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Title: What actions can novice nurse practitioners take to develop and maintain therapeutic relationships with adult patients in primary care?
Contributors: Tasenka Kushner (author), Erin Wilson (thesis advisor), Martha MacLeod (thesis advisor)
Abstract: Therapeutic relationships between health care providers and patients can have wide effects on patients’ health outcomes. There is a significant body of literature that has investigated therapeutic relationships in nursing and medicine. However, there is a lack of literature investigating therapeutic relationships between nurse practitioners and patients in primary care. The purpose of this integrative literature review is to identify actions that novice nurse practitioners can take to develop and maintain therapeutic relationships with adult patients in primary care. Using an integrative literature review approach, actions related to competence and knowledge, valuing and affirming exchanges, patient engagement and reciprocity, and appreciating context were identified. Engaging in these actions may help novice nurse practitioners develop and maintain therapeutic relationships with patients in primary care. Focusing on the British Columbian practice environment, this review makes recommendations related to professional identity, solidarity, role ambiguity, patient empanelment, complex patients, and transitions in care.
Discipline: Nursing-Family Nurse Practitioner

Title: NP-led obesity clinics: a NP guided primary care approach for managing obesity in low income preschool-age children in Canada
Contributors: Echo Heighes (author), Susan Johnson (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Childhood obesity continues to increase at alarming rates despite health prevention efforts to date. New innovative approaches are needed to help address this public health concern. Moreover, current literature confirms that early childhood is a fundamental time for establishing life behaviors that will follow into adulthood thus, the early years are considered to be an essential stage for developing both an unhealthy weight and its precursor behaviors. Social circumstances including socioeconomic status greatly impact health and are notable risk factors for the development of obesity. Acknowledging sociological influences and working within these constructs helps to create programs and care plans that are contextual. The purpose of this paper is to explore the role of nurse practitioners when working with low income families to address childhood obesity in the preschool-aged population in Canada, specifically within the setting of a NP-led obesity clinic. Literature to date does not exist for NP-led obesity clinics as this is a proposed approach to helping combat pediatric obesity. Existing literature regarding nurse-managed health centers and pediatric weight management programs were utilized to support the creation of a NP-led obesity clinic. Nurse-managed health centers have established that NPs are capable of providing appropriate medical treatment with positive health outcomes. Further, level of patient satisfaction and quality of care provided at nurse-managed health centers either met or exceeded national benchmarks for care. Pediatric weight management programs are in the infancy phase in Canada but have demonstrated positive weight management outcomes. Existing Canadian programs are informally evaluated to provide further support for the use of NP-led obesity clinics within the current Canadian health care system. This paper proposes that NP-led obesity clinics are a novel approach to help address childhood obesity within the primary care environment. --Leaf 2.
Discipline: Nursing-Family Nurse Practitioner

Title: Nurse practitioner use of a family centered care approach to manage childhood obesity in the primary health care setting
Contributors: Colleen Patenaude (author), Martha MacLeod (Thesis advisor), Linda Van Pelt (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Childhood obesity rates are rising at an alarming rate. Obesity has a negative impact on health and well being as well as social development. Obese children have a higher incidence of morbidity and mortality. Current clinical practice guidelines recommend practitioners use a family centered approach to managing childhood obesity. The purpose of this project is to examine the use of a family centered care (FCC) approach in managing childhood obesity in the primary health care setting and determine how best to incorporate it into managing childhood obesity in nurse practitioner (NP) practice. The principles of FCC are reviewed. NP use of existing nursing models such as the McGill model of nursing for guidance in incorporating family centered care into practice is examined and discussed. The research obtained during the literature review indicates using a FCC approach to disease management is effective and can be achieved in the primary health care setting. As a result of the findings, a five step approach to assessing and managing childhood obesity is recommended for NPs practicing in the primary health care setting. --Leaf ii.
Discipline: Nursing-Family Nurse Practitioner

