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The Ontario Heart Health Program has completed Phase I of a province-wide cardiovascular disease prevention program that employs community-based coalitions. Full-time heart health coordinates support the coalitions, but many coordinators left during Phase I, reducing coalition membership and compromising functioning. This thesis employed focused ethnography to explore the role, and turnover among heart health coordinators. A selective document review and thirteen telephone interviews with coordinators, chronic disease managers and coalition members from five different health units, found coordinators were challenged by: (1) an atypical job, (2) a lack of knowledge/experience (3) overwork, (4) a lack of support and recognition, and (5) coalition responsibilities. Coordinators required an understanding of the organizational structures, mandates, and funding requirements of the health unit, and the Ministry of Health and Long Term Care so they could mediate conflict, build relationships and advocate for heart health coalitions. Implications for education, practice, research and policy are discussed.

Background. In Ontario, the 1994 Tobacco Control Act allowed municipalities to legislate on second-hand smoke in public places. Public health departments were then mandated to promote the passage of smoke-free bylaws in various municipalities. Their efforts have met with varying degrees of success. However, in 2001, the city of Ottawa public health department successfully promoted the adoption of one the cornerstone 100% smoke-free bylaw in Canada. Objective. The purpose of this study was to examine the factors that influenced the process of municipal councillors' adoption of the Ottawa smoke-free bylaw. Methods. This mixed-methods case study focused on the public participation aspect of the case through the analysis of interviews, public opinion surveys and newspaper articles using qualitative, quantitative and triangulation methods. Findings. The study identified four critical elements in the passage of the smoke-free bylaw: (1) Initiation of the bylaw development process, (2) Municipal councillors' position before the final vote, (3) Municipal councillor's final vote and (4) Municipal councillors' position after the final vote. Five lever factors (1) Perceptions of public opinion, (2) Public participation, (3) Dynamics of the democratic process, (4) Context of the smoke-free bylaw development and (5) Context of newness were found to have influenced the critical elements, each in a particular way. Lever factors are presented as characteristics of the context of the bylaw adoption that increased the effect of the strategies and interventions conducted by the groups supporting the passage of the bylaw. Discussion. This case study identifies conditions that enhance the leverage of tobacco control strategies and highlights how the convergence of factors is key to successful tobacco control policy change at the municipal level.

Cette étude descriptive transversale, visait à verifier les connaissances relatives à trois types d'aphasie (Broca, Wernicke et globale) et l'expression des comportements jugés perturbateurs par le personnel soignant en CHSLD auprès de résidents ayant des troubles de communication de type aphasique suite à un AVC selon la fréquence, le moment du jour et l'élément déclencheur. L'échantillon (N = 58) était subdivisé en professionnels et non professionnels. Les résultats fournissent des profils selon les données socio-démographiques, les connaissances et l'expression des comportements rapportés par les soignants en termes d'agressivité physique, verbale, cris, demandés et mouvements répétitifs. Les connaissances et des comportements perturbateurs rapportés ne diffèrent pas significativement selon les catégories de personnels soignant et les correlations entre l'expérience et les connaissances sont quasi nulle. L'implication de cette étude pour la pratique démontre l'importance de la formation du personnel afin de gérer et de prévenir l'expression des besoins des résidents par des comportements jugés perturbateurs.

Purpose. To determine the relationship between maternal confidence, maternal characteristics and experiences with nursing support during pregnancy, birth and the postpartum period. Additionally, to describe and compare the maternity experiences of women with low and high confidence levels. Results. Multiparas were significantly more confident in the postpartum period than primiparas (p < 0.0001), although confidence increased over time for primiparas (p < 0.0001) and decreased over time for multiparas (p < 0.0005). Mothers who spoke a language other than English or French were significantly less confident caring for themselves at home (p < 0.0005) and caring for their baby at home (p < 0.0001). Mothers' rating of breastfeeding support in-hospital was significantly positively correlated with confidence breastfeeding upon discharge (p < 0.0001). Significant negative correlations were found between number of community services received or sought-out and all confidence measures (p ≤ 0.001). Women indicated that they would have liked more support from nurses for breastfeeding, infant and self-care. Women with low confidence commented more often on the need for teaching and education in the postpartum period when compared to women with high confidence. Both women with low and high confidence reported lack of nursing support for breastfeeding, although women with low confidence perceived the problem to be related to conflicting nursing advice, and women with high confidence perceived the problem to be related to pressure from nursing staff to breastfeed.

