The difficulties new nurses experience when first entering acute care work environments have been recognized since Kramer’s seminal work in the 1970s. Despite the implementation of interventions designed to help ease the transition, the literature continues to report that new graduates undergo stress when beginning their careers as nurses. The purpose of this study was to examine the effects of perceived demands, control, social support and self-efficacy on the job stress, job satisfaction and intention to leave of new nurses. The conceptual framework used in the study was Karasek’s (1979) Job Demands-Control-Support (JDC-S) model. This model posits that job demands increase employee stress, but that increasing control can alleviate the negative effects of high demands. Social support and self-efficacy were included in this study as potential moderators of the relationships between demands and control and the outcome variables. This was an exploratory study that utilized a cross-sectional survey was used to gather data. Surveys were mailed to the homes of new nurses working in acute care hospitals across Ontario, Canada. Data were received from 232 new nurses, a response rate of 23.8%. Nurses in the sample had an average of 18.2 months of experience. Data were analyzed using separate hierarchical regression models for each dependent variable. The results showed that the main effects of job demands, social support and self-efficacy provided partial support for the JDC-S model when examining job stress, job satisfaction and intention to leave the job. Only self-efficacy was significantly related to intention to leave the profession. There was no evidence of moderating effects of social support or self-efficacy. An understanding of factors in the work environment that influence new nurses may assist in supporting them during the transition. By exploring the effects of demands, control, social support and self-efficacy on new graduates’ job stress, job satisfaction and intention to leave, this study may provide direction to nursing leaders who are working new nurses in acute care.

Background: Ontario has the highest number of HIV positive test reports in Canada. Many of the HIV prevention interventions had a moderate effect on changing unsafe sexual behaviors within the young adult population. Participants’ preferences for such interventions could be a contributing factor to the moderate effect of the prevention interventions. Treatment preference is defined as a positive or negative attitude toward a particular treatment. To date few empirical studies examined preferences for educational and cognitive/behavioral interventions focusing on HIV prevention for young adults. Purpose: The purpose of this study is twofold: to examine participants’ preferences for different types of educational and cognitive/behavioral intervention components for HIV prevention and to explore socio-structural, psychological and intervention related factors that affect participants’ preferences for intervention. Design: The study used a cross-sectional mixed methods design. The data were collected using a face-to-face interview. Structured and open-ended questions were used to inquire about participants’ preferences for intervention. Sample: The sample consisted of 150 young adults ranging in age from 18 to 39 years, and able to speak and read English. The sample was recruited from the Greater Toronto Area. Measures: The measures included an adapted questionnaire to elicit participant preference for intervention, the multi-dimensional locus of control questionnaire, AIDS health locus of control questionnaire and standard demographic questions. Analysis: Descriptive statistics were used to examine preferences for intervention components. Regression analysis was done to explore the relationships between the selected factors and participants’ preferences for intervention. Findings: All 150 participants had a preference for an HIV prevention intervention. In terms of preference for treatment type, 64% preferred an intervention that incorporated a combination of educational and cognitive-behavioral components. Specifically, 23% preferred the intervention to incorporate all three components: educational information, communication skills and goal attainment. In addition, 49% of the participants’ preferred an intervention that incorporated an average of 1-4 sessions lasting 90 minutes in length. Of the socio-structural, psychological and intervention related factors hypothesized to be associated with participants’ preferences for intervention type, components and dose, intervention related factors were found to be the most significant factors related to participants’ preferences. Conclusions: Young adults preferred to have an HIV prevention intervention that encompassed a combination of education and cognitive-behavioral components when given the opportunity to choose their preferred interventions. Providing interventions that are consistent with participants’ preferences is posited as beneficial as it increases the participants’ sense of control, satisfaction with care, adherence to intervention protocol and achievement of desired outcomes.

Studies have indicated that weight gain, and being overweight, are risk factors for the development of cardiovascular disease. Weight management is particularly intense in cardiac rehabilitation (CR) settings where the majority of participants are medically defined as overweight or obese and often have co-morbid risk factors. CR programs in Canada focus primarily on cardiovascular fitness, but have extended their program interventions to address cardiac risk factor modification, including diet management and weight loss. Health-related research has indicated that on average, CR participants show weight neutrality (no change from baseline weight) upon CR program completion. Prior to this study there was no substantive qualitative data exploring why this occurs. This doctoral study was a concurrent analysis of a larger funded qualitative study that explored the everyday practices of people with heart disease and type 2 diabetes who were participating in one of three large urban CR programs. A total of 33 participants were enrolled in the study (17 men and 16 women). Data was collected through the use of in-depth interviews, an activity journal, and field notes. Data analysis used sociologist Chris Shillings’ work related to body projects and corporeal realism in order to explore themes related to body size, diet management, and weight loss. Study results pointed to the importance of recognizing the role of social practice in health behaviour change, and the role of social discourses in determining how healthy bodies should look and act. Participants described how their social worlds shaped their eating practices, and relayed accounts of attempting to integrate their CR prescription into their daily routines. These findings suggest that a more nuanced approach to CR programming that takes into account the medical and social influences at work on CR participants while they attempt to modify health behaviours, may further inform the development of future CR weight loss and diet programming.

