Student Impact
Rosentstadt Research Development Program
Since its launch in 2021, the Rosenstadt Research Development Program (RRDP) has provided countless research opportunities for students and faculty members alike at the Lawrence Bloomberg Faculty of Nursing. These research experiences have planted the seed of research interest particularly among the Faculty’s undergraduate BScN students, helping them realize the importance of nursing perspectives in not only research but patient outcomes.
For Kathy McGilton, a professor (status) and senior scientist at KITE-Toronto Rehabilitation Institute, UHN, the RRDP has allowed her to mentor students by integrating them into her lab. It has also given her a chance to advocate for the area of research she is most passionate about, long-term care (LTC).
“We don’t see a lot of RN’s practicing in long-term care which is unfortunate because it is an environment in which they could lead. By involving nursing students in my work, I’m actively trying to have them embrace the possibility of working with older adults in the future and let them see the impact they can have,” says McGilton.
As part of the 2023 RRDP, McGilton connected with BScN student Nicholas Tseng (BScN 24) and PhD graduate Shirin Vellani (now an adjunct faculty member), for a novel project examining the experiences of LGBTQ+ older adults who are admitted to long-term care.
The researchers identified gaps in supportive care in LTC and worked to establish an advisory committee that involved LTC residents as well as their care partners who identify as LGBTQIA+ who either have dementia or fear getting dementia.
“We were very lucky to have Nicholas as our RRDP student, he was passionate about the topic and it was inspirational to engage with him on this work,” says McGilton.
For his part Tseng was involved in working on analyzing data for the literature review particularly the integration of palliative care approaches for LGBTQIA+ individuals. He is still actively involved in the research and currently looking at the implementation of living labs with McGilton, which he describes as going into LTC settings and coming up with quality improvement initiatives in direct partnerships with frontline workers and clinicians.
“I feel like as a future nurse it was really important for me to see the ways in which care can be improved,” says Tseng.
One of the highlights of his time in the RRDP was meeting with primary investigators in Europe who are currently involved in integrating “living labs” into LTC. Being able to network with researchers from around the world and present alongside McGilton and Vellani, was a unique opportunity that Tseng says he will not soon forget.
“Having a research perspective has definitely made me a better clinician, and I know that I will have research be a part of my career,” says Tseng.
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Professor Martine Puts believes that research is a team sport. It is why she has consistently involved undergraduate BScN students in her research through the Rosenstadt Research Development Program.
“Nursing is a very practical program, there is no research project in the BScN program and the Rosenstadt Research Development Program helps us give students the chance to be engaged in research topics they might never have considered, while fostering their future interest in nursing science,” says Puts.
Vivian Li (BScN ’24) has been involved in Puts’ current research project funded by the Princess Margaret Hospital Foundation, which has focused on inequity and aging in cancer treatment. The team is specifically looking to understand barriers to enrolling racialized older adults in clinical cancer trials, and how they might address these barriers with future interventions.
According to Puts there is currently evidence of such barriers in the US but limited data available for Canada. Li who has been involved in the literature review and as a first author on their published protocol identified examples of barriers for racialized older adults from her analysis, which included a lack of knowledge about clinical trials, financial limitations, transportation issues and mistrust, which is particularly prevalent in the US based on historical misconduct in health settings.
Puts adds that there is some data on racism in health care in Canada in the area of cancer screening, but little information exists on racism and outcomes pertaining to clinical cancer studies.
“Canada is a country of immigrants so it is likely the situation is the same here, but if we don’t measure data related to inequities with regards to age, race and gender, we cannot address it,” says Li. “In the US it is well-documented that racism in healthcare impacts quality of life and life expectancy, and that older Black Americans often receive a cancer diagnosis late, which can further delay their treatment.”
Li says that she has always wanted to be involved in oncology research since her first undergraduate degree. For her, the RRDP has provided an additional level of support to help her build her research capacity, including information sessions and training on best practices in research, writing literature reviews.