This qualitative descriptive study captures reflections from third year baccalaureate nursing students who were asked to describe their experience with high fidelity human patient simulation (HPS) and the impact this experience had on their clinical reasoning skills. Currently educators in Ontario struggle to secure appropriate clinical placements for nursing students. Clinical practice is necessary for students to bridge the theory-practice gap and to become safe, competent practitioners. Nurses employ a clinical reasoning process in order to make health care decisions and it is through experience in practice that nurses develop that skill. Simulation is one way in which clinical reasoning skills can be developed. The study used individual interviews with six, third year nursing students who had participated in a quasi-experimental study where four days of their clinical time were spent in a high fidelity simulation laboratory. A detailed analysis of the transcribed data resulted in the emergence of the central theme of clinical confidence. Four interrelated components: realism, clinical scenarios, facilitation, and debriefing enhanced knowledge development and skill acquisition, which contributed to the development of confidence. Students were not able to articulate that HPS influenced their clinical reasoning skills; however, the four interrelated components contributed to the development of clinical reasoning. A focus group with five of the study participants followed the data analysis and confirmed the findings The study also provided insight into students' perceptions of effective teaching/learning strategies in simulation environments.

Accurate risk prediction models for in-hospital mortality are important for unbiased comparisons of hospital performance (by producing risk-adjusted mortality rates) and improved patient outcomes (by identifying high-risk patients in need of special medical attention). No previous risk prediction models have properly used post-admission information to predict risk of death in-hospital. In this study, we used administrative and laboratory data to derive and internally validate a Cox regression model (the "Escobar +" model) that predicts the risk of in-hospital death at any point during the admission. The model had excellent discrimination (c-statistic 0.895,95% confidence interval [CI] 0.889-0.902) and calibration. The Escobar+ model is a powerful risk-adjustment methodology that can be used in studies where the start of observation occurs post-admission. The model could also improve the quality and timeliness of patient care by providing health care workers with highly specific and accurate estimates of in-hospital death risk during the patient's stay.

Purpose. Explore the organizational barriers and examine determinants of nurses' intentions to practice continuous labour support (CLS). Design. Exploratory two-phase study using qualitative and quantitative methods. Participants. Childbirth nurses, educators and managers from two birthing units on two campuses of one hospital, in an urban city in Ontario, Canada. Phase I, N=10/10; Phase II, N = 97/129. Methods. Semi-structured interviews with content analysis followed by a survey using the Theory of Planned Behavior with descriptive, univariate and multiple regression analyses. Results. Unit acuity, method of patient assignment, need to cover other nurses for break and nurse-patient ratio, were the most frequently reported barriers. Nurses' attitude scores, subjective norm scores and intention scores toward providing CLS to women with epidural analgesia were lower than those for a non-epidural case study. Conclusions. Organizational barriers impact nurses' ability to provide CLS. Nurses have lower intentions to provide CLS to women with epidural analgesia.

