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Posts tagged ‘Sheryl Reimer-Kirkham’

Embedding a Palliative Approach in Nursing Care Delivery

We are delighted to feature the open access article titled “Embedding a Palliative Approach in Nursing Care Delivery: An Integrated Knowledge Synthesis” authored by Richard Sawatzky, PhD; Pat Porterfield, MSN; Della Roberts, MSN; Joyce Lee, PhD; Leah Liang, MSN; Sheryl Reimer-Kirkham, PhD; Barb Pesut, PhD; Tilly Schalkwyk, MSN; Kelli Stajduhar, PhD; Carolyn Tayler, MSA; Jennifer Baumbusch, PhD; and Sally Thorne, PhD. This article not only addresses the significant challenges of palliative care, but also serves as an example of the translation of knowledge into practice. We welcome you to download and read the article at any time – it is permanently available at no cost to readers.  Then return here and share your comments and ideas!  This is a message from Dr. Sawatzky about the work of this team of authors:

“A palliative approach is not a service” (quote from Carolyn Tayler)

Richard Sawatzky

Although we realize that end of life care may require care from professionals who have been formally trained in palliative care, mostpeople who have life limiting illnesses receive care in settings where access to palliative care professionals is limited. To address this, our team has been studying how the notion of “a palliative approach” can help to embed general principles and practices of palliative care broadly into the healthcare system. The Initiative for a Palliative Approach in Nursing: Evidence and Leadership (, led by Kelli Stajduhar and Carolyn Tayler) engages nurse researchers, practitioners, and administrators in British Columbia, Canada, who share a common goal to integrate a palliative approach throughout the healthcare system. Building on our prior publication on “Conceptual Foundations of a Palliative Approach” (Sawatzky, Porterfield et al. 2016), the current article is one of the iPANEL studies that specifically seeks to synthesize across insights derived from different sources of knowledge relevant to a palliative approach as the basis for supporting nursing care teams to embed a palliative approach into their practice. In doing so, we have broadened the scope of what is

Pat Porterfield

typically considered “knowledge synthesis”, by translating general knowledge from previous studies into particular contexts of nursing practice. This knowledge synthesis process reflects the fundamental form of nursing knowledge application we articulated in a prior publication in ANS on “Particularizing the General” (Thorne and Sawatzky, 2014). We hope that, in addition to contributing to an understanding of a palliative approach, the article will spark further discourse about effective methodologies for particularizing general knowledge within local contexts of everyday nursing practice.

Death Is a Social Justice Issue

Our first featured article from the latest ANS issue is titled “Death Is a Social Justice Issue: Perspectives on Equity-Informed Palliative Care” by Sheryl Reimer-Kirkham, PhD, RN; Kelli Stajduhar, PhD, RN; Bernie Pauly, PhD, RN; Melissa Giesbrecht, PhD; Ashley Mollison, MA; Ryan McNeil, PhD; and Bruce Wallace, PhD.  While this article is featured it is available for download at no cost! Please read it, then return here to join a discussion around these important ideas!  Here is a message from Dr. Reimer-Kirham about their work:

In this paper, we lay the theoretical groundwork and make the case for equity-informed palliative care.  We draw on the Equitable Access to Care (EAC) study to explore the end-of-life experiences of people who are ‘doubly

Sheryl Reimer-Kirkham

Sheryl Reimer-Kirkham

vulnerable’ – those who are dying and experiencing hardships due to social determinants of health such as poverty, homelessness, racialization and criminalization. Our research emerged out of the distress of health and social service workers who witnessed their clients dying prematurely because they were diagnosed with life-limiting conditions too late, when treatment options were either not available or less effective.

The EAC study seeks to understand barriers to quality end-of-life care and to create recommendations for policies and practices to improve equitable access and enhanced quality of care.  To conduct our research, we observe and interview people experiencing structural vulnerability at the end-of-life, their ‘chosen’ family and service providers, and key decision makers from various service backgrounds. Our study also looks at promising models and practices of end-of-life (EOL) care for homeless people that can be applied in the local context.

