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Investigating the Prevalence and Predictors of Apathy among the Canadian Long-Term Care Residents: A Secondary Data Analysis. 调查加拿大长期护理居民中冷漠情绪的普遍性和预测因素:二次数据分析
IF 1.7 Q2 NURSING Pub Date : 2024-12-01 Epub Date: 2024-08-28 DOI: 10.1177/08445621241276613
Aderonke Agboji, Shannon Freeman, Davina Banner, Joshua Armstrong, Melinda Martin-Khan

Background: In long-term care facilities (LTCF), apathy is a prevalent issue, leading to cognitive decline, functional impairment, and increased mortality risk. Despite its significance, apathy often remains underrecognized and undermanaged in these settings. Recognizing and addressing the predictors of apathy is critical for early intervention and improved care outcomes.

Purpose: This study aims to assess the prevalence of apathy and identify its associated risk factors among newly admitted residents in the Canadian LTCF, using the InterRAI Minimum Data Set (MDS 2.0).

Methods: We conducted a cross-sectional analysis of MDS 2.0 admission assessment data between 2015 and 2019, covering 157,596 residents across six Canadian provinces and one territory. Apathy was measured using the Apathy Index of the MDS 2.0, with the biopsychosocial model guiding the analysis.

Results: The prevalence of apathy was 12.5% (19,758 individuals). The most significant predictors include cognitive impairments, specific age groups, hearing impairments, vision impairments, facility size and location.

Conclusions: The findings of this study underscore the need for tailored strategies in LTCF to address apathy, considering individual, institutional, and regional variations. Emphasis on environmental and personal factors is crucial in the management and prevention of apathy in these settings.

背景:在长期护理机构(LTCF)中,冷漠是一个普遍存在的问题,它会导致认知能力下降、功能障碍和死亡风险增加。尽管冷漠很重要,但在这些环境中,冷漠往往仍未得到充分认识和管理。目的:本研究旨在使用 InterRAI 最低数据集(MDS 2.0)评估加拿大 LTCF 中新入院居民的冷漠症发生率并确定其相关风险因素:我们对2015年至2019年期间的MDS 2.0入院评估数据进行了横断面分析,涵盖了加拿大6个省和1个地区的157596名住院患者。冷漠使用 MDS 2.0 的冷漠指数进行测量,并以生物心理社会模型为指导进行分析:冷漠症的发病率为 12.5%(19758 人)。最重要的预测因素包括认知障碍、特定年龄组、听力障碍、视力障碍、设施规模和地点:这项研究的结果强调,考虑到个人、机构和地区的差异,有必要在 LTCF 中采取量身定制的策略来解决冷漠问题。强调环境和个人因素对于在这些环境中管理和预防冷漠症至关重要。
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引用次数: 0
Factors Influencing Novice and Beginner Nurses' Intention to Report Medication Errors and Near Misses. 影响新手和初级护士报告用药错误和险情意愿的因素。
IF 1.7 Q2 NURSING Pub Date : 2024-12-01 Epub Date: 2024-07-26 DOI: 10.1177/08445621241263438
Raouaa Braiki, Frédéric Douville, Marie-Pierre Gagnon

Introduction: Novice and beginner nurses make more medical errors than senior nurses. However, there is significant underreporting of medication errors and near misses among novice and beginner nurses.

Objective: To identify the factors that influence the intention of novice and beginner nurses to report medication errors and near misses.

Methods: A cross-sectional exploratory study was carried out among third-year nursing students in a Quebec university (n = 143). Data was collected through a self-reported questionnaire based on the adapted Theory of Planned Behavior. Simple descriptive analyses and a series of contingency analyses were performed using Chi-2 or Fisher exact tests. Correction of multiple tests was done using Bonferroni test.

Results: All theoretical constructs were significantly associated with intention. Sociodemographic factors (age, sex, experience and education program) were also associated with intention.

Discussion and conclusion: Further studies are needed to identify the determinants of intention to report medication errors and near misses among novice and beginner nurses. More attention is required in nursing practice and education to act on these factors, thus encouraging novice and beginner nurses to report medication errors and near misses.

