The primary purpose of this study was to explore the concepts of health and learning in the McGill Model of Nursing by examining the relationships between sense of coherence, self-directed continuing learning, and psychological well-being in a sample of white, middle class, English-speaking, elderly adults in a large, urban, long-term care residence. The secondary purpose was to contribute to the testing of the measurement instruments for use in studies with older adults. A quantitative, nondirectional, correlational design, using a sample of convenience, found a high positive correlation between sense of coherence and psychological well-being and a moderate positive correlation between sense of coherence and self-directed continuing learning. The results lend support to the relationship between health and learning in the McGill Model of Nursing and to the relevance of the model to gerontological nursing in long-term care. Further research is required to examine the relationship in other elderly populations.

Background: Cardiology acute care nurse practitioners (ACNP) enacting their roles in health care teams faced a number of challenges including a mix of positive and negative views of the ACNP role from health care team members, ACNP roles crossing the boundaries between the medical and nursing professions, and an expanded scope of practice that was not clearly defined. Understanding the process by which ACNP roles were enacted in teams is important since the boundaries between professions may change following the introduction of an ACNP role and affect the team's perceptions of its effectiveness. Little is known of how ACNP role enactment affects the team's perceptions of its effectiveness. Objectives: Following the introduction of a cardiology ACNP role in the health care team, the study aims to: 1) describe ACNP role components, 2) describe ACNP role enactment, and 3) explore how ACNP role enactment and boundary work of team members affect the team's perceptions of team effectiveness. Methods: The study was conducted in two university-affiliated teaching hospitals in Quebec. A descriptive multiple case study design with qualitative and quantitative data sources was used. The study produced a valid and reliable time and motion tool to measure cardiology ACNP activities. The study used Bales' interaction process analysis to identify differences in patterns of communication among team members. Findings: Team members believed they were more effective following the introduction of an ACNP role because the ACNP role filled a gap in patient care and improved team processes. The ACNP role components that were enacted were sensitive to the surrounding context and responsive to the needs of team members and patients. The patterns of communication among team members were aligned with the structural dimensions surrounding the team. A conceptual framework was developed. It highlighted the key inter-related dimensions and concepts that different stakeholder / Contexte : Les infirmières praticiennes spécialisées (IPS) en cardiologie qui exercent leur rôle au sein des équipes soignantes rencontrent certains défis. Des points de vue tant positifs que négatifs sont exprimés par les membres des équipes soignantes à l'égard du rôle même de l'IPS, du développement d'un rôle qui traverse les frontières entre les professions médicale, infirmière et autres professionnels et des modalités de pratique élargies non clairement définies. Par conséquent, il importe de comprendre le processus par lequel la pratique des IPS s'intègre aux équipes soignantes et bouleverse les frontières interprofessionnelles, et comment la présence des IPS influe sur les perceptions d'efficacité des équipes soignantes. Nous disposons de peu de données sur la relation entre le rôle des IPS et les perceptions d'efficacité des membres des équipes soignantes. Objectifs : Suite à l'introduction d'IPS en cardiologie au sein d'équipes soignantes, l'étude vise à : 1) décrire les composantes du rôle des IPS en cardiologie, 2) décrire le processus de développement du rôle des IPS, et 3) explorer comment ce processus et les changements au niveau des frontières interprofessionnelles entre les membres de l'équipe influencent leurs perceptions d'efficacité. Méthodologie : Nous avons réalisé une étude de cas multiples dans deux hôpitaux universitaires au Québec. Cette étude s'appuie sur des données qualitatives et quantitatives. Un outil de mesure des temps et mouvements valide et fiable a été développé afin d'étudier les activités des IPS en cardiologie. De plus, le système d'analyse des processus d'interaction de Bales a été utilisé pour identifier des modes de communications entre les membres des équipes. Résultats: Les membres des équipes soignantes estiment que l'introduction des IPS a amélioré leur efficacité parce qu'elles comblent une lacune en matière de soins aux patients et qu'elles per

