Showing papers in "Revue canadienne de recherche en sciences infirmières in 2005"

The Relevance of Postcolonial Theoretical Perspectives to Research in Aboriginal Health

Abstract: The authors critically examine the relevance of postcolonial theoretical perspectives to nursing research in the area of Aboriginal health. They discuss key theoretical underpinnings of postcolonial theory, citing differences and commonalities in postcolonial theory, postcolonial indigenous thinking, and other forms of critical theory. Drawing on insights from Aboriginal scholars, they critique the relevance of postcolonial discourses to issues of concern to Aboriginal peoples, and the potential limitations of those discourses. They then consider the implications of conducting research that is informed by postcolonial perspectives. They argue that postcolonial perspectives provide direction for research with Aboriginal communities in 4 interrelated ways. These are focused on (a) issues of partnership and "voice" in the research process, (b) a commitment to engaging in praxis-oriented inquiry, (c) understanding how continuities from the past shape the present context of health and health care, and (d) the colonizing potential of research. The authors draw attention to the concept of cultural safety as an instrument for incorporating postcolonial perspectives into the realm of nursing. To illustrate applications of postcolonial theory, they give examples from recent research conducted in partnership with Aboriginal communities. Although postcolonial theories are relatively new in nursing discourses, they provide a powerful analytical framework for considering the legacy of the colonial past and the neocolonial present as the context in which health care is delivered.

Profiling Canadian nurses' preferred knowledge sources for clinical practice.

Abstract: Several researchers have examined nurses' knowledge sources within the context of research utilization, but conclusions are equivocal Common problems include a lack of replication, conflicting results, poor generalizability of results, and unclear implications for practice The objectives of this study were to: (a) describe sources of knowledge and their frequency of use among staff nurses across 7 surgical units, (b) compare knowledge-source patterns across the units, (c) determine whether knowledge-source preferences correlate to research utilization scores, and (d) profile staff nurses' knowledge-source patterns over time A total of 230 nurses in 5 adult and 2 pediatric surgical units from 4 hospitals in the Canadian provinces of Alberta and Ontario completed a self-administered survey The results were compared to the findings of previous studies Nurses' knowledge-source preferences were consistent across the 7 units despite differences in education and in research utilization scores Across all units, nurses preferred to use knowledge gained through personal experience and interactions with co-workers and with individual patients rather than journal articles or textbooks These findings are consistent with the longitudinal comparison in the 2 earlier studies In contrast to the knowledge privileged by nurse clinicians, researchers tend to place greater value on research-based knowledge than on experience-based knowledge To increase research utilization in the practice setting, researchers and others need first to understand the reasons behind clinicians' valuing of experiential and social knowledge sources and then to consider research dissemination and implementation strategies that are more closely aligned with clinician preferences

Discourses influencing nurses' perceptions of First Nations patients.

Abstract: This study explores the social and professional discourses that influence nurses' knowledge and assumptions about First Nations patients. Through the use of an ethnographic design, in-depth interviewing, and participant observation, data were collected over a 9-month period of immersion in a midsized hospital located in western Canada. Purposive sampling was used to recruit 35 participants: nurses, First Nations women who were patients in the hospital, and key informants with expertise in Aboriginal health. The findings indicate that 3 overlapping discourses were shaping nurses' perspectives concerning the First Nations women they encountered: discourses about culture, professional discourses of egalitarianism, and popularized discourses about Aboriginal peoples. Cultural assumptions were intertwined with dominant social stereotypes and were sometimes expressed as fact even when they conflicted with egalitarian ideals. Conclusions highlight the need for strategies to help nurses think more critically about their understandings of culture, the sociopolitical context of health-care encounters, and the wider social discourses that influence the perspectives of nurses.

Transforming hope: how elderly palliative patients live with hope.

Abstract: Hope is important to palliative patients; however, the process by which these patients live with hope is unknown. The purpose of this study was to describe, using a grounded theory approach, the processes by which palliative patients live with hope. Sixteen interviews were conducted with 10 home-care palliative patients (mean age 75 years) in their homes using open-ended questions. The participants defined their hope as expectations such as not suffering more and having a peaceful death. They described their main concern as wanting to "live with hope" and they achieved this through the basic social process of transforming hope. Transforming hope involved acknowledging "life the way it is," searching for meaning, and positive reappraisal. The results of this study provide a foundation for future research and the development of interventions to engender hope in older palliative patients.

