Objective. Development and reinforcement of self-management skills for patients with Chronic Obstructive Pulmonary Disease (COPD) is an ongoing challenge. As the disease advances, hospitalizations increase, managing respiratory infections and medication administration become more difficult for patients. Pulmonary rehabilitation programs assist patients with mastery of self-management skills but access is limited. In 1996 less than two percent of Canadian COPD patients participated in rehabilitation programs. Hospitalization provides opportunity for interventions aimed at reinforcing self-management strategies. The following study sought to determine the feasibility of providing and evaluating an education intervention tailored to hospitalized COPD patients. Design. Feasibility pre-test post-test method. Setting. Three medical wards of a tertiary care teaching hospital. Participants. Convenience sample of 20 patients admitted with COPD/COPD exacerbation. Intervention. Participants received a maximum of three, 40 minute sessions during hospitalization. Content delivery was tailored to participants' learning needs and low self-efficacy areas. Based on Self-Efficacy Theory, teaching strategies included performance accomplishment, role modeling, and positive reinforcement. Outcome measures. Learning needs, descriptive and clinical data, program evaluation, COPD Self-Efficacy Scale (CSES) and Dartmouth Functional Health Status (FHS) Charts. Results. Key learning needs included: inappropriate medication inhalation technique (n = 19), lack of disease acknowledgement (n = 16), no previous self-management education (n = 10). Health care providers identified the need for better access to educational materials for patients and family members. FHS, in five of the nine domains, and CSES scores (z = 3.51, p = .004) improved. Participants evaluated the experience as positive and recommended the intervention for other patients (n = 20). Conclusions. An educational intervention for hospitalized COPD patients can feasibly be developed, implemented and evaluated.

En depit de l'urgence d'evaluer la qualite des soins infirmiers en sante communautaire, ce domaine de recherche demeure peu explore. L'evaluation de la qualite des soins infirmiers en sante communautaire exige un cadre de reference capable de tenir compte des realites inherentes a l'exercice infirmier communautaire. Dans un domaine ou les habiletes relationnelles ont preseance sur les habiletes techniques, le cadre de reference supportant l'evaluation doit faire une place preponderante a la relation infirmiitre-client. Dans ce contexte, le concept du caring, tel que definit par Watson, apparai t un indicateur pertinent de la qualite des soins infirmiers. S'appuyant sur la theorie de Watson, cette recherche descriptive a pour but d'identifier les comportements infirmiers qui sont percus par les clients en sante communautaire comme demontrant du caring. Pour ce faire, une liste de 98 items correspondants aux dix facteurs de caring fut elaboree. Des 684 clients francophones ayant recu des soins infirmiers a domicile dans un CLSC de l'Outaouais, 158 retournerent le questionnaire dament rempli. Les resultats obtenus permettent de determiner la valeur relative des comportements infinniers et des dix facteurs de caring, telle qu'attribuee par les repondants. Ainsi, les clients en sante communautaire placent en premiere priorite les comportements infirmiers qui sont empreints d'humanisme et qui temoignent de la competence relationnelle de l'infirmiere. Les resultats suggerent egalement l'existence de differences dans les perceptions selon les besoins de sante, l'age et le degre de scolarite des participants. Le concept de caring apparait un indicateur de qualite valable et devrait etre integre a un modele d'evaluation de la qualite en soins infirmiers en sante communautaire.

The purpose of the study was to describe and compare, in a tertiary care setting, the prevalence and severity of pressure ulcers in the neuroscience population to a non-neuroscience population. This study was guided by a conceptual schema that provided a physiological basis for the development of pressure ulcers. The presence of contributory clinical risk factors was compared between the two populations. The neuroscience population included patients admitted to the neurology and neurosurgery services (40 bed unit) while the remainder of the hospital population comprised the non-neuroscience population. A secondary analysis method was used to compare data obtained from four annual pressure ulcer prevalence studies conducted from 1993--1996. The instruments used were the Demographic and Clinical Profile Form, a Prevalence Grid and the Braden Scale for Pressure Sore Risk. Trend analysis and yearly comparisons were conducted with a level of statistical significance set at p = 0.05 level with a clinically important difference of ten percent or greater. (Abstract shortened by UMI.)

