Canadian Journal of Nursing Research最新文献

Background and PurposeEvidence-based practice (EBP) is essential for improving patient outcomes and healthcare quality. However, its implementation in acute care remains inconsistent due to organisational hierarchies, professional silos, and limited access to continuous professional development (CPD). Nurses play a key role in translating research into practice but often encounter barriers that limit their ability to lead EBP initiatives. Interprofessional collaboration and CPD are recognised enablers of EBP, yet their impact in acute care requires further investigation. This study explores how interprofessional collaboration, nurse-led initiatives, and CPD influence EBP adoption.Methods and ProceduresA collective qualitative case study was conducted across two acute care hospitals in the East Midlands, England. Data collection included 25 semi-structured interviews, nonparticipant observations, and document analysis over six years, with an intensive fieldwork phase in 2022. Thematic analysis was used to identify key patterns related to EBP adoption, interprofessional collaboration, and nurse-led knowledge implementation.ResultsNurses actively advocated for EBP integration but often worked independently due to the absence of formal collaboration structures. Interprofessional collaboration facilitated knowledge-sharing and decision-making, yet hierarchical constraints limited nurses' influence in clinical governance. CPD enhanced nurses' confidence and ability to challenge outdated practices, but disparities in access led to inconsistent EBP engagement across nursing teams.ConclusionStructured CPD, interdisciplinary collaboration, and inclusive decision-making are essential for EBP adoption. Addressing hierarchical constraints and resource limitations is crucial for sustaining evidence-driven care. Future research should explore the long-term sustainability of EBP implementation.

BackgroundTransgender and non-binary (TGNB) individuals face significant discrimination and underrepresentation in healthcare, particularly within the nursing workforce. These challenges often lead to increased stress, limited career opportunities, and the concealment of identities.PurposeThis study investigates the experiences and challenges faced by TGNB nursing students and nurses in Canada.MethodsAn online anonymous questionnaire, featuring both closed and open-ended questions, was used to gather data from participants recruited through social media and nursing networks across Canada.ResultsThe survey was completed by 101 participants, with most being nursing students (54.5%) or registered nurses (20.8%), and predominantly practicing in Ontario (53.5%). While many participants were open about their TGNB identity, they reported insufficient TGNB representation and inadequate education on TGNB healthcare. Disclosing their gender identity remained difficult primarily due to fear of rejection, with 43.6% encountering barriers related to their gender identity when applying to nursing programs. Additionally, 67.3% experienced derogatory comments personally, and 66.3% witnessed similar remarks towards the TGNB community. Among 46 nurse participants, 84.7% have noticed discrimination towards TGNB patients during care and 80.4% towards a peer, colleague or superior. Only 29.7% reported to have received education on TGNB topics, which was often superficial.ConclusionsThe study reveals significant challenges for TGNB individuals in nursing education and the workforce, including discrimination, inadequate educational content, and barriers in professional settings. These findings highlight the need for more inclusive, supportive, and comprehensive education on TGNB healthcare to create a more equitable environment for TGNB nurses and patients.

BackgroundCurrent nursing shortages are shifting approaches to health human resource planning. Broad changes are being implemented to support system planning, however, there is a need to engage in targeted strategies that address shortages in specialty nursing areas, such as the operating room.PurposeThe purpose of this study was to explore how Registered Practical Nurses (RPNs) are currently utilized within operating room settings in Ontario, Canada.MethodsA two-phase qualitative descriptive study design was conducted. Phase 1 consisted of an online survey and Phase 2 consisted of individual, semi-structured virtual interviews. Participants included nurses working in urban and community hospitals and/or private clinics. Descriptive statistics were used to report participant demographic data, and qualitative data were analyzed using inductive content analysis.ResultsSixty-five participants completed the survey, and 13 participants completed the semi-structured interviews. Participants identified differences in RPN role utilization within different healthcare settings, teamwork and work culture. Recommendations for RPN leadership opportunities, policy support, professional development, and the role of professional nursing organizations were also identified.ConclusionGiven the complex nature of healthcare systems, new models of care, and evolving scopes of practice for healthcare providers, it is important to consider how RPNs can be further utilized to support patient care including specialty areas. Re-evaluating the roles and responsibilities of RPNs in healthcare is essential to strengthen the nursing workforce and prepare for ongoing human resource challenges.

