This qualitative descriptive study captures reflections from third year baccalaureate nursing students who were asked to describe their experience with high fidelity human patient simulation (HPS) and the impact this experience had on their clinical reasoning skills. Currently educators in Ontario struggle to secure appropriate clinical placements for nursing students. Clinical practice is necessary for students to bridge the theory-practice gap and to become safe, competent practitioners. Nurses employ a clinical reasoning process in order to make health care decisions and it is through experience in practice that nurses develop that skill. Simulation is one way in which clinical reasoning skills can be developed. The study used individual interviews with six, third year nursing students who had participated in a quasi-experimental study where four days of their clinical time were spent in a high fidelity simulation laboratory. A detailed analysis of the transcribed data resulted in the emergence of the central theme of clinical confidence. Four interrelated components: realism, clinical scenarios, facilitation, and debriefing enhanced knowledge development and skill acquisition, which contributed to the development of confidence. Students were not able to articulate that HPS influenced their clinical reasoning skills; however, the four interrelated components contributed to the development of clinical reasoning. A focus group with five of the study participants followed the data analysis and confirmed the findings The study also provided insight into students' perceptions of effective teaching/learning strategies in simulation environments.

Objective. To evaluate the effectiveness of a patient decision aid (PtDA) for menopausal women facing decisions about natural health products (NHPs). Background. Women experience difficulty making decisions about NHPs for the management of menopausal symptoms. Factors influencing the decision include lack of information, and inadequate communication, and support from health care providers. Decision support interventions that have been demonstrated to be successful in addressing women's decisional needs are decision aids. Although a new decision aid is available, its English version has not been evaluated in a community-based/clinical setting to determine its effect on decision quality or the process of decision making. Design. A pre-/post-test quasi-experimental study. Setting. The Women's Health Center at The Ottawa Hospital, Ottawa Canada. Participants. Peri- or post-menopausal women aged 45 to 64 considering the use of NHPs for management of menopausal symptoms. Intervention. Self-administered NHP PtDA. Main outcome measures. The primary outcome measure was the level of decisional conflict as measured by the Decisional Conflict Scale. Secondary outcomes included knowledge, strength of values, and choice/preference. Results. Of 24 women, the typical participant was 50 to 59 years of age, Caucasian, married, and well educated. Compared to baseline, after using the decision aid, women's total decisional conflict was reduced from 63% to 23% (p < 0.001) and knowledge improved from 76% to 87% (p = 0.001). The values clarification exercise revealed that women who preferred NHPs were more likely to rate the non-chemical aspect as important and the cost of the NHP as less important. Of the 24 women, 10 were unsure of their choice at baseline and 3 post use of the decision aid (p = 0.015). Overall, women rated the decision aid as acceptable, clear, and balanced. Conclusion. The NHP PtDA improved decision quality and supported menopausal women who were facing health decisions around using NHPs for menopausal symptoms.

Cancer is predominantly a disease affecting older persons. 43% of new cancer cases in Canada occur among those who are at least 70 years old, while 25% occur in those aged 60--69 years. Cancer fatigue is the most common symptom associated with cancer and its treatment, and is often the most distressing symptom reported by cancer patients. Cancer fatigue adversely affects physical activity levels, physical function, and quality of life. Physical function is essential to older adults in maintaining independence and associated quality of life which is often more important to older adults than cancer survival. Recent research studies suggest that physical activity may reduce fatigue, and maintain or improve physical function levels and quality of life in cancer patients during and following treatment. This thesis examines cancer fatigue and its relationship to physical activity, physical function, and quality of life in older adults with cancer. The results of a systematic review and the findings of a secondary analysis research study are presented. The systematic review provided evidence that physical activity may reduce fatigue in older cancer patients during and after cancer treatment and may help to maintain or improve physical function and quality of life in this population. Results of the secondary analysis indicated that cancer fatigue is prevalent and was the most frequently reported symptom at baseline, three months and six months post consultation for cancer treatment. Cancer fatigue was associated with lower levels of physical function and quality of life. Physical activity, a modifiable factor, was found to be significantly related to cancer fatigue at three months and six months, regardless of age, and was significantly related to physical function at six months.

