<p><strong>Abstract</strong></p> <p>Health care practice environments are central to the safety and quality of patient care. Hospitals often develop and implement a professional practice model (PPM) to improve practice environments. In the United States, magnet hospital designation is a driving force in PPM implementation. In Ontario, Canada, despite the lack of magnet hospital designation, many hospitals have implemented PPMs. There appear to be differences in how PPMs are implemented in Ontario.</p> <p>This phenomenographic study examined professional practice experts’ conceptions of PPM implementation and use in Ontario acute care hospitals. The findings indicate that PPM implementation is a dynamic and emergent phenomenon that occurs in cyclical phases of growth and reduced activity.</p> <p>Seven categories of PPM use are described (a) creating alignment/consistency, (b) supporting evidence-based practice, (c) enabling interprofessional practice, (d) enhancing professional accountability, (e) enabling patient-centred care, (f) creating/ strengthening linkages, and (g) strategic positioning of professional practice. Categories exhibited hierarchical relationships, with more foundational uses providing support for higher level uses.</p> <p>Three structural themes are identified (a) model design/structure, (b) professional practice leadership, and (c) organizational support. These themes work individually and synergistically, within and across the categories to influence use and potential impact of the PPM. Progressively fuller and more complex use of the PPM appears to occur under increasingly intense influence of the structural themes.</p> <p>The analysis provides unique information about relationships within and among categories of PPM use. This provides insight regarding how organizations might maximize return on investment with PPM implementation. Seven recommendations are identified.</p> / Master of Science (MSc)

Rapid changes in the healthcare environment increase the need for nurse practitioners to be motivated, knowledgeable and skilled in order to ensure quality patient care. Accident and emergency units are challenging environments and by ensuring that nurse practitioners work in an enabling environment, they should be motivated, skilled and knowledgeable and be able to think critically to enhance their own professional growth and emancipated practice. This in turn may increase the nurse practitioners’ job satisfaction, which in turn encourage job retention and may influence patient outcomes positively. A journey towards a shared vision namely “emancipatory practice development” was undertaken in an accident and emergency unit of a Level III public hospital. Following the diagnosis of an emergency situation, action research was applied to change the perceived toxic environment to an enabling environment. The study was conducted within the critical social theory paradigm and descriptive, explorative and contextual in nature. Both qualitative and quantitative approaches were utilised. Throughout the action research for practitioners project, collaboration enhanced the emancipation of the nurse leaders, as key drivers of the process, as well as the nurse practitioners. Short and long-term actions were planned, implemented and amended based on observations and reflection following each cycle of the project. During this process a toxic environment was changed to an enabling environment, in which nurse practitioners were retained and additional spin-offs followed. Guidelines for the application and implementation of the process as utilised in this study were compiled to guide others who experience similar challenges. / Health Sciences / D.Litt. et Phil. (Health Studies)

Rapid changes in the healthcare environment increase the need for nurse practitioners to be motivated, knowledgeable and skilled in order to ensure quality patient care. Accident and emergency units are challenging environments and by ensuring that nurse practitioners work in an enabling environment, they should be motivated, skilled and knowledgeable and be able to think critically to enhance their own professional growth and emancipated practice. This in turn may increase the nurse practitioners’ job satisfaction, which in turn encourage job retention and may influence patient outcomes positively. A journey towards a shared vision namely “emancipatory practice development” was undertaken in an accident and emergency unit of a Level III public hospital. Following the diagnosis of an emergency situation, action research was applied to change the perceived toxic environment to an enabling environment. The study was conducted within the critical social theory paradigm and descriptive, explorative and contextual in nature. Both qualitative and quantitative approaches were utilised. Throughout the action research for practitioners project, collaboration enhanced the emancipation of the nurse leaders, as key drivers of the process, as well as the nurse practitioners. Short and long-term actions were planned, implemented and amended based on observations and reflection following each cycle of the project. During this process a toxic environment was changed to an enabling environment, in which nurse practitioners were retained and additional spin-offs followed. Guidelines for the application and implementation of the process as utilised in this study were compiled to guide others who experience similar challenges. / Health Sciences / D.Litt. et Phil. (Health Studies)