient views their role. The objective of this study is to explore cardiac surgery patients' perspectives on their role in postoperative pain management. This study used an interpretive phenomenological design and convenience sampling. Six participants who had undergone cardiac surgery were recruited from a cardiac rehabilitation program in Western Canada. The first author conducted semi-structured digitally recorded interviews. Sociodemographic characteristics and measures of anxiety and depression were also collected. Emergent thematic analysis of the qualitative data generated three themes: attitude, coping and care, and communication. The findings of this study address a gap in the literature with regard to patients' perceived roles in pain management. There is a complex relationship between patient attitude, coping and care, and communication which, in turn, influences how patients view their role within the pain management continuum. These themes contribute to the development of the patient role within the pain management continuum and form an integrated feedback loop. The patient's attitude contributes to their ability to cope with pain and participate in pain assessment and management. Furthermore, their ability to cope and desire to participate influences the development of their attitude. These findings may enhance providers' understanding of the patient's perspective and improve pain management outcomes.

Napping during breaks on night shift: critical care nurse managers' perceptions.

BACKGROUND: Fatigue associated with shiftwork can threaten the safety and health of nurses and the patients in their care. Napping during night shift breaks has been shown to be an effective strategy to decrease fatigue and enhance performance in a variety of work environments, but appears to have mixed support within health care. PURPOSE: The purpose of this study was to explore critical care unit managers'perceptions of and experiences with their nursing staff's napping practices on night shift, including their perceptions of the benefits and barriers to napping/not napping in terms of patient safety and nurses'personal health and safety. METHODS: A survey design was used. Forty-seven Canadian critical care unit managers who were members of the Canadian Association of Critical Care Nurses responded to the web-based survey. Data analysis involved calculation of frequencies and percentages for demographic data, use of the Friedman rank test for comparison of managers' perceptions, and content analysis for responses to open-ended questions. RESULTS: The findings of this study offer valuable insights into the complexities and conflicts perceived by managers with respect to napping on night shift breaks by nursing staff Staff and patient health and safety issues, work and break expectations and experiences, and strengths and deficits related to organizational napping resources and policy are considerations that will be instrumental in the development of effective napping strategies and guidelines.

Surgery patients' perspectives of their role in postoperative pain: A scoping review.

Background: Post-operative pain is a major factor in surgical recovery. There is evidence that pain remains undermanaged. Complications related to the undermanagement of acute pain can increase length of stay and contribute to readmission and the development of chronic pain. It is well acknowledged that pain assessment is critical to pain management and that self-report of pain is the gold standard. As a result, patients play a central role in their own pain management. A preliminary review of the literature failed to provide a clear or consistent description of this key patient role. Objective: A scoping review was conducted with the objective of reviewing literature that described adult patients' perspectives or highlighted the adult patient's role in post-operative pain management, including assessment. Understanding patients' attitudes toward their roles in pain management through a scoping review of the current literature is critical for informing research and improvements in post-operative pain management. Design: Scoping review. Methods: The databases searched for the review included CINAHL, MEDLINE, PubMed, and SCOPUS (ending May 2022). Thematic analysis, using the methodology of Arksey and O'Malley, was applied to the records identified. Results: Of the 106 abstracts initially identified, 26 papers were included in the final analysis. Two major themes identified through thematic analysis were attitudes toward pain and pain management, with the subthemes of patient expectations and beliefs and desire to treat; and care and communication, with the subthemes of pain assessment and education. Conclusions: This paper provides one of the first known comprehensive scoping reviews of surgical patients' perspectives of their role in pain management, including assessment, and offers an important global awareness of this patient role. The findings suggest that improved understanding of patients' perspectives of their roles in pain assessment and treatment is critical to improving post-operative pain management. Engaging patients as partners in their care can facilitate enhanced communication and improving congruence in pain assessment and treatment decisions. The complex nature of patients' beliefs, expectations, and subjective experiences of pain present challenges for health care practitioners. These challenges can be met with enhanced education for patients, respect for patients' beliefs and expectations, and the provision of dignified care.

