Sylvie Gendron

Sexuality in Montreal women living with HIV

The impact of learning a positive HIV test result on the sexuality of 161 women (47 injection drug users (IDU), 53 non-IDU women of Haitian or African origin (non-IDU-HA), and 61 non-IDU Caucasian women (non-IDU-C) was assessed using closed and open-ended questions. Self-reported CD4+ count correlated with any post-test (p = 0.001) and past month sexual activity (p = 0.007). After learning their HIV status, 110 women (68%) were sexually active, 48 (44%) of these within 1 month. After resuming sexual activity, 84% underwent a sexual adjustment period (median duration 8.5 months). IDU women were more likely to have frequent sex, be anorgasmic, and prefer sex less often. Consistent partner condom use was low in general (19% for IDU, 30% for non-IDU-HA, and 62% for non-IDU-C) and by partner type (new regular partner 58%, same regular partner 36%, casual partner 29%). Sexual satisfaction tended to decline post-test and then increase to higher than pre-test levels. Counselling focused on the safe and satisfying aspects of sex may assist women with HIV infection in sexual decision-making. Facilitating the access of IDU women with HIV infection to medically supervised drug provision and to detoxification and rehabilitation programmes can weaken the link between drug use and sex work.

Transitioning Care of an Adolescent With Cystic Fibrosis: Development of Systemic Hypothesis Between Parents, Adolescents, and Health Care Professionals

This qualitative study explored the experience of parents and adolescents living with cystic fibrosis prior to the transfer of the adolescent’s care from a pediatric to an adult health care facility. Semistructured interviews were conducted with seven families receiving care from a specialized cystic fibrosis clinic; parents and adolescents were interviewed separately, followed by a group interview with members of a health care team comprising eight professionals from the clinic. Interviews were analyzed through a systemic lens which accounts for interaction and reciprocity in relationships. The parents’ experience was marked by suffering and uncertainty that remained unexpressed to the health care team, even though team members had known the family since the child was first diagnosed. Findings led to identifying a systemic hypothesis that accounted for the interactions and relational processes between parents and the health care team. This hypothesis may guide the development of systemic family nursing interventions that target this complex, relational, transition process.

Advancing population-based health-promotion and prevention practice in community-health nursing: key conditions for change.

Community-health nursing practice is a pivotal aspect of present-day health reforms. In Quebec, Canada, the recent introduction of a population-based approach has entailed increasing the resources allocated to health promotion and disease prevention. Semistructured interviews were conducted with nurses and managers (N = 69) in an effort to understand how these new resources are reflected in nursing practice. Three classes of factors emerged as key conditions for change: contextual and historical, training and professional-development, and work-organization factors. The authors propose courses of action respecting these conditions to provide support for community-health nursing practices that incorporate a contemporary population-based approach.

Understanding similarities in the local implementation of a healthy environment programme: Insights from policy studies

This paper reports findings from an evaluation of the local implementation of a procedural public health programme whose objective is to create healthy environments (HE) for vulnerable families in the province of Quebec (Canada) through the funding of local projects. Considering the potential issue of programme-context interaction, our research question was the following: Does the procedural nature of this HE programme result in variation between local cases in terms of the types of projects and collaborations it subsidizes? Given that the creation of healthy environments requires intersectoral health action to address social determinants of health, the data were analysed with respect to intersectorality and cooperation. Results of this qualitative multiple case study (n = 8), for the period 2004-2009, show that the majority of subsidized projects were in the health and social services sector and focused on parenting, parent-child attachment, nutrition and the social networks of families. Only a few initiatives reached beyond the health and social services sector to address social health determinants such as education, housing and transportation. Membership and mandates of the local groups responsible for programme implementation also showed little intersectorality. The limited variation between these eight cases can be attributed to the configuration of the local networks, as well as to specific issues in urban and rural areas. To explain the overall similarity of results across cases, we turned to the literature on policy instruments which suggests that particular characteristics of a programme may produce effects that are independent of its intended objective. In our study, several programme mechanisms, such as those framing the definition of «healthy environment» and budget management rules, could have encouraged the local development of initiatives that focus on individual skills related to parenting and attachment rather than the development of intersectoral health action to address social determinants of health.

Figurative Thinking and Models: Tools for Participatory Evaluation

In sociological terms, an evaluation can be considered as a collective decision to step back, take a second look, and formulate a judgement on a public program. This collective decision is usually borne by a limited number of actors who elaborate their thinking with the advice and support of an evaluator. In the past two decades, major developments in the field of evaluation have emerged through the practice of “participatory evaluation.” This approach requires an expansion of the number of actors beyond the initial proponents and the evaluator so as to expand as much as possible the scope of the reflection. A public program involves many actors, all of whom have interests at stake, some of which are liable to be divergent. When judgements are made without somehow including the diverse stakeholders or their spokespersons, issues concerning the results and their utilization are more likely to surface (Weiss, 1983a). Over the years, evaluators have become increasingly aware

Nurse-Environment Interactions in the Development of Cultural Competence

Abstract Studies on the development of cultural competence among healthcare providers tend to focus on the clinical encounter, with little attention paid to the environment. In this paper, results from a grounded theory study conducted with nurses and students to understand cultural competence development are presented; with a focus on findings that call particular attention to nurse-environment interactions. Two concurrent processes, as students and nurses develop cultural competence through interactions with their environment, were identified: “dealing with structural constraints” and “mobilizing social resources”. These dynamic interactions between healthcare providers and the larger structures of healthcare systems raise critical questions about the power of healthcare providers to influence the structures that shape their practice. The intersection of nursing theory with social and critical theories is essential to gain a comprehensive understanding of cultural competence development and to transform healthcare providers’ education in the service of social justice and health equity.

Confianza, vigilancia y responsabilización: cambios en el desarrollo de la autonomía en las familias que viven con un adolescente que padece de fibrosis quística

OBJECTIVE A growing number of families with an adolescent who has cystic fibrosis can now envisage their child making the transition from adolescence to adulthood. Limited research has been conducted to date regarding the nature of the interactions between adolescents and their parents during the development of the adolescents independence. METHOD The aim of this qualitative case study was to explore the experience of families with an adolescent who has cystic fibrosis, at the pre-transfer stage from a paediatric clinic to adult care. A systemic framework was used to get a better understanding of this phenomenon. Semi-directed interviews with seven families were conducted and a content analysis was performed. RESULTS Features of the development of autonomy are characterised by three dimensions of the parental experience: (a) confidence that must be established between the adolescent and the parent, (b) adolescents gradual increase of responsibility and (c) parents supervision of the adolescent. CONCLUSIONS This study gives new information on parental experience as regards the development of autonomy in adolescents who have cystic fibrosis. The results underline the importance of taking parental experience into consideration in order to support families in the development of the adolescents autonomy.