Rural and Northern Health - Doctoral theses

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Thesis
(Laurentian University of Sudbury, 2013-10-09) Behdin, Nowrouzi
Nursing is a stressful occupation with various physical and psychosocial stressors inherent in its practice. While the physical stressors of nursing are generally understood, less understood are the psychological and social stressors of the profession. With the many changes in healthcare facilities and structures that are occurring today and, in turn, affecting nurses, it is increasingly important to better understand the psychosocial stress experiences of nurses. Grounded in the Job Demand-Control-Support Framework, the objectives of this study were to: 1) examine factors associated with quality of work life (QWL) of Registered Nurses working in four small urban hospital-based obstetric programs, 2) determine if nursing occupational stress, QWL, and various factors (e.g., demographic, locations with and without cross-training) are associated with nurses’ work ability, where work ability is the worker’s capacity to perform their work, as was measured by the work ability index, and 3) review and evaluate some workplace interventions targeting occupational stress management and burnout for nurses.
Promoting resilience and well-being for indigenous adolescents in Canada: connecting to the good life through an outdoor adventure leadership experience
(Laurentian University of Sudbury, 2014-05-21) Ritchie, Stephen D.
Background: Promoting mental health for Indigenous youth in Canada is a well-documented priority. Indigenous approaches to health promotion share similarities with the holistic process in outdoor adventure and experiential education contexts. The purpose of this study was to develop, implement, and evaluate an Outdoor Adventure Leadership Experience (OALE) for Indigenous adolescents from one First Nations community in Northeastern Ontario, Canada. Methods: Principles of community-based participatory research were used to guide this mixed method study that included three phases. Phase 1 involved the development of a culturally relevant OALE intervention. The intervention was available to adolescents, aged 12-18 years, living in Wikwemikong Unceded Indian Reserve. Phase 2 consisted of a quantitative evaluation of the effectiveness of the OALE, based on participant self-report. It focused primarily on assessing resilience using the 14-Item Resilience Scale (RS-14). Using an ethnographic approach, Phase 3 comprised a qualitative evaluation of the ways in which the OALE promoted resilience and well-being. Results: Phase 1 occurred over a period of 10 months (September 2008 to June 2009), and it resulted in the development of an intentionally designed 10-day OALE program. The program was implemented in the summer of 2009 and 2010 with 73 adolescent participants, aged 12-18 years. Results from Phase 2 revealed that there was a 3.40 point increase in mean resilience for the adolescent participants at one month post-OALE compared to one day pre-OALE (n=46, p=.011), but the improvement was not sustained one year later. Phase 3 results revealed that the OALE facilitated the development of resilience and well-being by helping the adolescents connect to Anishinaabe Bimaadziwin, an Ojibway concept that can be translated as the Good iv Life. Connecting involved an external experiential process of connecting with various aspects of creation and an internal reflective process of connecting within to different aspects of self. Conclusion: The OALE appears to be a program that helped the adolescents: (1) become more resilient in the short-term, and (2) become more aware of Anishinaabe Bimaadziwin (the Good Life) by providing opportunities for connecting with creation and self through a variety of experiences and reflections that were unique for each youth.
The lived experience of Anishinaabe people with cancer: a focus on Indigenous healing, Western medicine and Minobimaadiziwin
(2015-05-26) Peltier, Cindy M.
Cancer is a leading cause of death in Anishinaabe people and the incidence is increasing. Despite reported successes of integrating Indigenous healing and Western medicine in the treatment of addictions, domestic violence, mental health, palliative care and chronic illness, there is a paucity of such information for cancer. A number of studies highlighted the need for awareness for policy makers and physicians of the contribution of Indigenous healing to cancer care, as well as the need for cultural safety. This Indigenous inquiry examined potential benefits and challenges of including Indigenous healing in cancer care. Using a participatory approach, I investigated how the cancer experience was affected when Anishinaabe people included both Indigenous and Western medicine in treatment and when they did not. This inquiry also examined how Indigenous healing assisted in achieving Minobimaadiziwin, an Anishinaabe understanding of health. Interviews were conducted with thirteen adults diagnosed with cancer from five Manitoulin First Nation communities. Seventeen key informant interviews were conducted with those working from Indigenous and Western health perspectives. A conversational method was employed in this Indigenous research as it honoured the oral tradition of the Anishinaabe and was concerned with co-creating knowledge in a relational context. Understanding stories involved Indigenous knowledge and Western theory, framed as two-eyed seeing. Participants recognized that Minobimaadiziwin could not be realized with Western medicine alone. With the inclusion of IH/TM and recognition of the spiritual component of life, a person can approach Minobimaadiziwin despite the obstacle of cancer along their path. This is best iv facilitated by braiding the two types of healing. Dissemination of results took two forms: a collective, teaching story for the Anishinaabe people concerning cancer and Minobimaadiziwin and publications concerning potential benefits of and challenges with pluralistic medicine for Anishinaabe cancer care.
