Canadian Journal of Nursing Research最新文献

BackgroundAn academic-practice partnership was implemented in Northwestern Ontario with the goals of enhancing cross- sector collaboration, co-creating research knowledge related to transition to practice, engaging and recruiting nurses, and mobilizing knowledge to improve the transition experience. There is a growing nursing shortage requiring novel solutions to support retention, particularly for rural and remote populations. Academic-practice partnerships can be leveraged to improve working conditions and consequently job satisfaction (Padilla & Kreider, 2020; Rogers et al., 2020).MethodUsing qualitative methodology, semi-structured virtual interviews were conducted with nine Registered Nurse participants ranging in experience from three to seven months employed at the same hospital in Northwestern Ontario.The interview guide was developed collaboratively by an advisory board comprised of the researcher, hospital staff and input from two student ambassadors from the graduating class. Thematic analysis was completed and broad categories were established with data then expanded into five overarching themes.ResultsFive themes representing impactful sentiments shared by the new graduate nurses were identified: "I couldn't be the nurse I know I could be"; "I'm with you right now"; "You have to catch up"; "Do you want to learn it with me?"; and "I feel thrown in and unprepared".ConclusionNew graduate nurses experience a dissonance between expectations and reality influenced by their interactions with preceptors and colleagues. Academic-practice partnerships can create supportive learning environments, allowing new nurses to transition to independent practitioners while establishing stronger professional identity, which is a positive indicator for retention.

BackgroundA growing body of evidence supports the benefits of family engagement in patient care in intensive care units (ICUs). The English version of the FAMily Engagement (FAME) tool has been validated to measure ICU family engagement. This study aimed to validate the French-Canadian version of FAME.MethodsParticipant-level data from two prospective observational validation studies of the FAME tool, involving family members of patients from eight Canadian ICUs between May 2022 and July 2024, were included. Family members completed FAME in English or French-Canadian. Following discharge, family members completed questionnaires measuring care satisfaction and mental health (anxiety and depression). Reliability was assessed by internal consistency, and convergent and predictive validity by correlation between FAME and related outcome measures. A comparison of French and English scores was also conducted.ResultsA total of 104 family members completed the French-Canadian FAME questionnaire (age 57.0 ± 15.2 years; 62% women; 8% non-White; 53% spouse/partner). This version demonstrated internal consistency (Cronbach's alpha = 0.84) and convergent and predictive validity. FAME was associated with care satisfaction, but not anxiety or depression scores. There were no significant differences in overall FAME, care satisfaction, or anxiety and depression scores between the French and English cohorts (p > 0.05).ConclusionThe French-Canadian version of the FAME tool demonstrated reliability and convergent and predictive validity in French-Canadian speakers, supporting the inclusion of French-speaking family members in future studies utilizing the FAME tool to measure family involvement in ICU patient care.This study includes data from Measuring Family Engagement in Care (The FAME Study), ClinicalTrials.gov (NCT05659485): https://clinicaltrials.gov/study/NCT05659485.

BackgroundThe transition from student to full-scope Nurse Practitioner (NP) is a phase marked by challenges such as patient complexity, expanding scopes of practice, and role ambiguity. NPs expanding presence in healthcare environments, especially those involving complex patient care, necessitates the development of skills, competence, and confidence to practice at their full scope.PurposeThis study evaluated the experiences of NPs participating in the residency program within Fraser Health (FH), British Columbia, to gain insights into how the program impacted their transition to independent practice.MethodsA phenomenological qualitative approach was employed, involving semi-structured one-on-one interviews with fifteen NPs who completed the residency program. Data were analyzed using inductive thematic analysis to identify patterns and themes associated with various clinical phenomena.FindingsThree themes emerged from the analysis: recruitment, transition to practice, and areas for improvement. The residency program significantly influenced NPs' decisions to join FH, offering structured mentorship and professional development opportunities that attracted NPs from diverse backgrounds. Participants valued the exposure to various specialties and clinical environments, which enhanced their clinical skills and confidence. The program facilitated the building of professional networks, providing support and interprofessional collaboration. Despite the benefits, participants identified areas for improvement.ConclusionThe study highlighted the importance of structured residency programs in supporting new-graduate NPs during their transition to independent practice. Enhancing standardization and incorporating formal competency assessments could further improve residency outcomes. Investing in structured transition programs is essential to ensure new NPs are well-prepared to provide high-quality, independent care.

