Marilyn Evans | Western University Canada (original) (raw)

Papers by Marilyn Evans

Journal of Advanced Nursing, Oct 16, 2018

Aims: To explore the meaning of conscience for nurses in the context of conscientious objection (... more Aims: To explore the meaning of conscience for nurses in the context of conscientious objection (CO) in clinical practice. Design: Interpretive phenomenology was used to guide this study. Data sources: Data were collected from 2016-2017 through one-on-one interviews from eight nurses in Ontario. Iterative analysis was conducted consistent with interpretive phenomenology and resulted in thematic findings. Review methods: Iterative, phased analysis using line-by-line and sentence highlighting identified key words and phrases. Cumulative summaries of narratives thematic analysis revealed how nurses made meaning of conscience in the context of making a CO. Results: Conscience issues and CO are current, critical issues for nurses. For Canadian nurses this need has been recently heightened by the national legalization of euthanasia, known as Medical Assistance in Dying in Canada. Ethics education, awareness, and respect for nurses' conscience are needed in Canada and across the profession to support nurses to address their issues of conscience in professional practice. Conclusion: Ethical meaning emerges for nurses in their lived experiences of encountering serious ethical issues that they need to professionally address, by way of conscience-based COs. Impact: This is the first study to explore what conscience means to nurses, as shared by nurses themselves and in the context of CO. Nurse participants expressed that support from leadership, regulatory bodies, and policy for nurses' conscience rights are indicated to address nurses' conscience issues in practice settings.

International Journal of Africa Nursing Sciences

Applied Nursing Research

BACKGROUND This paper focuses on the identified value of a community-based project (CBP), includi... more BACKGROUND This paper focuses on the identified value of a community-based project (CBP), including residents' living within low income housing units and their reported experiences of receiving health and social services within two communities by nurse practitioners (NPs) and its impact on their communities. OBJECTIVE To gain insight into the lived experience of residents in the housing units from a collaborative interprofessional care approach provided in a clinic situated within each housing unit, in integrating health and social services within the residents' own 'community' and its outcomes. DESIGN A qualitative descriptive study to gain insight into the shared views of care informants. SETTINGS Two low income housing units in xxxxxxxxxxxxxxxxxxxx. PARTICIPANTS Twenty-two residents representing all genders who lived in the housing units. METHODS A purposive sampling of willing residents participated in a focus group interview. Each group comprised from 4 to 6 persons. Two focus group interviews occurred in each of the two housing units. RESULTS Their voices resulted in identification of two themes - clinic as a catalyst to creating a sense of community and clinic as assisting them in managing their overall health. Two subthemes were also identified within each theme. CONCLUSION Findings provide insight into the value of CBP, that a strengths-based and interprofessional care approach can serve as a catalyst for an evolving community.

$Research paper thumbnail of Rwandan Nursing and Midwifery Faculty\u27s Experiences of Applying Knowledge about Teaching Methodology to Practice in Academic and Clinical Settings with Students$

Aim and objectives: Nursing and midwifery faculty play a vital role in nursing and midwifery stud... more Aim and objectives: Nursing and midwifery faculty play a vital role in nursing and midwifery students' professional development as soon-to-be clinicians by enabling them to gain essential competencies in perinatal and neonatal care. To enhance the quality of pre-service education of nursing and midwifery students in Rwanda, nursing and midwifery faculty participated in continuous professional development (CPD) educational workshops about teaching methodologies. The study's aim was to explore nursing and midwifery faculty's experiences of translating the knowledge and skills acquired from the workshops about teaching methodologies into their teaching practice in academic and clinical practice contexts. Methodology: A qualitative descriptive design was used with a purposive sample of 15 nursing and midwifery faculty from six private and public schools. Participants were involved in semistructured individual interviews. Inductive content analysis was used for generating themes. Results: Five themes emerged: enhanced competencies about teaching practices, application of knowledge and skills into classroom and clinical teaching, collaboration and teamwork, facilitators and challenges to applying knowledge and skill into practice, and indirect outcomes to maternal and child health care. Discussion and recommendations: Although educators' knowledge, skills, and confidence for teaching practice increased after participation in CPD, application of new skills was often hampered by insufficient resources and heavy workloads. The results support ongoing CPD programs for nursing and midwifery faculty members to increase their competencies around classroom and clinical teaching practice which can create a positive learning environment for students. The findings of this study highlighted that the application of competencies acquired from CPD workshops into teaching practice was perceived to ultimately contribute to improved student learning outcomes, and thus, enhanced maternal and child health care in Rwanda.

