Strategies for implementing evidence in clinical practice are often applied with an aim to change provider behaviour and improve patient outcomes. In Canada, many health professionals in birthing units use continuous electronic fetal monitoring rather than intermittent auscultation, despite the fact that continuous electronic fetal monitoring is associated with increased caesarean section and obstetrical intervention rates without benefit to the fetus. Based on a synthesis of credible research, there are national and international guidelines recommending intermittent auscultation for low-risk labouring women. The purpose of this study was to evaluate two interventions, interactive education and Action Learning, that aimed to increase nurses' use of intermittent auscultation in low-risk labouring women as per the Society of Obstetricians and Gynecologists of Canada Fetal Health Surveillance Clinical Practice Guideline (Liston & Crane, 2002). Guided by Roger's (2003) theory of diffusion of innovation and the promoting action on research implementation in health services (PARiHS) framework (Kitson et al., 2008), I conducted a two-phase study. In the first phase, I used a pre-post design with staff nurses (N = 93) to evaluate the effectiveness of an educational intervention. In the second phase, I used a randomized controlled trial design to evaluate the effectiveness of the Action Learning strategy with staff nurses (N = 62) and randomized the nurses to either Action Learning or Usual Care. During labour, 270 consecutively admitted women who met the low-risk inclusion criteria received their care from either an Action Learning or a Usual Care nurse. Neither the interactive education intervention nor the Action Learning intervention had a significant effect on the nurses' use of guideline appropriate care, during episodes of care for low-risk labouring women. Various types of data were explored to determine their influence on the nurses' guideline adherence / Les stratégies de mise en œuvre des données probantes dans la pratique clinique sont souvent appliquées dans le but de modifier le comportement des fournisseurs de soins et d'améliorer les résultats des patients. Au Canada, de nombreux professionnels de la santé travaillant dans des unités d'accouchement surveillent constamment le rythme cardiaque du fœtus plutôt que de manière intermittente. Des directives nationales et internationales, recommandent l'auscultation intermittente pour les femmes en travail à faible risque. L'objectif de cette étude était d'évaluer deux types d'intervention : la formation interactive et l'apprentissage actif, destinées à augmenter l'usage de l'auscultation intermittente par le personnel infirmier pour les femmes en travail à faible risque, conformément à la directive de pratique clinique pour la surveillance de la santé du fœtus, directive fournie par la SOGC (Liston & Crane, 2002). En m'appuyant sur la théorie de la diffusion des innovations de Rogers (2003) et sur le modèle PARiHS – promoting action on research implementation in health services (Kitson et al., 2008), j'ai mené une étude en deux phases. Dans la première phase, j'ai utilisé un modèle avant-après avec des infirmières soignantes (N = 93) pour évaluer l'efficacité d'une intervention éducative. Dans la seconde phase, j'ai utilisé une méthodologie d'essai comparatif aléatoire pour évaluer l'efficacité de la stratégie d'apprentissage actif et j'ai assigné de manière aléatoire les infirmières (N = 62) au groupe bénéficiant de l'apprentissage actif ou au groupe dispensant les soins habituels. Durant le travail, 270 femmes admises consécutivement et répondant au critère de faible risque, ont reçu les soins d'une infirmière ayant suivi un apprentissage actif ou d'une infirmière dispensant les soins habituels. Ni l'intervention éducative interactive ni la stratégie d'apprentissage actif n'ont eu d'effet significatif su

The nurse-patient relationship is prominently featured in nursing discourse, particularly in the literature and practices of psychiatric-mental health (PMH) nurses. PMH nurses have found it challenging to focus on their relational work in the face of pressure to provide efficient, technological, and biomedical care, especially in hospital settings. The purpose of this inquiry was to explore the relational experiences of patients with acute mental illness and their nurses in inpatient psychiatric settings. The researcher engaged in conversations with ten PMH nurses and six patients hospitalized with acute episodes of severe mental illness. Interpretation of transcribed accounts yielded four dominant themes: engagement, withdrawal, mindful approach, and keeping safe. The author discusses the relational practices of nurses and their patients as experienced in the day-to-day world of an acute psychiatric inpatient unit. The author explores relational experiences