Nursing Publications

Commentary by Leipert

Beverly Leipert — Fri, 23 Mar 2012 12:15:15 PDT

Developing and Testing a New Measure of Staff Nurse Clinical Leadership: The Clinical Leadership Survey

Allison Patrick et al. — Wed, 21 Mar 2012 18:49:58 PDT

AIM: To test the psychometric properties of a newly developed measure of staff nurse clinical leadership derived from Kouzes and Posner's model of transformational leadership.

BACKGROUND: While nurses have been recognized for their essential role in keeping patients safe, there has been little empirical research that has examined clinical leadership at the staff nurse level.

METHODS: A non-experimental survey design was used to test the psychometric properties of the clinical leadership survey (CLS). Four hundred and eighty registered nurses (RNs) providing direct patient care in Ontario acute care hospitals returned useable questionnaires.

RESULTS: Confirmatory factor analysis provided preliminary evidence for the construct validity for the new measure of staff nurse clinical leadership. Structural empowerment fully mediated the relationship between nursing leadership and staff nurse clinical leadership.

CONCLUSION: The results provide encouraging evidence for the construct validity of the CLS.

IMPLICATIONS FOR NURSING MANAGEMENT: Nursing administrators must create empowering work environments to ensure staff nurses have access to work structures which enable them to enact clinical leadership behaviours while providing direct patient care.

Mothers with mental illness experiencing homelessness: A critical analysis

Sarah Benbow et al. — Wed, 21 Mar 2012 10:48:44 PDT

The experiences of homeless mothers with mental illness were examined from the critical perspective of feminist intersectionality. The purpose of this study was to unveil experiences of oppression and resistance in the lives of homeless mothers with mental illness, while learning from them what is conducive to their health. A qualitative secondary analysis was done using focus group transcripts from a study examining issues related to diversity and homelessness for psychiatric survivors and a study on mental health and housing. A purposive sample of 7 focus groups comprised of 67 participants was used for this study. Findings revealed three overarching themes: (1) discrimination based on intersecting social identities; (2) being stuck: the cycle of oppression; and (3) we're not giving up: resistance through perseverance. The contextual influences of mothering while homeless with a mental illness were emphasized in the results. The findings illuminate the need for increased on ongoing advocacy at individual and structural levels.

Attributing Selected Costs to Intimate Partner Violence in a Sample of Women Who Have Left Abusive Partners: A Social Determinants of Health Approach

Colleen Varcoe et al. — Wed, 21 Mar 2012 10:48:37 PDT

Selected costs associated with intimate partner violence were estimated for a community sample of 309 Canadian women who left abusive male partners on average 20 months previously. Total annual estimated costs of selected public- and private-sector expenditures attributable to violence were $13,162.39 per woman. This translates to a national annual cost of $6.9 billion for women aged 19–65 who have left abusive partners; $3.1 billion for those experiencing violence within the past three years. Results indicate that costs continue long after leaving, and call for recognition in policy that leaving does not coincide with ending violence.

Cet article rend compte d’une étude qui nous a permis d’évaluer certains coûts associés à la violence conjugale au sein d’un échantillon de 309 femmes qui avaient quitté leur conjoint abuseur depuis 20 mois en moyenne. Nous estimons ces coûts – c’est-à-dire les dépenses publiques et privées associées à la violence conjugale – à 13 162,39 $ par femme en moyenne. Si l’on considère l’ensemble des femmes canadiennes de 19 à 65 ans ayant un conjoint abuseur, les coûts associés à la violence conjugale se chiffrent donc à 6,9 milliards de dollars, et à 3,1 milliards si l’on considère les femmes victimes de violence conjugale au cours des trois dernières années. Ces résultats indiquent que la violence conjugale implique des coûts qui persistent longtemps après la séparation des conjoints. Il est donc important, en matière de politiques de lutte contre la violence conjugale, que les décideurs tiennent compte du fait que la séparation ne met pas un terme à cette violence.