Resilience and quality of life of francophone patients living with prostate cancer: an analysis of the situation in Northern Ontario, Canada
(Laurentian University of Sudbury, 2015-05-27) Côté, Kristy A.
Prostate cancer is the most prevalent cancer among Canadian men with current statistics estimating that one in eight men will develop this disease during his lifetime and for one in 28, it will be fatal (Canadian Cancer Society, 2014). Using social constructivism as its theoretical underpinning, the purpose of the present study was to develop a theoretical framework illustrating how Francophone men from Northeastern Ontario constructed their prostate cancer experiences. More specifically, this study sought to highlight the impact of this disease and the uncertainty it generates on Francophone patients’ resilience and overall quality of life by uncovering the strategies they utilized to construct and reconstruct their lives upon receipt of their initial diagnosis, to their selected treatment and subsequently, to their current post-treatment realities. The central question that guided this inquiry was: What are the strategies that Northeastern Ontario Francophone men utilize when faced with a diagnosis and subsequent treatment(s) for prostate cancer? This study was guided by a qualitative social constructivist grounded theory design. To collect data, 22 face-to-face, in-depth interviews were conducted with men from eight different communities throughout Northeastern Ontario. All interviews were digitally audio-recorded using two separate digital audio recorders and were transcribed verbatim in the language of the interview. Data were analyzed using the key principles of grounded theory, mainly, constant comparison, data saturation, as well as initial, focused, and theoretical coding. Results from this study highlighted the influence of language and culture on the illness experiences of Francophone prostate cancer patients from Northeastern Ontario. In addition, linguistic preferences and geographic locations were shown to be key considerations that weighed heavily within participants’ treatment decision-making processes. The role of the wife and the role of the primary family physician were also identified as important supports within the context of men’s overall assessment of their cancer experience and the impact of the disease on men’s post-treatment quality of life. Using a variety of formal and informal strategies, participants were able to mitigate some of the negative consequences of the disease and demonstrate resiliency in the face of a challenging and uncertain disease.
The effectiveness of a care transitions and rapid response nurse intervention at reducing readmissions and emergency department use for high risk patients: a mixed methods study
(2015-08-21) McNeil, David
The transition from hospital to home is a vulnerable period for the elderly patient with complex conditions, who are often frail, at risk for adverse events and unable to navigate a system of poorly coordinated care in the post-discharge period. Achieving seamless transitions between care settings is viewed as crucial to high-quality care for frail older persons. Care transitions interventions are seen as effective care coordinating mechanisms for reducing avoidable adverse events associated with the transition of the patient from the hospital to the home. This mixed methods study evaluates the effectiveness of a care transitions and rapid response nurse intervention at lengthening the time to first readmission and reducing total readmissions, emergency department use and total hospital bed days during the 30-day, 60-day and 90-day post-discharge periods for patients at high risk of readmission. The intervening impact of social isolation and patient frailty is evaluated. A randomized control trial was undertaken to evaluate the effectiveness of the intervention. Analysis was completed using the intention-to-treat principle. The primary end-point - the time to first readmission - was analyzed using the Kaplan-Meier survival analysis. The Fisher’s exact test compared differences in the post-discharge period, on the number of readmissions and emergency department visits and the Mann-Whitney-U test for hospital bed-days used. The intervening impacts of frailty and social isolation were evaluated using the independent t-test, Pearson correlation and two-way analysis of variance. Patient satisfaction with transition was evaluated using the Care Transitions Measure. Factors associated with inpatient and emergency department use were analyzed using a linear mixed model approach. No statistically significant differences were found between the intervention and control groups on the time to first readmission or in the post-discharge emergency department or inpatient bed use. Social isolation and frailty were not shown to significantly influence these outcomes but frailty was shown to be significantly associated with death. Men living alone were found to be more socially isolated. Linear mixed model analysis demonstrated that gender and previous emergency department and inpatient bed use to be significant predictors of future emergency department, readmission and inpatient bed use. No differences in patient satisfaction with the transitions were found between the intervention and control groups. A qualitative analysis was undertaken using focus groups and individual interviews, involving providers, to identify the factors that facilitated or were barriers to the implementation of this care transitions intervention. Using thematic content analysis, it was found that the effectiveness of transitional coordination efforts was thwarted by ineffective communication which affected the quality of the underlying relationships between the two teams. Other barriers to achieving the desired outcomes included: issues of role clarity, role awareness and acceptance of the positions within the respective organizations, the adequacy and reinforcement of coordinating mechanisms, and the effectiveness of the information exchange protocols. The combination of these factors limited the ability of the professionals to work effectively together to achieve the patient outcomes desired. Several improvement opportunities were identified. The activities of the individual professionals delivering care were patient focused.
