Measuring Scope of Practice Enactment among Primary Care Registered Nurses in Ontario

Background: Primary care is the sector of health care in which patients first establish contact with the health system, are provided person-focused care over time for all new or common needs, and receive coordinated integrated health services provided elsewhere by other members of the health care team. Registered Nurses (RNs) in Canada provide care within this sector in varying roles. The extent to which RNs enact their full scope of practice in primary care settings in Canada is not known. The Actual Scope of Practice questionnaire (ASCOP) is a 26 item Likert scale questionnaire developed by researchers in Canada and validated in the acute care setting to measure the extent to which RNs apply the knowledge, skills and competencies of the professional full scope of practice. Similar to the acute care setting, there is a need to measure scope of practice enactment in the primary care setting. Objectives: The overall aim of this thesis was to measure scope of practice enactment in the primary care setting. Two research objectives were addressed: (1) to revise and adapt the ASCOP questionnaire for use in the primary care setting, and (2) to determine internal consistency, construct validity, and sensitivity of the modified instrument, the ASCOP-PC. Methods: To address the first objective, a narrative literature review and synthesis and an expert panel review was conducted. To address the second objective a cross-sectional survey of 178 RNs working in primary care organizations in Ontario was conducted Results: The ASCOP, with few modifications, addressed key attributes of nursing scope of practice in the primary care setting. The ASCOP-PC yielded acceptable alpha coefficients ranging from 0.66 to 0.91 and explained variances from 44.2 to 62.6. Total mean score of 5.16 suggests that RNs within these models of care almost always engage in activities reflected in the ASCOP-PC. Interpretation: Findings from this study support the use of a the modified ASCOP questionnaire as a reliable and valid measure of scope of practice enactment among primary care nurses in the primary care setting.

Unsettling Histories: Representation and Indigenous Creative Art Praxis in Official Indian Residential School Redress

This dissertation offers an investigation of the role of visual strategies, art, and representation in reconciling Indian Residential School history in Canada. This research builds upon theories of biopolitics, settler colonialism, and race to examine the project of redress and reconciliation as nation and identity building strategies engaged in the ongoing structural invasion of settler colonialism. It considers the key policy moments and expressions of the federal government—from RCAP to the IRSSA and subsequent apology—as well as the visual discourse of reconciliation as it works through archival photography, institutional branding, and commissioned works. These articulations are read alongside the creative and critical work of Indigenous artists and knowledge producers working within and outside of hegemonic structures on the topics of Indian Residential School history and redress. In particular the works of Jeff Thomas, Adrian Stimson, Krista Belle Stewart, Christi Belcourt, Luke Marston, Peter Morin, and Carey Newman are discussed in this dissertation. These works must be understood in relationship to the normative discourse of reconciliation as a legitimizing mechanism of settler colonial hegemony. Beyond the binary of cooptation and autonomous resistance, these works demonstrate the complexity of representing Indigeneity: as an ongoing site of settler colonial encounter and simultaneously the forum for the willful refusal of contingency or containment.

PHYSICAL ACTIVITY EXPERIENCES OF PERSIAN WOMEN RECENTLY IMMIGRATED TO CANADA

New immigrants to Canada are generally in similar or better physical and mental health than people born in Canada, however, many studies suggest that their health tends to decline quickly after immigration. Lower physical activity levels among new immigrants might be contributing to this phenomenon. There is a paucity of information regarding the physical activity behaviour of the Canadian immigrant population in general and of West Asian women, such as Iranians (Persians), in particular. Given that this group is characterised by an increasing population growth and lower rates of physical activity, it is critical to understand how best to address physical activity promotion in this population. Purpose: To understand the physical activity experiences of Persian women recently immigrated to Toronto, Canada in order to develop recommendations for the design and implementation of tailored physical activity programs. Methods: A qualitative interpretive description approach was chosen to collect and describe ideas, experiences, and perceptions of physical activity within 10 new immigrant women. Using an inductive approach, two fundamental techniques of immersion and crystallization were used throughout the analysis. Thematic analysis was conducted by performing a sequential process of open and axial coding. Emerged themes were further conceptualized through a socio-ecological lens. Results: The facilitators and barriers to physical activity among the women were situated within five overarching categories, 1) Perceptions about physical activity, 2) New physical environment and social structure, 3) Cultural heritage values, 4) Settlement and immigration factors, and 5) Physical activity program features. Discussion: Findings revealed that Persian new immigrant women’s engagement in physical activity after immigration is influenced by factors across the individual, sociocultural, environmental, institutional, and policy levels. Newcomer women’s physical activity was influenced by their transition from their society of origin to the host society and the challenges and successes experienced throughout the settlement and acculturation process. The most noticeable barrier to physical activity in Canada for the women emerged as the lack of communication of physical activity information to newcomers. A set of recommendations is provided for developing efficient physical activity programs for Persian immigrant women, which may also be relevant for other immigrant groups in Canada.

