Canadian Journal of Nursing Research最新文献

BackgroundThe aim of this study is to explore the practice experiences of new graduate nurses (NGNs) in publicly funded acute healthcare settings in the Greater Toronto Area, their perspectives on the determinants of their desire to stay or leave the nursing profession, and to identify action-oriented strategies to promote retention of NGNs.DesignQualitative, descriptiveMethodsFifteen NGNs participated in focus group sessions, where a semi-structured interview guide was created to generate discussion on NGNs' lived and professional experiences. We utilised the Social Ecological and Intersectionality frameworks to guide data analysis with an emphasis on social identities, power relationships, and the personal, interpersonal, organizational, and structural determinants of nursing retention.ResultsParticipants contextualized their major challenges within four professional development phases: 1.) accessible nursing education and practicum placement; 2) preparedness, orientation and mentorship during entry to practice; 3) navigating transition to independent practice and multi-level structural violence; 3.1) retention strategies; and 4) perspectives on professional trajectory for NGNs.ConclusionNGNs experience major challenges throughout their nursing education and career. The study findings indicate that further research and systemic reform is essential to support, develop, and retain nursing leaders in the acute care setting. Furthermore, the findings can inform the development of evidence-based nursing curriculum reform.

BackgroundIntimate partner violence (IPV) is a wicked social problem affecting women of all social strata and geographical location, globally. Pregnancy may be a time of heightened risk of IPV and more deleterious outcomes. Breastfeeding - a protective factor for maternal and child well-being - may be jeopardized or more challenging for women experiencing IPV. This study explored the experiences of postpartum women with histories of IPV who sought trauma- and violence-informed breastfeeding support from primary care providers.MethodsUsing interpretive description and philosophically underpinned by intersectionality, in-depth semi-structured interviews were completed at 12-weeks postpartum with five breastfeeding mothers with a history of IPV who sought breastfeeding support from a family physician clinic employing a trauma- and violence-informed (TVIC) model of care.FindingsFour themes and two sub-themes shed light onto the experience of accessing breastfeeding support for women with a history of IPV and the perceived barriers that they faced when attempting to accesses this support, including: 1) The (demoralizing) navigation of the perinatal system; 2) Fostering trust: i) "It's support, but it's also knowledge"; and ii) TVIC: feeling safe and feeling "I mattered"; 3) Informal support: partners, family, and friends; and 4) Baby in focus: overcoming challenges and building confidence.ConclusionsTVIC may aid in the development of trusting therapeutic relationships, in turn improving access to breastfeeding support, breastfeeding self-efficacy, and breastfeeding success for women who experience violence. Further research on the implementation and evaluation of TVIC for perinatal breastfeeding education and care among women is required.

Study backgroundReducing children's vulnerability to climate change (CC) depends firstly on parents having the ability to adapt.PurposeThe purpose of this study was to describe knowledge, attitudes, and perceptions of nurses in support of parents' ability to adapt to CC to protect the physical and psychosocial health of 0-5 year olds.MethodsA cross-sectional descriptive study was used. A total of 127 pediatric nurses from the province of Quebec completed an online questionnaire documenting nurses' knowledge, attitudes, and perceptions about CC.ResultsA third of nurses have little or no knowledge of the health risks of CC for children, even though they consider it to be a major issue for children. Nurses perceive that parents don't generally consider their children to be among the most vulnerable to CC, trivialize their effects on their children's health, have little knowledge of the effects of CC mainly on their children's psychosocial health, know little about the means to use to protect them, and more readily seek help from family and friends to ensure their children's protection. Nurses affirm that they are responsible for discussing the health effects of CC with parents, introduce measures to reduce their effects, possess little knowledge and few skills for reducing their effects, and feel unprepared to deal with their effects in their practice.ConclusionsGreater access to training on CC-related concepts is needed to increase nurses' knowledge. Nurses' perceptions must be validated with parents to promote optimal protection of children from CC.