Promoting a decolonized model of type II diabetes care for Aboriginal peoples living along the North Shore of Lake Huron
(2015-10-13) Pilon, Roger S.
This thesis aims to identify and contextualize issues faced by Aboriginal peoples in the seven North Shore Tribal Council (NSTC) communities who live with type II diabetes. A constructivist grounded theory methodology, guided by a decolonizing approach to conducting research with Aboriginal peoples, was utilised in this study. Twenty two individuals living with type II diabetes participated in this qualitative study. The main research question explored the impact of colonization on the lived experience and perceptions about developing type II diabetes for Aboriginal peoples. Through the use of semi structured interviews the three main categories that emerged were changing ways of eating, developing diabetes, and choosing your medicine. I have developed a substantive theory that suggests that Aboriginal peoples, living with type II diabetes, often live with the perception that there is ‘no going back’ to the way things once were prior to European contact. As a result they have had to adapt the way they live with diabetes which can, at times, be at odds with Aboriginal world views. An adaptation that considers a complementary approach including both Traditional and Western ways may provide a framework for a decolonized model of type II diabetes care for Aboriginal peoples.
Youths aging out of foster care and their experiences learning mindfulness in an arts-based group program.
(2016-01-20) Lougheed, Sean C.H.
As the field of research investigating mindfulness-based interventions (MBIs) continues to expand, studies implementing MBIs with older marginalized youth are scarce. I developed and explored the implementation of an innovative MBI with a small group of youth transitioning out of foster care due to their age. In general, these youth remain underrepresented in qualitative research processes, furthering their public “invisibility” and hampering our understanding of their long-term health and education outcomes. Since we know that many youth in care suffer a variety of long term negative consequences due to experiences of trauma, loss, and family dysfunction, and because we lack understanding regarding beneficial programs for these youth, research is necessary to support policies and programs that promote the resilience of youth in care. I was interested in better understanding these youths’ viewpoints about resilience, and their understanding of mindfulness. The lack of research exploring MBIs with youth aging out of foster care necessitated an exploratory approach. Applying qualitative inquiry and a constructivist lens, I collected data from eight participants who participated in two different groups. I interviewed the youths using open-ended questions in three semi-structured interviews prior to, immediately after, and four months following participation in a holistic 10-week arts-based mindfulness group program. A follow-up meeting was held with all of the youth one year after the groups were completed. Using an inductive form of interpretive thematic analysis, my analysis of the data yielded themes illustrating the participants’ perceptions of the challenges that they endured; the key features of resilience; their understanding of mindfulness; the benefits of learning mindfulness; and the perceived helpfulness of the group experience. These findings helped me to illustrate new insights about the benefits, challenges, and opportunities afforded by implementing MBIs with older youth in care. I found that the arts-based mindfulness group program was suitable and the youth expressed several benefits of learning mindfulness for their day-to-day lives including increased self-awareness and improved emotion regulation. The implications for service providers and other allies of marginalized youth are considered, and recommendations for future researchers are provided.
Exploring how indigenous healing practices and a western treatment model “seeking safety” can co-exist in assisting indigenous peoples to heal from trauma and addiction
(2016-03-09) Marsh, Teresa Naseba
Background: Indigenous communities in Canada face significant challenges with trauma and substance use disorders (SUD). Most Elders, traditional healers and Indigenous scholars agree that connecting to culture, land, community, and spiritual practices is a pathway to healing trauma and SUD in Indigenous peoples. The purpose of this study was to explore whether the blending of Indigenous healing practices (IHP) and a mainstream treatment model, Seeking Safety (SS), resulted in a reduction of intergenerational trauma (IGT) symptoms and SUD. The SS model has been studied in other populations but there was no evidence of its effectiveness with Indigenous peoples. Some studies have shown the positive impact of Indigenous healing practices on SUD. Methods: A mixed-methods design was used to evaluate the impact of a 13-week Indigenous healing practices and Seeking Safety (IHPSS) implementation project. This was a pilot study with one group of 12 Indigenous women and one group of 12 Indigenous men (n = 24) in Northern Ontario. Semi-structured interviews and focus groups were conducted at the end of treatment. The transcripts underwent qualitative thematic analysis to depict themes and understand the ways in which the program promoted healing. Data was collected pre- and post-implementation using the following assessment tools: the Trauma Symptom Checklist-40 (TSC-40), the Addiction Severity Index-Lite (ASI-Lite), the Historical Loss Scale (HLS), and the Historical Loss Associated Symptom Scale (HLASS). The effectiveness of the new program was assessed using paired t-tests, with the TSC-40 as the main outcome. Results: A total of 17 participants completed the study. Four core themes emerged from the qualitative data that showed a positive impact on the symptoms and behaviors related to IGT and addiction in the participants. The benefits from both Indigenous healing practices and SS were clearly depicted through the voices and viewpoints of all 17 participants. Participants demonstrated improvement in the trauma symptoms, as measured by the TSC-40, with a mean decrease of 23.9 (SD=6.4, p=0.001) points, represented a 55% improvement from baseline. Furthermore, all six TSC-40 subscales demonstrated a significant decrease: anxiety (p = 0.001); depression (p=0.000); sexual abuse trauma index (p=0.0011); sleep disturbance (p=0.003); dissociation (p=0.027); and sexual problems (p=0.037). Substance use did not increase as measured by the ASI-Lite alcohol composite score (mean difference = -0.011) and drug composite score (mean difference = 0.032). Conclusion: Evidence from this mixed-methods pilot study indicates that blending IHP with the SS model was beneficial in reducing trauma symptoms. The combination of IHP and mainstream healing methods has the potential to enhance the health and well-being of Indigenous peoples.
