In Plain View: Gender in the Work of Women Healthcare Chaplains

In sociological studies of religion and chaplaincy, there is little research on how gender plays a role in structural inequalities and experiences of women chaplains. Through research on the work of women chaplains in public healthcare in Vancouver (Canada) and London (England) this qualitative study revealed that while they have opportunities for leadership and ministry in chaplaincy, they are often on the margins of the religious institutions they are affiliated with and the secular medical organisations that employ them. Simultaneously, they confront the social structuring of gender and race that can affect them being overlooked. By applying a lived religion and feminist intersectional analysis, this research focuses on an area of study that has received scant attention

The social relations of prayer in healthcare: Adding to nursing's equity-oriented professional practice and disciplinary knowledge

Although spiritual practices such as prayer are engaged by many to support well-being and coping, little research has addressed nurses and prayer, whether for themselves or facilitating patients' use of prayer. We conducted a qualitative study to explore how prayer (as a proxy for spirituality and religion) is manifest—whether embraced, tolerated, or resisted—in healthcare, and how institutional and social contexts shape how prayer is understood and enacted. This paper analyzes interviews with 21 nurses in Vancouver and London as a subset of the larger study. Findings show that nurses' kindness can buffer the loneliness and exclusion of ill health and in this way support the “spirit” of those in their care. Spiritual support for patients rarely incorporated prayer, in part because of ambiguities about permission and professional boundaries. Nurses' engagement with prayer and spiritual support could become a politicized site of religious accommodation, where imposition, religious illiteracy, and racism could derail person-centered care and consequently enact social exclusion. Spiritual support (including prayer) sustained nurses themselves. We propose that nursing's equity-oriented knowledge encompass spirituality and religion as sites of exclusion and inclusion. Nurses must be supported to move past religious illiteracy to provide culturally and spiritually sensitive care with clarity about professional boundaries and collaborative models of spiritual care

Host Agency Perspectives on Facilitating Community-Based Clinical Experiences for Nursing Students

Nurse educators have developed many innovations for nursing education in response to the current shortage of clinical placements. Nursing programs are increasingly relying on placements in community-based agencies (some of which are not health agencies) and university-agency collaborations are being developed to enhance capacity for student placements. Our interest in this qualitative study was to elicit the perspectives of host agencies in these alternate sites regarding hosting undergraduate student clinical placements. Aims were to gain insight about (1) how community-based host agencies decide to host students, including how the number of students hosted is determined; (2) the nature of agency-university partnerships; and (3) the agency’s experiences of hosting students in relation to benefits and issues that accompany hosting students. Administrators from twenty-five community-based agencies that hosted undergraduate nursing students from the researchers’ university were invited to participate in an online survey or telephone interview, with a final sample size of eighteen respondents. Each participant was given the option of a telephone interview but most elected to complete the online survey because of its flexibility; five participants were interviewed on the phone and 13 completed the open-ended survey questions online. Findings revealed that host agency decisions to host students could have an ad hoc nature to them, and were described as contingent on various explicit and implicit factors such as staff availability, the perceived contribution of students, or a philosophic commitment to contribute to student education. Smaller agencies reported and preferred informal partnerships with the educational institutions because they were perceived to be more flexible, and all sites emphasized the need for increased, improved communication with clinical instructors and more direct supervision of student placements by the educational unit. The benefits of hosting student nurses were described as outweighing the issues and challenges. The study also revealed incongruities between the perspectives of these host agencies and typically-held views of nursing programs, whereby host agencies spoke of the “ideal student” and nursing programs tend to seek an “ideal placement”. Further research is needed to generate knowledge about expanding capacity for clinical placements, enhancing partnerships, and enriching student learning outcomes. Résumé Compte tenu de la pénurie de places de stages cliniques, les professeures en sciences infirmières ont développé plusieurs innovations en formation infirmière. Les programmes de sciences infirmières comptent de plus en plus sur les stages au sein d’organismes communautaires (certains ne sont pas des organismes de santé) et les universités favorisent des partenariats avec ces organismes afin d’accroître la capacité d’accueil de stagiaires. Cette étude qualitative visait à décrire les perspectives d’organismes hôtes dans ces sites alternatifs concernant l’accueil d’étudiantes de premier cycle dans le cadre de stages cliniques. Les objectifs étaient de mieux comprendre : (1) comment les organismes communautaires hôtes prennent la décision d’accueillir des étudiantes dans le cadre de stages cliniques et comment ils déterminent le nombre d’étudiantes qui seront accueillies; (2) la nature des partenariats organisme-université; et (3) les expériences de l’organisme en ce qui concerne l’accueil des étudiantes, plus particulièrement les avantages et les problèmes liés à l’accueil des étudiantes. Des administrateurs de vingt-cinq organismes communautaires, qui ont accueilli des étudiantes en sciences infirmières de l’université d’attache des chercheurs, ont été invités à participer à un sondage en ligne ou à une entrevue téléphonique. La taille de l’échantillon final était de dix-huit participants. La plupart des participants ont opté pour le sondage en ligne à cause de sa flexibilité; cinq participants ont répondu à une entrevue téléphonique et treize ont complété le sondage en ligne qui comportait des questions ouvertes. Les résultats indiquent que les organismes hôtes décident d’accueillir des étudiantes en stage afin de répondre à des besoins spécifiques, et la décision dépend de plusieurs facteurs explicites et implicites, tels que la disponibilité du personnel, la perception de la contribution des étudiantes, ou un engagement philosophique à contribuer à la formation d’étudiantes. Les plus petits organismes ont indiqué qu’ils préfèrent les partenariats informels avec les établissements de formation car ils les perçoivent comme étant plus souples. Tous les sites ont souligné le besoin de communications plus fréquentes et améliorées avec les enseignantes cliniques et de supervision plus directe des stages des étudiantes par l’unité d’enseignement. Les avantages d’accueillir des étudiantes étaient décrits par les organismes hôtes comme dépassant les inconvénients ou les défis. L’étude a aussi révélé des incongruités entre les perspectives des organismes hôtes et celles des programmes de sciences infirmières : les organismes hôtes décrivent ce que serait un « étudiante idéale» et les programmes de sciences infirmières souhaitent trouver le « stage idéal ». D’autres recherches seront nécessaires afin de générer des connaissances sur l’augmentation de la capacité d’accueil de stagiaires, l’amélioration des partenariats, et l’enrichissement des résultats d’apprentissage des étudiantes