Title: Considering the use of motivational interviewing for nurse practitioner practice with Aboriginal clients
Contributors: Colleen Isaiah (author), Lyle Grant (Thesis advisor), Sylvia Barton (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: The purpose of this scholarly project was to explore how motivational interviewing (MI) as a behaviour change intervention may be used with Aboriginal clients by nurse practitioners (NPs) in primary health care settings. Four systematic peer-reviewed articles with meta-analyses were located through a literature search of 11 databases, annotated, and evaluated for empirical evidence supporting its use in clinical practice by health care professionals. Four themes relevant to the application of MI by NPs were identified across the four articles: dose of MI, target behaviours, practitioner training in MI, and the essential components of MI. Project findings provide support for the use of MI with Aboriginal clients, in order to influence health behvioural change. It is proposed, that based on a potential theoretical fit between MI and Aboriginal concepts of health, such as interconnectedness, balance, and respect. Aboriginal clients might be more receptive of an intervention that is flexible enough to incorporate an Aboriginal worldview. The project concludes with a discussion of the implications MI has for nurse practitioner practice.
Discipline: Nursing-Family Nurse Practitioner

Title: Addressing chlamydia in middle aged and older women in rural and northern British Columbia
Contributors: Leona Christine Smith (author), Martha MacLeod (Thesis advisor), Kathy Banks (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: The purpose of this literature review is to identify the ways in which nurse practitioners working in primary care can incorporate sexually transmitted infection (STI) screening as part of the well woman examination, especially among middle-aged and older women and Aboriginal women, in order to prevent long-term complications of undiagnosed STIs, such as pelvic inflammatory disease (PID) and an increased risk of acquiring HIV. An integrative literature review revealed that there is an abundance of research about STI screening for women under the age of 25. However, there is limited research about STI screening, prevention, and treatment among sexually active middle-aged and older women. Primary care providers can conduct screening and prevention practices for chlamydia and other STIs by normalizing STI screening with a nonjudgmental attitude. All primary care providers need further education about the increasing rates of chlamydia and other STIs in middle-aged and older women. --Leaf ii.
Discipline: Nursing-Family Nurse Practitioner

Title: Adolescence and depression: reducing cardiovascular disease through preventive health checks
Contributors: Ashley Elizabeth Gueret (author), Lela Zimmer (thesis advisor), Celia Evanson (thesis advisor), University of Northern British Columbia College of Arts, Social, and Health Sciences (Degree granting institution), Sandra Allison (committee member)
Abstract: Adolescent depression is a prevalent, serious health condition seen in primary care that is associated with many adverse physiologic changes, including cardiovascular disease. The aim of this integrative review was to examine those cardiovascular changes and determine whether preventive health checklists can help screen, identify, and ultimately prevent these changes. The eight studies selected for this review do not provide enough evidence to support the use of preventive health checklists as a way to prevent the cardiovascular effects of depression in adolescents. However, they form the basis for recommendations to be implemented in the primary care setting for ways to mitigate the risk of cardiovascular disease in adolescents with depression including using a multidisciplinary approach and guidelines for monitoring vital signs, weight, and bloodwork of these adolescents. Areas for future research are suggested and limitations of the evidence are also acknowledged.
Discipline: Nursing-Family Nurse Practitioner

Title: Complementary and alternative therapies: supporting the woman with inadquate milk production
Contributors: Eunice Finch (author), Lela Zimmer (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: While the benefits of breastfeeding are well established, and high initiation rates indicate that women recognize these benefits and wish to provide their infants with the healthiest beginnings, duration rates indicate that women are having difficulty overcoming challenges in the early weeks of breastfeeding. Studies indicate that early breastfeeding cessation is correlated with perceived or actual inadequate milk supply (Lewallen et al., 2006). While the traditional management of insufficient supply during breastfeeding has involved breastfeeding support with particular attention to effectiveness of maternal and infant position, milk transfer, and frequency of feeds, some women may not see improvement in supply from traditional measures. Breastfeeding websites, parenting books, and review articles by breastfeeding professionals suggest the use of complementary and alternative therapies such as acupuncture, herbal medicines, relaxation therapy, aromatherapy, and homeopathy to increase milk supply, however little clinical evidence exists to support the use of such therapies. This literature review summarizes the available data in research and grey literature regarding the use of acupuncture and herbal medicine in managing insufficient milk supply. The majority of evidence supporting the use of acupuncture and herbal medicine in the breastfeeding woman is qualitative and quasi-experimental, with few randomized controlled trials supporting the safety and efficacy of these treatments for increasing milk production in the lactating woman. The role of the nurse practitioner in supporting patients using complementary and alternative therapies is discussed. --Leaf 2.
Discipline: Nursing-Family Nurse Practitioner

