Facilitators and Barriers to Developing a Research Program: A Focused Ethnography of New Tenure-Track PhD-Prepared Nursing Faculty.

BACKGROUND: Creating a research program is a critical requirement for new PhD-prepared tenure-track nursing faculty in Canada. PURPOSE: The purpose of this article is to present key findings of new faculty members focusing on facilitators and barriers to development of their research program. METHOD: We conducted focused ethnography research examining the experience of 17 new faculty members from across Canada. RESULTS: The following themes were identified: teaching release, preparation from PhD program, intense feelings, supports and processes, mentoring, obtaining grants, and effects of the COVID-19 pandemic. CONCLUSIONS: Implications for practice include identifying ways to facilitate faculty retention as they develop their research program. This research will be of interest to deans of nursing and new faculty members.

Development and evaluation of shared decision-making tools in rheumatology: A scoping review.

INTRODUCTION: Shared decision-making (SDM) tools are facilitators of decision-making through a collaborative process between patients/caregivers and clinicians. These tools help clinicians understand patient's perspectives and help patients in making informed decisions based on their preferences. Despite their usefulness for both patients and clinicians, SDM tools are not widely implemented in everyday practice. One barrier is the lack of clarity on the development and evaluation processes of these tools. Such processes have not been previously described in the field of rheumatology. OBJECTIVE: To describe the development and evaluation processes of shared decision-making (SDM) tools used in rheumatology. METHODS: Bibliographic databases (e.g., EMBASE and CINAHL) were searched for relevant articles. Guidelines for the PRISMA extension for scoping reviews were followed. Studies included were: addressing SDM among adults in rheumatology, focusing on development and/or evaluation of SDM tool, full texts, empirical research, and in the English language. RESULTS: Of the 2030 records screened, forty-six reports addressing 36 SDM tools were included. Development basis and evaluation measures varied across the studies. The most commonly reported development basis was the International Patient Decision Aids Standards (IPDAS) criteria (19/36, 53 %). Other developmental foundations reported were: The Ottawa Decision Support Framework (ODSF) (6/36, 16 %), Informed Medical Decision Foundation elements (3/36, 8 %), edutainment principles (2/36, 5.5 %), and others (e.g. DISCERN and MARKOV Model) (9/31,29 %). The most commonly used evaluation measures were the Decisional Conflict Scale (18/46, 39 %), acceptability and knowledge (7/46, 15 %), and the preparation for decision-making scale (5/46,11 %). CONCLUSION: For better quality and wider implementation of such tools, there is a need for detailed, transparent, systematic, and consistent reporting of development methods and evaluation measures. Using established checklists for reporting development and evaluation is encouraged.

The meaning of preparedness for informal caregivers of older adults: A concept analysis.

AIM: To examine the concept of preparedness over time in research with informal caregivers of older adults. DESIGN: Concept analysis. METHODS: Rodgers' evolutionary method of concept analysis was used to guide this theoretical paper due to the dynamic nature of preparedness, which is influenced by both context and time. Using Rodgers' inductive approach, concept elements were derived from a content analysis of included studies. In the final step, to generate hypotheses and implications regarding the concept, the conceptual structure of preparedness of informal caregivers of older adults was connected to a theoretical problem in the nursing discipline using the Caregiving Stress Process Framework. DATA SOURCES: Four databases (EBSCO CINAHL, Ovid MEDLINE, Ovid PsycINFO and Scopus) were searched in November 2022 and updated in September 2023. No date limits were set for searching, as the intent was to analyse possible variations of the concept over time. RESULTS: The attributes of preparedness include self-confidence, having knowledge, skills and abilities to perform daily tasks, handling emotions and developed over time. These attributes can be compared with the stressors outlined in the Caregiving Stress Process Framework (i.e., the moment the caregiver identifies some 'stressor'; something that prevents them from feeling confident in their preparedness). CONCLUSION: The concept of preparedness of informal caregivers of older adults is defined as caregiver's self-confidence about their current competence related to the knowledge, skills and abilities to perform daily tasks, and to handle emotions over time. To link the concept to a theoretical perspective, we propose adaptations to a well-known theory, the Caregiving Stress Process Framework. Future research on caregiving preparedness needs to avoid circular definitions and work with the attributes of preparedness to support caregivers. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: This paper contributes to the development of interventions that focus on the health and preparedness of informal caregivers of older adults. Clarifying the concept of preparedness helps nurses to support caregivers since it is then known which aspects are included in the preparedness of caregivers (e.g., daily tasks and handling emotions). A more fulsome understanding of preparedness supports us to see beyond stressors of caregiving. IMPACT: This study addresses informal caregivers of older adults' preparedness to provide care. We synthesized existing definitions that have been used in research with this population to propose a robust conceptualization of the concept of preparedness, which contributes to better understanding of how preparedness can be supported. REPORTING METHOD: We were unable to locate a reporting method related to this kind of work (concept analysis). PATIENT OR PUBLIC CONTRIBUTION: Not applicable as no new data generated.

