International Journal of Qualitative Studies on Health
and Well-being

ISSN: (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/zqhw20

“You have to be okay with okay”: experiences
of flourishing among university students
transitioning directly from high school
Christina Volstad , Jean Hughes , Sonya L. Jakubec , Sonya Flessati , Lois
Jackson & Ruth Martin-Misener
To cite this article: Christina Volstad , Jean Hughes , Sonya L. Jakubec , Sonya Flessati , Lois
Jackson & Ruth Martin-Misener (2020) “You have to be okay with okay”: experiences of flourishing
among university students transitioning directly from high school, International Journal of Qualitative
Studies on Health and Well-being, 15:1, 1834259, DOI: 10.1080/17482631.2020.1834259
To link to this article: https://doi.org/10.1080/17482631.2020.1834259

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Published online: 26 Oct 2020.

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INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING
2020, VOL. 15, 1834259
https://doi.org/10.1080/17482631.2020.1834259

“You have to be okay with okay”: experiences of flourishing among university
students transitioning directly from high school
Christina Volstada, Jean Hughesb, Sonya L. Jakubecc, Sonya Flessatid, Lois Jacksone and Ruth Martin-Misenerf
a
Mental Health Nurse Clinician, Alberta Health Services, Calgary, Canada; bSchool of Nursing; Research Scientist at IWK Health Centre;
Senior Researcher with Healthy Populations Institute, Dalhousie University, Halifax, Canada; cFaculty of Health, Community and
Education School of Nursing, Mount Royal University, Calgary, Canada; dRegistered Psychologist, Mount Royal University, Calgary,
Canada; eHealth Promotion, School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, Canada; fSchool
of Nursing, Dalhousie University, Halifax, Canada

ABSTRACT

Mental health is central to overall wellbeing and, for students attending university, mental
health is critical for learning and academic success. A wealth of research has focused on
young people who experience psychosocial declines during academic and developmental
transitions, but little is known about how young people flourish in this transition. The first to
explore the experiences of flourishing among first-year Canadian university students making
the transition directly from high school, this study sought to develop an understanding of: 1)
the factors that promote flourishing amidst this academic and developmental transition, and 2)
how first-year students define and experience flourishing. An interpretive phenomenological
approach underpinned by Gadamerian hermeneutic philosophy was used to explore experi­
ences of flourishing, using semi-structured interviews, in a sample of nine full-time, first-year
university students, ages 18–20 years. What it meant to flourish amidst this developmental
and academic transition and how participants defined flourishing offer new understandings
of the concept associated with: 1) personal/individual aspects of flourishing, 2) contextual
nature of flourishing, 3) temporality of flourishing, 4) dialectic aspects of flourishing.
Implications for practice, policy, and research in light of these new understandings are
discussed.

Introduction
Mental health is central to overall well-being, linked to
better physical health (World Health Organization,
2014), and for students attending post-secondary
institutions, mental health is important for learning
and academic success (Schroeder & West, 2019).
Individuals between the ages of 15 and 24 years are
more likely to experience mental illness and/or sub­
stance use disorders than any other age group
(Centre for Addiction and Mental Health, 2020), and
this is a time when many young people graduate
from high school and go on to pursue postsecondary education. Since the 1970s there has
been a rise in the number of young people attending
post-secondary institutions (Clark, 2007; MacKean,
2011) and mental illness is one of the most significant
challenges faced within this context today. A wealth
of research has focused on young people who experi­
ence psychosocial declines (Hunt & Eisenberg, 2010;
Oswalt et al., 2020; Storrie et al., 2010); however, little
is known about how young people (age 18–20) are
adapting and coping well while making this academic
and developmental transition.
CONTACT Christina Volstad
Canada

christina.volstad@albertahealthservices.ca

ARTICLE HISTORY

Received 23 February 2020
Revised 27 September 2020
Accepted 30 September
2020
KEY WORDS

Flourishing; university;
students; transition;
qualitative; Gadamer’s
philosophical hermeneutics

Flourishing refers to the experience of feeling good
—high levels of emotional, psychological and social
functioning most of the time. As a relatively new
concept, agreement has yet to be reached among
scholars on how flourishing and its constituent indi­
cators are defined (Agenor et al., 2017; Hone et al.,
2014). To date, four conceptual frameworks with
assessment scales have been developed for measur­
ing flourishing: 1) Keyes’ Dimensions of Flourishing
Keyes, Huppert and So’s Flourishing Scale (Huppert
& So, 2013), 3) Diener et al.’s Flourishing Scale (Diener
et al., 2010) and, 4) The PERMA-Profiler (Butler & Kern,
2016). These frameworks and measures have helped
to define and understand the concept from
a quantitative perspective but the qualitative experi­
ence of flourishing has also been minimally explored
(Ashfield et al., 2012; Gokcen et al., 2012). There are
even fewer studies exploring the experiences of flour­
ishing among students during the transition to uni­
versity
(Knoesen
&
Naudé,
2017).
This
phenomenological study is an exploration of the
experiences of flourishing among university students
transitioning directly from high school to university
and provides a beginning understanding of how firstMental Health Nurse Clinician, Carewest Innovative Healthcare, Calgary,

© 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

2

C. VOLSTAD ET AL.

year students define flourishing and the factors that
promote it amidst this dual transition.

Background
Mental health issues among post-secondary students
have increased in chronicity and have involved
a range of problems which can negatively affect stu­
dents’ academic success (American College Health
Association, 2019; MacKean, 2011). With a rise in the
psychological distress of students, there is a growing
awareness among post-secondary administrators of
the need for more sustainable and long-term strate­
gies to promote mental health (University of Calgary,
2020; University of Toronto, 2018). Despite recent
mental health promotion efforts, strategies to
improve student mental health continue to empha­
size interventions to address problems and chal­
lenges, with fewer policies and resources devoted to
understanding the factors that keep students well (De
Somma et al., 2017).
The problem-solving orientation is similarly
emphasized in the 2019 National College Health
Assessment (NCHA), a survey of Canadian postsecondary students that explored their health beha­
viours, attitudes, and experiences over the previous
12 months (American College Health Association,
2019). The survey involved 58 campuses across
Canada and 55,284 students (American College
Health Association, 2019). Anxiety and depression
topped the list of mental health conditions diagnosed
or treated by a professional in the previous 12 months.
While the survey findings reported 44.4% of students
as flourishing (American College Health Association,
2019), it failed to provide an understanding of the
pathways used to maintain positive mental health,
the contextual factors that promote students’ flourish­
ing, or how mental health could be protected or
promoted.

