Elizabeth Peter

Elizabeth Peter
University of Toronto | U of T · Bloomberg Faculty of Nursing

PhD

About

120
Publications
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2,389
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Publications

Publications (120)
Article
Full-text available
Background: Stress, anxiety, distress, and depression are high among health care workers during the COVID-19 pandemic, and they have reported acting in ways that are contrary to their moral values and professional commitments that degrade their integrity. This creates moral distress and injury due to constraints they have encountered, such as limit...
Article
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Globally, nurses have experienced changes to the moral conditions of their work during coronavirus outbreaks. To identify the challenges and sources of support in nurses’ efforts to meet their ethical responsibilities during SARS, MERS, and COVID-19 outbreaks a scoping review design was chosen. A search was conducted for eligible studies in Ovid ME...
Article
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Background With the enactment of Bill C-7 in Canada in March 2021, people who are eligible for medical assistance in dying (MAiD), whose death is reasonably foreseeable and are at risk of losing decision-making capacity, may enter into a written agreement with their healthcare provider to waive the final consent requirement at the time of provision...
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Background The COVID-19 pandemic has forced rapid and widespread change to standards of patient care and nursing practice, inevitably leading to unprecedented shifts in the moral conditions of nursing work. Less is known about how these challenges have affected nurses’ capacity to meet their ethical responsibilities and what has helped to sustain t...
Article
This theoretical paper proposes a new perspective to understand the moral distress of nurses more fully, using virtue ethics. Moral distress is a widely studied subject, especially with respect to the determination of its causes and manifestations. Increasing the theoretical depth of previous work using ethical theory, however, can create new possi...
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The pursuit of more efficient patient-friendly health systems and reductions in tertiary health services use has seen enormous growth in the application and study of remote patient monitoring systems for cardiovascular patient care. While there are many consumer-grade products available to monitor patient wellness, the regulation of these technolog...
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Objective To determine if virtual care with remote automated monitoring (RAM) technology versus standard care increases days alive at home among adults discharged after non-elective surgery during the covid-19 pandemic. Design Multicentre randomised controlled trial. Setting 8 acute care hospitals in Canada. Participants 905 adults (≥40 years) w...
Preprint
BACKGROUND Stress, anxiety, distress and depression are high among healthcare workers during the COVID-19 pandemic and they have reported acting in ways that are contrary to their moral values, integrity, and professional commitments that degrade their integrity. This creates moral distress and injury as a result of constraints they have encountere...
Article
Background: While there have been studies exploring moral habitability and its impact on the work environments of nurses in Western countries, little is known about the moral habitability of the work environments of nurses and midwives in resource-constrained settings. Research objective: The purpose of this research was to examine the moral hab...
Article
Background Nurses have been labelled “heroes” by politicians, the mass media, and the general public to describe their commitment to providing front-line care to people with COVID-19, despite the risks of exposure and lack of clinical resources. Few studies have examined the implications of the hero discourse to nurses’ professional, social, and po...
Chapter
This chapter is an empirical case study based on Elizabeth Peter’s original empirical work that showcases contemporary geographies related to professional practice. It presents an analysis of published policy, and institutional, legal and media statements relating to a case where a nurse was found to be an extreme danger to health and life in long-...
Chapter
This chapter explores how geographical ideas have been central to thinking and acting in caring practice over many centuries in many places. This includes in forms of caring in prehistoric times; in the earliest origins of ancient Chinese and Indian medicine; in the health ideas of ancient Greek writers; in medicine in the age of European explorati...
Chapter
This chapter explores the potential for a more integrated and central geographical contribution to mainstream professional practice debates. As an example is describes how geography might play a fuller and more embedded role in understandings of ‘skills’. After briefly reviewing traditional approaches to studying and understanding skill in health p...
Chapter
This chapter explores the potential for a more integrated and central geographical contribution to mainstream professional practice debates. As an example it describes how geography might play a fuller and more embedded role in understandings of ‘person-centred care’ (PCC). After reviewing traditional research areas on PCC, it describes how PCC mig...
Chapter
This chapter reviews the contemporary geographical study of health care work. Initially it examines key ‘on the ground’ transformations in health and health care which are fundamentally geographical in their making, form and consequences; transformations which have demanded a geographical research perspective be taken as well-aligned vantage point...
Book
This book presents the first single comprehensive analysis of the scope of geographical realities and relevance in health care work. Conceptually, the book conveys how space, place and geographical ideas matter to clinical practice, from the historical beginnings of professional roles and responsibilities in medicine to the present day. In 8 chapte...
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Background: After nonelective (i.e., semiurgent, urgent and emergent) surgeries, patients discharged from hospitals are at risk of readmissions, emergency department visits or death. During the coronavirus disease 2019 (COVID-19) pandemic, we are undertaking the Post Discharge after Surgery Virtual Care with Remote Automated Monitoring Technology...
