Kendra L. Rieger

Arts-Based Learning: Analysis of the Concept for Nursing Education

Abstract Teaching and learning strategies are needed to support learner-centered curricula, and prepare nurses who are capable of working in today’s challenging health care environments. Although the traditional lecture is still widely used in nursing education, innovative approaches are needed to encourage discussion, debate, and critical reflection, activities that support lifelong learning. Arts-based learning [ABL] is a creative strategy with the potential to engage learners, foster understanding of multiple perspectives, and simultaneously connect cognitive and affective domains of learning. Walker and Avant’s method of concept analysis is applied to examine the uses of ABL in the literature, define the attributes, distinguish the antecedents and consequences, identify model and other cases, and determine empirical referents of this concept. This analysis is presented to facilitate the conceptual understanding of ABL for use in research and nursing education.

Exploring arts-based knowledge translation: sharing research findings through performing the patterns, rehearsing the results, staging the synthesis.

BACKGROUND Cultivation of knowledge translation (KT) strategies that actively engage health professionals in critical reflection of their practice and research-based evidence are imperative to address the research-practice gap. While research-based evidence is exponentially growing, our ability to facilitate uptake by nurses and other health professionals has not kept pace. Innovative approaches that extend epistemological bias beyond a singular standpoint of postpositivism, such as the utilization of arts-based methods, expand the possibility to address the complexities of context, engage audience members, promote dissemination within communities of practice, and foster new audiences interested in research findings. AIM In this paper, we address the importance of adopting a social constructivist epistemological stance to facilitate knowledge translation to diverse audiences, explore various arts-based knowledge translation (ABKT) strategies, and open a dialogue concerning evaluative tenets of ABKT. DISCUSSION ABKT utilizes various art forms to disseminate research knowledge to diverse audiences and promote evidence-informed practice. ABKT initiatives translate knowledge not based upon a linear model, which views knowledge as an objective entity, but rather operate from the premise that knowledge is socially situated, which demands acknowledging and engaging the learner within their context. Theatre, dance, photography, and poetry are art forms that are commonly used to communicate research findings to diverse audiences. Given the emerging interest and importance of utilizing this KT strategy situated within a social constructivist epistemology, potential challenges and plausible evaluative criteria specific to ABKT are presented. CONCLUSION ABKT is an emerging KT strategy that is grounded in social constructivist epistemological tenets, and holds potential for meaningfully sharing new research knowledge with diverse audiences. LINKING EVIDENCE TO ACTION ABKT is an innovative and synergistic approach to traditional dissemination strategies. This creative KT approach is emerging as potent transformational learning tools that are congruent with the relational nature of nursing practice. ABKT facilitates learning about new research findings in an engaging and critical reflective manner that promotes learning within communities of practice.Background Cultivation of knowledge translation (KT) strategies that actively engage health professionals in critical reflection of their practice and research-based evidence are imperative to address the research-practice gap. While research-based evidence is exponentially growing, our ability to facilitate uptake by nurses and other health professionals has not kept pace. Innovative approaches that extend epistemological bias beyond a singular standpoint of postpositivism, such as the utilization of arts-based methods, expand the possibility to address the complexities of context, engage audience members, promote dissemination within communities of practice, and foster new audiences interested in research findings. Aim In this paper, we address the importance of adopting a social constructivist epistemological stance to facilitate knowledge translation to diverse audiences, explore various arts-based knowledge translation (ABKT) strategies, and open a dialogue concerning evaluative tenets of ABKT. Discussion ABKT utilizes various art forms to disseminate research knowledge to diverse audiences and promote evidence-informed practice. ABKT initiatives translate knowledge not based upon a linear model, which views knowledge as an objective entity, but rather operate from the premise that knowledge is socially situated, which demands acknowledging and engaging the learner within their context. Theatre, dance, photography, and poetry are art forms that are commonly used to communicate research findings to diverse audiences. Given the emerging interest and importance of utilizing this KT strategy situated within a social constructivist epistemology, potential challenges and plausible evaluative criteria specific to ABKT are presented. Conclusion ABKT is an emerging KT strategy that is grounded in social constructivist epistemological tenets, and holds potential for meaningfully sharing new research knowledge with diverse audiences. Linking Evidence to Action ABKT is an innovative and synergistic approach to traditional dissemination strategies. This creative KT approach is emerging as potent transformational learning tools that are congruent with the relational nature of nursing practice. ABKT facilitates learning about new research findings in an engaging and critical reflective manner that promotes learning within communities of practice.

