Judy Mill

University of Alberta, Edmonton, Alberta, Canada

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Publications (43)31.21 Total impact

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    ABSTRACT: There is limited literature describing the methodological and pragmatic considerations that arise when conducting participatory action research utilizing Photovoice with children, particularly within sub-Saharan Africa. We provide a case example of these considerations based on a qualitative exploratory design that was conducted in June 2010 with 13 children between the ages of 12 and 18 years who were orphaned and living with HIV in a group home setting in Western Uganda. The main purpose of this study was to explore the children’s experiences while including them in a participatory way utilizing Photovoice to share their stories, define their issues, and propose their own solutions. Conducting research in another country where language and culture are different from the researchers’ can pose many unique methodological, epistemological, and ethical challenges. These issues are discussed by reflecting on the process of the study. Key lessons will also be discussed regarding the methodological and pragmatic considerations with the aim of providing new insights for researchers who want to conduct research in a cross-cultural and multilingual setting.
    Sage Open. 05/2014; 4(April-June):1-10.
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    ABSTRACT: Nurses are knowledgeable about issues that affect quality and equity of care and are well qualified to inform policy, yet their expertise is seldom acknowledged and their input infrequently invited. In 2007, a large multidisciplinary team of researchers and decision-makers from Canada and five low- and middle-income countries (Barbados, Jamaica, Uganda, Kenya, and South Africa) received funding to implement a participatory action research (PAR) program entitled “Strengthening Nurses’ Capacity for HIV Policy Development in sub-Saharan Africa and the Caribbean.” The goal of the research program was to explore and promote nurses’ involvement in HIV policy development and to improve nursing practice in countries with a high HIV disease burden. A core element of the PAR program was the enhancement of the research capacity, and particularly qualitative capacity, of nurses through the use of mentorship, role-modeling, and the enhancement of institutional support. In this article we: (a) describe the PAR program and research team; (b) situate the research program by discussing attitudes to qualitative research in the study countries; (c) highlight the incremental formal and informal qualitative research capacity building initiatives undertaken as part of this PAR program; (d) describe the approaches used to maintain rigor while implementing a complex research program; and (e) identify strategies to ensure that capacity building was locally-owned. We conclude with a discussion of challenges and opportunities and provide an informal analysis of the research capacity that was developed within our international team using a PAR approach.
    International Journal of Qualitative Methods. 05/2014; 13:151.
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    ABSTRACT: Purpose In 2009 we conducted a study to explore Ugandan nurses’ practice of universal precautions while caring for persons living with HIV. During our interviews about universal precautions, nurses’ also shared their experience with post-exposure prophylaxis (PEP) following needle-stick injuries. We present findings related to nurses’ understanding of PEP and their experience with, and reporting of, needle stick injuries. Background Nurses have high rates of exposure to blood-borne pathogens. Although there is minimal risk of the transmission of blood-borne pathogens from health care workers (HCWs) to patients and vice versa, post-exposure prophylaxis, has become routine following the occupational exposure of HCWs to HIV. Methods Focused ethnography was used to guide the data collection and in-depth interviews were used to collect the data between October and November 2009. Results Sixteen nurses from a variety of units in a large teaching hospital participated. Needle-stick injuries were a fairly common occurrence, but written policies were frequently inaccessible to nurses and they did not have adequate knowledge of PEP. Some nurses were reluctant to report injuries and avoided following PEP procedures due to lack of knowledge about PEP, concerns about anti-retroviral side effects and the stigma associated with PEP. Participants were aware of PEP however there was a wide variation in their understanding of the procedure to follow after a needle-stick injury. Conclusion Employers have a responsibility to update PEP guidelines and to orientate HCWs to these. Educators must ensure that undergraduate nurses have a comprehensive understanding of universal precautions and current practice for PEP.
    International Journal of Africa Nursing Sciences. 01/2014;
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    ABSTRACT: Some nurses who provide AIDS care, in addition to experiencing stigma themselves, also exhibit negative attitudes and perpetrate stigma and discrimination toward persons living with HIV (PLWHAs). We used a participatory research approach to explore the nature, context, and influence of stigma on the nursing care provided to PLWHAs in four low- and middle-income countries: Jamaica, Kenya, South Africa, and Uganda. Eighty-four registered nurses, enrolled nurses, and midwives participated in interviews and 79 participated in 11 focus groups. Nurses were very aware of the stigma and discrimination that AIDS evoked, and made adjustments to their care to decrease the manifestation of AIDS stigma. Despite the assurance that PLWHAs were treated equally, and that universal precautions were used consistently, we found that in reality, nurses sometimes made decisions about nursing care that were based on the appearance of the patient or knowledge of his or her status.