mental health and addictions supports (Academica
Group, 2020).
Programs across the country have been developed
and implemented in recent years. One program based
on Seligman and colleagues’ operational definition of
flourishing was offered to new students at Ryerson
University in Toronto, Ontario and aimed to support
students while increasing awareness about the link
between academic success and healthy lifestyle
(Ryerson University, 2020). In the fall of 2017, seven
Canadian universities partnered with the Mental
Health Commission of Canada (MHCC) to pilot “The
Inquiring Mind” program. This program, examines
topics of stigma, coping and managing stress, and
aims to empower students to understand and man­
age their mental health (Mental Health Commission of
Canada, 2020).
Encouragingly, models using a whole school
approach, such as the Comprehensive School Health
Framework (Pan-Canadian Joint Consortium for
School Health, 2017) to guide Mental Health
Promotion (MHP) efforts at the elementary and sec­
ondary school levels are now being introduced in
post-secondary settings. These mental well-being pro­
motion efforts draw from a broad range of upstream
approaches and have been incorporated into the fol­
lowing frameworks: The Campus Population Health
Promotion Model (Patterson & Kline), Ecological
Model (American College Health Association, 2018),
Healthy Minds/Healthy Campuses (Canadian Mental
Health Association, 2020), and the UK Healthy
Universities Model (Healthy Universities, 2020). The
Okanagan Charter, an international charter for pro­
moting the health of post-secondary students, con­
siders the social, cultural, political and economic
contexts in which individuals, communities and socie­
ties are immersed and which influence individuals’
mental health (Holt & Warne, 2007).

Developmental and academic transition
The post-secondary mental health context in
Canada
Canada has one of the world’s highest quality and
advanced higher education systems consisting of uni­
versities, community colleges and polytechnic institu­
tions (Usher, 2019). In 2019, Canada implemented
initiatives within several post-secondary institutions
to include: 24/7 mental health supports (via phone
or electronic device), expanded on-campus counsel­
ling services, new campus community spaces devoted
to mental wellness, artificial intelligence-powered
mental health assistants, along with supporting
increases in student service fees so that more mental
health services could be made available. The province
of Alberta alone awarded 22 USD million to 26 postsecondary institutions to support new and existing

Transitions across the lifespan involve the experiences
of dislocation, disorientation, and disruption,
a process of adaptation and characterized as multi­
dimensional, complex, and uniquely experienced by
individuals (Meleis et al., 2000; Schlossberg, 1981;
Schumacher & Meleis, 1994). The developmental and
academic transitions of young people (ages 18–20)
moving directly from high school to university require
a rapid change and adaptation within the new postsecondary education context. Beyond the context, the
period of late adolescence to young adulthood
(approximately
ages
18–20),
involves
a developmental transition in which physical, cogni­
tive, social, emotional, and moral changes occur.
Coinciding with these changes is risk-taking and
experimentation with substances, sexual partners

INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING

and societal rules and norms (Kloep et al., 2015). The
transition involves identity exploration, selfregulation, the development of new relationships
and the separation of the individual from the family
(Humphrey, 2009).
The transition directly from high school to university
is a highly anticipated life phase and it has the ability to
affect later life adjustment (Bland et al., 2012; Pratt et al.,
2000). The challenges faced in this transition include
leaving the parental home, experiencing financial strain,
fitting into a new environment, establishing new social
networks and supports, navigating the new postsecondary environment and adjusting to higher aca­
demic expectations and commitments (Clark, 2007;
Johnson et al., 2010).The inability to cope with stress
during this transition can result in adverse health beha­
viours and can affect the mental health status of young
people (Bland et al., 2012), both of which may place
students at risk for withdrawing from university
(Alarcon & Edwards, 2013). Some students are chal­
lenged by this transition, but others are successful at
adapting and flourishing during this transition.
Predictors of student success include the practice of
good health habits and risk management skills, as well
as positive psychological, emotional, intellectual, and
social development (Park et al., 2011).
In making the academic transition from high
school to university, students are expected to become
independent learners, manage time more effectively,
and make responsible decisions. Unlike developmen­
tal transitions, the academic transition to university is
an individual choice requiring students to adapt and
cope with a new environment. The cohort of
Canadian students (age 18–20) experiencing this aca­
demic transition is not, however, homogeneous.
Research suggests that diversity factors reflecting eth­
nicity, gender, sexuality, disability, culture, and inter­
national, and socio-economic status may significantly
heighten stress and psychological difficulties during
this dual transition period (Michalski et al., 2017;
Usher, 2019). Despite the challenges and develop­
mental tasks, or perhaps because of these conditions,
flourishing, or the experience of feeling good (high
levels of emotional wellbeing or hedonic wellbeing)
and functioning well (high levels of psychosocial well­
being or eudaimonic wellbeing) most of the time
(Hone et al., 2014), is possible for this population.

Flourishing
Flourishing is a relatively new concept and agreement
has yet to be reached among scholars on how flourishing
is defined, or its constituent indicators (Agenor et al.,
2017; Hone et al., 2014). To date four operational defini­
tions of flourishing with assessment scales have been