Chapter
Over the past 30 years, feminist ethics has influenced the evolution of nursing ethics. Its emphasis on social justice and power along with its understanding of persons as connected, interdependent, and uniquely situated have been characteristics that have resonated with nursing and midwifery scholars. In this chapter, we outline some of the early...
Chapter
Digital health technologies have become increasingly prevalent, including those that are in the homes of those receiving healthcare services. Their use in the home is raising ethical issues because they, along with other home care services, have the potential to disrupt practices of the home, including those that maintain the physical well-being of...
Article
Background: Continuous hemodynamic monitoring is the standard of care for patients intraoperatively, but vital signs monitoring is performed only periodically on post-surgical wards, and patients are routinely discharged home with no surveillance. Wearable continuous monitoring biosensor technologies have the potential to transform postoperative c...
Article
Objectives The purpose of this review was to identify pedagogical practices that contribute to professional identity formation in undergraduate nursing education and to map the components of professional identity described within these practices. Design A scoping review using a five-stage methodological framework was used to capture a range of evi...
Article
Background Family members and healthcare providers play an integral role in a person’s assisted dying journey. Their own needs during the assisted dying journey are often, however, unrecognized and underrepresented in policies and guidelines. Circumstances under which people choose assisted dying, and relational contexts such as the sociopolitical...
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The concept of relational autonomy was used to investigate how people with substance use disorders (SUDs) exercise their autonomy when using mental health services, according to stakeholders’ perspectives. A qualitative study, using a critical approach, was conducted with participants from a mental health service facility. We performed in-depth ind...
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Background: Cardiac and major vascular surgeries are common surgical procedures associated with high rates of postsurgical complications and related hospital readmission. In-hospital remote automated monitoring (RAM) and virtual hospital-to-home patient care systems have major potential to improve patient outcomes following cardiac and major vascul...
Article
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Objective: to identify, from the nurse perspective, situations that interfere with the availability of beds in the intensive care unit in the context of hospitalization by court order. Method: qualitative exploratory, analytical research carried out with 42 nurses working in adult intensive care. The selection took place by non-probabilistic snowb...
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Little is known about how research assistants (RAs) protect participants in vulnerable circumstances. Using a critical qualitative method informed by feminist ethics, we ran five focus groups with experienced RAs. We identified two themes: (a) expressing moral competencies (subthemes: recognizing power, privilege, and vulnerability; adapting proces...
Article
Although many studies have previously examined medicalisation, we add a new dimension to the concept as we explore how contemporary oncological medicine shapes the dying self as predominantly medical. Through an analysis of multiple case studies collected within a comprehensive cancer centre in Ontario, Canada, we examine how people with late‐stage...
Preprint
BACKGROUND Cardiac and major vascular surgeries are common surgical procedures associated with high rates of postsurgical complications and related hospital readmission. In-hospital remote automated monitoring (RAM) and virtual hospital-to-home patient care systems have major potential to improve patient outcomes following cardiac and major vascula...
Article
Full-text available
Advance care planning is a process that encourages people to identify their values, to reflect upon the meanings and consequences of serious illness, to define goals and preferences for future medical treatment and care, and to discuss these goals with family and health-care providers. Advance care planning is especially important for those who are...
Article
Background: The decision whether to initiate cardiopulmonary resuscitation may sometimes be ethically complex. While studies have addressed some of these issues, along with the role of nurses in cardiopulmonary resuscitation, most have not considered the importance of nurses acting as advocates for their patients with respect to cardiopulmonary re...
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Hiring and promotion of qualitative researchers in the health sciences, in Canada and internationally, is impacted by the prestige of quantification as the ultimate measure of scientific quality in current academic and health-care settings. This is further exacerbated by neoliberal notions of productivity, which offer very limited forms of assessme...
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Objective: to analyze how intensive care nurses practice patient advocacy in view of the need for hospitalization by court order to an intensive care due to bed unviability. Method: analytical exploratory qualitative research. Data were obtained through interviews with 42 nurses, selected via snowball sampling, between January and December 2016. T...
Article
Many studies have examined clinical and institutional moral problems in the practice of nurses that have led to the experience of moral distress. The causes and implications of moral distress in nurses, however, have not been understood in terms of their implications from the perspective of virtue ethics. This paper analyzes how nurses reach for th...
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Objetivo: Analisar a prática profissional de enfermeiros em um hospital privado acreditado, sob o prisma da ética da virtude. Metodologia: Estudo de caso qualitativo, realizado em um Hospital Privado “Acreditado com Excelência” em Minas Gerais. Os participantes foram 13 enfermeiros. A coleta de dados foi realizada mediante entrevista individual seg...