“I think the more involved in research I am, the more I see how fundamental it is and how it guides our clinical practices and processes. It is necessary groundwork that has the ability to shape and improve the care we provide as nurses,” says Li.
This research project is now in the phase of recruiting participants for its stakeholder survey, which is available in 15 languages. Puts notes that she and her team are actively working with community organizations to disseminate the survey and have included both patients and policymakers in cancer care.
For Li the RRDP has also helped her realize the potential for graduate education in nursing.
“I am now very interested in continuing to be a part of research and pursing a graduate degree, including a PhD, it is something I had not considered before, and I’m very glad to have had this opportunity,” says Li.
Three Bloomberg Nursing students receive CIHR Undergraduate Black Student Research Awards
In 2023, the Canadian Institutes of Health Research (CIHR) launched their Black Student Undergraduate Research Awards (USRAs) program, which aims to provide research experience that complements a student’s respective degree program and inspires them to consider graduate studies in the fields of health and life sciences.
Three undergraduate students from the Lawrence Bloomberg Faculty of Nursing were successful in their applications. Zé Jonathon Yearwood, Zaynashae Boreland, and Sarah Elkhalifa are recipients of the 2023 CIHR USRAs. Each were paired with Bloomberg Nursing faculty members who are conducting research across a broad range of topics, including cognitive function among people affected by cancer, pain care in pediatric cancer populations, and the prevalence and impact of drug infusion
clinics for high-cost biologics across Canada.
The opportunity to engage in research as part of their nursing undergraduate degree is something all three have found incredibly rewarding and they share that it has altered their perspective of how embedded the nursing profession is in driving solution-focused research that improves outcomes for patients. The program’s tailoring to Black students and encouragement of Black representation in research is also something
they have indicated as a positive step forward.
“This program is definitely a step in the right direction with respect to increasing spaces and opportunities for Black students to be a part of research, and connect them with mentors in the field,” says Boreland, who is now a registered nurse at the Hospital for Sick Children (SickKids).
Throughout her time in the CIHR USRA program, Boreland worked closely with Assistant Professor Lindsay Jibb on a project evaluating a co-designed mobile application for parents of children with cancer. The app which features algorithm-based instructions, provides parents of children with cancer information about what they can do to manage their child’s pain at home, in addition to using medications.
As part of the project’s assessment phase, Boreland was involved in data collection, including transcribing interview transcripts, and coding data from parent and patient feedback which helped to determine the success and future progress of the mobile app.
“Listening to the transcripts describing patient experiences was a significant highlight for me of participating in this project. It was humbling to hear what the parents and patients are going through, and to be able to learn how this research is aiming to support them,” says Boreland.
According to Jibb, the project’s lead and a Scientist in Child Evaluative Health Sciences at the Hospital for Sick Children (SickKids), Boreland’s work has been instrumental in helping her team learn how parents need to feel supported.
“We know that cancer pain is highly distressing for both parents and children, but we are hopeful that with this technological intervention, we will help parents feel empowered,” says Jibb. “Zaynashae has been a pleasure to work with on this project, her perspectives are unique, and she understands the importance of patient engagement in this research.”
For Zé Jonathon Yearwood, being a part of the CIHR USRA program has shifted his perspective about the role of nursing in patient care and allowed him to see the untapped potential for nurses to advocate for their patients through research.
Like Boreland, Yearwood says the fact that this program was tailored specifically
for Black students is encouraging, especially considering that there is an under representation of Black students in the health sciences overall.
“I think it is important to see that our perspectives are valued in these spaces, I felt like I had a chance to foster my interest in research as a result of this opportunity,” says Yearwood.
Partnered with Associate Professor Samantha Mayo, a prominent researcher in hematological cancer survivorship, Yearwood worked on a project that assessed patients experiences of cognitive functioning and the ways in which cognitive functioning is assessed and managed in the clinical environment.
According to Mayo, who is also the RBC Chair in Oncology Nursing Research, cognitive symptoms might include memory loss, difficulties concentrating or managing multiple tasks which can make returning to school or work more challenging.