3

developed for measuring flourishing: 1) Keyes’
Dimensions of Flourishing Keyes Huppert and So’s
Flourishing Scale (Huppert & So, 2013), 3) Diener et al.’s
Flourishing Scale (Diener et al., 2010); and 4) The PERMAProfiler (Butler & Kern, 2016). Despite the lack of consen­
sus on a theory, conceptualization and definition of flour­
ishing, there is strong agreement among all operational
definitions, that flourishing is a combination of a set of
hedonic and eudaimonic indicators, with overlap in the
areas of: 1) positive relationships, 2) positive affect (inter­
ested) and engagement, and 3) meaning and purpose
(Hone et al., 2014).
Although there are slight differences in how these
indicators are defined, the definitions generally come
from the same body of literature on well-being.
Keyes’s model is the most comprehensive in the
area of social well-being (Hone et al., 2013) and
uniquely situates flourishing within a model of mental
health (Dual Continuum Model of Mental Health)
(Keyes). There are four main theories proposing simi­
larities and differences among the constituent indica­
tors of flourishing; however, a lack of consensus exists
on a single measure to examine the prevalence of
flourishing among populations and cross-culturally.
The four theorists agree on similar indicators, but at
times different language is used to describe these
indicators (e.g., purpose in life vs. purpose and mean­
ing). In light of these contributions and what others
might view as an omission of certain indicators (such
as virtue, physical health, religion, security, grit and
growth mindset) no one particular operational defini­
tion was excluded from framing this study. Instead,
the value of having an awareness of all indicators and
the potential outliers of flourishing shaped the lead
researcher’s pre-understandings and provided a space
to remain open to all the possibilities of how univer­
sity students define and experience flourishing while
transitioning directly from high school.
The frameworks and measures have helped to
define and understand the concept from
a quantitative perspective but the experience of flour­
ishing has been minimally explored from a qualitative
perspective (Ashfield et al., 2012; Gokcen et al., 2012).
Studies exploring the experiences of flourishing
among students living through the transition from
high school to university are even fewer (Knoesen &
Naudé, 2017). Predictors of flourishing within the
post-secondary context include academic achieve­
ment (Antaramian, 2015; Howell, 2009), socially sup­
portive environments, ease with transitioning, sense
of belonging, civic engagement (Fink, 2014; Nicotera
et al., 2015) and study engagement and involvement
(Bowman et al., 2010; Low, 2011). To the authors’
knowledge there are currently no studies specifically
exploring the experiences of flourishing among

4

C. VOLSTAD ET AL.

university students transitioning directly from high
school within the Canadian context.

Methods
Setting
The site of this study was a university located in
a Western Canadian city of over a million people.
During the 2016/17 academic year, the full-time stu­
dent population at this undergraduate university was
approximately 10,000. International students com­
prised 3.5% and Indigenous students 5% of the total
population across all programs. Residence complexes
accommodated up to 1,000 students. With 12 degree
programs, and 32 majors, the average class size was
29 students in the 2016/17 academic year. The cam­
pus had competitive sports teams and a number of
other activities such as student and peer support
groups, volunteer and employment opportunities,
recreational programs/intramural/drop-in sports,
workshops, and international committees. In 2017,
the university became one of seven Canadian postsecondary institutions to partner with the Mental
Health Commission of Canada to pilot “The Inquiring
Mind” project referred to above, which was imple­
mented to train first-year students on how to better
understand and manage their mental health with
a focus on stigma reduction and building resiliency
(Mental Health Commission of Canada, 2020).

Population
The target study population was students between
the ages of 18–20 years who transferred directly
from high school into their first year of university
and enrolled in a full-time degree program. This
cohort was chosen due to heightened challenges of
first year that students may experience, including
moving away from their parental home, financial
strain, adjusting to higher academic expectations,
navigating a new social environment and establishing
new social networks and supports (Clark, 2007;
Johnson et al., 2010).

Sample
Interpretive phenomenological approaches tend to
produce a large amount of data; therefore, smaller
sample sizes are recommended (Smith & Osborn,
2015). Given the lack of any precise guidelines for
hermeneutic inquiry (Moules et al., 2015), the guiding
principle for determining the number of participants
for qualitative studies is data saturation (Mason, 2010).
For this study data saturation was reached when
further interviews failed to provide a clearer under­
standing of the experience (Laverty, 2003) and there

was diversity among participants in terms of gender,
ethnicity, degree program and living arrangements.
Predictors of flourishing within post-secondary
contexts include student engagement, involvement
and academic preparedness. Since students were not
given a rating scale to pre-determine flourishing, stu­
dents who self-identified as flourishing (feeling good
and functioning well most of the time) while making
the transition directly from high school to their
first year of university were eligible for inclusion.
Participants were included based on the following
criteria:
● Age 18–20
● First year of university
● Graduated

from high school in the last
12–18 months
● Enrolled in a full-time degree program
● Perceived self as feeling good and functioning
well most of the time

Data collection
Forty recruitment posters were displayed in desig­
nated pre-approved common areas on campus. The
posters used plain language, various fonts and colour
to draw students’ attention to the study. Recruitment
efforts involved contacting and meeting with various
stakeholders engaged with first-year students. Faculty
chairs and student advisors agreed to forward emails
to 1st-year students across all degree programs, and
post or share recruitment posters and emails on
approved campus social media outlets. According to
the Keyes’ Dual Continuum Model of Mental Health, it
is possible for individuals to flourish with a mental
illness; therefore, students were not excluded from
the study for voluntarily disclosing a diagnosis of
mental illness as long as they met the inclusion cri­
teria (Keyes).
Participation in the study required written
informed consent. Interested students who met the
inclusion criteria were given an overview of the study,
a copy of the consent form and encouragement to
contact the lead researcher with questions. In-depth
semi-structured interviews were the prime method for
collecting data in this study (Creswell, 2013; Smith
et al., 2009). The interview took a conversational nat­
ure to become fully immersed in the phenomenon of
interest (Cohen et al., 2000; Fleming et al., 2003) and
stay as close as possible to the lived experience
(Laverty, 2003), through “careful and mindful listening
and skilled questioning …” (Moules et al., 2015, p. 89).
Interviews varied in duration but overall were
between 60 and 120 minutes. The semi-structured
interview guide was informed by the operational defi­
nitions of flourishing and indicators found within each

INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING

of the definitions (Butler & Kern, 2016; Diener et al.,
2010; Huppert & So, 2013). Interviews were tran­
scribed by the lead researcher verbatim and pseudo­
nyms were used to protect anonymity.

5

methodological description to allow for scrutiny of
the research were provisions made to ensure confirm­
ability of the data collected (Creswell, 2013; Moules
et al., 2015; Shenton, 2004).