Factors Associated With High Levels of Perceived Prenatal Stress Among Inner-City Women.

OBJECTIVE To explore the factors associated with high rates of perceived prenatal stress among inner-city women. DESIGN Observational cross-sectional study. SETTING/PARTICIPANTS We conducted a secondary analysis of data from 603 inner-city women. In our study, 330 participants (54.7%) self-identified as First Nations, Metis, or First Nations/Metis. METHODS Prenatal stress was measured with Cohens Perceived Stress Scale. A social ecological model provided the theoretical framework for the study, and variables representing all levels of the model were selected for study. Data analyses included t tests to compare women with high stress and low/moderate stress, univariable logistic regression analysis to determine the association of selected factors with maternal stress, and multivariable logistic regression analysis to provide adjusted odds ratios and 95% confidence intervals for the factors. RESULTS Of the 603 participants, 17.2% (104) reported high levels of perceived stress, and 82.8% (499) reported low/moderate levels. The high-stress group included a significantly greater proportion of First Nations, Metis, or First Nations/Metis women (76.0%) than the low/moderate-stress group (50.3%). Low rates of self-esteem and social support, residential mobility, abuse before/during pregnancy, and experiencing discrimination were significantly associated with high levels of perceived prenatal stress. CONCLUSION Our findings demonstrated that factors that influence prenatal stress occur at all levels of the social ecological model. The identified factors are amenable to change, and implications for practice include the need for psychosocial risk assessment, alternative forms of prenatal care, relational care, and advocacy initiatives. A greater understanding of the complex factors associated with high rates of perceived prenatal stress can inform the development of effective interventions for inner-city women.

Digital storytelling as a method in health research: a systematic review protocol

BackgroundDigital storytelling is an arts-based research method with potential to elucidate complex narratives in a compelling manner, increase participant engagement, and enhance the meaning of research findings. This method involves the creation of a 3- to 5-min video that integrates multimedia materials including photos, participant voices, drawings, and music. Given the significant potential of digital storytelling to meaningfully capture and share participants’ lived experiences, a systematic review of its use in healthcare research is crucial to develop an in-depth understanding of how researchers have used this method, with an aim to refine and further inform future iterations of its use.MethodsWe aim to identify and synthesize evidence on the use, impact, and ethical considerations of using digital storytelling in health research. The review questions are as follows: (1) What is known about the purpose, definition, use (processes), and contexts of digital storytelling as part of the research process in health research? (2) What impact does digital storytelling have upon the research process, knowledge development, and healthcare practice? (3) What are the key ethical considerations when using digital storytelling within qualitative, quantitative, and mixed method research studies? Key databases and the grey literature will be searched from 1990 to the present for qualitative, quantitative, and mixed methods studies that utilized digital storytelling as part of the research process. Two independent reviewers will screen and critically appraise relevant articles with established quality appraisal tools. We will extract narrative data from all studies with a standardized data extraction form and conduct a thematic analysis of the data. To facilitate innovative dissemination through social media, we will develop a visual infographic and three digital stories to illustrate the review findings, as well as methodological and ethical implications.DiscussionIn collaboration with national and international experts in digital storytelling, we will synthesize key evidence about digital storytelling that is critical to the development of methodological and ethical expertise about arts-based research methods. We will also develop recommendations for incorporating digital storytelling in a meaningful and ethical manner into the research process.Systematic review registrationPROSPERO registry number CRD42017068002.

Should Consultation Recording Use be a Practice Standard? A Systematic Review of the Effectiveness and Implementation of Consultation Recordings

To conduct a systematic review of the effectiveness of consultation recordings and identify factors contributing to their successful implementation in health‐care settings.

A Template Analysis of Writing Self-Efficacy Measures

Background and Purpose: This investigation reviews the item content of writing self-efficacy (WSE) measures developed for undergraduate students. Bandura’s self-efficacy theory and a writing theory by Flower and Hayes informed the a priori themes used to develop a template of WSE categories critical to the concept. Method: Articles describing WSE measures were identified through Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Education Resources Information Center (ERIC), PubMed, Scopus, and Google Scholar (1984–2015). A template analysis method was used to analyze 182 individual items present on 11 WSE instruments. A nursing perspective was applied. Results: The analysis identified 16 categories influencing WSE as well as gaps in current measurement items. Conclusion: The theoretical examination of WSE is the first step toward the development of a WSE measure specific to the nursing context and contributes to nursing education by advancing the measurement of WSE.