This thesis describes the development of a curriculum for a prenatal breastfeeding workshop and the randomized controlled trial that was completed to test the hypotheses that the workshop would have a positive influence on maternal breastfeeding self-efficacy and that increased self-efficacy would positively affect breastfeeding duration. Breastfeeding self-efficacy, measured with the Breastfeeding Self-Efficacy Scale-Short Form, and breastfeeding duration, recorded as number of days and amount of breastfeeding, were measured at 4 and 8 weeks postpartum. The results of this study suggest that the prenatal breastfeeding workshop had a positive effect on maternal breastfeeding self-efficacy and on the amount women were breastfeeding. Over time, maternal breastfeeding self-efficacy scores increased in both groups with the intervention group having higher scores. At week 4, there was a significant difference in scores (control, M = 53.38 (SD = 9.1); intervention, M = 57.98 (SD = 8.6), t(78) = -2.32, p = .023, d = .523, CI -8.53, -0.65) At week 8, there was a difference in scores, but given the small sample size, these were not statistically significant (control, M = 58.91 (SD = 9.1); intervention, M = 61.70 (SD = 5.8), t(72) = -1.60, p = .115, d = .412). Although there was little difference between the groups in the number of days of breastfeeding, the intervention group had more exclusive breastfeeding (70% vs. 58%) and less weaning (15% vs. 22%) when compared with the control group. The most common reason for weaning was insufficient milk supply. (Abstract shortened by UMI.)

Reducing intimate partner violence levels in southern Africa is a necessary component of an effective HIV primary prevention strategy. A prerequisite to behaviour change is a shift in attitudes. This study sought to identify effective ways of assessing and changing attitudes and behaviours towards IPV to prevent HIV infection in a developing country context. Combining a systematic review of current evidence with advanced statistical analyses of data from a southern Africa regional household survey (n = 20,639), Soul City Regional Evaluation Phase 1, findings indicate that: a gold standard to measure IPV attitudes and behaviours is needed; interventions targeting structural change and based in the community are more effective; the effectiveness of mass media interventions may not be robust; the interaction of different prevention interventions may mediate overall effectiveness. Exploratory factor analysis, multiple imputation, and regression techniques were applied to complex, multileveled, and correlated data with missingness.

A qualitative study, using interpretive description, was conducted at a tertiary paediatric hospital. Its purpose was to determine attitudes and beliefs of nurses and physicians about parental presence during paediatric trauma resuscitations in the Emergency Department. Parental presence was believed to have both benefits and problems for patients, parents and the trauma team. Registered nurses and physicians expressed largely similar attitudes and beliefs related to parental presence. These depended heavily on context. Most participants believed presence was appropriate with stable children and when death was imminent. In between these two ends of the continuum, participants had greater variability in their attitudes and beliefs. Findings provide insight into how health care professionals believe they can deliver the highest quality technical care for the patient while meeting the psychosocial needs of all involved. Relevance of the findings to family centred-care is discussed. Implications for nursing practice, education and research are identified.

Objective. To conduct a pilot study describing the decision making needs of family caregivers of terminally ill patients when making or supporting decisions regarding place of care at the end of life. Design. A pilot needs assessment using a semi-structured interview questionnaire. Setting. Palliative Care Unit (PCU), hospice, and a community served by a Palliative Care Consultant Team. Participants. Convenience sample of 14 family caregivers of terminally ill patients. Outcome measures. Standardized semi-structured interview guide and scales eliciting family caregivers': Perceptions of the decision (perceived options, stage and predisposition, decisional conflict, knowledge, expectations, values); perceptions of others (support, pressure, roles); personal and external resources; preferred resources; and participant and patient characteristics. Results. Home, PCU, hospice, long term care facility, and hospital were identified as decision options, with home and PCU equally considered the best. Most participants were 'very sure' about their decision, considered it easy to make, perceived the patient to be 'very sure,' felt informed of the options and their pros and cons, had adequate support and advice, felt no pressure, preferred to share decision making, and had received information and emotional support. A minority of participants (3/14) expressed more decisional conflict as did those participants in earlier stages of decision making. The resource most needed was tangible support, and individual counseling and printed information were preferred over discussion groups and Internet information. Conclusion. Family caregivers have important informational, emotional, financial, tangible, and decisional support needs. The results of this pilot study indicate that it is feasible to conduct this research with a larger, more diverse population with some revisions to the research methods. This study is a promising step in describing the decision making needs of family caregivers of terminally ill patients when making or supporting decisions regarding place of care at the end of life.