Trustworthiness
The goal of hermeneutics is to provide the reader
with proof that what is presented is credible, believ­
able and recognizable (Moules et al., 2015).
Establishing trustworthiness involves four key con­
cepts common to all qualitative methodological
approaches: credibility, transferability, dependability,
confirmability (Creswell, 2013; Lincoln & Guba, 1985).
Considering credibility, participants were chosen for
their ability to shed light and bring knowledge to
the topic and expand understanding of the phenom­
enon of central focus (Moules et al., 2015); for this
study, flourishing.
Understanding the university context involved the
lead author’s consultations with a few faculty and
a health promotion specialist working directly with
students and reviewing select university reports and
the university website to understand student mental
health programs and services offered on campus.
Prior to engaging in semi-structured interviews, parti­
cipants were asked to provide some sociodemographic information. A reflective journal was
maintained throughout the study. Reflections were
discussed with the co-authors and linked to theory
as a way of ensuring credibility.
The issues of transferability are considered, how­
ever in hermeneutic inquiry generalizability and trans­
ferability are not where truth lies; instead, truth lies in
the extent to which the research raises more ques­
tions and extends understanding (Moules et al., 2015).
No two universities are alike. Their different demo­
graphic factors and use of different approaches to
promoting student mental health, and models or fra­
meworks constitute unique contexts which become
pivotal to understanding the transferability of inter­
view findings.
Dependability of the data and results was main­
tained through reflective journal and field notes.
Initial notes were taken immediately after the inter­
view. Brief phrases and words were written as
a reminder of critical points in the conversation—
further expansion and reflection followed. Each inter­
view was transcribed by the lead author, indicating
pauses, mishearings, mistakes and speech dynamics
(Biggerstaff & Thompson, 2008). Reflective notes were
written after each encounter with the data and after
weekly discussions with the second author. Reviewing
the
literature
facilitated
further
reflective
understanding.
The shortcomings of the study methods and
potential effects and a detailed in-depth

Data analysis
Phenomenology contains two main approaches:
descriptive and interpretive. The philosophical under­
pinnings for this study are rooted in interpretive phe­
nomenology, an approach consistent with the nature
of the research question. Within the interpretive phe­
nomenological branch, Gadamer’s hermeneutic phe­
nomenology provided the philosophical framework
for this study. Hermeneutics recognizes that
a phenomenon cannot exist without context and the
awareness of preunderstandings, central to under­
standing. The following Guidelines for a hermeneutic
practice, underpinned by Gadamer’s philosophy,
guided the hermeneutic inquiry:
1. The way of hermeneutic practice is determined by
the phenomenon, not the method.
2. Hermeneutic practice requires a disciplined (phe­
nomenological) focus on the particular.
3. Hermeneutic practice requires that we be vigilant
and open in our encounters with the life world.
4. Reading in the hermeneutic tradition involves
a practice of learning to read self and world differently.
5. The nature of hermeneutic practice is dialogical.
Hermeneutic analysis is a process of coconstruction between the researcher and participant,
engaging in a hermeneutic circle—an expanding cir­
cle of ideas that is created by using a back and forth
process with study participants, which helps the
researcher to discover true meaning in the experi­
ences (H.G. Gadamer, 2013, p. 302; Wojnar &
Swanson, 2007). Central to hermeneutic analysis is
the notion that neither the whole, or the individual
parts, can be viewed separately and must be under­
stood in reference to one another (Laverty, 2003;
Smith et al., 2009) and multiple realities and preunderstandings are brought to light amidst
a dialectical movement among the parts and the
whole. This interpretation arises from this fusion of
horizons of both participant and researcher (Laverty,
2003). Interpretive phenomenological analysis is
strongly influenced by Gadamer’s philosophical
underpinnings; therefore, the following step by step
approach outlined by Smith et al. (2009, pp. 82–103)
was used to guide the analysis phase:
1. Reading and re-reading
2. Initial noting
3. Developing emergent themes
4. Searching for connections across emergent themes
5. Moving to the next case
6. Looking for patterns across cases

6

C. VOLSTAD ET AL.

Taken together, this process enabled the formation of
a deeper understanding of flourishing for the
first year students characterized by four interrelated
emergent understandings: 1) personal/individual
aspects of flourishing, 2) contextual nature of flourish­
ing, 3) temporality of flourishing, and, 4) dialectic
aspects of flourishing. These understandings are the
central focus of this paper.

Findings
Demographics
Nine full-time students volunteered for the study
identifying as female (n = 8) and male (n = 1) and
were registered in the following programs: Bachelor
of Nursing (n = 6), Bachelor of Education (n = 1),
Bachelor of Business Administration (n = 1), and
Bachelor of Child Studies (n = 1). Participants’ diverse
ethnic backgrounds included: Caucasian, Caucasian/
Metis,
Caucasian/Filipino,
Chinese/Irish/English/
Scottish, Vietnamese, Chinese, Russian and Pakistani.
Two participants lived in campus residence, four were
living with parents or extended family, and three lived
off-campus independently in a family-owned apart­
ment, or with extended family. All students were
raised in Western Canada including two who had
immigrated before the age of 10.

Emergent understandings
Personal/individual aspects of flourishing
University provided a context in which participants
could enhance and improve areas of personal
strengths and personal challenge. Participants shared
personal coping and self-care strategies (exercise,
healthy diet, good sleeping habits) as part of
a regime that promoted flourishing in first year.
Most participants described personal characteristics
such as a willingness to adapt and step outside their
comfort zone that promoted flourishing amidst the
transition. Taking advantage of, and being flexible
and open to, opportunities for becoming involved
on campus contributed to making social connections
and feeling a sense of belonging in the university
environment. Mimi explained the adaptive quality in
this way:
… I would say to flourish in the first year would be, to
be able to adapt to any changes. To be resilient in the
changes and to be able to put yourself out there
because to be closed up in the first year of university
it’s really hard to make the connections and it’s hard
to feel like you belong unless you open yourself up
and put yourself out there … (Mimi, Int. 4)

For most participants, asking questions and asking for
help were personal challenges to be overcome in
first year in order to take advantage of the many oncampus supports, and resources to promote

wellbeing, academic success and expand social net­
works. As Alex explained:
… just knowing when to ask for help … because before
in high school … it’s not like you couldn’t ask, it’s just
that there was this stigma … What are you saying? That’s
a dumb question? … but I feel like it’s important to ask
the questions because that’s like what you’re going to
need to go on. First semester I definitely didn’t do that,
no confidence at all. I think it was because it was a new
place and not that many friends … (Alex, Int. 9)

Some participants indicated they experience physi­
cal and mental health challenges during the transi­
tion. However, many positive insights and new
personal understandings arose from this place of
challenge in terms of learning better coping and
self-care strategies. In the pre-transition period,
Penny developed a fear of being vulnerable which
followed her to university, making it difficult to trust
others and affecting her ability to establish social
connections. This was further complicated by the
exacerbation of symptoms of her pre-existing health
challenges and feelings of being invisible and
judged by others. Penny understood flourishing to
be routed in her personal journey of finding mean­
ing and coming to terms with having chronic health
conditions. As she commented, “… you have to settle
with feeling ok and functioning ok …”. The ups and
downs linked to her personal health challenges
made the process of flourishing in first year
difficult but during the challenging times there
was no doubt that Penny felt a sense of
accomplishment for her academic success because
as she noted,

… I was feeling okay and functioning okay … I don’t
think there’s ever going to be a good … it’s a chronic
condition … I would say that I was functioning ok
which is pretty awesome. After a while I found my
groove. I found a routine that worked kinda well …
So I was feeling like in the moment I was learning all
of this new stuff … (Penny, Int. 7).

