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Statement of the Problem It is essential to develop client-centred knowledge, skills, attitudes and values as healthcare providers strive to participate in interprofessional (IP) collaborative practice and provide high-quality health care (Canadian Interprofessional Health Collaborative, 2010). Limited research exists to help educators understand how to support healthcare student development of client-centredness. This study aimed to advance an understanding of the development of client-centredness from the perspective of pre-licensure healthcare students. Methods In this interpretive description study, six students from various professional health disciplines engaged in a series of three focus groups over the course of five months to explore students’ classroom and practice experiences with client-centredness. Focus groups were digitally audio-recorded and transcribed verbatim. Focus group data were inductively analysed using thematic analysis and findings were sent to participants for member-checking. Results This study revealed four themes which iteratively built upon each other. The themes were (a) scaffolding existing components of professional education programs form a base for client-centred development, (b) an evolutionary process to internalizing client-centredness, (c) IP discussion with stories enhances client-centred development, and (d) a reflective process to developing client-centredness. Conclusions Reflective healthcare students benefit from in-person, open discussion opportunities to learn with, from and about each other in an interprofessional education (IPE) context as they internalize client-centredness and move beyond the knowledge and skill-based foundations provided to them by their individual professional education programs. Knowledge gained in this study may help academic- and clinical-educators to better understand the client-centred development process so they can support graduates entering the health system as enhanced IP client-centred

Globally, physical and emotional punishments are the most prevalent forms of violence against children. Parents often justify punitive violence as ‘discipline’. Not only is punitive violence a risk factor for physical and mental health issues; it is also a human rights violation. Parenting education is an important component of strategies to eliminate punitive violence. However, most programs have been developed and evaluated in Western contexts. There is little information about the process of transporting these programs or their performance in diverse contexts. The purpose of this research was to evaluate the transportability of Positive Discipline in Everyday Parenting (PDEP), a rights-informed parenting program aimed at reducing support for punitive violence. Through a multi-case study conducted in three highly diverse contexts, I assessed the process of transporting PDEP and examined preliminary evidence of its effectiveness. First, I explored the transportability of PDEP to the occupied Palestinian territories, a region beset by decades of conflict, where many parents have low levels of education. Despite substantial challenges in the transportation process, virtually all of the 216 Palestinian parents perceived PDEP as relevant and their support for punishment decreased over the course of the program. Second, I investigated the transportability of PDEP to Japan, a country with a strong emphasis on child obedience and family hierarchy – and where thousands of families were affected by the 2011 earthquake. PDEP was delivered to 141 mothers; 82 from the earthquake-affected region and the 59 from Tokyo. Transporting PDEP to Japan was a relatively straightforward process. Nearly100% of the mothers perceived PDEP as highly relevant and reported less support for punitive violence over the course of the program. Third, I evaluated the transportability of the PDEP Facilitator Training program to Indonesia with a sample of 86 volunteer community health workers with low

How individual differences in shame are influenced by children’s developing social-cognitive skills is poorly understood in the psychological literature. Furthermore, developmental theories propose that social cognition and parental socialization jointly influence children’s emotional development. Despite the theoretical discussion about this developmental interplay, there is a paucity of empirical evidence about the relations between social cognition, socialization, and shame in childhood. The current study examined the relations among children’s interpretive theory of mind (IToM), authoritarian parenting style, parent religiosity, and children’s shame. Proneness to shame is problematic for some children, thus understanding why children vary in shame proneness could help us treat it. Method: Children completed tasks measuring IToM performance and self-reported shame. Mothers self-reported authoritarian parenting style, maternal religiosity, and reported on all relevant demographic variables. Analyses: Regression analyses tested the hypothesis that advanced IToM skills attenuate the positive association between authoritarian parenting and child shame. This study also predicted that maternal religiosity, child age, child gender, and social class, explain the variability in child shame. Discussion: Unexpectedly, the only significant outcome was a positive association between maternal religiosity and child shame. Results are discussed in the context of previous research on religiosity, socialization, social cognition, and child shame. In the literature, parental religiosity has been a largely overlooked influence on children’s self-conscious emotional development. Previous studies mostly examined religious affiliation, making this study’s finding an important contribution to the literature on children’s self-conscious emotional development.

