Showing papers in "Canadian Journal of Nursing Research Archive in 2004"

Are we missing anything? Pursuing research on attrition.

Abstract: Attrition, or loss of participants over the course of a study, presents a significant threat to the integrity of a longitudinal research study and theory development resulting from the study. Although there has been a recent resurgence of interest in attrition, it is an underreported and understudied phenomenon despite its potential to introduce bias. Internal and external validity, reliability, and statistical validity are all impacted by a small sample and, most likely, a non-randomness in the study sample. Development of a theory of attrition will assist researchers in development of sampling strategies that will enhance the quality of their data in longitudinal designs. An ecological theoretical model of research participation is proposed and described.

Designer's Corner/Le Coin du conceptur - Photovoice: Picturing the Health of Aboriginal Women in a Remote Northern Community

Abstract: The purpose of this paper, part of an evolving ethnographic doctoral study, is to describe the use of photovoice in exploring the health beliefs and health promotion practices of pregnant Tlicho women in Canada’s Northwest Territories. It is but a preliminary look at the method and its use in a remote community. What research methods are culturally appropriate for working with Aboriginal people? Photovoice, a technique based on participation, empowerment, and self-documentation, is a culturally appropriate method for conducting rural and remote health research. It is a way of capturing images of one’s everyday life experiences using a camera, then describing the images in the context of one’s life, thus allowing others to gain an insider’s view of everyday life in one’s community. In this paper we will describe how photovoice is being used as part of an ethnographic study, provide examples of its use, and describe lessons we have learned and challenges we have encountered. It has been said that a picture is worth a thousand words, but it is more than that.A picture is a way of gaining insight into the “humanness that surrounds us” (Collier & Collier, 1986, p. 1). In fact, Bach (1998) describes photographs as “mini-narratives.” It is this aspect of photography that drew our attention to the possibility of exploring its use as part of a research project with pregnant Tlicho women from a remote community in the Northwest Territories. The Tlicho (Dogrib) Nation is the largest Dene tribe in the Northwest Territories.The women who participated in the study were from the largest Tlicho community, which has a population of 1,864 (NWT Bureau of Statistics, 2001) and year-round road access to the city of Yellowknife. Meleis (1996) suggests that a true understanding of the health and illness status of a group can result only from the group’s own knowledge concerning its values, priorities, responses to life’s disruptions, perceptions CJNR 2004,Vol. 36 No 4,189–201

Adolescent Constructions of Nicotine Addiction

Abstract: The purpose of this qualitative study was to extend our understanding of how adolescents view nicotine addictionThis secondary analysis included 80 open-ended interviews with adolescents with a variety of smoking historiesThe transcribed interviews were systematically analyzed to identify salient explanations of nicotine addictionThese explanations presuppose causal pathways of nicotine exposure leading to addiction and include repeated use, the brain and body "getting used to" nicotine, personal weakness, and family influences A further explanation is that some youths pretend to be addicted to project a "cool" imageThese explanations illustrate that some youths see themselves as passive players in the formation of nicotine addictionThe findings can be used in the development of programs to raise youth awareness about nicotine addiction

Post-migration changes in gender relations among Ethiopian couples living in Canada.

Abstract: The Ethiopian community of Toronto, Canada, has identified the prevention of marital conflict and partner abuse as a priority issue. Previous research and community discussions suggested that changes in gender relations following migration contribute to both marital conflict and partner abuse. The objective of this community-based pilot study was to explore post-migration changes in gender relations among Ethiopian couples in order to inform the development of violence-prevention strategies. Qualitative research methods and analyses were used. In-depth interviews and focus-group discussions were conducted with 8 couples who had been married in Ethiopia and migrated to Toronto. The findings indicate changes in gender relations following migration as well as concordant and discordant patterns of change. Change was found to be associated with factors such as age, number of years married, experience in a third country, and gender-role socialization. Implications for future research and nursing practice are discussed.

Transitions, Continuity, and Nursing Practice

Abstract: Continuity of care is a term commonly used in nursing and in healthcare circles.The continuity-of-care concept is considered both an aim and a philosophy that affects the delivery of care. Most clinicians consider continuity a standard of care.The notion of continuity has been conceptually intertwined with discharge planning, transitional care, coordinated care, continuing care, and ongoing care. A distinction must be made between regular, ongoing sources of care, referred to as longitudinality, and the concept of continuity (Bedder & Aiken, 1994; Rogers & Curtis, 1980; Starfield, 1980).A definition that encompasses longitudinality, but also integration and comprehensiveness across transitions, with care provided over time in various episodes, is crucial. Consideration must be given to care activities (therapeutic and self-care) and linkages (communication, documentation, referrals, etc.) and the balance of care provision between professionals on the one hand and individuals and families on the other (Harrison, Browne, Roberts, Graham, & Gafni, 1999). For patients this means receiving the care they need, over time, in a coordinated and connected manner, with planned and supported continuity between the care they receive from professionals such as nurses and the care they may be assuming (or resuming) themselves. From a provider’s perspective, it means articulating transfer rather than admit and discharge, where responsibility typically begins and ends. Ideally it involves an in-reach and outreach that may not be formally funded or administered, by either the setting or the sector of care. To achieve continuity, settings and providers must make a proactive, systematic, intersectoral effort at the transition points. Continuity always involves transitions on the part of individuals, such as well to ill, home to hospital, and the gaps they may encounter along the way. For nurses, transitions are a focus of practice, as continuity involves transitions in care and affects mainly populations with complex health issues. During times of transition, the nurse is very often the health professional most involved in evaluation and in planning and delivering the change in care that is required. Complex health populations are charCJNR 2004,Vol. 36 No 2, 3–6

Nurses' construction of clinical situations: a study conducted in an acute-care setting in Norway.