A qualitative investigation of seniors' and caregivers' views on pain assessment and management.

Abstract: The literature suggests that pain in the elderly, especially among seniors with dementia, is under-assessed and under-treated. This qualitative study solicited the perspectives of seniors, front-line nursing staff, nursing-home administrators, and informal caregivers of seniors with dementia on the current status of pain assessment and management. The views of these participants complement the research findings reported in the literature. While some of their explanations and potential solutions concerning under-treatment of pain in seniors echo views that have been presented in the literature, the participants also pointed to factors and avenues that have been given less formal consideration (e.g., systemic barriers to effective assessment and treatment of pain). They also highlighted the need for pain-control strategies beyond medication. The implications of these findings are discussed.

Missing data: an introductory conceptual overview for the novice researcher.

Abstract: Missing data is a common issue in research that, if improperly handled, can lead to inaccurate conclusions about populations. A variety of statistical techniques are available to treat missing data. Some of these are simple while others are conceptually and mathematically complex. The purpose of this paper is to provide the novice researcher with an introductory conceptual overview of the issue of missing data. The authors discuss patterns of missing data, common missing-data handling techniques, and issues associated with missing data. Techniques discussed include listwise deletion, pairwise deletion, case mean substitution, sample mean substitution, group mean substitution, regression imputation, and estimation maximization.

A profile of registered nurses in rural and remote Canada.

Abstract: Research on nursing practice issues in rural and remote areas of Canada is very limited. This report describes the method and initial results of a comprehensive survey of registered nurses (RNs) practising outside the commuting zones of large urban centres, designed to determine: who practises nursing in rural and remote Canada; the nature and scope of their nursing practice; and their satisfaction with their work, community, and practice supports. Using a mailed questionnaire with persistent follow-up, the data-collection frame included a stratified random sample of rural RNs and the full population of RNs who worked in the northern territories and outpost ("remote") settings. The analyses focus on regional comparisons of demographics and primary work settings and on provincial comparisons of satisfaction levels related to work and community. The survey is part of a larger multi-method project intended to inform policy on rural nursing practice in Canada.

The effects of nursing turnover on continuity of care in isolated First Nation communities.

Abstract: Many of Canada's northern First Nation communities experience difficulty recruiting and retaining appropriate nursing staff and must rely on relief nurses for short-term coverage. The latter often are not adequately prepared for the demanding nature of the practice. This study examined the consequences of nursing turnover on the continuity of care provided to residents of three Ojibway communities in northern Ontario. The findings are based on a review of 135 charts of oncology, diabetes, and mental health clients, and on interviews with 30 professional and paraprofessional health-care providers who served the communities. Nursing turnover is shown to detrimentally affect communications, medications management, and the range of services offered; it also results in compromised follow-up, client disengagement, illness exacerbation, and an added burden of care for family and community members.

Social and geographical boundaries around senior nurse and physician leaders: an application of social network analysis.

Abstract: The purpose of this study was to describe the social and geographical boundaries around the networks of senior nurse executives and physician leaders and managers in acute-care hospitals in the United Kingdom. A telephone survey was conducted using standard social network methods. A random sample was drawn from a national list and repeatedly sampled until 100 respondents were interviewed. The response rate was 49.5%. Both groups tended to discuss "important professional matters" with others who were similar to themselves in terms of profession, gender, age, and seniority, with physicians being more extreme in this regard. The implication is that gaps in the network of informal ties will impede the dissemination of information and the spread of social influence between these 2 important groups. Managers (non-clinically qualified) appear to occupy a powerful "brokerage" role. Informal networks are mainly composed of local ties. The authors argue that dissemination and influence strategies that take features of the social structure into account are more likely to be successful.

Determinants of health-service use by low-income people.