BackgroundWounds are a significant national health concern, impacting individuals, healthcare systems, and the environment. Despite efforts by organizations to promote evidence-based practices, gaps persist between theory and nurse practice in wound care. Mobile apps show promises in enhancing wound care delivery, but their rapid evolution, including adaptations into different languages such as French, raises concerns about reliability and regulation. Evaluating these apps is crucial for ensuring patient safety and effective wound management.PurposeTo review and assess mobile wound care apps available in French for healthcare providers in Canada.MethodsA systematic search was conducted across the literature and the two main Canadian online app stores (App Store and Google Play). The included mobile apps underwent quality evaluation using the user version of the Mobile Application Rating Scale (uMARS).ResultsThe initial search retrieved 1,550 apps, of which 260 were screened and 5 included. Included apps were from France and were available on both stores. These apps varied in features, including wound dressing directory (n = 3), best practices reminders (n = 2), photography management and digital wound tracking (n = 1), and total body surface area calculator (n = 1). Evaluation using uMARS indicated total averages range from 3.52/5 to 4.10/5. The results offer scant insight into the design and evaluation of the apps included.ConclusionsThe study highlights the need for development and validation of a French wound care app tailored to Canadian healthcare contexts and best practice recommendations, emphasizing collaboration among nurses and stakeholders in technology enhancement for the benefit of Canadians' health.

ObjectiveTo explore diabetes self-management for older adults in rural Ontario.MethodsFourteen adults, 65 and older, with diabetes, participated in this study using a participatory, art-based approach involving photovoice and semi-structured interviews. Data underwent hermeneutic phenomenology analysis.FindingsFour themes emerged, elucidating the lived experiences of participants managing diabetes in a rural context.DiscussionThis study underscores the challenges and strategies of diabetes self-management in rural older adults. A holistic approach, encompassing physical, emotional, and mental well-being, is pivotal, augmented by proactive lifestyle choices. Effective coordination in medication management and enhanced communication among health care providers emerged as essential. The unique role of pets illuminates their profound impact on participants' activity levels and emotional fortitude, suggesting they can be vital assets in diabetes care. Collectively, these findings guide health professionals and policymakers in crafting nuanced, context-sensitive interventions to optimize diabetes management for older adults in rural contexts.

BackgroundEffective nurse-provider communication in the emergency department (ED) is crucial but often hindered by hierarchical dynamics and high workloadsObjectivesThis review aimed to examine, systematically map, and identify gaps in existing literature concerning ED registered nurse-provider communication.Eligibility CriteriaStudies focused on direct communication between bedside registered nurses (RNs) and providers, including physicians, physician assistants (PAs), and nurse practitioners (NPs) in the ED, encompassing verbal, non-verbal and electronic communication. Non-direct patient care roles were excluded. Sources of Evidence: A search in CINAHL, MEDLINE and ProQuest Nursing & Allied Health identified 1978 sources, of which 37 studies were included: 15 qualitative, 9 quantitative, 4 mixed methods, 6 commentaries, 1 performance improvement project, and 1 scoping review.Charting MethodsData were extracted using Joanna Briggs Institute (JBI) guidelines and thematically analyzed according to Levac's framework.ResultsFour key themes emerged: (i) Interruptions hinder communication but can be reduced by electronic supports facilitating asynchronous communication, (ii) Power imbalances and high workload/communication load impede effective communication, emphasizing the need for structured communication tools and interprofessional communication training, (iii) Shared workspaces, electronic supports, and collaborative, respectful interactions enhance communication (iv) Timely updates and collaborative planning are valued, emphasizing the significance of consistent communication.ConclusionsThis review identified interventions that can improve ED nurse-provider communication, including electronic supports, shared workspaces, structured communication tools, and interprofessional communication training. Future research should evaluate these strategies' effectiveness and explore regional differences, particularly in Canada, where the literature is limited.

ObjectivesWith nearly 50,000 people having died since 2016 as a result of the unregulated toxic drug supply, novel approaches to care are needed. A small number of Safer Stimulant Supply programs have been piloted in Canada, which seek to provide a pharmaceutical-grade stimulant medication replacement for the toxic unregulated stimulant supply. In this paper, we describe the results of retrospective Safer Stimulant Supply program medical chart reviews.MethodsWe extracted data from program intake and check-in forms collected on an ongoing basis by the clinical teams. In total, 28 medical charts were included in this evaluation. Data collected was reported using descriptive statistics.ResultsChart reviews showed that over the course of the program, program participants reported an overall decrease in their unregulated stimulant use. Specifically, at program intake and check-in appointments, cocaine use went from a median of 10 points/day to 0 points/day, and crystal methamphetamine use went from a median of 1.5 points/day to 0 points/day. Chart reviews also showed that program participants reported increased access to primary care and infectious disease programs and improvements in housing status.ConclusionsOur research demonstrated that program participants found Safer Stimulant Supply programs to be impactful in addressing ongoing drug use. Safer Stimulant Supply programs remain an underutilized but important harm reduction tool to address the drug poisoning crisis.