Studies have indicated that weight gain, and being overweight, are risk factors for the development of cardiovascular disease. Weight management is particularly intense in cardiac rehabilitation (CR) settings where the majority of participants are medically defined as overweight or obese and often have co-morbid risk factors. CR programs in Canada focus primarily on cardiovascular fitness, but have extended their program interventions to address cardiac risk factor modification, including diet management and weight loss. Health-related research has indicated that on average, CR participants show weight neutrality (no change from baseline weight) upon CR program completion. Prior to this study there was no substantive qualitative data exploring why this occurs. This doctoral study was a concurrent analysis of a larger funded qualitative study that explored the everyday practices of people with heart disease and type 2 diabetes who were participating in one of three large urban CR programs. A total of 33 participants were enrolled in the study (17 men and 16 women). Data was collected through the use of in-depth interviews, an activity journal, and field notes. Data analysis used sociologist Chris Shillings’ work related to body projects and corporeal realism in order to explore themes related to body size, diet management, and weight loss. Study results pointed to the importance of recognizing the role of social practice in health behaviour change, and the role of social discourses in determining how healthy bodies should look and act. Participants described how their social worlds shaped their eating practices, and relayed accounts of attempting to integrate their CR prescription into their daily routines. These findings suggest that a more nuanced approach to CR programming that takes into account the medical and social influences at work on CR participants while they attempt to modify health behaviours, may further inform the development of future CR weight loss and diet programming.

Background: Foot ulceration and subsequent lower extremity amputation are common, serious, and expensive chronic complications for patients with diabetes. Foot-care education, provided to patients with diabetes at low-risk for ulcers, prevents minor foot problems that may lead to ulceration. Little evidence is available to support the effectiveness of educational intervention in low-risk diabetic patients. Objectives: The objectives of the pilot study were to examine the feasibility and acceptability of the foot care educational intervention, and to explore its effects on patients’ foot self-care knowledge, efficacy, and behaviors, and the occurrence of minor foot problems in adult patients with diabetes at low risk for foot ulceration. Methods: A one group repeated measures design was used. The intervention was given over a 3-week period. The first intervention session consisted of a 1-hour one-on-one, provider-patient interaction to discuss foot self-care strategies; the second session involved a 1-hour hands-on practice training. The third and fourth sessions entailed two 10-minute telephone contact booster sessions. Seventy eligible participants with type 2 diabetes at low risk for foot ulcerations were enrolled in the study, and 56 participants (30 women and 26 men; mean age: 55.8±13.2 years) completed the study. The outcomes of foot self-care knowledge, efficacy, behavior, and foot and footwear conditions were assessed at pre-test, following the first two sessions, and 3-month follow-up. Repeated measures analysis of variance, and paired-t test were used to examine changes in outcomes over time. Results: The findings provided initial evidence suggesting the foot self-care educational intervention is feasible and acceptable to adult patients with type 2 diabetes. It was effective in improving patients’ foot self-care knowledge (F (2, 54) = 230.444, p < 0.01), self-efficacy (F (2, 54) = 94.668, p < 0.01), and foot self-care behaviors (t (55)=117.228, p < 0.01), in reducing the occurrence of minor foot skin and toenails problems (all p<0.05), and in improving wearing proper shoes and proper socks (all p<0.05 ) at 3-month follow-up. Conclusions: The findings from this pilot study support the effects of the intervention. Future research should evaluate its efficacy using a randomized clinical trial design, and a large sample of patients with diabetes at low risk for foot ulcerations.