Older people's perceptions and experiences of older people with the Sit-to-stand activity: An ethnographic pre-feasibility study / Percepções e experiências de idosos com a atividade Sit-to-stand: Um estudo etnográfico de pré-viabilidade / Percepciones y experiencias de los adultos mayores con respecto a la actividad Sit-to-stand: Un estudio etnográfico de viabilidad previa

Abstract Objective: the purpose of this pre-feasibility study was to examine perceptions and experiences of a Sit-to-stand activity with urban Brazilian community-dwelling older people in their homes. Method: the exploration method was focused ethnography. Purposive sampling was used to recruit 20 older people. Five means of data generation were used, namely: socio-demographic surveys, participant observations, informal interviews, formal semi-structured interviews, and field notes. Data analysis was qualitative content analysis. Results: the experience of mobility-challenged older people with the Sit-to-stand activity was dependent on their mobility expectations involving many factors that worked together to influence their beliefs and attitudes towards the activity, preferences, behaviors, and cultural perceptions. The participants of this study seemed to find the activity enjoyable; however, the most noticeable shortcomings for their engagement in the Sit-to-stand activity emerged as gaps in their personal and intrapersonal needs. Conclusion: the recommendations generated from the study findings call for the design of implementation strategies for the Sit-to-stand intervention that are tailored to this particular population's needs.

Resumo Objetivo: o objetivo deste estudo de pré-viabilidade foi examinar percepções e experiências da atividade de Sit-to-stand com idosos brasileiros residentes em suas casas, no meio urbano. Método: o método exploratório foi etnografia focada. Foi utilizada a amostragem intencional para recrutar 20 idosos. Foram utilizados cinco meios de geração de dados: inquéritos sociodemográficos, observações participantes, entrevistas informais, entrevistas formais semiestruturadas e notas de campo. Os dados foram analisados mediante análise de conteúdo qualitativo. Resultados: a experiência dos idosos com problemas de mobilidade na realização da atividade Sit-to-stand dependia de suas expectativas de mobilidade envolvendo muitos fatores coordenados que, de forma conjunta, influenciaram suas crenças e atitudes em relação à atividade, suas preferências, seus comportamentos e percepções culturais. Os participantes deste estudo pareciam considerar a atividade aprazível; no entanto, as deficiências mais perceptíveis para o engajamento dos participantes na atividade Sit-to-stand surgiram de falhas em suas necessidades pessoais e intrapessoais. Conclusão: as recomendações geradas a partir dos achados do estudo convocam a concepção de estratégias de implementação da intervenção Sit-to-stand adaptadas às necessidades dessa população em particular.

Resumen Objetivo: el propósito de este estudio de viabilidad previa fue examinar percepciones y experiencias con respecto a la actividad Sit-to-stand entre los adultos mayores de Brasil que viven en sus hogares en comunidades urbanas. Método: el método de exploración se enfocó en la etnografía. Se utilizó muestreo intencional para reclutar 20 adultos mayores. Se emplearon cinco medios para generar datos, a saber: encuestas sociodemográficas, observaciones participantes, entrevistas informales, entrevistas formales semiestructuradas y notas de campo. Para el análisis de los datos se recurrió a análisis de contenido cualitativo. Resultados: la experiencia de los adultos mayores con problemas de movilidad en relación con la actividad Sit-to-stand dependió de sus expectativas en torno a la movilidad, las cuales implicaron muchos factores que actuaron en conjunto para influenciar sus creencias y actitudes con respecto a la actividad, al igual que preferencias, conductas y percepciones culturales. Aparentemente, a los participantes de este estudio la actividad les resultó amena; sin embargo, los inconvenientes más notorios para adoptar la actividad Sit-to-stand surgió en la forma de déficits en sus necesidades personales e intrapersonales. Conclusión: las recomendaciones resultantes de los hallazgos del estudio indican la necesidad de diseñar estrategias de implementación para la intervención Sit-to-stand a la medida de las necesidades de este grupo poblacional específico.