Kijiikwewin aji: sweetgrass stories
(2017-01-01) Wabie, Joey-Lynn
Kijiikwewin-aji means ‘to become a woman now’ in Algonquin and describes the heart of the research. Sweetgrass stories shares the title of this thesis as it is part of the research methodology used with traditional Indigenous women. Through grounding myself with Indigenous Grassroots Theory, the creation of an Algonquin Indigenist paradigm and my relationship with knowledge, I formed an Indigenous research methodology called sweetgrass story weaving which focuses on traditional Indigenous women as they share their moontime stories. Within this thesis, I also share information relating to the historical roots and present state of rites of passage with traditional Indigenous women and discuss the research journey using the concept of ethical space. Using an international, national and grassroots level focus on strength, resilience and power, you will read traditional Indigenous women’s voices as they look back through lived experiences; hope and determination when looking forward to the future, and the shared theme of wanting their cultural traditions and ceremonies to live on through future generations of Indigenous girls and women, including young men. What is the current state of the Berry Fast, understanding the assimilative nature of colonization and the effects it has had on Indigenous women? How can we continue to honour these rites of passage while living in a world both with traditional Indigenous worldviews and colonial constructs? I propose the introduction of a sweetgrass knowledge transfer model for the Berry Fast using the transferrable characteristics harvested from my research methodology. This knowledge transfer model has the capacity to increase accessibility and decrease the difficulty in completing the Berry Fast in order for traditional Indigenous women to complete it in the present day. Furthermore, the introduction of the sweetgrass knowledge transfer model for the Berry Fast can assist with framing the perspective of Indigenous women as powerful beings who elicit respect and an equal place in contemporary society. Over time, the collective strength and wisdom of traditional Indigenous women will increase which is a step in the decolonized direction of preventative health care which promotes mino bimaadiziwin.
Evaluating the quality of work life of registered nurses in urban, rural and remote Northeastern Ontario
(2017-09-07) Horrigan, Judith Mary
The sustainability of our Canadian healthcare system to meet the demands of healthcare and healing for clients in urban, rural and remote hospital settings are dependent upon nurses’ health and the quality of nurses’ work life. The purpose of this research was to understand how Northeastern Ontario registered nurses’ (RNs’) in urban, rural and remote hospitals evaluated their quality of work life (QOWL), to examine similarities and differences of RNs’ evaluation related to their geographic locations, and to identify what QOWL and nursing practice environment factors were associated with nurses’ stress. A mixed methods sequential explanatory design was conducted that used an adapted version of the Nursing Work Life Model as the theoretical framework for Phase I. Quantitative data were collected from RNs working in urban, small urban, rural and remote Northeastern Ontario hospitals (n=4). The questionnaire consisted of demographic questions, the Brook’s Quality of Nursing Work Life, the Practice Environment Scale, the Nursing Stress scales (NSS), and a section for RNs to write comments. Multiple and logistic stepwise backward regressions were conducted to determine factors associated with nurses’ QOWL and stress scores. Phase II face-to-face interviews of RNs and nurse leaders (n=17) were conducted to explicate findings from Phase I results. Thematic analysis of participant comments (n=53), and semi-structured interviews were guided by Thorne’s (2008) Interpretative Description methods. A total of 319 packages were distributed and yielded a 54.23% response rate (n=173). The majority of RNs were female (93.1%) and ranged in age between 20 and 29 years (mean = 35.9, s.d. 11.0). Results from the QOWL multiple regression analysis indicated three key factors that explained 35% of the variance (R2 0.353) that included: general health, exhaustion, and factors in the staffing subscale of the Practice Environment Scale. Four key factors were associated with nurses’ stress scores that explained 42% of the variance (R2 0.423) and included: workload, work-home life balance, adequate support services, and factors