Nursing

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https://hdl.handle.net/10315/28619

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Open Access
Restorative Care Unit: A Focused Ethnography of Leadership in a 20- Bed Hospital
(2015-01-26) Elliott, Lucy Anthonia; Persaud, Malini
The creation of a restorative care unit (RCU) within an acute care environment caused a change in the nursing team relationships that impacted leadership and culture of the RCU. A focused ethnographic approach provided insight into the nursing team members’ (registered nurses [RNs], registered practical nurses [RPNs] and personal support workers [PSWs]) shared experiences, and the contextual factors that impacted the culture of the RCU. Critical Social Theory and intersectionality (Hankivsky & Christoffersen, 2008) provided the theoretical basis for the study design, data collection and data analysis for understanding the experiences on the RCU. This study found four themes: (1) uncertainty within a new intersection; (2) working together emerges from within; (3) leading within the hierarchy; and (4) everyone contributing within a team. The implications for practice, policy and research include PSWs being an integral part of the nursing team, need for more RCUs, and examining best place for RCUs.
Open Access
Can Practical Knowledge About Medication Safety be Simulated Through a Learning Module for Nursing Students
(2015-08-28) Krunic, Tanja; Singh, Mina
Purpose: To evaluate the effectiveness of introducing an online learning module to nursing students in the fourth year of a BScN program as a way of (a) increasing student knowledge of specific system factors and their role in medication errors; and (b) increasing student perceptions of competence in identifying specific system factors which contribute to medication errors. Methods: An experimental, prospective, single-blind, pretest posttest design was used. Conclusion: There were no significant differences in knowledge of system factors that contribute to medication errors between those students who participated both in the learning module and clinical experience compared to those students who participated in clinical experience only. Nursing students in fourth year of BScN program who participated in a learning module, in addition to clinical experience had greater perceived competence to identify system factors that contribute to medication errors than students who participated in clinical experience only.
Open Access
Opening the Closet Door on Reproductive Cancer Care for Sexual Minority Women: Interactions with Health Providers
(2015-08-28) Legere, Laura Ellen; MacDonnell, Judith Ann
The aim of this critical feminist study was to illuminate aspects of interactions between sexual minority women with reproductive cancers and their health care providers (HCPs) that may perpetuate or challenge barriers to receiving equitable care. For this qualitative inquiry, one-on-one interviews were conducted with six reproductive cancer survivors who self-identified as lesbian or bisexual women, four of whom were also health or service providers, and one Registered Nurse who was not also a cancer survivor (n=7). Four themes emerged from these interviews: the reproductive cancer journey, the meaning of family, interactions with HCPs, and environmental barriers. The participants outlined areas they felt were most important to their cancer care and interactions with HCPs, as well as some of the barriers they encountered. Aspects related to gender, sexuality, reproduction, and their intersections were pervasive throughout the findings and shaped the meaning of reproductive cancers for sexual minority women.
Open Access
A Secondary Analysis of the Differences in Accessing Health and Social Services Between Ethnically Diverse Individuals and the Mainstream Society
(2015-08-28) Ngo, Huy; Samuels-Dennis, Joan
Background: Mental illness is the third leading cause of disability and premature death in Canada. Research shows that access issues are a major concern, especially ethnically diverse individuals who may experience greater barriers. Purpose: This study is a secondary analysis that compares health and social service access difficulty, perceived barriers, and service effectiveness between mainstream and ethnically diverse individuals living with mental illness. Results: There were no significant differences between level of access difficulty, and perceived barriers between the ethnically diverse individuals and the mainstream society differentiated by race, but a significant difference was found in perceived service effectiveness between Caucasians born in Canada and ethnically diverse individuals born outside of Canada accounting for race and birth country. Discussion: Individuals living with mental illness experience comparable levels of access difficulty, barriers and service effectiveness. Additional studies with larger sample sizes from different socio-economic backgrounds are needed to strengthen this conclusion.
