The potential of outdoor contexts within community-based rehabilitation to empower people with disabilities in their rehabilitation.

Purpose: The aim was to examine the potential of outdoor contexts within community-based rehabilitation to empower people with disabilities in their rehabilitation.Materials and methods: Interpretive description was applied as the methodology in a 5-month ethnographic fieldwork study, and guided by social practice theory. In total, 115 people with disabilities were included for participant observation, of which 15 participants were recruited for individual walking interviews.Results: Analysis revealed four overlapping themes. Firstly, "Revisiting the Outdoors" appeared to be an overarching theme, which created a basis for "Building Autonomy" among the participants. The varied outdoor experiences empowered the participants to take a more active role in their rehabilitation. These experiences afforded unique opportunities for "Connecting with Community" and, finally, "Embodied Learning" - that could be transferred to home and to other everyday contexts.Conclusion: Outdoor contexts within community-based rehabilitation appeared to hold strong potential for connecting people with disabilities to communities. Although barriers exist, we argue that revisiting the outdoors supports collective awareness and action with the capacity to influence community attitudes more broadly.IMPLICATIONS FOR REHABILITATIONOutdoor contexts within community-based rehabilitation for people with disabilities capitalise on the features of both indoor and outdoor environments with activities that meet shifting individual priorities and needs.Outdoor contexts within community-based rehabilitation offer people with disabilities empowering experiences that are part of the landscape of everyday life and transfer well to home and other environments.Community-based rehabilitation directly involving outdoor contexts and supported by professional skills provides a crucial bridge from individual rehabilitation to community belonging.

Planting seeds of community-engaged pedagogy: Community health nursing practice in an intergenerational campus-community gardening program.

As part of a participatory action research (PAR) study, nursing student participants collaborated with faculty, along with older adults, people with mixed abilities, and preschool aged children in order to 'sow the seeds of social change' and grow a campus community gardening project. The focus of this article is on the community-engaged pedagogy within a community health nursing practice course that supported student learning. Insights were gleaned over the course of four academic semesters (and four student cohort groups) with students as co-developers of the campus-community garden and participants in the PAR. Key themes emerged from student participants in the PAR process including: (1) planning in community to "think global, act local"; (2) discovering 'the people in your neighbourhood' as socially just partnerships; (3) revisiting landscapes of social inclusion; and (4) reflecting on "humble togetherness" across generational gaps. The findings showcased here attest to how community-engaged pedagogy, in conjunction with PAR, can facilitate student learning outside of traditional settings and grow social inclusion, intergenerational connection, and social justice.

"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.

Collaboration with Rural and Remote Communities to Improve Sexual Assault Services.

After a recent sexual assault, clients in rural and remote communities do not typically receive comprehensive services. They experience delays with staff shortages and unfamiliarity with procedures, negative responses to disclosure such as disbelief, and may be turned away or required to travel elsewhere away from their support systems. These experiences increase their risks for mental health disorders and chronic diseases, placing a significant burden on the client's health and on the community. A participatory action approach was used in five Canadian communities to find collaborative solutions to their challenges. Mixed methods were used to collect data on the impact of community identified interventions on knowledge, service quality and comfort in providing services. Interventions included support for multidisciplinary advisory teams, resource development, and education sessions for service providers. The Enhanced Emergency Sexual Assault Services (EESAS) education selected by communities provided trauma informed knowledge of collaborative and comprehensive services in their community. Both focus group and survey data demonstrated increased collaboration and shared knowledge, enhanced communication, and improved services such as provision of increased privacy for clients. Knowledge increased in all key areas of services and service quality. Limited data suggests the changes are sustained for at least 6 months post-training. The combined findings of qualitative and quantitative data support the effectiveness of a multidisciplinary community development program. The increased knowledge, comfort and teamwork have potential to improve services clients receive and therefore the health of both the individuals and the community.

The business of managing nurses' substance-use problems.

Nurses' experiences in, and the overall effectiveness of, widely used alternative-to-discipline programs to manage nurses' substance-use problems have not been adequately scrutinized. We uncovered the conflicted official and experiential ways of knowing one such alternative-to-discipline program in a Canadian province. We explicated this conflict through an institutional ethnography analysis. Ethnographic data from interviews with 12 nurses who were enrolled in an alternative-to-discipline treatment program and three program administrators, as well as institutional texts, were analyzed to explore how institutional practices and power relations co-ordinated and managed nurses' experiences. Analysis revealed the acritical acceptance of a standardized program not based on current norms of practice. Potential and actual conflicts of interest, power imbalances, and prevailing corporate interests were rife. Nurses were not afforded the same rights to quality ethical health care as other citizens. 'Expert' physicians' knowledge was privileged while nurses' knowledge was subordinated. Conclusions were that regulatory bodies cannot rely on the taken-for-granted standardized treatment model in widespread use. Individualized treatment alternatives reflecting current, scientific evidence must be offered to nurses, and nurses' knowledge, expertise, and experiences need to be included in decision-making processes in these programs.

