Niki Kiepek

Permanent URI for this collectionhttps://hdl.handle.net/10222/79997

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Now showing 1 - 13 of 13

Open Access
Exploring care of hospital inpatients with substance involvement
(2021) Kiepek, Niki; Jones-Bonofiglio, Kristen; Freemantle, Stacey; Byerley-Vita, Mandy; Quaid, Kristine
INTRODUCTION: This article presents demographic and care factors related to persons who are substance-involved and require inpatient administration of intravenous antibiotics. PURPOSE: This study was conducted to explore healthcare responses to support substance-involved inpatients, through exploration of documented client outcomes, healthcare provider accounts, and representation of clients through documentation. METHOD(S): A patient-oriented research team undertook this multiple methods, exploratory study. A health record review included people admitted to a complex continuing care hospital, within a 2-year period, for long-term antibiotic treatment and concurrent illicit substance use. Correlations were examined between whether or not clients were discharged against medical advice (AMA) in comparison to demographic, medical, and care-related factors. Qualitative analysis of narrative health record data was undertaken. Semi-structured interviews of healthcare providers and decision makers were conducted. RESULTS: Twenty-five people met recruitment criteria for health record review; three people were admitted twice, resulting in 28 admissions. Interviews with seven healthcare providers and decision makers uncovered themes of client autonomy, professional liability, client responsibility, the “right” service, and burnout, hopelessness, and helplessness. CONCLUSION: Recommended strategies to effectively respond to substance use among clients admitted for general medical concerns are: i) support inpatients with complex health needs, including substance use, ii) ensure substance use and addiction services are integrated into all inpatient practice areas, iii) support effective harm reduction practices for hospital-admitted clients, and iv) develop robust policies and protocols to support healthcare providers and inpatients.
Open Access
Substance use by social workers and implications for professional regulation
(2019-06) Kiepek, Niki; Harris, Jonathan; Beagan, Brenda; Buchanan, Marisa
Purpose. This study explores the prevalence and patterns of substance use among Canadian social workers. Legalisation of cannabis is forthcoming in Canada in 2018 and it is anticipated that professional regulatory bodies will be pressed to consider implications for their members. Methodology. An online survey collected data about demographics and substance use prevalence and patterns. Statistical analysis involved pairwise comparisons, binary logistic regression models, and logistic regression models to explore correlations between substance use and demographic and work-related variables. Findings. Among the n=489 respondents, findings indicate that past-year use of cannabis (24.1%), cocaine (4.5%), ecstasy (1.4%), amphetamines (4.3%), hallucinogens (2.4%), opioid pain relievers (21.0%), and alcohol (83.1%) are higher than the general Canadian population. Years of work experience and working night shift were significant predictors of total number of substances used in the past year. Use of a substance by a person when they were a student was highly correlated with use when they were a professional. Discussion. Prevalence of substance use among social workers was found to be higher than the Canadian population; potential due to the anonymous nature of data collection. Originality. This study has implications for social conceptualisations of professionalism and for decisions regarding professional regulation. Previous literature about substance use by professionals has focussed predominantly on implications for increased surveillance, monitoring, and disciplinary action. We contend that since substance use among professionals tends to be concealed, there may be exacerbated social misconceptions about degree of risk and when it is appropriate to intervene.
