Rural and Northern Health - Doctoral theses

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The "Pebble in your shoe" model of effectiveness: Laurentien University Undergraduate students' perspectives on campaigns regarding alcohol use during pregnancy
(2024-09-09) Bibr, Celisse
Fetal Alcohol Spectrum Disorder (FASD) is the diagnostic term for the effects of alcohol use during pregnancy and is one of the leading causes of developmental disability. Both individuals with FASD and pregnant people require information and supports to promote their health. Currently, in Canada, these two needs are not being adequately or consistently met. Health promotion campaigns reach their highest barrier in the form of reactance, a reaction to advertising wherein individuals dismiss and reject messaging. This common occurrence is exacerbated during the experience of pregnancy when individuals are receiving a higher amount of health advice than the general population. While many health promotion campaigns about alcohol use during pregnancy exist, these campaigns have been criticized for their contribution to stigma due to their reliance on fear, blame and shame to deliver their message. This type of messaging also contributes to reactance, strengthening the barriers to receiving information about alcohol use during pregnancy. This type of education is essential to allow for pregnant people to make informed choices, which are currently complicated through misinterpretation of safe alcohol use by the media, anecdotal stories wherein friends or family drank alcohol during pregnancy and produced healthy children, and the cultural norm of using alcohol. Therefore, development of a new type of campaign that effectively informs pregnant people about the dangers of using alcohol during pregnancy, without contributing to the current stigma surrounding the disorder, should be explored. The first step in creating this type of campaign is to receive community input on previous worldwide campaigns. As such, this dissertation sought to understand the thoughts, opinions and perspectives of individuals of childbearing age on previous Level 1 FASD prevention campaigns. Using intersectionality theory, basic qualitative design, thematic analysis and focus group discussion, the “Pebble in Your Shoe” Model of Effectiveness was developed based on community perspectives. This model could be utilized in the development and evaluation of future Level 1 FASD Prevention campaigns.
Another fork in the road: the experiences of retired teachers and nurses living in Northeastern Ontario.
(2023-08-08) Patrick, Elizabeth Ann
Canadian women born after the Second World War, between 1945 and 1964, were both credited and criticized for their roles in challenging traditions and forging life pathways that were different to those before them. In recent decades, this cohort has been entering their retirement paths. This qualitative study explored stories about how some women were living the transcendent stage of later life in rural and small towns in Northeastern Ontario. Using a feminist narrative approach, twenty-one primarily boomer women were interviewed by telephone, using semi- structured questions. The women had retired from teaching or nursing, accomplished professional designations in their jobs, and lived in the target areas. Braun & Clarke’s (2022) reflexive thematic analysis was followed to generate codes and themes. Ten themes emerged: 1) how do I feel at this stage of my life?, 2) it’s my life, my time., 3) where did my identity go?, 4) what do I do now?, 5) the impact of gender roles on participants’ stories., 6) options for retirement and feelings about this life event., 7) expectations for the next fork in the road., 8) connection and purpose., 9) the importance of health-financial, mental and physical., and 10) let go, take the plunge. The results of this study supported the literature regarding retirement pathways; however, this group mainly identified with transitional or continuity models. Freedom to make choices, unencumbered by the rules of a job, resonated throughout the results. Data highlighted the importance of community and family involvement for overall health and wellbeing. This resilient group determined that they would learn new things and adapt to ongoing physical and mental health issues through staying busy and maintaining relationships with family and friends. Key words: Women, Retirement, Baby Boomers, Professional, Northeastern Ontario, Retirement pathways.