University students' knowledge, self-efficacy, outcome expectations, and barriers related to reducing sedentary behavior: a qualitative study.

ObjectiveTo explore university students' knowledge, self-efficacy, outcome expectations, barriers and ideas related to reducing sedentary behavior using a qualitative approach. Participants: Nineteen students from a Canadian university participated. Methods: Four focus groups were conducted. Discussions were recorded, transcribed, and coded to identify categories and themes. Results: Some students lacked knowledge of the concept, but most were generally aware of health risks associated with sedentary behavior. Most students were confident they could reduce sedentary behavior, but felt it would be unlikely they would actually do so because: (a) it is not a priority, (b) the health consequences are distal, (c) increasing standing and light-intensity activity would not provide meaningful health benefits, and (d) class schedules/norms/infrastructure encourage sitting and are not under their control to change. Conclusion: Findings from this study may help inform intervention strategies aimed at decreasing excessive sedentary behavior among university students.

Insights into patient characteristics and documentation of the use of sedative-hypnotic/anxiolytics in primary care: a retrospective chart review study.

BACKGROUND: Despite the known safety risks of long-term use of sedative-hypnotic/anxiolytic medications, there has been limited guidance for the safe and effective use of their chronic use in a primary care clinic setting. Understanding the characteristics of patients who receive sedative-hypnotic/anxiolytic medication and the clinical documentation process in primary care is the first step towards understanding the nature of the problem and will help inform future strategies for clinical research and practice. OBJECTIVES: Characterize patients who received a sedative-hypnotic/anxiolytic prescription in primary care, and (2) gain an understanding of the clinical documentation of sedative-hypnotic/anxiolytic indication and monitoring in electronic medical records (EMR). METHODS: A random selection of patients who received a prescription for a benzodiazepine or Z-drug hypnotic between January 2014 and August 2016 from four primary care clinics in Winnipeg were included. Data was collected retrospectively using the EMR (Accuro®). Patient variables recorded included sex, age, comorbidities, medications, smoking status, and alcohol status. Treatment variables included drug type, indication, pattern of use, dose, adverse events, psychosocial intervention, tapering attempts, social support, life stressor, and monitoring parameters for sedative-hypnotic use. Demographic and clinical characteristics were described using descriptive statistics. RESULTS: Records from a sample of 200 primary care patients prescribed sedative-hypnotic/anxiolytics were analyzed (mean age 55.8 years old, 61.5% ≥ 65 years old, 61.0% female). Long-term chronic use (≥ 1 year) of a sedative-hypnotic/anxiolytic agent was observed in 29.5% of the sample. Zopiclone (30.7%) and lorazepam (28.7%) were the most common agents prescribed. Only 9.5% of patients had documentation of a past tapering attempt of their sedative-hypnotic/anxiolytic. The most common indications for sedative-hypnotic/anxiolytic use recorded were anxiety (33.0%) and sleep (18.0%), but indication was undetermined for 57.0% of patients. Depression (33.5%) and falls (18.5%) were reported by patients after the initiation of these agents. CONCLUSIONS: A higher proportion of females and users 65 years and older received a prescription for a sedative-hypnotic/anxiolytic, consistent with previous studies on sedative-hypnotic use. We found inconsistencies in the documentation surrounding sedative-hypnotic/anxiolytic use. The indication for their use was unclear in a large number of patients. These findings will help us understand the state of the problem in primary care and inform future strategies for clinical research.

Sleeping with one eye open: the sleep experience of family members providing palliative care at home.

