Harrowing, Jean

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    Adolescent health: A rural community's approach
    (Journal of Rural and Remote Health, 2005) Harrowing, Jean N.; Miller, N.K.; Cooper, Natalie R.; Brown, S.; Hagen, Brad F.
    Introduction: Significant health problems encountered in adulthood often have their roots in health behaviours initiated during adolescence. In order to reverse this trend, school and health personnel, as well as parents and other community members working with high school students, need to be aware of the health-related beliefs and choices that guide the behaviours of teenagers. Although a wide variety of research has been conducted on this topic among urban adolescents, less is known about the health beliefs and behaviors of adolescents residing in rural areas, particularly in Canada. In general, rural Canadians are less healthy than their urban counterparts. Building on the knowledge and understanding of their own community, key stakeholders were invited to engage in the design and implementation of a participatory action research project aimed at understanding and improving the health of rural adolescents. Methods: A group of parents, teachers, students, school administrators and public health nurses engaged in a participatory action research project to better understand determinants of the health of rural adolescents at a high school in Western Canada. Group members developed and administered a health survey to 288 students from a small rural high school, in an effort to identify areas of concern and interest regarding health practices and beliefs of rural adolescents, and to take action on these identified concerns. Results: Results indicated some interesting but potentially worrying trends in this population. For example, while frequent involvement in a physical activity was noted by 75.9% of participants, close to half of the females (48%) described their body image as ‘a little overweight’ or ‘definitely overweight’, and approximately 25.8% of respondents noted that they skipped meals most of the time. Differences between the genders were apparent in several categories. For example, more girls smoked (16.2%) than boys (12.3%), and more males (55.0%) than females (41%) had tried illegal drugs. Participants indicated awareness of other health-compromising behaviours, including unsafe driving habits and high stress levels, and acknowledged several steps they wanted to take to improve their health, as well as the barriers to taking those steps. Students identified improved nutrition, stress reduction, and increased levels of physical activity as particular important health goals. Students also recommended ways in which information and support could be provided within the school environment to enable them to achieve their health-related goals. Several activities developed in collaboration with students have incorporated the recommendations, and have spawned other activities in response to the ongoing identification of new concerns. Conclusions: The process of including the rural community in the identification of health assets and needs from the perspective of students - as well as the planning and implementation of appropriate strategies to address those needs - demonstrates the strengths inherent within a small rural population. Community members’ awareness of the need to create a healthy environment for youth is reflected in their willingness to participate in activities leading to improved health. Greater awareness of the health needs of rural adolescents, and of the influence of gender in some aspects of health behaviors, will help researchers to explore ways in which the unique culture of rural communities can be harnessed to help shape health-focused interventions.
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    Challenging lifestyles: Aboriginal men and women living with HIV
    (Pimatisiwin, 2008) Mill, Judy E.; Lambert, Denise T.; Larkin, Kecia; Ward, Ken; Harrowing, Jean N.
    The Aboriginal people of Canada are over-represented in the HIV and AIDS statistics, compared with the rest of the population. A participatory action research study was conducted in Alberta, Canada to examine the experiences of HIV-positive Aboriginal individuals in the period following diagnosis. The goals of the study were to identify factors that limited or enhanced risky behaviours, and to develop and implement an intervention to promote healthier lifestyles for Aboriginal persons living with HIV/AIDS (APHAs).Thirty-one Aboriginal men and women participated in the study. Receiving and adapting to a positive HIV diagnosis was a difficult process for most participants, and resulted in a number of potentially harmful behaviours and painful emotions. Gradually, most participants accepted the diagnosis and found ways to take better care of themselves. Nevertheless, they faced ongoing challenges, including stigma and discrimination, coping with histories of abuse, and confidentiality concerns. The intervention included the development and presentation of a skills-building workshop for individuals living with HIV, some of whom were study participants. In addition, members of the team visited several communities in Alberta to discuss the findings and the most appropriate strategies to assist individuals living with HIV to adopt healthier lifestyles.
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    Compassion practice by Ugandan nurses who provide HIV care
    (OJIN, 2011-01-31) Harrowing, Jean N.