Objective. To evaluate the effectiveness of a decision aid developed specifically for family members considering whether or not their relative with dementia should be admitted to a care facility. Design. One-group non-randomized before and after study. Setting. Ottawa-Carleton, Ontario, Canada. Participants. Convenience sample of 27 family members responsible for making care decisions on behalf of a relative with dementia living at home. Intervention. Family members completed a self-administered decision aid fashioned as a workbook to learn about long-term care options available to persons with dementia. Main outcome measures. Decisional conflict (uncertainty about which course of action to take), knowledge of long-term care options, stages of change (pre-contemplation, contemplation, preparation, action and maintenance), choice predisposition (care at home versus admission to a care facility) as well as satisfaction with the decision aid and the decision making process. Results. After using the decision aid, family members had a significant reduction in decisional conflict and a significant increase in knowledge. The decision aid had a minimal effect on choice predisposition and appeared to be more useful to those in the contemplation stage. Generally, family members were satisfied with the decision aid but felt it was less successful at preparing them to make a better decision, to organize their thoughts, to look at the wishes of their relative with dementia, and to communicate their opinion about the options. Nevertheless, the majority reported that they would definitely recommend the decision aid to other family members facing the same decision. Conclusions. The decision aid shows promise in helping family members of persons with dementia make decisions about location of care.

Cette étude phénoménologique Heideggerienne vise à explorer et à décrire l'expérience de la souffrance et de la détresse spirituelle telles que vécues par des femmes atteintes d'un cancer du sein. L'échantillon se compose de six femmes sélectionnées dans un centre de cancérologie. Une entrevue servi-structurée a été réalisée auprès des participantes et les transcriptions verbatims ont constitué les données de ce projet de recherche. D'une part, la multidimentionnalité de la souffrance provoque de multiples pertes qui amène la destruction de l'entièreté de la femme. D'autre part, en réponse à l'expérience de la souffrance, les résultats d'analyse révèlent l'existence d'un processus dynamique de guérison en profondeur de nature spirituelle. Le cheminement évolue selon le cycle des cinq saisons de l'Arbre de Vie qui représente les différentes phases à compléter: (1) signal d'alarme; (2) perte; (3) métamorphose; (4) travail à accomplir et (5) guérison en profondeur. Des éléments clés tels que les réactions à la maladie, le soutien, l'espoir, le travail sur soi et la recherche de sens, favorisent le parachèvement de ce travail personnel menant vers la réconciliation de soi. La pierre angulaire de ce processus est une transformation intérieure qui implique une impression d'être accompagné par une présence supra-moi. De nombreuses implications pour les soins infirmiers découlent des résultats de cette étude ainsi que des pistes de recherche futures à réaliser auprès de femmes atteintes d'un cancer du sein.

This descriptive correlational study explored the relationship between perceived social support and perceptions of illness for individuals living with New York Heart Association Class Two or Class Three congestive heart failure. A total of 34 participants were interviewed at the University of Ottawa Heart Institute, Ambulatory Heart Failure Clinic. Participants completed three questionnaires, which included a demographic questionnaire, a social support questionnaire (PRQ-85/Part Two), and the Meaning of Illness Questionnaire (MOIQ). Results indicated that subjects perceived their social support to be high. Perceived social support was seen to account for 24% of the variance in MOIQ Factor 3 (degree of stress, change in commitments, and secondary coping resources to deal with it), and 11% of the variance in MOIQ Factor 2 (type of stress, negative attitude of harm, loss or threat, and viewing the illness as disabling, disfiguring and deteriorating). Content analysis revealed six major themes which described the subjects' feelings about how heart failure had affected their lives. The themes that were elicited were: physical limitations, surprise and disbelief, a need for knowledge, adjustment, support from significant others, and getting in touch with one's spirituality. (Abstract shortened by UMI.)

This hermeneutic phenomenological inquiry centered on the broad questions: how do practising nurses experience reflection? Where, when, and how does reflection enter the experience of practising nurses? Seven long-term care nurses, a culturally cohesive sample, each participated in two audiotaped conversational interviews. Through these conversations, I gathered and explored experiential narrative material. A focus group with long-term care nurses from a different region enabled expansion, clarification and verification of the data. Descriptions and patterns emerged from the texts/data and I linked them to reflection dimensions and four fundamental lifeworld themes. Images of watching a movie, puzzling through, and putting the pieces together, capture the complexity of reflection. Three constructions illuminate the nurses' experience of reflection: reflection and the geography of everyday life; reflection in the between; and reflection is relation. These original and innovative understandings address an absence of practising nurses' experiences in the extant literature and contribute to scholarly knowledge. Implications for practice include accepting the challenge from the College of Nurses, reflective inquiry culture and reflection for practice. Reflection is in two modes, annual and everyday. A culture of reflective inquiry frames practice. The nurses act knowledge in practice. There is a curious absence of reflection in action/practice, and an environment unsympathetic to reflection and reflective practice. Reflection in the geography of everyday life is a remarkable contrast to the almost reified conceptions of or formulae for reflection. The language of the everyday characterizes these nurses' experience of reflection. Reflection terminology has infiltrated practice, but it is unclear if practice has changed. Does reflection contribute to improvement in nursing practice and patient outcomes? The intersubjective nature of nursing and reflection is so strong that relationships, rather than individual functioning, might become the primary unit for reflection reflecting. In the geography of everyday life, reflection moves from the mountain tops to the everyday. This creates the potential to develop a new and potentially different reflection discourse. This construction provides a direction for developing new ways of speaking in and about practice.

