Up to 23,000 preventable deaths are estimated to occur each year in Canadian hospitals. Nurses who provide care at the bedside are well positioned to promote patient safety, because a critical component of their role is to notice and gauge potential risks. Although research suggests that nursesâ workload, training and experience influence patient mortality, little is known about the actual processes that nurses use to prevent or reduce error. Kim Shearer is applying the model of âSituational Awarenessâ (SA) to study pediatric nurses performing resuscitation of children in hospital. SA â defined as knowing what is going on in your environment â has been proposed as the primary basis for decision-making and performance in complex, dynamic systems, helping researchers understand how threats within the environment are gauged and safety is facilitated. Kimâs study will identify factors that promote or impede nursesâ ability to gauge the work environment and make decisions, generating the basic knowledge needed to create computer simulations for teaching and testing SA in pediatric resuscitation. Findings of this research will help to prevent or minimize error and enable development of novel health education interventions to improve SA and hence the safety of children in dynamic and complex acute care environments.
Research Pillar: Population Health
Dynamic Risk Factors for Violence in People With Major Mental Disorders
Major mental disorders are associated with increased rates of violence, which is a primary reason for involuntary psychiatric or community treatment for individuals with mental disorders. Within psychiatric inpatient units, violence compromises the safety of hospital staff and other patients, adversely impacts staff morale, jeopardizes the therapeutic setting, and presents a risk of physical injury. In order to prevent violence, it is important to identify the factors that can provoke violent outbursts. Certain known risk factors for violence do not change during a personâs life, such as their age at a first violent incident or early childhood maladjustment. However, there are also dynamic risk factors â such as emotional distress, treatment compliance, and symptoms of psychosis â that can and do vary over time. Catherine Wilson is studying a group of psychiatric inpatients admitted for treatment of a major mental disorder. Using specialized methods, she will measure these dynamic risk factors over time, from admission to discharge. The findings of Catherineâs study will increase our theoretical understanding of violence and assist the development of treatment and management programs designed to prevent violence by psychiatric inpatients.
First Nations Women Leaders: Building a Bridge from Cultural Identity to Healthy Youth
In British Columbia, First Nations youth are five to 20 times more likely to die by suicide than their non-Aboriginal peers. These youth suicide rates, however, are not uniformly high across the almost 200 First Nations communities in BC. Research has found that suicide rates are lowest in those communities that have been especially successful in preserving and promoting their cultural heritage and in securing local control over key aspects of community life. More recently, it has been found that suicide rates are lower in communities where women actively participate in their local government. Robin Yates is exploring the relationship between First Nations women leaders, cultural identity, and lower suicide and injury rates of youth in BC First Nations communities. The results of her research will enhance the development and exchange of knowledge regarding factors that preserve and promote healthy youth in First Nations communities.
Healing Practices of Azorean Immigrants: Implications for Practitioners in North America
Therapists in BC need to develop culturally sensitive mental health services to reflect the changing demographics of BCâs population and better serve immigrant clients. This is especially important because research has shown that immigrants simultaneously use traditional healers from their country of origin and local health care services to alleviate symptoms of illness. More than 30,000 BC residents report Portuguese origins. Birdie Bezanson is studying the beliefs, values and methods of traditional Portuguese healers in BC and the Azores Islands in Portugal, and the implications for local practitioners in multicultural counselling. Clinical practices and healing processes develop within and reflect particular cultures and value systems. Birdie is examining the interface between traditional and clinical methods of dealing with distress to develop a more comprehensive understanding of healing and well-being. This research is directed at informing the development of culturally sensitive treatment alternatives that will enable local practitioners to accommodate the needs of Portuguese clients and other immigrant communities in the province.
Genetic discrimination in mutation carriers identified through predictive testing for HD
In her earlier research supported by a MSFHR-BCMSF Junior Graduate Studentship Trainee Award, Yvonne Bombard completed a qualitative study of how individuals live with, and manage the potential for, genetic discrimination. Based on these findings, she adapted an Australian survey to reflect the concerns and experiences relevant to Canadians at risk for Huntingtonâs disease (HD). Yvonneâs work now focuses on recruiting 300 Canadian participants to complete the adapted survey. Survey results will then be analyzed to identify the nature and frequency of discrimination against Canadians who test positive for the HD gene mutation (but who have not yet developed outward symptoms) when applying for insurance, in their work environment, and in social and family settings. The findings of the study will help counsellors, patient support groups, and the health policy communities identify areas where more education or policy may be needed. Ultimately, this research may lead to better supports and improved health of individuals identified as being at risk for developing Huntingtonâs disease.