Background: Foot ulceration and subsequent lower extremity amputation are common, serious, and expensive chronic complications for patients with diabetes. Foot-care education, provided to patients with diabetes at low-risk for ulcers, prevents minor foot problems that may lead to ulceration. Little evidence is available to support the effectiveness of educational intervention in low-risk diabetic patients. Objectives: The objectives of the pilot study were to examine the feasibility and acceptability of the foot care educational intervention, and to explore its effects on patients’ foot self-care knowledge, efficacy, and behaviors, and the occurrence of minor foot problems in adult patients with diabetes at low risk for foot ulceration. Methods: A one group repeated measures design was used. The intervention was given over a 3-week period. The first intervention session consisted of a 1-hour one-on-one, provider-patient interaction to discuss foot self-care strategies; the second session involved a 1-hour hands-on practice training. The third and fourth sessions entailed two 10-minute telephone contact booster sessions. Seventy eligible participants with type 2 diabetes at low risk for foot ulcerations were enrolled in the study, and 56 participants (30 women and 26 men; mean age: 55.8±13.2 years) completed the study. The outcomes of foot self-care knowledge, efficacy, behavior, and foot and footwear conditions were assessed at pre-test, following the first two sessions, and 3-month follow-up. Repeated measures analysis of variance, and paired-t test were used to examine changes in outcomes over time. Results: The findings provided initial evidence suggesting the foot self-care educational intervention is feasible and acceptable to adult patients with type 2 diabetes. It was effective in improving patients’ foot self-care knowledge (F (2, 54) = 230.444, p < 0.01), self-efficacy (F (2, 54) = 94.668, p < 0.01), and foot self-care behaviors (t (55)=117.228, p < 0.01), in reducing the occurrence of minor foot skin and toenails problems (all p<0.05), and in improving wearing proper shoes and proper socks (all p<0.05 ) at 3-month follow-up. Conclusions: The findings from this pilot study support the effects of the intervention. Future research should evaluate its efficacy using a randomized clinical trial design, and a large sample of patients with diabetes at low risk for foot ulcerations.

Quality of life and well-being of patients living in chronic care (CC) are determined to a considerable extent by the relationships these patients have with nursing personnel caring for them. Given the importance of these relationships, there is an absence of empirical research and measurement tools to assess these relationships from a patient’s perspective. The purpose of this study was to develop and test valid and reliable instruments to determine what qualities of the humanistic relationships between cognitively competent patients and nursing personnel in CC settings were most important to patients and what they experience most. A conceptual framework based on the Humanistic Nursing Theory by Paterson and Zderad (1976) served as a foundation to develop two scales; the Humanistic Relationship Importance Scale (HRIS) assessed what attributes of the relationship are most important, and the Humanistic Relationship Experience Scale (HRES) assessed what attributes of the relationship are experienced. Sixty-nine content relevant items based on six dimensions of the Paterson and Zderad theory were developed and tested for content validity resulting in the deletion of 20 items. Forty patients completed the now 49-item scales to establish their initial internal consistency reliability, test-retest reliability and construct validity. Another 25 items were deleted in the process. The 24-item scales were completed by 249 patients in five CC facilities and the results subjected to a iii principal axis analysis (PAA). An oblique rotation resulted in a five factor solution labeled: relational availability, promoting quality of daily life, recognizing and supporting choice, forming connections, and supporting human uniqueness. This was a simplification of the original six dimensions of the Paterson and Zderad theory. A PAA of the 24-item HRES resulted in a one factor solution labeled humanistic connection. Reliability testing of the factors resulted in the deletion of one more item and an HRIS with a Cronbach′s alpha of .87 indicating strong internal reliability and an HRES with a Cronbach′s alpha of .98 suggesting some redundancy of items. Relational availability was rated as the most important factor in the nurse-patient relationship although all factors were important to patients. The mean score of the HRES indicated that patients experience a moderate level of humanistic connection in terms of frequency and intensity with nurses who generally care for them. Findings of this study have contributed to a better understanding of the nurse-patient relationship, and support the care, research, and theoretical knowledge of nurses and patients in these environments.

