Nursing

This article examines, through a synthesis of the literature and excerpts from a qualitative case study, the concept of exit strategy, specifically its relation to vulnerable populations (e.g., overweight adolescent boys) and potential impact on the researcher-participant relationship. The quality and duration of the researcher-participant relationship, along with rapport and trust building, are potential indicators for negotiated closure (i.e., exit strategy). Reframing this relationship as "participant-researcher" resituates vulnerable participants as foremost in such relationships. Given what is potentially at stake for participants in qualitative research, there is a moral and ethical imperative to enter into the dialogue of closure. Otherwise, participants may unwittingly serve as a means to an end, that is, as objects in the enterprise of qualitative research. Researchers, research supervisors, and human subject ethics committees are urged to establish protocols to guide how research relationships are ended within the context of qualitative methods, particularly with respect to vulnerable populations.

ing sensations were also claimed to accompany emotional satisfaction and bring about relief from stress, anger or boredom. Participants also expressed disinterest in smoking cessation strategies such as anti-smoking policies, ads and routine medical advice, stating that they do not gain direct benefits from these strategies, as compared to sustaining smoking. Conclusion: This study exposes important considerations that focus on entrenched personal emotional attachments to smoking, and directly implicates smoking cessation strategies that offer no more than information dissemination, pharmacological treatment and behavioral interventions.

Exploring childhood immunization uptake with first nations mothers in northwestern Ontario, Canada Background. Childhood immunization is an important component of preventive health care for young children. Successful control of vaccine-preventable diseases depends on high levels of immunization coverage. Immunization statistics show that on-reserve First Nations (Native Indian) children have lower vaccination coverage than children in the general Canadian population. There has been little research, however, conducted with First Nations populations on this topic. Aim of the study. This study explored First Nations parents' beliefs about childhood immunizations and examined factors influencing immunization uptake. Methods. This study used a qualitative descriptive design to explore the issue of childhood immunization uptake. Twenty-eight mothers from two First Nations communities in northwestern Ontario, Canada, were interviewed about their perceptions of childhood immunizations and vaccine-preventable diseases. The interviews were transcribed and content analysis was used to examine the data. Findings. Data analysis revealed the following six themes: (1) the fear of disease, (2) the efficacy of immunizations, (3) the immunization experience, (4) the consequences of immunization, (5) interactions with health professionals, and (6) barriers to immunizations. Participants were motivated to seek immunizations for their children by a fear of vaccine preventable diseases. A small proportion of mothers, however, questioned the effectiveness of vaccines in preventing disease. Traumatic immunization experiences, vaccine side-effects and sequelae, negative interactions with health professionals, and barriers such as time constraints and childhood illnesses all served as deterrents to immunization. Conclusions. The research outcomes highlight the varied beliefs of First Nations parents about childhood immunizations and the numerous factors that both positively and negatively influence immunization uptake. Further research is needed to explore the issue of childhood immunizations in First Nations communities and to determine strategies to improve uptake.

Protective care-receiving: the active role of care-recipients Historical and contemporary conceptualizations of caregiving have not addressed the active role of care recipients within caregiver-care-recipient relationships. Using an interpretive synthesis method, the authors developed the concept of protective care-receiving from three qualitative studies of different groups of care receivers (older adults with chronic illnesses, persons with AIDS, and persons in treatment for active cancer]. This paper descrihes the focus of care recipients' protective care-receiving efforts, the goals they hoped to achieve, and the strategies they used to assist themselves in attaining their goals. Examples of their efforts and strategies are illustrated with quotations from the data. These findings extend what is known ahout care recipients' selfcare activities. Moreover, the findings reveal a new dimension in the role of care recipients-protective care given hy care recipients to their professional care providers, family and friend caregivers, and other care recipients. The concept of protective care-receiving advances our understanding of caregiving relationships and presents researchers with the opportunity to investigate the complex encounter hetween caregiver and care recipient. Recognizing and facilitating care recipients' protective care-receiving is an ethical imperative for a 'caring' profession such as nursing. NURSING THEORISTS' GOAL include the concept of caregiving as actions wbich occur primarily witbin tbe context of tbe caregiver-patient Witb few exceptions (i.e. Leininger 1984, Watson 1985, encoimter (Eriksson 1994, George 1995). Regardless of Orem 1991), nursing theorists bave focused on nursing tbeir tbeoretical approacb to nursing (for example, needs, care and family/friend-provided care as actions done to interaction, or outcome theorists), nursiag tbeorists' preor for one person by anotber. Tbeoretical descriptions dominant goal bas been to describe, expledn or predict care as provided to care recipients (CRs).

In this article, the authors explore the home care experience as described by older physically impaired individuals and their caregiving spouses. Separate face-to-face semistructured interviews were carried out with each spouse from nine couples. Analysis of the interview data revealed four themes. For care receivers the themes were Independence and Developing a Trusting Relationship With Home Care Workers. Relief and Continuity were voiced by the caregiving spouses. The authors show how these themes relate to the participants' sense of security, which emerged as a key underlying concept in the home care experience. This study adds to the home care and caregiving literature as it expands our understanding of the relationship between formal and informal caregiving, highlights issues and concerns older couples face as they receive home-based care, and includes both older spouse caregivers and their direct-care recipients.