Routine childhood vaccination among ethnocultural groups in Canada during the COVID-19 pandemic: A national cross-sectional study.

Some ethnocultural groups in Canada experience low routine childhood vaccination, with social locations and discriminations contributing to inequities. This study aimed to characterize routine childhood vaccination in the context of the COVID-19 pandemic, including the influence of discriminatory experiences when accessing health services. We conducted a cross-sectional national survey to assess parents' acceptance of routine vaccines for their children ≤ 17 years in Oct/Nov 2021. Descriptive statistics were used to explore differences among ethnocultural groups and logistic regression to assess associations with parents' low acceptance. Of 2531 parents, 21.8 % self-identified as Racialized minorities, 7.7 % Indigenous, 23.3 % newcomers, 10.0 % spoke minority languages most often, and 69.6 % belonged to a reference group who did not report these characteristics. Statistically significant findings included 36.6 % of Indigenous parents reporting that the pandemic made them realize that routine vaccines were more important compared to 16.7 % of newcomers. Discrimination/racism when accessing health services was most often experienced by Indigenous (27.8 %) and Racialized minorities (20.2 %), compared to the reference group (4.8 %). Racialized minorities were more likely to report low acceptance of routine vaccination (aOR = 2.19, 95 % CI: 1.18-4.05), and younger parents and those with only preschool-aged children were less likely to have low acceptance (aOR = 0.59, 95 % CI: 0.37-0.94; aOR = 0.53, 95 % CI: 0.36, 0.79). Low acceptance was associated with everyday stress preventing vaccination (aOR = 2.18, 95 % CI: 1.41-3.38). Public health decision-makers should ensure equitable access to routine childhood vaccination that targets the inclusion of ethnocultural groups, who may experience disproportionate barriers and low acceptance.

Perceptions of Cannabis Use: A Qualitative Descriptive Study of Rheumatology Patients.

INTRODUCTION/OBJECTIVES: Some rheumatology patients use or contemplate using cannabis, however, may not be transparent about use with their providers. The objective of this qualitative descriptive study was to describe beliefs, perceptions, and learning needs of adults with rheumatic conditions regarding the use of cannabis products. METHODS: Purposive sampling was conducted through a rheumatology clinic and sought participants who were using or thinking about using cannabis. Two online focus groups based on cannabis use patterns (non-users and users) were conducted separately. Interviews were audio recorded and transcribed. Three research team members read the transcripts independently to identify initial codes and themes. Data saturation was reached with the interviews. RESULTS: We recruited 12 participants between 52 and 85 years old. The first theme was pain and desperation. Stigma was the second theme with a perception of physician opposition to cannabis, and the reluctance of many participants to discuss cannabis use with physicians. The final theme was a need for information and a general lack of trustworthy and credible sources. Users were willing to try cannabis even if they still had questions. CONCLUSION: Rheumatology patients are open to using cannabis due to the burden and suffering associated with pain. They remain silent on the topic, however, because of stigma and lack of engagement from health care professionals, particularly physicians. Patients voiced a strong need for information regarding cannabis and want healthcare providers to initiate discussion. These findings are clinically relevant to the management of rheumatic conditions and the promotion of therapeutic relationships.

Experiences of new tenure-track PhD-prepared faculty: a scoping review.

The purpose of this scoping review was to assess the state of the literature concerning the experiences of new PhD-prepared tenure-track faculty, with a keen interest in nursing faculty. Effective recruitment and retention strategies for new nursing academic faculty need to be found and implemented. A literature review based on Arksey and O'Malley's five-stage framework for scoping reviews was undertaken. Using the PRISMA protocol, a systematic literature search was conducted in seven databases of studies published in English. Based upon inclusion criteria and relevance, 13 studies out of 90 papers were included in this study. Themes identified from the studies were transitioning to academia, developing a research program, balancing work and life, and perceived inequity. The research was predominately American and Canadian based. Several gaps in the literature were identified. Further research is critical to make recommendations to key stakeholders for recruitment and retention strategies.