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The aim of this scoping review is to synthesize the academic and gray literature on the use of immediate staff debriefing following seclusion or restraint events in inpatient mental health settings. Multiple electronic databases were searched to identify literature on the topic of immediate staff debriefing. The analysis identified several core com...
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Worldwide, over 230 million adults have major noncardiac surgery each year. Although surgery can improve quality and duration of life, it can also precipitate major complications. Moreover, a substantial proportion of deaths occur after discharge. Current systems for monitoring patients postoperatively, on surgical wards and after transition to hom...
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Objective: To determine the perception of nurses, doctors, patients and family or relatives being present during cardiopulmonary resuscitation (CPR) in adult patients. Design: A qualitative exploratory study and thematic analysis were developed. SITE: Primary Care, Hospital Care and Emergency Service of the Basque Health Service. Participants:...
Article
OBJECTIVES: In 2012, Ontario pharmacists were granted immunization privileges to administer influenza vaccines to the public. This study explored the experiences and practices of pharmacist vaccinators and the impact of vaccination pain on their practice. METHODS: Semi-structured interviews were conducted with 12 pharmacists in the Greater Toronto...
Article
Most current management systems of healthcare institutions correspond to a model of market ethics with its demands of competitiveness. This approach has been called managerialism and is couched in terms of much-needed efficiencies and effective management of budgetary constraints. The aim of this study was to analyse the decision-making of nurses t...
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Research ethics committees (RECs) may misunderstand the vulnerability of participants, given their distance from the field. What RECs identify as the vulnerabilities that were not adequately recognized in protocols and how they attempt to protect the perceived vulnerability of participants and mitigate risks were examined using the response letters...
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Background In an era of a rapidly aging population who requires home care services, clients must possess or develop therapeutic self-care ability in order to manage their health conditions safely in their homes. Therapeutic self-care is the ability to take medications as prescribed and to recognize and manage symptoms that may be experienced, such...
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Background People seeking care for substance use (PSCSU) experience deep social and health inequities. Harm reduction can be a moral imperative to approach these persons. The purpose of this study was to explore relationships among users, health care providers, relatives, and society regarding harm reduction in mental health care, using a trust app...
Article
Sister (Sr.) Marie Simone Roach, of the Sisters of St. Martha of Antigonish, Nova Scotia, died at the Motherhouse on 2 July 2016 at the age of 93, leaving behind a rich legacy of theoretical and practical work in the areas of care, caring and nursing ethics. She was a humble soul whose deep and scholarly thinking thrust her onto the global nursing...
Article
It may be the case that the most challenging moral problem of the twenty-first century will be the relationship between the individual moral agent and the practices and institutions in which the moral agent is embedded. In this paper, we continue the efforts that one of us, Joan Liaschenko, first called for in 1993, that of using feminist ethics as...
Article
Background: Tens of thousands of cardiac and vascular surgeries (CaVS) are performed on seniors in Canada and the United Kingdom each year to improve survival, relieve disease symptoms, and improve health-related quality of life (HRQL). However, chronic postsurgical pain (CPSP), undetected or delayed detection of hemodynamic compromise, complicati...
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Background: Explicating nurses' moral identities is important given the powerful influence moral identity has on the capacity to exercise moral agency. Research objectives: The purpose of this study was to explore how nurses narrate their moral identity through their understanding of their work. An additional purpose was to understand how these...
Article
RÉSUMÉ La qualité de vie et le bien-être des patients âgés dans les installations pour les soins chroniques dépendent souvent de leurs relations avec les infirmières. Les auteurs ont développé et testé une échelle pour évaluer les points de vue des patients sur ce qui compte le plus relative aux infirmières. Basé sur la théorie de soins infirmiers...
Chapter
The death with dignity movement is a cultural response to the problems of illness, dying, and death. At the core of the movement is the belief that human dignity and autonomy are honored when people with a terminal illness have control over the circumstances of their death. The movement has a long history but can be traced to the early 1900s, when...
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A sound knowledge of the nature of qualitative research, along with an appreciation of some special ethical considerations, is needed for rigorous reviews to be conducted. The overall character of qualitative research is described with an emphasis on the tendency of qualitative researchers to explore sensitive topics using theoretically informed me...
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Little consideration has been given to how case study might be used in poststructural research to explore power relations that constitute a phenomenon. Many case study scholars, most notably Robert Yin, adopt a postpositivist perspective that assumes the "truth" can be accessed through applying prescriptive and rigid research techniques. Using a di...
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Using a poststructural perspective, we examine the subjectivities that are produced when advanced cancer patients seek life extension through biomedical treatments. Seven case studies were developed that included 20 interviews with patients, family, nurses, and physicians recruited from a tertiary hospital in Canada, 30 documents, and 5 hours of pa...
