A Critical Examination of the Social Organizations within Canadian NGOs in the Provision of HIV/AIDS Health Work in Tanzania

The purpose of this study was to critically examine the social organizations within Canadian non-government organizations (NGOs) in the provision of HIV/AIDS health work in Tanzania. Using a post-Marxist theoretical framework, I employed the tools of institutional ethnography to understand how distinct forms of coordinated work are reproduced and embedded within the institution of Canadian NGOs at the local site of lived experiences. Multiple, concurrent methods, including text analysis, participant observation and in-depth interviews, were utilized. Data collection occurred over approximately a 19-month period of time in Tanzania and Canada. Interviews were conducted with health work volunteers, NGO administrators and staff and bilateral agency employees. Participant observation was used to record insights from the interviews as well as observations of the participants’ everyday work experiences. Further, since text-based forms of knowledge are essential in understanding ideologies, working activities, and power relations of an institution, text-analysis was used as a data collection technique. The findings, implications and recommendations of this study were theoretically derived. Neoliberalism and neo-colonialism ruled the coordination of international volunteer health work. In this study, three social relational levels were exposed: interpersonal social relations, organizational social relations, institutional social relation. Gender, race and class were the interpersonal social relations that advantaged the international volunteer health workers as ‘experts’ over the local community. \u27Volunteer as client\u27, ‘experience as commodity\u27 and ‘free market evaluation\u27 were the organizational social relations pervasive in talk and text. Neoliberal ideology and the third sector were interwoven and worked together to inform values and activities of international health work volunteers. Finally, the three institutional social relations, ‘favoring private sector interests’, ‘hegemonic accountability’ and ‘reality disconnected from rhetoric’ exposed the conflation between aid and trade bilaterally. This study has extended our understanding of the ways in which health work volunteers, NGO administrators, and bilateral agency employees come together to produce health work in Tanzania. The findings illuminate the need to generate additional awareness and response related to social inequities embedded in international volunteer \u27health work\u27 beyond who constitutes ‘the expert’. Health promotion strategies include challenging the role of neoliberalism, including foreign trade, in the delivery of international aid

SIBLING/SIBLING-IN-LAW RELATIONSHIPS IN THE PROVISION OF PARENTAL CARE TO PERSONS LIVING WITH DEMENTIA: A CRITICAL ANALYSIS

The current homecare structure cannot sustain adequate care for seniors living at home even with the support of family caregivers (Forbes & Neufeld , 2008). Indeed, two thirds of community-dwelling seniors receive some form of care from their adult children/children-in-law. However, seniors living with dementia can have additional care needs. Siblings/siblings-in-law are often involved in the negotiation of homecare with their parents/parents-in-law living with dementia. Based on a larger critical ethnographie study of client-caregiver-provider relationships in home-based dementia care (WardGriffin, McWilliam, Forbes, Klosek, Mowatt, & Bol, 2008), the purpose of this qualitative secondary analysis was to examine the relationships of siblings/siblings-in- law in the negotiation of home-based dementia care. The findings revealed two overarching themes, the social determinants of care and the negotiation of care. There were three social determinants of care: gender, birth order and proximity. The negotiation of care was the continuous enactment of performance measurement and positional power, premised on a set of expectations and quantifiable benchmarks. The social determinants of care coupled with the negotiation of care shaped the health experiences of the siblings/siblings-in-law of this study. The health enhancing experiences were epitomized by family cohesion, while the health threatening experiences embodied conflict and inequities in the distribution of care. These findings have direct implications for homecare nursing practice, policy and future research, which could further recognize the complexity of sibling/sibling-in-law relationships in terms of care planning

Client or Volunteer? Understanding Neoliberalism and Neocolonialism Within International Volunteer Health Work

As international volunteer health work increases globally, research pertaining to the social organizations that coordinate the volunteer experience in the Global South has severely lagged. The purpose of this ethnographic study was to critically examine the social organizations within Canadian NGOs in the provision of health work in Tanzania. Multiple, concurrent data collection methods, including text analysis, participant observation and in-depth interviews were utilized. Data collection occurred in Tanzania and Canada. Neoliberalism and neocolonialism were pervasive in international volunteer health work. In this study, the social relations—“volunteer as client,” “experience as commodity,” and “free market evaluation”—coordinated the volunteer experience, whereby the volunteers became “the client” over the local community and resulting in an asymmetrical relationship. These findings illuminate the need to generate additional awareness and response related to social inequities embedded in international volunteer health work

Designing open access, educational resources / Développer des ressources éducatives en libre accès

