Primary nursing is a system of delivering nursing care when one nurse is responsible and accountable for the assessment of the patient's needs as well as the planning, implementing and evaluating of the nursing care throughout the patient's hospitalization. These activities are done in collaboration with the patient and other members of the health team. This system is a relatively recent development in the field of nursing. There has been little research done to either describe or evaluate primary nursing, particularly in the area of psychiatry. This study was an attempt to include both patients and nurses in such an evaluation. A validated and reliable questionnaire was developed by the author to obtain data related to patients' and nurses’ perceptions of the occurrence, importance and satisfaction of specific primary nursing behaviours. The questionnaire was administered to twenty-nine patients and their primary nurses during the last week of the patient's hospitalization. Nurses and patients reported that primary nursing behaviours related to discharge had a low occurrence rate. However, they attributed a high degree of importance to these same behaviours. Both groups reported a low occurrence and importance score for primary nursing behaviours related to family involvement with the primary nurse and the patient's treatment program. Both nurses and patients agreed on the occurrence and importance of most of the primary nursing behaviours. There was less agreement in the area of satisfaction. / Applied Science, Faculty of / Nursing, School of / Graduate

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Accountable care units (ACU-?¢) provide a new model for integrated patient care. The ACU-?¢ promotes patient centeredness in nursing units as team members work collaboratively with physicians to improve patient outcomes and reduce unwarranted variations. A health system in the southeastern United States incorporated the ACU-?¢ as part of their care model. These units were held accountable for their clinical, service, and cost outcomes but lacked a validation process to demonstrate the effective utilization of their data. The purpose of this DNP project was to create a patient centered care (PCC) certification process, guided by the Donabedian model, that would provide hospital units the opportunity to access their process and quality improvement outcome data and to improve patient care. For this project, 12- key individuals were interviewed to gain their perspectives and input on the development and implementation of the PCC certification process. Results from the interviews were compiled and reviewed for common themes, which included Magnet-?¢ recognition, patient experience, current unit goals, and hospital strategic plan. Using the results of the interviews, a PCC certification procedure was created to outline the steps required to achieve certification; and, an application was developed to provide a standard format for quality and process improvement projects and associated outcomes reporting. The certification procedure will be implemented in the health system in the next fiscal year. Evaluation of the effectiveness of the program and future refinement will be controlled by the Nursing Shared Governance. The project may promote positive social change as the staff nurses on the individual units use the unit metrics to improve patient outcomes and reduce variations in care.

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The Palliative and Therapeutic Harmonization (PATH) program was designed to help frail older adults and their family members prepare for and make medical decisions, in the context of frailty and dementia. This sandwich thesis includes three manuscripts that present the findings from a mixed methods study exploring the implementation and outcomes of the PATH program, in three long-term care (LTC) home settings. The purpose of the first sub study was to describe both the perceived need for the PATH program, and initial reactions following its training and implementation. Quantitative surveys and qualitative interviews with bereaved family members showed that prior to implementation, they were mostly satisfied with their relatives’ end-of-life care. Through qualitative interviews, clinical leaders shared a positive impression of the training and PATH principles. They also explained how the PATH program could help them improve palliative and end-of-life care planning and communication with residents and families. In the second sub study, qualitative interviews were conducted with family members to learn about their experiences with and perceived outcomes from the PATH program. All family members had a positive experience. They shared perceived outcomes such as, opportunities to share and learn about their relative’s health status and trajectory, creating a mutual understanding of directions for care, and receiving support and reassurance for health care decision making. Finally, the purpose of the third sub study was to describe both the perceived outcomes of the staff who implemented the PATH program, and differences in documenting residents’ advance care plans and discussions. Staff described both personal and practice related outcomes. In addition, documentation around advance care planning changed with the program’s implementation. Overall, the PATH program offered frail older adults, their family members and their professional caregivers an opportunity to communicate about and prepare to make decisions for palliative and end-of-life care. / Dissertation / Doctor of Philosophy (PhD)

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Background: Delirium is common in critically ill trauma patients, yet there is no evidence-based standard of care sedation agent for this population. Objective: This thesis aims to expand knowledge around dexmedetomidine, a sedative that has demonstrated potential superiority in other clinical patient populations. Methods: We conducted a systematic review and network meta-analysis to compare the effectiveness of sedatives on delirium and associated patient outcomes. We conducted a health records review of sedated trauma patients at The Ottawa Hospital. We derived a simple mathematical model to demonstrate potential impact of dexmedetomidine on resources. Results: There was no statistical difference between sedatives in preventing delirium. Approximately 79% of critical trauma patients were sedated with propofol, 18% with propofol and dexmedetomidine, and 3 with dexmedetomidine. Increasing the proportion of patients receiving propofol with adjunct dexmedetomidine could improve the number of freed ICU bed-days. Conclusion: Dexmedetomidine could have potential benefits in improving outcomes for critically ill trauma patients.

Current models of cancer care delivery in Canada are unsustainable due to the rapidly increasing number of cancer survivors at a time when there is a shortage of human and financial resources. With improvements in early detection, diagnosis, and treatment; patients diagnosed with cancer are living longer. There is also growing recognition of the chronic nature of cancer. Provincial cancer agencies have introduced new models of post-treatment follow-up involving early transition of cancer survivors back to their primary care providers. There is limited research evidence about the role nurses working in primary care settings play in the delivery of post-treatment follow-up and cancer survivorship care (CSC). The purpose of this study was to identify and examine, from the perspective of registered nurses, the strengths, barriers, and opportunities for optimizing nursing roles in the delivery of CSC in primary care. A qualitative descriptive study was conducted. Participants were recruited through membership lists from the College of Nurses of Ontario and the Canadian Family Practice Nurses Association Ontario and snowball sampling. Purposeful and maximum variation sampling techniques were employed. Participants completed an oral demographic questionnaire and individual semi-structured in-depth telephone interviews. Data collection and data analysis were conducted concurrently. The final study sample included 18 primary care registered nurses from 9 of 14 Local Health Integration Networks across Ontario. Overall, participants’ involvement in CSC was quite limited. Registered nurse involvement in CSC was categorized into three relevant themes: care coordination and system navigation; emotional support, and facilitating access to community resources. Barriers and facilitators to optimizing nursing involvement in CSC related to individual participant, practice setting, and primary care team factors. Participants recommended multiple strategies for expanding the role of nurses in CSC. / Thesis / Candidate in Philosophy / The current approach to cancer survivorship care (CSC) in Canada is unsustainable due to the rapidly increasing number of cancer survivors at a time when there is a shortage of human and financial resources. Patients diagnosed with cancer are living longer and there is growing recognition of the chronic nature of cancer survivorship. Provincial cancer agencies have introduced new models of post-treatment follow-up involving earlier transition of cancer survivors from specialist care back to their primary care providers. Currently, there is a gap in research evidence regarding the role nurses working in primary care settings play in the delivery of CSC. This thesis will describe the results of a qualitative descriptive study that identified and examined the strengths, gaps, barriers, and opportunities for optimizing nursing roles in the delivery of CSC within primary care settings from the perspective of registered nurses practicing in primary care.

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