One-third of American children under the age of 18 years and one in ten Canadian children aged 0-11 years are exposed to environmental tobacco smoke (ETS) predisposing them to multiple health problems. Although several intervention strategies to reduce ETS exposure among children have been tested, to date there is not enough evidence to recommend one strategy over another. The objectives of this study were: (a) to test if parents' participation in an intervention based on an empowerment ideology and participatory experiences decreases the number of cigarettes smoked in homes; and (b) to identify barriers to making homes and vehicles smoke-free, as well as facilitators used by parents to manage these barriers. To enable informed decision-making on how to measure empowerment, a systematic review was conducted to identify questionnaires that best measure health-related empowerment among adults and in families. / In a randomized controlled trial, 36 families were allocated to the intervention (n=17) or control group (n=19). The six week intervention included three, two hour group sessions, followed by three follow-up telephone calls, all at weekly intervals. Data were collected in interviewer-administered questionnaires at baseline and at six months follow-up. / No significant difference was detected between the intervention and control groups in the number of cigarettes smoked in the home daily at six months follow-up. However empowerment increased and the number of cigarettes smoked in the home decreased in both the intervention and control groups from baseline (median=17) to six-month follow-up (median=5). / Parents identified multiple barriers to smoke-free homes and vehicles including personal factors, factors involving others, and factors related to the physical environment. The most commonly identified barriers to smoke-free homes were personal factors, with tobacco addiction cited most often. In describing how to overcome barriers, parents identified facilitators involving other people as most effective, yet they most often relied on themselves. None ofthe parents identified a health provider as a facilitator. The multiple and complex barriers identified in this study suggest that interventions and practice guidelines should incorporate multiple strategies and individualized approaches to assist parents to make their homes and vehicles smoke-free.

Although the concept of caring is widely accepted as an essential component of nursing, little is known about the behaviors that communicate caring, especially from the family's perspective. Such practical attention to the concept of caring in critical care is crucial to the therapeutic nurse-family relationship. The purpose of this study was to design and test an instrument to measure the perceptions of family members and nurses about the relative importance of 50 nurse-caring behaviors towards family members in critical care. / The Family Care-Q Instrument (FCQI) was originally based on the Care-Q Caring Assessment Instrument designed by Larson (1981). Items not relevant to family nursing in critical care were eliminated from Larson's instrument and new ones were formulated. The newly designed instrument identifies two categories of nurse-caring behaviors, expressive and instrumental, which were further delineated into six sub-categories based on Watson's Theory of Caring and the literature on caring behaviors. The FCQI was translated into French. Evidence of internal consistency, stability and validity was established partially during the development and testing of the FCQI. / A pilot study using the instrument was conducted. Perceptions of 20 family members and 38 critical care nurses of most and least important nurse-caring behaviors towards family members in critical care were assessed. Similarities and differences in perceptions were identified between nurses and family members in specific behaviors and in the most and least important behaviors. Overall, critical care nurses ranked the category of instrumental caring behaviors as most important, while family members identified the expressive category as most important.

No description available.

No description available.