Our team is a community-academic partnership which includes the University of Victoria (Institute on Aging &

Kelli Stajduhar

Kelli Stajduhar

Lifelong Health, School of Nursing, and Centre for Addictions Research of BC), Trinity Western University (School of Nursing), BC Centre for Excellence in HIV/AIDS, Palliative Education and Care for the Homeless (PEACH), and the Palliative Outreach Resource Team (PORT). PEACH is a palliative consult/support service for homeless people in Toronto, ON. PORT is a group of service providers who work to improve quality and access to palliative and bereavement services for dying homeless people in Victoria, BC. Our study began in 2014 and we plan to release results by fall 2017.

As a community-academic partnership, it is important to us that we collaborate with our networks to foster

Bernie Pauly

Bernie Pauly

dialogue, raise awareness, and create practical recommendations to bring about social change.  Highlighted in this paper, last year we brought together specialized palliative care services with community health and social service workers to host A PORT in the Storm: A day of education and discussion about equitable access in palliative care. Outcomes from this event included networking, awareness, and greater understanding of services available, and the organizational barriers to providing quality care at EOL.

In this paper, we explore how a social justice lens in palliative care can illuminate how social and structural inequities profoundly shape health, illness, and dying experiences for people who are made particularly vulnerable by a constellation of socio-political, economic, cultural and historical forces.  By offering three exemplars – Leslie, George, and Cliff – we illustrate why an equity-informed approach to palliative care is desperately needed for a nuanced understanding regarding who current palliative care programs are failing.

Recently, our study team wrote an op-ed called Homeless Deserve End-of-Life Care but aren’t getting it to direct attention to the story of a homeless, Indigenous man in our community who was discharged from hospital after surgery with no place to go. Our study and the experience of homeless people at EOL garnered international attention when the Canadian Broadcasting Corporation (CBC)  picked up this story. Dr. Kelli Stajduhar recently spoke to The Walrus Talks Quality of Life audience about the value of palliative care and its lack of availability in Canada.  (see also Acknowledgements noted on manuscript).

Our hope is that our article and this blog increases awareness about the need for equity-informed approaches to palliative care, including prompting discussion around the following questions: What are the experiences of health and social service workers in providing EOL care (both ‘informal’ and specialized) to people experiencing structural vulnerability? What policies and practices have supported quality end-of-life care for this population?




Decolonizing Health Research on Female Genital Cutting

The current ANS featured article addresses a social/cultural and health issue that has engaged intense discussion in many circles for a number of years – the issue of genital cutting.  The article is titled “A Decolonizing Methodology for Health Research on Female Genital Cutting,” authored by Jane Werunga, MSN, RN; Sheryl Reimer-Kirkham, PhD, RN and Carol Ewashen, PhD, RN, and it is available for free download on the ANS website while it is featured. We invite you to download your copy of this article and return here to participate in discussion of ideas and issues addressed here.

Ms. Werunga shared this message about her work:

It is an immense pleasure to have our article featured on the ANS blog. The idea for this article was conceived from a course on critical perspectives in nursing and health care that I took under the guidance of Dr. Sheryl

Jane Werunga

Reimer-Kirkham in my quest to understand alternative methodologies for researching marginalized populations. Coming from a non-research background, I had very little knowledge on the multiple theories and methodologies that guide contemporary health research, but I understood that a fitting methodology would need to be sufficient enough to cover the complexity of the topic that I was proposing, which was research on African immigrant and refugee women and girls who have experienced female genital cutting (FGC).

Immigrants occupy unique cultural and spatial locations where they are constantly having to negotiate new ways of doing and being while adapting to new identities which for most, are marginalized and “marked” by historical, cultural, political, and migratory forces. The worldwide controversy surrounding the practice of FGC further compounds issues for affected women and girls living in Western locales particularly with regards to their health and wellbeing. I believe that nursing research on immigrants should reflect this conflation of experiences in order to fully lay bare the

Sheryl Reimer-Kirkham

Sheryl Reimer-Kirkham

socio-political and cultural structures that inform their health and health seeking behaviors. When I embarked on my doctoral research on FGC, I quickly realized that I could not locate this study within mainstream methodologies given the complexity of the issues therein. I needed a multifactorial approach that could fully capture the many forces at play. Critical decolonizing perspectives offer this alternative, and this article is an initial attempt to curve out an innovative methodology that combines several critical perspectives including African feminism, in an effort to reconceptualize FGC research in a new cultural dispensation. Critical perspectives disrupt commonplace pathologizing, criminalizing, and demonizing discourses, as reflected in the shift in language from “female genital mutilation” to “female genital cutting”.