Socio-cultural Aspects of Self-Management in Gestational Diabetes

Dhuha Youssef Wazqar et al. — Wed, 21 Mar 2012 10:48:28 PDT

Extensive research has been conducted into diabetes self-management; however, there is a significant knowledge gap relating to the socio-cultural factors that may affect self-management of women with gestational diabetes (GD). Such understanding may inform culturally sensitive interventions and educational programmes to improve self-management. The purpose of this secondary qualitative analysis, therefore, was to gain an understanding of the socio-cultural factors pertaining to pregnant women’s experience of diabetes self-management. The findings reveal that socio-cultural and family factors, family unity, social expectations, and knowledge and understanding about GD were important elements of diabetes self-management practices for pregnant Canadian women. Focusing attention on socio-cultural aspects in self-management in diabetes educational programmes may well be central to improving the health of women with GD. Further research is needed to consider how best to eliminate the subject of social stigma associated with GD.

Nursing Students' Perceptions of Clinical Teachers' Use of Empowering Teaching Behaviours: Instrument Psychometrics and Application

Yolanda Babenko-Mould et al. — Fri, 16 Mar 2012 20:32:27 PDT

The authors present findings of 2nd year nursing students’ (N = 352) perceptions of their clinical teachers’ use of empowering teaching behaviours (ETB) and to highlight steps undertaken to establish psychometric properties of the Empowering Teaching Behaviours Questionnaire – Student (ETBQ-S). The authors identify a) the process involved in the adoption of the ETBQ-S, b) ETBQ-S validity procedures completed prior to instrument implementation, c) results of nursing students’ responses to the ETBQ-S, d) criterion validity, and e) ETBQ-S confirmatory factor analysis findings conducted after study completion. The ETBQ-S reliably measures five facets of empowering actions that clinical teachers can employ with nursing students in practice to enhance their confidence, involve them in decision-making and goal setting, make learning meaningful, and help them to become more autonomous nurses.

Predictors of New Graduate Nurses' Workplace Well-being: Testing the Job Demands-resources Model

Heather K. Spence Laschinger et al. — Fri, 16 Mar 2012 20:05:50 PDT

BACKGROUND:: New graduate nurses currently experience a stressful transition into the workforce, resulting in high levels of burnout and job turnover in their first year of practice.

PURPOSE:: This study tested a theoretical model of new graduate nurses' worklife derived from the job demands-resources model to better understand how job demands (workload and bullying), job resources (job control and supportive professional practice environments), and a personal resource (psychological capital) combine to influence new graduate experiences of burnout and work engagement and, ultimately, health and job outcomes.

METHODOLOGY/APPROACH:: A descriptive correlational design was used to test the hypothesized model in a sample of newly graduated nurses (N = 420) working in acute care hospitals in Ontario, Canada. Data were collected from July to November 2009. Participants were mailed questionnaires to their home address using the Total Design Method to improve response rates. All variables were measured using standardized questionnaires, and structural equation modeling was used to test the model.

FINDINGS:: The final model fit statistics partially supported the original hypothesized model. In the final model, job demands (workload and bullying) predicted burnout and, subsequently, poor mental health. Job resources (supportive practice environment and control) predicted work engagement and, subsequently, lower turnover intentions. Burnout also was a significant predictor of turnover intent (a crossover effect). Furthermore, personal resources (psychological capital) significantly influenced both burnout and work engagement.

PRACTICE IMPLICATIONS:: The model suggests that managerial strategies targeted at specific job demands and resources can create workplace environments that promote work engagement and prevent burnout to support the retention and well-being of the new graduate nurse population.

The Influence of Personal Dispositional Factors and Organizational Resources on Workplace Violence, Burnout, and Health Outcomes in New Graduate Nurses: A Cross-sectional Study

Heather K. Spence Laschinger et al. — Fri, 16 Mar 2012 19:56:07 PDT

Background

The alarmingly high rate of illness-related absenteeism among nurses and recent reports of workplace violence and burnout are problematic for both the current workforce shortage and the recruitment and retention of new nurses.