Title: Collaborating with palliative care teams to provide end of life care for patients with heart failure
Contributors: Melanie Starzyk (author), Shannon Freeman (thesis advisor), University of Northern British Columbia College of Arts, Social, and Health Sciences (Degree granting institution), Fiona Hutchison (committee member)
Abstract: Advanced heart failure (HF) can be difficult for nurse practitioners (NPs) to manage in primary care due to the unpredictable nature of the condition. Further, barriers that patients with HF experience in regards to receiving end of life (EOL) care hinder NP collaboration with palliative care teams. The goal of the project is to answer: How can NPs working in a primary care setting collaborate with palliative care teams to provide patients who have HF with EOL care? A literature search was conducted using the Cumulative Index of Nursing and Allied Health, PubMed Medline, PsychInfo, Social Work Abstracts and the National Guideline Clearinghouse electronic databases. Evidence was also gathered using backward and forward reference searching, and highly relevant grey literature from the BC Heart Failure Network. The Canadian Interprofessional Health Collaborative (CIHC) framework was used to describe the theoretical underpinnings of this paper by outlining the factors involved to achieve interprofessional collaboration. There were 33 articles retrieved during the literature search to inform how NPs can collaborate with palliative care teams for patients with HF at EOL. There were no articles that answered the research question directly. Instead, barriers and issues for patients with HF receiving EOL care were identified in the findings. Nurse practitioners can collaborate with palliative care teams by addressing the barriers to EOL care for patients with HF that relates to communication, leadership, role clarification, team functioning, and conflict resolution. Nurse practitioners should be encouraged to collaborate with palliative care teams to improve accessibility to palliative care for patients with HF at EOL. Future research is needed to directly inform how collaboration can occur with palliative teams to provide patients who have HF with EOL care.
Discipline: Nursing-Family Nurse Practitioner

Title: The role of nurse practitioners in primary care in optimizing risk stratification for coronary heart disease in Canadian women: an integrative review
Contributors: Parveen Sangha (author), Caroline Sanders (Thesis advisor), Linda Van Pelt (Thesis advisor), Davina Banner-Lukaris (Thesis advisor), University of Northern British Columbia College of Arts, Social, and Health Sciences (Degree granting institution), Natasha Prodan-Bhalla (Committee member)
Abstract: Coronary heart disease (CHD) is the most common cause of morbidity and mortality in Canadian women. Despite advances in screening and research, CHD continues to pose a significant health care burden to Canadian women. This integrative literature review explores how a Nurse Practitioner (NP) in primary care can optimize risk stratification for CHD in Canadian women. A systematic search of the contemporary literature identified 11 key articles. These were analyzed using the Critical Appraisal Skills Programme tools to assess relevance and the strengths and weaknesses of the evidence. Three key themes emerged from the literature and are explored in detail: the limitations of current risk prediction models for risk stratification in women; the emergence and evolving importance of female-specific risk factors; and additional adjunctive testing (coronary artery calcium screening) that may improve the accuracy of risk prediction models in women. ...
Discipline: Nursing-Family Nurse Practitioner

