Mémoire numérisé par la Direction des bibliothèques de l’Université de Montréal. / Le corps professionnel infirmier qui regroupe 460 000 individus en France, assume une fonction sociale nodale au sein de nos systèmes de santé. Ce milieu professionnel qui offre une vision du travail du soin à double facette (Technique/relationnelle) est l'objet d'un intérêt multidisciplinaire croissant. Nonobstant, les études menées sur l'aspect identitaire de la profession, c'est sous l'angle de la santé au travail que nous appréhenderons son objet. Nombre d'études, menées ces vingt-cinq dernières années ont mis en évidence que les métiers en relation avec le public et plus particulièrement ceux en rapport avec la maladie et la mort, généraient des tensions émotionnelles et psychiques intenses. Selon cette perspective, le stress subi dans le quotidien du travail de l'infirmière a été abondamment développé, soit sous l'angle de l'épuisement professionnel ou encore sous celui de la détresse émotionnelle. Plus récemment, les centres d'intérêt se sont déplacés vers d'autres indicateurs, tels que la satisfaction au travail, le bien-être psychologique ou encore la qualité de vie au travail. Ces approches volontairement positives attestent que si le travail du soin est générateur de stress, ce dernier peut être modulé par des ressources personnelles ou situationnelles que l'individu interpose entre lui et le stimulus. Dans le contexte de rationalité économique actuelle où la restructuration complète des systèmes de santé fragilise le sentiment de sécurité au travail, il est pertinent, dans le souci du maintien de la qualité des soins, d'interroger en amont, la qualité de vie au travail des infirmier(e)s. C'est l'objet de la présente étude dont le but est de décrire les niveaux de qualité de vie et de soutien au travail ainsi que d'identifier les stratégies de coping utilisées par des infirmier(e)s d'un établissement psychiatrique de la région parisienne. En seconde intention, les relations possibles entre les différentes variables d'intérêt ont été examinées. L'échantillon de convenance de 131 individus constitué à partir de la population infirmière disponible de rétablissement a été invité à remplir un questionnaire auto administré constitué de trois instruments de mesure soit : le Work Relationshin Index (WRI) qui correspond à une des trois dimensions du Work Environment Scale (WES) élaboré par Moos (1986) ; Le questionnaire de copine de Paulhan , Nuissier, Quintard, Cousson et Bourgeois (1994) adaptation française du Ways of Coping Check-List de Vitaliano et al. (1985) ; l'échelle de la qualité de vie au travail de Elizur et Shye(1991) dans sa traduction française (Delmas, 1999) et d'un talon sociodémographique. La modèle d'adaptation de Roy (Andrews & Roy, 1991) a servi d'assise conceptuelle dans le cadre de cette recherche. Les données collectées ont été analysées statistiquement à l'aide du logiciel SPSS.9. Dans l'ensemble, il appert que les infirmier(e)s qui ont participé à cette étude témoignent d'une qualité de vie au travail modérée. Des éléments contextuels, tels que la perception d'etre moyennement soutenu par ses collègues de travail ou par son supérieur hiérarchique, de ressentir un stress intense face à certaines situations, appuient ce constat. La dimension relationnelle est omniprésente dans les résultats de cette recherche puisque, tant le soutien du supérieur que la cohésion entre les pairs sont associés significativement et positivement à la qualité de vie au travail de ces infirmier(e)s. Par ailleurs, la recherche de soutien social, stratégie la plus significative à l'endroit de la qualité de vie au travail, bénéficie de l'effet médiateur du soutien du supérieur et dans une moindre mesure, de la cohésion entre les pairs. Ces résultats confirment le rôle essentiel joué par le supérieur hiérarchique à l'endroit de la qualité de vie au travail perçue par les infirmier(e)s de cette étude. Bien qu'ils ne puissent être généralisés à l'ensemble de la population infirmière, ces résultats permettent néanmoins de poser l'importance de la dimension relationnelle dans les environnements de travail contraignants.

