In this descriptive case study, we aimed to understand the experiences of cancer diagnosis, treat... more In this descriptive case study, we aimed to understand the experiences of cancer diagnosis, treatment, and palliative care in Pakistan. The case was limited to a hospital for cancer and hospice care in Karachi, Pakistan. Data collection included interviews with patients who had a cancer diagnosis, family members, healthcare providers, and unstructured observations. Two themes of suffering and late diagnosis were developed to describe the experiences of people with cancer. Suffering occurred as a result of poverty, social ideas about cancer, and physical suffering. Late diagnosis happened because of cultural ideas about health, low health literacy, and healthcare challenges, although both themes are interconnected. The findings illuminate three key pathways that will improve cancer diagnosis and palliative care in Pakistan: specifically, the need to (a) educate healthcare providers about cancer and palliative care, (b) eradicate corruption in healthcare, and (c) develop policies for ...
Social and health inequalities are a reality around the world and one of the most important chall... more Social and health inequalities are a reality around the world and one of the most important challenges in the current age. Nurse educators can respond to these challenges by incorporating curricular components to identify and intervene in social and health inequalities. To examine how social and health inequalities have been addressed in the nursing curriculum. Informed by the work of Paulo Freire, a critical literature review was performed to examine how social and health inequalities have been addressed in the nursing curriculum. In July 2015, we searched for articles published from 2000 to 2015 in ERIC, CINAHL, Web of Science, Scielo, MEDLINE and LILACS databases. Main search terms included "disparity" or "inequality" and "curriculum" and "nursing." We included studies published in academic journals in English, Portuguese and Spanish. A total of 20 articles were included in this review. Most of the articles (15) were from the United States ...
The current state of the world has posed many challenges and demands on nurses throughout the wor... more The current state of the world has posed many challenges and demands on nurses throughout the world. We live in an age of contradictions where inequalities in the distribution of wealth, goods and services reflect both a state of abundance and scarcity. The 20th century and the advent of the 21st century havewitnessedmany scientific, technological, and economic advances. Yet backlashes in these fields have also been experienceddue towar, globalfinancial crises, severe poverty, and the emergence of new diseases, among others.While some are able to experience democratic freedoms, others have been the victims of lack of freedom and oppression. World citizens often find themselves in the middle of dominant discourses triggered by neoliberal globalizing forces such as the privatization of healthcare. This age of contradictions calls us to pay attention to the educational preparation of nurses to assist them to recognize the effects of globalizing forces in the health of the populations we serve (Camargo Plazas et al., 2012). In this article we seek to highlight the need for problematizing this reality as a way to promote critical pedagogical practice in nursing education. Our discussion draws on the work of critical educator Paulo Freire (1979, 1987) and his contributions to emancipatory practices in the context of oppression. Contemporary reality confronts us with a life filled with many mechanical tasks, predetermined norms and demands that make us act in a standardized manner, often reproducing hegemonic behaviors and discourses. In this age, where we seem to have been thrown into a time of “fast everything,” the opportunity to problematize the circumstances that surround us is often ignored or denied affecting the potential for critical, creative and transformative practice. Doing so implies questioning reality, positioning oneself and acting in the world against expressions that reduce humanization, in other words, a work of conscientização (Freire, 1997a). To assist the nurse to discern a way through these contemporary trends, our reflection and contributions are based on the works of Paulo Freire,who dedicated his life to education from the liberation perspective. In what follows, we present problematizing as a way of both situating oneself and intervening in the world. Our starting premise is that being in the world implies positioning oneself as subjects of our own history (Freire, 2000).We outline problematization and discuss the potential implications of problematizing in nursing education. Consideration is given to people's situation as well as how to engender thoughtfulness in nurses
Indigenous women face many barriers to maternal care during pregnancy in Canada. A participatory ... more Indigenous women face many barriers to maternal care during pregnancy in Canada. A participatory study was conducted in two First Nations Communities in Nova Scotia, Canada to gain new knowledge about Mi’kmaw women’s experiences of living with gestational diabetes mellitus (GDM). Relational ethics helped guide this journey. In this paper we describe how Indigenous and Western approaches were used to understand Mi’kmaw women’s experiences with GDM. It was important to us that the research methodology facilitated building relationship and trust. This led to an openness and willingness of the women to express their concerns and offer ways to address GDM in their communities. The challenges of blending Indigenous approaches with Western research are also discussed in the paper. The foundational principles that were used during this research included: 1) Staying true to my word; 2) Mutual Trust; 3) Mutual Respect; 4) Being Flexible; 5) Being Non judgemental; 6) Working in partnership; 7)...