Title: Nurse practitioner use of patient-centered care to improve the quality of life of women experiencing vasomotor symptoms of menopause
Contributors: Shannon Campbell (author), Lela Zimmer (Thesis advisor), Linda Van Pelt (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Menopause is a passage in every woman's life. Hormonal changes are responsible for the cessation of ovulation, and this transition can be difficult for some women. Vasomotor symptoms (VMS), consisting of hot flashes/flushes and night sweats, can be bothersome for some, and VMS are the primary reason for women to seek medical attention during menopause. Patient-centered care (PCC) is an approach which improves discussion, promotes patient involvement, and creates a positive provider/patient relationship with a result of improved quality of life (QOL). Hormone therapy, the gold standard for VMS relief, has come under scrutiny in recent years due to a fear of increased health risks with its use. Complementary and alternative medicines are being promoted as natural alternatives. Women are seeking help to make sense of the variety of treatment options available for VMS relief and nurse practitioners are in an optimal position to help these women. Through the use of PCC, nurse practitioners (NP) can conduct a thorough health history and assessment. They can provide expert advice, hold discussions with women about their preferences and assess them for individual risks with the ultimate provision of appropriate and individualized care for women experiencing VMS of menopause. --P. ii.
Discipline: Nursing-Family Nurse Practitioner

Title: Role of nurse practitioner in addressing aboriginal diabetes prevention
Contributors: Douglas Andrew King (author), Martha MacLeod (Thesis advisor), Denise Tarlier (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: The current epidemic of Type-2 diabetes among Aboriginal Peoples in Canada has been associated with the poor socioeconomic status of Aboriginal Peoples. Most strategies in diabetes prevention treat health behaviour as an individual choice and ignore how the social determinants of health shape people's health behaviour. The purpose of this project is to explore how NPs might more effectively approach diabetes prevention in Aboriginal communities. This integrative literature review includes a critical analysis of Aboriginal community-based diabetes prevention strategies. A synthesis of their shared characteristics shows that effective community-based diabetes prevention strategies are congruent with primary health care and social justice perspectives on health, which focus on empowering communities and correcting institutionalized discrimination. Community-based strategies empower communities to take control of health promotion efforts and improve community resources and infrastructures that support healthier lifestyles. With an understanding of community-based programs, NPs can begin identifying how primary health care and social justice perspectives can strengthen existing diabetes prevention efforts in Aboriginal communities. --P. i.
Discipline: Nursing-Family Nurse Practitioner

Title: Shared decision making in primary care: barriers and facilitators of shared decision making in the context of decreasing the use of unnecessary antibiotics for preschool children ages 3-5 with upper respiratory tract infections
Contributors: Danielle Raiser (author), Linda Van Pelt (Thesis advisor), Janet Bailles (Thesis advisor), University of Northern British Columbia College of Arts, Social, and Health Sciences (Degree granting institution), Chantel Canessa (Committee member)
Abstract: The unnecessary use of antibiotics for upper respiratory infections is a global public health concern (Alumran, Hou & Hurst, 2013; Lucas et al., 2015; Dwibedi et al., 2015; Kutty, 2011; Llor & Bjerrum, 2014; Rouusounides et al., 2011). This issue is most prevalent in preschool aged children, due to the frequency of upper respiratory tract infections in this group (Alumran, Hou, & Hurst, 2013; Clavenna & Bonati, 2011; Vodicka, et al., 2013). An integrative review was done and ten articles were chosen to answer the question: What are the barriers and facilitators to implementing shared decision making in relation to unnecessary antibiotic use in primary care settings when primary care providers are working with parents of preschool aged children with upper respiratory infections? Barrier subthemes identified were ineffective communication and lack of parental knowledge...
Discipline: Nursing-Family Nurse Practitioner

Title: Nurse practitioners: improving coronary heart disease management in South Asian Canadians
Contributors: Navineet Sahota (author), Davina Banner-Lukaris (Thesis advisor), Susan Johnson (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Coronary heart disease rates are much higher amongst South Asian Canadians than any other Canadian ethnic group. This project asks the question, How will a nurse practitioner implement culturally sensitive coronary heart disease interventions to improve the health outcomes of the South Asian population? To respond to this research question, a literature review and analysis of studies describing various research data, as well as perceptions among the South Asian community, was completed. Evidence suggests that the South Asian population has a genetic tendency to coronary heart disease. More importantly, there are environmental, dietary, and lifestyle factors that might also contribute to this higher incidence. South Asians are underutilizing the traditional health service. Research indicates that health services and treatments are not culturally relevant. Madeline Leininger's theoretical framework, which advocates for the theory of Culture Care Diversity and Universality, is utilized to examine the literature and used to prepare culturally sensitive coronary heart disease interventions for the South Asian population. In this paper, it is argued that implementation of culturally sensitive coronary heart disease interventions delivered by a nurse practitioner can positively influence the management and the outcome of coronary heart disease in the South Asian population. --P. ii.
Discipline: Nursing-Family Nurse Practitioner