    Compassion is fundamental to ethical nursing practice; it represents a commitment to acknowledge and respond to the suffering of the patient. Many structural, economic, and sociopolitical challenges confront Ugandan nurses in their efforts to incorporate compassion into their care of persons with HIV illness. After reviewing the literature related to compassion fatigue, the author describes nursing in sub-Saharan Africa and presents a qualitative study exploring the impact of education on 24 nurses’ lives, including their capacity to avoid or mitigate the development of compassion fatigue. Data were collected through interviews, observation, and focus group discussions. Findings illustrate the barriers participants faced in providing competent care and the liberating effects of new knowledge and skills. Engaging in meaningful relationships, maintaining hopeful attitudes, and advocating for the profession were found to transform and affirm the nurses’ approach toward their work and enhance their experiences of compassion satisfaction. The author discusses the unique aspects of the experience of compassion among Ugandan nurses caring for persons with HIV illness.
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    Critical Ethnography, Cultural Safety, and International Nursing Research
    (International Journal of Qualitative Methods, 2010) Harrowing, Jean N.; Mill, Judy E.; Spiers, Jude; Kulig, Judith Celene; Kipp, Walter
    Critical qualitative methodology provides a strategy to examine the human experience and its relationship to power and truth. Cultural safety is a concept that has been applied to nursing education and practice and refers to interactions that acknowledge and respect the unique cultural background of patients. It recognizes power inequities between caregivers who belong to dominant cultures and patients who may belong to oppressed groups. Culture is interpreted from a critical constructivist perspective as a fluid relational process that is enacted contextually. The purpose of this paper is to examine the congruence between and among critical methodology, cultural safety, and the conduct of nursing research in low- and middle-income countries by nurses from high-income countries. It is argued that if cultural safety is important and relevant to education and practice, then it might be appropriate to address it in research endeavors.
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    "Everything depends on good nursing" Spanish influenza epidemic of 1918-19
    (ProQuest, 2006-03) Harrowing, Jean N.
    Nurses have always played a vital role in the response to outbreaks of deadly illnesses. The story of Alberta nurses' heroic efforts in the face of the Spanish influenza epidemic of 1918-19, in the absence of public health infrastructure, reminds us of the importance of preparedness. The virus, which accompanied soldiers returning from Europe after the First World War, spread quickly along transportation routes from Eastern Canada to the West. Although many nurses had not yet returned from war service, or were assisting in Halifax following the explosion of 1917, those who were available in Alberta volunteered without hesitation to care for victims of the virus. In the absence of cure, good nursing care was usually the only treatment for the illness. Recognition of the need for planned response to crises, availability of resources and excellent skills and knowledge prompted nursing leaders to lobby the government for a formal public health system and contributed to the organization of professional nursing associations In the likely event of another global influenza pandemic, nurses may draw upon the lessons of the past as they once again face the complex challenges of a modern health crisis.
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    The impact of HIV education on nurses and nurse-midwives in Uganda
    (University of Alberta, 2009) Harrowing, Jean N.
    Over the past three decades, the HIV epidemic has gained a stranglehold in sub-Saharan Africa, where 10% of the world‟s population comprises more than 60% of all people living with the disease. Recent initiatives to boost prevention and treatment interventions are beginning to yield modest but promising results, as infection rates slowly start to stabilize. However, continued improvement will require aggressive and unrelenting efforts to prepare and equip a workforce for the tremendous challenges that remain. The purpose of this critical ethnography was to explore the impact of an intensive 6-month HIV/AIDS education program on the lives of 24 Ugandan registered nurses and nurse-midwives who worked at a large referral hospital. The study began following completion of the course and involved participant observation and semi-structured interviews for 18 weeks over a 2-year period. The findings are presented in this dissertation, which consists of four published or publishable manuscripts along with introductory and concluding chapters. The first paper describes the impact of education on the personal, professional, and social lives of the participants, and provides an account of their new ways of viewing themselves as nurses, leaders, and advocates. The second paper addresses ethical issues concerning the conduct of research in international settings. The third paper identifies the phenomenon of moral distress as it manifested in the participants, and the effects of education on their ability to transform practice and attitudes. The final paper examines the congruence between the critical qualitative methodology used in the study and the concept of cultural safety in the context of international nursing research. The dissertation concludes with a discussion of the crucial role of continuing professional education for the development of a strong and responsive nursing workforce that is prepared to contribute leadership and vision to addressing the obstacles presented by HIV and AIDS. Dealing effectively with the epidemic requires numerous interventions at various levels; the potential synergies offered by a small investment in education may have far-reaching effects. Finally, implications for nursing practice are presented along with suggestions for further research.
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    The impact of leadership hubs on the uptake of evidence-informed nursing practices and workplace policies for HIV care: a quasi-experimental study in Jamaica, Kenya, Uganda and South Africa
    (BioMed Central, 2016) Edwards, Nancy; Kaseje, Dan; Kahwa, Eulalia; Klopper, Hester C.; Mill, Judy E.; Webber, June; Roelofs, Susan; Harrowing, Jean N.