Child maltreatment is a significant public health issue. Reducing prevalence of coercive parenting is one means to reducing risk of maltreatment and negative developmental outcomes for children. Parental use of physical punishment has been associated with adverse consequences in childhood and adulthood. Parent education programs, such as the Positive Parenting Program (Triple P), that promote alternatives to using physical punishment with children may reduce coercive parenting. In this study, parental use of physical punishment, non-physical forms of punishment, and non-punitive parenting responses were compared before and after parents attended Level 2 Triple P parent education seminars. International Parenting Survey-Canada (IPS-C) data were used to examine Belsky’s (1984) theoretical proposition that parental factors are the strongest predictor of parenting behaviour followed by contextual and child factors. Independent samples t-tests, Wilcoxon Signed Rank Tests, and a series of regression models were used to examine the study’s hypotheses. A total of 27 parents attended the Triple P sessions. Parental use of physical punishment decreased on only one of the four physical punishment items (shaking) post- intervention. Although there were no significant differences in overall use of non-physical forms of punishment and non-punitive parenting strategies pre and post-intervention, there were significant increases in frequency of use of individual scale items pre- to post-intervention. IPS-C sample of 2,340 Canadian parents was used to examine Belsky’s postulate. Results were mixed and provided partial support for the postulate. Child behaviour problems, participation in parent education programs, parent employment status, and parent age predicted coercive parenting. Findings highlight the need to further examine these hypotheses.

Central venous access devices (CVADs) have become essential interventions for pediatric patients. However, their use is associated with serious complications. The most common and potentially preventable complication is catheter related blood steam infections (CRBSIs). Despite the implementation of interventions that have been shown to decrease their risk, CRBSIs still occur. Pediatric nurses were surveyed regarding their knowledge and application of recommended CVAD care practices, and their perspectives on possible factors that could contribute to the incidence of CRBSIs. Donabedian’s (1966) Structure-Process-Outcome Model guided the study. A cross-sectional, descriptive and exploratory mixed-methods survey design was used. The convenience sample consisted of 93 pediatric nurses. Findings indicate areas of concern related to adherence to CVAD care guidelines and situations that could interfere with the provision of recommended CVAD care. The primary factor identified was the use of improper technique by members of the healthcare team and the patients’ families.

Few studies have focused on evaluating nursing students' satisfaction with different types of simulation, and in particular using valid and reliable instruments. A descriptive, cross-sectional and retrospective post-test study was conducted to examine nursing students’ satisfaction with low-fidelity simulation (LFS) and high-fidelity simulation (HFS). Thirty-five 4th year nursing students who met the eligibility criteria completed the Satisfaction with Simulation Experience Scale (SSE) and a demographic questionnaire via Fluidsurvey. A paired t-test analysis revealed a significant difference in the CL subscale mean scores between LFS (M = 4.09) and HFS (M = 3.78), p = 0.008. The ranking question revealed that the opportunities to practice new skills, and to apply clinical reasoning and decision-making were among the top three ranked features for both LFS and HFS. Also included in the top three ranked items identified for LFS was the preparation of materials and orientation and for HFS was engagement and realism.

This qualitative study explores the experiences of mothers who have children with developmental disabilities. I sought to understand both the positive aspects of mothering a child with a disability, as well as understand the potential negative aspects of mothering a child with a developmental disability. I also explored how the mothers reflected on this experience of mothering a child with a disability. Furthermore, I sought information on what services and/or supports these mothers found helpful, and why. Six mothers were interviewed for this study. From these interviews, six themes were identified: 1. positive experiences and emotions; 2. mothering a child with a developmental disability as difficult, stressful, and overwhelming work; 3). mothers’ fears for their children; 4). mothers’ sense of loss; 5). mothers’ relationships with their non-disabled children; and 6). mothers’ perceptions of the helpfulness of formal and informal supports.