As part of Mayo’s research team, Yearwood conducted observations of different cancer clinics particularly brain cancer clinics, and interviewed patients, caregivers, and clinical staff to understand how cognitive symptoms are screened for, and what kinds of services are offered.
“This experience has helped me to see that there is a systemic way to address issues in health care and has demystified the research process for me, I can definitely see myself pursuing further education as a result of this program,” says Yearwood.
For Mayo, having Yearwood as part of her research team has proved immensely beneficial.
“Zé has been a fresh set of eyes noticing things as a student nurse that we might
not have and asking questions that challenge our assumptions about this area of research and practice,” says Mayo.
Quinn Grundy an assistant professor at Bloomberg Nursing, shares similar sentiments about her research student Sarah Elkhalifa. Grundy’s CIHR funded project is examining
the extent to which private infusion clinics provide infusion-related care for people
prescribed high-cost biologic and specialty medicines.
“Sarah’s involvement in our project was instrumental in developing key collaborations
and furthering health system impact,” says Grundy. “It was her initiative and discovery of a report by Canada’s Drug Agency, (CADTH) that led to a meeting with scientists there and further discussions about the prevalence of private infusion clinics and
health system capacity and readiness around infusion-related care.”
Elkhalifa helped to conduct a scan that would map more than 500 of these private
infusion clinics across the country, and the results have shown that there is limited transparency across the board. Elkhalifa has also been involved in helping to write research protocols and developing infographics to summarize the preliminary findings of this research.
“I’ve found this whole experience to be really rewarding. I’ve always been interested in pursing research as part of my education and this opportunity has enabled me to see how important knowledge translation is, and the impact it can have on health policy,” says Elkhalifa.
In addition to being able to meet other people and learn more about the collaborative nature of nursing research, Elkhalifa, who is also the President of the Canadian Black Nurses Alliance U of T Chapter, shared that this research opportunity for Black students is a positive commitment and incentivizes more students who identify as Black to be involved in research.
Provost’s Post-doctoral Fellowship
Aimable Nkurunziza is a recipient of the University of Toronto’s 2023 Provost’s Postdoctoral Fellowship, an annual program that provides funding to support the hiring of post-doctoral fellows from underrepresented groups. He is working under the supervision of Bloomberg Nursing Professor Cindy-Lee Dennis, a prominent researcher in the field of maternal mental health.
Nkurunziza aims to create a training intervention for nurses and midwives in Rwanda, that will improve health outcomes and reduce barriers to care access for young adolescent women in primary care settings. He has seen first-hand the unique challenges faced by young adolescent women in Rwanda who require appropriate reproductive and perinatal health care.
Healthy mothers are better equipped to raise healthy children, which in turn creates a healthy society.”
As a former assistant lecturer at the University of Rwanda and the Rwandan lead of the Center of International Reproductive Health Training (CIRHT), Nkurunziza is tasked with integrating family planning and comprehensive abortion care in nursing and midwifery curricula.
Together, he and Professor Dennis will evaluate and develop training modules that will be accessible not only to medical care providers, but also community health workers, who are often the ones connecting young pregnant women with health care services.
“These individuals are not formally educated, but they are trusted by members of the community,” says Nkurunziza. “They play a big role in identifying pregnant women and linking them with health care facilities to ensure they receive appropriate care including immunizations and follow-up antenatal care.”
As part of his post-doctoral work, Nkurunziza’s intervention and training module will utilize activity tested by EQUIP for Health Equity in Canada, a collaboration with the University of British Columbia and Western University that includes curriculum geared towards training nurses and health care providers about how to provide trauma- and violence-informed care.
During his PhD at Western University, Nkurunziza explored how perinatal services in primary healthcare settings in Rwanda supported adolescent mothers to inform the delivery of trauma- and violence-informed care. He also examined the antenatal care (ANC) and Prevent To Mother Child Transmission (PMTCT) guidelines and policies used in primary healthcare settings in Rwanda to understand the extent to which they were trauma- and violence-informed.