Abstract: The purpose of this study was to describe the nature of clinical constructions that nurses make in their practice. The study was based on a qualitative descriptive design in an acute-care setting in Norway with a convenience sample of 6 registered nurses providing direct patient care. These nurses were considered typical staff nurses working in acute-care settings. Data were collected through observation of and in-depth interviews with participants during 3 full shifts for each nurse and also from nursing documents regarding the patients. Qualitative data analyses were carried out using a method that coalesces analyses of the parts with analysis of the whole. The findings revealed that nurses encounter patients and provide direct care by formulating pictures of encountered clinical situations with a specific way of "seeing," which the authors conceptualize as a comprehensive nursing gaze. This nursing gaze was the basis upon which the nurses arrived at clinical constructions. There is a need for further research to investigate how nurses differentiate the significance of information in arriving at clinical constructions, and to investigate aspects of the nursing gaze in various clinical settings.

Implementation, Uptake, and Impact of a Provincial Postpartum Program

Abstract: This paper examines implementation and uptake of the Hospital Stay and Postpartum Home Visiting Program at 5 sites in the Canadian province of Ontario using a cross-sectional survey. It also examines concomitant changes in satisfaction with services and maternal and infant health indicators by comparing the findings of this survey, administered after policy implementation, with those of a previous survey. In both surveys, data were collected via a self-administered in-hospital questionnaire and a structured telephone interview at 4 weeks postdischarge. There were statistically significant differences in implementation of the 60-hour hospital-stay option across sites, with between 11.7% and 81.2% of women having been offered an extended stay. However, there were no significant differences in acceptance rates (21.1-39.4%) among those women given this option. There were no statistically significant differences in the offer of a home visit by a public health nurse (91.5-96.6%), but there were significant differences in uptake of a visit. Between 21.1% and 39.4% of those women who were offered a home visit accepted. When compared to the previous survey findings, there were few changes in client satisfaction with services and health indicators following program implementation. This study raises questions about the utility of the postpartum program as currently implemented and highlights the need for further research.

Program structure and continuity of mental health care.

Abstract: Continuity has been a much discussed but under-researched objective of mental health care, in part due to measurement challenges. A small body of research has identified program features associated with continuity, based on measures of service use. A recent planning project provided an opportunity to examine the effects of these features on continuity using a new self-report continuity measure. Nine program features were measured and linear regression analyses were used to assess the relationship between these features and continuity, controlling for client characteristics. Client continuity was higher in programs that offered some night or weekend coverage and lower in programs that provided more care in the community. This latter finding was unexpected and may represent program efforts to engage individuals experiencing difficulties with service access. The association between each of the other 7 program features and continuity was not significant. Possible explanations for this finding are explored.

Choosing a model of care for patients in alternate level care: caregiver perspectives with respect to staff injury.

Abstract: The population of alternate level care (ALC) patients utilizing acute-care hospital resources inappropriate to their needs is growing. The purpose of this study was to explore how the care of ALC patients was managed at 4 acute-care facilities in the Canadian province of British Columbia and to examine how this care impacts on outcomes of staff injury. Interviews were conducted to identify and characterize the different models of ALC. Injury outcomes for all caregivers were obtained (n = 2,854) and logistic regression conducted to compare staff injuries across ALC models. Injured workers were surveyed regarding their perceptions of injury risk and ALC. Five ALC models were identified: low-mix, high-mix, dedicated ALC units, extended care units, and geriatric assessment units. The risk for caregiver injuries was lowest on dedicated ALC units.These findings suggest that acute-care facilities faced with a growing ALC population should consider creating dedicated ALC units.

Designer's Corner - Conceiving Action,Tracking Practice, and Locating Expertise for Health Promotion Research

Abstract: Background Health promotion is the process of enabling persons, families, neighbourhoods, communities, sectors, and societies to take action around the development and implementation of health determinants.The goal is to put health determinants in the control of individuals through programming that enhances health promotion action at many levels.The following actions are health promotional: building healthy public policy, reorienting health services, strengthening community action, creating supportive environments, and developing personal skills. A health promotion program that is based on the following principles has a good likelihood of succeeding: comprehensive cross-action programming that contextualizes efforts; participation by all stakeholders in all stages of development, implementation, and evaluation; and capacity building that includes advocacy, enabling, and mediating approaches (Stewart, 1999; Wass, 2000). In order to contribute to the health of Canadians, health promotion programming and research must take into account these actions and principles and the relationship among them. The evaluation of health promotion programming is based on several factors. First, the model selected must facilitate the conceptualization and implementation of both health promotion action, at all levels, and health promotion principles. Second, the practices associated with health promotion must be documented rigorously at all levels of action.Third, effective means of measuring the desired outcome — enhanced control over the determinants of health — must be developed and used.