PURPOSE: To empirically describe the sleep experience of family caregivers (n=13) of advanced cancer patients. METHOD: Mixed methodology using: family interviews; Epworth Sleepiness Scale (ESS); Pittsburgh Sleep Quality Index (PSQI); and actigraphy measurement. Qualitative data analysis utilized constant comparative content techniques. Actiware for the actigraphy data and the Statistical Package for the Social Sciences-15 (SPSS-15) generated descriptive and correlation statistics. FINDINGS: The overarching theme "sleeping with one eye open" captures the vigilant nature of caregivers' sleep experiences. Caregiver narratives were validated by quantitative findings: 5 of the family caregivers (38.5 percent) had an ESS score > or =11 indicative of excessive daytime sleepiness, all caregivers had a PSQI global score >5 indicative of moderate to severe sleep problems, and actigraphy scores--including total sleep time, sleep efficiency, and time awake after sleep onset--fell beyond normal values documented in the literature. CONCLUSION: Impeccable assessment of the patient's and family's sleep status, sleep education, intervention strategies, and high-quality respite services are critical in community-based palliative care.

Benefits of napping on night shifts.

Many nurses deliver care when they are fatigued and sleep deprived, which may place them and patients at risk. A qualitative study found restorative napping on breaks during night shifts helped to improve energy, mood, decision-making and vigilance. This article looks at the benefits night napping can offer nurses doing shift work.

Early life exposure to antibiotics and the risk of mood and anxiety disorders in children and adolescents: A population-based cohort study.

OBJECTIVE: Mood and anxiety disorders (MADs) are common conditions with multiple aetiologies. Exposure to antibiotics has been proposed as a possible risk factor in animal studies. We aimed to assess maternal antibiotic use in pregnancy and child antibiotic use in the first three years of life, collectively called early life, as potential risk factors for subsequent development of MADs during childhood and adolescence. METHODS: A population-based retrospective cohort study was conducted including 221,139 children born in Manitoba, Canada between 1996 and 2012. Exposure was defined as having filled one or more antibiotic prescriptions during early life. Children were followed until the earliest MADs diagnoses, 19th birthday, migration, death, or end of the study period. We computed crude and adjusted hazard ratios (aHRs) with corresponding 95% confidence intervals (CIs) using Cox proportional hazard regression. RESULTS: Children born to mothers who received one or more antibiotic courses in pregnancy had significantly higher rates of MADs compared with non-exposed children (aHR 1.08, 95% CI 1.03,1.13). Overall antibiotic exposure during the first three years of life was not significantly associated with MADs (aHR 1.00, 95% CI 0.94,1.07). A significantly increased risk of MADs was observed after postnatal exposure to tetracyclines, aminoglycosides, quinolones (33%) or sulfonamides and trimethoprim (28%). Postnatal exposure to macrolides, lincosamides, and streptogramins significantly reduced the risk of MADs by 16%. CONCLUSION: Early life exposure to antibiotics is associated with different risk effects on MADs in children. The apparent associations may have been confounded by indication and may not be clinically meaningful.

Patient values and preferences on polypharmacy and deprescribing: a scoping review.

Background Understanding how patient values and preferences towards polypharmacy and deprescribing have been studied is important to gain insight on current knowledge in this area and to identify knowledge gaps. Aim To describe methods and outcomes for studying patient values and preferences towards polypharmacy and deprescribing, and to identify gaps in the existing literature. Method A scoping review was conducted on English-language studies that examined patient preferences and values related to polypharmacy and/or deprescribing among community-dwelling adults. MEDLINE, Embase, PubMed, PsycINFO, EconLit, Social Science Citation Index, Science Citation Index Expanded, International Pharmaceutical Abstracts, and CINAHL/AgeLine were searched. Results Thirty articles were included. Surveys (n = 17, 56.7%), interviews/focus groups (n = 9, 30.0%), and mixed methods (n = 3, 10.0%), were commonly used methods. Patients Attitudes Towards Deprescribing (PATD) was the most common tool used (n = 9, 30.0%). Twelve themes related to attitudes, social pressure, and control of polypharmacy/deprescribing were identified. The most frequently-encountered themes included desire or willingness to reduce medication load and influence of healthcare provider on medication use. Conclusion PATD was commonly used to assess preferences and values towards polypharmacy and limited knowledge on patient-important outcomes were addressed. Future research should focus on shared decision-making and communicating risk versus benefit of medications.

