Earle H. Waugh

Facilitators and barriers to safe emergency department transitions for community dwelling older people with dementia and their caregivers: a social ecological study.

BACKGROUND Internationally, older adults visit the ED at a rate higher than other age groups. Little attention has been given to ED care for older people with dementia, although concern for such care is growing with the increasing number of individuals worldwide affected by this significant disabling problem. It is critical to understand ED transitional processes and consequences because the complexity of dementia care poses multiple challenges to optimizing safety, effectiveness and quality of care during admission, assessment, and treatment in this setting. METHOD Using an interpretive, descriptive exploratory design with three iterative, interrelated phases, we conducted interviews, created a photographic narrative journal (PNJ), and finally held photo elicitation focus groups to identify factors that facilitate or impede safe transitional care for community dwelling older adults with dementia in two Canadian emergency departments, and to identify practice solutions for nurses. We purposively sampled to recruit ten older adult-family caregiver dyads, ten ED RNs, and four Nurse Practitioners. Data were analyzed using constant comparative analysis. RESULTS Four interconnected reinforcing consequences emerged from our analysis: being under-triaged; waiting and worrying about what was wrong; time pressure with lack of attention to basic needs; and, relationships and interactions leading to feeling ignored, forgotten and unimportant. Together these consequences stem from a triage system that does not recognize atypical presentation of disease and illness. This potentiated a cascade of vulnerability in older people with dementia and their caregivers. Nurses experienced time pressure challenges that impeded their ability to be responsive to basic care needs. CONCLUSIONS In an aging population where dementia is becoming more prevalent, the unit of care in the ED must include both the older person and their family caregiver. Negative reinforcing consequences can be interrupted when nurses communicate and engage more regularly with the older adult-caregiver dyad to build trust. System changes are also needed to support the ability of nurses to carry out best practices.

Cultural transition of international medical graduate residents into family practice in Canada.

Objectives To identify the perceived strengths that international medical graduate (IMG) family medicine residents possess and the challenges they are perceived to encounter in integrating into Canadian family practice. Methods This was a qualitative, exploratory study employing focus groups and interviews with 27 participants - 10 family physicians, 13 health care professionals, and 4 family medicine residents. Focus group/interview questions addressed the strengths that IMGs possess and the challenges they face in becoming culturally competent within the Canadian medico-cultural context. Qualitative data were audiotaped, transcribed, and analyzed thematically. Results Participants identified that IMG residents brought multiple strengths to Canadian practice including strong clinical knowledge and experience, high education level, the richness of varied cultural perspectives, and positive personal strengths. At the same time, IMG residents appeared to experience challenges in the areas of: (1) communication skills (language nuances, unfamiliar accents, speech volume/tone, eye contact, directness of communication); (2) clinical practice (uncommon diagnoses, lack of familiarity with care of the opposite sex and mental health conditions); (3) learning challenges (limited knowledge of Canada’s health care system, patient-centered care and ethical principles, unfamiliarity with self-directed learning, unease with receiving feedback); (4) cultural differences (gender roles, gender equality, personal space, boundary issues; and (5) personal struggles. Conclusions Residency programs must recognize the challenges that can occur during the cultural transition to Canadian family practice and incorporate medico-cultural education into the curriculum. IMG residents also need to be aware of cultural differences and be open to different perspectives and new learning.

Bridging the gap between the technological singularity and mainstream medicine : highlighting a course on technology and the future of medicine

The “technological singularity” is forecasted to occur in the mid-21st century and is defined as the point when machines will become smarter than humans and thus trigger the merging of humans and machines. It is hypothesized that this will have a profound influence on medicine and population health. This paper describes a new course entitled “Technology and the Future of Medicine” developed by a multi-disciplinary group of experts. The course began as a continuing medical education course and then transitioned to an accredited graduate-level course. We describe the philosophy of the course and the innovative solutions to the barriers that were encountered, with a focus on YouTube audience retention analytics. Our experience may provide a useful template for others.

The shaping of an American Islamic discourse : a memorial to Fazlur Rahman

To encourage the US public to explore Islam beyond the headlines and veils, a dozen Islamic studies specialists (mainly at US universities) honor Rahmans contribution to such studies by focusing on: Islamic priorities and the contextuality of discourse, Islam and philosophy, hermeneutics and contem

Dead Men in Sultry Darkness Western Theory and the Problematic of a Baseline Cultural Motif in Islamic Ascetic Tradition

In my researches on the mystical chanters in Egypt and Morocco, I have had to grapple with the problem of how to understand the whole culture of the ascetic tradition in Islam. I have concluded that the usual procedures among Western social sciences lead to a distortion of the lived experience of the Sūfīs and may not encapsulate Islamic tradition faithfully. This paper is an attempt to sketch a modified approach. The focal point of the paper is the claim that the potential member is initiated into a coherent socio-spiritual organization that transcends the normal time/space framework. It deals with issues of learning the code, with spiritual kin-group relationships and with the content of the spiritual cosmos. It suggests that the liturgical dimension of Sūfism is the central ingredient of an independent-minded spiritual movement ; it both holds the disparate social elements together, and connects the ordinary world with the supernatural world in an apparently seamless manner.