What it meant to flourish when making the transition
to university was less about feeling good and more
about the functioning well components of flourishing.
In this way, flourishing depends on the movement of
a person, in relationship and context. The essence of
all participants’ experiences of flourishing was, in the
end, more about the personal growth than the aca­
demic growth that had occurred as a result of pushing
through and growing in challenging times.
For Carlos, being happy was not at the heart of
flourishing nor was it a precursor to functioning well
during this transition. Happiness was characterized as
a result of functioning well and stepping outside of
one’s comfort zone and growing as a person. Carlos
stated that:

INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING

… flourishing would be stepping back, taking
account … acknowledging that you’re scared. That
university itself is terrifying to a high schooler … after
you’ve acknowledged you are scared, then next you
step outside of that boundary. Because now you
know where the line is, you know what you’re afraid
of and then if you explore something that you’re not
used to then you can grow as a person … (Carlos,
Int. 8).

Josephine shared her thoughts and understanding of
the need to push past her fear of emotional vulner­
ability in relationships. This is a goal that she would
like to work on even more in the future which empha­
sizes that time passing and the steps towards goals
are symbolic of continued personal growth. As
Josephine shared, putting herself more emotionally
into relationships and allowing herself to be vulner­
able, encouraged more meaningful relationships that
lead to an expansion of her social support networks.
Observing and experiencing her friend’s ability to be
vulnerable allowed her to consider what it might be
like for her to be emotionally vulnerable with others.
She commented that:
… I would really like to see myself put myself more
emotionally into relationships and like friendships.
I find it really easy to be vulnerable with my family
members … but people who are not in that little
circle I often do not tell anything that’s going on
with me personally … but I’ve had a way richer
experience because my friends have done that to
me. I’ve been able to help them and I felt super
accomplished because of that and I felt like I’ve
grown closer in my relationships with them and
I kind of haven’t done that in return so that’s a goal
that I have. Just being a little bit more vulnerable …
(Josephine, Int. 5).

Emerging from these challenges depended on the
individuals’ strengths and supports that could be uti­
lized to help them overcome their challenges and
experience personal growth. Of significant importance
was the perception of the challenge(s) and the inter­
pretation of adversities that determined whether they
would flourish, and this is consistent with what is
already known (as cited in Yeager & Dweck, 2012).

Contextual nature of flourishing
Flourishing within this transition was clearly an active
process involving participants shaping and interacting
with family, their living environment, and their com­
munity. Participants shared the many accounts of how
context contributed to what flourishing meant to
them and to the positive and challenging aspects of
the context in which they were immersed.

The family context
All participants described family/parental support and
challenges as a significant element of flourishing in

7

first year. Not only did family support for monetary
needs (financed accommodations, tuition and food)
significantly reduce stress in first year, but it also
provided stable and dependable emotional support.
As Gabby describes,
… my parents because they had supported me
through so much without them I don’t think I would
be able to make all of these transitions by myself. Just
having them there to provide me with physical sup­
port and economic support and anything that I could
ever need. Even though I do fight with my parents …
(Gabby, Int. 6).

In the pre-transition period, challenging times
brought family members together to support each
other amidst the transition to university as the follow­
ing quote from Pam indicates.
… one of my older brothers passed away last year, he
was living with [my older sister] … when he passed
she was living alone and I just couldn’t not allow
myself to not live with her especially when I had
that option because she just lost one of her best
friends as did I … we needed each other … (Pam,
Int. 3).

Family cultural practices (e.g., fasting) shared in the
pre-transition and transition period also contributed
to their ability to flourish, “ … currently I’m fasting so
that’s definitely a wellbeing kind of thing cause not only
is it good for you—like mentally … our values and our
beliefs … my parents have instilled that in me … ”
(Alex, Int. 9)

The living environment
Prior to entering first year, participants made inten­
tional and thoughtful decisions about where they
wanted to live in terms of how it would contribute
to their academic success and wellbeing in first year.
The living environment was experienced by all parti­
cipants as having some positive and challenging
aspects contributing to their ability to flourish. Some
participants’ living arrangements had not changed
from their pre-transition living environments which
facilitated receiving continued support from parents
and siblings, but it conflicted with their developmen­
tal needs of becoming more independent.
Experiences living away from the parental home
provided opportunities to develop life skills, establish
social support networks, explore identity and build
confidence as Rose explains.
… I’ve definitely grown up because I’m living on my
own and I’m responsible for feeding myself and going
to the dentist … it’s really made me my own person
and I realized that I don’t have to rely on my Dad for
everything … you know and I can figure things out
for myself … so I’ve learned how to be less uptight
and anxious about things … (Rose, Int. 1)

8

C. VOLSTAD ET AL.

The university environment
All participants reported that the small class sizes and
small student and faculty population at the university
made a positive difference in feeling a sense of
belonging to the university and contributed to their
establishing social networks and getting to know
faculty.
… It really helps here at [the university] because the
class sizes are really small compared to [other univer­
sities] where it’s 200-300 people. Whereas here it’s 35
so you really get to know your professor and they
know you by name and give you really good feed­
back on your work and make really good personal
connections with you … (Rose, Int. 1)

Several students shared that high school had not
prepared them for the higher expectations in univer­
sity. “ … high school didn’t really prepare me for the
writing … I also found the course load and specifically
in bio in high school we would spend around 2–3 weeks
per chapter but in uni., we’re now doing pretty much
a chapter a week … ” (Charlotte, Int. 2)
Faculty who were approachable, and willing to
help, made students feel like they were more than
just a number and promoted flourishing.
… They’ve all been really good so far … they all um
focus on the student as a whole instead of like
another number … it’s nice to know that they actu­
ally know your name and if you need any help or
anything you can just come in and talk to them, it’s
not intimidating or anything like that … (Gabby,
Int. 6)