The literature suggests that mentoring is an important factor in the development of nurse leaders. Preliminary evidence suggests that self-efficacy may provide the conceptual link between receipt of mentoring functions and leadership performance. The purpose of this study was to contribute to the scientific knowledge base that informs nursing administration by examining the contribution of mentoring to development of leadership self-efficacy (LSE) among nurses. The conceptual framework that guided the study integrated theoretical perspectives from mentoring, leadership, and self-efficacy theories. A prospective, repeated measures design was used. One hundred Registered Nurses completed measures of LSE at the beginning and conclusion of leadership training and three months following training, and mentoring just prior to the final LSE measurement. Hierarchical regression analysis was used to assess the effect of mentoring on self-efficacy for each of five leadership practices. The change in LSE levels over the course of the leadership training intervention was included as a control for the effect of training. Participant administrative experience and professional education were included as controls. Study results did not support the proposition that protégé exposure to career and psychosocial mentoring would lead to higher levels of LSE. Mentorship did not predict self-efficacy for any of the leadership practices. The impact of participants’ mentoring experiences prior to the study, low statistical power due to a small sample size, homogeneity of respondents with respect to their mentorship experiences, and the possibility of a ceiling effect for LSE are possible explanations for these results. Results did suggest that mentored nurses were able to enhance their LSE during leadership training, and to sustain this increase upon return to their home organizations. Findings also provided insight into the prevalence of mentoring among nurses who are actively pursuing leadership development. Nearly two-thirds of the respondents were mentored during the study period, and these nurses reported that their mentoring relationships were active and positive. Mentoring continues to be advanced as an important contributor to leadership development among nurses. This study reinforces the need for further exploration of this relationship to inform and guide developmental interventions and allocation of resources.

Nurse empowerment is a well-researched area of nursing practice yet the quality of work environments continue to be eroded, and interactions between nurses and nurse managers continue to be fragile. Power is integral to empowerment, yet the exercise of power between nurses and their managers have been under-investigated in the nurse empowerment literature. To advance our knowledge in the empowerment literature, the study explored the process of how power is exercised in nurse-manager relationships in the hospital setting. Strauss and Corbin’s (1998) grounded theory methodology informed the study. Multiple qualitative fieldwork methods were utilized to collect data on staff nurses about how the manager’s role affected their ability to do their work. The researcher conducted semi-structured interviews and participant observations with 26 participants on three units within a tertiary hospital in Western Canada. Seeking connectivity was the basic social process in which nurses strive to connect with their manager to create a workable partnership in the provision of quality patient care while responding to the demands in the organizational context. Conditions, actions, and consequences formed the theory of seeking connectivity as an extension of nurse empowerment theory. The overarching finding is that the manager plays a critical role in modifying the work environment for nurses and as such, nurses seek connection with their manager to accomplish their work. Institutional policies and practices combined in various ways to influence nurses’ thinking and shaped their actions. The first pattern of the process was characterized by the absence of meaningful engagement with the manager. Power was held over nurses restricting discussions with the manager, and nurses employed a variety of resistance strategies. In the second pattern of the process when managers provided guidance, advocated for nurses, and engaged nurses as collaborators, nurses were better able to problem solve and make decisions with the manager to positively influence patient outcomes. The theory of seeking connectivity is the explanatory framework emerging from the study that reveals how power is exercised in social relations between nurses and managers. Seeking connectivity is a recursive process that continues to evolve. The results of this study advance nurse empowerment primarily from a structural perspective and secondarily from a critical social perspective, suggesting nurses’ perceptions and abilities shape their work role and are foundational to promoting change through collective action. Study implications for research, practice and policy are addressed.

A growing body of research has drawn attention to the hierarchical and bureaucratic nature of the hospital organizational environment in which nurses seek to resolve ethical problems related to patient care, whereas other studies have focused on the impact of nurses’ personal or professional qualities on those nurses’ ethical problem solving. This qualitative investigation sought to elucidate the extent to which nurses perceived their personal or professional qualities, as well as organizational characteristics, as influencing their ethical decision making. This investigator interviewed 10 registered nurses in 2 acute-care hospitals that were different in size, location, and type. A relational ethics lens assisted in the analysis of the data, emphasizing ways in which the nurses’ ethical problem solving was socially situated within a complex of relationships with others, including patients, families, physicians, and coworkers. Data analysis revealed key themes, including the nurses’ concern for patients, professional experience, layered relationships with others, interactions within the organization, and situational analysis of contexts and relationships. Subthemes included the nurses’ relationships with patients, physicians, patients’ families, and coworkers. This study revealed a range of ethical problems. Nurses saw their patients as their greatest concern; the nurses worked within a social context of multilayered and complex relationships within a hierarchical, bureaucratic organization with the desire to bring about the best outcomes for patients. The participants described ethical concerns related to the actions or decisions of physicians, patients’ family members, and nurses’ coworkers. The nurses’ deliberation to resolve these ethical problems considered risks and benefits for patients, nurses, and others. The nurses seemed to carry out a contextual assessment, analyzing the presence of mutual respect, the extent of relational engagement, and the potential for opening relational space in order to work together with others to resolve the ethical problem for the patient’s best outcome. The nurses’ ethical actions were socially situated within this complex interpersonal context. This thesis discusses implications of these findings for nursing research, education, and practice.