Enhancing Resilience in Canadian Military Families and Communities: A Qualitative Analysis of the Reaching In Reaching Out and Bounce Back and Thrive! Resiliency Skills Training Programs.

Introduction: A new vision of resilience and well-being for Canadian military service members (SMs), Veterans and their families has been championed by the Canadian Armed Forces (CAF) and Veterans Affairs Canada (VAC). Operationalizing this vision, which aims to support those who serve/have served and their families as they navigate life during and post-service, requires the support of service providers (SPs). Training SPs to deliver complementary resilience-training programs Reaching In… Reaching Out (RIRO; for adults working with parents of young children) and Bounce Back and Thrive! (BBT; for parents of children aged 0-8 years of age) may support this vision. Objective: To assess the appropriateness of RIRO/BBT trainer training for SPs, and RIRO and BBT resilience-training for military populations and families. Methods: This qualitative descriptive study involved the delivery of RIRO/BBT trainer training to SPs (n = 20), followed by focus groups (n = 6) with SPs and organisational leaders (n = 4). Focus groups were recorded, and data were transcribed and thematically-analysed. Results: Several themes emerged: (1) RIRO/BBT trainer training enabled SPs to model resilience and deliver the resilience-training programs, (2) training was appropriate and adaptable for the CAF and SMs/CMFs, and (3) training could support the development of resilient communities. Discussion: RIRO/BBT trainer training and RIRO and BBT resilience-training programs use a holistic, integrated, experiential, and community approach to resilience-building and align with CAF and VAC initiatives. Once contextualised, such programs could support resilience-building in the military context.

"I Need Presence and a Listening Ear": Perspectives of Spirituality and Spiritual Care Among Healthcare Providers in a Hospice Setting in Pakistan.

This paper aims to describe how healthcare providers perceived spirituality and spiritual care while caring for dying patients and their families in a hospice setting in Karachi, Pakistan. Using a qualitative interpretive description design, individual in-depth interviews were conducted among healthcare providers. Thematic analysis approach was used for data analysis. Spirituality and spiritual care were perceived as shared human connections, relating to each other, acts of compassion, showing mutual respect while maintaining dignity in care and empowering patients and families. Developing spiritual competency, self-awareness, training and education, and self-care strategies for healthcare providers are essential components promoting spiritual care in a hospice setting.

Becoming a Channel of God: How Faith Community Nurses Develop Their Spiritual Practice.

PURPOSE: This study explored the underlying process faith community nurses (FCNs) experience in developing their spiritual nursing practice. DESIGN: A qualitative, exploratory design was used. METHOD: Data from interviews with six FCNs were generated and analyzed using Glaserian grounded theory. FINDINGS: The basic social psychological process, cultivating the soul to become a channel of God, explains the steps these nurses take to achieve stages of presence. Going through these stages of presence, FCNs develop a foundation of God-related beliefs and values, presence with self, presence with God, presence with others, presence with God and others, and become a channel of God. CONCLUSIONS: Developing spiritual care competence in assessing and meeting clients' spiritual needs is necessary to enhance person-centered practice, a vital aspect of holistic care. The model of presence can inform the development of spiritual care competencies and link to other nursing theories including Watson's theory of caring and Benner's novice to expert theory. Workplace support is needed for nurses to refine spiritual nursing care practices and integrate spiritual care into practice. Further research regarding the stages of presence could foster deeper understanding of how foundations of God-related values develop.

Factors affecting undergraduate nurse educators' knowledge, skills or attitudes about older persons and their care: An integrative review.