Hermeneutic phenomenology seeks to attain a deep understanding of human experience in the context... more Hermeneutic phenomenology seeks to attain a deep understanding of human experience in the context of a particular situation. In this paper, we examine how lifeworld existentials as a thematic method of analysis us to gain understanding of the experience of living with chronic illness under the pressure of social, economic and political forces. Lifeworld existentials assisted us to reveal more clearly the resourcefulness and resilience of research participants and invalidated the stigmas and stereotypes that led to discriminatory and stigmatization practices that ultimately kept alive their exclusion from society. Through this subjective lens, illness reframes from being a simple matter of functional impairments and physical discomforts. This approach helps nurses to understand aspects of the illness-health continuum that cannot be accessed by observation alone and has implications for understanding patients’ unique issues and facilitating better clinical outcomes for patients and th...
is a Professor Emerita in the Faculty of Nursing, University of Alberta. Her research focuses on ... more is a Professor Emerita in the Faculty of Nursing, University of Alberta. Her research focuses on reducing health disparities for marginalized populations in local and Air Hunger The Sublime In Nursing Practice Abstract: In sublime moments in practice we may be brought close, incredibly close, to what normally remains at a distance. Or we may momentarily discern what has always been before us and so close to us that it has never before been truly noticed. Two different nursing situations show how meaningful, yet ineffable the sublime in practice can be when it is evoked and how difficult it is to articulate aesthetic dimensions of nursing practices without covering them over with theory and theoretical knowledge. We consider the experience of taken for granted breathing when suddenly severe breathlessness appears. What is it to be present to those in extremis, to be close to the inside workings of human bodies? Using Jean-Luc Nancy's (1993) understanding of the sublime, we consi...
In sublime moments in practice we may be brought close, incredibly close, to what normally remain... more In sublime moments in practice we may be brought close, incredibly close, to what normally remains at a distance. Or we may momentarily discern what has always been before us and so close to us that it has never before been truly noticed. Two different nurs ing situations show how meaningful, yet ineffable the sublime in practice can be when it is evoked and how difficult it is to articulate aesthetic dimensions of nursing practices without covering them over with theory and theoretical knowledge. We consider the experience of taken for granted breathing when suddenly severe breathlessness appears. What is it to be present to those in extremis, to be close to the inside workings of human bodies? Using Jean-Luc Nancy’s (1993) understanding of the sublime, we consider how the experience of a patient’s breath can be existentially revelatory of nursing practice.
In Canada, Indigenous peoples bear a greater burden of illness and suffer disproportionate health... more In Canada, Indigenous peoples bear a greater burden of illness and suffer disproportionate health disparities compared to non-Indigenous people. Difficult access to healthcare services has contributed to this gap. In this article, we present findings from a dissemination grant aimed to engage Indigenous youth in popular theatre to explore inequities in access to health services for Indigenous people in a Western province in Canada. Following an Indigenous and action research approach, we undertook popular theatre as a means to disseminate our research findings. Popular theatre allows audience members to engage with a scene relevant to their own personal situation and to intervene during the performance to create multiple ways of critically understanding and reacting to a difficult situation. Using popular theatre was successful in generating discussion and engaging the community and healthcare professionals to discuss next steps to increasing access to healthcare services. Popular t...