导言:与资深护士相比,新手和初级护士会犯更多的医疗错误。然而,新手和初级护士对用药错误和差错的报告严重不足:确定影响新手和初级护士报告用药错误和差错意向的因素:在魁北克一所大学的三年级护理专业学生中开展了一项横断面探索性研究(n = 143)。数据通过基于改编的计划行为理论的自我报告问卷收集。使用 Chi-2 或费雪精确检验法进行了简单的描述性分析和一系列或然性分析。使用 Bonferroni 检验对多重检验进行校正:所有理论建构都与行为意向有明显关联。社会人口学因素(年龄、性别、经验和教育课程)也与意向有关:需要开展进一步研究,以确定新手和初级护士报告用药错误和差错的意向的决定因素。在护理实践和教育中需要更多地关注这些因素,从而鼓励新手护士报告用药错误和差错。
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引用次数: 0
A 2-Day Postpartum CBT-Based Training for Nurses. 为护士提供为期两天的产后 CBT 培训。
IF 1.7 Q2 NURSING Pub Date : 2024-12-01 Epub Date: 2024-09-09 DOI: 10.1177/08445621241276238
Madisyn Campbell, Erika Haber-Evans, Amanda Hicks, Ryan J Van Lieshout

Background: Public health nurses (PHNs) are often a first point of contact for postpartum individuals seeking mental health support, but report limited training related to mental health.

Purpose: To determine whether a two-day cognitive behavioral therapy (CBT)-based training program focused on postpartum maternal mental health can improve PHN perceptions of their ability to deliver CBT techniques, their confidence working with distressed clients, and with managing client resistance to treatment recommendations.

Methods: A convenience sample of 45 PHNs working in the Family Health Division of Niagara Region Public Health in Ontario, Canada were assessed before and after they received a two-day CBT-based training program. Before attending training, PHNs reported their current professional position, years of experience working in public health, and any previous mental health training. Their confidence in delivering CBT techniques, working with distressed clients, and with managing client resistance to treatment recommendations was assessed pre- and post-training. Participants also rated their satisfaction with the training.

Results: Statistically significant improvements were seen in confidence using CBT techniques, and in supporting and managing distressed or resistant clients. The two-day training was highly rated overall by participants. Medium to large effect sizes were found for changes in confidence-related questions.

Conclusions: Providing PHNs with brief CBT-based mental health-related training can increase their confidence in this aspect of their practice, and could potentially improve the quality of care they provide.

背景:目的:确定一个为期两天的以认知行为疗法(CBT)为基础的培训项目是否能提高公共卫生护士对其提供 CBT 技术的能力、与受困客户合作的信心以及处理客户对治疗建议的抵触情绪的认识:方法:在加拿大安大略省尼亚加拉地区公共卫生部家庭健康处工作的 45 名公共卫生护士在接受为期两天的 CBT 培训项目前后接受了抽样评估。在参加培训之前,公共卫生护士报告了他们目前的专业职位、在公共卫生领域工作的年限以及之前是否接受过心理健康培训。培训前和培训后都对他们在使用 CBT 技术、与有心理问题的客户打交道以及处理客户对治疗建议的抵触情绪方面的信心进行了评估。学员还对培训的满意度进行了评分:结果:在使用 CBT 技术、支持和管理受困扰或有抵触情绪的客户方面,学员的信心有了明显的提高。学员对为期两天的培训总体评价很高。在与信心相关的问题上发现了中等至较大的效应大小:为公共卫生护士提供基于 CBT 的简短心理健康相关培训可以增强他们在这方面的信心,并有可能提高他们所提供的护理质量。
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引用次数: 0
Psycho-social Stressors Experienced by Young war Refugees in Developed Countries: A Scoping Review. 发达国家年轻战争难民的社会心理压力:范围审查》。
IF 1.7 Q2 NURSING Pub Date : 2024-12-01 Epub Date: 2024-07-21 DOI: 10.1177/08445621241263459
Kateryna Metersky, Adam Jordan, Areej Al-Hamad, Maher El-Masri

Background: Refugees escaping political unrest and war are an especially vulnerable group. Arrival in high-income countries (HICs) is associated with a 'new type of war', as war refugees experience elevated rates of psycho-social and daily stressors.

Purpose: The purpose of this scoping review is to examine literature on psycho-social stressors amongst young war refugees in HICs and impact of stressors on intergenerational transmission of trauma within parent-child dyads. The secondary objectives are to identify the pre-migration versus post-migration stressors and provide a basis to inform future research projects that aim to lessen the burden of stress and inform evidence-based improvements in this population.