Behaviours common among youth (e.g., inconsistent condom use, substance use) place them at increased risk for sexually transmitted infections (STIs). Despite decades of prevention efforts, STIs in youth continue to be a major public health challenge in Canada. Factors affecting school-based intervention success or failure have yet to be explained; contextual factors external to the individual, yet to be defined; and the involvement of youth in the design and evaluation of curriculum interventions, remains poorly documented.A three-phase exploratory study was conducted in two Prince Edward Island schools to describe: (a) factors youth identify as being important to facilitate their ability to take control of their sexual health behaviour, (b) what these youth perceive their needs to be in terms of sexual health education, (c) how they perceive newly developed curriculum resources, and (d) what can be learned about their participation in a curriculum development process.In Phase I, 15 girls and 13 boys participated in focus groups (n=8) and engaged in participatory activities (e.g., reflective writing, role-play, drawing) in order to identify their sexual health education needs and to contribute to the form and content of educational resources to be developed. In Phase II, curriculum experts assisted with refining the youth-generated materials so that they might become resources for use in schools. Eventually this process led to a set of resources (e.g., vignettes, sexual-risk assessment activities, and games) that promote STI/HIV prevention. In Phase III, 22 of the 28 participants from Phase I participated in focus groups (n=4) to evaluate the curriculum resources refined in Phase II. Inductive analyses of data (thematic and content analysis) from student focus groups were undertaken. Youth described positive and negative influences (factors at the intrapersonal, interpersonal, organizational, and community levels) on their ability to take control of sexual health behaviour. The findings from this study offer insight into the social composition of sexual risk that needs to be considered in future intervention studies. A tailored approach to the development of sexual health curriculum resources for youth may improve school-based intervention success toward preventing STIs in this high-risk group. / Certains comportements courants adoptés par les adolescents (l'usage irrégulier du condom ou la consommation d'alcool et de drogues, par ex.) augmentent le risque de contracter une infection transmissible sexuellement (ITS). Malgré les efforts déployés depuis des décennies en matière de prévention au Canada, les ITS continuent de poser un grand défi pour la santé publique au sein de cette population. Les facteurs responsables de la réussite ou à l'échec des interventions en milieu scolaire sont mal connus; les facteurs contextuels (extérieurs à l'individu) restent à définir; enfin, la participation des jeunes à la conception et à l'évaluation des programmes scolaires a fait l'objet de peu d'analyses.Nous avons mené dans les écoles de l'Île-du-Prince-Édouard une étude exploratoire en trois volets qui visait à décrire: a) les facteurs jugés importants par les adolescents afin de favoriser leur propre responsabilisation en matière de santé sexuelle; b) les besoins qu'ils expriment en matière d'éducation sur le sujet; c) leurs perceptions à l'égard des ressources pédagogiques récentes; d) ce qu'on peut apprendre sur leur participation à la conception de programmes scolaires sur le sujet.Dans le cadre du volet I, 15 jeunes filles et 13 jeunes garçons ont pris part à des groupes de discussion (n=8) ainsi qu'à des activités participatives (exercice de réflexion par écrit, jeu de rôles, dessin) dans le but de définir leurs besoins en matière de santé sexuelle et de déterminer le format et le contenu de ressources pédagogiques éventuelles. Dans le volet II, des pédagogues ont contribué à peaufiner le matériel produit par les jeunes en vue de son utilisation en milieu scolaire. Cette démarche a conduit à la production d'un ensemble de ressources axées sur la prévention des ITS et du VIH (par. ex., sketches, activités d'évaluation du risque, jeux). Dans le volet III, 22 adolescents parmi les 28 qui avaient participé au premier volet ont évalué dans le cadre de nouveaux groupes de discussion (n=4) le matériel pédagogique conçu au cours du volet II. Nous avons procédé à une analyse inductive des données recueillies (analyse thématique et analyse de contenu). Les participants ont décrit l'incidence positive ou négative d'un ensemble de facteurs (de nature intrapersonnelle, interpersonnelle, organisationnelle et sociale) sur leur capacité de se responsabiliser. Nos conclusions jettent un éclairage sur la nature sociale du risque sexuel, une dimension qui demandera à être approfondie dans des recherches subséquentes. La conception de matériel pédagogique adapté aux besoins des jeunes pourrait accroître le succès des interventions en milieu scolaire en matière de prévention des ITS au sein de ce groupe à risque élevé.