Informal and formal programs, for example, the Peer
Learning Program, created opportunities for on cam­
pus involvement and a safe environment to receive
support. Penny explains that she loved peer learning
and that she felt comfortable asking questions in this
setting.
… … I knew that it was their job to understand more
things than I did and it was wonderful to not have to
be the smartest person in the room … there was
definitely things that I didn’t know that I needed to
ask clarifying questions for, that my fellow learners
didn’t judge me for and that the tutor didn’t judge
me for either … (Penny, Int. 7)

Participants shared that working with peers they
didn’t know—or who had a different work ethic, or
personality traits—was at times uncomfortable and
challenging. However, this became an opportunity
for personal growth as Carlos explains.
… for one of my classes in first semester … I was
placed into a group of three extroverted rap fans …
the stereotype wouldn’t have meant top quality
grades … but I left with an A+ and a lot of this was
due to their input and the way that they worked
together. So working in groups and seeing all these
personalities disproves some of the stereotypes of

what makes someone effective … you can’t just
assume that because someone’s extroverted, peppy
or talks as if they know what they’re doing … (Carlos,
Int. 8).

Compared to high school, a more intense course load
made it easy to lose touch with off-campus friends
and finding that balance between school and socializ­
ing was challenging, took time, and for many, this did
not occur until second semester. Charlotte explains
this as follows:
… In my first semester I was kind of sticking with the
people that I know because you know … transition­
ing … you don’t really know what to really expect,
you kind of hang on to people who you are familiar
with. Then in the second semester I found myself kind
of branching out and making new friends … it was
a pretty good experience … (Charlotte, Int.2).

Community environment
Off-campus involvement was experienced by many
participants as contributing to their ability to flourish
in first year. Some participants described off-campus
friendships in terms of being more meaningful and
providing them with the much needed break from
more academically focused social networks on cam­
pus. Mimi explains her experience with off-campus
friends in the following terms:
… Whenever I’m with them (off campus friends) I’m
like, we never talk about homework because we’re all
in different faculties and we’re all in different schools.
So whenever we hang out or anything it would be
like just to relax, like never on homework it’s more on
how our lives are going, we talk about how our well­
being is going basically like … we plan more fun
things like ice cream or like movies, anything like
that … (Mimi, Int. 4).

For some participants, the off-campus contexts
(attending church, volunteering, paid employment
and socializing with off-campus friends) promoted
flourishing, thus highlighting the multitude of con­
texts and many ways in which first-year students can
flourish. Josephine describes her personal experience
with attending church.
… another one that for me … encompasses all
aspects of health is going to church … So it’s like
this group of people that just wants to feed them­
selves spiritually and just take a break once a week.
Sometimes we’ll have meals together after church. At
first everyone was just kind of strangers and now it’s
just kind of my friends away from school and it’s been
awesome it’s been refreshing … I think it’s really
uplifted me … (Josephine, Int. 5)

Temporality of flourishing
The life experiences leading up to the transition to
university, flourishing amidst the transition, and parti­
cipants’ sharing goals and future aspirations speaks to

INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING

the temporal nature of flourishing and the realization
that we are always in flux with our history (McManus
Holroyd, 2007). In many ways, flourishing was similarly
experienced by participants as a process rather than
a destination or endpoint as expressed by Josephine.
… at the start of semester, I wasn’t involved in anything
school-related like except for academics … I kind of
closed myself off a little bit. I was in the library studying
24/7 or I was at the gym and I maybe had like 1 or 2
friends. But in the start of the next semester, I made
a goal for myself, to kind of like branch out a bit
more … that’s been a huge shift from my first semester
where I was more on the grind, I was still doing good,
I was still pretty healthy but my health had improved
significantly since I branched out … (Josephine, Int. 5).

Development takes time, as several participants
expressed, not yet feeling like an adult and in essence
characterizing the road to adulthood as temporal.
Rose indicates that she does not yet feel like an
adult.“ … I don’t have a job … My dad is loaning me
the money to go to university … I think maturity wise
I’ve grown up a lot … I still do stupid stuff sometimes
because I’m still a teenager, you know coming to [name
of province] the legal drinking age is 18 … so some­
times I let myself go a little too far with that but that
again is just a learning experience … ” (Rose, Int. 1).
Likewise, the temporal nature of flourishing was
influenced by participants’ life events leading up to
university and contributed to their experience of
flourishing in first year. Gabby illustrated this experi­
ence with immigrating to Canada and the challenges
her family had building a new life. These experiences
have contributed to her grit and perseverance in
pushing through tough times in university. This is
further illustrated in the final emergent understanding
whereby challenge is a necessary component of
Gabby’s experience of flourishing.
… my family has gone through so much stuff going
through all the changes and there has been so much
stuff during my childhood … [my dad] used to work
in [name of city} so when he’d be there he would be
fine, but he would come home he would end up
drinking a lot … so that was a lot of my childhood
and just being able to kind of push through that …
I think that factor kind of helped me build the emo­
tional resilience and kind of stability … (Gabby, Int. 6)

Dialectic aspects of flourishing
Participants experienced many personal and contex­
tual challenges that influenced fluctuations in their
emotional wellbeing and challenged their ability to
flourish in first year. Challenge was experienced by all
participants and interpreted to be a necessary ingre­
dient of flourishing within this context. Carlos shared
his thoughts on how his doubtful and quiet nature
helped him flourish within the university context.

