- ItemAn Environmental Scan of Intimate Partner Violence Prevention Programs: Reshaping Masculinity(Mount Saint Vincent University, 2023-08) Davis, AlexanderIntimate partner violence (IPV) and toxic masculinities plague our world more now than ever before. IPV is described as a series of violent acts or threats that cause emotional, physical, or sexual trauma to romantic partners (typically women), in both casual and committed relationships (Pereira et al., 2020; Webermann et al., 2022). It often involves coercion, social isolation, and reduction of freedom in the victim’s public and private life, including emotional, financial, and medical control (Pereira et al., 2020). Given that men are the predominant perpetrators (Donovan & Hester, 2008), and most violent tendencies are learned in childhood (via social learning), it is imperative that young adolescent males be educated about violence prevention to support a decrease of IPV in future generations. Through an environmental scan of 55 programs that exist to prevent intimate partner violence from occurring in the first place, and to help reshape masculinity it is clear not only that there are organizations and programs in existence already doing this work effectively. As well these programs often train their participants to become facilitators, thereby securing their sustainability. Programs also seem to be shifting towards a more unified model of education inclusive of sex education, IPV prevention, and redefined masculinities. While this is positive, more programs need to be created that not only meet the needs of their participants but encourage them to seek out new ways of thinking and avenues for positive relational and behavioral change. The overall goal is to reduce and eradicate IPV. When it comes to reshaping masculinity, what is evident is that while there may not be one set definition for what healthy masculinities look like, there is in fact a definition for unhealthy masculinities. The key is in education and curriculum that moves toward the development of masculinities that support and nurture rather than destroy and violate.
- ItemHow Home Care Communication Adapts Over Time to Meet Clients’ Needs: A Case Study of Home Care Constellations(Mount Saint Vincent University, 2023-09) Burke, RosanneHome care is an invisible, yet essential component of the health care system in Canada (Hewko et al., 2015). It is a complex, interdependent, and interactional process involving clients, families, and home support workers (HSWs) (Shaw et al., 2021) referenced as care constellations in this research. Every home care interaction involves communication (Gustafsson et al., 2021), therefore communication in home care is critical because it facilitates both task-based and psychosocial needs of clients being met (Höglander et al., 2020). Another essential principle in home care is the centrality of the client – namely person-centred care (PCC). Communication is a key component of a PCC approach, yet few studies have focused on communication in home care (Sundler et al., 2016; Kristensen et al., 2015). Using longitudinal secondary data (28 semi-structured qualitative interviews) from the Home Care Pathways Project (Keefe et al., 2020) and framed by person-centred care and critical relational theory, this study examined communication within two Nova Scotian care constellations and how communication adapted over time. An additional research question assessed how and if factors such as societal, structural, political, and historical factors influenced communication within the care constellation. Data analysis of each case was performed using thematic and temporal analysis of the qualitative interviews. A cross-case analysis between the two constellations revealed similarities and differences in the themes. Findings revealed three key themes. One temporal theme was identified in both cases: formal communication processes may or may not meet clients’ needs. Also, in constellation 1, the theme ‘the role of conversations in meeting clients’ psychosocial needs’ emerged and in constellation 2, the theme, ‘communication associated with maintaining independence’ was identified. The COVID-19 pandemic was a contextual factor that negatively impacted the health of both clients. Structural factors including a focus on safety, lack of accountability and time constraints were found to be barriers to client-centred communication. As noted in previous research, as the least powerful members of the caregiving network, HSWs and clients were the most depended upon for communication of clients’ needs (Funk et al., 2022). Implications of the study include recommendations for how to improve the education and training of home support workers as well as policy changes to enhance the delivery of client-centred care at both the organizational and systemic levels. Although specific to Nova Scotia, the findings will be of interest to other jurisdictions looking to improve home care communication within a client-centred care model.
- ItemSuicide of Older Adults: A Sad Ending to an Untold Story(Mount Saint Vincent University, 2023-10) White, Catherine MayMany older adults enjoy healthy aging while others face a range of losses (health, companions, resources, meaning in life) that can result in social isolation, loneliness, and fear that one will become a burden. The challenge of accepting a declining quality of life, lack of a sense of purpose, and increased dependence on others may become too great, contributing to the risk for suicide. While risk factors and protective factors are identified, each suicide is different. There is a lack of consensus on how suicidal ideation arises and little existing research to illuminate the lived experience of how older adults move from ideation-to-action. The purpose of this study was to create an opportunity for people over the age of 50 who have recently attempted suicide to share their personal experience. A better understanding of what leads older adults to attempt suicide may help to develop approaches to suicide prevention that better address their needs. Narrative Inquiry was chosen as the methodology for this study as it lends well to sharing stories of lived experience and accounts of specific events or actions, specifically ones with a turning point. Four participants engaged in two interviews. The first provided each person the opportunity to share their story, with minimal prompts provided. The second allowed them to review the preliminary findings and clarify as needed. Although the findings revealed alignment with the Interpersonal Theory of Suicide which posits that suicide is the result of simultaneous existence of thwarted belonging and perceived burdensomeness, accompanied by hopelessness, there was great diversity in the ways they did so. Some carried burden while others feared becoming a burden. Thwarted belonging was evident in the ways participants evaluated their role in the family. Some were socially excluded from family events, while others felt a general lack and having something to offer in the world. The Critical-Ecological Framework added an additional lens through which to view the findings. The intertwined ecological levels of the environment (microsystem, mesosystem, exosystem, macrosystem) added a depth of understanding that illuminated the challenges inherent with maintaining an exclusive focus on mental health issues as strictly an individual issue, as is often the case in mental health services. Participants wanted more than another prescription. They wanted to be included and valued, and to feel that they had something to offer. Mental health services could benefit from the knowledge that interventions such as social prescribing and occupational therapy could be a good fit for supporting people to supplement symptom management with finding meaningful activities in which to engage. Community responses to create welcoming, accessible and inclusive environments and opportunities for intergeneration participation could also be helpful. In conclusion, there are many pathways to suicidal ideation, requiring a multi- pronged approach when it comes to prevention. The biomedical approach is not enough to support older adults who are considering ending their lives. People need a sense of purpose. Battling ideologies such as agism and helping people to overcome barriers to inclusion and find activities that are meaningful are required.