Open Access
Parental Needs Rating By Parents and Nurses: Association With Illness Severity
(2016-09-20) Briscoe, Kadeen Nickeisha; Singh, Mina
The purpose of this study was to investigate parents and nurses perspectives on the psychosocial needs of parents, the extent to which those needs are viewed as met; and to understand the association between parental needs and the infants illness severity for parents with preterm infants born before 32 weeks gestation, in the first 10 days of hospitalization to the neonatal intensive care unit. This cross-sectional, descriptive-correlational, pilot study rated parental needs on an attitudinal scale. Twenty-four parents of preterm infants and 16 neonatal nurses participated in the study. The results showed no statistically significant difference in how parents and nurses reported parental needs in terms of importance. Differences were observed between the ratings of the top ten needs that were identified by parents and nurses. Statistically significant differences were observed in the perception of needs that are considered met. No correlation between parental needs and illness severity was detected.
Open Access
Collaborating for Better Outcomes: Exploring the Link Between Nurse-Nurse Collaboration and Nurse Job Satisfaction
(2016-09-20) Sheehan, Sinead Mary; Jensen, Elsabeth
As Registered Nurses (RNs) are crucial to delivering care, it is important to determine the factors which contribute to a healthy work environment for nurses and positive outcomes for patients. Past research has focused on the benefits of nurse-physician collaboration including improved nurse/ patient satisfaction and lower patient mortality. The few studies which have explored nurse-nurse collaboration have linked it with positive outcomes. To determine whether there is a relationship between nurse-nurse collaboration and nurse job satisfaction in the hospital setting, this correlational study involved a convenience/ snowball sample of RNs working in hospitals, who completed the two study instruments (Dougherty-Larson Nurse-Nurse Collaboration Instrument [DLNNCI] and McCloskey Mueller Satisfaction Scale [MMSS]). The results indicated a significant, positive correlation between nurse-nurse collaboration and nurse job satisfaction (r = .569, p<.01). Collaboration between nurses is associated with nurse job satisfaction and may contribute to the development of a healthy work environment
Open Access
Exploratory Study of Documented Psychosocial Nursing Interventions within the Palliative Care Setting
(2017-07-27) Fowler, Sarah Kathleen; Lum, Lillie L. Q.
Further research is needed to better understand issues related to the provision of psychosocial care at end-of-life (EOL). Nursing documentation provides an effective strategy for assessing quality of care. The objective was to assess the quality of documentation processes for EOL care and to identify the degree to which a process-based approach was utilized. A case study qualitative design was applied through a retrospective chart review of the Powerchart documentation database. The process-based framework set out in the Nursing Role Effectiveness Model (NREM) and a modified version of the Quality of Documentation of Nursing Diagnoses, Interventions and Outcomes (Q-DIO) instrument were utilized to guide data collection and analysis. The majority of nursing documentation was of poor quality and statistically significant differences were noted between Q-DIO subsections. This study showed that nurses working in a palliative care setting vary in their ability to complete accurate high quality documentation of psychosocial care.
Open Access
The Lived Experience of Bereaved Caregivers: Caring for Loved Ones at End of Life in Rural Ontario Home Settings
(2017-07-27) Amell, Travis; Johnston, Nancy E.
The purpose of this study was to explore the lived experience of bereaved caregivers who cared for their loved ones at end of life in rural Ontario home settings. van Manens hermeneutic phenomenology research method was utilized to guide this study and to gain a rich understanding of the lived experience through participants interviews. This studys sample consisted of eight participants from rural locations in the Eastern and Waterloo-Wellington counties of Ontario, Canada. Five themes were uncovered: (1) Facing a Terminal Prognosis and Deciding to be a Caregiver; (2) Being in it for the Long Haul; (3) Drawing on Sustaining Reservoirs; (4) Haunting Concerns and Comforting Memories; (5) Reflecting on an Invaluable Journey.
Open Access
"That Look That Makes You Not Really Want to Be There": Health Care Experiences of People Who Use Illicit Opioids in Small Urban and Rural Communities - A Critical Social Theory Analysis
(2017-07-27) Hardill, Kathryn Ann; van Daalen-Smith, Cheryl L.