Micro-meso-macro practice tensions in using patient-reported outcome and experience measures in hospital palliative care

This article applies a micro-meso-macro analytical framework to understand clinicians’ experiences and perspectives of using patient-reported outcome and experience measures (PROMs and PREMs) in routine hospital-based palliative care. We structure our discussion through qualitative analysis of a design and implementation project for using an electronic tablet-based tool among hospital-based palliative clinicians to assess patients’ and their family caregivers’ quality of life concerns and experiences of care. Our analysis identified three categories of practice tensions shaping clinicians’ use of PROMs and PREMs in routine care: tensions surrounding implementation, tensions in standardization and quantification, and tensions that arose from scope of practice concerns. Our findings highlight that clinicians necessarily work within the confluence of multiple system priorities, that navigating these priorities can result in irreducible practice tensions, and that awareness of these tensions is a critical consideration when integrating PROMs and PREMs into routine practice

Mothering, Albinism and Human Rights: The Disproportionate Impact of Health-Related Stigma in Tanzania

In many parts of sub-Saharan Africa, mothers impacted by the genetic condition of albinism, whether as mothers of children with albinism or themselves with albinism, are disproportionately impacted by a constellation of health-related stigma, social determinants of health (SDH), and human rights violations. In a critical ethnographic study in Tanzania, we engaged with the voices of mothers impacted by albinism and key stakeholders to elucidate experiences of stigma. Their narratives revealed internalized subjective stigma, social stigma such as being ostracized by family and community, and structural stigma on account of lack of access to SDH. An analysis of health systems as SDH revealed stigmatizing attitudes and behaviours of healthcare providers, especially at the time of birth; a lack of access to timely quality health services, in particular skin and eye care; and a lack of health-related education about the cause and care of albinism. Gender inequality as another SDH featured prominently as an amplifier of stigma. The findings pose implications for research, policy, and practice. A concrete avenue to de-stigmatization of mothers impacted by albinism exists by the application of principles of human rights, particularly equality and non-discrimination; contextual analysis of cultural dynamics including relevant ontology; meaningful participation of rights-claimants, such as peer groups of mothers; and accountability of governments and their obligation to ensure access to health information as a key social determinant of the right to health

Design and introduction of a quality of life assessment and practice support system: perspectives from palliative care settings

Background: Quality of life (QOL) assessment instruments, including patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs), are increasingly promoted as a means of enabling clinicians to enhance person-centered care. However, integration of these instruments into palliative care clinical practice has been inconsistent. This study focused on the design of an electronic Quality of Life and Practice Support System (QPSS) prototype and its initial use in palliative inpatient and home care settings. Our objectives were to ascertain desired features of a QPSS prototype and the experiences of clinicians, patients, and family caregivers in regard to the initial introduction of a QPSS in palliative care, interpreting them in context. Methods: We applied an integrated knowledge translation approach in two stages by engaging a total of 71 clinicians, 18 patients, and 17 family caregivers in palliative inpatient and home care settings. Data for Stage I were collected via 12 focus groups with clinicians to ascertain desirable features of a QPSS. Stage II involved 5 focus groups and 24 interviews with clinicians and 35 interviews with patients or family caregivers during initial implementation of a QPSS. The focus groups and interviews were recorded, transcribed, and analyzed using the qualitative methodology of interpretive description. Results: Desirable features focused on hardware (lightweight, durable, and easy to disinfect), software (simple, user-friendly interface, multi-linguistic, integration with e-health systems), and choice of assessment instruments that would facilitate a holistic assessment. Although patient and family caregiver participants were predominantly enthusiastic, clinicians expressed a mixture of enthusiasm, receptivity, and concern regarding the use of a QPSS. The analyses revealed important contextual considerations, including: (a) logistical, technical, and aesthetic considerations regarding the QPSS as a technology, (b) diversity in knowledge, skills, and attitudes of clinicians, patients, and family caregivers regarding the integration of electronic QOL assessments in care, and (c) the need to understand organizational context and priorities in using QOL assessment data. Conclusion: The process of designing and integrating a QPSS in palliative care for patients with life-limiting conditions and their family caregivers is complex and requires extensive consultation with clinicians, administrators, patients, and family caregivers to inform successful implementation