Strategies for implementing evidence in clinical practice are often applied with an aim to change provider behaviour and improve patient outcomes. In Canada, many health professionals in birthing units use continuous electronic fetal monitoring rather than intermittent auscultation, despite the fact that continuous electronic fetal monitoring is associated with increased caesarean section and obstetrical intervention rates without benefit to the fetus. Based on a synthesis of credible research, there are national and international guidelines recommending intermittent auscultation for low-risk labouring women. The purpose of this study was to evaluate two interventions, interactive education and Action Learning, that aimed to increase nurses' use of intermittent auscultation in low-risk labouring women as per the Society of Obstetricians and Gynecologists of Canada Fetal Health Surveillance Clinical Practice Guideline (Liston & Crane, 2002). Guided by Roger's (2003) theory of diffusion of innovation and the promoting action on research implementation in health services (PARiHS) framework (Kitson et al., 2008), I conducted a two-phase study. In the first phase, I used a pre-post design with staff nurses (N = 93) to evaluate the effectiveness of an educational intervention. In the second phase, I used a randomized controlled trial design to evaluate the effectiveness of the Action Learning strategy with staff nurses (N = 62) and randomized the nurses to either Action Learning or Usual Care. During labour, 270 consecutively admitted women who met the low-risk inclusion criteria received their care from either an Action Learning or a Usual Care nurse. Neither the interactive education intervention nor the Action Learning intervention had a significant effect on the nurses' use of guideline appropriate care, during episodes of care for low-risk labouring women. Various types of data were explored to determine their influence on the nurses' guideline adherence / Les stratégies de mise en œuvre des données probantes dans la pratique clinique sont souvent appliquées dans le but de modifier le comportement des fournisseurs de soins et d'améliorer les résultats des patients. Au Canada, de nombreux professionnels de la santé travaillant dans des unités d'accouchement surveillent constamment le rythme cardiaque du fœtus plutôt que de manière intermittente. Des directives nationales et internationales, recommandent l'auscultation intermittente pour les femmes en travail à faible risque. L'objectif de cette étude était d'évaluer deux types d'intervention : la formation interactive et l'apprentissage actif, destinées à augmenter l'usage de l'auscultation intermittente par le personnel infirmier pour les femmes en travail à faible risque, conformément à la directive de pratique clinique pour la surveillance de la santé du fœtus, directive fournie par la SOGC (Liston & Crane, 2002). En m'appuyant sur la théorie de la diffusion des innovations de Rogers (2003) et sur le modèle PARiHS – promoting action on research implementation in health services (Kitson et al., 2008), j'ai mené une étude en deux phases. Dans la première phase, j'ai utilisé un modèle avant-après avec des infirmières soignantes (N = 93) pour évaluer l'efficacité d'une intervention éducative. Dans la seconde phase, j'ai utilisé une méthodologie d'essai comparatif aléatoire pour évaluer l'efficacité de la stratégie d'apprentissage actif et j'ai assigné de manière aléatoire les infirmières (N = 62) au groupe bénéficiant de l'apprentissage actif ou au groupe dispensant les soins habituels. Durant le travail, 270 femmes admises consécutivement et répondant au critère de faible risque, ont reçu les soins d'une infirmière ayant suivi un apprentissage actif ou d'une infirmière dispensant les soins habituels. Ni l'intervention éducative interactive ni la stratégie d'apprentissage actif n'ont eu d'effet significatif su