The phenomenon of interest is the health care experiences of people who use illicit opioids in small Ontario urban and rural communities. Using the qualitative constructivist paradigm the perspectives of participants who used opioids and of nurse participants were interpreted using Frieres critical social theory framework to explore sociopolitical, economic and ideological influences. Findings describe a divide between people who use illicit opioids and the nurses who care for them: Its Like A Switch Gets Flipped (describing an abrupt change in attitude by nurses once illicit substance use is identified), Reciprocal Mistrust, Caring for Women is Different and In a Small Town the Stigma Lasts Forever. Discussion places these findings in the context of health care systems as agents of social control, the influence of neoliberalism, and the impact of the global War on Drugs. Findings lead to recommendations for contextualized nursing practice, education and research and for policy change.
Open Access
An Exploration of Work Related Mental Health Issues Experienced by Rural Emergency Nurses
(2017-07-27) Dekeseredy, Patricia Lynn; Landy, Christine Kurtz
Nurses working in rural emergency departments (ED) are exposed to trauma, pain, and suffering on a daily basis. They care for members of their community, including friends and neighbours in an unpredictable environment with limited resources. These contextual factors not only have a negative impact on provision of quality patient care, but also create very stressful work environment putting these ED nurses at high risk for experiencing emotional trauma. This exploratory, qualitative descriptive study used semi-structured interviews to investigate the experiences of rural emergency nurses. A qualitative content analysis was used to analyze the interviews. Findings describe the impact their work experiences had on the nurses mental health and illuminate factors that could contribute to the development of compassion fatigue, burnout and PTSD. Findings will be used to inform future research into early recognition and resiliency programs to mitigate the effects of occupational mental health issues for rural emergency nurses.
Open Access
Nurses' Perspectives when Working with Families while Delivering Function-Focused-Care to Older Adults in Acute Care Settings
(2017-07-27) Green, Whitney Nicole; Fox, Mary
Older adults are at increased risk for developing functional decline during hospitalization, putting them in danger of negative health outcomes including skin breakdown, impaired mobility and infections. Function-Focused-Care (FFC) is an approach to care designed to help prevent these adverse consequences in this patient population during hospitalization. Families are often present with older adults during their hospitalization but little research has explored nurses perceptions around working with families in FFC. This secondary analysis explored the perceptions of 57 nurses in working with families in delivering FFC to older adults in acute care settings. Two major themes were identified: 1) nurses perceived families as facilitating FFC, and 2) nurses identified families as constraining FFC. In conclusion, nurses viewed families as double-edged swords and described them as creating tension for nurses when caring for older adults. The findings from this study provide insight into the tension nurses experience when providing care for older adults and raises awareness about the importance of nurse-family collaboration in the delivery of FFC to older adults.
Open Access
RNs Experiences of Enactment of Psychotherapy Act, 2007: A Mixed Methods Study
(2018-03-01) Dresher, Ingrid; Singh, Mina
The College of Nurses of Ontario will comply with the Psychotherapy Act, 2007 by requiring nurses to initiate psychotherapy by an order from a physician or NP. This study examines the possible constraints to RN psychotherapy service delivery. Quantitative and qualitative date were gathered from 23 RNs using Barretts PKPKCT to measure power of participants experience for the anticipated regulatory change. Findings revealed concerns that RNs ability to practice psychotherapy would likely be negatively affected due to loss of autonomy, uncertainty and ambiguity. Research evidence has shown loss of autonomy and ambiguity in working environments is consistent with the findings in this study. Bureaucratic barriers to public access to RN psychotherapy, and the consequences of demoralization, devalued status and uncertainty regarding the changes to RNs practice are emotional factors that predict reduced ability for RNs to serve the already insufficient mental health care services in Ontario.
Open Access
Relationship Between Role Conflict, Role Ambiguity, and Interprofessional Team Collaboration Among Nurses Caring For Older Adults in the Intensive Care Unit (ICU)
(2018-11-21) Ejesi, Ike; Fox, Mary
The purpose of this cross-sectional study was to examine the relationship between role conflict (RC), role ambiguity (RA) and interprofessional team collaboration (ITC) among nurses caring for older adults in intensive care units (ICU). Using random sample (n = 403) selected from the primary study by Fox (2014), Pearsons correlations showed statistically significant relationship between RA, RC, as well as between ITC and highest level of nursing education resource availability, and institutional values. There was no statistical significant relationship between gender and ITC. Using regression analysis and controlling for the extraneous variables, a significant regression equation was found (F(7, 403) = 21.19, p < 0.0); whereas RA had a statistical significantly relationship with ITC, RC and the extraneous variables were not significantly associated with ITC. Results suggest a need to reduce role to improve interprofessional collaboration. Further research is needed to identify other variables related to interprofessional team collaboration.