BackgroundIn November 2022, Alberta Health Services launched a new province-wide electronic health record, Connect Care (Epic), with a tethered patient portal, MyAHS Connect, across all Cancer Care Alberta sites. Oncology patients now can view their health record (including results), view and manage appointments, enter data directly into their chart, and securely message their health care team.PurposeTo explore how an online patient portal effects nurses and the health care team's work in an outpatient oncology setting.MethodsA descriptive qualitative method was used for this research study. 15 health care providers were recruited (12 registered nurses, 2 medical oncologists, 1 clerical worker). Data was analyzed using thematic analysis with a technology-in-practice sociomaterial theoretical perspective informing our approach.ResultsThree main themes were generated: the invisibility of nurses' responsibility of supporting patient portal use, access to the portal shapes a new type of patient, and MyAHS Connect is as good as the networks of care provision in which it is embedded.ConclusionThis qualitative study details how patient access to the portal changed the ways that health care providers are working but the degree of this change was highly influenced by patient use of the portal, staff's use of the electronic health record, and the greater system context. This research highlights the substantial role of nurses when patient portals are used in health care practice settings.

BackgroundMental workload is an important indicator of an individual's interaction with task demands. Care aides in long-term care (LTC) settings frequently report excessive demands imposed on their daily work due to challenging resident behaviours and organizational expectations. Understanding mental workload in these contexts is key to predicting staff strain and guiding support strategies.MethodsTwenty-eight care aides from six LTC homes in New Brunswick, Canada, participated in a simulated care scenario involving common challenges encountered when completing resident care. Two physiological markers of mental workload, namely heart rate variability (HRV) and pupil dilation, were continuously measured across five experimental stages, each designed to elicit different cognitive and emotional demands. Hierarchical mixed-effects models assessed the impact of demographic variables and experimental stages on mental workload.ResultsMental workload increased significantly, as indicated by decreased HRV and increased pupil diameter, when the care aide was required navigate impossible requests made by the resident. Contrary to expectations, resistance to care, verbal aggression, direct time pressure, and intervention by a supervisor did not significantly influence physiological correlates of mental workload.ConclusionThese findings suggest that creative problem-solving, such as responding to impossible resident demands, may be more mentally taxing than expected stressors like aggression or time pressure. To manage mental workload, staff should be prepared and supported to adapt creatively under pressure. Further efforts should be made to understand the relationship between increased mental workload and cumulative stress in care aides.

BackgroundUp to 33% of newly graduated nurses leave the profession within the first two years. This high turnover rate can burden care teams, negatively impacting the quality of care provided. To alleviate this problem, transition programs are offered to new nurses; however, they vary considerably in type and duration. Despite this heterogeneity, many researchers conclude that transition programs have a positive overall effect on new nurses' competencies, self-confidence, satisfaction, stress, and retention, especially when they are longer than six months and have an explicit framework and structure, such as residency programs.PurposeTo conduct a pre-implementation analysis of a residency program in the Canadian context.MethodsUsing a case study methodology, two sequential steps were performed to model the already implemented transition program and its components that needed to be upgraded to a residency program. Data were collected through 1) document analysis (n = 1,601) with selected interviews of stakeholders (n = 5) and 2) a survey with new graduate nurses (n = 29) and preceptors (n = 11).ResultsA preliminary logic model of the program was developed, depicting the structure of the proposed activities in terms of organizational orientation, unit integration, autonomous practice, and additional support measures. The operationalization of some program components was variable and sometimes missing, thereby affecting its quality.ConclusionThis study showed how transition programs already implemented in clinical settings can be enhanced into residency programs by conducting a pre-implementation analysis. This can positively impact the transition of newly graduated nurses, including their retention.

Background and PurposeThe consequences of climate change on individuals' and communities' health are numerous. Nurses are among the healthcare professionals most confronted with the climate crisis, and have great potential to limit its impact on vulnerable populations. However, our knowledge of educational options for preparing nurses to address climate change remains limited. The aim of this scoping review was to examine how climate change is integrated into the academic curricula or continuing education of nurses.Methods and ProceduresArksey and O'Malley's (2005) framework was used to conduct this scoping review. Documentary search strategies were developed and tested in four databases, and a search of the grey literature was carried out. A two-stage selection process was implemented. Data from 16 scientific articles were extracted and 11 grey literature references were included in the analyses. A narrative summary allowed to synthesize the findings.ResultsAcademic and healthcare organizations are increasingly implementing innovative and participatory educational initiatives to raise nurses' awareness of climate change's health impacts and encourage students and nurses to act in their daily lives and clinical practice. Challenges include a dense curriculum, the absence of a climate competency framework, and theoretical content being presented in an unstimulating manner.ConclusionsThe use of innovative, interactive teaching methods, reference to a theoretical model centered on planetary health, and climate change content distributed throughout the curriculum are some ways to stimulate students' interest in climate issues. Collaborative efforts involving academia and organizations are needed to foster nurses' awareness and encourage a variety of climate-oriented actions with planetary reach.