Master of Public Health / Department of Kinesiology / Mary McElroy / Background and Purpose: Registered nurses (RN’s) are well positioned to provide physical activity counseling (PA counseling) to their hospital patients. RNs educate during ‘teachable moments” as hospital patients often find themselves in a state of readiness to make lifestyle changes such as increases in regular physical activity. Although the health benefits of physical activity are well documented, PA counseling has not been well studied among the nursing population or in the hospital environment. The main purpose of this study was to identify the percentage of RNs who provide PA counseling to their patients and to explore the factors which contribute to their decisions to provide PA counseling. Methods: A web-based survey was used to gather information from 323 hospital-based RNs employed at five hospitals in four states. The survey gathered information including current physical activity levels, thirteen perceived barriers to physical activity based on the Exercise Benefits and Barriers Scale, and information regarding whether RNs provide PA counseling to their hospital-based patients. Results: RNs reported an average of 3.3 barriers to being physically active. One hundred and eighty- seven RNs provided PA counseling to their patients (57.8%) and 133 did not provide PA counseling (41.1%). The presence of barriers to being physically active was related to PA counseling for nine of the thirteen barriers. The following hypotheses were supported: 1) RNs who report lower levels of perceived barriers to being physical active were more likely to provide PA counseling than those who report higher levels of perceived vigorous physical activity were more likely to provide PA counseling than those who reported lower levels of light, moderate, and vigorous physical activity. Conclusion: The findings from this study revealed RNs who are physically active and report fewer barriers to physical activity were more likely to provide PA counseling to their hospital-based patients. Future research needs to address types and quality of PA counseling as well as utilize theory driven intervention designs.

Problem: Financial strain has been reported by families of children with cancer. However, the specific costs and their impact on these families remain unknown. Objectives: (a) to identify the costs incurred by families of children newly diagnosed with cancer in Ontario, (b) to determine the variables that influence these costs, and (c) to explore the impact of these costs on families. Conceptual Framework: The conceptual framework incorporated the social, economic, disease, and treatment cost predictors with the direct and indirect cost of illness components. Setting: Two university-affiliated tertiary paediatric hospitals in Canada. Sample: English speaking parents of children newly diagnosed with cancer who were receiving treatment. Design: A prospective concurrent mixed method design. Instrumentation: The Ambulatory and Home Care Record © (AHCR) (Guerriere & Coyte, 1998) was used to record costs and an interview guide was developed to explore the impact of these costs on families. Procedure: Parents recorded the resources consumed and costs incurred during one week per month for three consecutive months beginning the 4th week following diagnosis and listed any additional costs incurred since diagnosis or between the face-to-face interviews. Parents also discussed the impact of these costs on their families in an audio taped interview. Data Analysis: Descriptive statistics and multiple regression modelling were used to describe families’ total costs (expressed in 2007 Canadian dollars) and to determine factors that influenced them. Descriptive qualitative content analytic methods were used to analyze the transcribed interview data. Results: In total, 99 parents including 28 fathers and 71 mothers completed three sets of cost diaries. The mean total three month expenditure was $28,475 (SD $12,670; range $2013 to $79,249) per family. There were no statistically significant factors that influenced families’ direct costs; however, 23% of the variance for indirect costs was explained by inpatient tertiary hospitalizations, language spoken at home, and distance to the hospital. Parents described the costs associated with their child’s illness and coping and management strategies used to lessen the financial impact including managing their expenses and seeking ways to increase their cash flow. Significance: Findings will inform health professionals and policy makers about families who are faced with potentially catastrophic costs following their child’s diagnosis with cancer.

Oral health has dramatically improved in most industrialized countries over the latter half of the 20th century. However, profound oral health disparities still exist especially for those most at risk of developing oral diseases and associated systemic consequences such as populations residing in long-term care facilities. Despite the growing body of literature that supports the link between oral microflora and the importance of oral hygiene in limiting the risk of pneumonia development, there are still gaps in our knowledge to effectively manage this risk. The research included in this dissertation sought to further our understanding of oral health and oral care in the context of pneumonia pathogenesis (chapter 3) and, by exploring the perspective of various stakeholders in oral health, we sought to further understand the factors that influence care provision (chapter 5). Additionally, a novel knowledge translation approach was tested to challenge traditional oral care interventions in order to promote improvements in front-line oral care practices (chapter 6). The relationship between oral microflora, oral care and pneumonia was found to be complex. It directs us to consider converging risk factors including a patient’s health status, health behaviours and access to oral care services. Different professional groups were found to possess different definitions of oral health, which influenced both their motivation to provide care as well as their focus of care. Definitions of oral health could also potentially influence the saliency of different types of oral care information to different targeted groups; therefore, this should be considered in developing education and training initiatives aimed at improving the provision of oral care. An appreciative knowledge translation approach was found to be effective in bridging the gap between oral care knowledge and the provision of care. Regardless of the type of intervention chosen, organizations were reported to play a crucial role in promoting oral health and supporting the successful implementation of oral care programs.