of the nursing ability subscale of the Practice Environment Scale. Nurses who reported decreased presence of factors associated in the Nursing Quality subscale were 12.39 (95% CI: 2.58- 59.64) times as likely to have lower QOWL scores (≤163). Nurses who did not have adequate support services that allowed nurses to spend time with patients were 3.56 (95% CI: 1.78, 7.10) times as likely to report higher stress scores (≥ 78). The overarching theme summarizing the findings was revealed to be Supporting Holistic Client Healing and Nurse Healers that described nurses’ and nurse leaders’ evaluation of Northeastern Ontario nurses’ QOWL and stress. This was supported by five key themes: 1) Holistic Healing of Clients: Dueling Ideologies, 2) Facilitating Healing at the Bedside: Supporting Nurses’ Work Life, 3) Geographical Hindrances to Healing: Healthcare System Inequalities, 4) Supporting Healing Beyond the Hospital Bedside: Healthcare System Inequities in Policies, Funding and Decision-Making Processes, and 5) Nurses’ QOWL and Health Consequences. The findings of this research elucidated new knowledge related to factors impacting Northeastern Ontario nurses’ ability to provide quality holistic care to facilitate their clients healing processes, which affected nurses’ QOWL and stress. Supporting the holistic healing of clients and nurse healers requires nurses being able to access the supports and resources they need that maintains their legal and ethical standards of care. Inequitable healthcare system policies and decision-making processes that perpetuate healthcare system inequalities need to change. Improving nurses’ QOWL and stress requires a concerted effort by several stakeholders. Healthcare policies and decision-makers need to listen to the voices of nurses and healthcare providers who live and work in rural and remote settings across Northern Ontario. New and unique solutions and policies can be created that may eventually actualize the vision of the delivery of high quality healthcare services that are equitable for all Ontarians regardless of their geographic location.
"If we have the knowledge, then that is power to help our expectant moms": Northern Ontario health care students' knowledge and attitudes addressing alcohol consumption during pregnancy.
(2017-09-28) Coons, Kelly D.
The current document is a paper-based dissertation investigating health care professionals’ knowledge, attitudes, and self-efficacy regarding fetal alcohol spectrum disorder (FASD) and alcohol consumption during pregnancy. This dissertation incorporates findings from a secondary data analysis of health care professionals in Ontario, as well as original data from health care students training in Northern Ontario. While previous research has demonstrated that health care professionals remain under-educated concerning FASD and alcohol use during pregnancy, limited research has investigated the knowledge and experiences of health care students. The first paper included is a secondary data analysis of the 2001-2002 Fetal Alcohol Syndrome Survey for Health Professionals. Ontario-specific data (N=834) were used to examine the awareness of FASD held by various provider groups in both rural and urban settings. Results from this study indicate that many physicians, midwives, and other health care professionals may have inconsistent knowledge regarding the impact of prenatal alcohol exposure, resulting in mixed messages for women of childbearing age about the safety of alcohol use during pregnancy. The second paper included is a qualitative analysis of scenario-based vignettes regarding alcohol use during pregnancy. Although almost all students (N=21) recognized that no alcohol consumption during pregnancy is the safest recommendation, many students noted that this advice is not always conveyed to pregnant women. Finally, the third paper included is also a qualitative analysis based on a thematic analysis of scenario-based vignettes and semistructured interviews. The third paper explores health care students’ (N=21) attitudes and beliefs about women who may continue to consume alcohol throughout their pregnancy and presents the often stereotypical and stigmatic perceptions of FASD and alcohol use during pregnancy held by health care professionals. Recommendations and implications for increasing students’ and professionals’ knowledge and self-efficacy regarding FASD management and prevention are discussed.
Northern Ontario nurse practitioner job satisfaction and intent to leave: a constructivist grounded theory study
(2018-04-12) Fournier, Jennifer L.