Leadership self-efficacy and nurses' aspiration to leadership: An evolutionary concept analysis.

BACKGROUND: The complex nature of leadership in nursing and healthcare requires a vast skill set. Leadership self-efficacy (LSE) has emerged as an important concept to support leadership development in the nursing literature. An analysis of LSE can clarify and inform strategies for leadership development among nurses. OBJECTIVE: To clarify the concept of LSE and understand how it relates to nurses' motivation and aspiration for formal leadership roles. METHOD: A concept analysis using Rodgers' evolutionary method identified attributes, antecedents, and consequences of LSE. Twenty-three articles published between 1993 and 2022 were analyzed following a Boolean search of four databases - Academic Search Complete, CINAHL, MEDLINE, and Scopus. RESULTS: LSE is an important element of nurses' aspiration to leadership. Leadership training, individual traits, and organizational support affect levels of LSE. When LSE is increased, job performance and nurses' motivation to take on formal leadership increase. CONCLUSION: The concept analysis further expands knowledge about factors that affect LSE. It provides data on how LSE can be harnessed to support leadership development and career aspiration for nurses. Developing and nurturing LSE among nurses may be key in promoting leadership career aspirations. Nurse leaders in practice, research, and academia can use this knowledge as a guide in leadership program development.

Experiencing Trauma During or Before Pregnancy: Qualitative Secondary Analysis After Two Disasters.

BACKGROUND: Despite the existing knowledge about stress, trauma and pregnancy and maternal stress during natural disasters, little is known about what types of trauma pregnant or preconception women experience during these disasters. In May 2016, the worst natural disaster in modern Canadian history required the evacuation of nearly 90,000 residents of the Fort McMurray Wood Buffalo (FMWB) area of northern Alberta. Among the thousands of evacuees were an estimated 1850 women who were pregnant or soon to conceive. In August 2017, Hurricane Harvey devastated areas of the United States including Texas, with 30,000 people forced to flee their homes due to the intense flooding. OBJECTIVE: To explore immediate and past traumatic experiences of pregnant or preconception women who experienced one of two natural disasters (a wildfire and a hurricane) as captured in their expressive writing. Research questions were: (1) What trauma did pregnant or preconception women experience during the fire and the hurricane? (2) What past traumatic experiences, apart from the disasters, did the women discuss in their expressive writing? METHODS: A qualitative secondary analysis of expressive writing using thematic content analysis was conducted on the expressive writing of 50 pregnant or preconception women who experienced the 2016 Fort McMurray Wood Buffalo Wildfire (n = 25) and the 2017 Houston Hurricane Harvey (n = 25) Narrative data in the form of expressive writing entries from participants of two primary studies were thematically analyzed. One of the expressive writing questions was used in this analysis: "What is the most traumatic, upsetting experience of your entire life, especially that you have never discussed in great detail with others?" NVivo 12 supported thematic content analysis. RESULTS: For some women, the disasters elicited immense fear and anxiety that surpassed previous traumatic life events. Others, however, disclosed significant past traumas that continue to impact them, including betrayal by a loved one, abuse, maternal health complications, and illness. CONCLUSION: We recommend a strengths-based and trauma-informed care approach in both maternal health and post-disaster relief care.

Older people's perceptions and experiences of older people with the Sit-to-stand activity: An ethnographic pre-feasibility study.

OBJECTIVE: the purpose of this pre-feasibility study was to examine perceptions and experiences of a Sit-to-stand activity with urban Brazilian community-dwelling older people in their homes. METHOD: the exploration method was focused ethnography. Purposive sampling was used to recruit 20 older people. Five means of data generation were used, namely: socio-demographic surveys, participant observations, informal interviews, formal semi-structured interviews, and field notes. Data analysis was qualitative content analysis. RESULTS: the experience of mobility-challenged older people with the Sit-to-stand activity was dependent on their mobility expectations involving many factors that worked together to influence their beliefs and attitudes towards the activity, preferences, behaviors, and cultural perceptions. The participants of this study seemed to find the activity enjoyable; however, the most noticeable shortcomings for their engagement in the Sit-to-stand activity emerged as gaps in their personal and intrapersonal needs. CONCLUSION: the recommendations generated from the study findings call for the design of implementation strategies for the Sit-to-stand intervention that are tailored to this particular population's needs.

