Nursing student Alaa Fouli knows she has a “kinesthetic” learning style — which means she learns by doing — so she leapt at the chance to do hands-on research as part of her Honors undergraduate program at the University of Alberta.
She spent the summer interviewing older Muslim women about how Islamophobia affects their ability to feel at ease when they’re out walking in Edmonton’s neighbourhoods and streets.
As one of 13 winners of the 2023 Undergraduate Summer Student Research Award, Fouli had the opportunity to advance nursing science and build her research and clinical skills.
“I did gain research skills, especially in terms of interviewing,” Fouli says, “but having those very personal conversations with people reminded me of what’s important in nursing: talking to patients, listening well, being empathetic and answering in a supportive way.”
Fouli is one of three undergraduate Honors nursing students that Folio spoke to about their summer research projects, which focused on the way vulnerable people interact with the health-care system. The students talked about their scientific findings and their sometimes surprising personal takeaways.
Jaxon Lutzer: Protecting and empowering the community
There’s lots of talk in research circles about participatory research, and at least one journal dedicated to it. Very broadly, participatory research is carried out in concert with and for the population it studies, involving them in research rather than performing research on them. It is a nuanced process.
Jaxon Lutzer aimed to identify the best methods for participatory research with his summer review of studies about the experiences of transgender people in health care.
“Transgender and non-binary individuals experience unique health inequities and discrimination, which can lead to mental health problems or underdiagnosis for cancer,” says Lutzer.
Under the supervision of assistant professor Gillian Lemermeyer, an expert in the ethics of nursing, Lutzer carried out a review of published studies that claim to have taken a participatory approach to the topic.
“The goal of this type of research is to protect and empower the community of interest, and there are clearly better and worse ways to do that,” Lutzer says. “The whole idea with the participatory methodology is that you want community members involved at every stage.”
He found that while numerous studies claimed to be participatory, only some lived up to the name.
The best studies included advisory committees of transgender people to develop research questions and community members to analyze data and shape how the results were reported. Without this end-to-end participation, Lutzer says, “the community voice gets drowned out by the academic perspectives.”
Some of the most effective studies included transgender academics on the research team, Lutzer found. “Then they have both the lived experience and the bird’s-eye view, because they’ve lived it and studied it,” he says.
Lutzer, who plans to start clinical practice when he graduates, says his research project underscored for him why patient-centred care is so important. It will also help him keep up with the latest nursing science.
“I'll be better equipped to take in new evidence,” he says, “because I know how to evaluate whether a study is well done.”
Priya Vyas: Communication is key
Priya Vyas’ summer research project focused on seniors’ health, in particular people living in long-term care homes. She analyzed the results of interviews with care aides from long-term care homes about missed care — how, why, and when it occurs
“Care aides provide 90 per cent of the direct care in long-term care homes,” Vyas notes. “They are involved with very basic but very important tasks like helping with elimination, feeding and taking the resident for a walk.”
Vyas’ project was part of Translating Research in Elder Care run by professor Carole Estabrooks, Tier I Canada Research Chair in Knowledge Translation and a leading authority on long-term care in Canada, particularly through the COVID-19 pandemic.
The most commonly missed long-term care tasks identified in the literature are oral care, bathing and spending time with residents. On the other hand, Vyas found from her interviews that giving medications and changing soiled briefs are rarely missed. She compared interview results from different care homes to look for patterns.
“It’s not a problem when it’s just once or twice that a care task is missed, but over time there can be physical and psychosocial consequences for the residents,” Vyas explains.
We already know that the major causes for missed tasks are lack of time and lack of staff, Vyas says. Fewer tasks are missed in teams that communicate well.
“Lateral, upward and downward communication among managers, registered nurses and care aides is extremely important in avoiding missed care tasks,” Vyas says. “It fosters a culture of collectivism among co-workers who help each other keep up.”
Vyas intends to work as a nurse for a while before returning for graduate nursing education.
She says she’s thrilled to have worked with a large research team. “I would share my findings with the other researchers, talk about it and implement their feedback in my data analysis,” she says. “They were really good mentors in terms of guiding me as a student and an early researcher.”
Vyas says she also gained a much greater appreciation of the role of care aides.
“I think the work that you do in clinicals can inform your research, but it definitely goes both ways, so the research sheds new light on the clinical work,” she says.
Alaa Fouli: Inspired by resilience
As a woman who dresses in an abaya, a hijab and a niqab (long-sleeved robe, headscarf and face covering), Alaa Fouli wears her religious identity every day. Sometimes people ignore her when she speaks to them. Others just stare.
Fouli has occasionally felt fearful when out walking on Edmonton streets, ever since she heard about the Afzaal family, who were intentionally struck in 2021 by the driver of a pickup truck in London, Ont., murdering four of the five of them. The driver reported targeting the group because the women were wearing traditional garb, in their case Pakistani clothing.
“It just pops into my head when I see one of those big trucks,” she says. “I just look at it and wonder, ‘Is it going to run me over now?’”
Fouli’s project was supervised by assistant professor Jordana Salma, whose research focuses on the health and well-being of immigrant and racialized older adults. It was partially funded by the Alberta Women’s Health Foundation through the Women and Children’s Health Research Institute.
Fouli led one focus group and 13 interviews with participants from an Edmonton mosque, with some of the interviews conducted while walking in the nearby neighbourhood.
“You could really see how they felt like they belonged in their community,” she recalls. “I asked them, did they feel safe walking? Did they feel unsafe? What factors contributed to them feeling that way? And if they felt unsafe, what precautions did they take?”
The women’s strategies to feel safer included not walking alone or at night, and avoiding alleyways. Fouli found that increasing media reports of Islamophobic events — both in Edmonton and elsewhere — left some of the women she interviewed feeling more fearful than others.
Fouli plans to work as a nurse while she decides on whether to undertake graduate school, but she is grateful to have had the chance to collect primary data as she completes her undergraduate degree and heads into the nursing workforce.
“I was really inspired to see how resilient these women were,” Fouli says. “I learned a lot from them.”
Fouli carried out all of the interviews in Arabic, which was her first language when she was growing up in Edmonton. Being able to answer questions in their own language gave the women confidence, she says.
Sometimes the participants would ask her personal questions in return, which at first made her uncomfortable.
“Then I realized, it’s OK for me to open up a little bit as a researcher and also as a nurse with my patients,” she says. “Of course still maintaining those nurse-patient boundaries but at the same time showing that I am a person, not just a random health-care provider walking in to do a task and then leaving.”
“It’s about building that relationship with my patients.”