NEIGHBORHOOD PERCEPTION OF SAFETY AND THE MOBILITY GAP BETWEEN MEN AND WOMEN IN OLD AGE

Background and Objectives: Mobility limitations are a prevalent issue in older adult populations, and an important determinant of disability and mortality. Neighborhood conditions are key determinants of mobility and perception of safety may be one such determinant. Women have more mobility limitations than men, a phenomenon known as the gender mobility gap. The objective of this work was to validate a measure of perception of safety, examine the relationship between neighborhood perception of safety and mobility limitations in seniors, and explore if these effects vary by gender. Methods: This study was cross-sectional, using questionnaire data collected from community-dwelling older adults from four sites in Canada, Colombia, and Brazil. The exposure variable was the neighborhood aggregated Perception of Safety (PoS) scale, derived from the Physical and Social Disorder (PSD) scale by Sampson and Raudenbush. Its construct validity was verified using factor analyses and correlation with similar measures. The Mobility Assessment Tool – short form (MAT-sf), a video-based measure validated cross-culturally in the studied populations, was used to assess mobility limitations. Based on theoretical models, covariates were included in the analysis, both at the neighborhood level (SES, social capital, and built environment) and the individual level (age, gender, education, income, chronic illnesses, depression, cognitive function, BMI, and social participation). Multilevel modeling was used in order to account for neighborhood clustering. Gender specific analyses were carried out. SAS and M-plus were used in this study. Results: PoS was validated across all sites. It loaded in a single factor, after excluding two items, with a Cronbach α value of approximately 0.86. Mobility limitations were present in 22.08% of the sample, 16.32% among men and 27.41% among women. Neighborhood perception of safety was significantly associated with mobility limitations when controlling for all covariates, with an OR of 0.84 (CI 95%: 0.73-0.96), indicating lower odds of having mobility limitations as neighborhood perception of safety improves. Gender did not affect this relationship despite women being more likely to have mobility limitations and live in neighborhoods with poor perception of safety. Conclusion: Neighborhood perception of safety affected the prevalence of mobility limitations in older adults in the studied population.

A HARD PUSH FOR SOFT SKILLS: AN EXAMINATION OF POLICY AND RESEARCH ON NON-COGNITIVE SKILLS IN CANADIAN K-12 SCHOOLING

Non-cognitive skills have caught the attention of current education policy writers in Canada. Within the last 10 years, almost every province has produced a document including the importance of supporting non-cognitive skills in K-12 students in the classroom. Although often called different names (such as learning skills, cross curricular competencies, and 20th Century Skills) and occasionally viewed through different lenses (such as emotional intelligence skills, character skills, and work habits), what unifies non-cognitive skills within the policy documents is the claim that students that are strong in these skills are more successful in academic achievement and are more successful in post-secondary endeavors. Though the interest from policy-makers and educators is clear, there are still many questions about non-cognitive skills that have yet to be answered. These include: What skills are the most important for teacher’s to support in the classroom? What are these skills’ exact contributions to student success? How can teachers best support these skills? Are there currently reliable and valid measures of these skills? These are very important questions worth answering if Canadian teachers are expected to support non-cognitive skills in their classrooms with an already burdened workload. As well, it can begin to untangle the plethora of research that exists within the non-cognitive realm. Without a critical look at the current literature, it is impossible to ensure that these policies are effective in Canadian classrooms, and to see an alignment between research and policy. Upon analysis of Canadian curriculum, five non-cognitive skills were found to be the most prevalent among many of the provinces: Self-Regulation, Collaboration, Initiative, Responsibility and Creativity. The available research literature was then examined to determine the utility of teaching these skills in the classroom (can students improve on these skills, do these skills impact other aspects of students’ lives, and are there methods to validly and reliably assess these skills). It was found that Self-Regulation and Initiative had the strongest basis for being implemented in the classroom. On the other hand, Creativity still requires a lot more justification in terms of its impact on students’ lives and ability to assess in the classroom.