Cardiovascular disease (CVD) continues to be the leading cause of death of Canadian women and while treatment for CVD has improved dramatically, women typically fare worse than men with regards to morbidity following cardiac event. Cardiac rehabilitation (CR) is well established as a key intervention in the treatment of coronary artery disease and has been shown to be effective in both men and women. CR remains largely underutilized, especially in women who comprise only 12 – 24% of contemporary CR programs, even though the prevalence of CVD in men and women is similar. The objectives of this pilot trial were to test the feasibility of all procedures, specifically to determine: 1) an estimate of patient recruitment rates, 2) acceptability and feasibility of the intervention and 3) barriers to CR attendance and resources required. Additionally, exploratory research questions were used to determine the effects of telephone coaching on women’s attendance at CR intake appointment, self-efficacy for cardiac exercise and self-efficacy to attend CR. A RCT design enrolled women with CVD referred for CR at a single site in Ontario. Patients were randomized, stratified for age, to either a usual care group or an intervention group. Participants allocated to usual care received a referral to CR. In addition to usual care, women assigned to the intervention group received individualized telephone coaching, designed to support self-management prior to CR intake. Eighty-three patients were approached and 70 consented to participate (usual care n = 36, intervention n = 34). Participants in the intervention group were significantly more likely to attend CR intake (p = 0.048). Participants were highly satisfied with their coaching experience; they found the information provided to be helpful with goal setting, action planning and assisted them in their interactions with their health care providers. Barriers to attendance identified included transportation, health concerns, timing and lack of physician endorsement. Most common resources identified included problem solving support, assistance with communication with physicians and information concerning CR. The evidence obtained from this pilot trial suggests that a telephone coaching intervention designed to enhance self-management is feasible and may improve attendance at CR intake for women following hospital discharge with a cardiac event.

The critical and growing shortage of nurses is a global concern. The growth and sustainability of the nursing profession depends on the ability to recruit and retain the upcoming generation of professionals. Understanding the career choice experiences of Millennial nurses is a critical component of recruitment and retention strategies. An interpretive, narrative methodology, was used to understand how Millennial explain, account for, and make sense of their choice of nursing as a career. Individual, face to face interviews were conducted with 12 Millennial Nursing students (born 1980 or after), for whom nursing was their preferred career choice. Participants were interviewed twice and chronicled their career choice experiences within reflective journals. Data was analyzed using Polkinghorne’s method of narrative configuration and emplotment. The participants’ narratives present a shift from understanding career choice within a virtuous plot to one of social positioning. Career choice was initially emplotted around a traditional and stereotypical understanding of nursing as a virtuous profession: altruistic, noble, caring, and compassionate. The narrative scripts evolved from positioning nursing as virtuous towards understanding the meaning of career choice in relation to one’s position in the social world. The narratives position career choice in relation to the participants’ desire for autonomy, respect and quality of life. Pragmatic considerations such as lifestyle, job security, salary and social status were also emphasized. The narratives represent career choice as a complex consideration of social positioning, fraught with hopes, dreams, doubts and tensions. The participants’ perceptions and expectations in relation to their future nursing careers were influenced by a historical and stereotypical understanding of nursing; an image that remains prevalent in society. Insight gained from this inquiry can inform recruitment, education, socialization and retention strategies for the upcoming and future generations of nurses.

Oral health has dramatically improved in most industrialized countries over the latter half of the 20th century. However, profound oral health disparities still exist especially for those most at risk of developing oral diseases and associated systemic consequences such as populations residing in long-term care facilities. Despite the growing body of literature that supports the link between oral microflora and the importance of oral hygiene in limiting the risk of pneumonia development, there are still gaps in our knowledge to effectively manage this risk. The research included in this dissertation sought to further our understanding of oral health and oral care in the context of pneumonia pathogenesis (chapter 3) and, by exploring the perspective of various stakeholders in oral health, we sought to further understand the factors that influence care provision (chapter 5). Additionally, a novel knowledge translation approach was tested to challenge traditional oral care interventions in order to promote improvements in front-line oral care practices (chapter 6). The relationship between oral microflora, oral care and pneumonia was found to be complex. It directs us to consider converging risk factors including a patient’s health status, health behaviours and access to oral care services. Different professional groups were found to possess different definitions of oral health, which influenced both their motivation to provide care as well as their focus of care. Definitions of oral health could also potentially influence the saliency of different types of oral care information to different targeted groups; therefore, this should be considered in developing education and training initiatives aimed at improving the provision of oral care. An appreciative knowledge translation approach was found to be effective in bridging the gap between oral care knowledge and the provision of care. Regardless of the type of intervention chosen, organizations were reported to play a crucial role in promoting oral health and supporting the successful implementation of oral care programs.