in brief encounters, as patients and nurses move toward the other in order to understand the other; in psychological work, as they attempt to achieve a shared understanding about future directions; and in practices related to caring for patients with physical needs related to activities of daily living. The author discusses the state of unknowing that some patients and nurses experience as they withdraw from the other. The author concludes that relational practices are a prominent feature of the work of psychiatric-mental health nurses in acute inpatient psychiatric units, but that the nature of these practices may be changing. The author also suggests that despite their occasional experiences of nurses' withdrawal and absence, patients highly value the experience of working with nurses in supportive, health-promoting relationships. / La relation personnel infirmier-patient a été un élément important du discours en sciences infirmières, particulièrement dans la documentation et la pratique du personnel infirmier en psychiatrie-santé mentale. Les infirmières/infirmiers en psychiatrie-santé mentale rencontrent des difficultés à se concentrer sur leur travail relationnel face à la nécessité de fournir des soins efficaces, technologiques et biomédicaux, particulièrement en milieu hospitalier. L'objectif de cette enquête était d'explorer les expériences relationnelles des patients atteints de maladies mentales aiguës et de leurs infirmières/infirmiers en milieu hospitalier psychiatrique. La chercheuse a engagé des conversations avec dix infirmières/infirmiers psychiatriques et six patientes/patients hospitalisés dans des unités de soins psychiatriques intensifs. L'interprétation de la transcription des conversations a révélé quatre thèmes dominants : engagement, repli sur soi, approche attentive et sentiment de sécurité. L'auteure discute des pratiques relationnelles du personnel infirmier et de leurs patients telles quelles sont vécues dans l'univers quotidien d'une unité de soins psychiatriques intensifs. L'auteure explore ces expériences relationnelles lors de rencontres brèves, lorsque les patients et le personnel infirmier vont l'un vers l'autre afin de mieux se comprendre; lors du travail psychologique, lorsqu'ils tentent de parvenir à une compréhension commune de l'orientation future; et lors des pratiques liées aux soins des patients présentant des besoins physiques en liaison avec les activités de la vie quotidienne. L'auteur discute du sentiment d'ignorance éprouvé par les patients et le personnel infirmier lorsqu'ils s'éloignent l'un de l'autre. L'auteur conclut que les pratiques relationnelles sont un élément important du travail des infirmières/infirmiers d'unités de soins psychiatriques qui ont participé à cette enquête, mais que la nature de ces pratiques pourrait être en train de changer. L'auteur suggère également qu'en dépit des expériences occasionnelles de retrait et d'absence du personnel infirmier, les patients interrogés dans cette enquête accordent une grande importance à la collaboration avec le personnel infirmier dans le cadre de relations de soutien et de promotion de la santé.

The notable lack of a health status measure specific to homeless persons triggered the development of a new instrument, The McCormack Assessment Scale for the Health of the Homeless (MASHH). This study was directed by five purposes: to delineate the empirical indicators that determine the health status of homeless people; to name the determinants of health influencing the health status of homeless persons; to maintain qualitative validation while generating beginning evidence of quantitative validation and reliability; to develop a health status measure for homeless persons that can be self or provider administered, and to gain increased knowledge about health and its determinants. A critical review of the literature revealed that no valid and reliable measure existed. The McCormack Assessment Scale for the Health of the Homeless (MASHH), inductively derived to include the health experiences of homeless persons, is a response to this problem for this population.A sequential triangulation design was employed for this study. In Stage 1, a theoretical definition was derived and a large item pool was generated from the analysis of qualitative data; in Stage 2, items were examined for clarity by undergraduate nursing research students; in Stage 3, the scale was constructed; in Stage 4, content validation was conducted by two expert groups - homeless persons assessed acceptability and clinical and research nurse experts assessed conceptual relevancy; and in Stage 5, a pilot study was conducted to garner beginning evidence of validation and reliability. Results from the pilot study indicated that MASHH operationalized an internal structure of health that specified 10 determinants influencing the health of homeless