Canadian Journal of Nursing Research最新文献

BackgroundDecades of war and political instability have forced millions of Afghans to flee from their homes, resulting in one of the world's largest humanitarian crises. Many refugees have resettled in North America, particularly in Canada and the United States, where they have encountered numerous psychosocial and systemic barriers to adapting to their new environment.ObjectiveThis scoping review aims to explore the settlement experiences of Afghan refugees in North America, synthesize existing evidence on integration challenges, and identify key gaps in the literature.MethodsFollowing Arksey and O'Malley's methodological framework, six electronic databases were searched for relevant literature published between 2014 and 2024, which focused on Afghan refugee settlement experiences in the North American context. Seventeen eligible studies were included in the final review.ResultsMental health emerged as the most studied topic, with Afghan refugees experiencing moderate to high rates of psychological distress, depression, and post-traumatic stress disorder. Key risk factors included female gender, older age, pre-migration trauma, financial constraints, and social isolation. Protective factors, such as, strong social support networks, English language proficiency, and gainful employment were associated with improved mental health outcomes. In spite of the generally positive healthcare experiences, Afghan refugees encountered language barriers, limited health literacy, transportation difficulties, and cultural misunderstandings with healthcare providers.ConclusionAfghan refugees in North America face complex and intersecting barriers to health and healthcare access, and integration. Current literature by and large focuses on mental health, and there is an urgent need to expand research in other important areas of post-migration and (re)settlement.

Shortages of registered nurses are frequently experienced in the provincial health care systems of Canada. The work environment needs attention to improve Nurses' Satisfaction with the Performance of their Duties (NSPD). A hypothesized model was developed to find the factors associated with NSPD. A cross-sectional study covering two similar-sized health regions in Canada was used to test the model developed. A self-reported survey was conducted for a sample of nurses (n = 230) consisting of Registered Nurses (n = 196) and Licensed Practical Nurses (n = 34) working in the cardiology or stroke units in the health regions of Halifax and Saskatoon. A regression model was built to test the hypothesized model. The final model specified significant predictors of NSPD with Years in Practice as a control variable. Significant predictors explaining the variance were: Hassles (21.0%, β = -0.098, p = 0.022); Positive Attitude (21.2%, β = 0.108, p = 0.011); Unit Organization (14.4%, β = 0.162, p = 0.003); Leader Actions (3.1%, β = 0.133, p = 0.007); Objective Culture (1.5%, β = 0.167, p = 0.003); Fulfillment (7.2%, β = 0.251, p < 0.000); and Recognition (4.2%, β = 0.295, p < 0.000). The final model explained 72.6% of the variation in SPD. The evidence from this study provides insight into factors associated with NSPD. Application of leadership, motivation, and organizational culture theories to manage the work environment of hospitals to improve NSPD has the potential to alleviate current and projected nursing shortages, thus securing an experienced and satisfied nursing workforce in hospitals.

Background and purposeAccess to healthcare remains difficult for many, particularly in underserved areas. In Italy's Marche Region, parish nursing agencies have been introduced as a territorial care strategy for enhancing access to healthcare and strengthening community-based services. The aim of this study is to assess the socio-demographic characteristics, service utilization, and satisfaction of users attending a parish nursing agency in the Marche Region.Methods and proceduresThis quantitative, cross-sectional explorative study drew on original data collected through an anonymous questionnaire completed by clients of a parish nursing agency. The responses were analyzed using descriptive statistical methods.Results82 individuals participated; 77% were autonomous, while 23% were accompanied by a caregiver. Among those without caregivers, 24% were foreigners, significantly higher than the regional average. Most users had a high educational level and at least one chronic condition. Frequently requested services included medical appointment scheduling, vital sign monitoring, and health information. Satisfaction was high: 83% rated the service as "excellent", and 17% as "satisfying".ConclusionThese preliminary findings indicate that parish nursing can provide accessible, person-centered, and satisfactory care to vulnerable individuals from diverse educational and socioeconomic backgrounds and suggest that parish nursing agencies could be considered a valuable component in shaping health policy recommendations.