The development of academic identity in graduate nursing students: An interpretive descriptive study.

BACKGROUND: Mentorship is an important element in the development of academic identity among graduate students in nursing. Although most often occurring within the context of faculty advisor-student relationships, mentorship should extend beyond formal advisor-advisee relationships. Peer mentorship is known to be beneficial for graduate students, yet little is known about how peer mentorship specifically impacts the development of academic identity. OBJECTIVE: The purpose of this study was to explore how peer mentorship, within the context of an international research conference, impacts the development of academic identity. DESIGN: Qualitative descriptive study. Graduate nursing students from a research-intensive university in Canada were invited to participate in a peer mentorship initiative. Data were collected through reflective journals. Data analysis was conducted iteratively and collaboratively using an interpretive descriptive approach. PARTICIPANTS: Eight mentees, two peer mentors and five faculty mentors participated in the initiative. With the exception of one faculty mentor, all participants provided reflective journals on their experiences, in response to journal prompts. RESULTS: Findings centered on five themes: walking through quicksand, navigating a complex academic world, developing academic identity through relationships, intentional cultivation of community, and finding solid ground. Our findings highlight the relational nature of academic identity development, and the significant benefit of providing mentorship to graduate nursing students outside of formal learning spaces. CONCLUSIONS: Given the urgent need to increase the numbers of nurses with advanced research training, it is important that effective strategies like this innovative mentorship initiative, that enhance professional identity development, are integrated into graduate education programs.

The arts as a catalyst for learning with undergraduate nursing students: findings from a constructivist grounded theory study.

Background: There is a growing interest in arts-based pedagogy (ABP) to promote the wide range of competencies needed for professional nursing. The aim of this study was to develop a theoretical understanding of how students learn through ABP in undergraduate nursing education. Methodology and Methods: We used a constructivist grounded theory methodology which incorporated art-elicitation interviews. Thirty nursing students and eight nurse educators shared about their ABP experiences. Data were analyzed with grounded theory procedures. Results: The arts as a catalyst for learning emerged as the core category and elucidates how the unique quality of the arts created powerful pedagogical processes for many students. When students engaged with these processes, they resulted in surprising and transformative learning outcomes for professional nursing. Conclusions: These findings provide insight into why and how students learned through ABP, and can inform the effective implementation of ABP into healthcare education.

Navigating creativity within arts-based pedagogy: Implications of a constructivist grounded theory study.

BACKGROUND: Educators implement arts-based pedagogy with the hope that it will foster meaningful learning for students. However, nursing students have varied reactions to artistic assignments, and there is a need to further understand students' learning processes with this novel approach and the factors influencing their learning. This understanding could promote the more effective implementation of arts-based pedagogy into nursing education. OBJECTIVE: To develop a theoretical understanding of how and when undergraduate nursing students learn through arts-based pedagogy. DESIGN: Constructivist grounded theory. SETTINGS: Canadian baccalaureate nursing program. PARTICIPANTS: Thirty third-year undergraduate nursing students and eight of their nursing instructors. METHODS: Participants who had experienced arts-based assignments were recruited with purposive and then theoretical sampling. We collected four sources of data: a socio-demographic questionnaire, semi-structured interviews, photo/art elicitation, and field notes. The socio-demographic data were analyzed with descriptive statistics and all other data with constructivist grounded theory procedures. RESULTS: Our findings revealed that students had to navigate a creative process with arts-based assignments, which involved several iterative phases. This type of learning was unique within their program and somewhat constrained by the context of nursing education. There was notable variation in the students' experiences. Although many reported meaningful learning, approximately 20% of the students did not value the assignment. Our findings elucidated multi-level enabling and restraining factors that influenced students' engagement with and learning from this creative process. CONCLUSIONS: These findings provide insight into modifiable factors that influenced students' engagement and learning, and have important implications for making ABP accessible and meaningful for more students.