persons and delineated critical indicators within each health determinant or subscale. Fundamental to attaining, maintaining, and regaining health for members of this population is the requirement to identify and understand how diverse determinants influence health. / Le manque notable d'une mesure de l'état de santé spécifique aux sans-abri a déclenché la mise au point d'un nouvel instrument, le Barème d'Appréciation McCormack pour la Santé des Sans-abri (BAMSS). Cette étude a été gouvernée par cinq objectifs : délimiter les indicateurs empiriques qui déterminent l'état de santé des sans-abri; nommer les déterminants de la santé influençant l'état de santé des personnes sans-abri; conserver une validation qualitative tout en générant des preuves préliminaires d'une validation quantitative, fiabilité; mettre au point une mesure de l'état de santé pour les personnes sans-abri qui peut être gérée par ces derniers ou par les prestataires; et enfin acquérir une connaissance accrue de la santé et de ses déterminants. Une révision critique de la documentation a dévoilé l'absence de toute mesure valable et fiable. Le Barème d'Appréciation McCormack pour la Santé des Sans-abri (BAMSS) dérivé par induction pour inclure les expériences en matière de santé des sans-abri, est une réponse à ce problème pour cette population. Un modèle de triangulation en série a été utilisé pour cette étude. Dans l'étape n°1, on est parvenu à une définition théorique et on a créé un groupe d'items étendu à partir de l'analyse de données qualitatives; dans l'étape n°2, les items ont été examinés, pour clarifier, par des étudiants de premier cycle en recherche en sciences infirmières; dans l'étape n°3 le barème a été construit; dans l'étape n°4, deux groupes d'experts ont procédé à la validation du contenu : les sans-abri en ont évalué l'acceptabilité et des experts en recherche clinique et en sciences infirmières en ont évalué la pertinence conceptuelle; dans l'étape n°5, on a mené une étude pilote pour recueillir des preuves préliminaires de validation et de fiabilité. Les résultats de cette étude pilote ont indiqué que le BAMSS opérationnalisait une structure interne en matière de santé qui spécifiait 10 déterminants influençant la santé des personnes sans-abri, et délimitait des indices de crise au sein de chaque déterminants de la santé ou sous-échelle. Pour que les membres de cette population aient, conservent ou recouvrent la santé, il est essentiel de pouvoir identifier et comprendre la façon dont divers déterminants influencent la santé.

Background. Hospitalized infants still experience pain from regularly performed tissue-damaging procedures. Nurses have knowledge to manage the pain but do not apply that knowledge. There is agreement that hospital organizational factors influence quality of care outcomes and some indication that patient factors may influence level of care. / Objective. This study examined the factors from a conceptual model entitled Knowledge Use for Pain Care. These were (1) nurse, (2) organizational and (3) infant factors in relation to nurses' management of tissue-damaging procedures in hospitalized infants. / Research design. A prospective study using two neonatal intensive care units in two Canadian provinces in 2005 was used. / Participants. Ninety-three nurses who performed 170 tissue-damaging procedures. / Measures. Nurse demographic data included education, and years of experience. Nurses' knowledge of pain was measured using the new Pain Knowledge and Use instrument. Organizational factors were measured using the nurse-doctor Collaboration and Satisfaction about Care Decisions Scale (Baggs, 1994), and the Environmental Complexity Scale (O'Brien, Irvine, Peereboom & Murray, 1997). Infant factors included age and intensity of care required. Actual pain care was measured by a scorecard of nurses' assessment, management and documentation for the tissue-damaging procedure. Estimates of professional nurse, organizational and infant effects on nurses' pain care for the tissue-damaging procedures were derived from general estimating equations. / Results. Higher procedural pain care was associated with higher nurse doctor collaboration (odds ratio {OR}, 1.44; 95% confidence intervals {CI} 1.05-1.98), infants with higher intensity of care (OR, 1.21; 95% CI, 1.06-1.39), unanticipated increases in the work of nurse assignments (OR, 1.55; 95% CI, 1.04-2.30). Nurse's level of pain knowledge was adequate but did not translate into actual care for tissue-damaging procedures. / Conclusion. The results suggest that the model was partly supported. In particular the importance of nurse-physician collaboration in pain care delivery, a variable amenable to intervention and further study was significant. Overall, the factors that influence nurse's use of their pain knowledge to provide better care remain a complex issue.