The impact of the COVID-19 pandemic on parents' perceptions and acceptance of routine childhood vaccination in Canada: A national longitudinal study.

BACKGROUND: A decline in routine vaccination was reported by some countries early in the COVID-19 pandemic. In the context of the pandemic, determinants of routine childhood vaccination may have changed. Changes over time in parents' perceptions of routine vaccines and intentions for their children during the pandemic have not been fully explored. Understanding changes provides opportunities to promote routine childhood vaccines and address factors that may compromise parents' acceptance. METHODS: We conducted longitudinal analysis of two sequential national surveys during the pandemic (Dec 2020 and Oct/Nov 2021) to assess changes over time in Canadian parents' perceptions of routine childhood vaccines, intentions to vaccinate, access for their children ≤ 17 years, and differences among sociodemographic characteristics. McNemar-Bowker tests were used to determine changes in parents' responses collected at two time points. RESULTS: Of the 650 parents in the sample, 25.1% with a child ≤ 6 years and 20.5% with a child 7-17 years perceived that routine childhood vaccines were more important because of the pandemic. Between the two time points, parents' confidence in the safety (72.8% to 80.2%, p <.001) and effectiveness (81.7% to 85.2%, p =.007) of routine vaccines increased, parents were more engaged in vaccine decision-making (73.4% to 79.8%, p =.006), and everyday stress preventing vaccination decreased (78.8% to 68.5%, p <.001). Acceptance of routine vaccines increased (82.9% to 86.5%, p =.021), but more parents were undecided about influenza vaccination (12.6% to 20.3%, p =.002). Compared to parents with 1 child, those with 2 children reported increased vaccination acceptance (82.6% to 87.4%, p =.024). INTERPRETATION: Under the spotlight of COVID-19, parents' confidence in routine vaccines, engagement in decision-making, and vaccination acceptance increased. Vaccination providers should support parents' decision-making as they navigate routine childhood vaccine uncertainties. Differences in parents' acceptance of routine and influenza vaccines for their children highlight the need for targeted communication strategies for specific vaccines.

Eco-anxiety in youth: An integrative literature review.

Climate change-related eco-anxiety in young people has made headlines around the world, but most study of this phenomenon has been limited to adults. Eco-anxiety is still not well defined in the literature, but generally refers to distress, worry, or concern related to the climate change crisis. Young people will be chronologically more exposed to climate change-related harms and problems, and this may be causing increased eco-anxiety in this population. This literature review aimed to summarize the relevant works on eco-anxiety in young people, provide a critique of the literature, identify gaps, and discuss the relevance to nursing practice. A literature search using multiple databases and other sources was completed, using applicable key terms and resulted in 23 sources to inform the review. Key themes of eco-anxiety definition variation, hopelessness and burden in young people, and responses to eco-anxiety are discussed, and critical analysis is undertaken. The main conclusions include a broad working definition of eco-anxiety that does not pathologize the eco-anxiety experience but recognizes that it can cause suffering. Also discussed is the role of nurses in reducing the potential or actual suffering of youth through hope promotion, challenging binary thinking patterns, building emotional resilience, encouraging action or involvement in climate change spheres, and promoting climate justice and advocacy. Recommendations for further research are offered.

A Concept Analysis of Structural Competency.

Structural competency is a concept that offers a way to understand and respond to health inequities and work toward antiracism in health care. This article undertakes a concept analysis of structural competency using Rodgers' evolutionary method. Based on this analysis, structural competency refers to the ability to recognize and act on structural inequities, skill development, multidisciplinary collaboration, and the reproduction of inequity over time. The meanings and use of this concept differ among disciplines. Multidisciplinary applications of structural competency offer insight into how this concept can foster health equity and antiracism in nursing care, education, research, and health services delivery.

Social Media Use for Research Participant Recruitment: Integrative Literature Review.