Beyond Winning and Losing: Guidelines for Evaluating High Performance Coaches

This paper proposes a three-step method of evaluating high performance coaches involving feedback from the athletes. First, data are collected using an instrument such as the Coaching Behavior Scale for Sport (CBS-S: Côté, Yardley, Hay, Sedgwick, & Baker, 1999). Second, a summary report is prepared with descriptive information regarding the frequency of behaviors demonstrated by the coach that can be compared to previous results or to a criterion measure. The third step involves appropriate personnel reviewing the report and subsequently providing guidance for individual coach development. This three-step appraisal method provides useful evaluative feedback to coaches and has been used in several sport programs in Canada, the United States, and Australia.

Evaluation of semi-passive treatment technologies for septic lagoon capacity expansion

In Canada, increases in rural development has led to a growing need to effectively manage the resulting municipal and city sewage without the addition of significant cost- and energy- expending infrastructure. Storring Septic Service Limited is a family-owned, licensed wastewater treatment facility located in eastern Ontario. It makes use of a passive waste stabilization pond system to treat and dispose of waste and wastewater in an environmentally responsible manner. Storring Septic, like many other similar small-scale wastewater treatment facilities across Canada, has the potential to act as a sustainable eco-engineered facility that municipalities and service providers could utilize to manage and dispose of their wastewater. However, it is of concern that the substantial inclusion of third party material could be detrimental to the stability and robustness of the pond system. In order to augment the capacity of the current facility, and ensure it remains a self-sustaining system with the capacity to safely accept septage from other sewage haulers, it was hypothesized that pond effluent treatment could be further enhanced through the incorporation of one of three different technology solutions, which would allow the reduction of wastewater quality parameters below existing regulatory effluent discharge limits put in place by Ontario’s Ministry of the Environment and Climate Change (MOECC). Two of these solutions make use of biofilm technologies in order to enhance the removal of wastewater parameters of interest, and the third utilizes the natural water filtration capabilities of zebra mussels. Pilot-scale testing investigated the effects of each of these technologies on treatment performance under both cold and warm weather operation. This research aimed to understand the important mechanisms behind biological filtration methods in order to choose and optimize the best treatment strategy for full-scale testing and implementation. In doing so, a recommendation matrix was elaborated provided with the potential to be used as a universal operational strategy for wastewater treatment facilities located in environments of similar climate and ecology.

An investigation of sugar-sweetened beverage consumption among Canadian youth

Background: Consumption of sugar-sweetened beverages (SSBs) is an important public health problem in Canada, especially among adolescents. Estimates show that rates of SSB consumption are particularly high in the northern territories, especially in Nunavut. This is concerning given that regular SSB consumption is associated with obesity, diabetes and tooth decay, among other health concerns. Objectives: This thesis has two objectives. The first is to describe SSB consumption patterns among adolescents from Nunavut specifically, all three territories combined and the provinces.The second is to determine the association between individual and cumulative school food programs and SSB consumption. Methods: Data were obtained from the Health Behaviour in School-aged Children study (HBSC); a cross-sectional survey of Canadian youth in grades 6-10. All frequencies for food and beverage consumption were obtained from a 7-day food frequency questionnaire. SSB consumption consisted of a composite measure including soft drinks, sports drinks and energy drinks. The types of school food programs were obtained from an administrative questionnaire filled out by each school’s Principal or delegate. Multilevel multivariate Poisson regression models were used to examine the associations between school food programs and SSB consumption. Results: Youth from Nunavut consumed the most SSBs (53.1% in 2010 and 55.0% in 2014 were daily consumers), followed by youth from the territories (31.1% in 2010 and 27.0% in 2014), then youth from the provinces (24.3% in 2010 and 19.1% in 2014). No significant relationships were found between school food programs and daily SSB consumption. Two school food programs were weakly associated with weekly SSB consumption: nutrition month activities (RR=0.93,CI=0.89, 0.98) and healthy options in the snack bar (RR=1.07, CI=1.01, 1.14). Conclusions:Rates of SSB consumption were highest among Nunavummiut youth followed by youth from all three territories combined and then the provinces. Little association was found between school food programs and SSB consumption among Canadian youth in grades 6-10. These findings point to the need for examining other determinants and potential areas for intervention, for reducing SSB consumption among Canadian youth, particularly in high consumer sub-populations.

