Through An Equity Lens: Illuminating The Relationships Among Social Inequities, Stigma And Discrimination, And Patient Experiences of Emergency Health Care

People who experience the greatest social inequities often have poor experiences in emergency departments (EDs) so that they are deterred from seeking care, leave without care complete, receive inadequate care, and/or return repeatedly for unre- solved problems. However, efforts to measure and monitor experiences of care rarely capture the experiences of people facing the greatest inequities, experiences of discrimination, or relationships among these variables. This analysis examined how patients’ experiences, including self-reported ratings of care, experiences of discrimination, and repeat visits vary with social and economic circumstances. Every consecutive person presenting to three diverse EDs was invited if/when they were able to consent; 2424 provided demographic and contact information; and 1692 (70%) completed the survey. Latent class analysis (LCA) using sociodemographic variables: age, gender, financial strain, employment, housing stability, English as first language, born in Canada, and Indigenous identity, indicated a six-class solution. Classes differed significantly on having regular access to primary care, reasons for the visit, and acuity. Classes also differed on self-reported discrimination every day and during their ED visit, ratings of ED care, and number of ED visits within the past six months. ED care can be improved through attention to how intersecting forms of structural disadvantage and inequities affect patient experiences

The Efficacy of a Health Promotion Intervention for Indigenous Women: Reclaiming Our Spirits

Indigenous women globally are subjected to high rates of multiple forms of violence, including intimate partner violence (IPV), yet there is often a mismatch between available services and Indigenous women’s needs and there are few evidence-based interventions specifically designed for this group. Building on an IPV-specific intervention (Intervention for Health Enhancement After Leaving [iHEAL]), “Reclaiming Our Spirits” (ROS) is a health promotion intervention developed to address this gap. Offered over 6 to 8 months in a partnership between nurses and Indigenous Elders, nurses worked individually with women focusing on six areas for health promotion and integrated health-related workshops within weekly Circles led by an Indigenous Elder. The efficacy of ROS in improving women’s quality of life and health was examined in a community sample of 152 Indigenous women living in highly marginalizing conditions in two Canadian cities. Participants completed standard self-report measures of primary (quality of life, trauma symptoms) and secondary outcomes (depressive symptoms, social support, mastery, personal agency, interpersonal agency, chronic pain disability) at three points: preintervention (T1), postintervention (T2), and 6 months later (T3). In an intention-to-treat (ITT) analysis, Generalized Estimating Equations (GEE) were used to examine hypothesized changes in outcomes over time. As hypothesized, women’s quality of life and trauma symptoms improved significantly pre- to postintervention and these changes were maintained 6 months later. Similar patterns of improvement were noted for five of six secondary outcomes, although improvements in interpersonal agency were not maintained at T3. Chronic pain disability did not change over time. Within a context of extreme poverty, structural violence, and high levels of trauma and substance use, some women enrolled but were unable to participate. Despite the challenging circumstances in the women’s lives, these findings suggest that this intervention has promise and can be effectively tailored to the specific needs of Indigenous women

Developing Resilience: Gay Men’s Response to Systemic Discrimination

Gay men experience marked health disparities compared to heterosexual men, associated with profound discrimination. Resilience as a concept has received growing attention to increase understanding about how gay men promote and protect their health in the presence of adversity. Missing in this literature are the perspectives and experiences of gay men over 40 years. This investigation, drawing on grounded theory methods, examined how gay men over 40 years of age develop resilience over the course of their lives to promote and protect their health. In-depth interviews were undertaken with 25 men ranging between 40 and 76 years of age who experienced an array of health concerns including depression, anxiety, suicidality, and HIV. Men actively resist discrimination via three interrelated protective processes that dynamically influence the development of resilience over their life course: (a) building and sustaining networks, (b) addressing mental health, and (c) advocating for respectful care encounters. Initiatives to promote and protect the health of gay men must be rooted in the recognition of the systemic role of discrimination, while supporting men’s resilience in actively resisting discrimination

Divided and Disconnected — An Examination of Youths’ Experiences with Emotional Distress within the Context of their Everyday Lives

This paper is based on a qualitative study conducted in a rural community in British Columbia, Canada. Ethnographic methods were used to: (1) to bring youth voice to the literature on emotional distress; and (2) to capture the ways in which context shapes young peoples’ experiences of emotional distress within their everyday lives. Our findings demonstrate how socio-structural contextual factors such as the local economy, geographical segregation, racism, ageism, and cutbacks in health and social service programming operate to create various forms of disconnection, and intersect in young peoples’ lives to shape their experiences of emotional distress

SPACES Study : [release statement]

Applied Science, Faculty ofNursing, School ofUnreviewedFacult

Nursing practice in sexually transmitted infections and HIV in British Columbia : report of survey findings