Mapping a research-advocacy-policy agenda on human rights and albinism: a mixed methods project

Background: Persons with albinism face challenges to their wellbeing, safety, and security, ranging from vision impairment and skin cancer to stigma and discrimination. In some regions, they also face human rights atrocities including mutilation and murder. Research on human rights and albinism is a relatively new field that has gained momentum since the United Nations appointment of an Independent Expert on the enjoyment of human rights by persons with albinism. In this paper, we present the results of a mixed methods study undertaken to identify priorities for research, advocacy, and policy on albinism and human rights. Methods: The first component was a synthesis of peer-reviewed and grey literatures at the nexus of albinism, spiritual/cultural beliefs and practices, and human rights. We then conducted a priority-setting survey, informed by Delphi methods, on extant knowledge-practice gaps and research, advocacy, and policy priorities. Inclusion criteria included demonstrated expertise in the field (e.g., peer-reviewed publications, funded research), membership on national or international associations, or advocacy (civil society organizations) of more than 2 years in albinism and human rights. Thereafter, we gathered leading researchers, policy-makers, and civil society stakeholders for a Roundtable to gain consensus on these priorities. Results: Access to skin and vision care, and education were not deemed high priority for research, likely because the evidence supporting the need for these is well established. However, they were priorities for advocacy and policy: what is needed is mobilization of this evidence through advocacy and implementation of such services (policy). Other social determinants of health (rurality, poverty, and gender equality) are present as subtext in the findings, more so than priorities for research, advocacy, or policy, despite their preponderance in the lives of persons with albinism. Research was prioritized on stigma and discrimination; advocacy; and witchcraft, but with some differentiation between Global North and Global South priorities. Priorities for research, advocacy, and policy vary in keeping with the explanatory frameworks at play, including how harmful practices and witchcraft are viewed. Conclusions: The lived experience of albinism is profoundly shaped by the social determinants of health (SDOH). Threats to the security and well-being of persons with albinism should be viewed through a human rights lens that encompasses the explanatory frameworks at play

Diverse perspectives on interdisciplinarity from the Members of the College of the Royal Society of Canada

Various multiple-disciplinary terms and concepts (although most commonly “interdisciplinarity”, which is used herein) are used to frame education, scholarship, research, and interactions within and outside academia. In principle, the premise of interdisciplinarity may appear to have many strengths; yet, the extent to which interdisciplinarity is embraced by the current generation of academics, the benefits and risks for doing so, and the barriers and facilitators to achieving interdisciplinarity represent inherent challenges. Much has been written on the topic of interdisciplinarity, but to our knowledge there have been few attempts to consider and present diverse perspectives from scholars, artists, and scientists in a cohesive manner. As a team of 57 members from the Canadian College of New Scholars, Artists, and Scientists of the Royal Society of Canada (the College) who self-identify as being engaged or interested in interdisciplinarity, we provide diverse intellectual, cultural, and social perspectives. The goal of this paper is to share our collective wisdom on this topic with the broader community and to stimulate discourse and debate on the merits and challenges associated with interdisciplinarity. Perhaps the clearest message emerging from this exercise is that working across established boundaries of scholarly communities is rewarding, necessary, and is more likely to result in impact. However, there are barriers that limit the ease with which this can occur (e.g., lack of institutional structures and funding to facilitate cross-disciplinary exploration). Occasionally, there can be significant risk associated with doing interdisciplinary work (e.g., lack of adequate measurement or recognition of work by disciplinary peers). Solving many of the world’s complex and pressing problems (e.g., climate change, sustainable agriculture, the burden of chronic disease, and aging populations) demand thinking and working across long-standing, but in some ways restrictive, academic boundaries. Academic institutions and key support structures, especially funding bodies, will play an important role in helping to realize what is readily apparent to all who contributed to this paper—that interdisciplinarity is essential for solving complex problems; it is the new norm. Failure to empower and encourage those doing this research will serve as a great impediment to training, knowledge, and addressing societal issues