First Peoples Child & Family Review, 2016

This study employed a critical narrative approach to examine the experience of Aboriginal Veteran... more This study employed a critical narrative approach to examine the experience of Aboriginal Veterans in Canada adopted and/or fostered during the Sixties Scoop. The objectives of this study was to: 1) understand lived experiences of Aboriginal veterans adopted and/or fostered during the Sixties Scoop, 2) investigate health needs articulated by this population, and 3) provide suggestions for the creation of health services to aid Aboriginal veterans adopted and/or fostered during the Sixties Scoop with their health needs. Individual interviews were audio-recorded and conducted with eight participants from across Canada. All interviews were transcribed verbatim and analyzed using the holistic-content model (Lieblich, Tuval-Mashiach & Zilber, 1998). Data analysis of the interviews uncovered three overarching themes: a) sense of belonging, b) racism: experienced and perceived, and c) resilience: not giving up in the face of adversity. Two main health needs conveyed by the participants inc...

Rural and Remote Health, 2016

Heterosexual female adolescents' decision-making about sexual intercourse and pregnancy in rural ... more Heterosexual female adolescents' decision-making about sexual intercourse and pregnancy in rural Ontario,

Journal of Diabetes Nursing, 2012

Extensive research has been conducted into diabetes self-management; however, there is a signific... more Extensive research has been conducted into diabetes self-management; however, there is a significant knowledge gap relating to the socio-cultural factors that may affect self-management of women with gestational diabetes (GD). Such understanding may inform culturally sensitive interventions and educational programmes to improve self-management. The purpose of this secondary qualitative analysis, therefore, was to gain an understanding of the socio-cultural factors pertaining to pregnant women’s experience of diabetes self-management. The findings reveal that socio-cultural and family factors, family unity, social expectations, and knowledge and understanding about GD were important elements of diabetes self-management practices for pregnant Canadian women. Focusing attention on socio-cultural aspects in self-management in diabetes educational programmes may well be central to improving the health of women with GD. Further research is needed to consider how best to eliminate the subject of social stigma associated with GD

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstétrique et gynécologie du Canada : JOGC, 2011

Across Canada, the rate of preterm birth (i.e., at < 37 weeks' gestation) has been steadil... more Across Canada, the rate of preterm birth (i.e., at < 37 weeks' gestation) has been steadily increasing. Advances in perinatal medicine and neonatal intensive care have resulted in an increased capacity to intervene at the extremes of prematurity, leading to an increase in the overall survival of infants born at early gestations. There has been little corresponding decrease in long-term complications. As a result, additional stresses are placed on neonatal intensive care units across the country, impacting families, health care professionals, and society as a whole. Moral distress and moral residue are often cited in the neonatal-perinatal literature as stressors experienced by those who participate in the resuscitation decision-making process. They are directly related to the challenge of making a concrete decision about life and death at extremely early gestations in the context of long-term uncertainty. In this review, we performed a systematic search of medical and ethics ...

Nursing Ethics, 2014

Objective: To increase our understanding of moral distress experienced by neonatal registered nur... more Objective: To increase our understanding of moral distress experienced by neonatal registered nurses when directly or indirectly involved in the decision-making process of resuscitating infants who are born extremely premature. Design: A secondary qualitative analysis was conducted on a portion of the data collected from an earlier study which explored the ethical decision-making process among health professionals and parents concerning resuscitation of extremely premature infants. Setting: A regional, tertiary academic referral hospital in Ontario offering a perinatal program. Participants: A total of 15 registered nurses were directly or indirectly involved in the resuscitation of extremely premature infants. Methods: Interview transcripts of nurses from the original study were purposefully selected from the original 42 transcripts of health professionals. Inductive content analysis was conducted to identify themes describing factors and situations contributing to moral distress e...

