2018-2019 Honors Students

Brittany DeGraves

Brittany DeGraves

Supervisor: Dr. Carole Estabrooks

Study: Predictors and Effects of Burnout on Health Care Aides who speak English as a Second Language in Nursing Homes

Background: Care aides provide up to 90% of care to residents in long-term care homes and approximately 50% of care aides report speaking English as their second language (ESL). All care aides are at risk for burnout; however, ESL care aides are particularly vulnerable due to factors such as communication and cultural barriers. Burnout in care aides has also been found to impact quality of work-life and quality of care outcomes including staff physical and psychological health decline, decreased job satisfaction, and reported patient satisfaction.

Aim: To identify the factors associated with the experience of burnout in ESL care aides and compare these associations between ESL and non-ESL care aides.

Methods: This study was a quantitative secondary analysis of the Translating Research in Elder Care (TREC) Wave 4 (2017) Survey which surveyed 4158 care aides across three western Canadian provinces. Data were analyzed using descriptive, bivariate, and multilevel analyses.

Results: 65.8% of care aides in our study reported that they speak English as their second language. No significant difference was found between levels of burnout in ESL and non-ESL populations. Both populations reported medium levels of emotional exhaustion, and high levels of both cynicism and efficacy. ESL and non-ESL populations both had statistically significant associations between multiple factors and burnout, including Work Engagement, Job Satisfaction, Empowerment, and Aggression. Factors including Organizational Slack-Space, and Formal Interactions only had significant associations with burnout in ESL care aides.

Conclusion: By identifying the factors associated with burnout in these two groups, we are providing a stepping-stone toward further research to develop and test interventions to reduce burnout and improve quality of work-life among care aides.

Danielle K. Sullivan and Tynisha D. Whynot

Danielle K. Sullivan  Tynisha D. Whynot

Supervisor: Dr. Hannah O'Rourke

Study: Influence of Baseline Contact Profiles on the Acceptability of a Personal Contact Intervention in Dementia

Background: Loneliness negatively affects older adults’ quality of life, and people with dementia are at increased risk. Evidence supports that personal contact interventions can help toaddress older adults’ loneliness. However, little research has involved people with dementia.

Purpose: To explore how people with dementia’s perceptions of the amount and nature of baseline personal contact might influence acceptability of a personal contact intervention.  

Methods: This descriptive, exploratory study was a secondary analysis of data from 14 people with dementia living in a long-term care facility who participated in Connecting Today. Connecting Today is a personal contact intervention that involves 30 minutes of unscripted interaction between residents with mild-to-moderate dementia and their personal contact for 6 weeks. The amount and nature of baseline contact was measured with several self-report questions. Perceptions of intervention acceptability were measured with an adapted Treatment Perception and Preferences Questionnaire, collected after each of the 6 sessions. Descriptive statistics were used to identify two subgroups – a high baseline contact subgroup (i.e., participants with weekly visits [n=7]) and a low baseline contact subgroup (i.e., participants with monthly visits or frequency of visits unknown [n=7]). The acceptability data from the two subgroups was reviewed using frequencies, displayed in bar charts.

Findings: Several hypotheses were generated for testing in future research: (1) Participants, regardless of baseline contact, seemed to find Connecting Today acceptable. (2) Differences in retention and attrition rates supported that Connecting Today may be more acceptable for people with lower baseline contact. (3) Those with lower levels of baseline contact had more positive perceptions of feeling better after a session, suggesting that it may be more effective in this group.

Emily Severson

Emily Severson

Supervisors: Dr. Joanne Olson and Ashley Hyde

Study: Experiencing Trauma During Pregnancy: An Analysis of Two Natural Disasters

Background: Natural disasters and associated stressors can compromise the mental health of vulnerable populations including pregnant women. Stress and exposure to traumatic experiences in pregnancy are correlated with adverse birth outcomes. The expressive writing of pregnant women exposed to natural disasters can offer a window into their experience of trauma.

Purpose: To explore immediate and past traumatic experiences of pregnant women who experienced the Fort McMurray Wood Buffalo, AB (FMWB) wildfire and Hurricane Harvey (Houston, TX) as captured in their expressive writing.

Research Questions: 1) What trauma did pregnant women experience during the fire and the hurricane? 2) What past traumatic experiences did the women discuss in their writing? 3) How are the traumatic experiences of both groups of pregnant women similar and different?

Methods: Narrative data in the form of expressive writing entries from participants of two primary studies was thematically analyzed following methodology outlined by Braun and Clarke (2006). NVivo 12 was used to support thematic content analysis. Memos and a researcher journal were maintained.

Participants:50 pregnant women from the expressive writing intervention groups of the FMWB (n = 25) and Houston (n = 25) studies.

