Comparisons of raw span (i.e., number of staff who report directly to a manager) within and across organizations can misrepresent managerial capacity to support staff because managers may not allocate the same amount of time to staff contact. The purpose was to examine the influence of alternative measures of managerial span on nurse satisfaction with manager’s supervision and on multidisciplinary teamwork. The alternative measures were (a) raw span as a measure of reporting structure and (b) time in staff contact as a measure of closeness of contact by the manager. The main effects of the alternative measures, leadership, hours of operation, and other covariates on outcomes were examined. The interaction effects of the alternative measures with leadership and hours of operation were investigated. The study framework was based on Open System Theory and the boundary spanning functions of managers. A descriptive, correlational design was used to collect survey and administrative data from employees, managers, and organizations. Managerial time allocation data were collected through self-logging and validated through observation. Acute care hospitals were selected through purposive sampling. For supervision satisfaction, the final sample size was 31 first-line managers and 558 nurses. For teamwork, the final sample size was 30 first-line managers and 754 staff. The Leadership Practices Inventory, the Satisfaction with my Supervisor Scale, and the Relational Coordination Scale were used. Hierarchical linear modeling was the main type of analysis conducted. Raw span interacted with leadership and hours of operation to explain supervision satisfaction. Teamwork was explained by leadership, clinical support roles, hours of operation, total areas, and non-direct reports, but not by raw span or time in staff contact. Large acute care hospitals can improve satisfaction with supervision and teamwork by modifying first-line management positions.

Background: The Senate of Canada asserts that quality end-of-life care is the right of every Canadian. Yet, little is known about the quality of end-of-life care for dying children and their families. Purpose: The study purpose was to develop and test an instrument to measure parents’ perspectives on the quality of care provided to families before, at the time of, and following the death of a child. Methods: In study Phase I, key components of quality pediatric end-of-life care were synthesized through a systematic review of research literature then validated and extended through focus groups with bereaved parents. In Phase II, instrument items were developed to assess structures, processes, and outcomes important to quality end-of-life care, then tested for content and face validity by health professionals and bereaved parents. In Phase III, the instrument was administered to bereaved mothers from across Canada and psychometric testing conducted. Results: Instrument items were developed based on review of 67 manuscripts and 3 focus groups with 10 parents. The Content Validity Index for the instrument was 0.84 as assessed by 7 health professionals. The instrument was assessed by 6 bereaved parents for face and content validity as well as their cognitive understanding of the items. In the final phase, 128 mothers completed the instrument and 31 of those completed it twice. Initial evidence for test-retest reliability, internal consistency, and construct validity was demonstrated for 7 subscales: Connect with Families, Involve Parents, Share Information with Parents, Share Information among Health Professionals, Support Parents, Provide Care at Death, and Provide Bereavement Follow-up. Additional items with demonstrated content validity only were grouped into three domains: Support the Child, Support Siblings, and Structures of Care. Implications: This study is a significant step forward in comprehensive measurement of the quality of children’s end-of-life care. The instrument provides a mechanism for feedback to health professionals, health systems, and policy makers to improve care provided to families facing the death of a child.

Background Nurses complete tasks during patient care to promote the recovery, or to maintain the health, of patients. These tasks can be routine or non-routine to the nurse. Non-routine tasks are characterized by unfamiliarity, requiring nurses to seek additional information from a variety of sources to effectively complete the tasks. Nurses’ perception of their problem-solving skills, as characterized by the attributes of personal control, problem-solving confidence, and avoidance-approach style, influences how information is sought. Objectives/Research Questions Guided by the information-seeking behaviour model, this study was designed to: (1) examine how the non-routineness of the task affects nurses’ information-seeking behaviour and the use of accumulated knowledge; and, (2) explore nurses’ perception of their problem-solving abilities. Methods An exploratory cross-sectional survey design was used. A random sample of critical care nurses who worked in a hospital setting were selected from the College of Nurses of Ontario (CNO) research participant database. Multiple regression analysis was used to examine the proposed relationships. Results Avoidance-approach style and, problem-solving confidence did not have a significant relationship with nurses’ information-seeking behaviour. None of the variables explained use of accumulated knowledge (F = 0.902, p > 0.05). Previous training (p = 0.008), Non-routineness of the task (p = 0.018), and Personal control (p = 0.040) had a positive relationship with information-seeking behaviour (Adjusted R2 = 0.136). Implications The study results provide evidence that problem-solving ability, and in particular the attribute of personal control, influences nurses’ information-seeking behaviour during the completion of nursing tasks. They reveal how information is sought from resources, and what specific information resources are necessary to promote access to, and use of, evidence-based information. The results also help direct efforts towards training nurses in issues related to problem-solving and information-seeking by targeting the development of personal control and retrieving evidence-based information.