Objectives

To test a model derived from Leiter and Maslach's (2004) Six Areas of Worklife Model linking workplace factors (six areas of worklife, experiences of bullying and burnout) and a personal dispositional factor (psychological capital) to new graduates mental and physical health in their first year of practice.

Methods

A cross-sectional survey design was utilized to survey 165 Ontario nurses with one year or less experience in nursing. Participants completed measures of nurses’ work environment quality, psychological capital, bullying exposure, burnout, and physical and mental health. Structural equation modelling was used to test the hypothesized model.

Results

The fit indices suggested a reasonably adequate fit of the data to the hypothesized model (χ² = 27.75, df = 12, CFI = .97, IFI = .97, RMSEA = .09), however an additional direct path from psychological capital to emotional exhaustion substantially improved the model fit (χ² = 17.94, df = 11, CFI = .99, IFI = .99, RMSEA = .06). Increased psychological capital positively influenced nurses’ perceived person-job fit, which in turn was negatively related to bullying exposure and emotional exhaustion, and ultimately influenced their physical and mental health.

Conclusions

The findings suggest that psychological capital and perceived person-job fit are key variables in new graduate nurses’ worklife, which may contribute to decreased nurses’ burnout and increased physical and mental well-being. The results support an expanded conceptualization of the Areas of Worklife Model.

Perceived Facilitators and Barriers to Physical Activity for Rural Youth: An Exploratory Study using Photovoice

Saagar Walia et al. — Thu, 15 Mar 2012 21:11:05 PDT

Introduction: Decreasing physical activity levels, particularly among youth, continue to be a prominent health concern in Canada, and youth living in rural areas may encounter unique facilitators and barriers to physical activity. In addition, current research suggests that overweight and obesity rates are higher for youth in some rural areas compared with urban areas. The goal of this study was to identify the perceived facilitators and barriers to physical activity for a selected sample of rural youth at a rural secondary school in south-western Ontario and examine how rural barriers and facilitators affect rural youth physical activity. Current Canadian literature addresses rural youth physical activity in a very limited fashion. Thus, the goal of this research was to provide important insights into physical activity for rural youth.

Method: Nine participants aged 13 to 18 years completed the study using the photovoice methodology and method. Photovoice is a relatively new method for health research that adopts an innovative approach whereby participants use cameras to document their perceived health realities. In photovoice the images and words from the life experiences of participants create the basis for discussion. Participants had 2 weeks to take photographs. After 2 weeks the cameras and logbooks were retrieved, the photographs were developed, and a one-on-one interview was held with each participant. The interviews focused on participants’ explanations of their photographs and their relevance to physical activity.

Results: Analysis of the pictorial, narrative, and logbook data provided by participants revealed 12 themes as facilitators and barriers to physical activity. Some of the themes relate to facilitators (eg early exposure to activities), some to barriers (eg lack of opportunities close to home), and some themes represent both a facilitator and a barrier (eg competitiveness, family support, and peer interests). The findings of this study may assist community stakeholders, school officials, and parents to better support the physical activity needs of rural youth.

Conclusions: Physical activity rates continue to decline and to be a major health concern for Canadian youth. Thus, it is becoming increasingly important to understand physical activity from the perspective of rural youth. Implications of this information for rural communities, rural schools, and rural residents are significant. These implications and recommendations may help facilitate increased participation in physical activity for rural youth by providing them, and their families and communities, with enhanced opportunities and resources to engage in physical activity. Further research is clearly indicated.