Abstract Women who are disadvantaged have higher rates of smoking during pregnancy and are at higher risk of tobacco-related harm. Smoking cessation interventions have been developed for pregnant and parenting women who smoke however, improvements to smoking cessation interventions for rural, disadvantaged pregnant and parenting women are needed. A multiple case study design was used to (1) describe the level of implementation of a smoking cessation intervention, Expecting to Quit (ETQ), in five Healthy Baby Clubs (HBC) in western Newfoundland; (2) describe barriers and facilitators to implementing ETQ; and (3) collect preliminary evidence of its effectiveness among rural, disadvantaged pregnant and parenting women. This study describes implementation of ETQ from the perspective of pregnant and parenting women (n=12), managers (n=5), and HBC Mothers (n=6). It offers insight into factors (i.e., training, policies and procedures, acceptability, appropriateness of the program) associated with implementation of ETQ. Data were collected through: (1) in-person one-on-one interviews; (2) focus group interviews; (3) training evaluation questionnaires; (4) knowledge, attitudes and beliefs questionnaires; (5) socio-demographics and smoking behaviour questionnaires; and (6) document review of annual reports, staff meeting minutes, and records of polices and procedures. Inductive analyses of data were undertaken including content analysis, constant comparison, and thematic analysis. Six integrated themes emerged: (1) Stigma and Judgment: Walking a Fine Line; (2) Social Context, Health and Place: Rural Living Affects Women; (3) Social Networks: Supporting Women Like Us; (4) Community Empowerment: A Catalyst to Get the Message Across; (5) Complexities in the Lives of Women: Just Trying to Get Through; and (6) Tobacco Reduction: It is a Success. The integrated themes suggest that cessation interventions in this context must address each of these issues. These findings may prov / RésuméLes femmes désavantagées sont plus à risque de fumer pendant leur grossesse et sont plus exposées aux risques associés à la consommation du tabac. Des interventions visant l’arrêt de la consommation du tabac ont été développées pour les femmes enceintes et les jeunes mères qui fument. Néanmoins, des améliorations doivent être apportées à ces programmes pour les femmes enceintes ou jeunes mères désavantagées en milieu rural. Une étude de cas multiples à été utilisée pour (1) décrire le niveau d’implémentation du programme d’intervention visant l’arrêt de la consommation du tabac « Expecting to Quit » (ETQ), dans cinq clubs « Healthy Baby Club » de la région ouest de Terre-Neuve, (2) décrire les obstacles et les aspects facilitant l’implémentation des « ETQ », et (3) rassembler les preuves préliminaires de son efficacité pour les femmes enceintes ou les jeunes mères désavantagées en milieu rural. Cette étude décrit la mise en place, des interventions « ETQ » du point de vue des femmes enceintes et des jeunes mères (n=12), des responsables du programme (n=5) et des mères, membres du club « HBC » (n=6). Cette étude apporte des éclairages sur certains facteurs (formation, règles et procédures, acceptabilité, niveau de pertinence) associés à la mise en place des interventions « ETQ ». Les données ont été récoltées à travers: (1) des entretiens en personne, (2) des entretiens en groupe, (3) des questionnaires d’évaluation de la formation, (4) des questionnaires de connaissances, d’attitudes et de croyances, (5) des questionnaires socio démographiques sur le comportement des fumeurs, et (6) la lecture de documents tels que: rapports annuels, compte rendu de réunion des employés, règles et procédures. Des analyses inductives des données ont été faites, incluant, l’analyse du contenu, la comparaison des constantes, et des analyses thématiques. Six thèmes intégrés en sont r

<p> Obesity has become the most significant noninfectious health risk in the United States, and the major causes of death and disability are shifting to chronic, non-communicable health conditions that are largely attributable to physical inactivity, overweight and obesity, and other diet-related factors. Among children and adolescents, the overweight/obesity rate is approaching 32%, with 17.9% of adolescents becoming obese. While the obesity rate has doubled in all age groups in the United States, it has tripled among young adults aged 18 to 28 years, and 70% of adolescents who are at a healthy weight will become overweight or obese as adults. At particular risk for rapid weight gain are college freshmen; the rate of weight gain in the first semester of college is twice that of same-age peers, and 77% of all college freshmen gain weight. The purpose of this descriptive study was to explore the personal, interpersonal, and