Methods: Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Extension (PRISMA-ScR) guided the reporting of this review that was performed using a prescribed scoping review method. Extracted from five databases, 23 manuscripts published in 2010 or later met the inclusion criteria.

Results: Three themes emerged: pre-migration stressors, migration journey stressors and uncertainty, and post-migration stressors. While post-migration environments can mitigate the health and well-being of war refugees, socio-cultural barriers that refugees often experience at the host country prevent or worsen their psycho-social recovery.

Conclusion: To assist the success of war refugees in HICs, therapeutic interventions must follow an intersectional approach and there needs to be a wider application of trauma informed models of care. Findings of this review may help inform future intervention studies aiming to improve the psycho-social health of this population.

背景:逃离政治动乱和战争的难民是一个特别脆弱的群体。目的:本范围综述旨在研究高收入国家(HICs)年轻战争难民的社会心理压力,以及这些压力对亲子关系中创伤代际传递的影响。次要目标是确定移民前与移民后的压力因素,为今后旨在减轻压力负担的研究项目提供依据,并为以证据为基础的改进措施提供参考:方法:本综述采用规定的范围界定综述方法,以《系统综述和荟萃分析首选报告项目》(Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review Extension,PRISMA-ScR)为指导进行报告。从五个数据库中提取的 23 篇 2010 年或之后发表的手稿符合纳入标准:出现了三个主题:迁徙前的压力因素、迁徙途中的压力因素和不确定性,以及迁徙后的压力因素。虽然移民后的环境可以减轻战争难民的健康和福祉,但难民在东道国经常遇到的社会文化障碍阻碍或恶化了他们的社会心理康复:为了帮助高收入国家的战争难民取得成功,治疗干预措施必须遵循交叉方法,并且需要更广泛地应用创伤知情护理模式。本综述的结果可为今后旨在改善这一人群社会心理健康的干预研究提供参考。
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引用次数: 0
Facilitators and Barriers to Developing a Research Program: A Focused Ethnography of New Tenure-Track PhD-Prepared Nursing Faculty. 制定研究计划的促进因素和障碍:以新的终身教职博士预备护理教师为重点的人种学研究》(Focused Ethnography of New Tenure-Track PhD-Prepared Nursing Faculty)。
IF 1.7 Q2 NURSING Pub Date : 2024-12-01 Epub Date: 2024-06-06 DOI: 10.1177/08445621241256702
Winnifred Savard, Christy Raymond, Solina Richter, Joanne K Olson, Pauline Paul

Background: Creating a research program is a critical requirement for new PhD-prepared tenure-track nursing faculty in Canada.

Purpose: The purpose of this article is to present key findings of new faculty members focusing on facilitators and barriers to development of their research program.

Method: We conducted focused ethnography research examining the experience of 17 new faculty members from across Canada.

Results: The following themes were identified: teaching release, preparation from PhD program, intense feelings, supports and processes, mentoring, obtaining grants, and effects of the COVID-19 pandemic.

Conclusions: Implications for practice include identifying ways to facilitate faculty retention as they develop their research program. This research will be of interest to deans of nursing and new faculty members.

背景:目的:本文旨在介绍新教职员工的主要研究结果,重点是研究计划发展的促进因素和障碍:我们对来自加拿大各地的 17 名新教师的经历进行了重点人种学研究:结果:确定了以下主题:脱产教学、博士课程的准备、强烈的感受、支持和过程、指导、获得资助以及 COVID-19 大流行的影响:结论:这项研究对实践的启示包括,在教职员工发展研究项目的过程中,确定促进教职员工留任的方法。这项研究将引起护理学院院长和新教师的兴趣。
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引用次数: 0
Navigating the Unseen Strain: The Hidden Challenges of Black Nursing Faculty in the Fight Against Anti-Black Racism. 驾驭看不见的压力:黑人护理教师在反对反黑人种族主义斗争中面临的隐性挑战》(The Hidden Challenges of Black Nursing Faculty in the Fight against Anti-Black Racism)。
IF 1.7 Q2 NURSING Pub Date : 2024-12-01 Epub Date: 2024-05-06 DOI: 10.1177/08445621241250209
Kimani Daniel, Anne-Laurie Beaubrun

As Black faculty members of a majority-White nursing school, we reflected on our unique experiences as part of a Black community engagement project, aimed at addressing anti-Black racism in nursing education. Our positionality created a complex scenario as we navigated emotionally heavy discussions, grappled with our ability to manage competing interests and care for our own well-being. The invisibility of the undue burden of anti-racism work is discussed. Recommendations for alleviating the burden are proposed based on this lived experience. Nursing schools must recognize the uniqueness of Black faculty members' experiences. Proposed strategies include creating mechanisms and resources for emotional support and incorporating anti-racism initiatives into the nursing school's values and strategic plan.