The nurse-patient relationship is prominently featured in nursing discourse, particularly in the literature and practices of psychiatric-mental health (PMH) nurses. PMH nurses have found it challenging to focus on their relational work in the face of pressure to provide efficient, technological, and biomedical care, especially in hospital settings. The purpose of this inquiry was to explore the relational experiences of patients with acute mental illness and their nurses in inpatient psychiatric settings. The researcher engaged in conversations with ten PMH nurses and six patients hospitalized with acute episodes of severe mental illness. Interpretation of transcribed accounts yielded four dominant themes: engagement, withdrawal, mindful approach, and keeping safe. The author discusses the relational practices of nurses and their patients as experienced in the day-to-day world of an acute psychiatric inpatient unit. The author explores relational experiences in brief encounters, as patients and nurses move toward the other in order to understand the other; in psychological work, as they attempt to achieve a shared understanding about future directions; and in practices related to caring for patients with physical needs related to activities of daily living. The author discusses the state of unknowing that some patients and nurses experience as they withdraw from the other. The author concludes that relational practices are a prominent feature of the work of psychiatric-mental health nurses in acute inpatient psychiatric units, but that the nature of these practices may be changing. The author also suggests that despite their occasional experiences of nurses' withdrawal and absence, patients highly value the experience of working with nurses in supportive, health-promoting relationships. / La relation personnel infirmier-patient a été un élément important du discours en sciences infirmières, particulièrement dans la documentation et la pratique du personnel infirmier en psychiatrie-santé mentale. Les infirmières/infirmiers en psychiatrie-santé mentale rencontrent des difficultés à se concentrer sur leur travail relationnel face à la nécessité de fournir des soins efficaces, technologiques et biomédicaux, particulièrement en milieu hospitalier. L'objectif de cette enquête était d'explorer les expériences relationnelles des patients atteints de maladies mentales aiguës et de leurs infirmières/infirmiers en milieu hospitalier psychiatrique. La chercheuse a engagé des conversations avec dix infirmières/infirmiers psychiatriques et six patientes/patients hospitalisés dans des unités de soins psychiatriques intensifs. L'interprétation de la transcription des conversations a révélé quatre thèmes dominants : engagement, repli sur soi, approche attentive et sentiment de sécurité. L'auteure discute des pratiques relationnelles du personnel infirmier et de leurs patients telles quelles sont vécues dans l'univers quotidien d'une unité de soins psychiatriques intensifs. L'auteure explore ces expériences relationnelles lors de rencontres brèves, lorsque les patients et le personnel infirmier vont l'un vers l'autre afin de mieux se comprendre; lors du travail psychologique, lorsqu'ils tentent de parvenir à une compréhension commune de l'orientation future; et lors des pratiques liées aux soins des patients présentant des besoins physiques en liaison avec les activités de la vie quotidienne. L'auteur discute du sentiment d'ignorance éprouvé par les patients et le personnel infirmier lorsqu'ils s'éloignent l'un de l'autre. L'auteur conclut que les pratiques relationnelles sont un élément important du travail des infirmières/infirmiers d'unités de soins psychiatriques qui ont participé à cette enquête, mais que la nature de ces pratiques pourrait être en train de changer. L'auteur suggère également qu'en dépit des expériences occasionnelles de retrait et d'absence du personnel infirmier, les patients interrogés dans cette enquête accordent une grande importance à la collaboration avec le personnel infirmier dans le cadre de relations de soutien et de promotion de la santé.

The notable lack of a health status measure specific to homeless persons triggered the development of a new instrument, The McCormack Assessment Scale for the Health of the Homeless (MASHH). This study was directed by five purposes: to delineate the empirical indicators that determine the health status of homeless people; to name the determinants of health influencing the health status of homeless persons; to maintain qualitative validation while generating beginning evidence of quantitative validation and reliability; to develop a health status measure for homeless persons that can be self or provider administered, and to gain increased knowledge about health and its determinants. A critical review of the literature revealed that no valid and reliable measure existed. The McCormack Assessment Scale for the Health of the Homeless (MASHH), inductively derived to include the health experiences of homeless persons, is a response to this problem for this population.A sequential triangulation design was employed for this study. In Stage 1, a theoretical definition was derived and a large item pool was generated from the analysis of qualitative data; in Stage 2, items were examined for clarity by undergraduate nursing research students; in Stage 3, the scale was constructed; in Stage 4, content validation was conducted by two expert groups - homeless persons assessed acceptability and clinical and research nurse experts assessed conceptual relevancy; and in Stage 5, a pilot study was conducted to garner beginning evidence of validation and reliability. Results from the pilot study indicated that MASHH operationalized an internal structure of health that specified 10 determinants influencing the health of homeless persons and delineated critical indicators within each health determinant or subscale. Fundamental to attaining, maintaining, and regaining health for members of this population is the requirement to identify and understand how diverse determinants influence health. / Le manque notable d'une mesure de l'état de santé spécifique aux sans-abri a déclenché la mise au point d'un nouvel instrument, le Barème d'Appréciation McCormack pour la Santé des Sans-abri (BAMSS). Cette étude a été gouvernée par cinq objectifs : délimiter les indicateurs empiriques qui déterminent l'état de santé des sans-abri; nommer les déterminants de la santé influençant l'état de santé des personnes sans-abri; conserver une validation qualitative tout en générant des preuves préliminaires d'une validation quantitative, fiabilité; mettre au point une mesure de l'état de santé pour les personnes sans-abri qui peut être gérée par ces derniers ou par les prestataires; et enfin acquérir une connaissance accrue de la santé et de ses déterminants. Une révision critique de la documentation a dévoilé l'absence de toute mesure valable et fiable. Le Barème d'Appréciation McCormack pour la Santé des Sans-abri (BAMSS) dérivé par induction pour inclure les expériences en matière de santé des sans-abri, est une réponse à ce problème pour cette population. Un modèle de triangulation en série a été utilisé pour cette étude. Dans l'étape n°1, on est parvenu à une définition théorique et on a créé un groupe d'items étendu à partir de l'analyse de données qualitatives; dans l'étape n°2, les items ont été examinés, pour clarifier, par des étudiants de premier cycle en recherche en sciences infirmières; dans l'étape n°3 le barème a été construit; dans l'étape n°4, deux groupes d'experts ont procédé à la validation du contenu : les sans-abri en ont évalué l'acceptabilité et des experts en recherche clinique et en sciences infirmières en ont évalué la pertinence conceptuelle; dans l'étape n°5, on a mené une étude pilote pour recueillir des preuves préliminaires de validation et de fiabilité. Les résultats de cette étude pilote ont indiqué que le BAMSS opérationnalisait une structure interne en matière de santé qui spécifiait 10 déterminants influençant la santé des personnes sans-abri, et délimitait des indices de crise au sein de chaque déterminants de la santé ou sous-échelle. Pour que les membres de cette population aient, conservent ou recouvrent la santé, il est essentiel de pouvoir identifier et comprendre la façon dont divers déterminants influencent la santé.