situational factors that influenced weight change in freshmen. Seventy-six college freshman completed measures of demographics, height and weight, physical activity, sedentary behavior, nutritional intake, beverage and snack intake, alcohol consumption, stress management, interpersonal relations, spiritual growth, and health responsibility at baseline and 15 weeks later during their first semester of college. Participants gained a mean of 2.3 pounds, with 43% gaining clinically significant weight (&ge; 3.5 pounds); 33% of the participants gained over five pounds. Two variables predicted 12% of this weight gain: a low level of health responsibility and having an underweight/normal BMI upon entrance to college. Identification of participants in the underweight/normal BMI category as the group at most risk for significant weight gain was an unexpected finding that merits further exploration. In addition, findings indicate that strategies are needed to create stronger support systems, to increase the level of health responsibility, and to encourage college freshmen to regularly perform behaviors to attain, or maintain, a healthy weight throughout the first year of college.</p>

<p> Blood transfusions occur in all areas of a hospital with nurses at the point-of-care responsible for specimen collection, blood administration, patient surveillance, and adverse event reporting. Unfortunately there is a paucity of nursing research on blood transfusions. The purpose of this study was to describe the state of the science of medical-surgical acute care nurses' practices with blood transfusion therapy. Seven research questions addressed the comprehensive scope of nurses' involvement with blood transfusions. Data was collected via a valid and reliable web-based survey, <i>Nurses' Practices with Blood Transfusions: Medical-Surgical Acute Care.</i> A random selection of U.S. hospitals with a nurse executive who was a member of the American Organization of Nurse Executives was recruited via postal letter. One survey was completed per hospital with 148 hospitals responding (18.3% response rate). </p><p> Nurses' practices in transfusion processes are similar across the country. The hospital's transfusion policy was the most influential source of information for nurses because it specified nurses' transfusion practices. Limitations in surveillance of the medical-surgical patient with a blood transfusion were due to the lack of current information on transfusion reaction symptoms included in the education programs, delegation of transfusion vital signs to non-licensed staff that were not educated on symptoms of a transfusion reaction and transportation of patients with blood infusing to tests and procedures. Hospitals were in the process of adopting electronic technologies to reduce or eliminate wrong-blood-in-tube errors or wrong blood administered mistransfusion errors. Nurses need to collaborate with the transfusion service to update the transfusion policy and the blood transfusion education programs; include non-licensed staff in compulsory blood transfusion education; and closely evaluate the capabilities of an electronic documentation system to truly match the patient to the blood product. This descriptive study is a foundation for future research of nurses with blood transfusions.</p>

<p> Oral oncolytics continue to come to market at an unprecedented pace. Traditionally, chemotherapy was delivered in the controlled environment of the infusion suite; however, with the increasing use of oral oncolytics, the burden of administration and monitoring has shifted to the patients and/or their caregiver. This paradigm shift, from intravenous chemotherapy to oral chemotherapy, has created new challenges in cancer care. Despite the seriousness of their diagnosis, oncology patients are not always adherent to these requirements. Oncology nurses have always taken the lead in patient education, yet that lead has mostly been in the context of intravenous chemotherapy. There is currently a lack of evidence to guide oncology nurses with their interactions with patients on oral chemotherapy. If patients are not adherent with their prescribed therapy, then progressive disease and premature death may be the outcome of their non-adherence. This project was a systematic review and synthesis of 51 articles on oral adherence and the subsequent development of a guideline based on the evidence that nurses can use to guide their interactions with patients on oral chemotherapy. The synthesis was divided into ways to measure adherence, factors contributing to non-adherence, and interventions to improve adherence. Knowing the factors contributing to non-adherence, how best to measure adherence, and the interventions to improve adherence can assist the nurse to plan individualized patient care. Adherence is critical for optimal patient outcomes and nurses play a key role in helping patients remain adherent. Education, monitoring, and ongoing support are necessary to help patients remain adherent and achieve optimal clinical outcomes. The scholarly product, a guideline on oral adherence, can be used by nurses to guide their interactions with adult patients on oral chemotherapy.</p>