The Health of Women Temporary Agricultural Workers in Canada: A Critical Review of the Literature

Kathryn Ann Edmunds et al. — Thu, 15 Mar 2012 20:56:41 PDT

Among high-income countries such as Canada, there is growing dependency on "low skilled" temporary foreign workers in a variety of sectors. The purpose of this review is to critically synthesize and analyze the theoretical and empirical literature on gendered and temporary migration in the context of globalization and the health of temporary agricultural workers, particularly women in Canadian programs. While the social sciences literature contains well-developed conceptualizations of gendered migration, the research has focused on women in feminized occupations such as domestic work. Multidisciplinary searches produced only 11 research and review publications on the gendered constraints or health of temporary agricultural workers in Canada. Further investigation is needed to explore and integrate the strengths, resiliencies, and health-care needs of women migrant agricultural workers in Canada, as well as the barriers they face, within the intersecting and gendered forces of inequities at all levels: local, national, and global.

Les pays à revenu élevé comme le Canada dépendent de plus en plus d'une main-d'œuvre étrangère temporaire « peu spécialisée » dans divers secteurs. Cette recension vise à synthétiser et analyser de façon critique la littérature théorique et empirique portant sur la migration sexospécifique et temporaire en contexte de mondialisation et sur la santé des travailleurs agricoles temporaires, notamment les femmes recrutées dans le cadre de programmes canadiens. Bien que la littérature en sciences sociales présentent des conceptualisations sexospécifiques très élaborées sur la migration, les chercheuses se sont particulièrement penchées sur les femmes qui occupent des emplois traditionnellement féminins, comme le travail ménager. Des recherches multidisciplinaires n'ont révélé que 11 publications de recherche et de recension critique traitant des contraintes liées au genre ou de la santé des travailleurs agricoles temporaires au Canada. D'autres recherches devront être réalisées pour explorer et intégrer la question des forces, de la résilience et des besoins des travailleuses agricoles migrantes en matière de santé, qui œuvrent au Canada. Elles devront aussi se pencher sur les obstacles auxquels elles font face, dans une perspective tenant compte du croisement des forces sexospécifiques de l'iniquité à tous les paliers, soit local, national et mondial.

Creating a Knowledge Translation Trainee Collaborative: From Conceptualization to Lessons Learned in the First Year

Evelyn Cornelissen et al. — Tue, 15 Nov 2011 17:20:32 PST

Trainees (e.g., graduate students, residents, fellows) are increasingly identifying knowledge translation as their research discipline. In Canada, a group of trainees have created a trainee-initiated and trainee-led national collaborative to provide a vehicle for trainees to examine the diversity of knowledge translation research and practice, and to link trainees from diverse geographical areas and disciplines. The aim of this paper is to describe our experience and lessons learned in creating the Knowledge Translation Trainee Collaborative. In this meeting report, we outline the process, challenges, and opportunities in planning and experiencing the collaborative's inaugural meeting as participant organizers, and present outcomes and learnings to date.

Some Psychiatric Survivors Can’t Survive the System

Cheryl Forchuk — Sun, 13 Nov 2011 18:33:05 PST

Single Mother’s Adverse and Traumatic Experiences and Post-Traumatic Stress Symptoms

Joan A. Samuels-Dennis et al. — Sun, 13 Nov 2011 18:14:52 PST

A random sample of 247 Canadian single mothers currently receiving social assistance participated in a study designed to: a) provide a comprehensive description of mother’s lifetime exposure to 11 adversities, four psychological traumas, and eight assaultive traumas; b) examine the association between exposure to childhood and adulthood adversities and traumas, and mother’s current post-traumatic stress symptom. Of those surveyed, 31% met the criteria for a probable PTSD diagnosis. Between 78% and 80% reported 1 or more lifetime adversity, psychological trauma, and assaultive trauma. Rates of adversities were similar to the general female population. However, rates of psychological and assaultive trauma were six to ten times greater than the general female population. Results show that level of exposure to psychological and assaultive traumas, but not adversity, differentially impacted both the patterning and severity of mothers’ current PTSD symptoms. Psychological trauma exposure was the only event type that differentiated the mean scores for the re-experiencing, avoidance/numbing, and hyper-arousal symptom clusters. While exposure to assaultive trauma differentiates mean scores primarily for the avoidance/numbing symptoms cluster. Implications for health promotion initiatives across health and social service sectors are discussed.