Background. Factors such as the shortage of personnel, hospital closures and mergers, the ageing of the population combined with the evolution of medical technologies have all added pressure to the health care system. These pressures have had an impact on current work environments and health care workers' satisfaction. In light of the evidence on the influence of job satisfaction and retention on the quality of tare and patient safety, interventions are needed to address these issues. / Objective. The objective were to examine the effect of Appreciative Inquiry on: (1) the development of innovative ideas regarding work organization; (2) changes in health care professionals' and particularly nurses' job satisfaction and intent to stay; and, (3) levels of empowerment, social network and perceived organizational support. / Research design. The study used a multiple embedded case study design to access the multifaceted aspects relating to retention and innovation and examine the changes engendered by an AI intervention. / Participants and setting. Two oncology ambulatory clinics constituted the cases; the embedded units were the health care and the management teams (N = 47 and 5) of an adult oncology division in a multi-site university affiliated health care centre in a large Canadian city. / Methods. Multiple sources of evidence were used. They consisted of participant observation, questionnaires providing quantitative and qualitative evidence, interviews, direct observation and documentation. / Results. AI provided a way to involve health care professionals in change processes by creating the opportunity and the conditions that promoted the emergent of innovative ideas. Some of these ideas were implemented during the study period. AI did not result in improved psychological empowerment, perceived organizational support, support network or decreased intent to stay. Job satisfaction decreased over time. Perceptions of organizational support and psychological empowerment were found to influence job satisfaction and intent to stay. / Conclusion. This study makes a contribution to micro-systems examination of change processes and reveals how ideas evolve and are developed in a multidisciplinary context. AI represents a way to tap into the innovative potential of individuals within an organization. The findings suggest that upper and middle management support is required throughout change processes and that multilevel interventions need to be pursued to facilitate the implementation of innovative ideas and subsequently improve work environments.

Light and noise in the neonatal intensive care unit (NICU) may be stressful to infants who are born preterm. The goals of this research were twofold: a) to evaluate the physiological stability (heart rate, heart rate variability, and oxygen saturation) of 28 to 32 gestational age preterm infants while wearing eye goggles and earmuffs for a 4-hour period, and b) to evaluate their pain response (heart rate and heart rate variability) during a painful procedure (heel lance) following the 4-hour period that they had worn the eye goggles and earmuffs. Preterm infants were recruited from four university-affiliated teaching hospitals in the Montreal region that have a level III NICU. A cross-over trial allowed the evaluation of physiological stability in a sample of 54 infants, and a randomized controlled trial with 44 infants was used to evaluate pain response. For the crossover trial, preterm infants were randomized in one of the following sequences: intervention - control or control - intervention. In the RCT, the first randomized study period (A or 8) of the cross-over trial determined whether preterm infants were or were not wearing eye goggles and earmuffs prior to a heel lance procedure. Data were collected using the Somte™ device allowing the continuous recording of outcome measures and infants were videotaped during the study periods for evaluation of potentially confounding variables. Results of the RM~ ANOVA revealed that infants were more physiologically unstable while wearing the eye goggles and earmuffs. This was shown by signs of stress, such as a significantly higher maximum heart rate and a significantly lower high frequency power (heart rate variability), during the intervention period compared with the control period. [...] / La lumière et le bruit dans l’unité néonatale peuvent être particulièrement stressants pour les prématurés. Les buts de cette étude étaient d’évaluer chez des prématurés de 28 à 32 semaines d’âge gestationnel: a) leur stabilité physiologique (rythme cardiaque, variabilité du rythme cardiaque et saturation d’oxygène) lorsqu’ils portent des lunettes et des couvre-oreilles pendant une période de 4 heures, et b) leur réponse à la douleur lors d’une prise de sang au talon (rythme cardiaque et variabilité du rythme cardiaque) après la période de 4 heures où ils ont porté les lunettes et les couvre-oreilles. Les prématurés ont été recrutés dans quatre centres hospitaliers de la région de Montréal qui possèdent une unité néonatale de soins intensifs. La stabilité physiologique a été évaluée à l’aide d’un plan croisé avec un échantillon de 54 prématurés alors que la réponse à la douleur a été évaluée à l’aide d’un essai clinique randomisé avec un nombre de 44. Pour le plan croisé, les prématurés ont été randomisés dans l’une des séquences suivantes : intervention - contrôle ou contrôle - intervention et pour l’essai clinique randomisé, la première période de la randomisation réalisée pour le plan croisé (A ou B) a déterminé si les prématurés portaient ou non les lunettes et les couvre-oreilles avant la prise de sang au talon. Les données ont été collectées à l’aide d’un appareiilage (Somté™) qui permettait un monitorage continu des variables dépendantes et des enregistrements vidéo des prématurés ont été réalisés pour l’évaluation de variables potentiellement confondantes.