Research suggests that interruptions are ubiquitous in healthcare settings and have a negative impact on patient safety. However, there is a lack of solutions to reduce harm arising from interruptions. Therefore, this research aimed to design and test the effectiveness of interventions to mitigate the effects of interruptions during medication administration. A three-phased study was conducted. First, direct observation was conducted to quantify the state of interruptions in an ambulatory unit where nurses routinely administered high-risk medications. Secondly, a user-centred approach was used to design interventions targeting errors arising from these interruptions. Finally, the effectiveness of these interventions was evaluated through a high-fidelity simulation experiment. Results showed that medication administration error rates decreased significantly on 4 of 7 measures with the use of interventions, compared to the control condition. Results of this work will help guide the implementation of interventions in nursing environments to reduce medication errors caused by interruptions.

Research suggests that interruptions are ubiquitous in healthcare settings and have a negative impact on patient safety. However, there is a lack of solutions to reduce harm arising from interruptions. Therefore, this research aimed to design and test the effectiveness of interventions to mitigate the effects of interruptions during medication administration. A three-phased study was conducted. First, direct observation was conducted to quantify the state of interruptions in an ambulatory unit where nurses routinely administered high-risk medications. Secondly, a user-centred approach was used to design interventions targeting errors arising from these interruptions. Finally, the effectiveness of these interventions was evaluated through a high-fidelity simulation experiment. Results showed that medication administration error rates decreased significantly on 4 of 7 measures with the use of interventions, compared to the control condition. Results of this work will help guide the implementation of interventions in nursing environments to reduce medication errors caused by interruptions.

Nursing is a high risk profession for injury. A Canadian survey reports many nurses are in poor physical and emotional health; they sustain more musculoskeletal and violence related injuries than other occupational groups. In Ontario, an injury management approach called Early Return to Work (RTW) requires injured workers, including nurses, to go back to work before full recovery. The Workplace Safety and Insurance Board cite this approach as beneficial to both the employer and employee. This study uses an institutional ethnographic approach to examine critically the RTW process from the standpoint of injured registered nurses. Through interviews and mapping activities with nurses, other health professionals and managers, a rendering of the social organization of hospital injury management emerges. The findings suggest that the implementation of RTW is complicated and difficult for nurses, their families and hospital employers. Injured nurses engage in significant amounts of domestic, rehabilitation and accommodation work in order to participate in the RTW process. When the returning nurse is unable to engage in full duties hospital operations become disorganized. Collective agreements and human resources procedures limit the participation of injured nurses in creative and/or new roles that could utilize their knowledge and skills. As a result, nurses are assigned to duties, which hamper them from returning to their pre-injury positions and cause their employment with the hospital to be reconsidered. The unsuccessful return of injured nurses to employment is counter to provincial retention initiatives, which seek to sustain an adequate cadre of nurses ready and able to care for the increasing health care needs of an aging population. Sites of change which could support and promote the successful return of these injured workers to nursing work are identified in this study.

Background: The Senate of Canada asserts that quality end-of-life care is the right of every Canadian. Yet, little is known about the quality of end-of-life care for dying children and their families. Purpose: The study purpose was to develop and test an instrument to measure parents’ perspectives on the quality of care provided to families before, at the time of, and following the death of a child. Methods: In study Phase I, key components of quality pediatric end-of-life care were synthesized through a systematic review of research literature then validated and extended through focus groups with bereaved parents. In Phase II, instrument items were developed to assess structures, processes, and outcomes important to quality end-of-life care, then tested for content and face validity by health professionals and bereaved parents. In Phase III, the instrument was administered to bereaved mothers from across Canada and psychometric testing conducted. Results: Instrument items were developed based on review of 67 manuscripts and 3 focus groups with 10 parents. The Content Validity Index for the instrument was 0.84 as assessed by 7 health professionals. The instrument was assessed by 6 bereaved parents for face and content validity as well as their cognitive understanding of the items. In the final phase, 128 mothers completed the instrument and 31 of those completed it twice. Initial evidence for test-retest reliability, internal consistency, and construct validity was demonstrated for 7 subscales: Connect with Families, Involve Parents, Share Information with Parents, Share Information among Health Professionals, Support Parents, Provide Care at Death, and Provide Bereavement Follow-up. Additional items with demonstrated content validity only were grouped into three domains: Support the Child, Support Siblings, and Structures of Care. Implications: This study is a significant step forward in comprehensive measurement of the quality of children’s end-of-life care. The instrument provides a mechanism for feedback to health professionals, health systems, and policy makers to improve care provided to families facing the death of a child.