The current document is a three-paper dissertation exploring northern Ontario primary healthcare Nurse Practitioners’ (NPs) job satisfaction and intent to leave. The characteristics of NP job satisfaction and intent to leave are poorly understood. The broader work on NP job satisfaction and intent to leave has relied heavily on quantitative cross-sectional methods. I decided to use qualitative methods in order to seek deeper understanding of NP job satisfaction and intent to leave. The sample for this constructivist grounded theory study included 18 primary healthcare NPs working full time in primary healthcare in Northern Ontario. Telephone interviews were conducted and transcripts were analyzed. We found that primary healthcare NP job satisfaction was dependent upon a particular mix of “satisfiers”. These satisfiers included independence and interdependence, challenging work, quiet moments, and beginnings and endings. NPs experience dissatisfaction related to role recognition, geographical distances, overwork, and feeling overwhelmed. Key features were identified as contributors to primary healthcare NP intent to leave. These included inadequate remuneration, the lack of a provincial government pension plan, the quality of their relationships with management and administration and extended benefits programs. Among those considering leaving a primary healthcare NP position, key features of a new position would include adequate remuneration, generous extended benefits, and a shorter distance from home and practice sites. Some respondents intending to leave their current practice setting identified that they would be seeking work outside of NP practice. This study served to clarify key job features and processes related to job satisfaction and intent to leave among Northern Ontario’s primary healthcare NP population. A broader theory of NP job satisfaction and intent to leave emanated from the analysis of relationships among these key concepts within the study. The findings of this study could serve to inform initiatives to retain and recruit primary healthcare NPs within both rural and urban practice settings across northern Ontario.
Giishpin Nonagzwaat Binoojiinyik Kanim Na Majiishkaami: determinants of obesity among indigenous children in six First Nations Communities in Northeastern Ontario
(2018-05-16) McGregor, Lorrilee E.M.
Background: Worldwide, childhood obesity rates are high and even higher among Indigenous children. Childhood obesity is of concern as it can result in metabolic conditions. Much has been written about the causes of obesity, usually focusing on individual behaviours, but a gap exists in understanding the social determinants of obesity in Indigenous populations. Methods: Survey data was collected from First Nations students in grades 6 to 8 through a diet and health behavior survey. Measurements including height, weight and waist circumference were taken. Focus groups with 33 caregivers were conducted to explore the determinants of physical activity and nutrition. Results: The prevalence of overweight/obesity in children was 65.8%. The prevalence central obesity was 37.7%. There was a strong positive correlation between waist circumference (cm) and BMI z scores (rs = 0.84, p>0). Daily physical activity (DPA) of 60 minutes per day was associated with a BMI ≤85th percentile and a waist circumference ≤90th percentile. Girls consumed 3.5 servings of fruits and vegetables and boys consumed 2.5 servings. Consuming fruit juice was directly associated with central obesity. Normal weight was associated with participation in at least four types of cultural activities. Caregivers identified impediments to physical activity as financial, recreational technology, safety concerns, and community activation. Changes in lifestyles, influenced by the consequences of colonization, have resulted in reduced physical activity. Colonial policies result in funding challenges for children’s recreation programs and a reliance on government develops. Safety concerns stem from intergenerational trauma created by colonial policies. Dietary decisions were influenced by the availability of fish and game, hunting and fishing regulations, food insecurity and the proliferation of processed foods. Dietary decisions are influenced by the contamination of traditional territories, the marginalization of culture, participation in the economy and issues of poverty. Conclusions: Waist circumference is an effective indicator of obesity along with BMI and should be used in public health screening of Indigenous children. Low fruit and vegetable consumption is of concern as is the consumption of fruit juice. Protective factors against obesity are 60 minutes of DPA and participation in at least four types of cultural activities. Colonialism is a determinant of physical activity, nutrition, and obesity in this population.