An interpretive description of health equity in chronic obstructive pulmonary disease (COPD) clinical practice guidelines
(2023-06-21) McMillan Boyles, Christina
Health equity is an increasing global phenomenon of interest among health care professionals (HCPs), researchers, and decision-makers. Clinical practice guidelines (CPGs) serve to promote standardized care and may have implications relative to health equity. Health care professionals rely on evidence including CPGs to be accountable, provide optimal care, and to advance advocacy efforts for people with chronic lung disease. However, CPGs for COPD may unintentionally exacerbate health inequities and health disparities experienced by those living in northern or rural areas where there may be decreased access to supports such as spirometry, pulmonary rehabilitation, and specialist care. The purpose of this study was to conduct an interdisciplinary analysis of COPD CPGs to understand the contribution and implications of these guidelines to health equity for individuals living with COPD. Different perspectives and representations of health equity across the guidelines may have problematic implications and challenges for patients, HCPs and decision-makers. The research question guiding this study is how do CPGs for COPD explicitly or implicitly address health equity? The study design, interpretive description, was guided by critical social theory. Using purposive sampling, publicly available international, national, and provincial English language CPGs for COPD were selected. Concurrent data collection and analysis was informed by five items of The Equity Lens instrument and the four items of Domain 5, outlined in the Applicability of the Appraisal of Guidelines for Research & Evaluation II (AGREE II) Instrument. The four stages of content analysis are decontextualization, recontextualization, categorization, and compilation. The results offer opportunities to engage multiple interdisciplinary knowledge users in dialogue about the implications of CPG adoption to move toward health equity and to best service individuals with COPD in Northeastern Ontario.
Stress, anxiety, and depression among mining workers: understanding the correlates of mental health and wellbeing
(2022-11-11) Dignard, Caroline
Background: Mental health problems are among the leading causes of disability. The consequences of poor mental in the workplace are numerous and well-documented. Despite this, mental health research specific to the mining industry remains scarce, especially in Canada where mining plays a significant economic role. What is more, workers in male-dominated industries have been found to be at greater risk for mood and anxiety disorders, and the limited existing literature depicts higher rates of mental illness among mining workers. This is relevant in Canada because the mining industry is a major employer of Canadians. Objective: Our research team conducted a study at a large mining company in Ontario, Canada to better understand the mental health and wellbeing of their workforce by assessing symptoms of various mental health problems and illnesses, as well as work and non-work-related factors that may be associated with these symptoms. As part of this study, my thesis examines the prevalence of stress, anxiety, and depression symptoms in this sample of Canadian mine workers, as well as the demographic, health-related, psychosocial, and work-related predictors of stress, anxiety, and depression symptoms for these workers. Methods: 2,224 mining workers across 25 worksites at one company in Ontario, Canada completed a self-reported questionnaire. The survey included assessments of symptoms of stress, anxiety, and depression, demographic questions, and assessments of psychosocial and healthrelated factors associated with stress, anxiety, and depression. Results: While stress levels were found to be comparable to the general working population, symptom prevalence of anxiety and depression were greater in this workforce than in the general working population of Canada. Significant correlates of these workers’ mental health and wellbeing were grouped into the following 8 categories: individual characteristics, interpersonal relationships, lifestyle, and the overlap between physical and mental health (see Chapter 6), as well as work schedule and demands, effort-reward imbalance and recognition and reward, job insecurity and job satisfaction, and the physical and psychological work environment (see Chapter 7). Conclusions: Findings are consistent with previous research and confirmed our hypotheses. Recommendations for addressing significant predictors of mental health and wellbeing for these workers are presented in Chapter 8.
Exploring the influence of language concordance and the active offer of French language physician services on patient satisfaction through a Northern Ontario continuing professional development initiative
(2023-01-16) Timony, Patrick
Francophone minority populations across Canada experience poorer health outcomes. A lack of French language health services may be a contributing factor. Interpersonal communication between patient and physician is essential to providing quality health care and the legislative landscape in Ontario is evolving to become more responsive to Francophone communication needs. For instance, the passing of Bill 74 and the modernisation of the French Language Services Act (that was first passed in 1989) have created an expectation that health service providers will proactively offer services in French. The purpose of the present thesis was to develop and evaluate the effectiveness of a continuing professional development (CPD) program that teaches patient-centered communication through the active offer of French language services; to investigate the presence of the active offer in Northeastern Ontario; and to explore the influence of language concordance and the active offer on patient satisfaction.
Evaluating mental disorders and physician-based mental health services for patients enrolled in opioid agonists treatment across Ontario, Canada
(2020-06-15) Morin, Kristen A.