- ItemIntegrating a Palliative Approach to Care in Long-Term Care: A Comparative Case Study of Two Provinces(Mount Saint Vincent University, 2021-10) Hubley, Emily V.Aging in place initiatives have contributed to a shift in long-term care (LTC) where residents are now entering at an older age, have greater health complexities, and have a shorter length of stay. Veering from the traditional biomedical approach to address the changing needs, integrating a palliative approach to care in LTC aims to provide comfort and improve the quality of life for residents and their families. A comparative case study design was used to understand how two Canadian jurisdictions, British Columbia (BC) and Nova Scotia (NS), integrate a palliative approach into LTC policy and how they differ. An iterative process of data collection and analysis was used wherein a total of 29 LTC-specific regulatory policies (16 in BC and 13 in NS) were examined using a qualitative content analysis method. Analysis was guided by an innovative framework of 10 domains developed specifically for this analysis (adapted from the Canadian Hospice Palliative Care Association and Accreditation Canada). The 10 domains encompass a palliative approach to care and are as follows: care delivery; care planning; communication; end-of-life care/management; loss/grief/bereavement; physical health; practical activities; psychological; social; and spiritual and cultural. After all policies had been coded as part of the content analysis, thematic analysis was used within each domain to uncover the specific themes related to a palliative approach to care and how they were supported in policy and similar to or different in each jurisdiction. Analysis revealed highly similar findings across both BC and NS in terms of the recurrence of domains that were supported. In both jurisdictions, communication, physical health, social, and care delivery were among the most coded and end-of-life care/management and loss/grief/bereavement were the least coded. Promising approaches were identified around open communication among the interdisciplinary team, processes to discuss and document an individual’s goals of care and advance care planning, health assessments and safety, and encouraging social relationships and activities were identified. Although many domains of a palliative approach to care are highly reflected in LTC policy, gaps are identified around end-of-life care and providing supports post-death in loss, grief, and bereavement. In conclusion, policy must go beyond the here and now and further support the final stages of life and post-death care to improve residents and families’ experiences at the end of life.
- ItemA Modified Institutional Ethnography of IPV Service Provision for Newcomer Women in the Halifax Regional Municipality(Mount Saint Vincent University, 2020-08) Tañafranca, Manila-Vicka PedrosaAlthough intimate partner violence (IPV) is a serious issue for both new immigrants and longer-residing Canadians, intersecting inequalities proliferate the disparity immigrant women face in instances of IPV. These disparities expose newcomer women to unique vulnerabilities, posing limitations to help-seeking behaviour. From the perspective of service providers, the present research identifies the barriers newcomer women face when seeking and using IPV programs and services in the Halifax Regional Municipality (HRM). Additionally, the research investigated the role that ideologies play in moderating the barriers to service access and utilization. Five interviews were conducted with service providers from organizations across the HRM. Interviews were analyzed using grounded theory techniques. A critical framework was adopted to identify and address the pervasive practices regulating localized experiences. Guided by the critical framework, a modified institutional ethnography (IE), focusing on the experiences of service providers, directed investigation. Utilization of an (IE) was meaningful for mapping the hidden systems of power, or ruling relations, that facilitate social inequity in cases of newcomer IPV. Through examination of ruling relations, IE attempts to display the connections between daily life, professional practice, and overarching discourses—termed texts. This is known as “textually mediated social organization” (Smith, 2005). Intersectionality arose as a recurring concept, specifically relating to the barriers newcomer women face due to their gender, immigrant status, and racialization. Core themes moderating resource access included a lack of resource awareness among immigrant women, funding and service limitations, the role of community in resource acquisition, and immigrant status. Themes of resource incongruence, men’s role in addressing IPV, and the criminalization of violence arose as central barriers surrounding the suitability of available resources. Mapping of the barriers from everyday activities to extra-local settings revealed that external texts including organizational mandates, laws and policies, criminal procedures, and immigration requirements influence local service provision. Although various ideologies emerged in the analysis, neoliberalism surfaced as an ideology that coordinated the numerous issues identified. Under neoliberalism, non-economic spheres are shaped and moderated by the discourses of the free market (Foucault, 2008). Three neoliberal processes arose as core reinforcers of existing service barriers. These include the economic regulation of immigration, the practice of austerity in service provision, and the neoliberal stance on criminalization and the justice system. Additional ideologies including patriarchy, familialism, marianism and multiculturalism emerged as interconnected with neoliberalism. These processes aid in reasserting and sustaining neoliberal goals. The implementation of neoliberal processes within localized discourses normalize and reinforce the barriers existing for newcomer women seeking IPV support. This sets the foundation for the development and implementation of policies, practices and decision surrounding newcomer service provision. Modification to current neoliberal practices would alleviate many of the existing barriers to service. Organizational expansion, through increasing staffing and immigrant-centred program offerings is valuable for providing accessible and appropriate service for newcomer populations. Extending service access to precarious status newcomers would also reduce barriers related to accessibility. Additionally, incorporating newcomer women’s voices in extra-local settings, such as government, is a valuable means of quashing existing service barriers.