Background and PurposeThis qualitative study is part of a larger Indigenous community-led project in Southern Ontario, Canada, to support Indigenous fathers and Two-Spirit parents through the development of a culturally relevant parenting program. Conducted during Phase 2, this study pretested six well-established instruments to assess their clarity, comprehension, and cultural safety for use in evaluating the parenting program in Phase 3.Methods and ProceduresSix participants, all of whom were First Nations or Métis, either expecting a baby or parenting a child under the age of three, completed five instruments, specifically the Parenting Sense of Competence Scale (PSOC), Edinburgh Postnatal Depression Scale (EPDS), Relationship Assessment Scale (RAS), General Self-Efficacy Scale (GSES), and either the Paternal Antenatal Attachment Scale (PAAS) or Paternal Postnatal Attachment Scale (PPAS). Semi-structured interviews were conducted to gather insights on the instruments' instructions, terminology, response scales, and cultural relevance. Data were analyzed using conventional content analysis.ResultsParticipants identified barriers to understanding and accurately completing the instruments, including challenging terminology, ambiguous response scales, and cultural safety concerns. Recommendations included simplifying language, clarifying scale anchors, adding culturally relevant questions, and establishing culturally safe support pathways for participants disclosing distress.ConclusionEuro-Western developed instruments require refinement to ensure accessibility, cultural relevance, and safety for Indigenous fathers and Two-Spirit parents. This includes adapting tools to reflect Indigenous literacy frameworks and holistic wellness perspectives. This study underscores the ethical imperative for researchers to ensure cultural appropriateness and safety when engaging Indigenous communities in research.

Background and PurposeModified Delphi methods are increasingly used to develop healthcare pathways with input from people with lived experience (PWLE) and clinicians/others. However, guidance on consensus analysis in this context remains limited. We examined consensus outcomes across different scoring methods and criteria when participants were treated as a single combined group (Objective 1) versus two distinct groups (Objective 2).MethodsWe conducted a secondary analysis of Round 1 data from a project involving PWLE (N = 8) and clinicians/others (N = 51). To assess agreement on 68 Delphi statements, we applied three methods for scoring percentage agreement that differed in how the middle response on a three-point Likert scale ("approve", "not sure either way", "do not approve") was treated. Method 1 excluded the middle response, methods 2 and 3 grouped the middle response with "do not approve", and "approve", respectively. We compared consensus rates (% of items reaching consensus) using percentage agreement cutoffs of ≥70%, ≥80%, and ≥90% of participants.ResultsConsensus results varied by participants grouping, treatment of middle response categories, and cutoff criteria. Results from the combined group of PWLE and clinicians/others provided a simplified overview consensus outcome. Treating the participants into as separate groups provide nuanced results.ConclusionThe analysis of data can change the results from which to draw conclusions and inform practice. Investigators should consider the alignment of each approach with the goals of their Delphi study.

ObjectiveThis scoping review aims to examine and map existing literature about barriers encountered by migrant farm workers accessing health care services in Canada.MethodsThe search was conducted in multiple databases and grey literature. The PRISMA-ScR was used to document the inclusion and exclusion process. Two or more team members screened and reviewed all articles to ensure accuracy in capturing data.Synthesis380 records were screened by examining abstracts and titles, and 325 were deemed irrelevant. Of the remaining records, 55 had full-text assessments; 16 were excluded because they did not meet the inclusion criteria. Thirty-nine articles were extracted. They represented a mix of qualitative and quantitative studies, reviews, and other forms of commentaries and analyses. The thematic analysis revealed barriers that affect migrant farm workers' access to Canadian health care services: (1) language and literacy challenges, (2) concern of medical repatriation, (3) lack of transportation, (4) barriers to timely care and medical follow-up, (5) restrictive work schedules, and (6) health care coverage issues.ConclusionThis review provides a synthesis of the barriers experienced by migrant farm workers when accessing Canadian health care services. Canadian health care policy experts and organizations where Canadian migrant farm workers seek care are encouraged to design and implement policies, practice changes and/or educational interventions to address these barriers. This review may also inform public health nursing programming to promote positive health outcomes in the migrant farm worker population.

Background and PurposeNurse practitioners (NPs) make treatment decisions impacting older people with neurocognitive disorders (NCDs), like mild cognitive impairment and dementia. Research has shown that when this patient population has cancer, they face barriers accessing care, have higher mortality rates and limited involvement in decision-making. Despite their critical role, few NPs have been included in studies exploring treatment decision-making affecting this population. To improve experiences for older people and their families, this study explored NPs' decision-making experiences when individuals were living with an NCD and cancer.MethodsThis qualitative study was informed by interpretive description, a practice-oriented approach. Data collection methods included semi-structured interviews and reflective journaling. Data analysis was iterative with identification and revision of themes that have accompanying illustrations. The research team drew on relevant nursing and practice knowledge to identify meaningful implications for NP practice.ResultsFive themes were identified which included the observation that participants' decision-making was shaped by NPs' knowledge and assumptions. NP participants experienced uncertainty and ethical challenges while needing to creatively navigate health systems. Drawing on nursing knowledge, NPs sought to actively involve older people and their family in decision making.ConclusionNPs experience complex treatment decision-making when older people are living with an NCD and cancer, requiring navigation of multiple factors and challenges. The results showed shared decision-making processes are applied, suggesting that NPs take up relational treatment decision-making practices. However, there is a need for institutional change, further education, and research about NPs experiences in community settings.