作为一所白人占多数的护理学校的黑人教师,我们反思了自己作为黑人社区参与项目一部分的独特经历,该项目旨在解决护理教育中的反黑人种族主义问题。我们的立场造成了一种复杂的局面,因为我们要驾驭情绪激烈的讨论,努力提高管理相互竞争的利益和关注自身福祉的能力。我们讨论了反种族主义工作中不应有的负担的隐蔽性。根据这些亲身经历,提出了减轻负担的建议。护理学校必须认识到黑人教职员工经历的独特性。建议的策略包括创建情感支持机制和资源,以及将反种族主义倡议纳入护理学校的价值观和战略计划。
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引用次数: 0
Impacts of Peer Support on Coping and Cortisol Levels for Women Affected by Domestic Violence and Coercive Control. 同伴支持对受家庭暴力和强制控制影响的妇女的应对能力和皮质醇水平的影响。
IF 1.7 Q2 NURSING Pub Date : 2024-12-01 Epub Date: 2024-08-16 DOI: 10.1177/08445621241272723
Nicole Letourneau, Carrie McManus, Jason Novick, Andrea Silverstone

Purpose: Gendered domestic violence and coercive control are prevalent public heath concerns in Canada with dire consequences for survivors. Peer support groups may address and reduce negative impacts of domestic violence and coercive control on women's stress, coping, safety, and alliances with social support network members, the focus of this study.

Methods: A one-group, pre-test/post-test quasi-experimental study was undertaken to evaluate the effectiveness of Growth Circle, a 14-week peer support program offered at an agency serving women affected by domestic violence in a major western Canadian city. Through convenience sampling, women 18 years and older who experienced domestic violence were recruited and provided data on stress, coping, safety-related empowerment, and social support/alliances. Thirty-five participants provided all pre-test and post-test data, with a subsample of 14 providing repeated hair samples. Hair was employed to determine stress hormone (cortisol) levels.

Results: A significant reduction in self-reported levels of perceived stress and stress hormone levels following completion of the Growth Circle program was revealed. Participants also reported a significant increase in safety-related empowerment, and supportive alliances with group members.

Conclusions: The Growth Circle peer support program was demonstrated to be effective. Further implementation and research into the Growth Circle program across Canada is recommended.

目的:性别化家庭暴力和胁迫性控制是加拿大普遍存在的公共健康问题,对幸存者造成了严重后果。同伴互助小组可以解决和减少家庭暴力和胁迫性控制对妇女的压力、应对、安全以及与社会支持网络成员的联盟等方面的负面影响,这也是本研究的重点:在加拿大西部的一个大城市,为受家庭暴力影响的妇女提供服务的机构开展了一项为期 14 周的同伴支持计划--"成长圈"。通过方便抽样,招募了 18 岁及以上经历过家庭暴力的妇女,并提供了有关压力、应对、安全相关赋权和社会支持/联盟的数据。35 名参与者提供了所有测试前和测试后的数据,其中 14 人提供了重复的头发样本。头发样本用于测定压力荷尔蒙(皮质醇)水平:结果表明,在完成 "成长圈 "计划后,参与者自我报告的压力感知水平和压力荷尔蒙水平均有明显下降。参与者还报告说,与安全相关的能力以及与小组成员之间的支持性联盟也有了明显提高:结论:"成长圈 "同伴支持计划被证明是有效的。结论:"成长圈 "同伴支持计划被证明是有效的,建议在加拿大进一步实施和研究 "成长圈 "计划。
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引用次数: 0
"It's a Thing": What Nurse Elders Believe Novice Nurses Need to Know About Managing Emotional Labour. "这是一件事":护士长认为新手护士需要了解的情绪劳动管理。
IF 1.7 Q2 NURSING Pub Date : 2024-12-01 Epub Date: 2024-08-09 DOI: 10.1177/08445621241272622
Charlotte A Ross

Background: Emotional labour (EL) can take a significant toll on nurses' mental health and well-being and has serious implications for the retention of nurses in the workforce. Nurse educators have struggled to prepare novices to manage EL or find serviceable resources with which to do so within the body of nursing literature, which is dominated by essentially unhelpful narratives and is absent of the practical, real-world wisdom of elder nurses.