The recent bourgeoning of open educational resources has meant greater access to materials with open licenses in the public domain than ever before. Open educational resources are learning tools, such as textbooks, that are freely available and typically accessed online. Despite the expansion of open educational resources, many educators are still unacquainted with the nature and process of producing such resources. The purpose of this discussion paper is to share our experience in developing an open educational e-textbook for students in post-secondary programs for nursing and other health professions while highlighting practical tips for educators. The exemplar referenced in this paper focuses on vital signs’ measurement, a familiar concept for nurse educators, and a topic ubiquitous in healthcare. This paper is suited for any user curious about designing open educational resources with consideration of key elements to produce quality and educational resources that support excellence in nursing pedagogy. We begin by providing a background to our specific project followed by a discussion of the planning phase, the design phase, and other considerations. The e-textbook falls under a Creative Commons license and can be accessed for free by educators and learners. Résumé Le développement récent de ressources éducatives en libre accès a permis une accessibilité beaucoup plus grande, comme jamais auparavant, au matériel avec licences ouvertes dans le domaine public. Les ressources éducatives en libre accès sont des outils d’apprentissage, comme les manuels scolaires, qui sont offerts gratuitement et qui sont généralement accessibles en ligne. En dépit de la prolifération des ressources éducatives libres, bon nombre de professeurs sont toujours peu familiers avec la nature et le processus de production de telles ressources. L’objectif de ce texte de discussion est de partager notre expérience du développement d’un e-manuel de formation en libre accès, pour les étudiants inscrits dans les programmes postsecondaires pour la profession infirmière et les autres professions de la santé, tout en soulignant des conseils pratiques pour les professeurs. L’exemple, cité en référence dans ce texte, est axé sur la prise des signes vitaux, un concept familier aux infirmières enseignantes et un sujet omniprésent dans le domaine de la santé. Cet article convient à toute personne curieuse d’en apprendre davantage sur la conception des ressources éducatives en libre accès en tenant compte d’éléments clés afin de produire des ressources éducatives de qualité qui appuient l’excellence de la pédagogie en soins infirmiers. Nous établissons d’abord le contexte du projet particulier suivi d’une discussion sur la phase de planification, la phase de conception et sur d’autres éléments à considérer. Le e-manuel relève d’une licence Creative Commons et est accessible gratuitement pour les professeurs et les étudiants

Dementia Home Care Resources: How Are We Managing?

With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1) finite formal care-inexhaustible familial care, (2) accessible resources rhetoric-Iinaccessible resources reality, and (3) diminishing care resources-increasing care needs. The development of policies and practices that provide available, accessible, and appropriate resources, ensuring equitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future

Predictors of pneumococcal vaccination among older adults with pneumonia: findings from the Community Acquired Pneumonia Impact Study

Abstract Background The incidence of community-acquired pneumonia (CAP) almost triples for older adults aged 65 years or older. In Canada, CAP is a leading cause of hospital admissions and mortality. Although CAP is very prevalent, complications due to CAP may be reduced with the pneumococcal polysaccharide vaccine (PPV). The purpose of this study was to identify predictors of pneumococcal vaccination among community-dwelling older adults with clinically diagnosed CAP. Methods A telephone survey was used to collect detailed information from adults aged 60 years and older with clinically diagnosed CAP. This was a community wide study with participants being recruited from all radiology clinics in one Ontario community. Results The most important predictors of pneumococcal vaccination among older adults included: getting an influenza vaccine within the past year (OR 14.5, 95% CI 4.27 to 49.0); at least weekly contact with a friend (OR 3.97, 95% CI 1.71 to 9.24); having one or more co-morbidities/chronic conditions (OR 3.64, 95% CI 1.60 to 8.28); being 70 years of age or older (OR 2.56, 95% CI 1.21 to 5.40); having health problems that limited physical activities (OR 5.37, 95% CI 1.49 to 19.3); having little or no bodily pain (OR 2.90, 95% CI 1.25 to 6.73); and reporting having spiritual values or religious faith (OR 3.47, 95% CI 1.03 to 11.67). Conclusions A wide range of factors, including demographic, co-morbidity, quality of life, social support and lifestyle were found to be associated with pneumococcal vaccination status among older adults with clinically diagnosed CAP. The findings from this study could inform future pneumococcal immunization strategies by identifying individuals who are least likely to receive the PPV

Predictors of Pneumococcal Vaccination among Older Adults with Pneumonia: Findings from the Community Acquired Pneumonia Impact Study

BACKGROUND: The incidence of community-acquired pneumonia (CAP) almost triples for older adults aged 65 years or older. In Canada, CAP is a leading cause of hospital admissions and mortality. Although CAP is very prevalent, complications due to CAP may be reduced with the pneumococcal polysaccharide vaccine (PPV). The purpose of this study was to identify predictors of pneumococcal vaccination among community-dwelling older adults with clinically diagnosed CAP. METHODS: A telephone survey was used to collect detailed information from adults aged 60 years and older with clinically diagnosed CAP. This was a community wide study with participants being recruited from all radiology clinics in one Ontario community. RESULTS: The most important predictors of pneumococcal vaccination among older adults included: getting an influenza vaccine within the past year (OR 14.5, 95% CI 4.27 to 49.0); at least weekly contact with a friend (OR 3.97, 95% CI 1.71 to 9.24); having one or more co-morbidities/chronic conditions (OR 3.64, 95% CI 1.60 to 8.28); being 70 years of age or older (OR 2.56, 95% CI 1.21 to 5.40); having health problems that limited physical activities (OR 5.37, 95% CI 1.49 to 19.3); having little or no bodily pain (OR 2.90, 95% CI 1.25 to 6.73); and reporting having spiritual values or religious faith (OR 3.47, 95% CI 1.03 to 11.67). CONCLUSIONS: A wide range of factors, including demographic, co-morbidity, quality of life, social support and lifestyle were found to be associated with pneumococcal vaccination status among older adults with clinically diagnosed CAP. The findings from this study could inform future pneumococcal immunization strategies by identifying individuals who are least likely to receive the PPV

Examining Newcomer Women’s Experiences with Perinatal Care in Ontario, Canada: An Application of Carspecken’s Critical Ethnographic Method

This article provides a practical description of Carspecken’s (1996) five-stage critical ethnographic approach entitled “Critical Qualitative Research (CQR).” Situated epistemologically and ontologically in the critical paradigm, this article is an exploration of critical ethnography as an important methodology for shedding light on the discursive culture of perinatal care for newcomer women during the three-month health insurance waiting period in Ontario, Canada. We argue that Carspecken’s approach to critical ethnography is especially instrumental in illuminating the social structures that contribute to health inequities