Results:For some women, the natural disaster elicited immense fear and anxiety that surpassed past traumatic life events. Others, however, disclosed significant past traumas that continue to impact them including betrayal of a loved one, abuse, maternal health complications and illness. Group similarities were striking, including similar past traumatic experiences, personal responses to trauma, and shared coping strategies such as support from strong relationships and community, sharing in common experiences, emotional disclosure, journalling, accessing counselling services and the passing of time.

Conclusions:A strengths-based approach and trauma-informed care is needed in both maternal health and post-disaster relief care.

Airlie Palichuk

Airlie Palichuk

Supervisor: Dr. Shannon MacDonald

Study: Immunization Coverage of Immunocompromised Children: A Scoping Review

Introduction: Immunizations are key to protect against vaccine-preventable diseases that can lead to disability and death. In Alberta, public health nurses are responsible for administering childhood immunizations. Immunizations are especially important for children with immunocompromising conditions, since they are more susceptible to vaccine-preventable diseases. However, this population may not be receiving the immunizations needed to adequately protect them due to various barriers. The purpose of this scoping review was to determine the current state of knowledge regarding the immunization coverage of immunocompromised children. Specifically, we sought to examine the extent, range, and nature of research activity and identify gaps in the existing literature.

Methods: We searched bibliographic databases and references lists of included studies. We included primary research from any year reporting on the immunization coverage of any vaccine in children with any immunocompromising condition. Records were screened independently by two reviewers. Data were extracted by one reviewer with validation from a second reviewer. Quality appraisal was completed independently by two reviewers. Data were analyzed quantitatively and narratively.

Results Of the 85 included studies, most were from North America (n=41) and Europe (n=29). Pneumococcal (n=39) and influenza (n=37) were the most commonly studied vaccines, followed by diphtheria- and/or tetanus- and/or pertussis- and/or poliomyelitis- and/or Haemophilus influenzae type B- and/or hepatitis B-containing (n=30), meningococcal (n=21), and varicella (n=20) vaccines. Cross-sectional study designs were the most prevalent study design. Immunocompromising conditions studied included cancer and stem cell transplants (n=22), solid organ transplants (n=21), sickle cell disease (n=17), HIV (n=12), immunosuppressive therapy (n=11), splenectomy (n=4), primary immunodeficiency (n=1), and others unspecified (n=2). Only 24 of 85 studies were of high-quality.

Conclusion: This scoping review emphasizes the need for higher-quality research to be conducted in this field. Future research should expand on the types of vaccines and immunocompromising conditions studied.

Saleen Shivji & Jenna Toogood

Saleen Shivji  Jenna Toogood

Supervisors: Dr. Margot Jackson and Dr. Jude Spiers

Study: Interpersonal Skills Developed by Vulnerable Youth in a Dance and Wellness Program

Art Connects is a dance and wellness community program, based out of Edmonton, Alberta which provides free dance classes to the community's vulnerable youth. The purpose of our study is to explore the impact of this program on the development of interpersonal skills in this population. Current literature recognizes resiliency and connectedness as outcomes of similar classes however the focus population in these studies is inpatient medical populations or patients in recovery. There is limited knowledge on these results in our focus population. We will sample six to eight participants aged 11-16 years attending classes at the Big Brothers Big Sisters Boyle McCauley Boys and Girls Club. Using an exploratory descriptive qualitative design, we will conduct non-participant observation and semi-structured interviews to collect data. Non-participant observation will consist of creating a detailed description of the class activities to provide context for the reader. Semi-structured interviews will consist of seven guiding questions focused on the development of interpersonal skills. Subsequently, we will use thematic analysis to derive common outcomes that the participants identify. The results of this research will inform future integration of this program in similar populations.

Hanna Moore

Hanna Moore

Supervisor: Wendy Beaudoin

Project: The Incidence of Post-Traumatic Stress Disorder in Caregivers of Pediatric Neurosurgical Patients

Background:Having a child receive a neurosurgical diagnosis creates significant stress and anxiety in caregivers. Caregivers frequently report symptoms similar to those associated with Post-Traumatic Stress Disorder (PTSD). This study was designed to gain an understanding of the incidence of PTSD symptoms within primary caregivers of pediatric neurosurgical patients. To our knowledge this is the first study examining the incidence of PTSD symptoms within this specific population.

Methods:A quantitative prospective cross-sectional survey method was utilized. Surveys were distributed both in person at and online between December 2018 and April 2019. Levels of PTSD symptoms were quantified using the Posttraumatic Stress Checklist for DSM-5 (PCL-5).