The major purpose of this randomized controlled trial was to examine the effect of a low-cost, community-based, nurse-delivered, group psychoeducation program entitled the Chronic Pain Self-Management Program (CPSMP) on a number of pain-related and other quality of life outcomes in those experiencing an idiopathic chronic non-malignant pain problem. One hundred and ten individuals referred by community-based health care professionals, a pain clinic service, or self-referral were randomly assigned to one of two conditions: the 12-hour CPSMP intervention group or the 3-month wait-list control group. One hundred and two individuals completed the study. Results of intention-to-treat statistical analyses indicated that the treatment group had significant improvement or strong positive trends to improvement in pain, dependency, mental health, disability, vitality, self-help role behaviours and other role functioning indicators, life satisfaction, and in self-efficacy and resourcefulness compared to the wait-list control group. / An additional purpose of this study was to test the hypothesized relationships in the Self-Help Model: Learned Response to Chronic Illness Experience. Causal modeling using path analyses tested the Model at two points in time: pretest and posttest. Overall, the hypothesized pattern of relationships in the Self-Help Model were supported by the data.

Background: The evidence to date in support of system related factors to account for medication administration errors (MAE) remains scant and inconclusive. Objective: To examine the predictive power of medication administration complexity (component and coordinative), work interruptions and nurses' workload as potential contributing factors to MAE. Design: A prospective correlational design. Setting: A medical patient care unit in a university teaching hospital Sample: A convenience sample of medication administration rounds performed by registered nurses with at least six months of professional experience. Method: Data were collected using direct observation (MAE and work interruptions), self-report measures (subjective workload, nurses' characteristics) and the Medication Administration Complexity (MAC) coding scale (component and coordinative medication complexity). Results: One hundred and two rounds were observed, during which 965 doses were administered and performed by 18 nurses. When wrong administration time errors were included, MAE rate was 28.4% whereas it decreased to 11.1% when wrong time errors were excluded. An interruption during the medication preparation phase (OR 1.596; 1.044 - 2.441) significantly increased the odds of MAE. Two significant interaction effects were found (patient demand for nursing care X overtime and patient demand for nursing care X professional experience). These interactions pointed to more negative effects of overtime and professional experience among nurses who rated the demand for nursing care as above average. Contrary to expectations, coordinative medication administration complexity significantly decreased the odds of MAE (OR 0.558; .322-.967). Including wrong administration time errors changed the cluster of predictors with component medication administration complexity (1.039; 1.016 - 1.062), and nurses' workload (1.221; 1.061 - 1.405) were significant pre / Introduction: Les résultats probants relatifs aux facteurs prédictifs des erreurs d'administration des médicaments (EAM) sont peu nombreux et non-concluants.Objectif: Examiner la complexité de l'administration (composante et coordination), les interruptions dans le processus d'administration des médicaments et la charge de travail infirmière subjective comme facteurs prédictifs des EAM.Devis: Un devis corrélationnel prospectif. Milieu: Une unité de médecine dans un centre hospitalier universitaire.Échantillon: Un échantillon de convenance formé de 102 cycles d'administration des médicaments effectués par 18 infirmières avec un minimum de six mois d'expérience professionnelle.Méthode: Les données ont été colligées par observation directe (EAM et interruptions), mesures auto-rapportées (charge de travail subjective, caractéristiques sociodémographiques) ainsi qu'avec l'échelle de la complexité de l'administration médicamenteuse (MAC coding scale).Résultats: 102 observations ont été effectuées au cours desquelles 965 doses ont été administrées par 18 infirmières. En incluant les erreurs de temps d'administration, le taux d'EAM était de 28.4% et diminua à 11.1% lorsque les erreurs de temps d'administration étaient exclues. Une interruption lors de la préparation des médicaments (OR 1.596; 1.044 - 2.441) augmente significativement le risque d'EAM. Deux interactions significatives ont été trouvées (charge de travail X temps supplémentaire et charge de travail X expérience professionnelle). Ces interactions indiquent un effet plus négatif du temps supplémentaire et de l'expérience professionnelle parmi les infirmières ayant une charge de travail supérieure à la moyenne. La complexité de coordination de l'administration de médicament, contrairement aux attentes, diminue significativement les risques d'EAM (OR 0.558; .322-.967). L'inclusion des erreurs de temp