The Impact of Civility Interventions on Employee Social Behavior, Distress, and Attitudes

Michael P. Leiter et al. — Sun, 13 Nov 2011 17:59:34 PST

Although incivility has been identified as an important issue in workplaces, little research has focused on reducing incivility and improving employee outcomes. Health care workers (N = 1,173, Time 1; N = 907, Time 2) working in 41 units completed a survey of social relationships, burnout, turnover intention, attitudes, and management trust before and after a 6-month intervention, CREW (Civility, Respect, and Engagement at Work). Most measures significantly improved for the 8 intervention units, and these improvements were significantly greater than changes in the 33 contrast units. Specifically, significant interactions indicating greater improvements in the intervention groups than in the contrast groups were found for coworker civility, supervisor incivility, respect, cynicism, job satisfaction, management trust, and absences. Improvements in civility mediated improvements in attitudes. The results suggest that this employee-based civility intervention can improve collegiality and enhance health care provider outcomes. (PsycINFO Database Record (c) 2011 APA, all rights reserved).

Evidence-Based Refinement of Health and Social Services: Exploring the Possibilities of Intravention Research

Carol L. McWilliam et al. — Sun, 13 Nov 2011 17:12:27 PST

To promote evidence-based refinement of quality health and social services delivery and care, decision makers, researchers, and practitioners often undertake intervention research. Intervention research tests and describes new strategies for achieving desired outcomes. But theoretical, methodological, and practical issues continue to plague even alternative participatory approaches to intervention research, raising questions about its potential for promoting quality health and social services and care. In response to this persistent challenge, the authors of this article propose a radical solution, namely intravention research, laying out its unique features as well as its theoretical and practical implications. Their conceptualization sets the stage for dialogue on options for advancing research methodologies and methods that might better promote evidence-informed health and social services.

A Canadian Model for Building University and Community Partnerships: Centre for Research & Education on Violence Against Women and Children

Peter G. Jaffe et al. — Sun, 13 Nov 2011 17:12:25 PST

The importance of Canadian research on violence against women became a national focus after the 1989 murder of 14 women at École Polytechnique in Montreal. This tragedy led to several federal government studies that identified a need to develop centers for applied research and community–university alliances on violence against women. One such center is the Centre for Research & Education on Violence against Women and Children. The Centre was founded in London, Canada in 1992 out of a partnership of a university, a community college, and community services. The centre’s history and current activities are summarized as a model for the development and sustainability of similar centers.

Dementia Home Care Resources: How Are We Managing?

Catherine Ward-Griffin et al. — Sun, 13 Nov 2011 17:12:21 PST

With the number of people living with dementia expected to more than double within the next 25 years, the demand for dementia home care services will increase. In this critical ethnographic study, we drew upon interview and participant data with persons with dementia, family caregivers, in-home providers, and case managers in nine dementia care networks to examine the management of dementia home care resources. Three interrelated, dialectical themes were identified: (1) finite formal care-inexhaustible familial care, (2) accessible resources rhetoric-Iinaccessible resources reality, and (3) diminishing care resources-increasing care needs. The development of policies and practices that provide available, accessible, and appropriate resources, ensuring equitable, not necessarily equal, distribution of dementia care resources is required if we are to meet the goal of aging in place now and in the future.

Development, Implementation, and Formative Evaluation of Pre-licensure Workshops using Participatory Action Research to Facilitate Interprofessional, Client-Centred Mental Healthcare

Evelyn Vingilis et al. — Sun, 02 Oct 2011 16:57:47 PDT

Background: This study presents a formative evaluation of nine pre-licensure workshops to educate on interprofessional, client-centred mental healthcare. The workshops, informed by the conceptual framework of Orchard, Curran, and Kabene had two key objectives: to stimulate networking and to socialize healthcare providers in working together.