    Background: The enormous impact of HIV on communities and health services in Sub-Saharan Africa and the Caribbean has especially affected nurses, who comprise the largest proportion of the health workforce in low-and-middle-income countries (LMICs). Strengthening action-based leadership for and by nurses is a means to improve the uptake of evidence-informed practices for HIV care. Methods: A prospective quasi-experimental study in Jamaica, Kenya, Uganda and South Africa examined the impact of establishing multi-stakeholder leadership hubs on evidence-informed HIV care practices. Hub members were engaged through a participatory action research (PAR) approach. Three intervention districts were purposefully selected in each country, and three control districts were chosen in Jamaica, Kenya and Uganda. WHO level 3, 4 and 5 health care institutions and their employed nurses were randomly sampled. Self-administered, validated instruments measured clinical practices (reports of self and peers), quality assurance, work place policies and stigma at baseline and follow-up. Standardised average scores ranging from 0 to 1 were computed for clinical practices, quality assurance and work place policies. Stigma scores were summarised as 0 (no reports) versus 1 (one or more reports). Pre-post differences in outcomes between intervention and control groups were compared using the Mantel Haenszel chi-square for dichotomised stigma scores, and independent t tests for other measures. For South Africa, which had no control group, pre-post differences were compared using a Pearson chi-square and independent t test. Multivariate analysis was completed for Jamaica and Kenya. Hub members in all countries self-assessed changes in their capacity at follow-up; these were examined using a paired t test. Results: Response rates among health care institutions were 90.2 and 80.4 % at baseline and follow-up, respectively. Results were mixed. There were small but statistically significant pre-post, intervention versus control district improvements in workplace policies and quality assurance in Jamaica, but these were primarily due to a decline in scores in the control group. There were modest improvements in clinical practices, workplace policies and quality assurance in South Africa (pre-post) (clinical practices of self—pre 0.67 (95 % CI, 0.62, 0.72) versus post 0.78 (95 % CI, 0.73–0.82), p = 0.002; workplace policies—pre 0.82 (95 % CI, 0.70, 0.85) versus post 0.87 (95 % CI, 0.84, 0.90), p = 0.001; quality assurance—pre 0.72 (95 % CI, 0.67, 0.77) versus post 0.84 (95 % CI, 0.80, 0.88)). There were statistically significant improvements in scores for nurses stigmatising patients (Jamaica reports of not stigmatising—pre-post intervention 33.9 versus 62.4 %, pre-post control 54.7 versus 64.4 %, p = 0.002—and Kenya pre-post intervention 35 versus 51.6 %, pre-post control 34.2 versus 47.8 %, p = 0.006) and for nurses being stigmatised (Kenya reports of no stigmatisation—pre-post intervention 23 versus 37.3 %, pre-post control 15.4 versus 27 %, p = 0.004). Multivariate results for Kenya and Jamaica were non-significant. Twelve hubs were established; 11 were active at follow-up. Hub members (n = 34) reported significant improvements in their capacity to address care gaps. Conclusions: Leadership hubs, comprising nurses and other stakeholders committed to change and provided with capacity building can collectively identify issues and act on strategies that may improve practice and policy. Overall, hubs did not provide the necessary force to improve the uptake of evidence-informed HIV care in their districts. If hubs are to succeed, they must be integrated within district health authorities and become part of formal, legal organisations that can regularise and sustain them.
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    Moral distress among Ugandan nurses providing HIV care: a critical ethnography
    (Elsevier, 2009-11-08) Harrowing, Jean N.; Mill, Judy E.