An evaluation of the quality of care of diabetic patients with multimorbidity at nurse practitioner-Led clinics in the North East and North Simcoe Muskoka LHINs
(2018-06-05) Heale, Roberta
A multiple case study was undertaken with five Nurse Practitioner-Led Clinics (NPLCs) in in the North East and North Muskoka Simcoe Local Health Integration Networks in Ontario, Canada. The purpose was to evaluate the quality of care in NPLCs, specifically to address the following research questions: What is the relationship between organizational processes in the NPLC model and the care of diabetic patients with multimorbidity? To what extent are clinical practice guideline indicators for diabetes care being met for patients with multimorbidity in five NPLCs? How do nurse practitioners practicing at NPLCs evaluate the impact of the NPLC model on the quality of the care they provide to diabetic patients with multimorbidity? The research was guided by the Donabedian Quality Framework. The study included three types of data collection. First, documents related to NPLCs were collected and the impact of the nurse practitioner (NP) as primary care provider was analyzed. Then the Chronic Care Model was used to guide the development of a chart audit in each of the five NPLCs, conducted on 30 charts per clinic (n= 150) for non-pregnant, adult diabetic patients with multimorbidity. Analysis determined relationships between diabetes indicator scores and organizational and patient data. Next, 8 NPs from 4 of the 5 NPLCs participated in interviews, guided by semi-structured questions arising from the document review and chart audit analysis. Interpretive description methods were used to analyze the transcripts and identify themes. A cross-case analysis was conducted to compare the results of all analyses across NPLCs. Themes emerging from this multiple case analysis confirmed that the NP is the primary care provider and clinical leader at NPLCs, which has contributed positively to the quality of care in NPLCs. NPLCs have suffered from poor NP recruitment and retention. This, along with insufficient health care resources in the communities where NPLCs are located and high patient vulnerability, has had a negative influence on the quality of care. Strategies including mentoring and changes to funding offer possible solutions to improve the quality of care at NPLCs. (336 words)
The impact of childhood obesity discourses on domestic and reproductive labour for single mothers in Northeastern Ontario : an institutional ethnographic study
(2018-08-24) O’Gorman, Laurel
Rationale: The term “healthy children” is often used to describe children whose weights are within a socially acceptable range which conflates health with thinness, often completely overlooking other aspects of health and employing body-stigmatizing language about children. Research Questions: 1. How do single mothers who live in poverty in Northeastern Ontario define good health for their children? What role do considerations of obesity play in their definition of good health? 2. What are the implications of participants understanding of health on their domestic and reproductive labour? 3. How are these experiences mediated by the families’ social location? Theory: Institutional ethnography (IE) is a theory and a method. IE investigates the coordination of ideologies that shape people’s experiences. Institutions made up primarily of government bodies and medical experts shape how childhood obesity is discussed in schools, the media, and in everyday life, impacting how we understand and speak about children’s bodies. This includes the amount and types of work expected of parents (primarily mothers) as well as the implications for bodies that do not meet the standard deemed acceptable in a particular time and place. Method: The research participants were twenty women residing in Northeastern Ontario who self-identify as a single mother living in poverty. I used two methods of data collection: interviews and guided tours of key areas impacting children’s health, such as grocery stores or places children play. Analysis: I analysed the interviews and the interactions between participants and their environment using an institutional ethnographic approach to coding. The aim of the analysis is to link the everyday lived experiences of research participants to the ruling relations in which they are shaped. Results: Participants talked about children’s health in ways that were consistent with obesity discourses. When I asked what the term healthy child meant to them, the first response was usually ‘food’ followed by ‘physical activity’. Mothers described a great deal of work that went into trying to make decisions that they felt were healthy. However, they also described many barriers to providing the types of healthy foods and activities they would like to provide for their children.
Vibration toolkit: an occupational health education intervention for the mining industry
(2018-09-04) Leduc, Mallorie Georgine
Background: Workers in the mining industry are exposed to whole-body vibration (WBV), hand-arm vibration (HAV), and foot-transmitted vibration (FTV). The purposes of the study were to: critically review occupational health and safety education intervention programs that have been conducted within rural and northern communities and industries; examine the vibration-focused education resources in northern Ontario; and develop, implement, and evaluate an occupational health education intervention program, the Vibration Toolkit.
Evidence-based strategies in occupational health: applying meta-analytic and qualitative methods to identify and understand sickness absence among nurses and health care aides with considerations for Northeastern Ontario
(2018-12-17) Gohar, Basem
Purpose: Compared to other employees, nurses and health care aides (HCAs) have the highest sickness absence rates in Canada yet the phenomenon remains insufficiently studied. Furthermore, the potential influence of geography on sickness absence has received scant attention. Guided by the Evidence-Based Practice in Occupational Health Psychology framework, this investigation aimed to identify factors associated with sickness absence, understand how they occur, and determine factors that may be specific to communities in northeastern Ontario. Methods: A systematic review identified relevant studies through structured search strategies, article screening, and quality testing. Pooled statistics in the form of odds ratios and confidence intervals were computed. Follow-up analyses examined heterogeneity (Q& I2). Qualitatively, focus group sessions were held with registered nurses (n= 6), registered practical nurses (n= 4), HCAs (n= 5), and key informants specialized in nursing, occupational health, disability management, and rehabilitation (n= 5). Nursing personnel were recruited from hospitals and long-term care facilities. Narrative data were analyzed using thematic analysis. Results: Meta-analytic searches yielded 812 studies, of which 27 met eligibility, and 11 variables that influenced the odds of sickness absence in a statistically significant manner (p< .05). Variables include: sex, occupation, health rating, previous sick leave, musculoskeletal pain, poor mental health, fatigue, night shifts, pediatric and psychiatric units, increased occupational demand, and work support. Poor health rating was highly heterogeneous (p< .05; I2= 82.77%). Thematic analysis revealed four primary themes: (1) Organizational factors including exposure to infectious diseases, shift work, safety climate, and work setting; (2) the jobs’ physical impact, mainly musculoskeletal pain; (3) psychological/mental impact including guilt, anxiety, and burnout; and (4) factors unique to northeastern Ontario including poor weather and road conditions, especially for HCAs providing home care, and the limited opportunity of interconnected health care networks where employers make staff available during worker shortages. Factors leading to sickness absence were described, with staff shortage serving as an important underlying contributor. Conclusion: This investigation points to the complexity and intricacy of factors influencing sickness absences. The qualitative results helped deepen the understanding of the quantitative findings, while considering northern-specific factors. Several concerns were attributed to staff shortages.