In families where genetic testing for the breast cancer 1 and 2 genes (BRCA1/2) has not identifie... more In families where genetic testing for the breast cancer 1 and 2 genes (BRCA1/2) has not identified a deleterious mutation, the risk for hereditary breast cancer (HBC) can still be high when there is a strong family history. Little is known about how an awareness of risk for HBC impacts the everyday lives of unaffected women (no personal history for breast and/or ovarian cancer) in these families. The aim of this study is to explore how unaffected women, living in BRCA1/2-negative families, experience living with risk for HBC. van Manen's hermeneutic phenomenological approach guided this study. Unaffected at-risk women were recruited from a hereditary breast and ovarian cancer clinic in Western Canada. Nine women participated in 20 open-ended conversations. Phenomenological reflection on the 4 life existentials (lived space, body, time, and relations) revealed "Moving In and Out of the What-Ifs" as an overarching description that was communicated through the following themes: "Just Moving Along: Living a Normal Life," "Moving Into Those Dark Spaces," "Is there Something Wrong With Me"? "Markings in Time," "Living in the Moment," "Being Cared For," and "Keeping Me Grounded." The findings reveal how knowledge from predictive medicine impacts the lives of women and the importance of supportive relations and provides a foundation for future research into how health is perceived. The findings inform the practices of healthcare professionals as they engage in discussions with women living with risk for HBC and highlight the importance of a supportive relationship.
In seeking for an understanding of ethical practices in health care situations, our challenge is ... more In seeking for an understanding of ethical practices in health care situations, our challenge is always both to recognize and respond to the call of individuals in need. In attuning ourselves to the call of the vulnerable other an ethical moment arises. Asking 'how are you?' in health care practice is our very first possibility to learn how a particular person finds herself or himself in this particular situation. Here, 'how are you?' shows itself as an ethical question that opens up a relational space that calls forth a response. It is a way to understand the situated moments in which we are already that enables us to act respectfully. Our ethical frameworks assist us in trying to decide what is the right thing to do given a set of circumstances. Yet there is a prior step that already calls us to ethical attention; this is when we ask 'how are you?', which transforms a seemingly small interaction into an ethical moment. 'How are you?' is a question that turns us back to who we are as health care professionals and calls us to be more deeply attentive to the moment. When we sincerely ask 'how are you?' we enact our ethical commitments to one another.
Historically, comfort has been a quintessential aspect of nursing practice. Currently, it is ques... more Historically, comfort has been a quintessential aspect of nursing practice. Currently, it is questionable whether or not comfort remains an integral facet of nursing care. The increasing trend to focus on the technological and institutional aspects of patient care rather than the individual's response to illness and subsequent treatment is heard again and again from the growing vocal consumer movement. This study of comfort from a patient's viewpoint (a grounded theory) attempted to address both the current state of comfort care found within nursing practice and the patient's view of what constituted comfort while in hospital. The most significant finding was that comfort was not a passive process whereby the patients waited in hope of receiving comfort (i.e. such as someone to come and soothe their fevered brows). Comfort was found to be a dynamic process, with each patient actively engaged in increasing personal comfort levels. Indeed, the lack of comfort was found to be the stimulus for patients to embark on a process called 'integrative balancing'.
The Canadian Journal of Nursing Research Revue Canadienne De Recherche En Sciences Infirmieres, Aug 31, 2011
The authors designed a participatory qualitative research study to develop a collaborative partne... more The authors designed a participatory qualitative research study to develop a collaborative partnership between palliative care practitioners in Canada and in Chile. The research goal was to support the provision of palliative care in vulnerable settings through a participatory knowledge exchange process using qualitative and participatory methodologies. The study involved an interprofessional palliative care team from a primary health care centre in Chile and 5 adults receiving palliative care and their relatives. It also involved the participation of registered nurses and allied health professionals from a palliative home care team in Canada. Participatory knowledge exchange activities included teamwork with the primary health care team in Chile and a process of participatory knowledge exchange with palliative care clinicians in Chile and Canada. The study produced qualitative evidence on the efficacy of a process of participatory knowledge exchange with palliative care practitioners from 2 diverse settings.
