Ethical conflicts experienced by community nurses: A qualitative study.

BACKGROUND: Despite news reports of morally distressing situations resulting from complex and demanding community-care delivery in Canada, there has been little research on the topic of ethical conflicts experienced by community-based health care professionals. RESEARCH AIM: To identify ethical conflicts experienced by community nurses. RESEARCH DESIGN: Data were collected using semi-structured interviews and then relevant text was extracted and condensed using qualitative content analysis. This research was part of a larger grounded theory project examining how community nurses manage ethical conflict. RESEARCH CONTEXT AND PARTICIPANTS: Community nurses, including 13 public health nurses and 11 home care nurses from two Canadian provinces, were interviewed. ETHICAL CONSIDERATIONS: Study approval was granted by the Health Research Ethics Authority of Newfoundland and Labrador and by provincial health authorities. FINDINGS: Seven ethical conflicts were identified and assigned to one of two groups. In the grouping categorized as challenges with obligations or risks, the ethical conflicts were: (1) screening for child developmental issues knowing there is a lack of timely early intervention services; (2) encountering inequities in the health care system; (3) not fulfilling principles, goals, and initiatives of primary and secondary prevention; and (4) feeling powerless to advocate for clients. The remaining ethical conflicts were categorized as challenges with process, risks, and consequences, and were: (5) jeopardizing therapeutic relationships while reporting signs of a child at risk; (6) managing confidentiality when neighbors are clients; and (7) supporting client autonomy and decision-making but uncertain of the consequences. CONCLUSIONS: Research investigation will continue to be important to raise awareness and mobilize ethics supports as health care services are steadily shifted from institutional to community settings. Moreover, with heightened potential for communicable disease outbreaks across international borders from global warming, community nurses around the world will continue to be required to address ethically-difficult care situations with competence and compassion.

"Something is just not right with my hearing": early experiences of adults living with hearing loss.

OBJECTIVE: To understand the psychosocial process of how adults experience hearing loss; specifically, their readiness to accept that they may have hearing loss, and the challenges and coping strategies associated with it. DESIGN: A grounded theory methodology guided the research. A patient-orientated research approach informed the study. Thirty-nine individual interviews and six focus groups were completed. STUDY SAMPLE: Participants included 68 individuals aged 50 years and older with self-reported hearing loss living in Newfoundland and Labrador. RESULTS: The theoretical construct, 'Realising that something is just not quite right with my hearing' captured individuals' experiences as they gradually awakened to the fact that they had hearing loss. Three categories describe the process: (1) Rationalising suspicions, (2) Managing the invisible and (3) Reaching a turning point. CONCLUSIONS: Many individuals do not recognise hearing loss in its early stages, although they may be already experiencing its negative effects. It is important to identify motivators to engage individuals as early as possible in their hearing health. Taking a proactive approach to hearing health can help mitigate the potential negative outcomes of hearing loss.

Constant negotiating: managing work-related musculoskeletal disorders while remaining at the workplace.

We used grounded theory to explore processes and strategies used by workers affected by work-related musculoskeletal disorders (WMSDs) while they remained in the workplace, and we developed a theory to describe the overall process. Participants included 25 workers affected by WMSDs who were currently employed in various workplaces in Newfoundland and Labrador, Canada. The theoretical model has five main phases: (a) becoming concerned, (b) getting medical help, (c) dealing with the workplace, (d) making adjustments to lifestyle, and (e) taking charge, each with separate subphases. Constant negotiating was the core variable that explained the overall process, with workers engaged in negotiations with others in occupational, health, and social contexts. Using a two-dimensional figure, we illustrate the negotiation strategies workers used. We discuss implications for health care, workplaces, education, and research for creating a culture of understanding and respect for injured workers who wish to remain working after developing WMSDs.

Older Adults' Experiences with Remote Care for Specialized Health Service During the COVID-19 Pandemic: A Descriptive Qualitative Study.