Manitoba Parent-Child Coalitions are tasked with identifying community support needs and priorities for parents with young children and developing a sustainable plan for addressing needs. The methods used to establish community needs and priorities vary considerably. Use of a systematic participatory needs assessment (NA) process such as the Concerns Report Method (CRM) could provide communities with important information about parents’ community support needs while involving parents in the decision-making process. The CRM uses a mixed methods exploratory sequential research design. Phase 1 of the CRM involved the use of several qualitative methods: a document review, interviews and focus groups with parents (N=29) and service providers (N=11). Phase 1 results were used to develop a Community Concerns Report Survey for parents (N=319) and service providers (N=47) used in Phase 2. Logistic regression helped to determine the family characteristics that were associated with parent perceived community support needs. Existing community data revealed important socioeconomic differences across neighbourhoods, but the Early Development Instrument showed that kindergarten children from all socioeconomic backgrounds were not ready for school. Four themes emerged from the interviews and focus groups: 1) Availability of/ access to community supports, 2) Barriers and facilitators to participation, 3) Parent and child transition periods, and 4) Making connections with parents/ service providers. The survey results extended our understanding of these issues and showed that parents and service providers prioritized community support needs differently but also had shared areas of concern. Finally, very few of the family characteristics were associated with parent perceived needs. Despite only examining the first two phases of the CRM, this study adds to the body of literature on use of the CRM in the context of identifying the community support needs of parents with young children.

There is research to support the existence of an over representation of Aboriginal children in the care of child and family services agencies in Manitoba. This issue presents many challenges in providing culturally appropriate foster care in order to promote the well-being and self-identity of Aboriginal children in care. The majority of these children are placed in non-Aboriginal foster homes. This study explored the experiences of non-Aboriginal foster parents in order to better understand their experiences and the services and supports necessary in providing culturally appropriate care to children from remote First Nations communities. A qualitative research design based on a phenomenological approach was utilized. Significant themes that emerged through the study were the foster parents’ motivations to foster and the challenges they face. Other significant themes are their perceptions of the services and supports available to them, and future resources that would assist them to provide care to children from remote First Nations communities. The results of the study indicate that the non-Aboriginal foster parents were culturally receptive and willing to provide culturally sensitive care to children from remote First Nations communities. The study results suggest that there needs to be further research exploring the motivations, roles, and responsibilities of foster care providers. By gaining a better understanding of their motivations, perceived roles and responsibilities, foster care agencies may be better informed when designing recruitment, retention strategies, and training for foster care providers in cross cultural foster care.

‘Families First’ is a home visiting program implemented across the province of Manitoba, Canada. Public health nurses complete a psychosocial assessment as part of their follow up with postpartum families. This assessment determines if families are offered this voluntary home visiting service. The assessment data is entered into a database maintained by the Healthy Child Manitoba Office (HCMO). The hypothesis for this quantitative study was that a positive relationship exists between participation in the Family First program and children’s school readiness. The Early Development Instrument (EDI) is a tool developed and used across Manitoba by Kindergarten teachers to assess children’s school readiness. The Families First and EDI databases were linked, and multiple regression analysis models were applied. A marginal statistically significant positive relationship between the Family’s First program and school readiness was identified. Further research is necessary to understand and define the relationships.

Filipino internationally educated nurses (IENs) constitute a major portion of the IENs in Manitoba and Canada. Acculturating to Canada can be difficult and can affect job satisfaction and retention. The focus of this research is on Filipino IENs’ acculturation to Canada, sources of workplace support and perceived job satisfaction. Berry’s (1997) acculturation framework guided the study. A cross-sectional descriptive-correlational method was used. An on-line survey resulted in a study sample of 124 participants. Quantitative and qualitative analysis techniques were used to determine relationships among the variables and to identify recommendations to assist other IENs. Job satisfaction was positively associated with one dimension of acculturation and informal sources of workplace support by immigrants and Canadian co-workers, administration, and the union. When these independent variables were entered into a multiple regression model, only administration support significantly predicted job satisfaction. Implications for nursing practice, leadership and research are discussed.

Mothers with mental illness are in need of support as they struggle to cope with competing demands of their illness and those of parenting. Health professionals’ attitudes and experiences have been shown to affect how clients with mental illness are assessed and what resources are provided. The purpose of this research was to explore and describe experiences of Public Health Nurses (PHNs) in Manitoba who visited families in the postpartum period. Qualitative data were collected via focus groups consisting of PHNs within the city of Winnipeg. Emerging themes, “Dealing with where they’re at”; “Treasure hunting”; “I kept wanting more”; “You can only do so much” together aimed at a common theme, “Helping Moms succeed”. Results suggested that PHNs wanted to provide the best resources for mothers to succeed at parenting. PHNs provided recommendations for the needs of families and changes in practice to help improve service to families.