Problem: Financial strain has been reported by families of children with cancer. However, the specific costs and their impact on these families remain unknown. Objectives: (a) to identify the costs incurred by families of children newly diagnosed with cancer in Ontario, (b) to determine the variables that influence these costs, and (c) to explore the impact of these costs on families. Conceptual Framework: The conceptual framework incorporated the social, economic, disease, and treatment cost predictors with the direct and indirect cost of illness components. Setting: Two university-affiliated tertiary paediatric hospitals in Canada. Sample: English speaking parents of children newly diagnosed with cancer who were receiving treatment. Design: A prospective concurrent mixed method design. Instrumentation: The Ambulatory and Home Care Record © (AHCR) (Guerriere & Coyte, 1998) was used to record costs and an interview guide was developed to explore the impact of these costs on families. Procedure: Parents recorded the resources consumed and costs incurred during one week per month for three consecutive months beginning the 4th week following diagnosis and listed any additional costs incurred since diagnosis or between the face-to-face interviews. Parents also discussed the impact of these costs on their families in an audio taped interview. Data Analysis: Descriptive statistics and multiple regression modelling were used to describe families’ total costs (expressed in 2007 Canadian dollars) and to determine factors that influenced them. Descriptive qualitative content analytic methods were used to analyze the transcribed interview data. Results: In total, 99 parents including 28 fathers and 71 mothers completed three sets of cost diaries. The mean total three month expenditure was $28,475 (SD $12,670; range $2013 to $79,249) per family. There were no statistically significant factors that influenced families’ direct costs; however, 23% of the variance for indirect costs was explained by inpatient tertiary hospitalizations, language spoken at home, and distance to the hospital. Parents described the costs associated with their child’s illness and coping and management strategies used to lessen the financial impact including managing their expenses and seeking ways to increase their cash flow. Significance: Findings will inform health professionals and policy makers about families who are faced with potentially catastrophic costs following their child’s diagnosis with cancer.

The critical and growing shortage of nurses is a global concern. The growth and sustainability of the nursing profession depends on the ability to recruit and retain the upcoming generation of professionals. Understanding the career choice experiences of Millennial nurses is a critical component of recruitment and retention strategies. An interpretive, narrative methodology, was used to understand how Millennial explain, account for, and make sense of their choice of nursing as a career. Individual, face to face interviews were conducted with 12 Millennial Nursing students (born 1980 or after), for whom nursing was their preferred career choice. Participants were interviewed twice and chronicled their career choice experiences within reflective journals. Data was analyzed using Polkinghorne’s method of narrative configuration and emplotment. The participants’ narratives present a shift from understanding career choice within a virtuous plot to one of social positioning. Career choice was initially emplotted around a traditional and stereotypical understanding of nursing as a virtuous profession: altruistic, noble, caring, and compassionate. The narrative scripts evolved from positioning nursing as virtuous towards understanding the meaning of career choice in relation to one’s position in the social world. The narratives position career choice in relation to the participants’ desire for autonomy, respect and quality of life. Pragmatic considerations such as lifestyle, job security, salary and social status were also emphasized. The narratives represent career choice as a complex consideration of social positioning, fraught with hopes, dreams, doubts and tensions. The participants’ perceptions and expectations in relation to their future nursing careers were influenced by a historical and stereotypical understanding of nursing; an image that remains prevalent in society. Insight gained from this inquiry can inform recruitment, education, socialization and retention strategies for the upcoming and future generations of nurses.

In the midst of the progressive era, American nursing and medical education witnessed tremendous reform. The increase in the number of hospitals during the early twentieth century brought a growing demand for nurses and led to varying standards in admissions and education within hospital training schools. In addition, the rise of the field of public health led to a campaign by a number of American nurse leaders to reform nursing education. This campaign included: the formation of several national professional organizations; gaining the support of prominent medical officials, including those close to the Rockefeller Foundation, an influential philanthropic organization; and successfully arguing against the sending of public health nurses overseas during the First World War. Although these steps were taken prior to the end of the war, the period immediately following the war, and the 1918 pandemic spread of influenza, provided fertile ground for reopening discussions regarding nursing education both nationally and internationally. Following the war, the involvement of numerous American-backed organizations, including the Rockefeller Foundation (RF), the League of Red Cross Societies (LRCS), and the American Red Cross (ARC), in the training of nurses in Europe highlighted the numerous and conflicting ideals of American nurses in regards to nursing education during this period. In particular, those who had campaigned for the training of public health nurses in the USA — led primarily by the formidable nurse Annie Goodrich — voiced differing ideals for the training of nurses than those American nurses who led the work of the RF, the LRCS and the ARC in Europe following the war. It will be argued here that, contrary to earlier theses that have suggested the spread of a singular “American gospel” of public health nursing education, in fact there were several hotly contested ideas being conveyed in Europe by several different American individuals and organizations at this time. In particular, the RF’s support of two opposing ideals — that of their own nursing representative, Elisabeth Crowell in Europe, and that of Goodrich in the USA — heightened this conflict. The eventual success of one set of these ideas depended on the alignment of congruent ideals in the training of health care professionals with influential individuals and organizations. Furthermore, this dissertation suggests that the outcome of this debate influenced the future direction of nursing education in both Europe and North America.