Effectiveness and experience of arts-based pedagogy among undergraduate nursing students: a mixed methods systematic review.

BackgroundTo develop well rounded professional nurses, educators need diverse pedagogical approaches. There is growing interest in arts-based pedagogy (ABP) as the arts can facilitate reflection, create meaning and engage healthcare students. However, the emerging body of research about ABP needs to be systematically examined. ObjectivesTo synthesize the best available evidence on the effectiveness of ABP in enhancing competencies and learning behaviors in undergraduate nursing education and to explore nursing students’ experiences with art-based pedagogy. Inclusion criteria Types of participantsThe review considered studies that included participants who are undergraduate nursing students. Types of intervention(s)/phenomena of interestThe qualitative (QL) component considered studies investigating nursing students’ experiences of ABP, and the quantitative (QN) component considered studies evaluating the effectiveness of ABP in undergraduate nursing education. Types of studiesThe QL component considered QL studies including designs such as phenomenology, grounded theory, ethnography, action research and feminist research. The QN component considered studies that examined the effectiveness of ABP including designs such as randomized controlled trials, non-randomized controlled trials, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies, analytical cross-sectional studies, case series, individual case reports and descriptive cross-sectional studies. OutcomesThe following QN outcomes of ABP were assessed: knowledge acquisition, level of empathy, attitudes toward others, emotional states, reflective practice, self-transcendence, cognitive/ethical maturity, learning behaviors and students’ perspectives of ABP. Search strategyAn extensive three-step search strategy was conducted for primary research studies published between January 1, 1994 and April 7, 2015. The strategy included searching CINAHL, MEDLINE, ERIC, PsycINFO, Academic Search Complete, Arts and Humanities Citation Index, Art Full Text, Scopus, ProQuest Dissertations and Theses, A&I, and gray literature. Only studies published in English were included. Methodological qualityTwo reviewers assessed all studies for methodological quality using appropriate critical appraisal checklists from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) or the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI). Data extractionData were extracted from included articles using the standardized data extraction tool from JBI-QARI or JBI-MAStARI. Data synthesisQualitative studies were pooled through a meta-synthesis. Data from the QN studies were combined using a narrative synthesis as a meta-analysis was not possible. The researchers used a segregated mixed methods approach to integrate the QL and QN components. ResultsTwenty-one QL studies of high methodological quality were included. The two synthesized findings revealed that art forms could create meaning and inspire learning in undergraduate nursing education and that ABP can develop important learner outcomes/competencies for professional nursing. These synthesized findings received a moderate ConQual rating. Fifteen experimental/quasi-experimental studies of moderate methodological quality were included. The narrative synthesis suggested that ABP improved nursing students’ knowledge acquisition, level of empathy, attitude toward others, emotional states, level of reflective practice, learning behaviors and aspects of cognitive/ethical maturity. In five cross-sectional studies, the majority of students had a positive perspective of ABP. When the QL and QN findings were interpreted as a whole, ABP appeared to facilitate learning in the cognitive and affective domains and may be especially useful in addressing the affective domain. ConclusionNurse educators should consider using ABP as students found that this approach offered a meaningful way of learning and resulted in the development of important competencies for professional nursing. The QN studies provide a very low level of evidence that ABP improved students’ knowledge acquisition, level of empathy, attitude toward others, emotional states, level of reflective practice, learning behaviors and aspects of cognitive/ethical maturity. Although the QN findings can inform future research, the evidence is not robust enough to demonstrate improved outcomes.

Enlivening a Community of Authentic Scholarship: A Faculty-Mentored Experience for Graduate Students at the 2016 Qualitative Health Research Conference