    Qualitative Health Research 06/2013; · 2.19 Impact Factor
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    ABSTRACT: In this article, we consider how the broad context of Aboriginal people's lives can shape their experience and understanding of their HIV diagnosis. We conducted interviews across Canada with 72 Aboriginal people living with HIV who also reported feelings of depression. Consistent with what has been found in previous studies, participants responded to their HIV diagnosis with shock, disbelief, and often anger. Prior depression, drug and alcohol use, multiple losses, stigma, and social isolation also shaped how participants experienced their diagnosis. We consider how the history of colonization of Aboriginal communities in Canada relates to the experience of HIV diagnosis, and end with a discussion of the service implications of our findings.
    Qualitative Health Research 03/2013; · 2.19 Impact Factor
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    ABSTRACT: Richter M.S., Mill J., Muller C.E., Kahwa E., Etowa J., Dawkins P. & Hepburn C. (2013) Nurses' engagement in AIDS policy development. International Nursing Review60, 52-58 Background: A multidisciplinary team of 20 researchers and research users from six countries - Canada, Jamaica, Barbados, Kenya, Uganda and South Africa - are collaborating on a 5-year (2007-12) program of research and capacity building project. This program of research situates nurses as leaders in building capacity and promotes collaborative action with other health professionals and decision-makers to improve health systems for human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) nursing care. One of the projects within this program of research focused on the influence of workplace policies on nursing care for individuals and families living with HIV. Nurses are at the forefront of HIV prevention and AIDS care in these countries but have limited involvement in related policy decisions and development. In this paper, we present findings related to the barriers and facilitators for nurses' engagement in policymaking. Methods: A participatory action research design guided the program of research. Purposive sampling was used to recruit 51 nurses (unit managers, clinic and healthcare managers, and senior nurse officers) for interviews. Findings: Participants expressed the urgent need to develop policies related to AIDS care. The need to raise awareness and to 'protect' not only the workers but also the patients were critical reason to develop policies. Nurses in all of the participating countries commented on their lack of involvement in policy development. Lack of communication from the top down and lack of information sharing were mentioned as barriers to participation in policy development. Resources were often not available to implement the policy requirement. Strong support from the management team is necessary to facilitate nurses involvement in policy development. Conclusions: The findings of this study clearly express the need for nurses and all other stakeholders to mobilize nurses' involvement in policy development. Long-term and sustained actions are needed to address gaps on the education, research and practice level.
    International Nursing Review 03/2013; 60(1):52-8. · 0.94 Impact Factor
  • Linda Ogilvie, Judy Mill
    The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 12/2012; 44(4):11-4.
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    ABSTRACT: The purpose of this community-based research was to examine the experiences of Canadian Aboriginal youth regarding accessing HIV testing and care services. We used a mixed method exploratory research design; 413 participants completed a self-administered survey and 25 youth participated in in-depth semistructured interviews. Findings reported here are from the 26 survey participants (12.4%) and nine interview participants (28.9%) who self-reported being positive for HIV. Results of this study suggest that some Aboriginal youth do not test for HIV until late in the course of their disease, and once diagnosed, a significant number of youth delay accessing care. Support from friends, family, and others is an important motivator for youth to initiate care and treatment. Integrated, comprehensive, youth-friendly, and culturally safe services are important to keep youth in care.
    Journal of HIV/AIDS & Social Services 01/2011; 10(4):395-413.
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    ABSTRACT: Stigmatization contributes to inequity by marginalizing persons living with HIV and AIDS (PHAs). In this study we examined the stigmatizing practices in health care settings from the perspectives of PHAs and health care providers (HCPs). A qualitative design, using a participatory action research approach, was used. Interviews and focus groups were completed with 16 aboriginal and 17 nonaboriginal individuals living with HIV (APHAs and PHAs) and 27 HCPs in Ottawa and Edmonton, Canada. We present findings to support the premise that stigmatization can be used as a social control mechanism with PHAs. Participants described both active and passive social control mechanisms: shunning and ostracizing, labeling, and disempowering health care practices. Forgiving behavior, balancing disclosure, practicing universal precautions, bending the rules, shifting services, and reducing labeling were strategies to manage, resist, and mitigate social control. The findings illustrate the urgent need for multilevel interventions to manage, resist, and mitigate stigma.