BackgroundDelirium is a common yet underdiagnosed condition in hospitalized older adults, particularly challenging to detect early in cardiology settings. Although delirium assessment tools improve detection rates, observations by family caregivers of patients' cognitive changes can offer valuable insights, supplementing assessments by healthcare professionals. However, validated French-language tools for family caregivers to assess delirium in acute care settings in Canada are lacking.PurposeTranslate, culturally adapt, and validate the Family Confusion Assessment Method for French-speaking cardiovascular patients and their caregivers (FAM-CAM-Fr).MethodsThe translation and cultural adaptation of the FAM-CAM were conducted following the guidelines of Sousa and Rojjanasrirat (2011). Criterion validation involved 100 dyads of family caregivers and hospitalized cardiovascular patients. The FAM-CAM-Fr's performance was assessed by comparing it to the Confusion Assessment Method (CAM) and the DSM-5 diagnostic criteria for delirium. Measures of sensitivity, specificity, and agreement with the CAM were calculated.ResultsThe FAM-CAM-Fr showed high specificity (92.6%) but low sensitivity (58%) in detecting delirium. Cohen's Kappa indicated a moderate agreement (>0.50) between the FAM-CAM-Fr and the CAM. Despite family caregivers using the tool without prior training, indicating its usability in real-world settings, sensitivity was lower compared to studies that included caregiver training, though specificity was similar.ConclusionThe FAM-CAM-Fr is promising as a specific tool for screening delirium in cardiovascular patients. Despite its low sensitivity, its high specificity indicates that it is effective at ruling out delirium. Future research should focus on further validation across various settings.

BackgroundThe increased demands and stressors from the COVID-19 pandemic led to widespread burnout and job stress, prompting concerns about retention rates. This study identifies demographic and occupational predictors of Canadian nurses' intent to leave their jobs due to burnout and job stress during the COVID-19 pandemic.MethodsData was utilized from the Survey on Health Care Workers' Experiences During the Pandemic conducted by Statistics Canada. Multivariate logistic regression models were generated to analyze the associations between demographic and occupational factors and nurses' intent to leave.ResultsA total of 12,246 eligible participants responded to the survey (54.9% response); however, the analysis was restricted to 1138 nurses after excluding participants of other healthcare occupations. Younger nurses were significantly more likely to consider leaving their jobs [OR = 9.95, 95% CI: (5.92-16.73)], as well as nurses living in Alberta [OR = 3.16, 95% CI: (1.58-6.32)] and British Columbia [OR = 3.16, 95% CI: (1.66-6.03)]. Moreover, nurses with less work experience [OR = 3.91, 95 CI = (2.53-6.05)], work in acute care [(OR = 3.31, 95 CI = (1.69-6.51)], experienced changes in workload [OR = 2.69, 95% CI: (1.58-4.57)], had increased work hours [OR = 1.92, 95% CI: (1.27-2.92)], and lacked emotional support [OR = 3.43, 95 CI = (2.31-5.09)] had greater odds of intending to leave.ConclusionThe findings underscore the need for strategies to mitigate stress and burnout among nurses, particularly during public health crises. Implementing measures to address these factors could help improve retention rates and ensure a stable nursing workforce during future pandemics.

BackgroundAccess to primary care is a challenge across Canada. In the province of New Brunswick (NB), approximately 15% of citizens do not have a primary care provider (PCP). The Government of NB recently implemented clinics staffed by nurse practitioners (NPs) in various regions in the province to reduce the provincial waitlist for a PCP.PurposeThis study aimed to identify facilitators and barriers to NP-led clinic implementation, as perceived by clinic staff.MethodsUsing a cross-sectional qualitative descriptive design, data was collected using semi-structured interviews and analysed using qualitative content analysis.ResultsStudy participants included 16 employes of two NP-led clinics in NB (NPs, registered nurses (RN), licensed practical nurses (LPN), administrative staff, and managerial staff). Facilitators include having experienced mentors, collaborative practices, and well-equipped clinics. Barriers include rushed timelines, complex decision-making processes, large and complex caseloads, inadequate clinic space, and difficulty in staff recruitment and retention. Participants discussed the positive impact of NP-led clinics through improved access to primary care, resulting in reduced burdens on emergency departments and walk-in clinics. Participants recommend adding additional NP-led clinics and integrating multidisciplinary allied health professional teams to enhance care integration.ConclusionNP-led clinics are increasingly being implemented across Canada to improve primary care access, particularly in areas where there are shortages of PCPs. Findings from this study will help inform the development and implementation of other NP-led clinics across NB and Canada.