Beyond the Slogans: Understanding the Ecological Consciousness of Nurses to Advance Ecological Knowledge and Practice.

Despite unprecedented global environmental changes with widespread health effects, and rapid advances in nursing knowledge and education, the concept of environment within the discipline remains restricted. Environmental health continues to be marginalized in nursing education and practice, with nurses struggling to get beyond the slogans to arrive at practical applications. Framed by ecohealth and radical ecopsychology theory (concerned with nature connection, individual wellness, and social/earth justice), this study employed an online survey (n = 40) with thematic content analysis. The study explored factors that influenced eco-consciousness, how it affected nursing work, and how it was integrated into practice The 40 participants from 3 Canadian provinces included 32 nurses employed in education and clinical practice and 8 student nurses. Three main themes emerged: awakening consciousness, challenges in the discipline and profession, and finding opportunities. In particular, the students expressed a need for early integration of environmental health teaching into curriculum. Results illustrate an ongoing knowledge-practice gap and highlight the frustration and dismay of nurses whose efforts remain marginalized. Motivations and opportunities for nurses to undertake an expanded role in adopting environmental health as central to the discipline and practice of nursing can and must be more intently harnessed. As curricular approaches are expanded, further inquiry is proposed into the role of both early experiences and nursing education to transform the response to the ecological crises of our times.

"A Two Glass of Wine Shift": Dominant Discourses and the Social Organization of Nurses' Substance Use.

We undertook an institutional ethnography utilizing the expert knowledge of nurses who have experienced substance-use problems to discover: (a) What are the discourses embedded in the talk among nurses in their everyday work worlds that socially organize their substance-use practices and (b) how do those discourses manage these activities? Data collection included interviews, researcher reflexivity, and texts that were critically analyzed with a focus on institutional features. Analysis revealed dominant moralistic and individuated discourses in nurses' workplace talk that socially organized their substance-use practices, subordinated and silenced experiences of work stress, and erased employers' roles in managing working conditions. Conclusions included that nurses used substances in ways that enabled them to remain silent and keep working. Nurses' education did not prepare them regarding nurses' substance-use problems or managing emotional labor. Nurses viewed alcohol as an acceptable and encouraged coping strategy for nurses to manage emotional distress.

An alphabetical mnemonic teaching strategy for constructing nursing care plans.

The strategy of mnemonics has long been used as an aid to learning biology, physiology, pathophysiology, and health assessment in nursing. An application of an alphabetical mnemonics strategy to teaching and learning nursing processes and constructing care plans has been explored for patients with increased intracranial pressure (ICP), hepatic failure, and chronic renal failure. A specific application of this strategy for teaching care planning for patients with ICP is described. Student feedback appears to be positive, and reviews of the teaching-learning experience have received approval in students' evaluation of instruction. The mnemonics strategy presented has the potential for applicability and transferability to other areas of nursing care planning and other course contexts.

Introducing a multimedia course to enhance health professionals' skills to facilitate communities of practice.

