Jill Bally

Knowledge of the professional role of others: A key interprofessional competency

In this paper, the authors present the results of a study which delineated six key competencies of interprofessional collaborative practice for patient-centred care: communication; strength in ones professional role; knowledge of professional role of others; leadership; team function; and negotiation for conflict resolution. While all of these competencies are important and require special attention, this paper examines and discusses the competency knowledge of professional role of others and its associated behavioural indicators, especially as these relate to the interprofessional education of nursing students. The identification of these competencies and their behavioural indicators serve two purposes. It forms the basis for the preparation of students, preceptors, and faculty for interprofessional practice, and it develops a tool for assessing student performance in such practice. Consequently, we believe that the utilization of this key competency and its behavioural indicators will contribute to the development of programs that include specific knowledge and skills related to interprofessional nursing education. This will enable educators to support and evaluate students in interprofessional educational experiences more efficiently and effectively. Ultimately, as nursing students practice and become fully functioning practitioners, client care will be optimized.

Understanding Parental Experiences Through Their Narratives of Restitution, Chaos, and Quest Improving Care for Families Experiencing Childhood Cancer

The purpose of this secondary analysis was to develop an enhanced understanding of the experiences of parents who have children in treatment for cancer. Data collected from 16 parents (12 mothers and 4 fathers) were analyzed using Frank’s dialogical narrative analysis. Findings demonstrated that parents’ experiences were represented in chaos, restitution, and quest narratives. Each of these narratives was only one instance of a very complex and changing parental experience that cannot be understood in isolation from the others. The holistic understanding provided by these findings contributes to a more comprehensive understanding of parental experiences of their child’s illness and highlights the need for health professionals to invite conversations about parents’ illness experience and attend to the specific narrative type parents are presenting to support them adequately. Additional research is required to develop supportive approaches for each narrative which takes into account the complexities of parents’ experiences.

Keeping hope possible: a grounded theory study of the hope experience of parental caregivers who have children in treatment for cancer.

Background: Hope has been found to support parents as they care for their child with a life-limiting or life-threatening illness. However, very little research focuses on the nursing care of parents of pediatric oncology patients, and therefore, nurses may have difficulty in understanding and supporting parental well-being. Objective: The purpose of this qualitative study was to gain an understanding of the experience of hope for parents who care for their child in treatment for cancer. Methods: Using purposive theoretical sampling, 16 parents participated in this study. Thirty-three open-ended, face-to-face interviews were conducted, and 14 parent journals were collected. Analysis of the data was conducted using Charmaz’s constructivist grounded theory approach. Results: A developing, substantive grounded theory was constructed. Parental hope was described as an essential, powerful, deliberate, life-sustaining, dynamic, cyclical process that was anchored in time; was calming and strengthening; and provided inner guidance through the challenging experience of preparing for the worst and hoping for the best. Parents’ main concern was “fearing the loss of hope,” which was ameliorated by the basic social process of “keeping hope possible” through accepting reality, establishing control, restructuring hope, and purposive positive thinking. Conclusions: Parents journeyed through numerous transitions related to the treatment of cancer that caused feelings of uncertainty, anxiety, stress, and loss of control. Hope was identified as vital to parents. Implications for Practice: To minimize these adverse experiences, nurses can support parents’ ability to keep hope possible and thus to optimize their well-being by understanding, assessing, and supporting parental hope.

Developing and pilot-testing a Finding Balance Intervention for older adult bereaved family caregivers: A randomized feasibility trial.

PURPOSE This study aimed to test the feasibility of a psychosocially supportive writing intervention focused on finding balance for older adult bereaved family caregivers of advanced cancer patients. METHOD The Finding Balance Intervention (FBI) was tested for feasibility, acceptability and potential influence on increasing hope, coping and balance through a multi-method pilot study employing a randomized trial design with 19 older adults with an average age of 72 years. The intervention group received the FBI and a follow up visit from an RN-RA. The control group received the FBI at a second visit. The FBI, a theory-based intervention was developed from grounded theory qualitative data, applying Delphi methods to design a self-administered, psychosocially supportive, writing intervention for older adults who had lost a spouse after caregiving. RESULTS Feasibility was assessed and specific modifications identified. The FBI was easy to use, acceptable and of benefit. The FBI offered validation of emotions and ways to discover new ideas to find balance, which may enable bereaved caregivers to move forward on a unique journey through grief. The treatment group showed a statistically significant increase in restoration-oriented coping and higher oscillation activity. CONCLUSIONS The results suggest the FBI was easy to use, acceptable and of benefit. A full scale study, with specific modifications to the design, is needed to test the effectiveness of this innovative intervention.

Caring For Kids Where They Live: interprofessional collaboration in teaching and learning in school settings.

Across North America, educators are challenged with finding learning opportunities for students in the health professions. Faculty members with a pediatric specialization in nursing recognized that schools were an ideal setting to provide children with care from the health continuum including health promotion, assessment and treatment, and chronic disease management. The faculty of nursing at a Western Canadian University established a unique educational approach by creating an interprofessional pediatric clinical learning experience titled, Caring For Kids Where They Live. This practicum brings together students in the health professions (nurses, dentists, and kinesiologists) and students and their families from three urban schools; one elementary school and two high schools. The primary goals of this partnership were to create an interprofessional clinical learning experience and to promote health and wellness of children and youth. This initiative far exceeded the initial goals. This descriptive article with the use of reflective elements from student journals, identifies learning that occurred in an environment whereby students from the health professions had the opportunity to meet and interact, to collaborate, and to gain experience in caring for children and youth.