    Qualitative Health Research 11/2010; 20(11):1469-83. · 2.19 Impact Factor
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    ABSTRACT: The objective of this study was to explore HIV testing experiences and service views of Canadian Aboriginal youth in order to provide information for HIV testing services. An exploratory, mixed-method, community-based research design was used for this study. Findings reported here are from 210 survey participants who had experienced an HIV test. Youth were recruited through 11 Aboriginal organizations across Canada, including AIDS service organizations, health centers, community organizations, and friendship centers. Youth who had tested for HIV ranged in age from 15 to 30 years of age (20% were <20), and came from First Nations (75%), Metis (14%), and Inuit (9%) backgrounds. Participants lived in all provinces and one territory. Over half (62%) were female. While the majority of survey respondents indicated at their last HIV test they had been treated with care (80%), respect (77%), or kindness (76%), some reported being treated with hostility (19%), fear (12%), discrimination (11%), avoidance (10%), or being treated in a bored way (15%). When asked about information they had received, 28% of survey respondents could not remember; 23% said they were not given any information, and 24% said their questions were not answered. Emotional reactions to testing ranged from anxiety/apprehension (64% of survey respondents) to being "calm" (19%). When asked for suggestions to improve testing services, participants indicated emotional support, compassion, professional yet personable services, and personalized HIV information were important. Study results suggest that to facilitate HIV testing for Aboriginal youth, testing services and counseling must be respectful, compassionate, non-judgmental, and culturally responsive in order to provide emotional support and HIV information that is meaningful and memorable.
    AIDS Care 10/2010; 22(10):1269-76. · 1.60 Impact Factor
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    ABSTRACT: HARROWING J.N., MILL J., SPIERS J., KULIG J. & KIPP W. (2010) Culture, context and community: ethical considerations for global nursing research. International Nursing Review57, 70–77High-quality research is essential for the generation of scientific nursing knowledge and the achievement of the Millennium Development Goals. However, the incorporation of Western bioethical principles in the study design may not be suitable, sufficient or relevant to participants in low-income countries and may indeed be harmful and disrespectful. Before engaging in global health studies, nurses must consider carefully the cultural and social context and values of the proposed setting in order to situate the research within the appropriate ethical framework.The purpose of this paper was to examine the ethical principles and considerations that guide health research conducted in international settings using the example of a qualitative study of Ugandan nurses and nurse-midwives by a Canadian researcher.The application of Western bioethical principles with their emphasis on autonomy fails to acknowledge the importance of relevant contextual aspects in the conduct of global research. Because ethics is concerned with how people interact and live together, it is essential that studies conducted across borders be respectful of, and congruent with, the values and needs of the community in which it occurs. The use of a communitarian ethical framework will allow nurse scientists to contribute to the elimination of inequities between those who enjoy prosperity and good health, and those who do not.
    International Nursing Review 02/2010; 57(1):70 - 77. · 0.94 Impact Factor
  • Jean N Harrowing, Judy Mill
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    ABSTRACT: The phenomenon of moral distress among nurses has been described in a variety of high-income countries and practice settings. Defined as the biopsychosocial, cognitive, and behavioural effects experienced by clinicians when their values are compromised by internal or external constraints, it results from the inability to provide the desired care to patients. No research has been reported that addresses moral distress in severely resource-challenged regions such as sub-Saharan Africa. To describe the manifestation and impact of moral distress as it was experienced by Ugandan nurses who provided care to HIV-infected or -affected people. A critical ethnography was conducted with 24 acute care and public health nurses at a large referral centre in Uganda. Data were collected through interviews, observation, and focus group discussions. Participants described their passion for nursing and commitment to patients. They experienced moral distress when a lack of resources put patients' wellbeing at risk. The trauma imposed by systemic challenges on the nursing profession was acknowledged, as was the perception that the public blamed nurses for poor patient outcomes. However, participants were determined to serve to the best of their abilities and to take satisfaction from any contributions they were able to make. They cited the importance of education in the development of their capacity to provide care with a positive attitude, and demonstrated a collective resilience as they discussed strategies for addressing issues that affected them and their colleagues. The experience of moral distress among nurses in Uganda differed somewhat from the experience of nurses in high-income countries. Constraints imposed by the inability to implement skills and knowledge to their fullest extent, as well as a lack of resources and infrastructure may result in the omission of care for patients. Moral distress appears to manifest within a relational and contextual environment and participants focussed on the impact for patients, communities, and the nursing profession as a whole, rather than on their own personal suffering. The opportunity for continuing education led to strategies to transform personal attitudes and practice as well as to enhance the presentation of the profession to the public.