Health science students are faced with a reduction in acute care clinical placement opportunities, which are considered essential for developing clinical competence. Education methods using high-fidelity human patient simulation (HPS) may provide a way to ensure students are meeting minimal levels of competence. Using a quasi-experimental design pilot study, clinical competence among 19, third year baccalaureate nursing students was investigated. The experimental group (n = 10) received four days of HPS as part of their clinical practicum, while the control group (n = 9) participated in their regular clinical practicum. Clinical competence was measured using final grades from a medical-surgical theory course and an Objective Structured Clinical Examination (OSCE). There was no significant difference in clinical competence between the groups, as was evidenced by their final theory grades; t (17) = 1.090, p = .291 and OSCE scores (M = 60 for both groups). The results from this pilot study can guide future research using HPS in health care education. A randomized controlled study with a larger sample needs to be completed to provide more insight into the outcomes of HPS in health care curricula.

Dans le cadre d'un traitement des dépendances, les infirmières jouent un rôle important (Rassool & Villar-Luis, 2004). Chaque jour, elles composent avec une clientèle non seulement en situation de sevrage mais aussi gravement malade sur les plans physique et psychologique (Naegle & Erickson D'Avanzo, 2001). La recension des écrits rapporte peu de recherches sur les rôles exercés par les infirmières em milieux de désintoxication. En effet, les infirmières doivent articuler des fonctions visant à maintenir l'ordre allant même jusqu'à la mise en oeuvre d'un traitement forcé ou fortement suggéré par des instances juridiques (Thomas 2005). Or certains articles sur le sujet mentionnent le besoin d'offrir au client "un encadrement" afin de lui permettre de suivre son traitement ou de cesser sa consommation. Bien que la nécessité d'un encadrement strict ait été évoquée, aucune recherche sur cet aspect de la pratique infirmière dans ce type de milieu n'est documentée dans les écrits consultés. Étant donné que l'unité de désintoxication est fortement investie par une régulation comportementale, il est nécessaire de s'attarder non seulement à l'angle caritatif de l'exercice infirmier mais aussi aux aspects politiques du soin. Les rapports de pouvoir entre le personnel infirmier et les personnes admises en désintoxication constituent donc la pierre angulaire de cette recherche. Dans la mesure ou les aspects politiques du soin sont au coeur de cette recherche, notre choix de cadre théorique s'est arrêté sur les travaux de Michel Foucault. Plus spécifiquement, notre analyse foucaldienne s'appuiera sur le concept de pouvoir disciplinaire afin de supporter notre recherche au plan théorique. Au plan méthodologique, un devis qualitatif a été privilégié. Les résultats de cette recherche montrent que le soin infirmier dans une unité de désintoxication est assorti de composantes caritatives et disciplinaires qui se juxtaposent continuellement. Les infirmières qui ont participé à cette étude ont clairement exprimé qu'il leur serait impossible de soigner la clientèle sans la structure, les mécanismes de contrôle et les mesures disciplinaires dont elles disposent. L'examen des données de l'observation du milieu et des documents écrits a corroboré l'existence de telles pratiques, qui sont entérinées, du moins en partie, par la direction sous formes de politiques et procédures.