In this descriptive case study, we aimed to understand the experiences of cancer diagnosis, treat... more In this descriptive case study, we aimed to understand the experiences of cancer diagnosis, treatment, and palliative care in Pakistan. The case was limited to a hospital for cancer and hospice care in Karachi, Pakistan. Data collection included interviews with patients who had a cancer diagnosis, family members, healthcare providers, and unstructured observations. Two themes of suffering and late diagnosis were developed to describe the experiences of people with cancer. Suffering occurred as a result of poverty, social ideas about cancer, and physical suffering. Late diagnosis happened because of cultural ideas about health, low health literacy, and healthcare challenges, although both themes are interconnected. The findings illuminate three key pathways that will improve cancer diagnosis and palliative care in Pakistan: specifically, the need to (a) educate healthcare providers about cancer and palliative care, (b) eradicate corruption in healthcare, and (c) develop policies for ...
Social and health inequalities are a reality around the world and one of the most important chall... more Social and health inequalities are a reality around the world and one of the most important challenges in the current age. Nurse educators can respond to these challenges by incorporating curricular components to identify and intervene in social and health inequalities. To examine how social and health inequalities have been addressed in the nursing curriculum. Informed by the work of Paulo Freire, a critical literature review was performed to examine how social and health inequalities have been addressed in the nursing curriculum. In July 2015, we searched for articles published from 2000 to 2015 in ERIC, CINAHL, Web of Science, Scielo, MEDLINE and LILACS databases. Main search terms included "disparity" or "inequality" and "curriculum" and "nursing." We included studies published in academic journals in English, Portuguese and Spanish. A total of 20 articles were included in this review. Most of the articles (15) were from the United States ...
The current state of the world has posed many challenges and demands on nurses throughout the wor... more The current state of the world has posed many challenges and demands on nurses throughout the world. We live in an age of contradictions where inequalities in the distribution of wealth, goods and services reflect both a state of abundance and scarcity. The 20th century and the advent of the 21st century havewitnessedmany scientific, technological, and economic advances. Yet backlashes in these fields have also been experienceddue towar, globalfinancial crises, severe poverty, and the emergence of new diseases, among others.While some are able to experience democratic freedoms, others have been the victims of lack of freedom and oppression. World citizens often find themselves in the middle of dominant discourses triggered by neoliberal globalizing forces such as the privatization of healthcare. This age of contradictions calls us to pay attention to the educational preparation of nurses to assist them to recognize the effects of globalizing forces in the health of the populations we serve (Camargo Plazas et al., 2012). In this article we seek to highlight the need for problematizing this reality as a way to promote critical pedagogical practice in nursing education. Our discussion draws on the work of critical educator Paulo Freire (1979, 1987) and his contributions to emancipatory practices in the context of oppression. Contemporary reality confronts us with a life filled with many mechanical tasks, predetermined norms and demands that make us act in a standardized manner, often reproducing hegemonic behaviors and discourses. In this age, where we seem to have been thrown into a time of “fast everything,” the opportunity to problematize the circumstances that surround us is often ignored or denied affecting the potential for critical, creative and transformative practice. Doing so implies questioning reality, positioning oneself and acting in the world against expressions that reduce humanization, in other words, a work of conscientização (Freire, 1997a). To assist the nurse to discern a way through these contemporary trends, our reflection and contributions are based on the works of Paulo Freire,who dedicated his life to education from the liberation perspective. In what follows, we present problematizing as a way of both situating oneself and intervening in the world. Our starting premise is that being in the world implies positioning oneself as subjects of our own history (Freire, 2000).We outline problematization and discuss the potential implications of problematizing in nursing education. Consideration is given to people's situation as well as how to engender thoughtfulness in nurses
Indigenous women face many barriers to maternal care during pregnancy in Canada. A participatory ... more Indigenous women face many barriers to maternal care during pregnancy in Canada. A participatory study was conducted in two First Nations Communities in Nova Scotia, Canada to gain new knowledge about Mi’kmaw women’s experiences of living with gestational diabetes mellitus (GDM). Relational ethics helped guide this journey. In this paper we describe how Indigenous and Western approaches were used to understand Mi’kmaw women’s experiences with GDM. It was important to us that the research methodology facilitated building relationship and trust. This led to an openness and willingness of the women to express their concerns and offer ways to address GDM in their communities. The challenges of blending Indigenous approaches with Western research are also discussed in the paper. The foundational principles that were used during this research included: 1) Staying true to my word; 2) Mutual Trust; 3) Mutual Respect; 4) Being Flexible; 5) Being Non judgemental; 6) Working in partnership; 7)...