Open Access
A pilot study to explore the effects of substances on cognition, mood, performance, and experience of daily activities
(2018-03) Kiepek, Niki; Beagan, Brenda; Harris, Jonathan
Methods: A mixed methods design was implemented, involving ecological momentary assessment (EMA)and interviews. The analysis presents interpretations about the perceived impact of substance use on the performance and experience of everyday activities. Results: Caffeine, alcohol, antidepressants, pain suppressant, and cannabis were used by the most participant. Participants reported effects of substances that directly or indirectly enhanced performance (e.g., sleep, socialisation), mood (e.g., manage stress, relax), cognition (e.g., energy and clarity of thought),and the general experience of activities (e.g., enjoyment). Less common effects included impaired work, school, or leisure performance, injury, sleep disruption, and pain or discomfort. Reactivity was an unexpected effect, with almost half of the interviewees reporting changes in their thoughts about their substance use, and 30% of interviewees making active changes. Conclusion: This study was novel in population and data collection. Complex perspectives about substance use were offered by recruiting professionals and students outside at-risk populations or addiction-related services. By examining effects of substances, this research offers nuanced understandings of self-reported effects of psychoactive substances on performance, mood, cognition, and quality of experience.
Open Access
Addictions and impulse-control disorders as occupation: A selected literature review and synthesis
(2011-07) Kiepek, Niki
Objective. The question addressed in this paper is: “Are activities that are classified as ‘addictions’ and ‘impulse-control disorders’ occupations?” Background. Current conceptualisations of occupation focus on positive contributions to health and well-being. We suggest that occupations are neither inherently healthy nor unhealthy but are associated with positive and/or negative consequences. Methods. Integrative and interpretative literature syntheses were undertaken. Findings. Findings demonstrated that activities classified as addictions and impulse-control disorders meet the criteria of occupation, in that they give meaning to life; are important determinants of health, well-being and justice; organize behaviour; develop and change over a lifetime; shape and are shaped by environments and have therapeutic potential. Conclusion. The findings have implications for the conceptualization of occupations, including the relationship between occupation and health, the potential risk for negative consequences through occupational engagement, a deeper exploration of occupational patterns and performance and the influence of context. Finally, a potential role for occupational science in the field of addictions and impulse-control disorders is proposed.
Open Access
Ecological momentary assessment: Enriching knowledge of occupation using App-based research methodology
(2018-06) Kiepek, Niki
This paper introduces occupational therapists to ecological momentary assessment (EMA) and outlines factors that guide the process of designing a project. EMA methodology is a research methodology that uses electronic devices and specially designed software, or Apps, to collect real-time data. This methodology may enhance the ecological validity of research by collecting data about daily occupations in situated contexts. EMA data collection provides access to highly detailed and specific data and has the potential to reveal longitudinal patterns of change over a short period of time. It is valued as a means to examine events, precursors, and consequences. EMA methodology presents an innovative approach to explore occupation, thus maximizing existing technology and software. It can also be a useful method for evaluative assessment, given its responsiveness to detecting change over time.
Open Access
Innocent observers? Discursive choices and the construction of “occupation”
(2020-08) Kiepek, Niki
As scholars engaged in processes of knowledge production and knowledge sharing, occupational scientists are afforded a degree of social privilege, authority, and legitimacy and are therefore accountable for the ways in which constructs of occupation are produced. As the concept of ‘occupation’ broadens to encompass a wider range of lived experiences, an opportunity to critically reflect on how discursive choices shape epistemic knowledges is presented. This paper begins with an overview of contemporary, evolving conceptualisations of occupation, followed by discussions about the constructive potential of discourses and considerations for writing and talking about occupation and people who engage in occupation. It is not intended as a summative review; rather, it is a continuation of conversations within occupational science.