BACKGROUND: Social media tools have provided health researchers with the opportunity to engage with communities and groups in a nonconventional manner to recruit participants for health research. Using social media to advertise research opportunities and recruit participants facilitates accessibility to participants from broad geographical areas and diverse populations. However, little guidance is provided by ethics review boards for researchers to effectively use this recruitment method in their research. OBJECTIVE: This study sought to explore the literature on the use of social media for participant recruitment for research studies and identify the best practices for recruiting participants using this method. METHODS: An integrative review approach was used to synthesize the literature. A total of 5 health sciences databases, namely, EMBASE (Ovid), MEDLINE (Ovid and EBSCOhost), PsycINFO (Ovid), Scopus (Elsevier), and CINAHL Plus with Full Text (EBSCOhost), were searched using predefined keywords and inclusion and exclusion criteria. The initial search was conducted in October 2020 and was updated in February 2022. Descriptive and content analyses were applied to synthesize the results, and the findings are presented in a narrative and tabular format. RESULTS: A total of 96 records were included in this review, 83 (86%) from the initial search and 13 (14%) from the updated search. The publication year ranged between 2011 and 2022, with most publications (63/96, 66%) being from the United States. Regarding recruitment strategy, 45% (43/96) of the studies exclusively used social media, whereas 51% (49/96) used social media in conjunction with other strategies. The remaining 4% (4/96) provided guidelines and recommendations for social media recruitment. Notably, 38% (36/96) of these studies involved hard-to-reach populations. The findings also revealed that the use of social media is a cost-effective and efficient strategy for recruiting research participants. Despite the expanded use across different populations, there is limited participation of older adults in social media recruitment. CONCLUSIONS: This review provides important insights into the current use of social media for health research participant recruitment. Ethics boards and research support services in academic institutions are encouraged to explicitly provide researchers with guidelines on the use of social media for health research participant recruitment. A preliminary guideline prepared based on the findings of this review is proposed to spark further development in this area.

New Life Through Disaster: A Thematic Analysis of Women's Experiences of Pregnancy and the 2016 Fort McMurray Wildfire.

Background: On May 3, 2016, residents of Fort McMurray Wood Buffalo, Alberta were evacuated due to an uncontrolled wildfire. The short-notice evacuation had destabilizing consequences for residents, including changes in routines, loss of control, and increased uncertainty. These consequences were especially detrimental to women who were pregnant or pre-conception during the evacuation. Pregnant and pre-conception women are particularly susceptible to a vast range of negative consequences during and post natural disasters, including elevated stress and higher incidence of pregnancy complications including gestational diabetes mellitus, pregnancy induced hypertension and C-section. The aim of this study was to understand the experiences, perceived stress and resilience of women who were pregnant during the wildfire. As well as to explore potential interventions to promote the health and enhance resilience of pregnant women and to assist in recovery after exposure to a natural disaster or other traumatic events. Methods: A qualitative thematic analysis of 16 narratives penned by pregnant women and recounted in Ashley Tobin's compilations 93/88,000 and 159 More/ 88,000: Stories of Evacuation, Re-Entry and the In-Between was conducted. Results: Analysis revealed five key themes: (1) experience of stress responses due to personal and external factors, (2) social connectedness and support as a facilitator of resilience, (3) performance of resilience-enhancing activities, (4) the roles of pregnancy and motherhood in the experiences of loss and resilience, and (5) the importance of home. Conclusion: Pregnant women have unique barriers that may negatively impact them during a natural disaster or other form of stressful event. They may benefit from assistance with navigating role transition during pregnancy, training in stress management strategies, and writing interventions to build resiliency and begin the process of recovery from trauma.

The experiences of nurse educators in establishing a teaching practice in the care of older persons: A focused ethnography study.

BACKGROUND: Gerontological nursing is not a career choice for most new graduates. Nurse educators, who influence students' career decisions, lack expertise in older person care. The academic culture may affect educators developing gerontological expertise. PURPOSE: The study explored the culture of a Canadian pre-licensure nursing education program in relation to educators' expertise in gerontological nursing. METHODS: In a focused ethnography, 22 nurse educators/researchers/administrators participated in interviews and/or observations conducted from March 2018 to December 2018. Content analysis of interview transcripts and fieldnotes occurred concurrently with data collection. RESULTS: Themes characterizing the culture were: Structure and Hierarchy, Losing Gerontology, Teaching Challenges, and Valuing Older Persons and Their Care. Participants felt: a hierarchy limited gerontologists' support for undergraduate educators and the curriculum; the integrated curriculum reduced the focus on gerontology; limited professional development opportunities and excessive workload constrained building gerontology expertise; and valuing older persons and their care influenced access to gerontology resources. CONCLUSIONS: The culture of a pre-licensure nursing program impacted educators building expertise in older person care. More research is needed to overcome barriers that constrain educators' proficiency in gerontological nursing. Increasing the number of educators adept in gerontology will develop nurse graduates with an appreciation for working with older persons.