The purpose of this study was to identify the best set of variables measured at in-hospital interview to predict perceived pain-related impairment of function at three week follow-up in 361 hospitalized adult patients with pain (173 males, 188 females; mean age 48.3 years). / Multiple regression analyses were performed on a subset of data from a large prospective pain prevalence study. Three models were developed to predict perceived overall function, physical function and psychological function on a training sample (n = 252) and tested for reliability on a cross validation sample (n = 109). Independent variables measured at the in-hospital interview included sociodemographic, cognitive, physical and psychological variables. The dependent function variables were assessed at three week follow-up. / Overall functional impairment at three weeks was best predicted by perceived overall function, pain quality, nonsurgical pain, and hospital stay of one to three months in the past year. Impairment of physical function was predicted by perceived physical function, pain quality, one-to-three month hospital stay during the past year, and pain duration of greater than three months. Impairment of psychological function was best predicted by perceived psychological function, pain quality, and nonsurgical pain. The models explained 22%, 19% and 23% of the variance respectively. Statistical reliability was established for each model through the process of cross validation.

A head injury is an unexpected and potentially life-threatening event that frequently results in physical, cognitive, and emotional changes in the patient. As a result, a head injury affects the whole family, and mothers and wives may be potentially at risk because they tend to assume the primary caregiving role post-trauma. Current thinking is that a person's ability to restore a sense of meaning in life is an important aspect of psychological adjustment following the traumatic injury of a loved one. However, little is currently known about the process of finding meaning during the early phase of recovery. The purpose of this qualitative study was therefore to generate a theory about how mothers and wives find meaning during the early phase of recovery following the head injury of their loved one. / Grounded theory methodology was used to explore the experience of 5 mothers and 9 wives whose family member had suffered a moderate or severe head injury. Participants were recruited from three major Level I Canadian trauma centres using inclusion criteria and theoretical sampling to achieve theoretical completeness. They were interviewed on two occasions: 1 to 5 weeks and again 6 to 8 weeks following their family member's head injury. Iterative analysis and constant comparative methods were used throughout the study and the data revealed a process of finding meaning embedded in three distinct phases: "Focusing on the here and now", "Expanding perspective", and "Resuming life". The process of finding meaning was characterized by an emerging fit between the participants' perception of their current situation and their pre-trauma value and belief system. This process helped participants to find a new way of thinking about their world and to find a new order and sense of direction in their lives. / The findings of this study augment our theoretical understanding of family members' psychological responses to traumatic events, and may be helpful to guide nursing care of the whole family during the early phase of recovery following a head injury.