    International journal of nursing studies 12/2009; 47(6):723-31. · 1.91 Impact Factor
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    ABSTRACT: AIDS stigma has serious consequences. This study explored those practices within health-care organizations that persons with HIV perceive as stigmatizing. It used an exploratory, descriptive design using a participatory action research approach. Interviews and focus groups were conducted with 16 Aboriginal and 17 non-Aboriginal persons living with HIV as well as with 27 health-care providers. The AIDS stigma perceived by many participants often intersected with other forms of stigma, related to behaviour, culture, gender, sexual orientation, or social class. In addition, policies at the organizational level contributed to AIDS stigma and at times intersected with stigma at the individual level. Participants' experiences of stigma and discrimination were shaped by the organizational policies (universal precautions, models of care) and design (physical layout) under which care was provided. Several paradoxes associated with secrecy, health-care settings, and the layering of stigma emerged in the reported experiences.
    The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 09/2009; 41(3):168-85.
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    ABSTRACT: AIDS stigma has serious consequences. This study explored those practices within health-care organizations that persons with HIV perceive as stigmatizing. It used an exploratory, descriptive design using a participatory action research approach. Interviews and focus groups were conducted with 16 Aboriginal and 17 non-Aboriginal persons living with HIV as well as with 27 health-care providers. The AIDS stigma perceived by many participants often intersected with other forms of stigma, related to behaviour, culture, gender, sexual orientation, or social class. In addition, policies at the organizational level contributed to AIDS stigma and at times intersected with stigma at the individual level. Participants' experiences of stigma and discrimination were shaped by the organizational policies (universal precautions, models of care) and design (physical layout) under which care was provided. Several paradoxes associated with secrecy, health-care settings, and the layering of stigma emerged in the reported experiences. French La stigmatisation associée au VIH/sida a de lourdes conséquences. Nous avons cherché à examiner les pratiques qui, au sein des établissements de santé, sont perçues comme étant stigmatisantes par les personnes vivant avec cette maladie. De nature exploratoire et descriptive, notre étude s'inscrit dans une approche de recherche-action participative. Nous avons mené des entrevues et des groupes de discussion auxquels ont participé 16 Autochtones et 17 non-Autochtones vivant avec le VIH/sida, ainsi que 27 prestataires de soins de santé. La stigmatisation ressentie par de nombreux participants se conjugue souvent à d'autres facteurs qui accentuent cette perception, et qui sont associés au comportement, à la culture, au sexe, à l'orientation sexuelle ou à la classe sociale. On a constaté également que les politiques organisationnelles contribuaient à la stigmatisation et qu'elles se conjuguaient parfois aux facteurs individuels. Les expériences de la stigmatisation et de la discrimination sont façonnées par les politiques organisationnelles (précautions universelles, modèles de prise en charge) ainsi que par l'aménagement (la disposition matérielle) des lieux où sont dispensés les soins. On a relevé dans les témoignages des participants un certain nombre de paradoxes relatifs au respect de la vie privée, au cadre de prestation des soins et à la conjonction des facteurs de stigmatisation.
    The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 08/2009; 41(3):168-185.
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    ABSTRACT: Aim:  To discuss factors that have influenced the development of research capacity among nurses in lower and middle-income countries (LMICs).Background:  Concerned health scientists have addressed the importance of building research capacity among health professionals. Strengthening capacity specifically among LMIC nurses has been infrequently discussed. Without the requisite educational preparation or an enabling environment for research, nurses are unlikely to either demand research capacity-building opportunities or initiate research examining nursing practice and health system challenges.Methods:  A scan was conducted of nine internationally funded research capacity-building initiatives to identify programme targeting and the proportion of nurse trainees. A literature review examined graduate and post-graduate training opportunities for LMIC nurses, and barriers and enablers to nurses' involvement in research. Informal consultations were held with nurse leaders in 15 LMICs and leaders of eight LMIC nursing organizations.Findings:  The scan found a generic targeting of health professionals with a very low percentage of nurse trainees. Programmes specifically targeting nurses did attract and prepare a significant number of nurses. Factors limiting nurses' involvement in research include hierarchies of power among disciplines, scarce resources, a lack of graduate and post-graduate education opportunities, few senior mentors, and prolonged underfunding of nursing research.Conclusions:  Fully engaging LMIC nurses in health services research may yield pragmatic and evidence-informed service delivery and policy recommendations. Investments in supports for nursing research capacity may enrich global health policy effectiveness and improve quality of care.