Open Access
The Effect of Method of Delivery and Psychosocial Factors on Postpartum Sexual Satisfaction
(2018-11-21) Cateni, Debora; Landy, Christine Kurtz
OBJECTIVE: The aim of this study was: 1) to determine factors associated with postpartum sexual satisfaction at 6 and 12 months postpartum; 2) to examine the effect of method of delivery on postpartum sexual satisfaction at 6 and 12 months postpartum. METHODS: This study undertook a secondary data analysis of The Ontario Mother and Infant Study (TOMIS) III which recruited 2560 postpartum women. Participants completed self-report in-hospital questionnaires and structured telephone interviews at 6 months and 12 months. RESULTS: Statistically significant factors associated with sexual satisfaction at 6 months postpartum were country of birth, breastfeeding status, physical health scores, perceived social support, mental health scores and the risk of postpartum depression. At 12 months postpartum, breastfeeding status, physical health scores, perceived social support and mental health scores were associated with postpartum sexual satisfaction. Method of delivery was not found to be statistically significant at both time points.
Open Access
Exploring the Attitudes, Beliefs and Practices Concerning Mental Health Amongst African Immigrant Youth Living in Canada: An Interpretive Description Study
(2018-11-21) Olawo, Omolola Olumayowa; Pilkington, Beryl F.
There has been limited research in Canada on the mental health of African immigrant youth. An Interpretive Description methodology was utilized to interview eight African immigrant youth on their attitudes and beliefs towards mental health, their mental health practices, and factors affecting their mental health. Themes that were identified surrounded transitioning into adulthood, between geographical locations, and between identities; protective factors, including resilience, religion, and hyper-masculinity, and the differing immigration experiences of African immigrant youth. This research brings attention to intersectional factors that play a role in the mental health of African immigrant youth, as well as gender differences in their mental health experiences. It also highlights the need for cultural humility in care as well as the importance of critical inquiry when interacting with immigrant populations. Implications for practice and future research are suggested to help advocate for and effectively treat African immigrant youth experiencing mental health challenges.
Open Access
Nursing Students' Beliefs About Substance Use Disorders
(2019-03-05) Elchuk, Stephanie Ann; Jensen, Elsabeth
Persons with substance use disorder (SUD) are subject to stigma and judgement. Stigma worsens clinical outcomes, undermines life opportunities, and decreases well-being of persons who use substances (Corrigan, Schomerus, Shuman, Kraus, Perlick et al., 2017). This meta-narrative reports on the beliefs of nine fourth year nursing students, using direct quotations to express salient beliefs about SUD, recovery, and nursing. Participants' beliefs evolved throughout the lifespan, with a significant shift in understanding occurring in response to education. SUD is seen as a biopsychosocial condition which is not a choice, but rather an attempt to cope with, or escape from, challenging life circumstances. Participants were reluctant to address stigma in their personal and professional lives. It is recommended nursing students are prepared to address workplace and societal stigma. Due to the effect of social environments outlined in symbolic interactionism, it is recommended to interview the same participants at graduation and in five years time.
Open Access
Relational Care and Long-Term Care Home Transitions: Enabling and Constraining Practices
(2019-03-05) Cope, Martha Mary; Choiniere, Jacqueline A.
