Canadian Journal of Nursing Research最新文献

Background: Interprofessional teams working in the Intensive Care Unit (ICU) care for patients requiring varying degrees of life sustaining therapy. A patient's code status can help clinicians to understand the appropriate life support measures to deliver to patients in this setting. Members of the interprofessional team, such as physicians and nurses, can experience challenges related to communication when the code status is unclear.

Purpose: The purpose of this study was to explore how nurses and physicians in the ICU experience communication of code status escalations.

Methods: A qualitative case study approach was used. Participants were physicians and nurses, working in the medical-surgical ICU of a large, urban academic hospital. Data were collected using semi-structured interviews, observations of health care rounds and a chart review. Data were analyzed using qualitative content analysis.

Results: Thematic findings include: (1) engaging in an interprofessional discussion, (2) finding consistent documentation, (3) revisiting the code status, and (4) telling the patient story. The study findings also provide contextual information about participants' experiences of code status communication during the first wave (February 2020 to May 2020) of the COVID-19 pandemic.

Conclusions: The results of this study could inform standard communication frameworks or practices related to dissemination of code status decisions among members of the ICU team.

Background: Research conducted on conflict between Registered Nurses (RNs) has established that it happens regularly within the hospital setting, that it adversely affects the health and well-being of RNs, impacts the effective functioning of the health care organization, and compromises quality patient care. In this article, the phrase conflicting working relationships (CWRs) is used to represent working relationships between RN peers that are non-collegial, uncaring, and non- supportive, and inclusive of the behaviours associated with incivility, horizontal violence, and bullying, among others.

Purpose: To examine how nursing, including nursing knowledge and practice, is socially organized within the hospital setting and how this organization is linked to CWRs between RN peers.

Methods: Interviews were conducted with 17 RNs, followed by text analysis and mapping guided by institutional ethnography (IE) as the research methodology.

Results: The intersections between should nursing, double domination, and the big picture threads shows work environments where RNs struggle to provide appropriate care and conflict has become institutionalized. The intersection between threads can be used as caution areas for RNs and individuals in leadership positions to reflect on nursing practice when conflict is being experienced.

Conclusions: The contextual variables surrounding professional nursing practice are very influential with respect to how RNs relate to each other. A new type of dialogue about the organization of nursing practice in the hospital setting is needed to support more relational practices between RNs.

Older immigrants represent 28% of the Canadian population who are over the age of 60. World-wide 1 in 6 older persons experiences abuse. Due to population aging, attention must be paid to the abuse and victimization of older immigrant persons, and the concept of elder abuse. The purpose of this integrative review was to understand elder abuse from the perspective of older immigrants, who came to Canada in their 60s or older as dependents of families or sponsors. Whittemore and Knafl's (2005) method of review resulted in six articles that met the inclusion criteria. Results revealed three themes: conceptualization of abuse, post-immigration stressors and cultural factors, and barriers to access support and protection. The perpetrators were often close family members including intimate partners, spouses, children, children-in-laws and grandchildren. Contextual factors that influenced abuse included: power imbalance, change in social status from head of the families to legal and financial dependents due to immigration, culture, ethnicity, gender role expectations and language barrier. More research is needed to understand the diverse older immigrants experiences of elder abuse.

Study background: Despite the growing understanding of preconception care, numerous barriers to its delivery still exist, including a lack of evidence-based, accessible screening tools.

Purpose: To validate a new digital Preconception Health Assessment Tool (PreCHAT) against the current best practice, physician-delivered tool in Ontario, Canada, and explore how PreCHAT's design impacts its risk identification abilities relative to the comparison tool.

Methods: A criterion validation study was conducted with 53 female participants aged 18-44 years. Participants completed both tools in a controlled setting. PreCHAT was completed on a tablet individually by participants, while the comparison tool was administered by a physician. Three physicians administered the comparison tool. Measures of strength of agreement between PreCHAT and the comparison tool were calculated using percent agreement, Cohen's Kappa, and prevalence-adjusted and biased-adjusted kappa (PABAK).