Scholarship in Health Promotion: Complexity and Challenge

Abstract: Health promotion is an expanding interdisciplinary Ž eld of study and practice that is of central concern to the discipline of nursing.The papers included in this issue of the Journal speak to both recent developments in the Ž eld and nursing’s contribution to them. In CJNR’s Ž rst focus issue on health promotion, published some 7 years ago, O’Neill (1997) suggested that nursing has been on the periphery of health promotion discourse and practice and that its apparent lack of in uence stems, in part, from an individualistic orientation that fails to consider the broader context in which health develops.The extent to which this perspective was valid then or is valid now is a matter of debate. However, the papers included in this focus issue of CJNR offer some current insights into the question. The papers included in this issue highlight the complexity and range of interests in the Ž eld of health promotion and re ect the perspectives of authors who are situated both within and outside of nursing. Collectively, the papers address the breadth of knowledge needed to understand the processes by which people take control of their health and improve their quality of life (World Health Organization, 1986) as well as the practices that may be used by professionals to support these efforts. There is a decidedly ecological emphasis across these papers, and a conscious effort to consider the interactions between people and their social worlds. Two qualitative studies included in this issue provide a glimpse into people’s health experiences in the context of their everyday lives that is foundational to health promotion practice. Bottorff et al.’s analysis of the ways in which adolescents come to think about and understand nicotine addiction highlights their varied and sometimes competing explanations and raises questions about their sense of personal agency to avoid or overcome such addiction. Similarly,Ward-GrifŽ n’s feminist study of the experiences of nurses who Ž nd themselves in both professional and family caregiving roles illustrates the bind that can occur when women must constantly negotiate the boundaries of their public and private CJNR 2004,Vol. 36 No 1, 9–11

Innovative Methodology - Personal Construct Theory: A Strategy for the Study of Multidimensional Phenomena in Nursing

Abstract: Nursing research is characterized by the study of complex phenomena relative to health behaviours, health-care services, illness, and hospitalization events.The challenge for researchers is to accurately capture and analyze multidimensional phenomena in the context of a dynamic interplay of events and interactions in clinical settings.Traditional methodologies measure a variety of concepts using strategies such as observation and questionnaires that rely on descriptive and inferential statistical analysis. However, the dynamic interplay of experiences, perceptions, and meanings in the social context of the clinical setting is more difficult to examine using these methodologies. In a recent study, an innovative, multidimensional theory and accompanying methodology were employed to examine parents’ experiences in the dynamic social context of the hospital setting. Personal Construct Theory, with its accompanying methodology, Repertory Grid Technique, is a new approach (based on an old theory) to nursing research that is especially well suited to the study of complex, multidimensional research questions. Implications for nursing research, theory development, and practice will be examined relative to the utility of Personal Construct Theory.

Designer's Corner - Enhancing Continuity of Care Through Outcomes Measurement

Abstract: Outcomes research seeks to link the care that people receive to the outcomes they experience. It is considered the key to developing better ways to monitor and improve the quality of health care (Agency for Healthcare Research and Quality, 2000). Outcomes assessment is conducted largely through the use of administrative and clinical databases (Jefford, Stockler, & Tattersall, 2003). Because of the fragmentation of health-care services, there are significant challenges associated with the evaluation of outcomes across the continuum of care. Our ability to accurately and consistently track patients’ outcomes as they transition through care is important for both outcomes research and care management. The timely and accurate transfer of data on the patient’s condition and on the management of the patient’s health problems across the continuum of care is an important component of continuity of care (Canadian Council on Health Services Accreditation, 1997; Harrison, Browne, Roberts, Graham, & Gafni, 1999; Hennan, 1975; Lou, 2000; Reid, Haggerty, & McKendry, 2002; Rogers & Curtis, 1980). The patient’s response to a health intervention is critical and should be communicated so that appropriateness of care can be evaluated and so that health professionals have information on which interventions have and have not been effective for the patient.To that purpose, the Ontario Ministry of Health and Long-Term Care initiated the Nursing and Health Outcomes Feasibility Project (NHOP) with the object of building a database that contains better information about nurses’ contribution to health care than currently exists.A team of researchers received funding to evaluate the feasibility of instituting outcomes data collection by nurses at the point of care in four health-care sectors: acute care, home care, complex continuing care, and long-term care (Doran et al., 2004). This project represented an excellent opportunity for researchers to explore issues in assessing patient outcomes across the continuum of care. These issues and what we have learned about outcomes measurement across the continuum of care are described below. CJNR 2004,Vol. 36 No 2, 83–87