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Background: Nurses who provide aggressive care often experience the ethical challenge of needing to preserve the hope of seriously ill patients and their families without providing false hope. Research objectives: The purpose of this inquiry was to explore nurses' moral competence related to fostering hope in patients and their families within t...
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Background: While witnessing and providing aggressive care have been identified as predominant sources of moral distress, little is known about what nurses "know" to be the "right thing to do" in these situations. Research objectives: The purpose of this study was to explore what nurses' moral knowledge is in situations of perceived overly aggre...
Article
To explore the social organization of food provision and dietary intake in seriously mentally ill people with diabetes who reside in a for-profit group home. Institutional ethnography was used to explore diabetes-related care practices among 26 women in a rural residential care facility in southern Ontario. Semi-structured, in-depth interviews were...
Article
To explore barriers and constraints to physical activity, as an integral component of diabetes care, in those with serious mental illness who reside in a for-profit group home. Institutional ethnography was the approach used to explore diabetes-related care practices among 26 women in a rural residential care facility in southern Ontario. Semi-stru...
Article
Abstract Health human resource and workforce planning is a global priority. Given the critical nursing shortage, and the fact that nurses are the largest group of healthcare providers, health workforce planning must focus on strategies to enhance both recruitment and retention of nurses. Understanding early socialization to career choice can provid...
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Moral distress has been written about extensively in nursing and other fields. Often, however, it has not been used with much theoretical depth. This paper focuses on theorizing moral distress using feminist ethics, particularly the work of Margaret Urban Walker and Hilde Lindemann. Incorporating empirical findings, we argue that moral distress is...
Article
The growth and sustainability of the nursing profession depends on the ability to recruit and retain the upcoming generation of professionals. Understanding the career choice experiences and professional expectations of Millennial nurses (born 1980 or after) is a critical component of recruitment and retention strategies. This study utilized Polkin...
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Although unrelieved pain continues to represent a significant problem, prelicensure educational programs tend to include little content related to pain. Standards for professional competence strongly influence curricula and have the potential to ensure that health science students have the knowledge and skill to manage pain in a way that also allow...
Article
To explore how intrapartum nurses understand and negotiate their moral responsibilities toward women during childbirth. Qualitative critical narrative. Labor and birth unit in an urban Canadian hospital. Fourteen intrapartum registered nurses. Critical narrative analysis using a feminist ethics perspective. Nurses understood their moral responsibil...
Article
leung d., esplen m.j., peter e., howell d., rodin g. & fitch m. (2012) How haematological cancer nurses experience the threat of patients’ mortality. Journal of Advanced Nursing68(10), 2175–2184. Aim. This article explores how cancer nurses experienced the threat of patients’ mortality on malignant haematology units of one institution in Ontario, C...
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In the last 2 years, we have witnessed considerable social and economic change in Europe, with clashes in the streets of Greece being its most recent manifestation and the political stability of the European Union put to test. In this commentary, we argue that the decline of the Mediterranean welfare state, in particular with respect to Spain, has...
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Nurse-client relationships are valued in descriptions of public health practice and require consideration as work involving knowledge, skill, and personal engagement. Even so, in public health, they are largely taken-for-granted, particularly in the area of tuberculosis (TB). Instead, TB nursing is often structured by a population focus, which at t...
Article
This study explored patients' narratives of technology in heart surgery and recovery. A narrative inquiry was conducted with a sample of 16 individuals. Interviews were completed 2 to 4 days after transfer from cardiovascular intensive care, and 4 to 6 weeks after discharge. Participants completed journals between these 2 time periods. Discharge an...
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The context of forensic psychiatric nursing is distinct from other psychiatric settings as, it involves placement of patients in secure environments with restrictions determined by the courts. Previous literature has identified that nurses morally struggle with respecting patients who have committed heinous offences, which can lead to the patient b...
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Aim: To examine interruptions to nurses' work, the systems issues related to these and the associated outcomes. Background: While some research has described the role interruptions play in medication errors, work is needed to examine specific factors in the nursing work environment that cause interruptions and to assess the impact of these on nu...
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Through a qualitative of study of public health nurses and their clients in Toronto, Canada, displacement is described as a central feature in illness and care. Specifically, how client experiences are anchored in circumstances of international migration and contagiousness is described, along with how nurses take up understandings of displacement a...
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There are three main conceptualizations of nurses' stress: occupational stress, moral distress, and traumatization (compassion fatigue, secondary traumatic stress, vicarious trauma). Although we have learned a great deal from these fields, some of them lack important contextual aspects of nurses' practice, such as the gendered nature of the workfor...
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In this narrative inquiry, we examined patients' experiential accounts of technology in open-heart surgery and recovery. A convenience sample of sixteen individuals was recruited from a preoperative clinic at a regional centre for cardiac services in Canada. Each participated in two interviews following transfer from cardiovascular intensive care a...