Nursing Ethics, 2017

Background: Lack of compassion is claimed to result in poor and sometimes harmful nursing care. D... more Background: Lack of compassion is claimed to result in poor and sometimes harmful nursing care. Developing strategies to encourage compassionate caring behaviours are important because there is evidence to suggest a connection between having a moral orientation such as compassion and resulting caring behaviour in practice. Objective: This study aimed to articulate a clearer understanding of compassionate caring via nurse educators’ selection and use of published texts and film. Methodology: This study employed discourse analysis. Participants and research context: A total of 41 nurse educators working in universities in the United Kingdom (n = 3), Ireland (n = 1) and Canada (n = 1) completed questionnaires on the narratives that shaped their understanding of care and compassion. Findings: The desire to understand others and how to care compassionately characterised educators’ choices. Most narratives were examples of kindness and compassion. A total of 17 emphasised the importance o...

Background: The vast majority of maternal deaths occur in Low- and Middle-Income Countries. Postp... more Background: The vast majority of maternal deaths occur in Low- and Middle-Income Countries. Postpartum haemorrhage (PPH) remains a major global burden contributing to high maternal mortality and morbidity rates. Assessment of PPH risk factors should be undertaken during antenatal, intrapartum and postpartum periods for timely prevention of maternal morbidity and mortality associated with PPH. The aim of this study is to investigate and model risk factors for primary PPH in Rwanda. Methods: We conducted an observational case-control study of 430 (108 cases: 322 controls) pregnant women with gestational age of 32 weeks and above who gave birth in five selected health facilities of Rwanda between January and June 2020. Poisson regression, a generalized linear model with a log link and a Poisson distribution was used to estimate the risk ratio of factors associated with PPH. The research protocol was approved by the University of Rwanda, College of Medicine and Health Sciences Instituti...

Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses, Jan 3, 2014

Although the term survivor is frequently used in cancer discourse, the meaning of survivor and ho... more Although the term survivor is frequently used in cancer discourse, the meaning of survivor and how people identify with this term can be difficult to understand. The purpose of this qualitative study is to explore the meaning of the term survivor from the perspective of young adults who have experienced a pediatric brain tumor (PBT). A constructivist grounded theory was utilized in this study with 6 young adults who had a PBT. This study also used semistructured interviews with participants who also completed reflective journals, which were focused on the survivor concept. Data were analyzed through coding strategies and constant comparative methods. Findings present 4 major themes of process: (a) reviewing the illness experience, (b) qualifying as a survivor, (c) thinking positive, and (d) being changed. These themes are important to consider in the construction, interpretation, and understanding of how the majority of this population do not identify with the current social use of ...

BMC Pregnancy and Childbirth

Background Reduction of maternal mortality and morbidity is a major global health priority. Howev... more Background Reduction of maternal mortality and morbidity is a major global health priority. However, much remains unknown regarding factors associated with postpartum hemorrhage (PPH) among childbearing women in the Rwandan context. The aim of this study is to explore the influencing factors for prevention of PPH and early detection of childbearing women at risk as perceived by beneficiaries and health workers in the Northern Province of Rwanda. Methods A qualitative descriptive exploratory study was drawn from a larger sequential exploratory-mixed methods study. Semi‐structured interviews were conducted with 11 women who experienced PPH within the 6 months prior to interview. In addition, focus group discussions were conducted with: women’s partners or close relatives (2 focus groups), community health workers (CHWs) in charge of maternal health (2 focus groups) and health care providers (3 focus groups). A socio ecological model was used to develop interview guides describing fact...