Purpose: This exploratory research study illuminated elder nurses' experiential knowledge and beliefs of what is important for novices to learn about EL.

Methods: Conventional Content Analysis (CCA) of qualitative survey data from 688 nurses with 20+ years of experience.

Results: CCA generated descriptive categories and sub-categories: What the elders themselves learned as student nurses, and their advice to novices in the individual realm, ("It's a Thing," healthy disengagement, supporting mental and physical well-being, reframing self-reproach), team realm (peer support, mentors), and institutional realm (structural barriers to mentors' support of novices, building novices' capacities for self-advocacy, resources to support health and well-being).

Conclusions: The elders' data confronted and reframed legacy individuated narratives in the literature by supporting and contextualizing nurses' emotional work. Elders advised novices that EL is a reality requiring concrete strategies to manage it throughout their practices. Elders extended their focus for management of EL beyond the individual to include peer support, mentorship, and the structural conditions in which nurses perform their EL, highlighting the need to empower nurses by building their capacity for self-advocacy of their workers' rights.

背景:情绪劳动(EL)会严重影响护士的心理健康和幸福感,并严重影响护士的留任。护士教育者一直在努力让新手做好管理情绪劳动的准备,或在护理文献中找到可用的资源,这些文献主要是无益的叙述,缺乏年长护士的实际、现实世界的智慧。目的:这项探索性研究阐明了年长护士的经验知识和信念,即新手学习情绪劳动的重要性:对来自 688 名有 20 年以上工作经验的护士的定性调查数据进行常规内容分析(CCA):CCA产生了描述性类别和子类别:长者们自己作为学生护士学到了什么,以及他们在个人领域("这是一件事"、健康的脱离、支持身心健康、重塑自责)、团队领域(同伴支持、导师)和机构领域(导师支持新手的结构性障碍、培养新手的自我倡导能力、支持健康和幸福的资源)给新手的建议:长者们的数据通过支持护士的情感工作并将其背景化,对抗并重构了文献中遗留的个性化叙述。长者建议新手,EL 是一个现实,需要在整个实践过程中采取具体的管理策略。长者们将管理情绪低落的重点从个人扩展到了同伴支持、指导以及护士开展情绪低落工作的结构性条件,强调需要通过培养护士自我维护工作者权利的能力来增强护士的能力。
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引用次数: 0
Nurses Navigating Mental Health During Uncharted Times: Self, Others, Systems (S.O.S)! 护士在未知时期驾驭心理健康:自我、他人、系统 (S.O.S)!
IF 1.7 Q2 NURSING Pub Date : 2024-12-01 Epub Date: 2024-07-26 DOI: 10.1177/08445621241266291
Chaman Akoo, Sheri Price, Kimberly McMillan, Kenchera Ingraham, Abby Ayoub, Shamel Rolle Sands, Mylène Shankland, Ivy Bourgeault

Study background: The nursing profession is facing a multiplicity of stressors that have both predated and been exacerbated by the Covid-19 pandemic. The emotional and physical demands entailed in nursing predispose nurses to suboptimal mental health and burnout.

Purpose: This paper draws upon the narrative interviews of 53 Canadian nurses as part of a larger pan-Canadian, cross disciplinary study that examined the gendered experiences of mental health, leaves of absence, and return to work of 7 professions.

Methods: Thorne's interpretive descriptive guided Iterative and thematic analysis which identified three predominant themes within the nursing dataset, this paper focuses on the substantive theme of 'Navigating it Alone,'.

Results: Nurses expressed a profound sense of isolation at 3 particular levels: at home, at work, and in systems - while simultaneously balancing uniquely gendered familial responsibilities and workplace demands.

Conclusions: These results illuminate instrumental pathways for stakeholders to attenuate the personal and professional pressures that continue to be disproportionately carried by nurses as they navigate these particularly challenging times.