Title: Clinical encounters in Canada's northern territories: implications for nurse practitioners working with aboriginal women to promote sexual health
Contributors: Michelle R. Wolsky (author), Martha MacLeod (Thesis advisor), Janet Baillies (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: In Canada's northern territories, nurse practitioners (NPs) play a significant role in the delivery of health care and are often the first and only point of contact as primary health care providers for Aboriginal women. As such, NPs are uniquely situated to work with Aboriginal women in northern communities to address the greater health inequities, incidences of communicable and chronic disease in ways that account for locally specific historical, geographic, economic, social, and cultural contexts. However, it is increasingly evident that clinical encounters between NPs and Aboriginal women in the north are not resulting in improved sexual health outcomes. The intent of this review was to explore the factors influencing why sexual health outcomes for Aboriginal women are not improving. A review of Nursing and Aboriginal peoples' health literature revealed that, while broader colonial contexts inform Aboriginal women's health, there are concrete structural and interpersonal factors that most directly impact clinical encounters. These include how health services are delivered to Aboriginal peoples in Canada, the health policies that govern the delivery of health care to Aboriginal women, and NP clinical practice issues in the north. These factors come together to inform how relationships between NPs and Aboriginal women can and does evolve in clinical settings. What is evident from this review is the importance of NPs becoming aware of the historical complexities and post colonial processes that impact Aboriginal women's health. This awareness will allow NPs to work collaboratively with Aboriginal women to address those mechanisms of delivery, policies, and cultural attitudes that can act as barriers for accessing health care. It is through working collaboratively with Aboriginal women to improve clinical encounters that changes in sexual health outcomes will occur. --P. iii.
Discipline: Nursing-Family Nurse Practitioner

Title: Effects of primary prevention on early childhood caries in Canadian First Nations children ages 0-4 years
Contributors: Shirley Nixon (author), Heather Correale (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Early childhood caries (ECC) in Canadian First Nations (FN) children is at disproportionately high levels compared to the national average. Current literature suggests a paradigm shift in approach to the causes and management of ECC can significantly decrease these levels. The purpose of this paper is to critically analyze the question 'For Canadian First Nations children, ages 0-4, could the introduction of primary disease prevention and self management reduce levels of ECC compared with the present model of care?'
Discipline: Nursing-Family Nurse Practitioner

Title: Collaborative nurse practitioner and physician health care service provision for at-risk seniors in Fort St. John, B.C.
Contributors: Diella Schatz (author), Martha MacLeod (Thesis advisor), Lela Zimmer (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Collaborative nurse practitioner and physician primary health care service provision has the potential to improve access, ensure quality, and promote cost effective primary health care and case management for frail elders. Through a critical appraisal of research, this paper will seek to explore outcomes regarding the provision of collaborative nurse practitioner and physician community based primary health care service for the frail elderly. The research substantiates that collaborative nurse practitioner and physician health care service provision to at-risk seniors reduces emergency department utilization, reduces admissions to hospitals and nursing homes, and maintains or improves functional capacity. Three integrated health care service delivery models will be discussed, critiqued, and woven into these research findings to serve as a framework to sift these research finding into practice. Finally, recommendations based on this research will be proposed for integration into the Northern Health Authority Integrated Health Network for at-risk seniors in Fort St. John, B.C. for application of these research findings in practice..--P.ii.
Discipline: Nursing-Family Nurse Practitioner