During 2009-2010 investigators from the BC Centre for Disease Control (BCCDC) and the School of Nursing at the University of British Columbia, in collaboration with regional health authorities, First Nations communities and private service organizations undertook a project aimed at understanding the nature and scope of public health nursing practice in the area of sexually transmitted infection including HIV prevention and control. The final data set included responses from 314 public health nurses. Data sources consisted primarily of census data from the College of Registered Nurses and a self-administered 62-item questionnaire. A total of 576 public health nurses working in STI including HIV prevention and control were identified through analysis of employing agencies identified within the CRNBC census data. The questionnaire was designed to assess the demographic characteristics of public health nurses, the client populations served, workload distribution, clinical practice activities, nursing practice resources, and continuing education needs. The majority of nurses were baccalaureate-prepared women with an average age of 44. The nurses, had been practicing for an average of 18 years, nine of which were in STI and HIV prevention and control. Approximately half of the nurses worked on a full-time basis. Community/public health centres in urban settings were the most common site of employment. On average, nurses spent 28% of their work in the area of STI and HIV care. Women were reported as recipients of nursing care more frequently than any other client population. The majority of nurses (76%) provided care in both STI and HIV prevention and control and spent at least half of their time in direct client care activities. Approximately 78% of nurses undertook STI and HIV testing. Seventy-four percent of the nurses provide clients with medication as part of STI treatment and oral antibiotics were the most commonly administered and dispensed medications. Emergency contraceptives and oral contraceptives were also administered by over 70% of the nurses. Referrals to other health service providers was common practice with physicians, abortion services, mental health care, and community organizations identified as the most common sources of referrals. Nurses were active in the reporting process for reportable infections and regularly engaged in health education activities primarily at the level of individual clients, although community-based education practice was reported by half the participants. Public health nurses were predominantly satisfied with many elements of their work, particularly in relation to direct client care interactions. Nurses were less satisfied with the amount of administrative support they obtained in their work setting, the physical space in which they worked, and their limited opportunities for continuing education and professional development activities. This project represents a detailed analysis of nursing practice in STI prevention and control in British Columbia and will provide an essential baseline for future investigations pertaining to the outcomes associated with legislated changes in nursing practice in the field of STI prevention and control.Applied Science, Faculty ofNursing, School ofUnreviewedFacult

Condom use in context : women’s experiences in the massage parlour industry in Vancouver, Canada

Investigation into condom use in sex work has aroused interest in health promotion and illness prevention. Yet there remains a dearth of inquiry into condom use practices in the indoor sex industry, particularly in North America. We performed a thematic analysis of one aspect of the indoor sex work by drawing on data from a larger mixed-methods project that investigated women’s health issues in the massage parlour industry in Vancouver, Canada. Using a ‘risk context’ framework, condom use was approached as a socially situated practice constituted by supportive and constraining dynamics. Three analytic categories were identified: (1) the process of condom negotiation, (2) the availability of condoms and accessibility to information on STI and (3) financial vulnerability. Within these categories, several supportive dynamics (industry experience and personal ingenuity) and constraining dynamics (lack of agency support, client preferences, limited language proficiency and the legal system) were explored as interfacing influences on condom use. Initiatives to encourage condom use must recognise the role of context in order to more effectively support the health-promoting efforts of women in sex work.Applied Science, Faculty ofNursing, School ofNon UBCReviewedFacultyResearcherPostdoctora

2022 Research & Teaching Scholarship Report

Applied Science, Faculty ofNursing, School ofUnreviewedFacultyUndergraduat

Controlling Chaos: The Perceptions of Long-Term Crack Cocaine Users in Vancouver, British Columbia, Canada

People who smoke crack cocaine are described as chaotic and more likely to engage in risky sex, polysubstance use and contract infectious diseases. However, little is known about how individuals perceive smoking crack as compared to other forms of cocaine use, especially injection. We explored the lived experience of people who smoke crack cocaine. Six gender-specific focus groups ( = 31) of individuals who currently smoke crack in Vancouver, Canada, were conducted using a semi-structured interview guide. Focus groups were transcribed and analyzed by constant comparative methodology. We applied Rhodes' risk environment to the phenomenological understanding that individuals have regarding how crack has affected their lives. Subjects reported that smoking rather than injecting cocaine allows them to begin "controlling chaos" in their lives. Controlling chaos was self-defined using nontraditional measures such as the ability to maintain day-to-day commitments and housing stability. The phenomenological lens of smoking crack instead of injecting cocaine "to control chaos" contributes a novel perspective to our understanding of the crack-smoking population. This study examines narratives which add to prior reports of the association of crack smoking and increased chaos and suggests that, for some, inhaled crack may represent efforts towards self-directed harm reduction

Male ICU nurses’ experiences of taking care of dying patients and their families: a gender analysis

Male intensive care unit (ICU) nurses bring energy and expertise along with an array of beliefs and practices to their workplace. This article investigates the experiences of male ICU nurses in the context of caring for dying patients and their families. Applying a gender analysis, distilled are insights to how masculinities inform and influence the participants' practices and coping strategies. The findings reveal participants draw on masculine ideals of being a protector and rational in their decisive actions toward meeting the comfort needs of dying patients and their families. Somewhat paradoxically, most participants also transgressed masculine norms by outwardly expressing their feelings and talking about emotions related to these experiences. Participants also reported renewed appreciation of their life and their families and many men chronicled recreational activities and social connectedness as strategies for coping with workplace induced stresses. The findings drawn from this study can guide both formal and informal support services for men who are ICU nurses, which in turn might aid retention of this subgroup of workers