    International Nursing Review 02/2009; 56(1):88 - 94. · 0.94 Impact Factor
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    ABSTRACT: HIV infection is a serious concern in the Canadian Aboriginal population, particularly among youth; however, there is limited attention to this issue in research literature. The purpose of this national study was to explore HIV testing and care decisions of Canadian Aboriginal youth. A community-based mixed-method design incorporating the Aboriginal research principles of Ownership, Control, Access and Possession (OCAP) was used. Data were collected through surveys (n = 413) and qualitative interviews (n = 28). Eleven community-based organizations including urban Aboriginal AIDS service organizations and health and friendship centres in seven provinces and one territory assisted with the recruitment of youth (15 to 30 years). Average age of survey participants was 21.5 years (median = 21.0 years) and qualitative interview participants was 24.4 years (median = 24.0). Fifty-one percent of the survey respondents (210 of 413 youth) and 25 of 28 interview participants had been tested for HIV. The most common reason to seek testing was having sex without a condom (43.6%) or pregnancy (35.4%) while common reasons for not testing were the perception of being low HIV risk (45.3%) or not having had sex with an infected person (34.5%). Among interviewees, a contributing reason for not testing was feeling invulnerable. Most surveyed youth tested in the community in which they lived (86.5%) and 34.1% visited a physician for the test. The majority of surveyed youth (60.0%) had tested once or twice in the previous 2 years, however, about one-quarter had tested more than twice. Among the 26 surveyed youth who reported that they were HIV-positive, 6 (23.1%) had AIDS at the time of diagnosis. Delays in care-seeking after diagnosis varied from a few months to seven years from time of test. It is encouraging that many youth who had tested for HIV did so based on a realistic self-assessment of HIV risk behaviours; however, for others, a feeling of invulnerability was a barrier to testing. For those who tested positive, there was often a delay in accessing health services.
    BMC Infectious Diseases 11/2008; 8:132. · 3.03 Impact Factor
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    ABSTRACT: This article reports the findings from a participatory action research study concerning the experience of Ugandan nurses caring for individuals with HIV illness. Six key informants from government and non-governmental organizations were interviewed using a semistructured format. Six nurses from a large national referral hospital in Kampala, Uganda, participated in 10 focus group meetings during a period of 11 months. In-depth interviews, focus groups, and photovoice were used to collect the data. Findings indicate that nurses faced many challenges in their daily care, including poverty, insufficient resources, fear of contagion, and lack of ongoing education. Nurses experienced moral distress due to the many challenges they faced during the care of their patients. Moral distress may lead nurses to quit their jobs, which would exacerbate the acute shortage of nurses in Uganda. This study provides important knowledge for guiding clinical practice and nursing education in resource-constrained countries like Uganda.
    Journal of Transcultural Nursing 08/2007; 18(3):257-64. · 0.51 Impact Factor
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    ABSTRACT: Increased international migration of health professionals is weakening healthcare systems in low-income countries, particularly those in sub-Saharan Africa. The migration of nurses, physicians and other health professionals from countries in sub-Saharan Africa poses a major threat to the achievement of health equity in this region. As nurses form the backbone of healthcare systems in many of the affected countries, it is the accelerating migration of nurses that will be most critical over the next few years. In this paper we present a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one's country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to non-discrimination and equality. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health.
    Nursing Inquiry 07/2007; 14(2):114-24. · 1.03 Impact Factor
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    ABSTRACT: In this article the authors present findings from a qualitative research study carried out with Ugandan nurses from September 2003 until June 2004. They highlight the process and philosophical basis of participatory action research (PAR) by reflecting on the challenges, opportunities, outcomes, and ethical issues encountered during the conduct of the research. In this study PAR fostered a climate in which nurses could engage in collective reflection on their practice, make sense of their experiences, and thereby change their understanding of their work.
    international journal of qualitative methods. 01/2007; 6(2).
  • Caribbean Journal of Nursing and Midwifery. 01/2007; 2:29-36.