A phenomenological study was conducted to understand the lived experience of parents parenting a child with autism in a rural area. The philosophy of hermeneutic phenomenology was used to guide this inquiry. Interviews of 26 families served as primary data. Thematic statements were isolated using van Manen’s (1990) selective highlighting approach. Making the invisible, visible emerged as the essence of the parents’ experience. Parents shared that although autism is an invisible disability, they in fact made it visible in their constant battles to ensure their child received the best quality of life. Five themes represented this essence: using autism to enable, lifelong advocating, centering autism within the family, the ups and downs of living rurally, and a renewed sense of parenting. Findings from this study may be used to guide program development that is concerned with improving the quality of life families of children with autism.

Caring for children with cancer involves caring for the entire family. Treatment for childhood cancer is centralized in major centres. A phenomenological study was conducted to elicit the lived experience of parents caring for a child who had completed treatment for cancer who do not live near their child’s cancer treatment centre. Interviews with five parents exploring their recollections of parenting their child with cancer during and after treatment were conducted. Data analysis revealed the essence of the parents’ lived experience as a journey within a journey. Four themes characterized the essence of parents’ lived experience: (1) travelling for care, (2) learning to navigate their journey with healthcare providers, (3) coping with change, and (4) giving back. Similarities and differences between the findings from this study and other studies of families with childhood cancer are presented. Recommendations relating to nursing practice, education, research and healthcare policy are provided.

Both intermittent oral gavage tube placement(0G) and indwelling nasogastric tube placement (NG) are acceptable methods for feeding preterm infants. A randomized controlled pilot study was conducted to examine the impact of OG versus NG placement on premature infant feeding transition. Twenty healthy premature infants were enrolled and thirteen completed the study. The results were not statistically significant. Age at last tube feed averaged 35 weeks gestational age (GA) for the intermittent group and 35+4 weeks GA for the indwelling group (p=0.181). Infants in both groups were discharged at an average of 36 weeks GA (p=.836) and averaged suckled volumes at 35 weeks GA was 134.4cc/kg/day for the intermittent group versus 111.8cc/kg/day for the indwelling group (p=0.240). Infant feeding patterns were analyzed descriptively and found to be consistently variable. The lack of consistency in feeding development has implications for feeding plan development and feeding transition care.

Respect is a concept crucial to nursing but one which has not been explored adequately. Respect may mean different things to different people, depending on age or culture. It has been determined that disrespect is closely linked with abusive behaviour. Lack of respect may be seen not only as a form of abuse, but also as the cause from which all other forms of abuse develop. In order to truly understand the development of abuse in long-term care, we must have an understanding of the key concepts that contribute to it. Respect is one of these concepts. The goal of this practicum was to develop a strategy that would promote the development of policies and the reinforcement of behaviours that reflect “respect”. The key words used to define respect and specific comments related to respect were identified by residents, family members and staff of a long-term care facility. The meaning of respect from the perspective of the resident, family members and staff of Deer Lodge Centre was explored through a questionnaire. Results of the questionnaire were tabulated and shared through presentations to all participant groups. Recommendations on policy change based on the results were identified and shared.

The link that has been found between parental use of physical punishment and increased risk of child physical abuse has led public health professionals to target physical punishment as part of their child abuse prevention strategies. However, current programs are limited in their effectiveness because the major reasons for its use are unclear. The purpose of this study was to examine the roles of cognition and affect in maternal use of physical punishment. A social information processing model was used to identify distal (pre-existing) and proximal (situational) maternal predictors. A random sample of 110 mothers of 3-year old children were interviewed regarding two disciplinary situations that occurred during the previous two-week period: one which resulted in the use of physical punishment and one which did not. Logistic regression analysis was conducted to assess the relative individual contributions of both distal and proximal predictors of physical punishment use. The distal variable of maternal attitude toward physical punishment and the proximal maternal variables of perceived seriousness and intent of the child misbehaviour and anger in response to the child misbehaviour predicted physical punishment use. Logistic regression analysis was conducted on a modified social information processing model that included both cognitive and affective predictors of physical punishment use. This model explained 53% of the variance in physical punishment use. The identification of these key components of the decision making process in disciplinary situations can be utilized to establish priorities in educational prog amming aimed at decreasing the rates of parental use of physical punishment and child physical abuse.