<p> Pain is a significant problem for nursing home residents. Pain assessment is complicated by the high prevalence of cognitive loss in this population. Because licensed nurse (LN) staffing levels are low in nursing homes, the majority of resident care is performed by certified nursing assistants (CNAs) who do not have formal training or skills to assess or manage pain. CNAs' role in the assessment and management of pain in nursing home residents is not well understood, because few studies have explored this issue. </p><p> To address this gap in our knowledge, a qualitative study using Grounded Theory Methodology was undertaken. The study was conducted at two skilled nursing facilities: Memory Care Units within a large county run hospital and at a 99 bed for-profit corporate owned facility. Twenty-six individuals were interviewed (16 CNAs and 10 LNs) using semi-structured interview guides. CNAs were asked about their experiences caring for residents in pain. LNs were asked about how they perceived CNAs' role in pain management. Interviews were transcribed verbatim and analyzed using grounded theory constant comparative methods. </p><p> Both CNAs and LNs perceived that CNAs had a role in the pain management of nursing home residents. CNAs' recognized pain by using techniques of asking and listening and by observing behaviors. They distinguished pain that they considered normal (everyday pain) from pain that they reported to LNs. As well as reporting pain, they responded to residents who had pain by performing resident-centered care, giving physical care and providing attention to distract residents from their pain. Their ability to do this work was founded on their understanding of pain as multidimensional and their intimate knowledge of individual residents. They described their knowledge of residents as being informed by two types of knowing: working knowledge and knowing residents as individuals. Contextual factors that both promoted and hindered CNAs having a role in pain management were identified. These factors included CNAs' individual skills and experience, low levels of staffing, and working more than 40 hours a week. From this understanding of CNAs' role in pain management, implications for clinical practice and research are identified.</p>

While there is evidence that the interactions that occur in the early years of life between very-low-birthweight (VLBW) infants and their mothers affects later child development, little is known about the factors that are associated with responsive and sensitive mother-VLBW infant interaction. Belsky's (1984) model of the determinants of parenting proposes that multiple child, parent, and contextual factors influence parenting behaviour. This prospective study examined the combined influence of a set of infant (i.e., birthweight and perinatal illness severity), mother (i.e., state anxiety and parenting sense of competence), and contextual variables (i.e., maternal received and perceived helpfulness of support, and marital adjustment) on mother-infant interaction, and assessed which factors were associated with sensitive and responsive interaction. / The participants were 72 mothers and their VLBW infants (<1500 grams). Infant, mother, and contextual variables were assessed at 3- and 9-months of age (corrected). At 9 months, mother-infant teaching interactions were observed in the home and later coded using the Nursing Child Assessment Teaching Scale (NCATS). / Hierarchical multiple regression analyses were used to examine the relationship between mother-infant interaction and the infant, mother and contextual variables. The prospective model explained 33% of the variance in the interactive behaviour of the dyad. Dyads whose interaction was more sensitive and responsive at 9 months included mothers who were better-educated, less anxious at 3 months, and reported higher perceived support at 3 months. The concurrent model explained 29% of the variance in the interactive behaviour of the dyad. Dyads whose interaction was more sensitive and responsive included mothers who were better-educated and reported higher perceived support at 9 months. The hypothesis that the mother variables would be more important than the contextual variables in explaining mother-infant interaction was not supported. The findings highlight the importance of examining multiple infant, parent, and contextual variables to explain mother-VLBW infant interaction.