This article reflects my doctoral work-in-progress; PhD supervisors and co-authors, Dr. Ewashen and Dr. Reimer-Kirkham, remain instrumental in the conceptualization of this methodology as I move into the fieldwork phase of my research. Dr. Ewashen’s knowledge on body politics, critical feminist, and poststructural research

( and Dr. Reimer-Kirkham’s vast experience in

Carol Ewashen

Carol Ewashen

the areas of culture, equity, and health ( will no doubt be invaluable as I map out a rigorous and scientifically valid method that reflects the complexities of the experiences of affected women and girls. The endpoint of my research is the provision of socially just, relevant, timely, and equitable nursing and other health care services to marginalized populations.

We appreciate the opportunity to share our developing ideas in this area of nursing research.



Integrated Knowledge Translation: Addressing the Knowing/Doing Gap

Gweneth Hartrick Doane and Sheryl Reimer-Kirkham have been working with a team of nursing scholars for several years, exploring the philosophic underpinnings and the practice implications of translational research.  The current issue of ANS features two articles based on their work.  The current featured article is “(Re)theorizing Integrated Knowledge Translation: A Heuristic for Knowledge-As-Action” authored by Gweneth Hartrick Doane, PhD; Sheryl Reimer-Kirkham, PhD; Elisabeth Antifeau, MSN and Kelli Team600Stajduhar, PhD.  The second article which will appear as a featured article starting on September 19th, is titled “Translational Scholarship and a Palliative Approach: Enlisting the Knowledge-As-Action Framework” authored by Sheryl Reimer-Kirkham, PhD; Gweneth Hartrick Doane, PhD; Elisabeth Antifeau, MSN; Barbara Pesut, PhD; Pat Porterfield, MSN; Della Roberts, MSN; Kelli Stajduhar, PhD; and Nicole Wikjord, MSN. Dr. Doane and Dr. Reimer-Kirkham provided this message about their work for ANS readers:

We have been engaged in translational scholarship—under the umbrella of “knowledge translation” for some time, interested in its philosophic underpinnings on the one hand and its practice orientation on the other. The two papers in the ANS 38:3 issue were developed in the context of a research-practice collaborative in British Columbia (iPANEL) that shares a common goal of advancing the further integration of a palliative approach into the healthcare system. We are indebted to the many nurses engaged in this initiative as investigators, clinicians, and affiliates and to Michael Smith Foundation for Health Research (MSFHR) for their generous funding.

Within the knowledge translation (KT) literature how to actually do interactive and integrative KT has been identified as the primary question researchers are currently facing. It has become increasingly clear that something beyond instrumental, prescriptive approaches that arise out of externally-driven knowledge concerns, and impose directives for evidenced-based ‘best’ practice are needed to affect meaningful change at the practice level.

As we have conducted our various KT research projects and pondered possibilities, three key insights that offer a different KT approach (at the conceptual and practical level) have emerged. First, we have come to see the fundamental importance of KT being an inquiry process. Taking an inquiry approach involves working between the existing (what is known) and the emergent (what is not fully known and/or what might be needed). Structuring KT as a process of inquiry and working ‘in-between’ what is known/not known focuses attention on the specific features of a situation and highlights that the question “How best to proceed?” can only be answered within those particularities.

Typically KT is focused toward ‘filling a knowledge gap.’ It is assumed that ‘the problem’ is one of knowledge—people simply lack the latest research knowledge. However, that assumption has not held up in our research. As we describe in our papers, even when the latest research evidence is known there may still be a gap between the care that should be provided and the care that is offered. Subsequently a second insight we propose is that KT is not about filling a gap as much as working in the gap—the gap between the real and the ideal, between realities and possibilities— and seeing that practice gap as a fruitful site for the development of knowledge and practice capacity. It is this gap between real and ideal practice that is of utmost concern to patients, nurses and other health practitioners and that serves as the greatest impetus for practice change. Orienting KT toward a shared practice concern (i.e., the gap between real and ideal care) serves to align practitioners’ deeply felt concerns with their capacity to address those concerns. Moreover, it enables practice concerns to be heard and shared and knowledge to be enlisted to effect change. It also democratizes the knowledge process and knowledge milieu, fostering inclusivity and responsiveness to multiple forms of knowledge.