PURPOSE: Scholarship about communities of practice (COP) is uncovering evidence that interactivity between community members contributes to improvement in practice. Leadership and facilitation are crucial elements of successful COP implementation. The purpose of this paper is to describe an innovative COP facilitator's course and report on the experiences of participants in the first course. DESIGN/METHODOLOGY/APPROACH: In response to this need and emerging evidence, an on-line COP facilitator's course was developed and implemented in Alberta, Canada, in 2011. This course included a home-based COP practicum, introductory face-to-face session, an on-line discussion board moderated by faculty and on-line learning modules. Evaluation of the course was formalized in a qualitative study incorporating content analysis of postings, semi-structured interviews of successful participants and narrative responses to questions in a post course survey. FINDINGS: A total of 15 of 22 participants perceived they acquired basic knowledge about community facilitation by completing the self-learning modules and assignments. Many did not establish home-based COP and only partially participated in the interactive components of the course. Six participants successfully completed the course by establishing home-based COP and actively participating in the social and interactive components of the course. They perceived they met course objectives and greatly benefited from participation in the course, in particular when they pushed themselves to facilitate in new and different ways, and when they were actively engaged with their home-based COP where they could practice and receive feedback. RESEARCH LIMITATIONS/IMPLICATIONS: While the main reasons why participants dropped out or failed to complete all course components were reported, the experiences and perceptions of six participants who successfully completed all course components form the major part of the evaluation of the course and hence introduce bias. A more in depth analysis of why learners are reluctant to engage in participatory learning could be the focus of further studies. PRACTICAL IMPLICATIONS: The following key recommendations emerged in the study alongside recommendations for further study of best practices in supporting COP facilitation. First, a formal interview before enrollment into the COP facilitator's course is recommended to reinforce the comprehensiveness, time commitment and the practical applications intended within the course. Second, methods of "aggressive facilitation" with skilled COP facilitators can best model facilitation to those involved in the course. Third, supporting course participants to trial out a diversity of community facilitation skills in the safety of the course is crucial to success. ORIGINALITY/VALUE: The collaboration, networking and interactivity of interdisciplinary health care workers is of tremendous consequence to health outcomes and a vital concern to practitioners and administrators. Little is currently understood of the leadership and facilitation of the COP models and these discoveries lend a timely contribution to the field.

Nature-based experiences and health of cancer survivors.

PURPOSE: Although exposure to, and interaction with, natural environments are recognized as health-promoting, little is understood about the use of nature contact in treatment and rehabilitation for cancer survivors. METHODS: This narrative review summarizes the literature exploring the influence of nature-based experiences on survivor health. Key databases included CINAHL, EMBASE, Medline, Web of Science, PubMed, PsycArticles, ProQuest, and Cancerlit databases. RESULTS: Sixteen articles met inclusion criteria and were reviewed. Four major categories emerged: 1) Dragon boat racing may enhance breast cancer survivor quality of life, 2) Natural environment may counteract attentional fatigue in newly diagnosed breast cancer survivors, 3) Adventure programs provide a positive experience for children and adolescent survivors, fostering a sense of belonging and self-esteem, and 4) Therapeutic landscapes may decrease state-anxiety, improving survivor health. CONCLUSIONS: This review contributes to a better understanding of the therapeutic effects of nature-based experiences on cancer survivor health, providing a point of entry for future study.

Identificación de las fortalezas, preocupaciones y necesidades educativas del Servicio Rural de Agresión sexual en las comunidades rurales y aborígenes de Alberta (Canadá) / Identifying rural sexual assault service strengths, concerns and educational needs in rural and aboriginal communities Alberta, Canada

Las mujeres en las comunidades rurales no reciben regularmente la atención integral de salud debida después de haber sufrido agresiones sexuales, lo que resulta en un aumento de las tasas de enfermedad mental, abuso de sustancias, revictimización, y problemas de salud crónicos. Además, las mujeres corren el riesgo de una victimización secundaria, de una estigmatización y de una revictimización derivada de las respuestas de los otros a la agesión. La victimización secundaria aumenta cuando las víctimas deben ser transportadas fuera de la comunidad rural para su tratamiento, debido a las demoras en los servicios, cuando los profesionales reaccionan de forma negativa hacia ellas, o sencillamente prestan unos servicios incompletos. Un estudio de investigación se hace necesario para abordar estos riesgos y comprender la necesidad de recursos educativos para los trabajadores que están a cargo de la crisis en las comunidades rurales y de aborígenes. Los hallazgos de las entrevistas de grupo con profesionales interdisciplinarios en las zonas rurales de Alberta, Canadá, identificaron algunas fortalezas, pero también revelan desafíos y la prioridad de una educación necesaria para aquellas personas que cuidan de las víctimas de agresión sexual(AU)

Women in rural communities do not regularly receive comprehensive health care following sexual assaults, resulting in increased rates of mental illness, substance abuse, re-victimization, and chronic health problems. Additionally, women are at risk for secondary victimization, the stigmatization and re-victimization that results from the responses of others to the assault. Secondary victimization is amplified when victims must be transported out of a rural community for treatment, receive delays in services, when professionals react negatively towards them, or provide incomplete services. A research study sought to find ways of addressing these risks and understanding the educational resources needed for crisis care workers in rural and Aboriginal communities. The findings from focus group interviews with interdisciplinary professionals in rural Alberta, Canada, identified strengths, challenges and priority educational needs for those caring for sexual assault victims(AU)

Students connecting critical appraisal to evidence-based practice: a teaching-learning activity for research literacy.