Hermeneutic phenomenology seeks to attain a deep understanding of human experience in the context... more Hermeneutic phenomenology seeks to attain a deep understanding of human experience in the context of a particular situation. In this paper, we examine how lifeworld existentials as a thematic method of analysis us to gain understanding of the experience of living with chronic illness under the pressure of social, economic and political forces. Lifeworld existentials assisted us to reveal more clearly the resourcefulness and resilience of research participants and invalidated the stigmas and stereotypes that led to discriminatory and stigmatization practices that ultimately kept alive their exclusion from society. Through this subjective lens, illness reframes from being a simple matter of functional impairments and physical discomforts. This approach helps nurses to understand aspects of the illness-health continuum that cannot be accessed by observation alone and has implications for understanding patients’ unique issues and facilitating better clinical outcomes for patients and th...
is a Professor Emerita in the Faculty of Nursing, University of Alberta. Her research focuses on ... more is a Professor Emerita in the Faculty of Nursing, University of Alberta. Her research focuses on reducing health disparities for marginalized populations in local and Air Hunger The Sublime In Nursing Practice Abstract: In sublime moments in practice we may be brought close, incredibly close, to what normally remains at a distance. Or we may momentarily discern what has always been before us and so close to us that it has never before been truly noticed. Two different nursing situations show how meaningful, yet ineffable the sublime in practice can be when it is evoked and how difficult it is to articulate aesthetic dimensions of nursing practices without covering them over with theory and theoretical knowledge. We consider the experience of taken for granted breathing when suddenly severe breathlessness appears. What is it to be present to those in extremis, to be close to the inside workings of human bodies? Using Jean-Luc Nancy's (1993) understanding of the sublime, we consi...
In sublime moments in practice we may be brought close, incredibly close, to what normally remain... more In sublime moments in practice we may be brought close, incredibly close, to what normally remains at a distance. Or we may momentarily discern what has always been before us and so close to us that it has never before been truly noticed. Two different nurs ing situations show how meaningful, yet ineffable the sublime in practice can be when it is evoked and how difficult it is to articulate aesthetic dimensions of nursing practices without covering them over with theory and theoretical knowledge. We consider the experience of taken for granted breathing when suddenly severe breathlessness appears. What is it to be present to those in extremis, to be close to the inside workings of human bodies? Using Jean-Luc Nancy’s (1993) understanding of the sublime, we consider how the experience of a patient’s breath can be existentially revelatory of nursing practice.
In Canada, Indigenous peoples bear a greater burden of illness and suffer disproportionate health... more In Canada, Indigenous peoples bear a greater burden of illness and suffer disproportionate health disparities compared to non-Indigenous people. Difficult access to healthcare services has contributed to this gap. In this article, we present findings from a dissemination grant aimed to engage Indigenous youth in popular theatre to explore inequities in access to health services for Indigenous people in a Western province in Canada. Following an Indigenous and action research approach, we undertook popular theatre as a means to disseminate our research findings. Popular theatre allows audience members to engage with a scene relevant to their own personal situation and to intervene during the performance to create multiple ways of critically understanding and reacting to a difficult situation. Using popular theatre was successful in generating discussion and engaging the community and healthcare professionals to discuss next steps to increasing access to healthcare services. Popular t...