Background: Critical and engaged qualitative scholarship depends on high-quality graduate training. The need to reexamine graduate student mentorship has become particularly pressing, given the high level of mental health distress experienced by students. It is unclear whether mentorship emerging within the student–advisor relationship is sufficient to ensure comprehensive mentorship. Innovative, experiential pedagogical approaches that integrate emotional and intellectual aspects are limited but may play a vital role in mentorship. There is a critical need to develop and study creative mentorship initiatives for emerging qualitative scholars. Methods: This study used interpretive description methodology and a community of practice theoretical framework to describe a faculty-mentored experience for graduate nursing students at the 2016 Qualitative Health Research Conference (FM-QHR) hosted by the International Institute for Qualitative Methodology. Participants completed written journals elucidating their experiences throughout FM-QHR. The textual data were analyzed using a constant comparative group analysis process, leading to the development of salient and interconnected themes. Results: Six graduate students and four faculty mentors submitted journals. Three interrelated themes articulate how this FM-QHR initiative enlivened a community of authentic scholarship: Questioning the Academic Self: Unvoiced Experiences of Angst, Uncertainty, and Fear; Cocreating Authentic Community through Shared Vulnerability; and Generative and Emergent Empowerment. Conclusion: These findings provide compelling insights into the importance of assisting students to navigate the emotional experiences that are a part of qualitative graduate training. Relational, mentorship initiatives hold potential to not only alleviate emotional distress but also support student empowerment, socialization, and entrance into a community of international qualitative researchers.

Discriminating among grounded theory approaches

Abstract To rationalize the selection of a research methodology, one must understand its philosophical origins and unique characteristics. This process can be challenging in the landscape of evolving qualitative methodologies. Grounded theory is a research methodology with a distinct history that has resulted in numerous approaches. Although the approaches have key similarities, they also have differing philosophical assumptions that influence the ways in which their methods are understood and implemented. The purpose of this discussion paper is to compare and contrast three widely used grounded theory approaches with key distinguishing characteristics, enabling a more thoughtful selection of approach. This work contributes to the existing literature through contrasting classic Glaserian grounded theory, Straussian grounded theory, and constructivist grounded theory in a systematic manner with prominent distinguishing characteristics developed from a review of the literature. These characteristics included historical development, philosophical perspective, role of the researcher, data analysis procedures, perspective of the grounded theory, and strengths/critique. Based on this analysis, three considerations are proposed to direct the methodological choice for a study: purpose, philosophy, and pragmatics. Understanding the similarities and differences in the grounded theory approaches can facilitate methodological transparency and determine the best fit for ones study and worldview as a researcher.

Young women's experiences of psychotic illness: a systematic review of qualitative research.

Background The relationship between young adulthood, women and psychosis was the focus for this systematic review. Age and gender are factors that can influence responses to illness. Research indicates that there are differences in how young men and women are affected biologically and psychosocially, including the presentation of a constellation of symptoms, response to anti-psychotic medications and how they assess their life circumstances. Yet in literature that examines experiences of young people with psychosis, the specific needs of young women are usually not presented separately. To better understand and address young adult womens healthcare and social service needs, a synthesis of evidence addressing the relationship between young adulthood, women and psychosis is needed. Objectives The aim of this systematic review was to synthesize the best available evidence on the experiences of young adult women (aged 18–35 years) living with a psychotic illness in the community. Specifically, the review question was: What are the experiences of young adult women living with a psychotic illness? Inclusion criteria Types of participants Participants were young women between 18 and 35 years of age who were living with a psychotic illness in the community. Phenomena of interest The phenomenon of interest was the experiences of living with a psychotic illness of women aged 18–35 years in the community. Experiences were defined broadly as and inclusive of perceptions and experiences with health and social systems. Context The context for this review was the community setting. Types of studies The current review included studies that focused on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, action research, feminist research and the qualitative component of mixed methods studies. Search strategy A three-step search strategy was used to locate both published and unpublished studies. The search was limited to studies published from 1995 to the search date of May 13, 2015. Methodological quality Two reviewers independently appraised the nine included studies using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI) assessment tool. Data extraction Data were extracted from included papers using the standardized data extraction tool from JBI-QARI. Data synthesis Two reviewers independently reviewed the extracted findings to identify potential categories to pool similar findings. A third member of the team met with the reviewers to collaboratively review these derived categories to create a meta-synthesis that reflected a comprehensive set of synthesized findings. Results Based on the thematic findings from nine qualitative studies, two synthesized findings were identified: (1) the complexity of living with psychosis and finding health, and (2) the presence of harming and healing relationships in young womens lives. The included studies explored a range of experiences relevant for women within the broader phenomenon of experiences of living with a psychotic illness, including experiences within healthcare and social systems. Conclusion The systematic exploration of the literature resulted in identification of nine studies of moderate-to-high methodological quality that met the inclusion criteria. The ConQual evaluation of the level of evidence resulted in synthesized finding 1 (the complexity of living with psychosis and finding health) rated as moderate and synthesized finding 2 (the presence of harming and healing relationships in young womens lives) rated as low. Practitioners can use these findings to guide practice. Further research exploring other experiences relevant for this population is needed.