Linda Reutter

“Who Do They Think We Are, Anyway?”: Perceptions of and Responses to Poverty Stigma

In this article, we report on qualitative findings pertaining to low-income peoples perceptions of and responses to “poverty stigma,” a key component of social exclusion with important implications for health and well-being. Our findings are drawn from a multimethod study designed to investigate experiences of social exclusion and social isolation among people living on low incomes. We conducted semistructured individual interviews (n = 59) and group interviews (total n = 34) with low-income residents of two large Canadian cities. Data were analyzed using thematic content analysis techniques. Participants overwhelmingly thought that other members of society tend to view them as a burden to society—as lazy, disregarding of opportunities, irresponsible, and opting for an easy life. Low-income people responded to perceived stigma with a variety of cognitive and behavioral strategies that reflected their efforts to reconcile their perceived “social” and “personal” identities. These strategies included confronting discrimination directly, disregarding responses from others, helping other low-income people, withdrawing and isolating themselves from others, engaging in processes of cognitive distancing, and concealing their financial situation.

Developing Resilience: How Women Maintain Their Health in Northern Geographically Isolated Settings:

The purpose of this study was to explore how women maintain their health in northern geographically isolated settings, using a feminist grounded theory method. Twenty-five women of diverse backgrounds in northern British Columbia, Canada, engaged in qualitative interviews over a 2-year period to express perspectives about how the north affects their health and how they maintain their health in northern settings. Findings reveal that the women experienced vulnerability to physical health and safety risks, psychosocial health risks, and risks of inadequate health care. The women responded to these vulnerabilities by developing resilience through the strategies of becoming hardy, making the best of the north, and supplementing the north. These strategies, which reflect both individual and collective actions, were determined by the needs and interests of the women and their social and personal resources. The findings have implications for women’s health research and health practices and policies in geographically isolated settings.

The Road Less Traveled: Nursing Advocacy at the Policy Level

A frequent observation made about nursing advocacy at the policy level is its absence—or at least its invisibility. Yet there is a persistent belief that nurses will participate in advocacy at the societal level in matters of health. Although gaps exist in our knowledge about how to advocate at the policy level, the authors suggest that a number of other factors contribute to the disconnect between what nurses are expected to do in terms of policy advocacy and what they actually do. There are two main purposes in this article: to review the epistemological foundations of advocacy in nursing, and to present a discussion of other factors that limit our participation in policy advocacy. The authors discuss challenges within the discipline, in the practice context, and at the interface of the worlds of policy and nursing practice. The article concludes with a discussion of possible strategies for moving forward.

Preparing Nurses to Promote Health-Enhancing Public Policies

Nursing leadership in policy development continues to be acknowledged as an important aspect of professional practice. The past decade of health services restructuring has led to a renewed emphasis on nursing’s role in health care policy; however, there is also a need to focus more broadly on policies outside the health care sector that influence health. A critical question is how to prepare nurses to influence the development of “healthy public policy.” This article describes shifts in thinking about policy in health and what this portends for nursing education. The authors argue that comprehensive preparation in public policy for nurses is an essential element of graduate education. The article describes faculty and student perspectives and experiences in the first offerings of the nursing graduate course, Promoting Health-Enhancing Public Policy. The article concludes with recommendations that may assist students to acquire knowledge regarding the policy process and approaches to policy advocacy.

Poverty, Sense of Belonging and Experiences of Social Isolation

This article compares experiences of social isolation and perceptions of belonging between lower-income and higher-income people. We conducted individual interviews with 60 higher-income and 59 lower-income study participants and six group interviews with 34 low-income participants from two Canadian cities. Subsequently, a representative sample of 1,671 lower- and higher-income participants was surveyed by telephone. Income was a consistent predictor of measures of isolation and sense of belonging to the community: lower-income people experienced greater isolation and a lower sense of belonging than did higher-income people. Poverty shaped low-income peoples perceptions and experiences of stigmatization and isolation.

Engaging with nature to promote health: new directions for nursing research.