Background & PurposeParents of children with medical complexity (CMC) provide continuous, intensive care that encompasses a range of technical tasks, emotional support, advocacy, and coordination within fragmented healthcare systems. Existing research often treats caregiving as a discrete phenomenon, overlooking how parents make meaning of their roles amid uncertainty and moral distress. This study aimed to explore the lived experiences of parents caring for children with medical complexity at home, examining how caregiving is experienced, sustained, and made meaningful in everyday life.Methods & ProceduresAn exploratory qualitative design was used to conduct in-depth, semi-structured interviews with 15 parents (13 mothers, two fathers) of CMC receiving home care in Ontario, Canada. Purposive sampling was used to recruit parents. Data were analyzed using Braun and Clarke's thematic analysis approach.ResultsTwo overarching themes emerged from parents' accounts: (1) The Layered and Relentless Nature of Caregiving; and (2) The Transformation of Self Through Caregiving, with effects spanning social life, identity loss, mental and physical health decline, and financial strain. Parents reported role overload, identity loss, chronic fatigue, emotional isolation, and ongoing pressure to advocate within unresponsive systems. The lack of consistent and reliable home care and financial support intensified challenges.ConclusionCaring for a CMC impacts parental well-being and reshapes their identity. Sustainable caregiving requires policies and services that support more than just childcare. Integrated mental health services, equitable access to respite, income protections, and caregiver-informed systems are needed to relieve families of unsupported responsibilities and ensure the long-term sustainability of home-based complex care.

BackgroundHomelessness among women and children is a growing concern, shaped by intersecting structural inequities. Service providers working with women who are homeless, particularly those who are pregnant and/or parenting young children, navigate complex responsibilities that span legal, medical, housing, child welfare, and psychosocial domains. These responsibilities are often carried out in under-resourced environments and in response to trauma rooted in systemic injustice. A feminist pragmatist perspective recognizes the relational, embodied, and context-specific nature of this work, and values the insights of direct care providers as essential to shaping equitable and responsive care.PurposeOur study purpose is to deepen our understanding of the ethical tensions and emotional and embodied labor inherent in the work of service providers who work with pregnant and/or parenting women who are homeless, while advocating for structural reforms that support both client outcomes and provider well-beingMethodsThis study is part of a larger community-based research initiative. This article draws on a subset of data from 22 semi-structured interviews and two focus groups with service providers, including social workers, nurses, nurse practitioners, psychologists, corrections staff, outreach workers, and health administrators. Data were analyzed thematically, guided by feminist pragmatist principles that center experience, reflexivity, and practical action.ResultsFindings reveal persistent systemic barriers to care, including inadequate housing, fragmented services, and institutionalized discrimination. Despite these challenges, service providers expressed a deep sense of purpose and fulfillment in their work, rooted in relational engagement, advocacy, and bearing witness to the resilience of the women they support.ConclusionAwareness of the human condition and a commitment to relational, justice-oriented care are central to effective service delivery. Health systems must prioritize equity and justice, ensuring that nurses and service providers are empowered and supported as advocates for pregnant and/or parenting women who are homeless.

BackgroundNurse care coordinators strive to build connections between different organizations to assist patients with complex needs in navigating the healthcare system. However, they often lack adequate support in their roles and encounter challenges related to the tasks themselves and to organizational and systemic factors.PurposeThis study aims to evaluate a care coordination program in Quebec from the perspectives of both providers and beneficiaries.MethodsWe used a qualitative research design following an experience-based co-design approach.19 semi-structured interviews were held, ten with nurse care coordinators and nine with older adults and informal caregivers. An interview guide based on Valentijn et al. framework was used. Data were analysed using both deductive and inductive approaches.ResultsFactors influencing care coordination practice and the experience of older adults were identified. These include growing complexity of needs, patient-centered care, trusting relationships, interprofessional collaboration, communication tools, role clarity, shared values and objectives, the merger of health and social care institutions, and governmental guidelines and standards.ConclusionMany integrated care objectives are effectively implemented. Despite nurses' efforts, older adults have expressed a need for more presence from care coordinators and better communication. This stems from the increasing complexity of patients' needs and situations, as well as the nursing shortage. The study provides a systemic perspective on the challenges of a care coordination program at various levels. As such, it offers valuable insights for care providers, staff managers, and policymakers in integrated healthcare systems, enabling targeted improvements and offering guidance for broader application.

BackgroundThe COVID-19 pandemic required Nurse Practitioners (NPs) in Fraser Health Authority (FHA) to rapidly pivot to virtual care health services. Most NPs had little to no education on providing virtual care and there is a paucity literature on how to best deliver this type of care.PurposeThe purpose of this study was to explore the experiences of NPs in FHA who were required to rapidly integrate virtual care into their practice due to the COVID-19 pandemic, while considering competencies and supports needed to integrate virtual care successfully into NP practice.MethodsThis mixed-methods study purposively sampled 41 NPs in FHA in urban British Columbia. Methods consisted of electronic surveys, and semi-structured interviews and focus groups. Data was analyzed using an interpretive description approach.ResultsThe study found a significant increase in the use of virtual care during the pandemic, with NPs reporting improved efficiency (68.3%) and comfort in virtual care delivery. However, challenges were identified in relational practice, confidence, and workflow, particularly in maintaining therapeutic relationships and conducting physical assessments. Themes from qualitative data highlighted the need for targeted education, standardized protocols, and improved technological infrastructure to support virtual care integration.ConclusionThe findings underscore the complexity of adapting to virtual care and emphasize the importance of training, policy development, and system-level supports to enhance its implementation. These results provide critical insights into the competencies required for virtual care and inform future strategies to improve its integration into NP practice in Canada and beyond.