Social media is a powerful tool to promote and communicate nursing scholarship. As the nursing profession evolves with advances in technology, platforms including X, LinkedIn, and TikTok offer unique opportunities for academic engagement and professional networking at the individual and collective level. This editorial explores the growing role of social media use in nursing scholarship, and highlights its potential to bridge the gap between clinical practice, research, and education, by introducing practical strategies for new and experienced users to leverage their existing work and reach new audiences including: themed content posting, showcasing initiatives, and creative research dissemination methods. Despite its benefits, effective use of social media in nursing scholarship also requires awareness of potential risks including concerns about maintaining professionalism, data privacy, and upholding ethics. Drawing from personal experiences, this editorial provides recommendations for developing a professional digital presence, avoiding public backlash, and fostering a respectful online community.

BackgroundThis survey of rural nurses' experiences is part of a program evaluation of the Rural Surgical and Obstetrical Networks (RSON), a five-year initiative (2018-2023) to strengthen and stabilize rural hospitals in British Columbia (BC), Canada.PurposeOur aim was to measure changes in professional and work-related quality-of-life of rural surgical and obstetrical nurses in eight communities across BC and determine if the RSON initiative mitigated impacts of the COVID-19 pandemic on nurses' quality of life.MethodsThis longitudinal evaluation was administered via online surveys in 2021 and 2023. Work-related quality of life was measured with 23 items that assess job satisfaction, general wellbeing, work-life balance, stress level experienced at work, control, and working conditions. Professional quality of life was measured along three dimensions: compassion satisfaction (CS), burnout, and secondary traumatic stress (STS) (10 items each). Responses were linked by code and changes in quality of life were analyzed using paired Student's t-test.Results107 nurses participated at time 1 and 28 at time 2. Burnout and secondary traumatic stress scores at time 1 were lower among older nurses and those with children. Over the two-year period (2021 to 2023), significant increases were observed in burnout (p < 0.001), and secondary traumatic stress (p = 0.04), while work-related Quality-of-Life decreased significantly (p = 0.04). Compassion satisfaction decreased over time, though not statistically significant.ConclusionsWhile the RSON initiative could not mitigate decreases in professional and work-related quality-of-life during COVID-19, it offered opportunities for clinical education and professional development among rural nurses.

BackgroundMaintaining cultural safety during advance care planning (ACP) discussions is an essential component of holistic care provision. Most nurses feel unprepared to engage in ACP and the current literature offers limited recommendations on how nurses can lead culturally safe ACP discussions. Internationally educated nurses (IENs) have unique personal and professional experiences to address this gap.PurposeThe purpose of this study was to understand IENs' contributions to culturally safe ACP and its implications to nursing practice and ACP policy.MethodsAn interpretive descriptive approach was undertaken. Ten IENs working in Ontario, Canada were individually interviewed using a semi-structured guide to understand their perspectives and experiences of engagement in culturally safe ACP practices.ResultsIENs utilized various approaches that were reflected in three actions: practicing cultural humility, utilizing a cautious approach, and empowering clients and families. IENs engaged in intrapersonal and interpersonal cultural humility practices to recognize the unique influence of one's culture on the ACP process. Establishing trust in the nurse-client relationship and cautiously approaching ACP conversations was recognized as important in maintaining cultural safety. IENs also empowered clients by addressing knowledge deficits, misconceptions about ACP, and informing them of their decision-making rights.ConclusionNurses require education and resources to carry out culturally safe ACP. Education should begin at the undergraduate level and include self-engagement in ACP and cultural humility training. Practicing nurses need ACP training and clear standards/guidelines. There is an opportunity for healthcare organizations and professional/governing nursing bodies to collaborate on developing culturally safe ACP guidelines.