Background. Hospitalized infants still experience pain from regularly performed tissue-damaging procedures. Nurses have knowledge to manage the pain but do not apply that knowledge. There is agreement that hospital organizational factors influence quality of care outcomes and some indication that patient factors may influence level of care. / Objective. This study examined the factors from a conceptual model entitled Knowledge Use for Pain Care. These were (1) nurse, (2) organizational and (3) infant factors in relation to nurses' management of tissue-damaging procedures in hospitalized infants. / Research design. A prospective study using two neonatal intensive care units in two Canadian provinces in 2005 was used. / Participants. Ninety-three nurses who performed 170 tissue-damaging procedures. / Measures. Nurse demographic data included education, and years of experience. Nurses' knowledge of pain was measured using the new Pain Knowledge and Use instrument. Organizational factors were measured using the nurse-doctor Collaboration and Satisfaction about Care Decisions Scale (Baggs, 1994), and the Environmental Complexity Scale (O'Brien, Irvine, Peereboom & Murray, 1997). Infant factors included age and intensity of care required. Actual pain care was measured by a scorecard of nurses' assessment, management and documentation for the tissue-damaging procedure. Estimates of professional nurse, organizational and infant effects on nurses' pain care for the tissue-damaging procedures were derived from general estimating equations. / Results. Higher procedural pain care was associated with higher nurse doctor collaboration (odds ratio {OR}, 1.44; 95% confidence intervals {CI} 1.05-1.98), infants with higher intensity of care (OR, 1.21; 95% CI, 1.06-1.39), unanticipated increases in the work of nurse assignments (OR, 1.55; 95% CI, 1.04-2.30). Nurse's level of pain knowledge was adequate but did not translate into actual care for tissue-damaging procedures. / Conclusion. The results suggest that the model was partly supported. In particular the importance of nurse-physician collaboration in pain care delivery, a variable amenable to intervention and further study was significant. Overall, the factors that influence nurse's use of their pain knowledge to provide better care remain a complex issue.

Cancer represents a threat to health which leads long-term cancer survivors to appraise uncertainty about the outcome regularly. This descriptive correlational study examined the level and stress of uncertainty and related variables in a sample of 72 adult cancer survivors of eight to twelve years. The conceptual framework was based on Hilton's uncertainty stress model (1988, 1994) and Lazarus and Folkman's conceptualization of coping (1984). The objectives were to determine if there was a relationship between person factors and uncertainty and between uncertainty and psychological responses. Data included demographic and physical status, locus of control, uncertainty and stress, depression, psychological distress, and perceived control. The overall level of uncertainty was low, but it was positively associated with recurrence, depression, and illness worry. Results support uncertainty as a mediator between person factors and psychological responses. Nursing implications include periodic assessment of uncertainty long after diagnosis.