Cette étude a été réalisée dans le but d'explorer la relation entre les besoins et le niveau de dysphonie des membres de la famille durant les 72 premières heures suivant l'arrivée à la salle d'urgence d'une victime de traumatisme crânien (TC). L'étude s'est déroulée auprès d'un l'échantillon de convenance de 23 sujets, entre les mois d'octobre 2001 et de mars 2002. Le Depressive Adjective Check List version G (DACL-G) de Lubin (1981) et l'Inventaire des besoins des familles (IBF) de Chartier et Coutu-Wakulczyk (1991 a) ont été utilisés. Les résultats de FIBF montrent des scores identiques ou relativement similaires aux scores normatifs. Au plan de la dysphorie les résultats obtenus différent significativement du groupe normatif (p < 0.01). La distance parcourue explique 49% de la variation des dimensions I et II (p < 0.01) et 38% de la variation du Score global des besoins et de l'Indice d'intensité des Besoins (p < 0.01) de l'IBF.

Le but de cette étude exploratoire inspirée de la théorie de la dissonance cognitive et réalisée selon la méthode de la théorisation ancrée était de décrire, chez le personnel infirmier, les facteurs reliés à la non dénonciation des actes de maltraitance envers les personnes âgées vivant en centres de soins de longue durée. Une entrevue semi-structurée fut conduite auprès de sept infirmières et infirmières auxiliaires recrutées selon l'échantillonnage par réseaux dans deux CHSLD de la région de Montréal. De l'analyse des données recueillies ont émergé sept facteurs: expériences antérieures difficiles, prise en main de la situation, inertie organisationnelle, culture du silence, niveau de gravité de la maltraitance, désensibilisation et relations contraignantes au travail. Les résultats révèlent l'absence de référence aux codes d'éthique. La non dénonciation découle de plusieurs facteurs évoluant dans une dynamique complexe engageant à la fois le personnel infirmer et son environnement et s'accompagne d'une importante souffrance émotionnelle.

Objective. To evaluate the effectiveness of a patient decision aid (PtDA) for menopausal women facing decisions about natural health products (NHPs). Background. Women experience difficulty making decisions about NHPs for the management of menopausal symptoms. Factors influencing the decision include lack of information, and inadequate communication, and support from health care providers. Decision support interventions that have been demonstrated to be successful in addressing women's decisional needs are decision aids. Although a new decision aid is available, its English version has not been evaluated in a community-based/clinical setting to determine its effect on decision quality or the process of decision making. Design. A pre-/post-test quasi-experimental study. Setting. The Women's Health Center at The Ottawa Hospital, Ottawa Canada. Participants. Peri- or post-menopausal women aged 45 to 64 considering the use of NHPs for management of menopausal symptoms. Intervention. Self-administered NHP PtDA. Main outcome measures. The primary outcome measure was the level of decisional conflict as measured by the Decisional Conflict Scale. Secondary outcomes included knowledge, strength of values, and choice/preference. Results. Of 24 women, the typical participant was 50 to 59 years of age, Caucasian, married, and well educated. Compared to baseline, after using the decision aid, women's total decisional conflict was reduced from 63% to 23% (p < 0.001) and knowledge improved from 76% to 87% (p = 0.001). The values clarification exercise revealed that women who preferred NHPs were more likely to rate the non-chemical aspect as important and the cost of the NHP as less important. Of the 24 women, 10 were unsure of their choice at baseline and 3 post use of the decision aid (p = 0.015). Overall, women rated the decision aid as acceptable, clear, and balanced. Conclusion. The NHP PtDA improved decision quality and supported menopausal women who were facing health decisions around using NHPs for menopausal symptoms.