Optimal use of linked SNP marker data in genetic association studies
Heart disease, diabetes and other complex diseases involve genes that combine with lifestyle and environmental factors to increase disease susceptibility. To find the genetic factors that influence disease outcomes, researchers have begun using haplotypes â sets of closely linked genetic variants inherited together as a unit. However, the use of haplotypes introduces its own complexities, including uncertainty in haplotype measurement, handling of rare haplotypes and the optimal length of haplotypes to examine. By incorporating the genetic relatedness of haplotypes into statistical estimation, Kelly Burkett hopes to address these points to more effectively predict the effects of haplotypes on disease outcomes. The methods will not only enable researchers to identify genetic risk factors but also the connections between genetic and non-genetic factors, such as lifestyle, environmental and occupational risks. The identification of such risk factors is hoped to eventually lead to improved disease treatment and prevention by highlighting new drug targets and lifestyle modifications for those with increased disease susceptibility.
Preventing Vicarious Traumatization of Mental Health Therapists: Identifying Protective Practices
As part of their work, trauma therapists must listen to detailed descriptions by patients of horrific events such as abuse, violence and disasters. Over time, the psychiatrists, psychologists, social workers and psychiatric nurses who treat seriously traumatized individuals are themselves at risk for vicarious traumatization and burnout. Richard Harrison is studying the factors that contribute to the resilience and health of trauma therapists. He will identify the individual characteristics, as well as the organizational practices, that help professionals succeed in their work and remain healthy. He hopes his work will help lessen the âcosts of caringâ for this group of health professionals, and prevent the loss of therapists who quit the profession because of burnout and vicarious traumatization.
Decision Making Related to Cancer Risk-Reduction Among BRCA1/2 Carriers
Women who learn through genetic testing that they are at high risk for developing hereditary breast and ovarian cancer may choose to undertake several risk-reducing strategies, including surgery, chemoprevention, and increased screening. An emerging body of research is beginning to describe high-risk womenâs experiences and satisfaction upon adopting these risk-reducing strategies; however, little is known about how women come to make these decisions. Because of the highly personal nature of this decision, most health care providers attempt to support decision-making about risk-reducing strategies, rather than recommend particular courses of action. In order to support women and to develop and evaluate appropriate interventions, it is essential to understand how women arrive at these decisions. Fuchsia Howard is identifying the personal, psychological and social contextual factors that influence womenâs decision-making about breast and ovarian cancer risk-reducing strategies. This research will contribute to an understanding of the impact of genetic testing for hereditary breast and ovarian cancer risk on the psychological health and quality of life of women found to be at high-risk. This understanding will inform future development of appropriate interventions within programs offering genetic services.
Socio-ecological analysis of HIV/AIDS treatment-related behaviours and health outcomes in an era of HAART: Considering individuals in the context of their communities
âHighly active antiretroviral therapyâ (HAART) has led to dramatic improvements in quality of life and survival for people infected with HIV/AIDS. But these positive outcomes are not evenly distributed among HIV-infected individuals. Despite access to free medications in Canadaâs publicly funded health care system, vulnerable groups such as HIV-positive women, injection drug users and socio-economically disadvantaged people have not experienced the health improvements others have. Research to date has focused largely on individual risk factors. Angela Kaida is examining how individual and community factors, such as neighbourhood income levels and the availability of HIV/AIDS services, affects the quality of treatment and health outcomes of people infected with HIV. Angela is assessing the role these factors play in delaying entry into treatment, non-adherence to treatment, and the advance of HIV/AIDS disease and death. In earlier research, Angela studied the impact of HIV/AIDS on agricultural production, food security and rural livelihoods in Malawi, and on male involvement in family planning in Uganda. The findings from her current study have the potential for application in the design of community programs and policies to improve equal access to HAART in Canada, and may be applied in global settings with high HIV prevalence.
Assessing risk of myocardial infarction among fire fighters
Firefighters work in hazardous environments that may put them at risk of developing diseases such as cardiovascular disease. While job-related exposure to hazardous conditions is believed to increase firefightersâ risk of heart attack, there is little data available regarding their levels of exposure to hazardous work conditions and the risk associated with health outcomes. Canadian policy-makers are seeking new evidence to help them develop compensation programs and policies with regards to the risk of cardiovascular disease associated with work-related exposures among firefighters. Tracy Kirkhamâs research is directed at identifying the types of hazardous exposures that may be related to an increased risk of heart attack among firefighters. Her study includes firefighters who had a heart attack while working at one of seven BC fire departments between 1984 and 2000. She is also monitoring and analyzing firefightersâ exposure to air pollutants and noise as well as using other indicators of exposure, such as signs of physiological stress, and numbers and types of fires fought. The results of this study may provide policy-makers with information to help inform decisions regarding compensation for work-related heart disease among firefighters. In addition, the results may be applied to other occupational groups with similar exposures to hazardous substances.