The Manitoba Personalized Lifestyle Research (TMPLR) study protocol: a multicentre bidirectional observational cohort study with administrative health record linkage investigating the interactions between lifestyle and health in Manitoba, Canada.

INTRODUCTION: Lifestyle factors, such as diet, physical activity and sleep, are associated with the development of many chronic diseases. The objective of The Manitoba Personalized Lifestyle Research study is to understand how these lifestyle factors interact with each other and with other factors, such as an individual's genetics and gut microbiome, to influence health. METHODS: An observational study of adults, with extensive phenotyping by objective health and lifestyle assessments, and retrospective assessment of early life experiences, with retrospective and prospective utilisation of secondary data from administrative health records. STUDY POPULATION: A planned non-random convenience sample of 840 Manitobans aged 30-46 recruited from the general population, stratified by sex (equal men and women), body mass index (BMI; 60% of participants with a BMI>25 kg/m2) and geography (25% from rural areas). These stratifications were selected based on Manitoba demographics. MEASUREMENTS: Lifestyle factors assessed will include dietary pattern, physical activity, cardiovascular fitness, and sleep. Factors such as medical history, socioeconomic status, alcohol and tobacco consumption, cognition, stress, anxiety, and early life experiences will also be documented. A maternal survey will be performed. Body composition and bone density will be measured by dual energy X-ray absorptiometry. Blood pressure, pulse wave velocity, and augmentation index will be measured on two consecutive days. Chronic disease risk biomarkers will be measured in blood and urine samples. DNA will be extracted for genetic analysis. A faecal sample will be collected for microbiome analysis. Participants may provide their Manitoba personal health information number to link their study data with administrative health records. ETHICS AND DISSEMINATION: Ethics approval has been obtained from the University of Manitoba Health Research Ethics Board (protocol # HS18951; 05/01/2016). Data analysis, release of results and publication of manuscripts are scheduled to start in early 2019. Additional information at www.TMPLR.ca. TRIAL REGISTRATION NUMBER: NCT03674957; Pre-results.

A curriculum-wide assessment of writing self-efficacy in a baccalaureate nursing program.

OBJECTIVES: This study explores patterns of writing self-efficacy fluctuation across three academic years in a baccalaureate nursing program. The goal was to assess if writing self-efficacy predicted program grades. DESIGN: Longitudinal exploratory design. SETTING: Three-year accelerated nursing program in a college setting in Canada. PARTICIPANTS: Follow-up cohort included 49 students; 32 (65.3%) synchronous in program progression and 17 (34.7%) had become asynchronous between first and third year. METHODS: Data was collected five times between August 2013 and May 2016 at program admission, the start of their discipline-specific first-year writing course, the end of the writing course, start of third-year, and the end of third-year. Variables assessed included writing self-efficacy (two measures), writing anxiety, entrance degrees of reading power (DRP) scores, final college cumulative grade point average (GPA), and grades earned on first, second, and third-year papers. RESULTS: Writing self-efficacy statistically significantly improved from the start of the nursing program to the finish (p < .001). Writing self-efficacy fluctuated decreasing from post first-year writing course to the start of the third-year, returning to or exceeding end of writing course levels by the end of the third year. Students who progressed normally through the program (synchronous) were academically stronger (paper grades, DRP, GPA scores) and had higher writing self-efficacy scores than asynchronous students. Using hierarchical regression, DRP scores and synchronous/asynchronous status in the program made a larger contribution to the prediction of final program GPA and paper grades, while the inclusion of writing self-efficacy in the models made a minor contribution to overall variance. CONCLUSIONS: Writing self-efficacy will fluctuate based on context and complexity of writing demanded in academic programs. Second and third-year students require continued support with writing beyond an introductory course. Programs should attend to developing reading comprehension in students as part of their across-the-curriculum writing plans.