Journal of Developmental Origins of Health and Disease

Currently, there is limited knowledge on how health care providers perceive and understand the De... more Currently, there is limited knowledge on how health care providers perceive and understand the Developmental Origins of Health and Disease (DOHaD), which may impact how they inform patients and their families throughout the perinatal period. This qualitative descriptive study explored if and how health care providers counsel on in utero programming and future health outcomes with parents, both preconception and during pregnancy. One-on-one, semi-structured interviews were conducted with 23 health care providers from varying health disciplines including obstetrics and gynaecology, midwifery, paediatrics, endocrinology and internal medicine. Audiotaped interviews were transcribed verbatim and analysed using inductive thematic analysis. Three themes were identified: Knowledge about DOHaD, Counselling on DOHaD in Practice Settings and Impact of DOHaD on Health. Health care providers not only expressed excitement over the potential health benefits of DOHaD counselling but also indicated ...

Canadian Journal of Nursing Research

Study Background The stress of immigrating, settling into Canada, and being a new mother, may pla... more Study Background The stress of immigrating, settling into Canada, and being a new mother, may place newcomer women at risk of mental health challenges. However, little is known on Black African newcomer women’s perspectives of postpartum mental health care after experiencing childbirth in Canada. Purpose To explore sociocultural factors that impact Black African newcomer women’s perception of mental health and mental health service utilization within a year after childbirth in Canada. Methods This qualitative study, set in Southern Ontario, purposively sampled 10 African newcomer women who birthed a baby in Canada within the past year. Open-ended, semistructured interviews were conducted individually, transcribed and analyzed using thematic analysis. Results Black African newcomer women rely on mental strength, nonmedical treatment preferences, spirituality, and spousal support for fostering postpartum mental health. Furthermore, cultural beliefs, racial discrimination, and temporar...

International Journal of Human Caring

This descriptive study explores the concept of caring in nursing education from the students’ per... more This descriptive study explores the concept of caring in nursing education from the students’ perspective. Students were asked to share moments of caring that they experienced in a nursing course. A content analysis revealed a relational nature of humanistic caring demonstrated by the following themes: connectedness, presence, growth, and respect. Results identified caring as relational and being connected with other; that is, caring is grounded in nurse-educator-student relationships.

Journal of Child Sexual Abuse

Journal of Advanced Nursing

Child abuse & neglect, Jan 12, 2018

Research regarding child sexual abuse (CSA) indicates significant gender differences in disclosur... more Research regarding child sexual abuse (CSA) indicates significant gender differences in disclosure rates, with males less likely to disclose their abuse compared to females. CSA can have lasting impact on a children's emotional, physical, and psychological wellbeing. While service providers play an instrumental role in providing care and support for male CSA survivors, little is known about their perceptions and experiences related to disclosure among these men. The aim of this qualitative study was to explore service providers' perceptions and awareness of disclosure-related barriers and facilitators amongst male CSA survivors. Individual interviews were conducted with eleven service providers. Study findings reveal four key themes related to the disclosure process among male CSA survivors: (a) personal characteristics, (b) interpersonal relations, (c) institutional elements, and (d) societal norms. Findings indicate that service providers understand and respond to complex ...

Nursing ethics, 2018

While conscientious objection is a well-known phenomenon in normative and bioethical literature, ... more While conscientious objection is a well-known phenomenon in normative and bioethical literature, there is a lack of evidence to support an understanding of what it is like for nurses to make a conscientious objection in clinical practice including the meaning this holds for them and the nursing profession. The question guiding this research was: what is the lived experience of conscientious objection for Registered Nurses in Ontario? Interpretive phenomenological methodology was used to gain an in-depth understanding of what it means to be a nurse making a conscientious objection. Purposive sampling with in-depth interview methods was used to collect and then analyze data through an iterative process. Participants and research context: Eight nurse participants were interviewed from across practice settings in Ontario, Canada. Each participant was interviewed twice over 9 months. Ethical considerations: This study was conducted in accordance with Health Science Research Ethics Board ...