Abstract: Poverty influences health status, life expectancy, health behaviours, and use of health services. This study examined factors influencing the use of health-related services by people living in poverty. In the first phase, 199 impoverished users of health-related services in 2 large Canadian cities were interviewed by their peers. In the second phase, group interviews with people living in poverty (n = 52) were conducted. Data were analyzed using thematic content analysis. Diverse health-related services were used to meet basic and health needs, to maintain human contact, and to cope with life's challenges. Use of services depended on proximity, affordability, convenience, information, and providers' attitudes and behaviours. Use was impeded by inequities based on income status. To promote the health of people living in poverty, nurses and other health professionals can enhance the accessibility and quality of services, improve their interactions with people living in poverty, provide information about available programs, offer coordinated community-based services, collaborate with other sectors, and advocate for more equitable services and policies.

Comparing the Health Services Utilization of Long-Term-Care Residents, Home-Care Recipients, and the Well Elderly

Abstract: Research has typically supported the concern that health services utilization increases with aging. Yet most health services utilization studies have focused on the use of 1 as opposed to all health services, the use of health services over 1 year as opposed to a longer period, and the use of health services during the 1970s or 1980s. Current, comprehensive utilization studies are needed in order to better inform health policy and health services decision-making. This study was designed to compare the health services utilization of 3 groups of seniors: those residing in long-term-care (LTC) facilities, those receiving home care, and those neither institutionalized nor receiving home care. Individual-anonymous and population-based inpatient hospital data, ambulatory care (day surgery, outpatient clinic, and emergency room) data, and physician services data collected by the health ministry of the Canadian province of Alberta over a 2-year period were analyzed using descriptive and comparative statistical tests available in the SPSS computer program. With the exception of physician and LTC services, LTC residents were the least likely to use health services. Furthermore, and despite concerns that LTC residents may be stigmatized or rationed with regard to access to tertiary care, the data indicate that LTC residents are not disadvantaged in terms of type or scope of hospital services. These and other findings suggest an appreciation for LTC in managing both the health and the care needs of the oldest seniors. The findings also raise concerns about the adequacy of formal home care and of the health care received by the well elderly.

Registered nurses working alone in rural and remote Canada.

Abstract: This paper describes the demographics of Registered Nurses (RNs) who work alone in rural and remote Canada, their workplaces, and the benefits and challenges of this unique nursing employment situation. Data presented are from a national survey, one of 4 principal approaches used in conducting the project The Nature of Nursing Practice in Rural and Remote Canada. Of the total survey sample, 412 nurses (11.5 %) were employed as the only RN in their work setting. Variables of interest included level of education, employment setting, and regional distribution of workplaces. An exploration of predictors of work satisfaction confirmed previous research findings with respect to the importance of continuing education and face-to-face contact with colleagues. Findings from this analysis may inform policy decisions regarding the employment of RNs in rural and remote Canada.

So, what do we mean by "rural," "remote" and "northern"?

Abstract: At the stroke of midnight on December 31, 2000, the residents of the homes dotted along the western shores of Kukagami Lake suddenly became “urban.” Minutes before, they and their neighbours in the unincorporated township of Rathbun had been “rural.” Kukagami Lodge, advertising “northern” and “remote” wilderness experiences for its guests, is now located in one of the 27 largest urban centres in Canada — that is, it is now located within a census metropolitan area. Rathbun Township has been amalgamated into the new City of Greater Sudbury in northern Ontario. So, what do we mean by the terms “rural,”“remote,” and “northern”? Thankfully, the guest editor for this issue of the CJNR has not asked me to answer these questions. Rather, she has invited me to provide some personal reflections on the methodological issues surrounding the defining of these terms in the context of rural health research in Canada. Over 20 years ago Bosak and Perlman (1982) reviewed 178 articles on rural mental health and sociology, and found that 43% of them did not even include a definition of rural. In discussions on physician practice locations, recruitment, and retention published in the Journal of Rural Health between 1993 and 1995, there are wide variations in how rural is defined (Ricketts & Johnson-Webb, 1997). Reviews (Pitblado & Pong, 1999;Williams & Cutchin, 2002) of more recent literature suggest, perhaps overly pessimistically, that there are almost as many definitions of rural as there are researchers (Pong & Pitblado, 2001). There does, however, seem to be general acceptance of the notion that the approaches to defining rural fall into two categories: technical and social (du Plessis, Beshiri, Bollman, & Clemenson, 2001; RyanNicholls & Racher, 2004).These categories are used below to reflect on some of the difficulties that surround defining rural.As a footnote, the technical approaches are often referred to as “geographical.”While I have also used this terminology in the past, I have substituted the word techCJNR 2005,Vol. 37 No 1,163–168