Background and purposeOpen educational resources (OER) are socially progressive learning resources that are well positioned to disrupt the exclusionary and marginalizing processes that can sometimes occur within nursing texts. Recognizing the social justice underpinnings of OER, the study focus was to examine how leadership teams should integrate equity, diversity, and inclusion (EDI) into the design and production of nursing-related OER.Methods and proceduresThis study was theoretically informed by the concept of Othering. The interpretive descriptive methodology involved reflexive and critical dialogue with focus group data that honed skeptical thinking and encouraged the search for alternative ways to think about how codes and themes were named and conceptualized.FindingsParticipating in the two hour focus group were nine leaders, who were authors of two nursing-related OER. Participants included six nurse educators, one educational developer, and two students. Three themes were identified including: diversifying design and production; centring social justice; and nuancing inclusion.Discussion and conclusionPart of the blueprint to the design and production of OER that are shaped by EDI must include incredibly rich, vibrant, and diverse voices and teams who are focused on social justice. This approach offers ways to create space for the beauty of human difference, the nuances of inclusion, and the flourishing and growth of learners. Although we may never produce resources that fully embrace inclusion and belonging, we are confident that diverse and critical voices will shift us closer while centring social justice.

In an increasingly interconnected academic landscape, research is expanding beyond local and institutional boundaries, creating new opportunities for global collaboration among students, highly qualified personnel (HQPs), and faculty across career stages. While traditional mentorship models rooted in local faculty and student relationships remain valuable, they can restrict the broader relevance and innovation potential of research. Internationalization offers a compelling response by linking scholars across disciplines, cultures, and regions, enriching methodological diversity, cultural perspectives, and global visibility of scholarly work. For faculty, international collaboration strengthens research networks and enhances global impact. For HQPs, such engagement fosters globally minded researchers, builds institutional research capacity, and deepens international academic connections. Programs such as the Mitacs Globalink Research Internship, Academics Without Borders, and Global Affairs Canada mobility initiatives exemplify structured pathways that support cross border research, skill development, and collaborative knowledge creation. Although benefits are substantial, international research and mentorship present challenges, including visa complexities, language barriers, and variations in research training. These obstacles, however, can be mitigated through intentional mentorship strategies such as clear communication, structured orientations, peer pairing, and the use of translation technologies, turning challenges into opportunities for mutual learning and skill development. Ethical mentorship further requires equitable recognition of international scholars' contributions, ensuring reciprocal and respectful collaboration. To realize the full potential of research internationalization, institutions and mentors must intentionally cultivate inclusive environments that value diverse perspectives. By embracing equitable, and globally engaged mentorship, academia can advance research that transcends borders and contributes to a shared pursuit of global knowledge.

Background & PurposePatient clinical deterioration is a major safety concern. One strategy implemented for health providers to improve the timely recognition and response to patient deterioration is the Rapid Response Team (RRT). Despite this resource, patient deterioration still occurs and delayed activation of the RRT is one contributing factor. Little is known about unit-level nurses' experiences related to RRT activation, especially within the Canadian context, which is problematic given they are the ones who are primarily responsible for initiating the process. The purpose of this study was to understand the experiences of nurses practising on general adult inpatient medicine units and their activation of the RRT.Methods & ProceduresThe research question was addressed with a descriptive, exploratory qualitative study. Nurses working on general adult inpatient medicine units at an Ontario hospital study site were purposively recruited to participate. Semi-structured interviews with the six participants were held online and audio-video recorded. Inductive, thematic analysis was used.ResultsEleven themes about the barriers and facilitators to RRT activation, and one overarching theme-the Self-Imposed Complexity of Deciding to Activate the RRT-resulted in relation to the nuanced, multi-factorial decision-making process unit-level nurses undertake when considering activation.ConclusionThis study contributes novel information to better understand RRT activation by nurses and will inform practice changes surrounding RRT policies, nursing education about the RRT, and new research on optimizing strategies for RRTs and deteriorating patients. The multi-layered activation process intricacies positions future work to improve escalation of patient clinical deterioration.