Methods and Findings: A participatory action research (PAR) methodology was used for workshop planning and evaluation. Descriptive surveys and feedback forms using closed- and open-ended questions were used to examine whether the intended population was reached, to determine participant satisfaction, and to investigate to what level program objectives had been implemented. Students (625) from different disciplines attended two-hour after-class workshops. The results indicated that students were interested in learning about interprofessionalism and satisfied in the knowledge, attitude, and skills (practice) they received from the workshops. Participants indicated that they had or intended to use some of their learning about interprofessional practice. Key successful approaches, such as the partnership with psychiatric consumers, were incorporated into later workshop series.

Conclusions: The workshops demonstrated that interprofessional workshops can be one training component for pre-licensure students and can increase academic interest in interprofessional education.

'I Am Part of the Community but...' The Changing Context of Rural Living for Persons with Advanced Cancer and Their Families

Wendy D. Duggleby et al. — Sun, 02 Oct 2011 15:50:14 PDT

Introduction: Older rural persons who are receiving palliative care experience multiple co-existing transitions that can be distressing. These transitions do not occur in a vacuum, but occur in a context that reflects the uniqueness of rural living and the complexities of end of life in rural settings. The context or situation (geographical, physical, and social) in which an experience occurs influences the way people view and interpret the world around them; this contextual perspective contributes greatly to perceptions held by rural residents. Purpose:The purpose of this study was to explore the context in which older rural patients receiving palliative care and their families experience transitions. Following a study of the transition experiences of older rural palliative patients, an in-depth interpretive description analysis was conducted specific to the context in which the participants transitions occurred.

Methods: Twenty-seven open-ended, individual, audio-taped, qualitative interviews were conducted and 4 focus group discussions were held to gather data. Individual audio-taped interviews were conducted with six older rural persons with advanced cancer and 10 bereaved (post-death) family caregivers. Four focus groups were conducted with 12 palliative care healthcare professionals. Participants were recruited from 3 rural health regions in a western Canadian province classified as one of the most 'rural' Canadian provinces. All interviews were transcribed verbatim, coded, and analyzed using Thorne's interpretive description qualitative approach.

Results: From the data analysis four themes emerged: (1) community connectedness/isolation; (2) lack of accessibility to care; (3) communication and information issues; and (4) independence/dependence. Participants described feelings of being connected to the community at the same time as they also reported feeling isolated. They described their value of independence at the same time as finding themselves becoming increasingly dependent on others. At times this value of independence interfered with their seeking and accessing needed health or supportive care. They perceived their lack of access to health care resulted in little or no choice in where they die.

Conclusions: These findings reveal that the rural context has a major impact on the types of community support and healthcare services needed by older persons with advanced disease and their families. With advanced disease, the participants sense of solitude became one of isolation, and with increasing dependence on others, they needed more connection and support from others. The findings reflected a more complex view of rural aging and dying than has been cited in the literature to date. This study suggests there is a need to renegotiate community supports and the independence available to persons with advanced disease as they undergo multiple transitions near the end of life.

Using Photovoice Methodology to Investigate Facilitators and Barriers to Food Acquisition and Preparation by Rural Older Women

Carly Neill et al. — Sun, 02 Oct 2011 15:50:12 PDT

This research investigates facilitators and barriers that rural women aged 65 to 75 years in Southwestern Ontario experience in acquiring and preparing food through the use of photovoice methodology. Eighteen participants in five rural communities used a camera and log book to document their experiences and perspectives relating to the acquisition and preparation of food, and they each participated in two focus groups to engage in critical dialogue and knowledge sharing regarding the meaning and significance of the pictures they took. Analysis of photographs, log books, and focus group data revealed 13 themes, 3 emerging as facilitators to food acquisition and preparation (availability of food, social networks and values, personal values and resources), 5 as barriers (adjusting to changing family size, winter weather, food labeling issues, grocery shopper resources, limited physical capacity), and 5 as both facilitators and barriers (economics, valuing a healthy diet, technology changes, transportation, location and nature of grocery stores). Data also revealed rurality, age, and gender as foundationally influential factors affecting rural older women's food acquisition and preparation.