Global Threats, 2014

In this poll on global and national threats to security and safety, just over half (55%) of Canadians say they aren't confident in the ability of domestic security services to prevent homegrown radicals from carrying out terrorist attacks in Canada.

Baggage Fees, 2014

Canada's major airlines are on the hot seat as a result of recently announced $25 fees for the first checked bag for flights in Canada. This poll shows that Canadian adults are widely opposed to the baggage fees recently imposed by domestic airlines.

Examination of body image among Canadian adolescents: Relations with physical activity and screen time

Background: Adolescence is a period of life associated with self-perceptions of negative body image. Physical activity levels are low and screen time levels are also high during this stage. These perceptions and behaviours are associated with poor health outcomes, making research on their determinants important. With adolescent populations, certain groups may be at higher risk of body dissatisfaction than others, and body dissatisfaction may influence individual physical activity and screen time levels. Objectives: The objectives of this thesis were to: 1) describe body image among young Canadians, examining possible health inequalities 2) estimate the strength and significance of associations between body satisfaction, physical activity and screen time, and 3) examine the potential etiological role of biological sex. Methods: Objective 1: The 2013/2014 Health Behaviour in School-aged Children study was employed. Sex-stratified Rao-Scott chi-square analyses were conducted to examine associations between socio-demographic factors and body satisfaction. Objective 2: The 2005/2006 and 2013/2014 cross-sectional and 2006 longitudinal HBSC data sets were used. Sex-stratified modified Poisson regressions were conducted and risk estimates and associated confidence intervals obtained. Results: Objective 1: Among males, being older, of East and Southeast Asian ethnicity, and reporting low SES all were associated with body dissatisfaction. Among females, being older, of Arab and West Asian or African ethnicity, being born in Canada, and reporting low SES were all associated with being body dissatisfied. Objective 2: Cross-sectionally, males who reported ‘too fat’ body dissatisfaction were more likely to be physically inactive. Adolescents of both sexes who reported ‘too fat’ body dissatisfaction were more likely to engage in high levels of screen time. Data from the longitudinal component supported the idea that male ‘too fat’ body dissatisfaction temporally leads to physical inactivity, but showed an inverse relationship between body dissatisfaction and screen time. Conclusions: Objective 1: Future prevention efforts in Canada should target subgroups to effectively help those at greatest risk of body dissatisfaction, and ameliorate potential inequalities at the population level. Objective 2: The presence of these relationships may inform future interventions as part of a multi-factorial etiology, in order to increase physical activity and decrease screen time among youth.

The Debate on First Nations Education Funding: Mind the Gap (Working Paper 49)

It is at long last becoming part of the public discourse that improving living conditions and opportunities for First Nations communities in Canada is a national imperative. It is also widely recognized that the education is critical to fostering a better future for First Nations people. Yet, for many First Nations youth, particularly those on reserve, completing even high school is well beyond reach. The graduation rate of First Nations people living on reserve was 35.3 per cent as recently as 2011 compared with 78 per cent for the population as a whole. At the same time, the First Nations population is young and growing fast - in First Nations communities 49 per cent of the population is under 24 years of age compared to 30 per cent of the general population. Despite some incremental improvements in education success rates for First Nations students in recent years, the education gap between First Nations and the rest of the country is increasing. The concerns expressed in the 2011 Auditor General report continue to hold weight: "In 2004, we noted that at existing rates, it would take 28 years for First Nations communities to reach the national average. More recent trends suggest that the time needed may still be longer.