This randomized controlled trial determined whether the delivery of a telehealth program after discharge from hospital for coronary artery bypass graft (CABG) surgery made a difference in the post-surgical adjustment and health service use of patients and caregivers. Patients and caregivers (n=182) consented to be randomly assigned to receive one week of daily home audio-video visits from a nurse or routine cardiac instruction only in-hospital. Participants completed individual telephone interviews the day before surgery and 5 days and 3 weeks after discharge.. / The primary outcomes were changes in anxiety between entry into the program and 3 weeks after discharge for patients and caregivers. Exploratory outcomes included changes in participants' depression symptoms, perceived uncertainty, illness control, support, and conflict with the caregiver, as well as use of health services over the same time period. The potential moderating effects of sex and coping style were also explored.. / Data were analyzed using 2x2 analyses of covariance assessing the main effects of telehealth and patient sex and their interaction on changes in the dependent variables, including baseline scores as covariates. Results showed no difference between changes in anxiety for patients in telehealth versus usual care. However, patients in telehealth showed greater decreases in perceived uncertainty (p=.03) and increases in perceptions of treatment control (p=.09) than the comparison group. Also, fewer telehealth patients contacted their physicians (p=.04). For caregivers of male patients in telehealth there was a greater change in anxiety than for caregivers of male patients in usual care (p=.0003). While greater decreases in uncertainty (p=.002) and increases in perceived personal control (p=.10) were also realized for caregivers of male patients, greater reductions in depression symptoms (p=.03) and perceptions of conflict (p=.04) were experienced by caregivers in telehealth compared to usual care, regardless of the sex of the caregiver. The coping styles of neither patients nor caregivers influenced their responses to telehealth. Finally, changes in caregivers of male patients' uncertainty were associated with reductions in anxiety, and accounted for more than one third of the observed changes in anxiety. These results can help guide the recruitment of patients into telehealth with knowledge that male and female CABG surgery patients and caregivers can benefit from the service, though in different ways. Future research that examines caregiver and patient outcomes needs to include enough participants of both sexes in order to achieve adequate power to detect clinically meaningful results for women and men. / Cet essai clinique randomisé (ECR) servait à déterminer si la prestation d'un programme de Télésanté après un congé de l'hôpital à la suite d'une intervention de pontage aortocoronarien a eu un impact positif sur l'adaptation postopératoire et l'utilisation de services de santé chez les patients et les aidants naturels. Les patients et les aidants naturels (n=182) ont consenti à être répartis de façon aléatoire en deux groupes : l'un recevant des visites audio vidéo quotidiennes à la maison et l'autre, des instructions de routine suivant une intervention cardiaque seulement à l'hôpital. Les participants ont pris part à des entrevues téléphoniques individuelles la journée précédant l'intervention, puis 5 jours et trois semaines après le congé de l'hôpital. / Les mesures de résultats primaires incluaient les changements au niveau de l'anxiété chez les patients et les aidants naturels entre la date d'entrée dans le programme et trois semaines après le congé de l'hôpital. Les mesures de résultats exploratoires, incluaient les changements au niveau des symptômes de dépression des participants, de l'incertitude perçue, du contrôle de la maladie, du soutien/des conflits avec l'aidant naturel et de l'utilisation des services de santé au cours de la même période. Les effets modérateurs potentiels du sexe et du style d'adaptation ont également été explorés. / Les données ont été examinées selon des analyses de covariance 2x2 évaluant les effets principaux du programme de Télésanté et du sexe des patients, et de leur interaction sur les changements dans les variables dépendantes, incluant les pointages de bases comme covariables. Les résultats n'ont révélé aucune différence entre les changements au niveau de l'anxiété chez les patients qui ont bénéficié du programme de Télésanté versus ceux qui ont disposé des soins habituels. Toutefois, les patients qui ont bénéficié du programme de Télésanté ont présenté des baisses plus importantes au niveau de l'incertitude perçue (p=.03) et des hausses au niveau des perceptions quant au contrôle du traitement. De plus, on a constaté que moins de patients qui ont bénéficié du programme de Télésanté ont contacté leurs médecins (p=.04). Les aidants naturels des patients de sexe masculins ont connu de plus importants changements au niveau de l'anxiété que les aidants naturels des patients de sexe masculins qui ont bénéficié de soins habituels (p=.0003). Tandis qu'il y a eu d'importantes baisses au niveau de l'incertitude (p=.002) et des hausses au niveau de la perception du contrôle personnel (p=.10) auprès des aidants naturels des patients de sexe masculins, tous les aidants naturels du programme de Télésanté ont connu de plus importantes baisses au niveau des symptômes de la dépression (p=.03) et des perceptions au niveau des conflits (p=.04) que les aidants naturels de soins de santé habituels et ce, indépendamment du sexe des patients . Ni le style d'adaptation des patients ou des aidants naturels n'ont eu d'influence sur leurs réponses au programme de Télésanté. Enfin, les changements au niveau de l'incertitude chez les aidants naturels des patients de sexe masculins ont été associés à la baisse de l'anxiété, et représentaient plus du tiers des changements observés au niveau de l'anxiété. Ces résultats pe

Purpose. The purpose of this study was to examine the relationships between women's perceptions of their childbirth experiences and their early postpartum parenting behaviours and to determine the factors that predict the birth experience. Methods. Of all women giving birth on Prince Edward Island between October 27, 2004 and December 31, 2005, 652 women and their newborns were recruited from the postpartum units of two general hospitals. Initial data were collected at 12 to 48 hours postpartum using three self-report questionnaires and chart review. Women's childbirth perceptions were then scored, and a sub-sample of these mother-infant pairs (n=175) was assigned to cohorts based on positive (n=95) or negative (n=80) birth perceptions. They were visited at home at 1 month postpartum, where data were collected with three questionnaires using self-report, observation, and biophysical measurements. Results. Based on the results of linear and logistic regression, women's perceptions of their childbirth experience were not predictive of five parenting behaviours/indicators at 1 month postpartum: feeding score (representing attachment and responsiveness), exclusive breastfeeding, protection from harm, and maternal perception of infant health and contentment (representing infant health). Of the 20 predictors of women's childbirth perceptions, the strongest were: type of birth; degree of awareness, relaxation, and control; helpfulness of partner support; and being together with the infant following birth. Conclusion. Most women, even those who had negative experiences, were parenting effectively at 1 month postpartum. Of the predictors of a quality birth experience, most were amenable to nursing interventions. Thus there are important implications for nurses to enhance patient awareness, relaxation, and control; promote partner support; and provide immediate opportunities for women to be with their babies.