The overall purpose of this thesis was to explore the relationship between physician-based mental health services and all-cause mortality, emergency department visits and, hospitalizations among patients receiving opioid agonist treatment (OAT) in different regions of Ontario. I conducted a retrospective cohort study using secondary health administrative data from ICES. Specifically, I used the Ontario Health Insurance Plan (OHIP) and the Ontario Drug Benefit Plan (ODB) databases to identify patients. Eligible patients were 15 years of age and over and were receiving OAT from January 1, 2011, and December 31, 2015. I conducted quantitative analyses using logistic regression and propensity score matching methods to test the relationship between concurrent physician-based mental health services and OAT and health service outcomes. Five core findings were brought together in this thesis: (a) having a diagnosis of one or more mental disorders while in OAT was associated with a higher likelihood of mortality and a more complex profile of health service utilization when compared to patients in OAT who had not been diagnosed with mental disorders; (b) active engagement in OAT was associated with a reduced likelihood of all-cause mortality, emergency department visits, and hospitalizations compared to patients who had been but were not actively engaged in OAT; (c) receiving mental health services from physicians (i.e., psychiatrists, primary care or both) while actively enrolled in OAT was associated with a reduction in the likelihood of all-cause mortality compared to patients not receiving mental health services while in OAT; (d) physician-based mental health services (from psychiatrists, primary care or both) while enrolled in OAT was associated with frequent ED visits and hospitalizations; and (e) fewer patients accessed mental health services while enrolled in OAT in northern and rural Ontario compared to southern and urban regions of the province.
Chronic obstructive pulmonary disease (COPD): the Impact of occupational hazards in the minerals industry
(2022-02-11) Mongeau, Sherry
This study aimed to explore the psychosocial, occupational, financial, and physical impact of chronic obstructive pulmonary disease on underground workers in the minerals industry in Northeastern Ontario, describe their experiences with the Ontario workers’ compensation claim process. This study also aimed to communicate experiences of physicians and union workers with underground mineral workers diagnosed with COPD as an occupational illness and the Ontario workers’ compensation claim process experience. Data were collected via semi-structured telephone interviews with 16 underground mineral workers with occupational COPD, four union compensation representatives and four physicians (two primary care and two specialists). Interviews were transcribed verbatim, and a thematic analysis was completed. Examples of themes that arose from the findings of the underground mineral workers’ COPD group included: 1) COPD affects quality of life, 2) I smoked; I did not think I could get compensation, 3) the compensation process is a joke, 4) doctors do not know anything, and 5) working in the mine is a dirty job – we did not know any better. Themes from the union compensation representatives and physicians included: 1) additional support resources required, 2) smoking cessation is essential, 3) the compensation claim process is challenging, 4) occupational diseases are challenging to prove, and 5) occupational COPD is costly. These results suggested that advocacy is critical to ensuring underground workers receive the support they need to obtain approval of a compensation claim. The results also illustrated the need for further education about the ability to document and support an occupational illness for physicians and worker’s compensation caseworkers involved in caring for an underground mineral worker diagnosed with occupational COPD. Continued research about occupational diseases and the compensation claim process for those with COPD is required to address the barriers and challenges experienced.