Cette etude descriptive-correlationnelle vise a explorer l'existence de relations entre les dimensions du fonctionnement familial chez les meres d'enfants ages de 0 a 6 ans, actives sur le marche due travail et l'utilisation qu'elles font des services de sante. L'echantillon se compose de 33 sujets, selectionnes dans un hopital universitaire a partir d'une fiche de recrutement. Le "Questionnaire sur la famille et le travail" et le "Family Assessment Device III" ont permis de quantifier les resultats. Des relations significatives ont ete trouvees entre les roles, le controle des comportements et les services utilises ainsi qu'entre certaines variables sociodemographiques et du reseau de soutien. Les resultats fournissent des pistes interessantes pour la planification d'interventions aupres des familles et pour des recherches ulterieures.

This case-control study compared the caregiving experience of adult daughters of parents with and without dementia who resided in the community. A synthesis of diverse theoretical perspectives, developed by the researcher, provided direction for this study. The data used in the analysis were drawn from the 1991-92 Canadian Study of Health and Aging. A representative sample of 106 daughters of parents with dementia and 45 daughters of parents without dementia provided information regarding the context, stressors, and the level and correlates of depressive symptomatology associated with provision of care to parents. Daughters of parents with dementia tended to be slightly older, single or widowed, co-resided with their parent and used more formal care services when compared to daughters of parents without dementia. Differences between groups were also found regarding the stressors they experienced while providing care. More specifically, daughters of parents with dementia assisted with more personal and instrumental care. Their parent's functional status was more impaired and they contended with more behavioural disturbances and experienced greater burden than daughters of parents without dementia. There were no statistical differences between groups with respect to mean scores on the CES-D scale. However, fully one quarter of daughters of parents with dementia and one fifth of daughters of parents without dementia achieved scores indicative of at least a mild level of depressive symptomatology. Finally, self-reported health, health interferences, the need for additional formal care services and feelings of caregiver burden were associated with depressive symptoms for both groups of daughters. In addition, for daughters of parents with dementia, depressive symptoms were associated with the provision of personal care tasks, behavioural disturbances and the functional status of parents. (Abstract shortened by UMI.)

Research into the phenomenon of burnout has been of an anecdotal nature. The literature abounds with definitional, analytical and psychometric limitations. Although burnout has been defined by numerous researchers in varying terms, research still lacks a universal definition and theory. Therefore, it is essential to develop this universal definition by investigating the existence, and the determinants of the concept. One approach hypothesized to establishing a theoretical definition of burnout is to use a sophisticated and rigorous analyses such as structural equation modeling with a sample of a professional's exhibiting symptoms of burnout. This present study focuses on the nursing profession and endeavours to propose at least an initial theoretical definition of the burnout construct for this profession. Research has determined that nursing is a profession prone to burnout. The current study elaborated on a postulated framework of burnout as it impacted on a nursing sample of 340 general staff nurses and 204 critical care nurses. In testing this model, the more salient determinants drawn from the research literature, were validated. The model incorporated such variables as Locus of Control, Professional Identity, and Femininity (personal variables); Role Conflict, Role Ambiguity, Workload, and Autonomy (organizational variables); and Self-esteem and Job Satisfaction (mediating variables). It was determined that nurses in this sample obtained from three major Ontario hospitals were indeed reporting levels of burnout. Further, the general staff nurses and critical care nurses reported differences in how they experienced that burnout. This information is particularly useful in developing programs to increase the quality of worklife for nurses. This study provides a foundation on which to expand the knowledge of burnout as a construct, its definition and its determinants. The study concludes with limitations and directions for future research.