Acute care nurse practitioners (ACNPs) are a new addition to the Canadian health care system, having been introduced in the Canadian health care system in the late 1980s. While some authors have suggested that nurse practitioners offer “something special” to patient care, no evidence to date has substantiated this claim. The findings of this grounded theory study offer a theory (Acute Care Health Professional-Patient Relationship (ACHPPR) Theory) to describe how three types of health care professionals establish relationships with patients in acute care settings (Figure 7). This qualitative study explored relationships that ACNPs, physicians and staff nurses establish with patients in a large urban multi-site university-affiliated hospital. Six quartets (patient, ACNP, physician, staff nurse) were recruited and interviews, using a semi-structured guide were audio-taped and subsequently transcribed verbatim. Each type of relationship was found to have a unique focus; ACNPs focus on making connections with patients, physicians focus on managing patients’ diseases and staff nurses focus on meeting patients’ needs. In order to establish relationships with patients, readiness conditions must be met. Health professionals use strategies to influence the achievement of readiness conditions as well as to move forward with relationship development. Each type of relationship varies in the range of potential intensity that can be achieved, which is influenced by various dimensions. Relational intensity ranges from the uncommon clinical relationship, which focuses on the patient’s disease, through the more typical professional relationship characterized by a comfortable rapport and then finally to the most relationally intense, but rare, personal relationship. If a relationship reaches professional or personal levels of relational intensity, relational products become evident. When comparing these three health professional-patient relationships, similarities and differences have been identified. Analysis of patient interviews yielded themes that substantiate the ACHPPR theory. The ACHPPR theory offers a beginning understanding of the complementary nature of three types of health professional-patient relationships in the acute care setting and has the potential to influence practice, education, theory development and future research related to ACNP-patient relationships.

Hypertension occurs in nearly 10% of pregnancies, and is associated with infant and maternal morbidity and mortality. Prior studies of non-pregnant adults have demonstrated the effectiveness of a variety of relaxation therapies in reducing blood pressure. A pilot randomized controlled trial was conducted, the purposes of which were 1) to provide preliminary evidence regarding the usefulness of guided imagery (GI) in reducing blood pressure in hypertensive pregnant women, and 2) to answer feasibility questions for a larger trial. Pregnant women with hypertension prior to 37 weeks gestation (n = 69) were randomized to either 15-minute periods of guided imagery (n = 34), or of quiet rest (QR) (n = 35), twice daily for four weeks or until delivery, whichever came first. Daytime ambulatory mean arterial pressure (MAP), systolic and diastolic blood pressures, anxiety, rest and GI use were measured weekly, to a maximum of four weeks. Sixty women completed at least one week in the study; 46.4% completed four weeks. Compliance was excellent. Intention to treat analysis was used. In the unadjusted analysis, women allocated to GI had significantly lower average daytime ambulatory mean MAP elevations from baseline to their last week of study participation than women allocated to quiet rest (GI: M = 1.58 mmHg, SD = 7.63; QR: M = 5.93 mmHg, SD = 6.55; t = 2.36, p = .02). However, the effect was no longer statistically significant (p = 0.14) when adjusted for baseline mean arterial pressure and gestation. There was no statistically significant difference in the numbers of women who were prescribed antihypertensive medication after randomization (GI: n = 16, QR: n = 13, X2 = 0.74, p = .46). There was also no evidence of an effect of guided imagery on anxiety. Nearly 90% (n = 26) of the guided imagery group indicated they would use it again, either in a subsequent pregnancy or during stressful life events. Given the ease of use, low cost, acceptability to women, and lack of risk of guided imagery, an adequately-powered randomized controlled trial is warranted.

The purpose of this study was to develop a theory to explain how nurses experience and respond to uncertainty arising from patient care-related situations and the influence of uncertainty on their information behaviour. Strauss and Corbin’s (1998) grounded theory approach guided the study. Semi-structured face-to-face interviews were conducted with 14 staff nurses working in an adult medical-surgical intensive care unit (MSICU) at one of two participating hospitals. The grounded theory recognizing and responding to uncertainty was developed from constant comparison analysis of transcribed interview data. The theory explicates recognizing, managing, and learning from uncertainty in patient care-related situations. Recognizing uncertainty involved a complex recursive process of assessing, reflecting, questioning and/or predicting, occurring concomitantly with facing uncertain aspects of patient care situations. Together, antecedent conditions and the process of recognizing uncertainty shaped the experience of uncertainty. Two main responses to uncertainty were physiological/affective responses and strategies used to manage uncertainty. Resolved uncertainty, unresolved uncertainty, and learning from uncertainty experiences were three consequences of managing uncertainty. The ten main categories of antecedent, actions and interactions, and consequences that comprised the theory were interrelated and connected through temporal and causal statements of relationship. Nurse, patient, and contextual factors were linked through patterns of conditions and intervening relational statements. Together, these conceptual relationships formed an explanatory theory of how MSICU nurses experienced and responded to uncertainty in their practice. This theory provides understanding of how nurses think through, act and interact in patient situations for which they are uncertain, and provides insight into the nature of the processes involved in recognizing and responding to uncertainty. Study implications for practice, nursing education, and further theory development and research are discussed.