A wellness framework for pediatric nursing clinical practice.

This article presents a proposed holistic Framework for Exploring Adolescent Wellness specific to the discipline of nursing. Conceptualized as a practical adolescent wellness assessment tool, the framework attends to the physical, spiritual, psychological and social dimensions of adolescent health. Through the discussion of a reconstructed case study the frameworks application to nursing practice is illustrated. Nurses are distinctly positioned to promote adolescent wellness. This approach facilitates the exploration of the multiple influences on the health of adolescents, across a variety of clinical practice specialties and settings, by nurses of varying experiences.

Type 2 Diabetes in Canadian Aboriginal Adolescents: Risk Factors and Prevalence

Purpose To identify the risk factors and prevalence rates of prediabetes and type 2 diabetes among northern Canadian Aboriginal adolescents. Design and Methods In this novel exploratory, quantitative study, 160 high school students (aged 13–21) from three northern, predominantly Canadian Aboriginal communities were screened for risk for prediabetes and type 2 diabetes including demographic data, family medical history, anthropometric measurements, blood pressure, and hemoglobin A1c (HbA1c). Descriptive and inferential statistics, in addition to chi‐square analysis, were used to establish risk and prevalence rates for prediabetes and type 2 diabetes in Aboriginal adolescents. Results At least half of the adolescents presented with multiple risk factors for type 2 diabetes. In this sample, 10% had an HbA1c > 5.7%, 22.5% were overweight, 17.5% were obese, and 26.6% had prehypertension or hypertension. Conclusions Prediabetes and type 2 diabetes are emerging as serious health concerns for young Aboriginal Canadians. This is troubling because both result from modifiable risk factors. As this study is the first to examine the prevalence of prediabetes in Canadian Aboriginal adolescents in the last decade, the findings underscore the necessity for early screening of Aboriginal adolescents for both prediabetes and type 2 diabetes. Practice Implications Recommendations toward positive health outcomes include the introduction of early age screening programs, followed by culturally relevant interventions, specific to the modifiable risk factors (overweight/obesity and hypertension), and developed in collaboration with the communities. Such approaches have the potential to prevent the progression of prediabetes to diabetes and reduce complications related to type 2 diabetes. HighlightsAdolescents (N= 160) living in northern Aboriginal communities were screened for risk for prediabetes and type 2 diabetesAt least half of those screened presented with multiple risk factorsOf those screened, 10% were pre‐diabetic, 27% were prehypertensive or hypertensive, and 41% were overweight or obese

Predictors of Physical Activity in Positive Deviant Adolescents

UNLABELLED The purpose of this analysis was to examine the predictors of PA in positive deviant adolescents in comparison to average or underachieving adolescents on the same criterion. DESIGN AND METHODS A survey of Canadian adolescents aged 13-20 (N=603), based on a multidimensional wellness model and an ecological model, provided the data for a multiple regression analysis to identify predictors of PA in positive deviant adolescents defined as having higher than average levels of PA. RESULTS Significant predictors of PA for positive deviant girls were recreational time, an increased sense of wellness, age, and family support (explaining 47.7% of variance for girls). Within the positive deviant group, older girls were less active than younger girls. For positive deviant boys, use of recreational time was the only significant predictor of PA (explaining 5.9% of the variance). CONCLUSIONS Wellness as a significant predictor of PA in positive deviant adolescent girls is a new and unique finding. The measurement of wellness in this study was a composite score of the physical, social, and psychological developmental dimensions of adolescent lives. PRACTICE IMPLICATIONS Pediatric nurses may wish to consider a multidimensional wellness approach, family support, and recreation time as major foci of PA interventions in adolescents.

A Multidimensional Investigation Into the Predictors of Physical Activity in Canadian Adolescents

Background: The percentage of overweight and obese Canadian children and youth is dramatically increasing. Approaches to reducing obesity in adolescents should include the promotion of physical activity (PA) because a continued physically active lifestyle into adulthood may lower rates of chronic diseases associated with unhealthy body weight. Purpose: The current study expands on existing assessments of PA to include predictors based in a multidimensional adolescent wellness and ecological model. Method: Canadian adolescents (N = 603) were surveyed and the resulting data analyzed using multiple regression analysis. Findings: Overall, 57.5 and 52.9% of the unique variance in PA for females and males, respectively, were explained by the predictors. Significant predictors for females included age, recreational time, family, leadership, and social comparison (cognitive development) skills. For males, equipment at home was also associated with increased PA. Conclusions: The finding that social comparison and leadership skills are significant predictors of PA in adolescents is new. Nurses should consider a holistic approach to promoting PA whereby these developmental dimensions are included in assessment and prioritized in providing nursing care. Additionally, individualized PA intervention strategies can then be tailored to this unique population.

Viewing the art and the science of pediatric nursing through the lens of paradigms: The impact on hope for the future

PURPOSE The purpose of this study was to examine the strengths and limitations of common research paradigms used in the study of the hope of parents who have children with a variety of illnesses. CONCLUSIONS Research findings on parental hope extracted from only one paradigm present limitations to related knowledge development. To take into account the contributions from each paradigm and to allow for a multidimensional understanding of parental hope, a multiparadigmatic approach is needed. PRACTICE IMPLICATIONS The complementary findings from multiple research paradigms can lead to a comprehensive base of knowledge that can guide future research and develop effective, family-centered pediatric nursing care.