Finally our third insight is the importance of having a KT process in which nurses and other health practitioners play a central role. And this is where the KITE heuristic, the Knowledge-AS-Action Framework (see Figure below), that we describe in our papers comes in. If the goal of KT is to have the most up-to-date knowledge inform and reshape practice, is it not the practitioners who need to be supported to take the active and central role of determining the relevance and usability of any research knowledgeand, moreover, of determining the direction of the KT process itself? The KITE heuristic opens the space for practitioners to put their own expertise to work. At the same time the heuristic structure serves to identify the multiple forms of knowledge that exist, the further knowledge that might be needed as well as directions for action. The heuristic by its very nature provides an integrated way of thinking about practice development and change that is grounded in explicit and shared values and goals.

While our papers discuss the use of the KITE heuristic in integrating a palliative approach into nursing practice, we believe the heuristic may have utility across a range of practice contexts and concerns. As part of the blog discussion we invite you to consider that possibility and respond to what we have proposed—even consider trying out the heuristic in your area of nursing practice and/or with a current concern. We look forward to hearing your thoughts and experiences.

Indeed, these two articles provide compelling insights and possibilities for practice in many clinical situations. I hope you will visit the ANS web site, download these articles while they are featured, and then return here to add your responses and ideas!

Design by University Communications, Trinity Western University

Design by University Communications, Trinity Western University

Spirituality and Social Justice

In the current ANS featured article, author Sheryl Reimer-Kirkham, PhD, RN explores an area of scholarship that is rare in nursing literature – the interplay between social justice, religion, spirituality, health, and nursing. The article is titled “Nursing Research on Religion and Spirituality Through a Social Justice Lens.” Dr. Reimer-Kirkham uses the critical perspectives of postcolonial feminism and intersectionality to inform nursing’s perspectives on spirituality and social justice. She has shared this background about her work in this area:

Bringing together critical perspectives (such as postcolonial feminism and intersectionality) and research on religion and spirituality in nursing has opened up new and productive terrain.  And yet, conversations on religion/spirituality and social justice can be contentious:  for some religion is dismissed as too irrational, too political or violent, or too bound up in structures of power; for others religious/spiritual beliefs are held as too “sacred” for objective, scholarly analysis.  Such contentions leave many to appeal to secularism as the way to manage religion and spirituality in the public sphere.

Dr. Reimer-Kirkham

Dr. Reimer-Kirkham

However, attempting neat separations between religion and the secular can, according to philosopher Charles Taylor, do more to obscure what is going on in our world than clarify the moral issues we face.  Shying away from critical analyses of the intersections of faith with nursing, religion/spirituality with social justice and equity, leaves us open to incomplete analyses, and fails to account for influences on the values, beliefs and practices of many of our patients.  Several recently published books by nurse scholars move beyond generic approaches to spirituality to engage more specifically with the influence of various religious traditions.  See for example Stajduhar and Coward’s (2012) Religious understandings of a good death in hospice palliative care, SUNY Press; Taylor’s (2012) Religion: A clinical guide for nurses, Springer; and Fowler et al.’s (2011) Religion, Religious Ethics and Nursing,Springer.

My entrée into the integration of religion/spirituality with critical research came about during my doctoral research that examined intergroup relations in hospital settings.  As I conducted this ethnographic research, I realized that many of the hardspots described by nurses and patients in intergroup interactions were directly shaped by religious perspectives and often involved accommodating religious values and rituals, and yet these situations were nearly always conveyed to me as cultural matters.  While there is significant overlap between culture and religion/spirituality, there are also important distinctions. So I have worked toward more intentional analyses of religion and spirituality in the context of health and healthcare, and am convinced of the importance of intersectional approaches in such scholarship. Intersectional analyses inevitably require that we take seriously social relations of power mobilized through religion as it intersects with gender, race, class, ability, and other social categories; particularly as these social relations contribute to equity and inequity.  The relationship between social justice and religion is critical, but not always straight forward.  Human rights and religious accommodation can, in fact, represent competing interests (e.g., religious freedom vis-à-vis heteronormativity or patriarchy).

In this manuscript, I propose critical nursing scholarship on how religion and spirituality relate to social justice and social transformation in the context of health and healthcare. I look forward to your views on the matter!

I too hope you will read Dr. Reimer-Kirkham’s article and return here to join in a discussion of her ideas!  You can download the article at no cost while it is featured on the ANS web site!  

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