The Nursing Division of the Saskatchewan Institute of Applied Science and Technology (SIAST) first included systems and patient safety as a priority in its institutional business and strategic plan in 2003. Three interrelated leading-edge, twoyear projects (2004-2006) were launched: Best Practice, Mentorship and Patient Safety, with the intent that each project would enhance the others. This case study focuses on the work of the Patient Safety Project Team. The team developed a project framework and strategic plan, conducted a literature review and identified key concepts related to systems and patient safety. Strategies to integrate these concepts into the school's 15 nursing education programs are being implemented.

Nurse educators in Canada and the United States have a tremendous responsibility in relation to leadership and the nursing profession. Nursing schools are charged with ensuring that graduates are competent practitioners. Moreover, graduates must actualize leadership within the profession. Leadership occurs at those relationship intersections where nurses come into contact with the public: patients and families, agencies and institutions, the healthcare system and government at all levels. The seeds of leadership are planted in entry-to-practice programs, taking root and growing strong in supportive practice settings. It is at the master's and doctoral levels of education that many of our leaders fully blossom in all nursing domains: practice, education, administration and research. When we (Gregory, Russell) reflect on our roles as clinicians, educators, researchers and education administrators over the past two decades, we can make two major observations: • The development of our leadership skills was mostly ad hoc, "on the job" and occasionally "post-hoc." There was no systematic or integrated leadership immersion within and across the programs we completed. The seeds of leadership were scattered haphazardly. Ongoing and sustained nurturing with respect to leadership was lacking. Leaders most often grew by chance, in spite of what was or was not done to enhance that growth. • Explicit leadership connections among education, practice, administration and research were often

This paper forms the foundation for the promotion of mental health with rural Mi’kmaq youth through a community based participatory research project. Western understandings of mental health and illness are compared and contrasted with Aboriginal understandings. Mainstream mental health services that accommodate cultural differences do not speak to the totality of Aboriginal understandings of mental health or to self-determination and self-reliance of Aboriginal peoples. The paper comprises three sections. Differences in the major understandings of mental health and illness are examined in the first section and common understandings associated with these concepts are addressed in the second section. Within the third section an analysis of three exemplar models of Aboriginal mental health and illness services is conducted. These models illustrate similarities and differences, and provide evidence of the effectiveness of health promotion that is inclusive of difference. The paper concl...

This paper forms the foundation for the promotion of mental health with rural Mi'kmaq youth through a community based participatory research project. Western understandings of mental health and illness are compared and contrasted with Aboriginal understandings. Mainstream mental health services that accommodate cultural differences do not speak to the totality of Aboriginal understandings of mental health or to self-determination and self-reliance of Aboriginal peoples. The paper comprises three sections. Differences in the major understandings of mental health and illness are examined in the first section and common understandings associated with these concepts are addressed in the second section. Within the third section an analysis of three exemplar models of Aboriginal mental health and illness services is conducted. These models illustrate similarities and differences, and provide evidence of the effectiveness of health promotion that is inclusive of difference. The paper ...

The purpose of this study is to examine the complexities of recruiting overweight and obese adolescent boys for qualitative research, discuss specific recruitment considerations for this population, and offer guidance to researchers interested in recruiting overweight adolescent boys. Three overweight adolescent boys and six community professionals participated in this study. Data collection methods included fieldwork observations (60 hours) and person-centered interviews (N=9). Emergent themes revealed that establishing trust, understanding the sensitivities of discussing obesity, and considering adolescent boys' fears of sharing personal information may have enhanced recruitment success. Researchers should consider the importance of building relationships with professionals who can recruit vulnerable adolescents, as well as the time required to establish trust with both overweight adolescent boys and their parents.

Gender, the complex of social relations and practices attached to biological sex, is one of the most important socio-cultural factors influencing health and health-related behavior. Although a large body of health research suggests that men with similar social disadvantages as women experience poorer health outcomes in relation to disability, chronic illness, injury rates and mortality, men's health is rarely deconstructed through the lens of gender. The purpose of this article is to increase understanding of the

This report discusses the case of a young Pakistani child diagnosed with idiopathic pulmonary hemosiderosis (IPH). The key features of IPH were iron deficiency anemia and pulmonary symptoms due to recurrent pulmonary hemorrhages. The child showed complications of the disease process because of late diagnosis. Because various ethical and moral issues were associated with the diagnosis and management of IPH, this case provides insights about the care burden of health care professionals and a child's parents in a Pakistani pediatric setting. During the course of the child's treatment at one of the private tertiary care settings of Karachi, Pakistan, the key challenges were as follows: declaring the diagnosis to the parents, dealing with the request of the child's parents for withdrawal of ventilatory support and withholding treatment, deciding the code status of the child, and ensuring the quality of the child's life after discharge from the hospital. It was learned from this case report that shared decision making and open communication with the child's family enabled the pediatric health care professionals to determine what was in the best interest of the child, resulting in provision of effective palliative care to the child. Moreover, it was realized that early detection of the disease and availability of hospice care can facilitate palliative care of children diagnosed with IPH.