9

… I doubt a lot of things and that’s a good strength
so then I can go back and question it and work at it.
Another strength … I’m so quiet, I guess then it
means I can listen more … I don’t have to prove
anything because I’m more interested in what you
can teach me than what I can say about what you
taught me … (Carlos, Int. 8)

Mental health struggles were perceived as a way of
developing positive coping strategies for Josephine
that helped her flourish in her first year.
… I think that the struggles that I’ve been through
with my mental health … have kind of formed these
coping mechanisms which have turned into very
healthy coping mechanisms, which is something
that I’m very fortunate … (Josephine, Int. 4)

Discussion
This study found that among students transitioning to
university who perceived themselves to be function­
ing well, the essence of the experience of flourishing
involved “challenge” as a universally experienced
characteristic. The research indicates that flourishing
is not simply a compilation of a set number of positive
indicators at a particular point in time but that chal­
lenge is critical to flourishing, because challenge and
flourishing are connected and interdependent as sug­
gested by Lomas and Ivtzan (2016) in their discussion
of the components of a dialectical process.
Personal strengths and areas of personal challenge
were important aspects of the experience of flourish­
ing for participants who encompassed a mindset in
which challenges were perceived from a place of
possibility and opportunity, and which arose from
having the courage to be vulnerable. Participants’
descriptions of the challenges included: facing fears
about moving into residence, having the courage to
persevere in the face of academic challenges, the
courage to expand horizons and take advantage of
opportunities within the university environment, the
courage to continue with one’s studies after a painful
family loss, and challenges with personal chronic
health issues.
The level of perseverance, determination and pas­
sion for achieving long-term goals was a key character­
istic among all participants in this study. Grit is
a personality trait defined simply as “perseverance and
passion for long term goals” (Duckworth et al., 2007,
p. 1087), and although grit is absent from the four
operational definitions of flourishing it was present in
the participants’ interviews. In addition, while a growth
mindset also was not an indicator included in any of the
four operational definitions, it appeared in the interpre­
tation of the meaning of participants’ experiences of
flourishing. A growth mindset is defined in terms of
embracing challenges, persisting in the face of setbacks,
viewing effort as the road towards mastery, and

10

C. VOLSTAD ET AL.

learning from criticism as well as from the success of
others (Dweck & Leggett, 1988; Mindsetworks, 2017). All
participants shared experiences that reflected having
a growth mindset rather than a fixed mindset which is
one that is static, views effort as fruitless, ignores feed­
back and feels threatened by the success of others
(Dweck & Leggett, 1988; Mindsetworks, 2017).
Transitions are processes that take place over time;
involve development, flow, or movement from one
state to another; include stages or phases; and result
in changes in identity, roles, relationships, abilities,
and patterns of behaviours (Schumacher & Meleis,
1994). In our study, flourishing was similarly experi­
enced as a process that took place over time in terms
of the personal growth that participants experienced
and the time it took to arrive at a place where they
could perceive themselves as flourishing in their
first year. Flourishing was a process, not an endpoint.
Development takes time, and as several participants
expressed, they were not yet feeling like an adult. In
essence, they characterized the road to adulthood as
temporal, and likewise flourishing was characterized
as temporal and as affected by participants’ personal
histories. Framed by development and movement
over time, flourishing for first-year university students
was expressed through an ecological frame of perso­
nal, relational, dialectic, contextual, and temporal fac­
tors. Although there are no absolute truths in
understanding as understanding is never final, we
can say with confidence that flourishing is not
a “primarily private phenomenon” (Keyes, p. 121).
Flourishing can only begin to be understood in
terms of its relationship with context, or perhaps
more accurately a myriad of contexts (family, living
environment, university and community). Participants
shared many accounts of how context contributed to
what flourishing meant to them and to the positive
and challenging aspects of the context in which they
were immersed. In terms of the developmental transi­
tion that participants between the ages of 18–20
experienced, university is a context that encourages
and influences the movement from adolescence to
young adulthood. The university context required
that the student s be active in the process of taking
advantage of opportunities in their environment to
build confidence and skills that would help in the
subsequent years of their study and in life. The perso­
nal strengths, challenging experiences, and opportu­
nities leading up to university influenced how
participants flourished during the transition which
demonstrates that historical awareness is always at
work (H. G. Gadamer, 2006).

Strengths and limitations
A key strength of this study is that interviews with
students took place at the end of the first year of

university, allowing participants to reflect back over
the course of the entire academic year and provide
rich in-depth accounts of their experiences of flourish­
ing. If this study had involved students speaking
about their experiences at the beginning of
first year, it is unlikely they would have spoken
about the opportunities or resources on campus that
promoted their flourishing, as most participants
became more involved in University activities in
the second semester.
There has been an increase in student diversity on
Canadian campuses since the start of the 21st century
(Michalski et al., 2017) and although there was some
diversity among the study participants there was an
absence of international students transitioning to
first year directly from high school in their country
of origin. Students identifying with gender and or/sex
identities other than male and female did not volun­
teer to participate in this study which is also
a limitation of the study. Further, only one male stu­
dent volunteered to take part in the study. Men typi­
cally participate less in qualitative health research
(Affleck et al., 2013), and this may help to explain
why more men did not volunteer for our study. The
recruitment for this study also yielded many Bachelor
of Nursing students, and there was limited diversity of
participants in terms of programs of study. In spite of
these limitations, however, our study does add to the
knowledge base.

Implications for practice, policy and research
Exploring the experiences of flourishing has provided
insight into programs and policies that might be
implemented in high schools and universities to
ease this transition for those students who are strug­
gling, and promote continued flourishing among
those who are thriving. High schools could, for exam­
ple, have mentoring programs whereby university
students who have made the transition to university
speak to high school students about their experiences
with the transition. To facilitate this type of program­
ming in rural and remote communities, videoconfer­
encing could be arranged.
University life is not only concerned with aca­
demic development but achievement of develop­
mental growth in the transitions is also central to
the experience of flourishing at university. Fostering
students’ personal strengths and capabilities
(Davidson et al., 2009; Galassi, 2017; Xie, 2013),
normalizing challenges experienced in first year,
and encouraging students to take on challenges is
critical to supporting academic success and well­
being (Yeager & Dweck, 2012). Exploring ways of
changing perceptions at all levels, from the indivi­
dual student level to administrative levels at high
school and university about the importance of

