10 minute read
BUILDING FUTURE RESEARCHERS
from Lawrence Bloomberg Faculty of Nursing Research Report 2020-2022
by Lawrence Bloomberg Faculty of Nursing, University of Toronto
EXPLORING SELF-MANAGEMENT AND A STRENGTHS-BASED APPROACH FOR TYPE 2 DIABETES
IN INDIGENOUS MEN, WOMEN AND TWO-SPIRITED INDIVIDUALS
Heather Burnside, a PhD candidate at the Lawrence Bloomberg Faculty of Nursing and a member of the Saugeen First Nation, is examining gender influences and type 2 diabetes in Indigenous communities as well as the ways in which treatment and self-management of this chronic disease, can be inclusive of Indigenous knowledge and practice. The focus on gender Burnside says, stems from the fact that not much is known about diabetes self-management in Indigenous communities, and that in nonIndigenous populations, type 2 diabetes is generally more common in men. However, recent evidence has shown that Indigenous women are developing type 2 diabetes at a faster rate than men. Through the support of the Canadian Institutes of Health Research (CIHR) Transitions to Leadership Fund, Burnside will be working closely in collaboration and partnership with Indigenous communities in the Kitchener-Waterloo area to ensure that her research and the data collected, is meaningful to the community. “Historically, research on Indigenous communities has included “helicopter research,” where non-Indigenous researchers have gone into communities, taken information and data, without considering the priorities or needs of the population,” says Burnside. To address this particular concern, Burnside is keenly focused on the knowledge translation component of her research. To present her research findings in a diverse way, Burnside is looking to expand beyond colonial thinking of how research should be shared, such as through traditional journal publications. Instead, Burnside has proposed the concept of a patient journey map, with the hopes of collaborating with an Indigenous artist, to showcase the data collected from the study visually, mapping the journey of men, women and two-spirited individuals, as they self-manage their diabetes. “I’m always thinking about how to present information in the best and most useable way, how to disseminate the results of my work for people outside the academic community,” says Burnside. “I want not only to make this research accessible but to show Indigenous communities that they have the strength and the knowledge to manage their diabetes.” “The strength of Heather’s research is that she is uniquely aware of the impact of a patient-oriented approach,” says Monica Parry, an Associate Professor at the Lawrence Bloomberg Faculty of Nursing and Burnside’s PhD supervisor. “Her focus on bringing patient partnerships and collaborative community engagement to the forefront of her research will have a considerable impact on the knowledge generated and disseminated with Indigenous individuals living with diabetes.” Burnside points out that there are many contextual factors surrounding the development of diabetes in the population she studies. Having worked as a rural nurse in an Indigenous community, she recalls having a heightened awareness around the impact of diabetes, where the disease can affect an entire family and not just the individual, from the family’s dietary patterns to their ability to access fresh food and appropriate and timely health care, particularly for those who must travel to larger urban centres. “As Indigenous people, our kinship ties are strong, and we look at things from a broader community focus as opposed to a individualistic focus,” says Burnside, “I see this research as an opportunity to highlight the strengths of Indigenous communities and their knowledge, traditional healing and practice.”
SSHRC RECIPIENT EXPLORES SILENCING OF NURSING VOICES
Bloomberg Nursing PhD student Andrea Baumann wants to examine factors contributing to the systemic marginalization of nursing voices. To understand this issue in the context of the COVID19 pandemic, Baumann with the support of a $105,000 grant from the Social Sciences and Humanities Council (SSHRC) Doctoral Fellowship, will interview individual nurses in the GTA about their experiences during the pandemic, and examine the impact of structural power inequities on their ability to provide care and work in a safe environment. “The pandemic has shone a spotlight on the many preexisting challenges in health care. One such issue pertains to the barriers that restrict nurses from speaking out,” says Baumann. “The ways in which nurses are silenced, can be perceived as a form of structural violence, and it affects not only nurses but the safety and quality of care of their patients as well.” Pre-pandemic, research showed that nurses reported “feeling punished,” for speaking out. During the emergency phase of the pandemic it became common knowledge that nurses were dealing with unsafe working situations whether that was an inadequate supply of PPE, or other concerns about patient safety. This persistent constraint on nursing voices reflects deeper issues within the organizational structure of health systems. Baumann describes the “normalization of the abnormal,” as a characteristic of the devaluation of nurses, and a precedent for the treatment of nurses from both a gender and race-based perspective. “In Canada over 90 per cent of the nursing work force is female. Historically, this gendered aspect of the role means that the work of nurses has been imbued with the traditional female characteristics of caring, and has not been valued as highly as the contributions of historically male dominated professions such as medicine. I am curious about how this gendering of nursing work may have contributed not only to the subordination of the position, but also to the constraints against nurses’ ability to speak out,” says Baumann. As part of her doctoral research, Baumann will draw upon historical examples of how the silencing of nursing voices puts patient safety at risk. One such instance will reflect on the landmark case in Winnipeg in the early 1990’s where twelve children died due to complications from cardiac surgery. Though nurses had repeatedly voiced their concerns about the surgeon’s incompetence and the possibility of malpractice, they were consistently overlooked. “This case was significant because findings of the inquiry recommended a review of hierarchy within that work environment and also that the perspectives of nurses be valued,” says Baumann. “Of the many issues contributing to nurses’ inability to speak up and speak out, I feel that race is likely to be a strong indicator of whose voice gets heard,” says Baumann, “I want to bring this issue into focus by hearing directly from those who feel they are voiceless.” The pandemic Baumann believes, has generated a form of currency for nurses that can be leveraged. Capitalizing on this increase in public interest and support that has not been seen since the 1918 flu pandemic provides an opportunity for nursing leaders and policy makers to create lasting change. “I do hope that my study will be one contribution to building on this understanding of structural power inequities that either enable or constrain the ability of nurses to voice their concerns,” says Baumann. “People are listening now, we need to raise our voices.”