Results:168 caregivers of pediatric neurosurgical patients were included in this study. According to the DSM-5 diagnostic criteria, 44% (n = 74) screened positively for significant PTSD symptoms. Caregivers identified as having significant PTSD symptoms experienced a high level of disturbing memories, physical reactions to the events including being hyper alert, and avoiding reminders of the experience. They also reported loss of interest in activities, feeling distant from other people, and difficulty with concentration and sleep. The specific neurosurgical diagnosis (p = 0.016), number of surgeries (p = 0.006), and category of the last surgery (p = 0.034) impacted the rate of PTSD symptoms in this population. There was no significant relationship between caregivers who identified having a high level of anxiety before their child was diagnosed and the incidence of PTSD symptomology.

Conclusion: This study has identified a significantly higher level of PTSD symptoms within caregivers of pediatric neurosurgery than previously reported in other pediatric populations. The results highlight the need for further research to identify ways to decrease the impact of a pediatric neurosurgical diagnosis on the mental health of this vulnerable population.

Chisom Onyegbula

Chisom Onyegbula

Supervisor: Dr. Jordana Salma

Project: Healthy Ageing in Immigrant Muslim Women

Background: There is a steady increase in immigrant populations in Canada. Older immigrant women encounter unique stressors in their lives which increase their vulnerability and decrease quality of life as they age.

Purpose: The purpose of this secondary analysis was to shed light on the aging experiences of Muslim immigrant women from diverse ethno-cultural communities with a particular focus on factors that increase vulnerability in older age.

Methods: I completed a secondary analysis of qualitative data from a community-based study on the experiences of aging in Muslim communities in Edmonton, Alberta (2017-2018). Secondary data consisted of 17 individual interview transcripts from interviews with Muslim immigrant women aged 55 and older from diverse ethnic and linguistic groups who were experiencing multiple individual and contextual factors that made them vulnerable. I used Braun and Clarke’s approach to thematic data analysis, with the aid of NVIVO 12 qualitative analysis software. I also used an intersectional lens which entailed attending to the inter-related dimensions of social positioning and identity that influenced immigrants’ lives.

Findings: My analysis resulted in four themes: A. living with prejudice; stigma and discrimination, this theme talks about the preconceived ideas from within the Muslim community and from outside the Muslim community that can be detrimental to healthy ageing. B. intersecting barriers that create isolation, which entails different factors that converge and lead to isolation in this population. C. lack of access to resources needed for healthy ageing, which involves converging barriers to accessing health and social services required for healthy ageing. D. strategies for empowerment; micro, meso, and macro, this theme looks at different strategies that can be used to promote healthy ageing in this population.

Implications: These findings show how intersecting social factors create vulnerability and point to strategies that can be taken to improve the health of minority women.

Elizabeth Swoboda

Elizabeth Swoboda

Supervisors: Vera Caine and Elaine Hyshka

Study: Contemplating questions of relational care, ethics and harm reduction: A narrative analysis of a harm reduction program located in an acute care setting

Purpose: People who use drugs (PWUD) are often discharged from hospitals against medical advice which puts them at increased risk for mortality, readmission for the same condition and longer hospital stays. The needs and concerns of PWUD often go unaddressed. Little research has examined the perspectives of care providers about the impact of addiction medicine consultation teams [AMCTs] on their practices in acute care settings. In this study we inquired into practitioners understanding of harm-reduction oriented AMCTs using a relational care framework.

Methods: Semi-structured interviews were conducted with internal stakeholders (n = 10) from an urban acute care hospital in Western Canada with AMCTs and analyzed thematically. The AMCTs were launched in 2014 to provide integrated addiction medicine, harm reduction services, social support and wraparound care. This study is situated within a larger mixed methods research study in which data was collected from patients and key external and internal stakeholders in 2015.

Results: Analysis of the data indicates that care providers are silent on the core concepts of relational care in relation to PWUD. Rather than forefronting the complex life experiences of PWUD, care providers focus primarily on issues of addictions. There was a strong focus on referring clients to the AMCTs and as a result care some providers described abdicating their responsibilities in providing care for PWUD.

Implications: There is an urgent need to help care providers in acute care institutions engage in relational care for PWUD. This will ensure that harm reduction is not only a pragmatic approach to addressing concerns of PWUD, but also an ethical approach which recognizes people in their complexities.