The coronavirus disease (COVID-19) pandemic necessitated a rapid uptake of remote health care services. This qualitative descriptive study was designed to gain an understanding of older adults' experiences of remote care (telephone or online video conference appointments) for specialized health services during the COVID-19 pandemic. Twenty-one older adults (ages 65 years and older; 8 men and 13 women) living in eastern Canada participated in a semi-structured telephone interview. Data were analysed using qualitative content analysis. The vast majority of older adults were overall satisfied with their remote experiences of specialist care. Advantages to remote care for specialized services included convenience, safety during the pandemic, comfort, efficiency, and ease of visit. Disadvantages included communication not as effective, feeling depersonalized or disembodied, missing the human relationship, and wanting reassurance of physical assessment. It is important that health professionals understand the disadvantages for older adults of remote care visits in order to mitigate them.

"I Know How to Advocate": Parents' Experiences in Advocating for Children and Youth Diagnosed With Autism Spectrum Disorder.

BACKGROUND: Parental advocacy is a dynamic process that changes depending on the circumstances and needs of the child and parent. Communication deficits related to an Autism Spectrum Disorder (ASD) diagnosis often necessitate parental advocacy. This study describes how parents and caregivers of children and youth diagnosed with ASD engage in parental advocacy, the challenges they encounter and the advocacy skills they develop. METHOD: We used descriptive exploratory methodology informed by reflexive thematic analysis. The aim of the study was to explore advocacy in parents and caregivers of children and youth diagnosed with ASD. RESULTS: We conducted in-depth, semi-structured interviews with 15 parents of children and youth with an ASD diagnosis living in 4 provinces of Atlantic Canada. The pathway in parents' advocacy journey included: (1) Expressing concerns; (2) Seeking help, assessment, and diagnosis; (3) Acquiring services; (4) Removing barriers; and (5) Developing advocacy skills. CONCLUSIONS: Our findings illustrate the process of parental advocacy, skill development, and the barriers parents encounter in advocating for their children with ASD. Future research might explore how health professionals can support parents' advocacy efforts.

"Managing the Wait": Parents' Experiences in Accessing Diagnostic and Treatment Services for Children and Adolescents Diagnosed With Autism Spectrum Disorder.

BACKGROUND: Parents of children and adolescents diagnosed with autism spectrum disorder (ASD) report delays in accessing timely diagnostic and treatment services for their children. Research has generally focused on parents' experiences in caring for a child diagnosed with ASD. This study describes the process of how parents access ASD services for their children and adolescents. METHOD: This study used a qualitative research design that was informed by grounded theory methodology. We used constant comparative analysis to develop a process model and a core concept. RESULTS: Seventeen parents of children and adolescents diagnosed with ASD were interviewed. Our process model included 3 main phases: Watchful waiting (noticing suspected behaviors, and searching for assessment and diagnosis); Informed waiting (receiving the diagnosis, facing challenges in accessing treatment services, and realizing the impact of an ASD diagnosis); and Contemplative waiting (pondering the future, reflecting on the past, and making recommendations). "Managing the Wait" was identified as the core category central to parents' experience of this process. This process was found to be impacted by socioeconomic status, parents' skills and capacity to advocate on their child's behalf, and severity of their child's ASD. CONCLUSIONS: Our findings illustrate the many barriers families face during their journey in accessing ASD services. Our results illustrate the need to address wait times for services, and provide education and support services for parents as a means of improving their self-advocacy skills, especially for parents of children and adolescents with severe disability.

How Community Nurses Manage Ethical Conflicts: A Grounded Theory Study.

Research is limited on how nurses in community settings manage ethical conflicts. To address this gap, we conducted a study to uncover the process of behaviors enacted by community nurses when experiencing ethical conflicts. Guided by Glaserian grounded theory, we developed a theoretical model (Moral Compassing) that enables us to explain the process how 24 community nurses managed challenging ethical situations. We discovered that the main concern with which nurses wrestle is moral uncertainty ("Should I be addressing what I think is a moral problem?"). Moral Compassing comprises processes that resolve this main concern by providing community nurses with the means to attain the moral agency necessary to decide to act or to decide not to act. The processes are undergoing a visceral reaction, self-talk, seeking validation, and mobilizing support for action or inaction. We also discovered that community nurses may experience continuing distress that we labeled moral residue.

Parents' and guardians' experiences of barriers and facilitators in accessing autism spectrum disorder diagnostic services for their children: a systematic review protocol of qualitative evidence.

REVIEW QUESTION: What are parents' and guardians' experiences of barriers and facilitators in accessing autism spectrum disorder diagnostic services for their children?