Open Access
Methamphetamine use among gay men: An interpretive review of a non-sanctioned occupation
(2019-07) Gish, Alexander; Kiepek, Niki; Beagan, Brenda
Introduction. Attending to the nuanced meanings of non-sanctioned occupations holds the potential to better grasp the influences of occupational contexts at multiple levels. This interpretive review of the literature examines the recreational use of methamphetamine (meth) by gay men. We bring attention to potential benefits, without undermining potential risks for harm. The intent is to broaden current knowledge about meth use by gay men and to understand the many motivations and contexts, as well as influences on other occupations. Method. 15 articles were reviewed and critically appraised. Themes emerged iteratively with interpretation focused on deepening understandings of meth use as an occupation, and in relation to other occupations as engaged in by gay men. Results. Four themes were identified: i) motivations for using meth, ii) disinhibition vs. losing control, iii) contextual factors and patterns of use, and iv) meth use, sex, and harm reduction. Discussion. Advantages and valued benefits associated with using meth recreationally co-occur with potential risks and disadvantages. Experiences of meth use shape and are shaped by social and physical contexts, including community norms and group rituals. Using meth also alters engagement in and performance of other occupations, including sex, socializing, productivity (e.g., work, household chores), and leisure occupations (e.g., dancing, playing pool). The centrality of risk to the experience of using meth suggests that perspectives rooted in health promotion and risk avoidance may misconstrue the occupation itself, something to be considered for all non-sanctioned occupations.
Open Access
Seeking legitimacy for broad understandings of substance use
(2019-07) Kiepek, Niki; Van de Ven, Katinka; Forlini, Cynthia; Dunn, Matthew
This commentary invites discussion about implicit and explicit factors that impede research about substance use from a nuanced perspective that recognises potential benefits and advantages. It is argued that explicit efforts to engage in scholarship beyond those informed by theoretical and philosophical assumptions that substance use is inherently risky and problematic can enhance genuine inquisition about substance use and transform which discourses and interpretations are legitimised. Prioritisation of scholarly funding and publication has largely been predicated on the notion that illicit substances pose an inherent risk for individual and social harm. This has implicitly and explicitly influenced what type of research has been conducted and how substance use is constructed. Researchers who engage in research that suspends assumptions of risk and problems associated with substance use may become subject to judgement about their credibility, ethics, and expertise. Moving forward, we suggest that conscientiously attending to broad, nuanced experiences associated with substance use will contribute to a stronger evidence base. Equal opportunity should be given to examine the complexity of lived experiences. It may also be timely to consider what brings value to scholarly pursuit, recognising that health is but one valued social outcome. Perhaps other outcomes, such as human rights, compassion, and justice are equally commendable. To advance substance use scholarship, it is essential that decision-makers (e.g., funding bodies, editors) embrace research that does not conform to assumptions of risk or inherent problems as exclusively legitimate, advocate for scholarship that resists conforming to dominant discourses, and create spaces for critical perspectives and interpretations.
Open Access
Silences around occupations framed as unhealthy, illegal, and deviant
(2019-07) Kiepek, Niki; Beagan, Brenda; Laliberte Rudman, Debbie; Phelan, Shanon
Occupational science has made tremendous strides in establishing a theoretical and empirical knowledge base grounded in the study of occupation. Yet given its origins in occupational therapy, a health profession aimed at enhancing health and well-being through engagement in meaningful and purposeful occupation, there has been sustained focus on the health-enhancing qualities of occupation. This has effectively silenced a significant realm of human experience: namely, occupations that are considered within dominant worldviews and societal groups to be unhealthy, illegal, and/or deviant. Our intent in this paper is to both explicate why attention to non-sanctioned occupations is important as a means to diversify perspectives on occupation, and point to key framing concepts, such as deviance, hegemony, and resistance, for such scholarship. We emphasize that examinations of this nature evoke critical reflection on underlying disciplinary assumptions, enactments of social power, and values and moral standpoints that inform knowledge production in occupational science, helping to diversify understandings of occupation itself.