Results: PreCHAT identified 135 individual risk factors, while the comparison tool identified 102. Both tools shared the same 14 domains of preconception care and 88 risk factors; of the 88 risk factors, PreCHAT identified an average of 3.42 (p < 0.0001) more risks per participant than the comparison tool. PABAK scores indicated almost perfect agreement between PreCHAT and the comparison tool.

Conclusions: This study suggests that PreCHAT is valid against the current best practice tool and is broader in its risk identification among individuals of reproductive age. PreCHAT's patient-facing, digital, EMR-integrated design may offer unique benefits to providers and patients. PreCHAT offers providers an innovative approach to deliver preconception care and may positively impact reproductive, maternal, and child health.

Background: Alongside declarations against racism, the nursing profession in Canada needs examination of experiences of racism within its ranks. Racism at multiple levels can create a context wherein racialized nurses experience barriers and ongoing marginalization.

Purpose: This critical interpretive qualitative study asks how interpersonal, institutional, and structural racisms intersect in the professional experiences of racialized nurses in Canada, and how nurses respond.

Methods: Self-identified racialized nurses (n = 13) from across Canada were recruited primarily through snowball sampling, and each was interviewed by phone or in person. Once transcribed, interviews were analyzed inductively, which led to the levels of racism as a guiding framework.

Results: From entry to nursing education throughout their careers participants experienced racism from instructors, patients, colleagues and managers. Interpersonal racism included comments and actions from patients, but more significantly lack of support from colleagues and managers, and sometimes overt exclusion. Institutional racism included extra scrutiny, heavier workloads, and absence in leadership roles. Structural racism included prevalent assumptions of incompetence, which were countered through extra work, invisibility and hyper-visibility, and expectations of assimilation. Racialized nurses were left to choose among silence, resisting (often at personal cost), assimilation and/or bolstering their credibility through education or extra work. Building community was a key survival strategy.

Conclusions: Everyone in nursing needs to challenge the culture of silence regarding racism. White nurses in particular need to welcome discomfort, listen and learn about racism, then speak out to help disrupt its normative status.

Background: Caring for older adults is among the most challenging issue of public health and social care systems in modern societies. By enhancing the nursing curriculum, nursing students will be qualified to provide gerontology care, and they will be acknowledging and working to eliminate ageism from the health care system.

Purpose: This study explores nurses' and nursing students' knowledge and attitudes in caring for older adults and addresses the factors contributing to nurses' perspectives. It also examines the nursing curriculum's contributions to nurses' knowledge and attitudes and provides suggestions aimed at reconfiguring the nursing curriculum for comprehensive gerontology nursing care.

Methods: A mixed-method research design was utilized, and quantitative and qualitative data were collected from 90 nurses and nursing students through an online questionnaire. Data were analyzed via SPSS and NVivo 12 software programs.

Results: The results revealed that most nurses possess neutral attitudes toward caring for older patients, and their knowledge ranged from average to above-average levels. Statistical analysis revealed no statistically significant difference between gender and nurses' attitudes or between gender and knowledge. Similarly, there was no statistically significant difference between work status and nurses' attitudes. Results showed a statistically significant positive correlation between nurses' attitudes and knowledge level. This study demonstrated the positive impact of the Canadian nursing curriculum on nurses' knowledge and attitudes.

Conclusion: The current study recommends providing gerontology nursing courses as a mandatory separate course in nursing education to enhance nursing students' knowledge and skills for high-quality gerontology nursing care.

Background: Throughout and following the ongoing Coronavirus outbreak, there is an urgent need to focus on organizational support strategies aimed at improving the resilience of nurses.

Purpose: This research aims to examine the relationship between the nurses' perceived organizational support and their resilience levels, and to reveal the characteristics that make a significant difference.

Methods: The data of this descriptive and cross-sectional study were collected from 722 nurses in February 2021 using the web-based survey method. The study followed the STROBE guideline. The data collection tools included the Introductory Information Form, the Survey of Perceived Organizational Support, and the Psychological Resilience Scale.