Introduction. In the last two to three decades, research findings have gradually been permeating the culture of nursing. Increasingly, nurses are expected to integrate evidence-based practices into specific nursing policy/protocols and patient care decisions (Polit and Beck, 2004; Rogers, 2004). In truth, research utilization is dependent on nurses' actual direct or indirect use of evidence in the clinical setting (Estabrooks, 1999). To date, researchers have been able to conclude that the more positive a nurse's attitude the more likely the nurse will use research findings (Ehrenfeld & Eckering, 1991; Camiah, 1997; Estabrooks, 1999; Olade, 20203, 2004). The nursing literature reveals a dearth of studies examining nurses' "actual ongoing use" of research and the related factors/challenges affecting their continued use of research findings in clinical practice. Purpose. Why do some nurses continue to use research while others do not where organizational policy supports the ongoing use of evidence-based practice? The purposes of this study are to validate whether nurses' are continuing to use the RNAO's Falls Risk Prevention Best Practice Guidelines (BPG) policy/protocol in 2 units of a tertiary clinical care setting, to examine practicing nurse's attitudes, beliefs and perceptions related to their intention continue to use the policy/protocol; to examine the importance of each variable (beliefs, subjective norms, perceived behavioural controls) related to their intention to continue to use the policy/protocol; and to examine nurses' perceptions and experiences regarding the facilitators, barriers and organizational structures that impact their continued use of research in their practice setting. Methods. This survey correlation design study used Ajzen's Theory of Planned Behaviour (Godin & Kok, 1996) as a theoretical framework to examine practicing nurse's attitudes, beliefs, perceptions related to their intention to continue to use the Registered Nurse's of Ontario Association (RNAO)'s Falls Risk Prevention Best Practice Guideline (BPG) in their clinical practice. Findings. Sixty four percent of surveyed nurses (n=22/44) report using the Falls protocol (a direct type of research) always (18%) and/or often (46%) in their clinical practice. They also reported using the Falls Protocol on their previous shift an average of 2.6 patients per nurse. The main sources of falls research education where nurses first learnt about the RNAO's BPG were during their nursing practice (46%), a form of continuing education (27%), or in a conference/seminar setting (18%). Composite mean scores related to surveyed nurses attitudes, social norm and control beliefs ranged from 1.71 to 2.43 indicating strong positive attitudes, a strong sense of social pressure and greater level of control over their ongoing use of the Falls Protocol in their daily practice. Nurses' attitudes, social and control beliefs explained 46% of the variance in intention related to its ongoing use every 3 months and 73% of ongoing use after a patient fall incidence. Surveyed nurses identified 9 facilitators and 4 potential barriers related to the ongoing use of the Falls Protocol in their clinical practice. Conclusions. Findings reveal nurses in a tertiary care facility demonstrate 'strong generalized intentions' towards the ongoing use of the direct form of research, the Falls Risk Prevention BPG on admission, on a quarterly basis and after a patient fall incident. The 'ongoing utilization of research' in practice is definitely of interest and viewed positively by nurses in this setting despite their educational profile, limited research education and minimal exposure to in-house continuing education. This result indicates exposure to research is necessary in developing favourable attitudes towards RU. Furthermore, nurses' intention to 'continue to use' the Falls Protocol in this tertiary care facility is significantly influenced by the social expectations of referent persons and by their perceived behavioural control (PBC) beliefs. Surveyed nurses also report that three factors facilitate their 'ongoing use' of the Falls Protocol in their setting; these are congruent with those found in the literature relating to the initial adoption of research. These facilitators include: (1) providing research in a usable form; (2) attending conferences or seminars to remain current with new research related to their clinical setting; and (3) engagement in research activities such as the development, updating and implementation of the Falls BPG for use on their units.

Les infirmières qui travaillent avec des personnes atteintes de problématiques sexuelles, et plus particulièrement d'une ITS, sont souvent affligées d'un sentiment de malaise, manifestent de la désapprobation morale ou tout simplement démontrent un manque de sensibilité envers la situation de leurs clients, ce qui décourage plusieurs de ces derniers dans leur quête d'aide ou d'information (Kinghorn, 2001). La gêne, la honte, la peur du discours moralisateur ou le manque de discrétion de la part du professionnel infirmier expliquent souvent l'hésitation des personnes atteintes d'une ITS à consulter les services de soins appropriés (Germain et Langis, 1990; Holmes et O'Byrne, 2006). Bref, les infirmières jouent un rôle important dans la santé sexuelle de la personne et doivent être en mesure de prodiguer des soins adéquats et exempts de jugements moralisateurs. L'objectif de cette recherche est d'étudier le processus interactionnel, soit la nature de l'interaction, entre l'infirmière et la cliente consultant des services de santé sexuelle pour des tests de dépistage (ITS), et ce, lors de la rencontre initiale, c'est-à-dire à l'étape de la collecte de données. Plus précisement, la présente recherche cherche à comprendre comment les infirmières, exerçant en clinique de santé sexuelle, construisent l'identité de jeunes filles adolescentes qui consultent pour des tests de dépistage d'infections transmises sexuellement. Compte tenu de l'état des connaissances actuelles et de la question de recherche, la théorisation ancrée a été privilégiée pour orienter notre recherche au plan méthodologique alors que les travaux de Goffman (1998) ont été consultés pour assurer la sensibilité théorique de la chercheure. Les résultats de la présente étude, obtenus par l'entremise d'entrevues semi-structurées, sont très intéressants. La plupart des informants croient que le questionnaire est inapproprié pour amasser des données sur la santé sexuelle des clients et, tout particulièrement des clientes adolescentes, car les questions posées sont personnelles, intimes, privées et invasives, pour d'autres informants le questionnaire est complètement inutile; le questionnaire entrave le dialogue entre le client et l'infirmière; le questionnaire entrave l'établissement et le développement d'une relation thérapeutique entre le client et l'infirmière; le questionnaire décourage les clients à consulter des services de santé sexuelle offerts. De même, les informants attestent que les questions posées lors de la collecte des données suscitent des sentiments négatifs chez le client, sauf que la plupart d'entre eux reconnaissent également l'infirmière comme étant un outil de stigmatisation.