研究背景:护理行业正面临着多重压力,这些压力既早于 Covid-19 大流行,也因 Covid-19 大流行而加剧。目的:本文借鉴了对 53 名加拿大护士的叙述性访谈,作为一项大型泛加拿大跨学科研究的一部分,该研究考察了 7 个职业的护士在心理健康、请假和重返工作岗位方面的性别体验:索恩(Thorne)的解释性描述指导了迭代分析和主题分析,在护理数据集中确定了三个主要的主题,本文重点讨论 "独自导航 "这一实质性主题:结果:护士们在三个特定层面上表达了深刻的孤独感:在家里、在工作中、在系统中--同时还要平衡独特的性别家庭责任和工作场所需求:这些结果为利益相关者提供了减轻个人和职业压力的有效途径,护士们在这一极具挑战性的时期仍然承受着巨大的个人和职业压力。
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引用次数: 0
Developing Policy Infrastructure to Guide Genomics-Informed Oncology Nursing in Canada: An Interpretive Descriptive Study. 开发政策基础设施以指导加拿大的基因组学肿瘤护理:一项解释性描述研究。
IF 1.7 Q2 NURSING Pub Date : 2024-12-01 Epub Date: 2024-05-09 DOI: 10.1177/08445621241252615
Patrick Chiu, Jacqueline Limoges, Rebecca Puddester, Andrea Gretchev, Lindsay Carlsson, Kathleen Leslie, Don Flaming, Ann Meyer, April Pike

Background: Genomic technologies such as genetic testing and precision treatments are rapidly becoming routine in oncology care, and nurses play an increasingly important role in supporting the growing demands for genomics-informed healthcare. Policy infrastructure such as competencies, standards, scope of practice statements, and education and curriculum frameworks are urgently needed to guide these practice and education changes.

Purpose: This study is part of a larger three-phase project to develop recommendations and catalyze action for genomics-informed oncology nursing education and practice for the Canadian Association of Nurses in Oncology and the Canadian Association of Schools of Nursing. This phase aimed to enhance understanding of policy needs and action drivers for genomics-informed oncology nursing education and practice through the perspectives of Canadian oncology nurses and patient partners.

Methods: Interpretive description methodology guided the study. Twenty semi-structured virtual interviews were conducted; 17 with oncology nurses in various domains of practice, and three with patient partner representatives. Data collection and analysis occurred concurrently.

Results: Our analysis identified three themes: 1) nurses and patients recognize that it is time for action, 2) nurses and patients see advantages to executing intentional, strategic, and collaborative policy development, and 3) leadership and advocacy are required to drive action.

Conclusion: Nursing policy infrastructure is required to increase genomic literacy, support nurses in providing safe patient care, and establish clear roles, responsibilities, and accountabilities within the interdisciplinary team. Strong leadership and advocacy at the practice, organizational, and systems levels are vital to accelerating action.

背景:基因检测和精准治疗等基因组学技术正迅速成为肿瘤治疗的常规方法,护士在支持基因组学医疗保健日益增长的需求方面发挥着越来越重要的作用。目的:本研究是加拿大肿瘤科护士协会(Canadian Association of Nurses in Oncology)和加拿大护理学校协会(Canadian Association of Schools of Nursing)一个更大的三阶段项目的一部分,该项目旨在为基因组学知情肿瘤护理教育和实践提出建议并促进行动。本阶段旨在通过加拿大肿瘤科护士和患者伙伴的视角,加深对基因组学知情肿瘤护理教育和实践的政策需求和行动驱动力的理解:方法:本研究采用解释性描述方法。研究人员进行了 20 次半结构化虚拟访谈,其中 17 次访谈的对象是不同实践领域的肿瘤科护士,3 次访谈的对象是患者合作伙伴代表。数据收集和分析同时进行:我们的分析确定了三个主题:1)护士和患者认识到现在是采取行动的时候了;2)护士和患者看到了执行有意、战略性和合作性政策制定的优势;3)需要领导和宣传来推动行动:结论:需要建立护理政策基础设施,以提高基因组知识水平,支持护士为患者提供安全护理,并在跨学科团队中确立明确的角色、职责和责任。在实践、组织和系统层面进行强有力的领导和宣传对于加快行动至关重要。
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引用次数: 0
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