« Je ne me reconnais plus » : rupture biographique de l’identité sexuelle de femmes aux prises avec un cancer gynécologique – une recherche narrative appuyée par la création artistique
(2021-12-16) Rivard, Sylvie
Cette recherche narrative, ancrée dans des valeurs féministes et une démarche de réflexivité, aborde l’expérience de femmes aux prises avec un cancer gynécologique. Les concepts abordés ciblent les expériences de femmes francophones vivant en contexte linguistique minoritaire dont le corps est marqué par la maladie et les traitements médicaux, leur fonctionnement sexuel, l’expression de leur sexualité et de leur identité. L’identité narrative (Bamberg, 2011; Reissman, 2008), l’identité corporelle (Le Breton, 2016) et l’identité sexuelle (Dillon et coll., 2011; Worthington et coll., 2002) sont mises en lien avec divers éléments – notamment l’hégémonie hétérosexuelle et l’hétérosexualité obligatoire (Rich, 1980) – afin de dégager comment ces femmes s’identifient lorsque la maladie et les traitements altèrent leur corps, son fonctionnement, et en conséquence, leur identité familière et préférée. La méthodologie de recherche narrative (Clandinin, 2007; Reissman, 2008), dont le récit de vie (Atkinson, 2007; Bertaux, 2005) appuyée par l’art (Cole et Knowles, 2008) utilisée dans cette thèse de doctorat permet d’explorer, raconter et représenter une multiplicité d’expériences vécues. L’histoire individuelle des quatre participantes est accompagnée des autoportraits qu’elles ont créés à l’aide de médiums artistiques : le moulage du corps et le collage. Par la suite, une analyse narrative thématique dégage les thèmes suivants : prendre conscience de la possibilité de sa mort; vivre dans le moment présent; reconfigurer ses attentes du futur; composer avec des défis dans la langue de communication avec le personnel médical et l’expérience de la dilatation vaginale. Une analyse narrative structurelle présente comment, à la suite de traitements médicaux, ces femmes ne se reconnaissent plus dans leur corps et leur identité sexuelle de femme hétérosexuelle. L’invisibilité des effets de la maladie, des traitements et du stigmate social qu’elles y associent, la menace à leur vie, les multiples pertes et la pression des normes sociétales hétérosexuelles où la pénétration du pénis dans le vagin est le mode d’expression privilégié et perçu comme essentiel dans leurs relations de couple, sont des facteurs vécus comme une rupture biographique qui les contraignent à une transformation de leur identité. Enfin, une analyse narrative dialogique/en action réflexive explore mon engagement en tant que chercheure et mes interactions avec les participantes.
Midwives integration of manual vacuum aspiration for postabortion care in the Kinshasa and Kongo central provinces of the Democratic Republic of Congo
(Laurentian University of Sudbury, 2020-11-22) Bourret, Kirsty Marie
Illicit abortion in the Democratic Republic of Congo (DRC) results in the deaths of tens of thousands of women each year. There is great humanitarian potential for a return on investment if midwives are properly supported in integrating post-abortion care into their practice. In 2017, over 350 Congolese midwives were trained in the use of manual vacuum aspiration (MVA), an inexpensive and lifesaving post-abortion procedure. Yet, to date there is little understanding of its integration into midwifery practice in the DRC. The overarching aim of this thesis was to conduct collaborative research with the Professional Association of Congolese midwives (SCOSAF) in the provinces of Kinshasa and Kongo Central that would assist Congolese midwives to increase their practice of MVA, while modeling an equitable research partnership based on mutual trust and collaboration. The thesis has three chapters that build on each other and serve to demonstrate the unique substantive, methodological and theoretical contributions of the research. Substantively, the dissertation provides initial insight into those midwives who have integrated MVA post training compared to those who have not, as well as an exploration of those strategies used to successfully incorporate it into practice. Furthermore, the dissertation provides a model for conducting collaborative abortion research with midwifery associations and offers an advocacy tool that the midwifery association of SCOSAF can use to influence their expertise in midwifery led post-abortion care in the DRC. Methodologically, the dissertation introduces a novel combination of a mixed method case group comparison using a positive deviant approach. By applying a positive deviant assessment to the research, the dissertation provides a solution-based approach to uncovering the practical ways in which midwives can be supported in integrating post-abortion care into their practice. Lastly, the dissertation advances understanding of Congolese midwives’ integration of post-abortion care into practice through the proposition of a theoretical model that is aligned with regional knowledge.
Health equity and rurality in Northern Ontario
(2021-07-28) Scott (Spiro), Grace M.