Title: Screening for glucose metabolism disorders: a comprehensive review
Contributors: Enid O'Hara (author), Davina Banner-Lukaris (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: There is an epidemic of Type 2 diabetes. It is predicted that by 2030 that the number of those with Type 2 diabetes will rise to over 350 million globally. There has been much debate regarding the cost effectiveness of early intervention in Type 2 diabetes. Studies have shown that despite ' intensively' treated patients serious complications still occur. Research indicates there is demonstrable and quantifiable insulin resistance and either impaired fasting glucose or impaired glucose tolerance for 5 to 10 years before the onset of Type 2 diabetes. It is in this state of a glucose metabolism disorder there is an opportunity to prevent or delay the onset of diabetes. This project provides a comprehensive review of the contemporary research literature to answer the question What is the best test to screen adults for glucose metabolism disorders, for earliest possible detection in a primary care setting in Canada . A review of 71 studies identified strengths and weaknesses of a variety of screening modalities. The key finding was that the Oral Glucose Tolerance test (OGTT) is the most sensitive test in all populations for identification of glucose metabolism disorders. It is also clear that despite recommendations by contemporary clinical guidelines, the use of HbA1c is ill suited to identification of glucose metabolism disorders. It is therefore recommended that the OGTT be used were feasible in testing for glucose metabolism disorders, preferably with plasma insulin levels being done at the same time to facilitate the use of an insulinogenic index. If this is not possible, consideration should be given for using glucose challenge testing or Hba1c and fasting plasma glucose in combination. The Nurse Practitioner, along with other primary health care practitioners, is in an ideal position to intervene in the disease trajectory through effective screening and patient education. Interventions have the promise of improving patient and health system outcomes and reducing the future personal and financial
Discipline: Nursing-Family Nurse Practitioner

Title: Group appointments & lifestyle coaching to reduce complications of type 2 diabetes in primary care settings
Contributors: Natalie Manhard (author), Vincent Salyers (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Type 2 diabetes is a common illness and affects many people. It will afflict approximately 7 million people yearly and reach epidemic proportions by 2025. This project provides an overview of literature from 1998-2008 supporting group medical appointments as a means for overseeing type 2 diabetes care, with an emphasis of self-management and nurse-practitioner coaching in chronic disease management.
Discipline: Nursing-Family Nurse Practitioner

Title: Nurse practitioner models of care in rural northern British Columbian emergency care settings
Contributors: Linda Van Pelt (author), Eileen Owen-Williams (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Emergency room congestion and long wait times have become prevalent in emergency departments across Canada. Emergency care providers in the Northern Health Authority region of northern British Columbia also struggle to provide quality emergency care in the face of challenges that impact access to timely emergency care. Nurse Practitioners are a new class of health care provider in British Columbia that have the skills and knowledge to provide care for many of the patients who present to Northern Health Authority emergency departments. The question posed in this project is as follows. Would a model of emergency care utilizing the NP role increase patient access and decrease wait times in British Columbia's Northern Health Authority emergency departments as compared to the current model of care? The focus of this project is a review of literature related to the role of Nurse Practitioners (NPs) in emergency department settings, as well a consideration of NP models of emergency care that would increase access and decrease wait times for quality emergency care in the Northern Health Authority. The results of the literature review support the addition of a NP model of care to emergency care setting in northern British Columbia. As Nurse Practitioners are deployed across British Columbia and the Northern Health Authority, continued assessment, analysis, planning, pilot project implementation, change management, evaluation and research related to NP roles in emergency care settings are pivotal to the successful implementation of NP models of emergency care in the region.--P.ii.
Discipline: Nursing-Family Nurse Practitioner

Title: Anticoagulant versus antiplatelet therapy for acute ischemic stroke
Contributors: Tracey L. Rutledge (author), Martha MacLeod (Thesis advisor), Amy Klepetar (Thesis advisor), University of Northern British Columbia (Degree granting institution)
Abstract: Acute ischaemic stroke is a leading cause of death in Canada and should be a priority in health care. This paper defines acute ischaemic stroke and provides current statistics, economic costs, risk factors, treatments, and management options. A gap between current practice and literature is identified. Specific treatments of anticoagulant and antiplatelet therapy are explored through systematic reviews, clinical trials, and national guidelines. Considerable consistency in research findings have led to evidenced-based guidelines. Implications for practice, including barriers and facilitators to incorporating evidence-based recommendations are identified. The study concludes with an identification of current provincial guidelines that will provide best patient care in treating patients with acute ischaemic stroke.
Discipline: Nursing-Family Nurse Practitioner