    Background: The phenomenon of moral distress among nurses has been described in a variety of high-income countries and practice settings. Defined as the biopsychosocial, cognitive, and behavioural effects experienced by clinicians when their values are compromised by internal or external constraints, it results from the inability to provide the desired care to patients. No research has been reported that addresses moral distress in severely resource-challenged regions such as sub-Saharan Africa. Aim: To describe the manifestation and impact of moral distress as it was experienced by Ugandan nurses who provided care to HIV-infected or -affected people. Method: A critical ethnography was conducted with 24 acute care and public health nurses at a large referral centre in Uganda. Data were collected through interviews, observation, and focus group discussions. Results: Participants described their passion for nursing and commitment to patients. They experienced moral distress when a lack of resources put patients’ wellbeing at risk. The trauma imposed by systemic challenges on the nursing profession was acknowledged, as was the perception that the public blamed nurses for poor patient outcomes. However, participants were determined to serve to the best of their abilities and to take satisfaction from any contributions they were able to make. They cited the importance of education in the development of their capacity to provide care with a positive attitude, and demonstrated a collective resilience as they discussed strategies for addressing issues that affected them and their colleagues. Conclusions: The experience of moral distress among nurses in Uganda differed somewhat from the experience of nurses in high-income countries. Constraints imposed by the inability to implement skills and knowledge to their fullest extent, as well as a lack of resources and infrastructuremay result in the omission of care for patients. Moral distress appears to manifest within a relational and contextual environment and participants focussed on the impact for patients, communities, and the nursing profession as a whole, rather than on their own personal suffering. The opportunity for continuing education led to strategies to transform personal attitudes and practice as well as to enhance the presentation of the profession to the public. copyright 2009 Elsevier Ltd. All rights reserved.
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    Pedagogy as influencing nursing students’ essentialized understanding of culture
    (International Journal of Nursing Education Scholarship, 2010) Gregory, David M.; Harrowing, Jean N.; Lee, Bonnie K.; Doolittle, Lisa; O'Sullivan, Patrick S.
    In this qualitative study, we explored how students understood “culture.” Participants defined culture and wrote narratives regarding specific cultural encounters. The sample comprised both nursing (n=14) and non-nursing (n=8) students to allow for comparison groups. Content analysis of the narratives revealed two broad paradigms of cultural understanding: essentialist and constructivist. Essentialist narratives comprised four themes: determinism (culture defied individual resistance); relativism (the possibility of making value judgments disappeared); Othering (culture was equated to exotica, and emphasized difference); and reductionism (personhood was eclipsed by culture). In contrast, the constructivist narratives were characterized by influence (non-determinism); dynamism (culture was dynamic and evolutionary); and relationship-building. The unintended negative consequences of essentialist notions of culture were revealed in the nursing students’ narratives. Pedagogy is implicated in nursing students’ essentialized understanding of culture.
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    Qualitative research in an international research program: maintaining momentum while building capacity in nurses
    (Sage, 2014) Mill, Judy E.; Davison, Colleen; Richter, Solina; Etowa, Josephine; Edwards, Nancy; Kahwa, Eulualia; Walusimbi, Mariam; Harrowing, Jean N.
    Nurses are knowledgeable about issues that affect quality and equity of care and are well qualified to inform policy, yet their expertise is seldom acknowledged and their input infrequently invited. In 2007, a large multidisciplinary team of researchers and decisionmakers from Canada and five low- and middle-income countries (Barbados, Jamaica, Uganda, Kenya, and South Africa) received funding to implement a participatory action research (PAR) program entitled “Strengthening Nurses’ Capacity for HIV Policy Development in sub-Saharan Africa and the Caribbean.” The goal of the research program was to explore and promote nurses’ involvement in HIV policy development and to improve nursing practice in countries with a high HIV disease burden. A core element of the PAR program was the enhancement of the research capacity, and particularly qualitative capacity, of nurses through the use of mentorship, role-modeling, and the enhancement of institutional support. In this article we: (a) describe the PAR program and research team; (b) situate the research program by discussing attitudes to qualitative research in the study countries; (c) highlight the incremental formal and informal qualitative research capacity building initiatives undertaken as part of this PAR program; (d) describe the approaches used to maintain rigor while implementing a complex research program; and (e) identify strategies to ensure that capacity building was locally-owned. We conclude with a discussion of challenges and opportunities and provide an informal analysis of the research capacity that was developed within our international team using a PAR approach.
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    Seeking serenity: living with HIV/AIDS in rural Western Canada
    (Rural and Remote Health, 2007-05-05) Harrowing, Jean N.; Robinson Vollman, A.
    The purpose of this naturalistic inquiry was to describe the experience of living with HIV infection in rural Alberta, Canada. Although the urban HIV epidemic has been well researched, the virus continues its spread into more remote populations where there is a need to understand and address its impact. Affected rural residents form a diverse and marginalized group that includes women, Aboriginal peoples, immigrants, injecting drug users, and men who have sex with men, yet there are few data available to inform appropriate health and social services and practice. A number of factors, such as stigma, invisibility, isolation, confidentiality, poverty, and risk behaviours, contribute to the rural experience, but have not been clearly explicated in the literature. This study was conducted in order to better understand the perceptions of health in a rural setting, the processes involved in accessing care, the challenges and benefits associated with rural life, and the relationship between personal beliefs and values and the nature of the disease.