In families where genetic testing for the breast cancer 1 and 2 genes (BRCA1/2) has not identifie... more In families where genetic testing for the breast cancer 1 and 2 genes (BRCA1/2) has not identified a deleterious mutation, the risk for hereditary breast cancer (HBC) can still be high when there is a strong family history. Little is known about how an awareness of risk for HBC impacts the everyday lives of unaffected women (no personal history for breast and/or ovarian cancer) in these families. The aim of this study is to explore how unaffected women, living in BRCA1/2-negative families, experience living with risk for HBC. van Manen's hermeneutic phenomenological approach guided this study. Unaffected at-risk women were recruited from a hereditary breast and ovarian cancer clinic in Western Canada. Nine women participated in 20 open-ended conversations. Phenomenological reflection on the 4 life existentials (lived space, body, time, and relations) revealed "Moving In and Out of the What-Ifs" as an overarching description that was communicated through the following themes: "Just Moving Along: Living a Normal Life," "Moving Into Those Dark Spaces," "Is there Something Wrong With Me"? "Markings in Time," "Living in the Moment," "Being Cared For," and "Keeping Me Grounded." The findings reveal how knowledge from predictive medicine impacts the lives of women and the importance of supportive relations and provides a foundation for future research into how health is perceived. The findings inform the practices of healthcare professionals as they engage in discussions with women living with risk for HBC and highlight the importance of a supportive relationship.
In seeking for an understanding of ethical practices in health care situations, our challenge is ... more In seeking for an understanding of ethical practices in health care situations, our challenge is always both to recognize and respond to the call of individuals in need. In attuning ourselves to the call of the vulnerable other an ethical moment arises. Asking 'how are you?' in health care practice is our very first possibility to learn how a particular person finds herself or himself in this particular situation. Here, 'how are you?' shows itself as an ethical question that opens up a relational space that calls forth a response. It is a way to understand the situated moments in which we are already that enables us to act respectfully. Our ethical frameworks assist us in trying to decide what is the right thing to do given a set of circumstances. Yet there is a prior step that already calls us to ethical attention; this is when we ask 'how are you?', which transforms a seemingly small interaction into an ethical moment. 'How are you?' is a question that turns us back to who we are as health care professionals and calls us to be more deeply attentive to the moment. When we sincerely ask 'how are you?' we enact our ethical commitments to one another.
Historically, comfort has been a quintessential aspect of nursing practice. Currently, it is ques... more Historically, comfort has been a quintessential aspect of nursing practice. Currently, it is questionable whether or not comfort remains an integral facet of nursing care. The increasing trend to focus on the technological and institutional aspects of patient care rather than the individual's response to illness and subsequent treatment is heard again and again from the growing vocal consumer movement. This study of comfort from a patient's viewpoint (a grounded theory) attempted to address both the current state of comfort care found within nursing practice and the patient's view of what constituted comfort while in hospital. The most significant finding was that comfort was not a passive process whereby the patients waited in hope of receiving comfort (i.e. such as someone to come and soothe their fevered brows). Comfort was found to be a dynamic process, with each patient actively engaged in increasing personal comfort levels. Indeed, the lack of comfort was found to be the stimulus for patients to embark on a process called 'integrative balancing'.
The Canadian Journal of Nursing Research Revue Canadienne De Recherche En Sciences Infirmieres, Aug 31, 2011
The authors designed a participatory qualitative research study to develop a collaborative partne... more The authors designed a participatory qualitative research study to develop a collaborative partnership between palliative care practitioners in Canada and in Chile. The research goal was to support the provision of palliative care in vulnerable settings through a participatory knowledge exchange process using qualitative and participatory methodologies. The study involved an interprofessional palliative care team from a primary health care centre in Chile and 5 adults receiving palliative care and their relatives. It also involved the participation of registered nurses and allied health professionals from a palliative home care team in Canada. Participatory knowledge exchange activities included teamwork with the primary health care team in Chile and a process of participatory knowledge exchange with palliative care clinicians in Chile and Canada. The study produced qualitative evidence on the efficacy of a process of participatory knowledge exchange with palliative care practitioners from 2 diverse settings.
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Papers by Brenda L. Cameron