PurposeColonial frameworks remain embedded within nursing education, mandating a critical and ethical response to the Truth and Reconciliation Commission's Calls to Action to integrate diverse knowledge systems into curricula and pedagogical practices. This paper aims to provide settler educators with a structured framework to decolonize educational practices and fostering culturally safe and reciprocal learning environments.MethodsThis framework integrates decolonial approaches from scholars and collectives, adapting them to local Indigenous contexts and institutional initiatives. The framework's five-phase process - (1) Grounding, (2) Interrogation, (3) New Learning, (4) Commitment, and (5) Rebuilding- was used to guide the critical examination and transformation of curriculum and pedagogy.Major Findings: Called to deepen their colonial consciousness, the authors engaged in learning and unlearning through intentional relationships with local Indigenous communities, being gifted knowledges from Elders and Indigenous scholars. The authors critically reflected on how nursing is taught and evaluated, focusing thier transformative change on their Health in a Global Context and Enacting Social Justice nursing courses. This process revealed the epistemic injustice and pervasive white-centring embedded in course design, assessments, and pedagogical approaches. Engaging in the decolonizing framework led to course redesign that prioritizes diverse ways of knowing in content, assessment, and pedagogy.ConclusionThis study highlights how engaging in a minor reform, can become a catalyst for broader decolonization efforts, but true transformation requires sustained commitment, critical self-reflection, and institutional accountability. Decolonizing nursing education is a collective responsibility, that involves dismantling colonial frameworks and actively prioritizing Indigenous knowledges within nursing pedagogy and practice.

BackgroundDespite stated commitments to equity, nursing education environments remain sites of pervasive everyday discrimination, especially for students with intersecting marginalized identities.PurposeThis study aimed to examine patterns of everyday discrimination among undergraduate nursing students using an intersectional lens, with particular attention to how experiences vary across overlapping axes of social identity and structural vulnerability.MethodA cross-sectional survey of 260 undergraduate nursing students was conducted at a large Canadian university. Everyday discrimination was measured using the Everyday Discrimination Scale (EDS), alongside sociodemographic variables related to race, gender, disability, financial insecurity, and English language status. Data were analyzed using ANOVA and factorial interaction models, with QuantCrit principles informing variable construction, modeling, and interpretation.ResultsEveryday discrimination was commonly reported and significantly higher among students identifying as racialized, especially those born in Africa, financially insecure, or with a disability. Interaction effects revealed that students at the intersection of multiple marginalized identities, particularly women with disabilities or racialized students with financial insecurity-reported the highest levels of discrimination.ConclusionFindings reveal that discrimination is structurally patterned and intensifies at the intersections of race, class, gender, migration, and disability. Through our intersectional and QuantCrit lens, this study advances how inequities are reproduced in Canadian nursing programs and raises urgent questions about ethics, responsibility, and institutional accountability, particularly in relation to the recruitment and support of racialized, international, economically disadvantaged students.

Climate change is one of the greatest global health challenges of the twenty-first century, with wildfires, heat waves, floods, and other extreme events posing profound threats to health systems, communities, and vulnerable populations. Nurses, as the largest segment of the healthcare workforce, are uniquely positioned to respond to these crises, yet climate literacy and climate-health research remain underdeveloped in nursing. While recent progress has been made in embedding environmental health into Canadian nursing curricula, implementation is inconsistent, and research examining the intersections of climate change, health outcomes, and nursing practice is limited. This editorial argues that advancing both nursing education and nursing research is essential to prepare the profession for the realities of a climate-altered world. Climate literacy must be integrated into all levels of nursing education, moving beyond elective or peripheral status to become a core competency. At the same time, nursing research must expand its scope to evaluate disaster nursing interventions, address inequities faced by Indigenous and racialized communities, explore community resilience strategies, and assess the long-term impacts of climate-focused education on workforce readiness. By embedding climate literacy in curricula and prioritizing nursing research, the discipline can generate evidence to inform practice, shape policy, and strengthen health system resilience. Nurses equipped with climate literacy competencies will be able to provide effective care during climate-related disasters, advocate for systemic reforms, and build equitable, sustainable communities. In doing so, nursing can take a leadership role in addressing the health impacts of climate change and advancing global health equity.