This article describes the implementation of an innovative research literacy teaching-learning activity. The Research in Practice Challenge activity promoted the importance and relevance of evidence-based practice with second-year nursing students in an undergraduate research course. Students appraised the evidence within policies and practice guidelines identified by managers in practice. Collaboration among students, faculty, managers, and the librarian enabled completion of the activity. Essential skills of identifying research problems in practice, searching the literature, and critically evaluating evidence were applied. Ultimately, students were asked to respond to the question: "Does this policy or guideline need revision, and how, based upon current evidence?" Effectiveness of this activity was garnered from the students' responses to course evaluations and analysis of teaching notes. Course evaluation revealed that students valued how the activity highlighted the relevance of research literacy for their practice. Further recommendations for research literacy teaching and learning are suggested.

Listening to different voices.

Grounded theory research provides the foundation for this case analy sis about listening to the voices of refugee immigrant women in order to improve access to health care. The authors share the case study of "Elena" (pseudonym), a Latin American refugee immigrant to Canada, and explore listening as an individual and collective intervention. The feeling of being degraded, ignored or dismissed by others has serious consequences for refugee immigrants to Canada. The authors recommend a social advocacy approach with both individual and collective strategies for responding to the lack of cultural sensitivity and genuine listening evidenced by Elena's case. Inclusive and partnership approaches, an "inequities imagination" and relational approaches to difference are required to loosen our thinking about what shapes refugee immigrant health. A critical cultural perspective asks that practitioners not only listen for history and context in individual practice, but also take those discoveries further to change policy and practice systemically.

The "World Mental Health" framework: Dominant discourses in mental health and international development.

This paper draws on experiences and research in mental health and international development to explore a dominant "World Mental Health" discourse. This kind of analysis provides a starting place to examine the critiques and ongoing theorizing of a global mental health ideology. Seeing the field as it is socially organized (Smith, 1987, 1990a, 1999) necessitates an understanding of how an ideological "World Mental Health" is discursively arranged as part of a global undertaking to decrease poverty and increase capitalist productivity and trade. Through this exploration of the discourses in use internationally, I argue that rediscovering local truth is possible as researchers pursue and share knowledge that has as its starting place a way of knowing outside these dominant discourses.

Out of the multiple margins: older women managing their health care.

This feminist phenomenological study explores the meaning of older women's experiences as they negotiate health care. Several interviews with diverse groups of older women (immigrant, First Nations, and Japanese-Canadian women and those involved in community and social clubs) reveal that negotiating to have their health needs met was a challenging process requiring mutual support. Their health-care experiences were influenced by issues surrounding access to services, power, and poverty. For many participants, the conversational interview format served to inspire consciousness-raising, activism, and reflection. The findings suggest that such reflection may help other women to understand the "multiple margins" (being older, being a woman, being a member of a visible minority) that constrain and challenge their access to health care.

"Like, what am I supposed to do?": adolescent girls' health concerns in their dating relationships.

This ethnographic study explored the health-related concerns, within dating relationships, of 40 female adolescents aged 15 and 16. The results reveal a complex interaction of male/female relational dynamics and socialization processes in these relationships. To avoid behaviours risky to their health, participants had to negotiate power relationships with partners and peers; yet, paradoxically, any increase in their power could increase the threat of violent confrontation, loss of power, and further health compromises. The girls' desire to have a dating partner outweighed their desire to avoid health threats such as substance abuse and violence. This dynamic can be understood in terms of patriarchal power imbalances. These findings point to the gravity of adolescent girls' health issues and the need for interventions that challenge mainstream culture and that foster empowerment among female adolescents.

Mental health research and cultural dominance: the social construction of knowledge for international development.

This institutional ethnographic work uses the first author's experience as an international development worker, educator, and community mental health nurse in West Africa to illustrate how official research and policy on mental health services reflect Western academic, corporate, economic, and cultural dominance. Focusing on a critical textual analysis of a survey intended to support funding applications to international aid/lending agencies, the authors show how official processes privilege Western policies/research approaches and subordinate local perspectives. If nurses, researchers, and policy-makers are to be effective in carrying out development work in Africa, they must learn to appreciate the subtle exertion of dominance inherent in Western approaches. The authors propose that understanding local knowledge be foregrounded rather than backgrounded to the complex global interpretive frames for international research and international development policy.