BACKGROUND: Nurses are increasingly expected to provide care for older persons; however, there are too few nurse educators with expertise in older person care to ensure students graduate with the requisite competencies. METHODS: An integrative review, using Whittemore and Knafl's framework, was undertaken to identify and synthesise evidence about factors affecting nurse educators' knowledge, skills or attitudes about older persons and their care. RESULTS: Forty-four articles met the inclusion criteria. All but three papers originated in the USA. Content analysis yielded three central themes: external-level factors, employer-level factors and individual-level factors. Findings demonstrated that external funding from philanthropic organisations and government agencies supported many of the national, regional and site-specific initiatives, which were, in many cases, underpinned by professional regulatory frameworks. Negative attitudes of administrators and reduced budgets of educational institutions impeded the availability of such initiatives. Negative attitudes of individual educators towards older person care and the specialty of gerontology constrained their pursuit of such learning, as did their lack of awareness of current gerontology resources. CONCLUSIONS: The lack of educators with gerontology knowledge, skills and requisite attitudes requires a focused effort from external and professional bodies, and from educational institutions to ensure the resources are available to enhance educator expertise in gerontology. Rigorous study addressing the factors influencing educators' knowledge, skills or attitudes towards older persons and their care is required. IMPLICATIONS FOR PRACTICE: Addressing the lack of nurse educator expertise in gerontology could help to ensure new nurses have the required competencies to provide quality older person care.

Rise Above: Experiences of Spirituality Among Family Caregivers Caring for Their Dying Family Member in a Hospice Setting in Pakistan.

Family caregivers experience multiple transitions, resolutions, loss, and grief where their search for meaning becomes evident. Spirituality is an important dimension of palliative care, yet little attention has been given to this important aspect of spirituality especially among the family caregivers in a hospice setting. The study aimed to bring the hidden voices of family caregivers, their own spiritual experiences caring for their dying patients in a hospice setting, to guide and direct the care practices of health care professionals. An interpretive descriptive approach guided the study using a purposive sample of 18 family caregivers from a hospice in Karachi, Pakistan. Major themes were family love, attachment, and belongingness; honoring family values and dignity; acts of compassion and selfless service; and seeking God's kindness and grace. Spirituality enabled family caregivers to uncover meaningful engagement and provided strength and peace while serving a dying family member in challenging caregiving situations such as adversity and limited resources. They highly valued the love, respect, and honor of the family; showed compassion; believed in God's blessings; and experienced spiritual growth and self-transcendence. Spirituality was found to be a major resource of coping among family caregivers. Health care professionals need to integrate spirituality while developing family-centered interventions in hospice care.

Spirituality among family caregivers in palliative care: an integrative literature review.

BACKGROUND: Family caregivers experience spiritual and existential concerns while caring for their terminally ill family members. AIM: To evaluate and synthesise studies on spirituality among family caregivers in palliative care. DESIGN: An integrative literature review of peer-reviewed articles published between 2000 and 2016. SAMPLE: Participants were family caregivers (parents, spouses, relatives or friends) caring for an adult (age>18 years) family member with a terminal illness in a palliative care setting. RESULTS: Data from 26 published research papers were systematically analysed. Five themes were identified regarding spirituality and family caregiving: a close and meaningful connection, spirituality as a way of coping, spiritual needs and expressions among family caregivers, spirituality to transcend fears, and spirituality in family caregivers' decision-making. IMPLICATIONS FOR PRACTICE: Nurses are encouraged to explore the spirituality and spiritual experiences of family caregivers to support their spiritual wellbeing while caring for their terminally ill family members.

Exploring the Influence of Social Determinants, Social Capital, and Health Expertise on Health and the Rural Church.

In rural communities, religious places can significantly shape health for individuals, families, and communities. Rural churches are prominent community centers in rural communities and are deeply woven into rural culture. Thus, health influences arising from the rural church likely have health implications for the greater community. This article explores health influences emerging from rural churches using social determinants of health, social capital, and health expertise. Although nurses are important health resources for all populations, their value in rural areas may be exceedingly significant. The contribution of nurses to church-based health capital in rural communities may be quite significant and underestimated, although it remains poorly understood.

Healthy Spaces in Meaningful Places: The Rural Church and Women's Health Promotion.