What he uncovered, was that although some adolescent women might have an initial positive experience with the primary care they receive, many of the policies and practices in place retraumatize them or create barriers to future care access.
He points specifically to a policy around HIV testing, that is offered to all new mothers as well as their partners and husbands. For adolescent mothers who come alone to the clinic, they are offered these services only after they provide an explanation or copy of permission from their local leaders, which further delays their care, and access to appropriate care services.
Nkurunziza is hopeful that his research will not only improve the lives of young women in Rwanda, but also inspire a new generation of researchers who wish to support women’s health.
“Healthy mothers are better equipped to raise healthy children, which in turn creates a healthy society. It is also why I am passionate about conducting research that improves health outcomes for women, children and families, particularly from a social justice and health equity lens,” says Nkurunziza.
International Doctoral Research Award winners work to improve care in Ghana and Rwanda for women and infants
Two PhD students from the Lawrence Bloomberg Faculty of Nursing, Kokui Klutse and Marie Goretti Uwayzu, are the successful recipients of the 2022 and 2023 International Doctoral Research Award (IDRC) presented by Universities Canada. The annual awards which recognize exemplary PhD students, also serve to help build capacity and research in areas that will aid in the improvement of people’s lives in the
developing world.
For Klutse, a registered pediatric nurse from Ghana, winning this award is also a testament to the support of her supervisory committee and Professor Linda Johnston, whom she says have made her feel immensely welcome as an international PhD student.
“There have been countless times where I have experienced imposter syndrome, especially when I attended my first class in the program and noticed I was the only Black student there,” says Klutse, “but the encouragement and cordial relationship between students and staff, which is a hallmark of U of T and the Faculty of Nursing in particular, has made me feel like I was right where I should be.”
Klutse’s research explores developmentally supportive care practices for preterm infants in Ghana. It is a two-phase study that will first use a quantitative approach to describe what the preterm infant populations are like in three healthcare facilities in Ghana, and include key points about the gestational ages, feeding modalities, congenital abnormalities, and kangaroo care practice, all of which can affect preterm infant survival.
Klutse’s research is also aligned with one of Ghana’s Sustainable Development Goals (SDG goal 3); which aims to reduce the global neonatal mortality rate to 12 per 1000 live births by 2030. The current neonatal mortality rate in Ghana is close to 25 per 1000 live births, and Klutse is hopeful her research will facilitate the creation of new policies that support better care for preterm infants in the NICU.
“We don’t need a million dollars to implement these interventions; we need individual commitment and changes at the policy level,” says Klutse.
Marie Goretti Uwayezu, supervised by Professor Kelly Metcalfe, is originally from Rwanda and has worked as an oncology nurse, clinical instructor, and assistant lecturer in the School of Nursing and Midwifery at the University of Rwanda. As a result of her experience, Uwayezu has seen first-hand in her clinical role, the number of women living in Rwanda who are diagnosed with late-stage breast cancer.
“Research has shown that close to 70 per cent of women with breast cancer living in Rwanda are diagnosed with stage 3 or 4 of the disease and this is despite the establishment of the Rwandan Women Early Detection Program which is aimed at preventing this late-stage detection of the disease,” says Uwayezu.
Uwayezu will be exploring the association between certain social demographic factors and health focused ideologies on the use of breast cancer screening modalities in women living in Rwanda. She is hopeful her research will be able to support future recommendations about what more can be done to prevent detection of breast cancer at late stages.
Nurse-led interventions such as education sessions and community outreach, are often underutilized methods of engaging with populations to provide important preventative health care, and Uwayezu envisions these types of interventions as being key to improving health outcomes for women in Rwanda.
“Detecting breast cancer at an earlier stage improves survival and care options immensely, and we should be doing all we can to ensure women in Rwanda have the opportunity to access the care that they need and deserve,” says Uwayezu.