This case was significant because findings of the inquiry recommended a review of hierarchy within that work environment and also that the perspectives of nurses be valued,”
Andrea Baumann
PhD student, Lawrence Bloomberg Faculty of Nursing
PHD STUDENT RECEIVES GIPPECC GRANT TO EXPLORE THE ROLE OF PSW’S IN END-OF-LIFE CARE FOR LONG-TERM CARE RESIDENTS
Bloomberg Nursing PhD candidate Danielle Just received a grant from The Global Institute of Psychosocial, Palliative and End-of-Life Care (GIPPEC) at the Princess Margaret Cancer Centre, to support her doctoral research project exploring the role of personal support workers (PSWs) in end-of-life care in long-term care (LTC). The goal of the project, which includes a virtual case study conducted in an Ontario LTC home, is to improve the quality of end-of-life care for LTC residents. While PSW’s remain an unregulated profession globally, Just’s study seeks to enhance knowledge about the role of PSWs in end-of-life care and inform future studies seeking to develop policies for education or clinical practice guidelines. “Poor quality end-of-life care in LTC homes is a critical issue for Canada’s LTC system, this crisis has been further amplified by the devastating impact of the COVID-19 pandemic and needs to be addressed,” says Just, who is completing her doctoral work under the supervision of Associate Professor Lisa Cranley. PSWs provide most of the daily care for LTC residents including end-of-life care. Just’s study will mark one of the first times to their knowledge, that PSW’s and LTC residents and family caregivers will be able to share their perspectives on the evolving role of PSWs in end-of-life care. With the support of the GIPPEC grant, Just has been able to disseminate the results of her virtual case study and initial findings at two national conferences where she has had the opportunity to share the perspectives of multiple stakeholders on PSWs’ invaluable role in end-of-life care in LTC. “End-of-life care requires an interdisciplinary and collaborative approach to provide high-quality care to residents in LTC,” says Just. “It makes sense that to improve care, our research must also include an interdisciplinary and collaborative approach. I’m grateful to work with an expert team of interdisciplinary Canadian researchers on this project.”
End-of-life care requires an interdisciplinary and collaborative approach to provide high-quality care to residents in LTC.”
EXPLORING LOSS OF DECISION-MAKING CAPACITY AND ACCESS MEDICAL ASSISTANCE IN DYING (MAID)
Caroline Variath, a PhD student at the Lawrence Bloomberg Faculty of Nursing, first became interested in understanding access to medical assistance in dying (MAiD) while she was providing end-of-life nursing care to incapacitated patients in acute and critical care settings. “I noticed that some patients who were found to be eligible for MAiD were unable to access it because of a loss of capacity to consent,” says Variath. “So, I became interested in learning about the type of end-of-life care offered to these patients, which became the basis for my doctoral work.” Variath received a $3,900 research grant in 2021 as well as approximately a total of $3,300 in knowledge transfer grants between 2021 and 2022 from the Canadian Association of MAiD Assessors and Providers (CAMAP) to explore the experiences of health care providers with eligible patients who experienced a loss of decision-making capacity while awaiting MAiD. Variath also wanted to understand the perspectives of healthcare providers on using the waiver of final consent amendment that was introduced with Bill C-7. “The waiver of final consent amendment introduced with Bill C-7 offers eligible patients an opportunity to enter into an agreement to waive the final confirmation of consent, an option which minimizes their risk of becoming ineligible for MAiD due to a loss of decision-making capacity,” explains Variath. The findings of Variath’s study will help, she says, to inform policies and guidelines on the implementation of the recent amendments to the Canadian MAiD legislation (Bill C-7) as well as help support the care of patients who were assessed and approved for MAiD but who later became ineligible because of their loss of decision-making capacity. Variath notes that her research also has strong implications for policies on advance care planning and considerations to further expand access to MAiD for those with capacity limiting conditions. “The generous support offered by CAMAP has allowed me to focus on my research and disseminate my findings widely through open access publications,” says Variath of the importance of the grants. “The support of my supervisor Dr. Elizabeth Peter has been integral to my research, and I hope to continue to advocate for the needs of patients and healthcare providers to improve end-of-life care.”
I hope to continue to advocate for the needs of patients and healthcare providers to improve end-of-life care.
Caroline Variath
PhD student, Lawrence Bloomberg Faculty of Nursing