PURPOSE: The influence of place on health is beginning to be addressed in health research. Current understanding of rural places, however, remains in a state of disequilibrium, balancing between geographic and sociocultural positions. This article illuminates the significance of place for rural women's experiences of health promotion in the rural church. DESIGN: This study used a novel approach to interpretive phenomenological methodology by including the photovoice method to elicit both individual and shared experiential meanings. METHOD: Twenty-two participants took pictures, wrote in logbooks, and participated in individual and group interviews to share their experiences of health promotion in the rural church. FINDINGS: The church as a place was realized through three broad discourses: (a) an intersection of physical and geographic environments, (b) a gateway to experiential attachment and personal meaning, and (c) a connection to shared culture and beliefs. It is also suggested that place may best be interpreted with an experiential lens as it exhibits lived and felt spaces. CONCLUSIONS: Data analysis suggests that place consists of both physical and experiential realities, in addition to being a resource of culture and meaning. Implications for rural women's health promotion include fostering a deeper recognition of place-shaped experiences of health.

Workplace model for physical therapists and occupational therapists.

PURPOSE: The purpose of this paper is to test a model linking physical therapy (PT) and occupational therapy (OT) practitioners' perceptions of resonant leadership, structural empowerment and psychological empowerment to their experiences of spirit at work (SAW), job satisfaction and organizational commitment within the Canadian workplace. DESIGN/METHODOLOGY/APPROACH: The authors tested the model using LISREL 8.80 and survey data from 101 OTs and 169 PTs, randomly selected by the Alberta professional licensing associations. Content analysis of responses to the open-ended comments section provided additional depth and insight. FINDINGS: Analysis of results culminated in minor modifications to the original theoretical model, creating separate PT and OT models. Both models revealed a good fit with the observed data. Several SAW concepts accounted for moderate to large amounts of variance in both PT and OT models, indicating that SAW is a comprehensive workplace outcome. RESEARCH LIMITATIONS/IMPLICATIONS: Theory was derived from business and nursing research literature due to limited rehabilitation research literature. Discussion of OT results must consider the small sample size. This study is initial exploratory research. PRACTICAL IMPLICATIONS: Each discipline-specific model provides professionals, health care leaders and policy makers with a rich body of information upon which to base beneficial workplace decisions. SAW will guide leaders in the holistic development and enrichment of the work environment. ORIGINALITY/VALUE: This research contributes to the substantive knowledge of the OT and PT disciplines, particularly in the areas of leadership, workplace structural organization and indicators of healthy work environments such as SAW, empowerment, job satisfaction and organizational commitment.

Learning to care for spiritual needs: connecting spiritually.

Despite mandates to provide spiritual care, confusion persists among nurses about spirituality, spiritual needs, and related roles. To discover how practicing nurses acquire knowledge for spiritual care, the authors chose a grounded theory design. They constantly compared and analyzed verbatim transcribed interview data to find the core variable, categories, and properties. Connection, manifesting as a state, act, or process, appeared throughout the data. Categories emerged as Needing Connection, Nurturing Connection, Learning Connection, and Living Connection. Nurses used a cyclical, intertwined, and progressive learning process of opening to, struggling with, and making connections between numerous discrete personal and professional experiences. Shifting attention between these interconnected experiences fueled knowledge acquisition. Whether referring to how nurses learn, what they do, or with whom, the theory Connecting Spiritually joined categories into a cumulative experiential learning process that explained how nurses learn to care for spiritual needs.

Addressing the spiritual dimension in Canadian undergraduate nursing education.

The purpose of this study was to identify the extent to which the spiritual dimension is addressed in Canadian university undergraduate nursing curricula. An exploratory descriptive design was used to gather data from faculty members at Canadian university schools of nursing. Eighteen (62%) of the 29 eligible schools participated. The findings indicate that conceptual confusion exists and that the spiritual dimension is rarely defined or included in curricular objectives. However, they also indicate that the spiritual dimension is more frequently evident in course objectives and that a number of creative methods are used to address it. Testing in this area is sporadic and limited. The results indicate that greater attention could be given to this dimension.