Nursing

The purpose of this study is part of a larger three-phase project to develop recommendations and catalyze action for genomics-informed oncology nursing education and practice for the Canadian Association of Nurses in Oncology and the Canadian Association of Schools of Nursing. This phase aimed to enhance understanding of policy needs and action drivers for genomics-informed oncology nursing education and practice through the perspectives of Canadian oncology nurses and patient partners.

The learning initiative called the British Columbia Nursing Administrative Leadership Institute (BCNLI) for first line nurse leaders was developed to address the need for educating and mentoring new nurse leaders. The program was a joint project between the Ministry of Health Services Nursing Directorate, British Columbia’s Chief Nursing Officers and the School of Nursing at UBC. The BCNLI program is evidenced based and included information on leadership, management concepts and relevant issues for leaders, (MacPhee & Bouthillette, 2008). The front line nurse leaders who participated were provided education and mentoring, to increase their skills. The front line nursing leaders selected year long projects as part of the program. This study examined if there was any change to the types and scope of control of projects front line nurse leaders chose as part of learning and mentoring initiative. 211 nurse leaders’ projects from the BCNLI project data web pages were examined for scope of control, type of project, and Donabedian’s (1982) structure process outcomes framework using content analysis (Graneheim & Lundman, 2004). These projects provide a window to the types of issues that were relevant and seen as important to the front line nurse leader participants in each cohort of the BCNLI program from 2007 to 2010. This research found that there was no change between the nine cohorts as to structure or process coding. The majority of the projects were structure coded. The content analysis identified five main themes of recruitment/retenton, communication, education, care delivery evaluation, and tool development. The ability to identify the scope of projects of front line nurse leaders was important as very little research exists on scope of control for front line nurse leaders. Only 61% of the projects are at the nursing unit or front line (level two) position. There are concerns that front line nurse leaders were working beyond the nursing unit level. This research will help to understand if nurse leaders are taking on issues or problems that are beyond their roles and the type of projects that exist in the British Columbia Health Care.

Health personnel, especially nurses, are often victims of workplace violence. Unfortunately, little is known about the nurses' experience of violence. A research study was initiated to further explore the nurses' accounts of workplace violence so as to make dimensions of the nurses' experience visible and more fully understood. Interpretive description was the research methodology adopted for this study. Using theoretical sampling, ten Registered Nurses from the lower mainland and Vancouver Island, British Columbia participated in semi structured, audiotaped interviews. In this research, the nurses' experience of workplace violence emerged as a highly complex entity, deeply embedded in relationships and context. How nurses perceive the contextual factors of the organization, their immediate work environment and their individual attributes were found to play a significant role in how they respond to the phenomenon. The findings of this study suggest that organizational culture is an important determinant in managing workplace violence and that policy and administrative personnel play a pivotal role in influencing the problem. Nursing culture also influences the nurses' expectations, assumptions and actions towards violence. Participants voiced that role conflict often challenged their ability to enact acquired professional ideals and that that they routinely undertake roles in dealing with violence that are not appropriate to their level of knowledge or skill. Within the nurses' immediate work environment, bullying as well as physical and verbal abuse was commonplace. Overcrowding, long waits for service, poor environmental design and inadequate staff to patient ratios were seen as factors that increased nurses' risk. Individual factors were associated with emotional and psychological harms that nurses endured. Workplace violence affected self-concept, self-esteem, self-efficacy and the nurses' sense of control. Moral distress, self-blame, feelings of failure, loss of motivation and leaving the nursing profession were significant findings. The results of this study demonstrate a need to re-think how we can address workplace violence in nursing. Research and intervention is needed to further explore organizational policy and governing structures, the culture and climate of practice environments, and the fundamental role nursing education programs have in preparing nurses to manage workplace violence.

Objectives First to develop a short survey based on the 2004 Health Canada / Public Health Agency of Canada recommendations for key infection prevention and control (IP&C) structures and processes in long term care facilities and the five Institute of Medicine safety principles published in ‘To Err is Human’ (2000). Then, to establish the validity and feasibility of the survey when used to describe key IP&C structures and processes in LTC facilities within the context of the five safety principles. Methods This study was designed using a three-phase methodology. During Phase I, a conceptual model for IP&C was created to develop six structural and process composite indices. The concepts and components covered within each index were developed based on the 2004 Public Health Agency of Canada recommendations for IP&C programs in the LTC setting and a thorough literature review. During the second phase of the study, a group of 7 experts in LTC IP&C were recruited from BC’s Provincial Infection Control Network to validate and further develop the survey and one of these dropped-out at the beginning of the process. The five Safety Principles published in 2000 by the Institute of Medicine were also provided to the experts so they could be used to complement and further develop the concepts covered by the survey. The Delphi methodology was used in this phase of the study so that experts may reach consensus on modifications made to survey questions. The Delphi phase began in April and ended in October 2007; 114 worksheets were sent to experts to support the consensus-reaching process. Consensus was defined as 67% concordance of opinions and experts were given almost unlimited time to respond to worksheets. Once the validity of new survey questions had been established based on expert-group consensus in Phase II, a second draft of the survey was prepared and pilot-tested in Phase III. An invitation letter was sent to a random sample of 20 LTC facilities stratified by facility ownership and governance structure in Fraser Health. The 14 facility Senior Managers who agreed to participate were sent a cover letter and electronically fillable survey. An analysis of the validity of the survey questions and the feasibility of the use of the survey in a larger study was performed, and revisions were made to the survey based on the findings of this analysis. Conclusions The three-phase methodology used in this study was very useful and innovative way to further develop and validate the literature-based survey developed in Phase I for IP&C in long term care. In addition, by merging two bodies of knowledge and thought into the process, concepts and components that are not explicitly described in IP&C literature yet were felt to be key in program success, were incorporated into the measurement tool. Using Delphi, the experts expressed a need for IP&C professionals working in LTC to increase their knowledge, understanding and use of safety theory and strategies. They also felt that interdisciplinary work, the development of a culture of safety, and the development clear and simple IP&C systems are key ways in which infections can be prevented and outbreaks quickly controlled. In Phase III, the pilot-study analysis demonstrated the utility, validity and reliability of the survey. In addition, the analysis showed that there is a tendency for facilities to have lower levels of components within the Leadership Index and the ICP Index. If confirmed in a larger study, this would be a major concern as all studies and expert advisory bodies for both IP&C and safety state that a strong, dedicated and knowledgeable leadership is the key to program effectiveness. Further validation of the survey and score calculation methodology should now be performed when the survey is used in a larger study.