Perceptions and experiences of functional mobility for community-dwelling older people: A focused ethnography.

BACKGROUND: Mobility challenges may indicate functional decline and are a relevant problem faced by older people. An individual's perception of mobility is affected and moderated by several factors and varies significantly from one community to another. Providing an improved understanding of how older people perceive and experience mobility is a step towards better preparing nurses for roles they are increasingly expected to play. PURPOSE: The purpose of the study was to investigate perceptions and experiences of mobility in a group of Brazilian community-dwelling older people living with mobility challenges. METHOD: Data were generated between June and October 2018 through in-depth interviews, socio-demographic surveys and field notes. Purposive sampling strategies were used to recruit 23 Brazilian older people to participate in this focused ethnographic study. Data were analysed using qualitative content analysis. FINDINGS: Perceptions of Brazilian community-dwelling older people living with mobility challenges were culturally learned and influenced by the social, physical and health environments. Participants' previous experiences with mobility had significant implications on values they attributed to mobility challenges. In addition, older people's experiences with mobility challenges were an integral part of sense of self and strongly related to contextual factors. CONCLUSIONS: This study contributes new information to the field of inquiry on mobility of older people as it focuses on the perceptions of a specific age group and culture and attends to the interrelationships between health conditions and contextual factors affecting the mobility of older people. IMPLICATIONS FOR PRACTICE: This study's particular contributions to the nursing discipline are related to improving care by revealing the significance of the context of mobility in which nursing actions are applied.

An evolutionary concept analysis of learner-centered teaching.

BACKGROUND: An increasing emphasis on a paradigm shift from the traditional teacher-centered approach has led to the adoption of learner-centered teaching in many nursing education programs. However, the lack of consensus regarding the meaning warranted an analysis of learner-centered teaching. OBJECTIVE: The objective of this analysis was to clarify the concept of learner-centered teaching for nursing education and research. DESIGN: An evolutionary framework was used to perform a comprehensive review of both theoretical and empirical literature relevant to learner-centered teaching. An evolutionary concept analysis is a method of inquiry used to analyze the literature, with the purpose of identifying the attributes, antecedents, and consequences of a concept. SAMPLE AND SETTING: Empirical and theoretical literature selected from the fields of education, nursing, and medicine. METHODS: A comprehensive review and analysis of theoretical and empirical publications from nursing, medicine and education disciplines provided a rich data source for this concept analysis. RESULTS: Four defining attributes of learner-centered teaching were identified: autonomy, empowerment, collaboration, and engagement. Four antecedents, three surrogate terms, eight related concepts, and nine primary consequences of learner-centered teaching were also identified. Exemplar cases of learner-centered teaching emerged from personal teaching practice experience and the empirical literature. CONCLUSIONS: Learner-centered teaching is a complex concept with many aspects conceptualized or operationalized which make it difficult to authoritatively define the concept. However, the features of learner-centered teaching identified in this analysis offered a good basis for the evaluation, application, and further development of the concept in nursing.

Toward a moral commitment: Exposing the covert mechanisms of racism in the nursing discipline.

Recent Canadian and international events have sparked dialogue and action to address racism within the nursing discipline. While the urgency to seek and implement antiracist solutions demands the attention of nurses, we contend that a contemporary analysis of the mechanisms that continue to perpetuate racism within nursing's theoretical foundation is required first. This study reconsiders the perceived functions of racism within the current state of nursing concepts and theories. In particular, we expose the role that covert racism plays by inadvertently sustaining racism through nursing's theoretical foundation, and how this process strengthens white supremacy. We argue that, in the absence of exposing these covert mechanisms, the development of solutions will be futile in dismantling racism. By making visible the covert mechanisms of racism within nursing's theoretical foundation, we attempt to establish an opportunity for the nursing discipline to dismantle its racist foundation and engage in sustained antiracist action. Lastly, this study demonstrates the need to equip the discipline with a moral commitment to antiracism in an effort to emancipate nursing from its racist legacies.