Unit culture and research-based nursing practice in acute care

Abstract: The purpose of this multiple-case study of research utilization (RU) was to examine whether and how nursing practices in acute-care units are built on research and to identify potential explanations for the observed patterns. Open-ended data were collected from staff nurses and nursing leaders on 8 acute-care units through interviews and observation. RU varied within and across units, but unit culture emerged as the principal factor linked to patterns of RU. Unit-culture themes that formed the links were harmony of research perspective, motivation to learn, goal orientation, creativity, critical inquiry, mutual respect, and maximization of resources. The findings provide a rich description that could serve as a basis for self-assessment of unit culture in inpatient and outpatient acute-care units.

Critical analysis of the evolution of a Canadian nurse practitioner role.

Abstract: The purpose of this paper is to critically analyze the evolution of a nurse practitioner (NP) role in Canada using the province of Ontario as an example. Two theoretical models are used to highlight the historical development of this role and provide direction for further NP role development. The evolution of the NP role encompasses 2 critical phases: initiation and discontinuation (early 1970s to mid-1980s) and establishment and impasse (early 1990s to the present). Current barriers to the full integration of NPs within primary health care include the lack of a workable and stable funding plan for NPs, restrictions on scope of practice, work-related tensions between physicians and NPs, and lack of public and professional awareness of the role. Nurses can address these barriers through advocacy, lobbying, and public education.

Innovations and Issues in the Delivery of Continuing Education to Nurse Practitioners in Rural and Northern Communities

Abstract: This paper addresses the need to provide rural nurse practitioners (NPs) with the distance education that is considered vital to the upgrading of their professional skills. The method of delivering the courses is a critical aspect of their success. The authors trace and describe the innovative delivery of the Rural Ontario Nurse Practitioner Continuing Education Initiative, from the initial needs assessment study through to the implementation and evaluation study. In each study, a multi-method action research model was used. The respondents showed a preference for face-to-face modalities that were perceived to be constrained by barriers. These barriers were subsequently addressed by the pilot project. Those living in rural areas recognized the benefits of information technologies. Implementation was effectively weighted on multiple modes of online course delivery and the use of constructivist pedagogy. The findings suggest that the delivery of continuing education to rural and remote NPs is still wrought with challenges.

Lives of rural women after myocardial infarction.

Abstract: This study examines the influences of rurality on the lives of women postmyocardial infarction (MI). Using a critical ethnographic approach, the researchers analyze in-depth interviews with 12 women from southwestern Ontario, Canada, for the ways in which their experiences were related to social, political, and cultural forces associated with rurality. Data analysis revealed 4 themes: reticence, characterized by a tendency to minimize worry and accept one's life post-MI; referral games, or the challenges associated with accessing tertiary care; resourcefulness in managing one's recovery; and relationships, with rural health professionals and institutions being highly valued. The findings have relevance for nurses in both rural and urban settings who care for women postMI and form a basis for supporting and building culturally specific post-MI care.

Self-Determination: Analysis of the Concept and Implications for Research in Palliative Care

Abstract: This paper analyzes the evolution and the definition, current use, and application of the concept of self-determination in palliative care research and practice. Undertaken as a foundation for the development of a palliative care research program, the analysis considers selected historical, bioethical, legal, clinical, and relevant medical and nursing health-care literature on adults with chronic and terminal illness. Based on a synthesis of the literature, a conceptual definition is proposed and ways of integrating the concept of self-determination into palliative care intervention research are identified.

Establishing roles in genetic nursing: interviews with Canadian nurses.