INTERNATIONAL JOURNAL OF QUALITATIVE STUDIES ON HEALTH AND WELL-BEING

“challenges” has the most promise for helping with
the transition and encouraging students to flourish.
It is also important that universities foster safe
environments in which students feel comfortable
asking for help to ease their transition. Asking for
help was particularly challenging for many partici­
pants in this study and, ideally, learning this skill in
the pre-transition period would better equip stu­
dents entering their first-year university (Fainstad
et al., 2018).
Opportunities within the university context for
health promotion initiatives involving peer support
might also contribute to flourishing in first year of
university. Studies have found peer learning in
undergraduate nursing programs to be effective in
developing communication and critical thinking skills
as well as boosting students’ self-confidence, with an
added benefit of being a cost-effective way of hav­
ing students support one another’s learning (Stone
et al., 2013). Peer-led support for first-year students
might involve students in their fourth year, sharing
with students in first year the challenges they faced
and how challenges were overcome, or by assigning
first-year students a peer mentor who has transi­
tioned to university and who can assist them
in navigating the new environment (Miller et al.,
2019).
Universities are invested in helping prepare stu­
dents for the workforce which includes learning
how to work with others and develop the necessary
social and emotional skills to transition into the
workforce. Although sometimes challenging for stu­
dents, group work fosters social and emotional
development (Laal & Ghodsi, 2012) and is key to
academics and success in life (Kosterman et al.,
2019). Learning these social and emotional skills in
elementary and secondary schools might be bene­
ficial in fostering social and emotional competence
entering first-year university (Wyatt & Bloemker,
2013).
Faculty can also support students by having an
awareness of common challenges faced by first-year
students and understanding these challenges.
Participants in our study were more likely to reach
out to faculty who embodied qualities of openness,
patience, acceptance and genuinely cared about
their wellbeing. Faculty awareness of on-campus
supports and resources is important but there is
also a need for faculty to provide opportunities for
students to feel safe discussing concerns, and sup­
porting students to solve their own challenges.
In our study the midsized university and small
class sizes provided opportunities to have meaning­
ful relationships with faculty and peers which, as
others have noted, promotes students’ sense of
belonging to the university environment and their
program of choice (Chapman & Ludlow, 2010) but

11

responsibilities for easing the transition do not lie
solely with universities and include families. Among
some of the participants in our study, family and
parental support was a significant resource for flour­
ishing, yet family challenges were also present. High
schools, and other stakeholder organizations such
as community health centres, could provide educa­
tion and support for parents who need it prior to
their children making the transition to postsecondary education in order to help promote
family and parental support. Parenting workshops
aimed at fostering children’s strengths and educat­
ing parents on how to apply a strength-based par­
enting approach to deal with everyday challenges
and managing the transition to university could
feature in community programs.
Further qualitative studies involving other postsecondary contexts, such as at colleges and
technology institutes might mean the discovery of
additional factors associated with flourishing speci­
fic to these contexts and populations of students.
Future studies could also target specific populations
making critical transitions such as mature students
making a career transition, or mature students with
no previous post-secondary educational experience.
Longitudinal studies are also of importance as they
could explore the experiences of flourishing over
time beginning in high school, throughout univer­
sity, and then following students into the workforce.
Longitudinal studies would help build an under­
standing of the experiences of flourishing over
time and within changing contexts. Studies of this
nature are adept at identifying pathways, meaning,
turning points, changes and interpretive stances
over the course of one's life, (Hermanowicz, 2016).

Conclusion
Our research explored the experience of flourishing
among full-time students between the ages of
18–20 transitioning directly from high school to
university. This transition may be challenging, how­
ever there are students who are able to flourish.
Exploring the experiences of flourishing using
Gadamer’s hermeneutics unearthed the individual,
contextual, temporal and dialectical nature of flour­
ishing during this transition. Further qualitative
research is critical in order to advance our under­
standing of flourishing within other post-secondary
contexts in light of the growing concern for student
mental health.

Ethical considerations
This study was approved by Dalhousie University Research
Ethics Board and the Research Ethics Board (of the site of study).

12

C. VOLSTAD ET AL.

Disclosure statement
The authors have no financial and/or business interests that
may be affected by the research
reported in the enclosed paper. We disclosed those
interests fully to Taylor & Francis. The funding received for
this study was not granted by the institution in which the
study was conducted.

Funding
This work was supported by the Dalhousie University
Nursing Research and Development Fund; School of
Nursing, Dalhousie University [37291];

Notes on contributors
Christina Volstad, the lead researcher, is a mental health
nurse clinician with Carewest Innovative Healthcare in
Calgary, Alberta. She completed a Master of Nursing at
Dalhousie University, centred on mental health promotion
and wellbeing across populations and settings. She has 25
years of nursing experience in the psychiatric/mental health
nursing specialty in adult and adolescent populations in a
variety of clinical, leadership, teaching and research roles.
Dr. Jean Hughes is the lead researcher’s thesis supervisor
and full professor in the School of Nursing, Dalhousie
University. Her research and publications concentrate on
marginalized populations with a focus in mental health.
She integrates diverse research designs along with a
range of disciplines and sectors to enable a holistic explora­
tion of phenomena with particular attention on mental
health promotion.
Dr. Sonya L. Jakubec is a Professor in the School of Nursing
and Midwifery at Mount Royal University, Calgary, Alberta
where she teaches and researches in the areas of commu­
nity mental health and wellbeing across the lifespan as well
as research literacy for health and community practice. Her
current program of work concentrates on social determi­
nants of mental health, particularly the influence of physical,
social and policy environments on palliative, end of life and
grief care.
Dr. Sonya Flessati is a member of the lead researcher’s
committee and is an Associate Professor at MRU where
she works as a Registered Psychologist in Student
Counselling Services. Sonya works as a counsellor with a
diverse population of young adults at MRU. Her interest in
helping MRU students flourish is rooted in positive psychol­
ogy concepts and strength-based approaches. Her expertise
lies in her understanding of the emerging adult population,
the concept of flourishing and promotion of mental wellbeing and resilience of students in the post-secondary
context.
Dr. Lois A. Jackson is a professor of Health Promotion in the
School of Health and Human Performance, Faculty of
Health,
Dalhousie
University
(Canada).
Dr.
Jackson's program of research centres on the health and
well-being of marginalized populations with a particular
focus on access to health services. She has conducted
research with diverse populations including youth living in
rural places, and has expertise in various qualitative meth­
ods as well as community-based research.

Dr. Ruth Martin-Misener NP, PhD, FAAN is Director and Full
Professor in the School of Nursing and Assistant Dean,
Research in the Faculty of Health at Dalhousie
University. She is also the Co-Director of the Canadian
Association of Advanced Practice Nursing at McMaster
University and an Affiliate Scientist with Nova Scotia
Health as well as the Maritime Strategy for PatientOriented Research Support Unit. Dr. Martin-Misener’s
research evaluates the implementation and outcomes of
inter professional team-based models of care and nurse
practitioner and other advanced and specialized nursing
roles in primary health care and long-term care.

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