Background: The current climate in Ontario, Canada is one where access to health and social services, healthcare experience and health/social outcomes vary widely across the province. The existing health disparities in Ontario disproportionately affect those living in rural and northern areas. Current indicators used to measure this variability have been developed in the context of health systems in more densely populated areas and may not be relevant for more rural and remote geographic areas. As such, the objectives of this thesis were: (1) to develop a health equity measurement approach specific to Northern Ontario based on input from Northern Ontario health decision-makers, and (2) to operationalize a rurality measurement approach for Northern Ontario. Methods: This two-phase exploratory sequential mixed methods study included a qualitative inquiry followed by a descriptive rurality measurement. The first phase explored health equity measurement in the context of Northern Ontario through in-depth interviews with Northern Ontario health equity key informants. The resulting thematic analysis informed a proposed Northern Ontario health equity measurement approach and the rurality stratifier exploration in phase-two. The second phase included a descriptive analysis using secondary data. The two rurality measurement approaches included were Statistical Area Classification Type and the Remoteness Index. Chi -squared tests for independence were used to assess the level of association between all classification methods including alternate categorization approaches within the Remoteness Index measure. Results: The thematic analysis in phase-one revealed four health equity indicators of relevance to Northern Ontario: infant mortality, overall mortality, perceived health status, and satisfaction of health care received. Furthermore, two stratifiers were identified as uniquely important to measuring health equity in Northern Ontario contexts. These two stratifiers included geographic position (rurality), as well as material welfare (income). The descriptive analysis of the rurality stratifier in phase-two recommended two methods of categorization using the Remoteness Index to consider as a complement or replacement to the Statistical Area Classification Type approach. Conclusion: This exploration of health equity measurement in the context of Northern Ontario proved to be a feasible and productive way to engage key informants in health equity indicator/stratifier selection and recommendation. Certain health equity stratifiers – including rurality – are elusive to define and measure; however, the Statistical Area Classification Type and Remoteness Index should both be considered as rurality measures in Northern Ontario.
The perceptions of women in Northern Ontario about their reproductive healthcare
(2021-10-15) Morgan, Lisa
With a goal to improve service provision, this study examined the experiences of women in Northern Ontario with respect to their uptake of reproductive healthcare services. As part of my mixed methods study, women in Northern Ontario completed a survey, offered in English and French, about their reproductive healthcare experiences, and a portion of participants were also interviewed. A multimodal recruitment strategy and maximum variation sampling was applied, with a goal of collecting the experiences of a diverse group of women. Analysis was based on 173 completed surveys and 19 semi-structured qualitative interviews. The interview data is grouped under five conceptual constructs, with “gender” as an overarching construct, found to be a factor in the remaining four: the characteristics of good care; the relationship with the provider; the care environment, and administrative practices. Additionally, respondents felt that midwives excelled at providing quality reproductive healthcare and would favour increased access to midwives for reproductive health care throughout their lives. For the survey data, I used descriptive statistics and multivariate linear regression models to determine whether residency, language, education, income, overall health, access to care, having a family physician, and preferring female providers (independent variables) were associated with the perceived quality of reproductive healthcare services and choosing a midwife. Most survey participants rated their reproductive healthcare experiences as fair to good overall but indicate room for improvement in the relationships with their providers and administrative support. Women residing rurally, without a family physician, and lower socioeconomic status are statistically more likely to prefer a midwife for reproductive healthcare. The survey results indicate a preference for female healthcare providers by the majority of interviewees. Changes driven by strong health policy may be required to engage women in recommended reproductive healthcare more fully. Although northern geography will always present challenges that may not be subject to amelioration, other factors preventing women from accessing care are more amenable to change, and as argued here, this is a right of women and an obligation on the part of governments to provide equitable access for all Canadians to healthcare services.