AIM The aim of this paper is to offer a conceptual framework for nature-based health promotion in nursing and provide related recommendations for future nursing research. BACKGROUND Empirical data suggest that interaction with nature has direct health benefits. When people attend to outdoor habitats, gardens and other forms of nature, they are more likely to engage in physical activity and other behaviours that improve health. Engaging with nature can even cultivate ecological sensibilities that motivate us to protect the health of our planet. DATA SOURCES Multidisciplinary theoretical and research publications from 1985 to 2008 were examined in the development of the framework. DISCUSSION As the health of our planet continues to deteriorate, there is a pressing need for theoretically informed, ethical, sustainable ways of engaging with nature to promote human and environmental health. We adapt principles and socio-ecological thinking from the fields of nursing, health promotion and ecological restoration to delineate the essential elements of the proposed framework. Implications for nursing. Although evidence-based knowledge about nature-based health promotion is not readily used in nursing and health care, its development and application are critical to designing effective strategies to strengthen both human and environmental health. CONCLUSION Nurses can use nature-based health promotion concepts to work with citizens, health practitioners and policymakers to explore and optimize reciprocal, health promoting relationships among humans and the natural environment. To the extent that nurses integrate nature-based health promotion into their research efforts, we can expect to contribute meaningfully to both environmental and human health in communities across the globe.

“You Need to Know Where We’re Coming From”: Canadian Aboriginal Women's Perspectives on Culturally Appropriate HIV Counseling and Testing

The purpose of this qualitative descriptive study was to determine Canadian Aboriginal womens perspectives on culturally appropriate HIV counseling and testing. Data were collected through semistructured individual interviews with 7 Aboriginal women, and one focus group, in a western Canadian city. Four major categories were elucidated through thematic content analysis: Aboriginal womens life experiences that may influence their risk of HIV infection and their response to testing; barriers to HIV testing; guiding principles of the ideal HIV testing situation; and characteristics of culturally appropriate HIV testing. The fear of being judged by both the Aboriginal and non-Aboriginal communities and the need for sensitivity to the historical and current context of Aboriginal womens life experiences were pervasive themes throughout the findings.

A Support Intervention to Promote Health and Coping Among Homeless Youths

Homeless youths are often vulnerable to limited support resources and loneliness. Peers are a potent source of social support. A support intervention for homeless youths was designed to optimize peer influence and was pilot tested. The intervention was based on an initial assessment of support needs and intervention preferences from the perspective of 36 homeless youths and 27 service providers. Based on the results, a 20-week pilot intervention program was designed, consisting of 4 support groups, optional one-on-one support, group recreational activities, and meals. Support was provided by professional and peer mentors, including formerly homeless youths. A total of 56 homeless youths aged 16 to 24 took part. Participants completed pre-, mid-, and post-test quantitative measures and qualitative interviews. In spite of challenges due primarily to attrition, the youths reported enhanced health behaviours, improved mental well-being, decreased loneliness, expanded social network, increased coping skills, enhanced self-efficacy, and diminished use of drugs and alcohol. Further research could focus on replication at other sites with a larger sample.

Incorporating a research apprenticeship model in a Canadian nursing Honors Program

In this article, we describe the development of a BScN (Honors) Program in a large Canadian university. We describe the elements of the program, including the application of a research apprenticeship model as the core of the program. We provide examples of student learning experiences culminating in the Honors project. Recruitment, balancing clinical and research interests, financial support, and manageability of the Honors project emerged as key challenges in our first offerings of the program. Overall, students perceived that experiential research learning enhanced their research skills, increased appreciation of the process and outcomes of nursing research, and inspired confidence to pursue graduate education. We conclude that an apprenticeship model providing students with experiential research learning with established faculty researchers is an effective and efficient way to deliver the Honors Program in the context of a research-intensive nursing faculty.

Left Out: Perspectives on Social Exclusion and Inclusion across Income Groups

Abstract The goal of this paper is to explore the experiences of exclusion and inclusion of both low and higher-income people within a ‘social determinants of health framework’. In the first phase of this research, individual interviews with 60 high-income and 59 low-income participants, and group interviews with 34 low-income participants were conducted. During the second phase, 1671 higher and low-income participants were surveyed by telephone. The findings revealed that inadequate financial resources, ill-health, and unwelcoming behaviours inhibited participation in community activities among low-income respondents. Higher-income earners were more likely to engage in social and group civic activities. Participants in the low-income category were less able to participate in desired activities due to user fees and poor health. Data revealed significant relationships between self-rated health and measures of exclusion and inclusion. Based on the responses of participants, the paper concludes that structural rather than interpersonal change contributes significantly to increased levels of social inclusion, and ultimately, improvements in health outcomes.