Student Financial Aid:The Roles of Loans and Grants (Working Paper 37)

This paper addresses the roles of loans and grants as forms of student financial aid. It begins with a simple choice model where individuals decide to pursue post-secondary studies if i) the net benefits of doing so are positive and ii) no financing or liquidity constraints stand in their way. The effects of loans and grants on these two elements of the schooling decision are then discussed. It is argued that based on equity, efficiency, and fiscal considerations, loans are generally best suited for helping those who want to go but face financing constraints, whereas grants are more appropriate for increasing the incentives for individuals from disadvantaged backgrounds to further their studies. Loan subsidies, which make loans part-loan and part-grant, are also discussed, including how they might be used to address “debt aversion”. Given that subsidised loans have a grant (subsidy) element, while grants help overcome the credit constraints upon which loans are targeted, the paper then attempts to establish some general rules for providing loans, for subsidising the loans awarded, and for giving “pure” grants. It concludes with an application of these principles in the form of a recent proposal for reforming the student financial system in Canada. *

An Ergonomic Evaluation of a Wrist Brace for Canadian Tree Planters

Tree planting is one of the most physically demanding occupations in Canada and as a result, tree planters are at an elevated risk of injury, specifically at the wrist. Wrist injuries develop on account of the highly repetitive nature of the job, as well as other musculoskeletal risk factors including non-neutral wrist postures and high impact forces sustained at the wrist during shovel-ground impact. As a result, wrist brace use has become common among planters, in an effort to limit deviated wrist postures while also providing enhanced stability at the wrist. The external stability provided by a wrist brace is thought to reduce the muscular effort required to provide stiffness at the wrist during shovel-ground impact. Since these prospective benefits have not been formally investigated, the purpose of this study was to determine the effect of a wrist brace on wrist posture, muscle activity, and joint rotational stiffness about the wrist joint (for two degrees of freedom: flexion/extension and ulnar/radial deviation). We hypothesized that the brace would promote more neutrally aligned wrist angles, and that muscle activity and joint rotational stiffness would also decrease when participants wore the brace. Fourteen tree planters with at least one season of experience were recruited to complete two planting conditions in a laboratory setting: one condition while wearing the brace (with brace, WB) and one condition without the brace (no brace, NB). The results from this study showed that at shovel-ground impact muscle activity trended towards increasing in three muscles when participants wore the brace. Additionally, wrist angles improved about the flexion/extension axis of rotation while increasing in deviation about the ulnar/radial axis of rotation when participants wore the brace. Joint rotational stiffness increased when participants wore the wrist brace. Participants from this study indicated difficulty gripping the shovel due to the bulk of the wrist brace, and this feature is discussed with possible suggestions for future iterations of design. In addition to grip diameter this analysis also prompts the suggestion that hand length and experience should also be considered in the design of tree planting tools, specifically an ergonomic aid such as a wrist brace.

Stitching Settler Identities: Canadian Quilts and Their Makers, 1800-1880

Stitching Settler Identities: Canadian Quilts and their Makers, 1800-1880 explores the making, use, and circulation of handmade settler quilts as representation of nineteenth-century women’s social, cultural and economic histories in Canada. An important part of Canadian settlement history is the making and use of handmade quilts in the settler homestead. Handmade coverlets that provided both physical and emotional warmth in the home were a measure of a settler-woman’s careful management of resources and a display of her innovation and creativity. Few settler women recorded their daily experiences; however, most women could sew and quilts offered a method of expression that allowed them to reflect and portray their identities. Thus far, the few studies of quilts have been limited to exhibition catalogues or research that considers a quilt’s aesthetics or its historic significance. While several scholars have called for a reclassification of textile production and needle arts to advance the way in which settler women were viewed as social beings – creating, producing, communicating, and circulating cultural values, most studies on quilts have overlooked a coverlet’s materiality. This study aims to expand the research on quilts as material culture within the context of art history by also considering a quilt’s materiality and when possible, its maker's biography.