Open Access
Substance use and professional identity
(2018-01) Kiepek, Niki; Beagan, Brenda
Processes of professional socialization influence types of substances used, patterns of use, and estimation of normalization. This project explores psychoactive substance use among professionals and students in professional programs in Canada, rationales for use, strategies to manage use and potential consequences, and factors within professional education and culture that influence decisions about use. The intent of this study is to uncover social processes through which professional contexts influence substance use. The researchers sought to explore how professionals and professional students described their own decision-making about substance use and their perceptions of professional influences. The mixed methods pilot study involved ecological momentary assessment (EMA), using an app designed for the study, and qualitative interviews. Participants completed a brief survey on the app each time they used a substance during a 4-week period, reporting what substance was used, how much, where, who with, and anticipated or delayed effects. Thirty-four participants were involved in the EMA component, 20 of whom engaged in interviews. The findings suggest a certain amount of substance use is expected, accepted, and even promoted in professional fields. Thematic analysis revealed novel understandings about (i) deliberate decisions, (ii) disclosure and use, (iii) stigmatized substance use, (iv) normative substance use, and (v) the professional context. This study demonstrates potential advantages of undertaking research to explore substance use, as distinct from substance abuse, problematic use, dependence, or addiction. Conceptualizing substance use more broadly can help to identify factors that both encourage use (e.g., performance demands, social norms) and constrain use (e.g., responsibility, role modeling). This can expand approaches to address substance use that look beyond the individual to social and institutional contexts, acknowledging that responsibility is a collective process.
Open Access
Enhancing occupation through use of substances: A critical interpretative synthesis
(2019-11) Kiepek, Niki; Beagan, Brenda; Phelan, Shanon
Introduction. Substance use, as an occupation, is typically portrayed as problematic and the target of occupational therapy intervention and remediation. At the same time, psychoactive substances may be used to enhance mood, cognition, occupational performance, and/or experience, a perspective that is large absent from occupation scholarship. Objectives. We examine substance use in relation to the enhancement of occupation, drawing on the theoretical notion of agential realism. This theory suggests that in the social world ‘reality’ is not so much objective fact, stable and predictable, but rather continuously produced and reproduced, through doing and intra-active becoming. Methods. A selected integrative, critical interpretive synthesis of the literature as conducted. The analysis is focused on synthesizing literature about substance use and enhancement of occupation. Results/Discussion. Occupation does not exist independent of the doing, but also in ‘becoming.’ Sometimes using a substance is in itself an occupation – having a drink, or going out for coffee. Sometimes using a substance is a means to enhance another occupation – taking erectile dysfunction medication to improve sex, or amphetamines to improve studying. Sometimes using a substance simply alters the experience of an occupation – using cannabis or psychedelics to enhance the experience of listening to music. Conclusion. Adopting a focus on occupation may encourage novel ways of understanding substance use and what constitutes optimal quality of life and meaningful experiences. It may also facilitate better understanding of how people employ alternative, non-substance means to achieve desired occupational outcomes.
Open Access
Use of substances among professionals and students of professional programs: A review of the literature
(2017-09) Kiepek, Niki; Baron, Jonnie-Lyn
Background and aims: This literature review investigates the scope of information regarding selfreported substance use by professionals and students in professional programs, with a focus on anticipated and actual effects of substances. Methods: A review of English, peer-reviewed journals and professional journals was conducted. Articles were included if they reported empirical findings of original research and specifically described an aspect of substance use (e.g. type of substance used, patterns of use, reasons for use) by professionals or students. Results: Of the 130 articles ultimately included, 105 involved anonymous self-administered survey methodology. Self-reported data about the effects of substance use or reasons for use were reported in 35 articles. Reasons for use included positive impact on performance and experience, such as fun, pleasure, sleep, enhanced work performance, improved attention and concentration, and relaxation. Predictive associations were analysed regarding demographic factors, mental health, type of profession, and area of specialisation. Conclusions: Little is known about the effects of substance use on the performance or experience of professionals or students in professional programs. Research is required that incorporates qualitative methodologies, elicits anticipated and actual effects of substance use, including controlled and beneficial patterns of use. Minimisation of research bias is key to future study of the effects of substance use by professionals or students in professional programs.
Open Access
Patient-oriiented research best practice recommendations
(2020) Kiepek, Niki; Freemantle, Stacey; Quaid, Kristine; Jones-Bonofiglio, Kristen; Byerley-Vita, Mandy; White, Tara

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