Joachim Wach's “Master and Disciple” Revisited: A Contemporary Symposium

Joachim Wachs classic 1924 treatment of two types of teaching and learning relationships is summarized by Professor Denny and commented on from three contemporary perspectives by three teaching scholars who raise the basic question, “Are Wachs models of student and disciple adequate for the nineties?” Following an introduction by Frederick M. Denny, the contributions presented are: I. Are Wachs Models of Student and disciple Adequate for the Nineties?, by Margaret R. Miles, II. Response to Joachim Wachs “Master and Disciple: Two Religio-Sociological Studies”: Buddhism, by Charles Hallisey and III. Wach and the Double Truth, by Earle H. Waugh.

Transition From Pediatric to Adult Services: Challenges for Family Caregivers of Young Adults With Traumatic Brain Injury

Family caregivers are the main source of support for survivors of traumatic brain injury (TBI) while they transition from pediatric to adult care service and support systems. Yet there is little research that examines the needs of these caregivers during the transition phase. The aim of this qualitative phenomenological study was to examine the lived experiences of family caregivers of young adults with TBI who had recently transitioned from services for children and adolescents to adult care service and supports. The study sample comprised 15 family caregivers of young adult TBI survivors who had transitioned to adult services in the last 5 years. They were recruited from two large hospitals and a caregiver support center in a city in Western Canada. Semistructured interviews were conducted with the caregivers and the data were analyzed using Colaizzi’s approach in developing an essential structure of the phenomenon of caregiving. Fifteen themes emerged from the analysis and these are discussed under two broad domains: (a) caregivers’ experiences and challenges with their relative at the time of transition; (b) caregivers’ challenges with services and supports systems during transition. Findings suggest that there is a wide gap between what caregivers need and what is available to them to support their young adult relative through the transition process and beyond. Most caregivers reported that the transition phase is overwhelming and has a profound and pervasive impact on their lives. Implications of the findings and recommendations for policy and practice are discussed.

The Foundations of Aboriginal Spirituality and Healing from the Perspective of Rogier Vandersteene

In the light of the Truth and Reconciliation Commission (TRC), and the often troubling rush to judgment towards the missionaries by many today, it is well to pause and consider those individuals, flawed as they were, who saw deeper truths in Aboriginal culture than was acknowledged in their day. Consider one known as “Steentje, Little Stone,” in Belgium, and eventually as “Ka Miyohtwat – the good man” among his parishioners. Few Canadian missionaries have had the kind of impact that Roger Vandersteene had upon the Cree of Northern Alberta: he was accorded an extraordinary place in the religious terrain at a time when antagonism towards the role of the Church in residential schools was beginning to swell. This article summarizes some of the key points of his achievement, focusing purposely on his perceptions of his mission and the ramifications for understanding traditional Aboriginal spiritual values. He saw these values expressed most effectively in the close relationship between the spiritual world and the potential for wellness and healing.

Comptes rendus / Reviews of books: The Oblate Assault on Canada's Northwest Robert Choquette Religions and Beliefs Series, 3 Ottawa: University of Ottawa Press, 1995. vii + 258 p

Cet ouvrage, le premier d’une collection intitul6e «Perspectives en th6ologie pratique», se situe dans la foul6e des recherches doctorales de 1’auteure. 11 se divise en trois parties. Dans la premiere (p. 31-102), cinq femmes en attente de leur premier enfant racontent cette experience unique entre toutes. A partir de quatre recits biographiques et un autobiographique, l’auteure nous fait alors entrer au coeur meme des relations -m6re-enfant, femme-femme, fille-m6re, homme-femme, femme-institutions» (p. 21). Dans la deuxieme partie (p. 102151), l’auteure interroge le texte biblique de Genese 2,4b-3,24 et les r6cits de naissance selon Matthieu et Luc, sur les rapports de mutualite femme-homme. Dans

Comptes rendus / Reviews of books: Muslims, Their Religious Beliefs and Practices, Vols. 1 and 2: Andrew Rippin New York: Routledge, 1993. Vol. 1, x + 171 p.; Vol. 2, xviii + 155 p

The last quarter of this century has seen a phenomenal number of publications on Islam. Many of these have arisen out of reaction to Islamic militancy, too little, perhaps, has responded to the core religious reality of Islam itself. One side effect of this flood of material is that even the most devoted students of religion feel overwhelmed, for they know that each writer has a certain &dquo;slant&dquo; dictated by his or her assumptions about this tradition which are seldom stated at the outset. The result is that novices have the impossible task of trying to decipher just where a writer stands without the critical knowledge to aid judgment. Rippin’s texts are a breath of fresh air.