Abstract: The purpose of this qualitative study was to describe nurses' roles in providing clinical genetic services related to adult onset hereditary disease and factors that influence genetic nursing practice in Canada. The study involved semi-structured telephone interviews with 22 nurses from 5 Canadian provinces with full-time or part-time roles in providing genetic services. The interviews included open-ended questions to elicit descriptions of genetic nursing roles and factors that support and limit opportunities in genetic nursing practice. Thematic analysis of the transcribed interviews revealed that, in addition to genetic counselling, the nurses reported a wide range of roles and responsibilities related to the provision of genetic services that drew directly on their nursing background (e.g., patient assessment, health promotion). Factors identified as supporting genetic nursing roles included nursing background, being part of a multidisciplinary team, and receiving mentorship. Challenges in establishing roles in genetic nursing were related to role ambiguity, lack of recognition of nursing expertise, limited availability of genetics education, isolation, and instability of nursing positions. Recommendations to support the development and expansion of genetic nursing practice were identified. A coordinated national effort among all stakeholders is needed to provide the resources necessary to support the appropriate and effective use of nursing expertise as genetics is integrated into the Canadian health-care system.

Rethinking emancipation and empowerment in action research: lessons from small rural hospitals.

Abstract: A primary goal of action research is social change that is driven largely by the research participants. A major assumption is that through the research process, participants are enabled to take knowledgeable action in their personal, work, or community environments, and that through this action they experience empowerment. Another is that action becomes possible as a result of enlightenment and emancipation through participation in the research. These assumptions were called into question during the course of an interpretive action research study conducted with nurses employed in 3 small rural hospitals in northern British Columbia, Canada. Examination of the issues that emerged during the study illuminates the ways in which nurses' professional and community lives are intertwined. This interconnection provoked a re-examination of how empowerment and emancipation can be realized by nurses in small rural hospitals.

Categorical service allocation and barriers to care for children with chronic conditions.

Abstract: Parents raising children with chronic conditions face the challenge of locating and coordinating appropriate community-based resources and services for their child. The purpose of this secondary analysis was to determine parents' view of the mechanisms used to allocate health, education, and social services to children with chronic illness and disability and their caregiving families. A thematic analysis was conducted on data from interviews with 30 mothers and 13 fathers. These parents described 11 mechanisms that were used to determine eligibility and/or to ration services: diagnosis, age, technology dependence, severity, functional ability, guardianship status, geographic location, financial resources, judged parental coping, failure to inform parents about available services, and cyclical funding. These mechanisms were complex, inconsistent, and subject to change. Mechanisms that are integrated, proactive, flexible, and fair are needed to reduce parents' workload and to ensure more equitable allocation of services.

Rural health research: building capacity and influencing policy in the United States and Canada.

Abstract: The majority of health services research in the United States has been deeply enmeshed in the financing of health care, which may partly explain the limited exchange between researchers in the United States and those in countries with very different funding systems. Rural health research, on the other hand, has been concerned more with access, regardless of how services are funded, and should offer more opportunities for international exchange. Rural health research means different things to different folks.Those accustomed to thinking about research in terms of randomized clinical trials, or at least in terms of a quasi-experimental design, in which an intervention is assessed for its effect on outcomes, may be surprised to learn of the large body of funded research that makes little or no use of such methods.The former approach to health services research is not primarily concerned with the geography of the patients or clinicians. If there is any acknowledgement that geography may have some influence on outcomes, it is addressed by including a dichotomous urban-rural variable in a multivariate analysis.The primary question in such studies concerns the clinical intervention, not the place. In contrast, much of the rural health research currently funded in the United States is undertaken not to discover effective clinical interventions but to discover effective policy interventions.Those who labour in this vineyard have fashioned their research portfolios to address how rural is different, why rural is different, and, in most cases, whether the differences merit a policy intervention. In a recent publication (Hartley, 2004), I argue that rural health research is a field that has come into maturity in the United States, as evidenced by the existence of its own journal (for the past 14 years) as well as two sentinel publications that have served to establish and to some CJNR 2005,Vol. 37 No 1,7–13

Factors to weigh when considering electronic data collection.

Abstract: Researchers are increasingly considering the adoption of electronic data-collection methods--which entail the use of the Web, e-mail, and desktop and handheld computers--for surveys, diaries, research instruments, and focus groups. Based on prior research findings on electronic data collection, the authors delineate the key factors, which incorporate population, data, and resource characteristics, that guide researchers in selecting the data-collection method most appropriate for their research question. Population factors to consider in data-collection decisions are age, gender, socio-economic status, and access to technology. Key data factors influencing the selection of collection method include sensitivity of the topic, time sensitivity, longitudinal data, and contextual data. Data-collection decisions are also based on financial, time, and technological resources. Technology and demographics will continue to change and affect data-collection methods and possibilities. By examining these key factors, however, researchers will be able to reach data-collection decisions that are appropriate for each project.