The engagement of the raising the Spirit’ Mental Wellness Team with First Nation communities in the Manitoulin, North Shore and Bemwijaang Tribal Council areas
(2021-08-31) Manitowabi, Susan Jane
The “Raising the Spirit” Mental Wellness Team (MWT) was funded as a pilot project in 2007. Funding for this project was made available by the federal government under the Mental Wellness Advisory Committee (MWAC) Strategy (see appendix 1). This pilot project partnered with ten First Nations communities from the Manitoulin Island, North Shore and Waabnoong Bemwijaang Tribal Council areas, in Northeastern Ontario. The goal of this pilot project was to work collaboratively with mental health and addiction workers and other service providers to improve access to specialized services; enhance knowledge, skills, and capacities of community workers; provide support, consultation, clinical supervision, coaching and mentoring; and, braid traditional and mainstream approaches to wellness. The focus of this research study was to evaluate how the MWT pilot project maintained the engagement and support of the participating First Nations communities. Areas explored included: the collaboration within and across Aboriginal communities; the integration of mainstream and traditional approaches; and, capacity building at the community level. Self -reflective journals, photovoice and narrative storytelling interviews were chosen because of their congruence with traditional ways of knowing and understanding which were also viewed as being culturally appropriate. These evaluation methods were extremely powerful means of telling the story of the relationship between the MWT and the First Nations communities involved in this project. One major contributing factor that enhanced the ability of the MWT pilot project to maintain the engagement with the First Nations communities was the strong commitment to the intent of the iv pilot project by all partners. Although there were many challenges that could have impacted the ability of the MWT to engage with the First Nations communities, there was good support from the First Nation leadership who recognized the benefits of enhanced mental health and addictions services in their communities. The pilot project offered an opportunity for the First Nations communities to access additional mental health and addiction services as well as increased access to traditional healing services. The Traditional Advisory Committee (TAC) was instrumental in creating opportunities through the Traditional Teaching Series for frontline workers to learn more about traditional healing practices and teachings. This had the added benefit of increasing their skills and abilities to utilize both traditional and mainstream approaches in their service provision to their clients, as well as themselves and their families.
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.
A study of family physician scope of practice in Ontario
(2020-01-20) Myles, Sophia M.
The broad aim of the research described in this thesis was to develop a more comprehensive understanding of scope of practice (SOP) within medicine in Canada, with an emphasis on family and general practice in Ontario. A more specific objective was to determine the common conceptual elements of SOP, what differences there are in how SOP is conceived, and what implications these differences have for health policy, physician regulation, continuing professional development and practice. This study aimed to answer three research questions, resulting in chapters two, three and four of this thesis. A sequential qualitative methods approach based on a modified institutionalist conceptual framework of ‘ideas, interests and institutions’ guided the overall approach to this study.
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.
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.
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.
Older adult mistreatment, dementia, and the family caregiver in the Northeastern Ontario home: the influence of context on professional agency
(2019-06-24) Lindenbach, Jeannette M.
This integrated-article thesis presents the findings of a qualitative critical inquiry with three related aims: to understand the experience of formal care practitioners who encounter mistreatment of an older adult with dementia by their family caregiver in the home; to explain the influences of the domestic, health care, geographical, and socio-political contexts upon that experience; and to facilitate empowerment and collective action to improve policy, practice and care outcomes. Viewing this experience through a Critical Social Theory lens, data collection methods consisted of interviews, reflective journals, and inquiry and action focus groups. Practitioners representing 23 organizations providing care to older adults in their homes in urban and rural Northeastern Ontario participated over the course of two phases of Understanding and Empowerment. In this thesis, Chapter 1 will review the literature, identifying gaps in knowledge and describing the critical theoretical underpinnings, methodology and theoretical thematic analysis which were instrumental to facilitate self-reflection of past cases, critique of socially dominant ideologies and structures, dialogue with other practitioners also encountering these cases, and dialectic reasoning, a process of examining contradictions of what is, versus what should be in cases of older adult mistreatment and dementia. Chapter 2 presents the findings on the experience of practitioners with these cases. More specifically, practitioners described a lack of professional agency defined as the ability to control outcomes and act in a meaningful way in their cases. Next, Chapter 3 examines the home, familial, health care, geographical and socio- political contexts and their influences on professional agency. Those findings describe the oppression of these contexts on practitioners who could not control the outcomes of older adult mistreatment [OAM] within them. Chapter 4 then presents the process of empowerment during which practitioners shared their concerns related to these oppressive contexts and collaborated towards collective action projects to improve policy, practice and outcomes. Chapter 5 situates the significance of the findings within the field of OAM and dementia and discusses cross- cutting themes linking the papers. Limitations of the study will be reviewed as well as recommendations for policy, practice and research.
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.
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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