Background. Emergency room nurses work in an area in which the workload is unpredictable and chaotic. Treatment measures are usually aggressive and the goal of care in the emergency department is to restore physiological stability in a sick or injured person. As treatment measures usually occur quickly and nurses care for many patients throughout their shifts, there is often a lack of time to establish relationships with patients and/or family members. In a situation when treatment is needed immediately, there may not be enough time to discuss advanced directives with patients and/or family members. Although most patients are seen, treated and sent home or are admitted and recover, more than 7000 lives end in Canadian emergency departments each year (CIHI, 2006). Death in an emergency department is almost always considered a tragic event, regardless of whether the event was unexpected or expected. This view contrasts with the idealistic view of death occurring in a hospice or at home, free of pain and suffering and surrounded by loved ones. In an emergency department, treatment of critical illnesses and/or injuries begins immediately, leaving nurses or other members of the team little time to discuss advance directives or establish rapport with patients and/or family members. Purpose. The purpose of this research study was to improve our understanding of the experience of emergency room nurses when caring for an adult who dies in the emergency department.

Canada's aging population and increasing incidence of cancer, in both older and younger adults (Canadian Cancer Society, 2007), has resulted in palliative care becoming a growing concern for Canadians. Family caregivers are expected to provide care to ill family members at home with limited training, support or community resources. While research has recognized numerous challenges of providing care at home along with the consequences on the caregiver, a thorough literature review showed little research has been published about the caregiver's transitional experience of admitting a family member from home to the palliative care unit (PCU). Thus, a Heideggerian phenomenology qualitative approach was used in this study to explore the question: What are the family caregivers' transitional experiences of admitting family members from home to the PCU? Ten participants completed in-depth interviews and Colaizzi's (1978) approach guided the study's analysis. The findings produced a framework entitled: Transitional Experiences of Family Caregivers: A Puzzle of Care Provision. It contained eight themes of "In the beginning - Searching for answers", "Managing at home - Juggling act", "Trying to get through it", "A shifting situation - Triggers leading to PCU admission", "The transition - Making the decision to go to PCU", "Getting near the end - PCU", "Looking back on care", and "Getting ready to move on". Follow up interviews verified that the themes and framework accurately described participants' experiences. This study is the first to thoroughly illustrate the family caregiver's transitional experience of caring for a family member from home to the PCU. It is hoped that this study raises greater awareness and understanding of the family caregivers' transitional experiences.

A mixed method study was conducted to gain an understanding of the role of the eating disorders (ED) nurse and to explore the nurse-patient therapeutic alliance in this context. Thirty-five nurses from six ED treatment centres in Canada and America participated. The qualitative component involved manifest and latent content analyses of semi-structured interviews. From this, nine nursing roles were identified in addition to the skills, challenges and rewards of ED nursing. Three themes emerged in relation to the therapeutic alliance: creating a therapeutic environment, establishing a connection, and empowering patients. The quantitative component consisted of an established measure of therapeutic alliance in questionnaire form. Results from the survey supported the qualitative findings in identifying differences between Canadian and American nurses.