Dementia care in rural and remote areas: the first year of a CIHR new emerging team.

Abstract: The Canadian Institutes of Health Research (CIHR) New Emerging Team (NET) program was designed to provide 5 years of support for the creation of new teams or the development of existing teams of investigators conducting collaborative multidisciplinary research in identified areas of focus. A NET group at the University of Saskatchewan was funded under the Cognitive Impairment in Aging focus for a project titled Strategies to Improve the Care of Persons with Dementia in Rural and Remote Areas. In this article we describe the research program developed by the team and implemented during the first year of our mandate.

For work and for school: internal migration of Canada's rural nurses.

Abstract: Using data from the Registered Nurses Database and a recently conducted national survey, this study examined the internal migration patterns of Canadian-educated rural RNs. Inter-provincial migration rates, ranging from 11% to 27% depending on the database used, mask much wider variations in sub-provincial movement rates, which are particularly relevant when considering the provision of nursing services in rural and remote communities. Rural RNs are more likely to migrate if they are female, older, working in nursing stations, and living in remote communities. A majority of RNs whose migration is associated with going to school after their initial nursing education do not return to the jurisdiction where they were first registered. Targeted migration studies are needed to fully understand both the detailed patterns and the predictors of such movements in order to better assess recruitment and retention policies and to enhance our overall health human resources planning models.

Enhancing Health-Care Research: An Interdisciplinary Collaborative Approach

Abstract: Many research programs tackle complex problems that cannot be comprehensively investigated by a sole researcher or a research team from a single profession. Interdisciplinary teams can develop a collective mass of common knowledge, broaden the scope of research, and produce more clinically relevant outcomes that are sensitive to the realities of practice. The authors describe the experience of a research team from the perspective of its members. The purposes of the paper are to highlight the benefits of an interdisciplinary collaborative approach to research and to describe the characteristics of a successful team. Some of the benefits discussed include increased research productivity and quality, professional development and mentorship, support and encouragement, expanded resource networks, and bridging of the gap between academia and practice. The authors also discuss the characteristics of a successful research team, associated challenges, and recommendations for enhancing research endeavours through collaboration.

Aboriginal Health Human Resources Initiatives: towards the development of a strategic framework.

Abstract: Every province and territory in Canada is experiencing a shortage of health human resources (HHR).This shortage is also evident in Aboriginal communities and in the delivery of health services to Aboriginal people in urban centres.The Royal Commission on Aboriginal Peoples (1996) recommended that 10,000 health professionals be educated over the succeeding decade. In September 2004, following their annual meeting, the First Ministers announced a Pan-Canadian Health Human Resources Strategy with four main components: HHR Planning, Inter-professional Education for Collaborative Patient-Centred Practice, Recruitment and Retention, and Aboriginal HHR Issues.The HHR Strategy seeks to create a stable health-care workforce with an appropriate number and mix of health professionals as well as a renewed and revitalized health system that provides care to Canadians when they need it, regardless of their geographical location. Because of the poor health indicators among Aboriginal peoples compared to the Canadian population at large, and because of particular issues related to the need for both Aboriginal and non-Aboriginal HHR, governments committed $100 million to an Aboriginal Health Human Resources Initiative (AHHRI). Funding for the Strategy was agreed upon (at $20 million annually) for a 5-year period commencing in 2003–04.The purpose of AHHRI is to

Community partnerships: translating research for community development.

Abstract: The foundation of partnerships, the bond that sustains relationships, and the mechanism for community action is open dialogue. Effective dialogue nurtures partnerships, mobilizes citizens, and is ultimately a cornerstone of community development. In a partnership, sharing of information is both fundamental and reciprocal. Partners learn from each other, discover new knowledge, and come to new understandings through their work together. Knowledge transfer can be particularly productive when community members and university researchers partner (Walsh & Annis, 2003) in order to undertake participatory action research (PAR) with a goal of community development, a discussion of which is the focus of this paper.