Care planning in long-term residential care is currently determined mostly by institutional practices whereby decisions about staffing, care delivery, and accountability are made using traditional biomedically focused models. These structures also reflect the influences of neoliberal health care reforms, which began to dominate health care delivery and practices starting in the mid-1990s, creating tensions for nurses between quality of care and the corporatization of health care. A consequence is that long-term care (LTC) care planning and delivery does not emphasize relationships between residents, their family members, and staff as much as it does the biomedical (physical, clinical) aspects of care. Highlighting care as a relationship promotes the uniqueness of individuals. The concern, then, is that relational care (also referred to as relationship-centered care or relationship-focused care) is not being enabled for staff, families, and residents, particularly during transitions. Person-centered (resident-centered) initiatives in LTC have been underway for many years with the intent to improve quality of life and care of residents. In spite of this person-centered notion, long-term residential care homes (LTCHs) are challenged to deliver care that is relational. Transitioning into LTC has been shown to be a stressful and uncertain time for residents and families and a demanding time for staff. Current research lacks experiential data from residents themselves and also about how staff experience this process. Therefore, looking more closely at the specific ways that residents, families, and staff experience transitions will aid in identifying what is currently happening in this area and what could make it better. A qualitative case study design, using purposeful sampling with semi-structured interviews, was used to gather data from various stakeholders in one LTCH. In this thesis I use a critical paradigm and feminist political economy approach to explore what residents, families, and staff identify as the current challenges during transitions into LTC and what would improve this process to further reinforce care as a relationship. This research will contribute to nursing by acknowledging the importance of the nexus of relationships involved in LTCHs and how relational care can offer constructive strategies to address the tensions involved in care quality, accountability, and work conditions so often experienced during transitions.
Open Access
Companioning End-Of-life: Nurses' Experiences of Caring for the Child Who is Dying Through a Relational Ethics Lens
(2019-07-02) Deangelis, Karlie-Carmen; Jonas-Simpson, Christine M.
Caring for children who are dying requires exploration to understand and validate the meaning of this lived experience for nurses. This study uses a qualitative descriptive method to answer the research question: What is the meaning of caring for a dying child for nurses within their collective ethical commitments and responsibilities in neonatal and paediatric intensive care units? Relational ethics was the theoretical framework guiding this study, where semi-structured interviews were conducted with eleven intensive care nurses. Participants were also asked to provide an image that reflected the meaning of providing this care. Findings are presented in five thematic patterns: a) Careful cultivation of a team approach shapes end-of-life decisions; b) Resilience and affirming of self as nurse arise with alleviating suffering; c) Navigating sustained turmoil; d) Willingly sojourning in loving presence; and, e) Facilitating and valuing a familys role in their experience of end-of-life
Open Access
Canadian Women's Contemporary Experiences Accessing Abortion
(2019-11-22) Lebold, Margaret; MacDonnell, Judith Ann
This thesis explores Canadian womens contemporary experiences accessing abortion. Abortion is a womens health issue, yet little nursing research addresses womens experiences or well-documented barriers to care. After Health Canadas approval of the abortion pill, Mifegymiso (RU-486) in 2015, women had an alternative to surgical abortion. This qualitative study uses narrative and critical feminist approaches, and purposive convenience sampling to explore Canadian womens experiences of abortion and access to care. Seven women over the age of 18, diverse in age, education, sexual orientation, geography and experience with medical or surgical abortion completed semi-structured interviews. Critical analysis illustrated the complex, varied meanings that abortion has for women, including the motherhood journey (regardless of whether or not they considered themselves mothers), the pivotal nature of support, and barriers to access. Implications for nursing include challenging the silence in research and augmenting reproductive justice approaches.
Open Access
Public Health Nurses' Perceptions of Assessing, Identifying, and Addressing Elder Abuse: A Descriptive Qualitative Study
(2020-05-11) Agbi, Funmilayo Ibiso; Khanlou, Nazilla
This descriptive qualitative study explores public health nurses perceptions of assessing, identifying, and addressing elder abuse. Ten public health nurses from four public health units were interviewed for the study. Questions were categorized under perceptions of elder abuse, assessment and identification, and addressing elder abuse. A descriptive framework was developed, and findings revealed that the influence of ageism on public health nurses knowledge of elder abuse determined how elder abuse is perceived. Despite general awareness, there is limited knowledge of elder abuse; nurses utilized alternative strategies to assess and identify elder abuse due to absence of screening tools, limited knowledge of interventions, professional obligations and organizational policies and guidelines. This research brings attention to the knowledge gap on elder abuse in nursing scholarship and public health nursing. It highlights the importance of education to advance understanding and promote screening of elder abuse in community nursing. Practice implications and suggestions for future research are provided to aid intervention and advocacy.