Esther Nick-Ani

Esther Nick-Ani

Supervisor: Dr. Jordana Salma

Project: Caregiving in Muslim Immigrant Communities in Edmonton, Alberta: A Secondary Analysis

Informal caregiving is increasing in Canada as larger numbers of Canadians enter older age. Informal caregiving poses economic and personal stressors to the caregiver but also provides a sense of satisfaction and fulfillment. Muslim immigrants view caregiving as an act of worship and resist institutionalization of aging family members. Providing informal care, however, can result in psychological, social, and economic strain. The purpose of this research was to explore the experiences of Muslim informal caregivers who care for older family members and to understand caregivers’ needs and facilitating factors for support. This qualitative secondary analysis of data from a community-based participatory research project on healthy aging in immigrant Muslim communities (2017-2018) included participants who were community leaders, caregivers, older adults, and service providers from diverse ethnocultural Muslim communities. I analyzed 16 individual interviews and five focus group transcripts using an inductive thematic data analysis approach. Study themes include: (a) values and norms that shape caregiving in Muslim communities, (b) caregiving stressors, and (c) solutions for stressors. Muslim caregivers provide majority of care to female seniors and newcomers. A lot of importance is placed on caregiving religiously and culturally but due to acculturation and other changes that occur as a result of immigration, seniors and caregivers might experience stress, abuse, burnout and tensions in family relationships. Lack of culturally and religiously appropriate services for seniors also increases the stress of caregivers. The provision of Islamically oriented services and policies that favor informal caregiving in the Islamic community are some of the strategies participants suggested to make the caregiving process less stressful and meet the needs of the population. The results shed a light on the unique perspectives and values around caregiving in Muslim communities.

Breanne Linttell and Simranpreet Puar

Breanne Linttell  Simranpreet Puar

Supervisor: Dr. Simon Palfreyman

Study: Does a Pressure Injury Risk Score Impact the Use of Specialty Beds and Mattresses in the Rehabilitation Hospital Setting?

Background: A pressure injury (PI) is localized damage to the skin resulting from prolonged and/or intense pressure along with friction or shear. Risk is determined by the Braden Score and/or patient comorbidities. Pressure relieving surfaces are available to reduce the interface friction between the patient and the bed. There is currently minimal information regarding mattress selection in a rehabilitation setting.

Purpose: Evaluate whether mattress selection was determined by pressure injury risk, or other confounding variables such as the Function Independence Measure (FIM) or comorbid conditions.

Research Objectives:

  • Describe the use of specialty surfaces and mattresses at the Glenrose Rehabilitation Hospital (GRH).
  • To identify the association between comorbidities, risk factors, FIM score, and pressure injury risk (Braden Score).
  • Describe the level of risk for patients at the GRH using the Braden Scale.
  • Determine the extent to which clinical guidelines are being adhered to at the GRH.

Design: Quantitative, descriptive cross-sectional cohort study.

Methods: A survey of 103 beds was conducted at the GRH. Data collected was: Braden Score, type of bed/mattress, patient comorbidities, FIM score, and patient demographics. Associations between Braden Scale score, presence of PI, and mattress type were assessed.

Sample: All individuals admitted to the hospital at the time of survey.

Data Analysis: Descriptive statistics and correlations between variables including: age, gender, comorbidities, mattresses, FIM, and Braden Score.

Results: A small but significant negative association was found between presence of pressure injury and type of surface used (r= -0.34, p<0.05), explaining 12% of allocation variance in surfaces. However, no statistically significant association was found with mattress type and Braden score (r= -1.49, p>0.05). Comorbid conditions increased the chances of pressure injury development.

Conclusion: The results provided an insight into how standard foam mattresses, and low air loss mattresses are distributed at this setting. The findings of this study raises awareness of increasing clinician education around the use of assessment tools and in increasing screening practices for mattress allocation.

Simin Popat

Simin Popat

Supervisor: Dr. Colleen Norris

Study: Is there an association between pregnancy history and cardiovascular events in Women in Alberta?

Background: Although there is an increasing amount of research done on cardiovascular risk factors in women, less is yet known about a women’s cardiovascular response to pregnancy, which appears to be an early indicator of future maternal cardiovascular risk. Therefore, identifying risks related to the development of cardiovascular disease during the reproductive years may provide future potential to improve women’s cardiac health.

Methods: This was a cross-sectional retrospective descriptive study. Data was collected using a questionnaire that was sent to all females in Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) registry. The questionnaire collected data on the obstetrical histories of these women, who have already had a heart event. It was distributed by mail and included a self-addressed stamped envelope. Preliminary descriptive analysis was conducted on quantitative variables included in the survey. Once all the questionaries’ are completed and returned, we will examine if there are any significant correlations between any pregnancy complications, extent of coronary artery disease and outcomes of the heart event.

Results: The following is an interim report on the 199 surveys returned to date (n=199). Preliminary results in this study indicate that 35.7% of the women who reported having been pregnant also reported a pregnancy related complication. The highest pregnancy complications reported were hypertensive disorders in pregnancy and macrosomia, 26% and 20% respectively. Of the 199 responses 14% of the women reported never being pregnant.

Conclusion: The study is ongoing and future analyses will include exploration of the associations of pregnancy complications and outcomes including level of occlusive disease and rehospitalization.