Results: Nurses were concluded to have perceived a moderate level of organizational support and their psychological resilience were found to be higher than average. A positive relationship was determined between the organizational support perceived by nurses and their psychological resilience. The gender, position/title of nurses, their work experience in COVID-19 treatment services, and having been infected with the COVID-19 virus were found to affect their perception of organizational support and resilience.

Conclusion: Organizational support perceived by nurses significantly affects their resilience. Resilience programs should, in particular, prioritize permanent clinical nurses who are in the risk group in terms of resilience, female nurses, nurses who had been infected with the COVID 19 virus, and nurses who have been assigned to COVID-19 treatment wards.

Background: Individuals experiencing and perpetrating intimate partner violence (IPV) are frequently in contact with general health and mental health services. Health service providers, including nurses, thus have a key role in identifying and responding to initial indicators of IPV risk.

Purpose: The present study provides descriptive information about current assessment and intervention practices of health and mental health service providers when patients are presenting with concerns about IPV.

Methods: A secondary data analysis of interviews with general health practitioners (n = 17) were coded and dominant themes analyzed through thematic analysis.

Results: The present study uncovered ways in which IPV-related risks are, and are not, recognized and responded to. A metaphorical visual display in the form of a "domestic violence supply room" depicts the level of access and degree of competency described by practitioners in respective areas of practice. Within reach for all practitioners is the knowledge of factors that increase risk and vulnerability to IPV. Out of reach is a comprehensive understanding of the needs of children and perpetrators as well as the consistent ability to consider intersectionality and be reflexive when working with culturally and linguistically diverse populations. The step ladder to improved IPV response, including formal supports such as training and procedures, is frequently described as lacking.

Conclusions: A consistent and empirically supported approach to IPV assessment and response is rare to find across generalist service provision. Although service providers possess basic knowledge of risk factors, organizational direction is needed to allow providers to address IPV confidently and effectively.

Background: Intimate partner violence (IPV) persists as a serious challenge, globally, with regions in Central and Northern Canada reporting the highest rates of shelter use to escape abuse, of sexual assault, and of IPV in the country. Despite research into IPV, barriers and gaps exist in understanding what an effective response to IPV in rural and northern communities should look like.

Methods: To enhance this understanding, qualitative interviews and focus groups with a total of 55 participants were conducted with service providers, including shelter services, victims services, the Royal Canadian Mounted Police, counselors, and others (e.g., psychologists). A grounded theory approach was used to analyze data, with findings illustrated in a schematic that conceptualize the challenges service providers experience.

Results: The findings reveal how an IPV environment, characterized by oppression, abuse, and illness, requires transformation into an IPV-free environment, characterized by empowerment, positive social connections, and wellness. As service providers work to influence this transition, they become experts in understanding the sociocultural context, formal services, and informal supports accessible or not for women experiencing IPV. Service providers encourage social media use into service delivery to improve communication; lobby for rural-specific IPV specialists; and recognize isolation as a barrier to seeking out safe shelter and housing, transportation, and economic assistance.

Conclusion: In order to reduce rates of IPV, the results suggest we must support service providers, document service gaps, and maximize policy change and community action based on IPV as it is experienced in rural and northern regions of Canada.

Background: Online educational programs for nurse preceptors have been created based on various theoretical frameworks; however, no programs using a Strengths-Based Nursing (SBN) approach could be located. Purpose: This qualitative descriptive study explored the nurse preceptors' experiences in using a SBN approach to provide clinical teaching to nursing students after completing an online SBN clinical teaching course. Methods: Semi-structured interviews were conducted with six nurses. Data was thematically analyzed. Findings: Although their levels of familiarity with SBN varied, all preceptors acknowledged that using a SBN approach in clinical teaching benefits both students and educators. They reported that it empowered students and that it allowed them to discover their strengths. Getting to know their students helped the preceptors provide tailored learning experiences and feedback. Using the SBN approach simultaneously enhanced the preceptors' self-confidence and created opportunities for shared learning. Conclusion: Using a strengths' approach offers nurse preceptors a powerful tool to facilitate student learning and skills development in clinical practice.