A population-based retrospective cohort study of pediatric diabetic ketoacidosis (DKA) hospital admissions in Northern and Southern Ontario: do geography and physician diabetes care matter?
(2019-01-07) Mian, Oxana
Background: Diabetic Ketoacidosis (DKA), an acute complication of diabetes, is a major cause of death and disability in children with diabetes. The main purpose of this study was to describe the prevalence of DKA hospital admissions in Ontario children with diabetes and examine how it is associated with children’s geographic location and use of physician diabetes care services. The secondary purpose was to describe trends in pediatric diabetes incidence in Northern and Southern Ontario and the entire province.
An exploration of interprofessional education in four Canadian undergraduate nursing programs
(2019-01-25) Donato, Emily
Formal inclusion of interprofessional education (IPE) curricula within Canadian undergraduate nursing programs has been occurring since 2012. While there is evidence that Canadian university nursing programs are working to achieve the integration of IPE throughout undergraduate curricula, a gap exists in what is known about IPE integration in Northern Ontario nursing programs, particularly from the perspectives of faculty members and program administrators. This multiple case study explored how four undergraduate university nursing programs in Northern Ontario integrated IPE into their curricula, including the opportunities and challenges of this work. Program experiences were explored within, and across, four undergraduate nursing programs located in Sudbury (including both English language and French language programs), Thunder Bay, and North Bay. Data acquisition strategies consisted of interviews with program directors (n=3), focus groups (n=10) and interviews (n=3) with faculty members, review of available program documentation and websites, and on-site program observations. Thematic analysis was undertaken for each case and during the cross-case analysis stage. The cross-case synthesis resulted in the following themes: 1) varied understandings of IPE, 2) diverse IPE learning activities within curricula, 3) the requirement for support and resources for IPE and research, 4) student participation and leadership in IPE, and 5) limited IPE evaluation. These results highlight IPE practices within these nursing programs and what supports them. Faculty development, IPE research, student involvement, and administrative support are required to maintain and sustain IPE. Dissemination of results may encourage further research and dialogue on current IPE practices among nursing programs in Northern Ontario and beyond.
Food insecurity, poverty and lived experience of homelessness: a study of women in Northeastern and Southwestern Ontario
(2019-03-21) Al-Hamad, Areej
Understanding the connections between geographical location (Northern vs Southern Ontario) and gender inequalities and food insecurity, poverty, homelessness and health is vital within the current social and political context characterized by restraints in public funding. First, this study describes the experiences of poor and/or homeless women with or without dependents in two mid-size urban communities in Northeastern Ontario (City of Greater Sudbury) and Southwestern Ontario (City of London Ontario) with regard to food insecurity, homelessness, poverty and the perceived impacts on physical and mental health. Second, it identifies the profile of food-insecure women in Northeastern and Southwestern Ontario, as well as the factors associated with their general and mental health perceptions. The study employed a sequential descriptive multi-methods approach to address the objectives. A descriptive, qualitative exploration of food insecurity experiences among poor and/or homeless women in the two regions was conducted. Data were collected through a semi-structured interview with twenty poor and/or homeless women, 10 from each of the two communities. The participants were near homeless or absolutely homeless and all had prior histories of homelessness. The interview data were thematically analyzed. Subsequently, a quantitative secondary data analysis of extracted variables including sociodemographic, health and food insecurity from the Canadian Community Health Survey (CCHS, 2014) was conducted to describe the profile and factors associated with general and mental health perceptions for 408 women in the northeast and southwest of Ontario. The main themes were food and financial hardship, motherhood, resourcefulness and health perceptions. The quantitative findings did not capture the association between health perceptions and place of residency among food-insecure women. The general and mental health perceptions of these women were significantly related to household size, employment, worries about running out of food, inability to afford balanced meals and cutting or skipping meals regardless of where they lived. This study’s findings highlight the intersection of geography, health, gender and vulnerability to food insecurity and show that Northeastern and Southwestern women merit greater attention and support in accessing nutritious food. Such findings are important in shaping gendered public and social policies.

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