Young, Queer and Trans, Homeless, and Besieged: A Critical Action Research Study of How Policy and Culture Create Oppressive Conditions for LGBTQ Youth in Toronto's Shelter System

This dissertation is about lesbian, gay, bisexual, transgender, transsexual, and queer (LGBTQ) youth and the shelter system. This work focuses on the denial of home and safety to queer and trans youth. Over approximately two years, different groups of people came together to discuss what is holding up and sustaining the homophobia and transphobia in the shelter system, how homophobia and transphobia occurs and is managed in the shelter system, and how broader policy issues serve to create oppressive contexts for LGBTQ youth. This is a Critical Action Research study that was informed by Critical Ethnography and Institutional Ethnography. In order to investigate what disjunctures occur for LGBTQ youth in the shelter system and how those disjunctures come about, this dissertation draws upon one-on-one interviews with LGBTQ youth experiencing homelessness, shelter Executive Directors, City of Toronto management, and training facilitators; focus groups with frontline shelter staff; and training observations. This study suggests that it is both the excessive bureaucratic regulation and the lack of necessary bureaucratic regulation in highly significant areas, that play a key role in creating the disjunctures that occur for queer and trans youth in the shelter system. This dissertation describes the findings of this study in five major themes, which include: Homophobia and Transphobia in the Shelter System, LGBTQ Youth Invisibility, Inadequate, Invasive and Otherwise Problematic Rules, Lack of Knowledge, and Inconsistent Conformity to Formal Rules. A Digital Storytelling project was created with one youth and was used as a Knowledge Mobilization strategy for this study. The film helped generate extensive media attention and facilitated change in the shelter system, at the City of Toronto, and at a policy level. This research study has made it possible for the voices of LGBTQ homeless youth to be heard in the context of a critical public health and social justice problem. Detailed policy and practice recommendations and changes to the Toronto Shelter Standards are provided at the end of this dissertation and are meant to help Toronto's shelter system become safe, accessible, and supportive of LGBTQ youth.Ph.D.2018-06-13 00:00:0

The development and implementation of an electronic departmental note in a colposcopy clinic

Hospital-wide electronic medical records can be limited in addressing clinical department needs. A study was undertaken to examine the development and implementation of an electronic informaton system in a colposcopy unit in a large teaching hospital in Canada. A case study design was used, and 24 semistructured interviews were conducted with nurses and physicians working in the colposcopy clinic and individuals from the information technology team. Interviews occurred in two phases-directly after implementation and again 9 months later. Computerized audit data were gathered to examine usage patterns. The results provide insight into the processes and challenges of defining and capturing information for both clinical and research purposes and creating a standardized referral note. The findings demonstrated some initial uncertainty around roles and responsibilities concerning the electronic system and its integration into clinical routines. After a period of 12 months, and further refinement, it was found that the system was accessible and user-friendly, although some concerns raised during the developmental stage persisted. Audit data revealed that 9 months after its introduction, nurses' adoption of the system rate reached 89%, and physicians, 96%. This study has demonstrated that practitioners in a colposcopy clinic successfully collaborated with information technology specialists and each other to develop and implement a clinical departmental information system. While certain challenges were encountered, nurses and physicians have bought into the system, recognize its potential for research and patient care, and are therefore committed to figuring out how to adapt to the changes in communication both within the clinic and with referring physicians

Implementing an interprofessional patient safety learning initiative : insights from participants, project leads and steering committee members

INTRODUCTION: Effective teamwork and interprofessional collaboration are vital for healthcare quality and safety; however, challenges persist in creating interprofessional teamwork and resilient professional teams. A study was undertaken to delineate perceptions of individuals involved with the implementation of an interprofessional patient safety competency-based intervention and intervention participants. METHODS: The study employed a qualitative study design that triangulated data from interviews with six steering committee members and five members of the project team who developed and monitored the intervention and six focus groups with clinical team members who participated in the intervention and implemented local patient safety projects within a large teaching hospital in Canada. RESULTS: Our study findings reveal that healthcare professionals and support staff acquired patient safety competencies in an interprofessional context that can result in improved patient and work flow processes. However, key challenges exist including managing projects amidst competing priorities, lacking physician engagement and sustaining projects. CONCLUSIONS: Our findings point to leaders to provide opportunities for healthcare teams to engage in interprofessional teamwork and patient safety projects to improve quality of patient care. Further research efforts should examine the sustainability of interprofessional safety projects and how leaders can more fully engage the participation of all professions, specifically physicians