Background: Deployed military nurses frequently experience moral dilemmas in their delivery of care, putting them at risk to suffer moral distress. Purpose: The purpose of this study was to understand the experience of deployed Canadian Forces nurses and moral distress. Methods: A grounded theory approach provided the framework for the study's design and data analysis. Semi-structured interviews were conducted with ten nurses previously deployed on combat or humanitarian missions. Findings: A new Moral Distress Model was developed reflecting four contributing factors to the development of moral distress: patient care delivery, chain-of-command, lack of moral preparation and training, and lack of professionalism. The central category -- "unique environment" -- suggests that moral distress is a two-part process: moral deliberation, and moral impact, influenced by the unique environment. Conclusion: Moral distress was a prominent phenomenon affecting deployed CF nurses. Pre-deployment training and on-going educational and supportive strategies are suggested to mitigate the significant impact of moral distress. Keywords: ethics, morals, nurses, military nurses, military personnel, decision making

Objectives. To determine whether vulnerability factors (confidence with breastfeeding, postpartum depression, supplementation and perceived adequacy of support) explain breastfeeding outcome at six weeks postpartum after controlling for age and education. To describe the use of breastfeeding resources by women with vulnerability factors. Design. Cross-sectional telephone survey at six weeks postpartum. Setting. Ottawa-Carleton, Ontario, Canada. Participants. A proportionate, consecutive sample of breastfeeding women from each of four hospitals in the region was conducted (n = 526/554, 95% response rate). Methods. Secondary analyses of data, using stratified bivariate analyses to examine the relationship between each factor and breastfeeding outcome. Multivariate logistic regression analyses examined relationships between all factors and breastfeeding outcome. Missing data was 7.0%. Results. For breastfeeding mothers (n = 526), while confidence, postpartum depression and supplementation were significantly related to breastfeeding in the bivariate analyses, only confidence with breastfeeding (OR: 1.85, 95% CI: 1.50, 2.27, p < 0.001) and postpartum depression (OR: 0.28, 95% CI: 0.11, 0.71, p = 0.007) were independently related to breastfeeding in the logistic regression analyses. Approximately half of the women (n = 262, 49.8%) did not access any community resources. Conclusions. Assessment of maternal confidence with breastfeeding and postpartum depression need to be conducted. Intervention strategies to address these vulnerability factors need to be evaluated. Supplementation policies of infants in hospital need review. A cost-effectiveness analysis of the use of community resources is recommended.

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The purpose of this thesis is to review the overarching purpose of healthcare, examine race-related disparities in minority patient outcomes within specific fields of medical practice, and discuss whether these disparities are the result of racial discrimination within the clinical setting, or are due at least partially to genetic and environmental factors, followed by an examination of how cross-cultural education for healthcare professionals can be improved to equip medical personnel with the attitudes, knowledge, and skills necessary to provide effective care to a culturally diverse patient populace. The benefits of recruiting a culturally and linguistically diverse team of healthcare providers are also discussed. Review of literature seems to indicate that poor patient outcomes for minority groups are due at least in part to forms of discrimination in healthcare provision, and therefore academic initiatives to implement for current and future medical practitioners in order to address current racial disparities and discrimination in healthcare and improve health outcomes for minority patients are also examined.

Nursing is a popular career choice in the twenty-first century, and there are many opportunities within the profession to serve. An American nurse has the ability to utilize nursing skills in Africa and share knowledge with the locals. The American nurse may face challenges when adapting to the African culture and healthcare but also may be blessed by the work and ministering to the people. The American nurse faces specific challenges such as educational differences, lack of facilities and equipment, unique diseases, and poor sanitation. In spite of these challenges, the American missionary nurse is able to grow through this experience, develop a stronger relationship with the Lord, and be blessed by the grateful attitude of the African people.

Cyclic oral contraceptive and continuous oral contraceptives have many similarities yet a few distinct differences. One of the major differences between cyclic and continuous oral contraceptives is that cyclic oral contraceptive pills have twenty one active pills and seven inactive pills versus the new continuous oral contraceptive pills which have 28 active pills and no inactive pills. However, though cyclic and continuous oral contraceptives do have a few differences, both types of oral contraceptives affect a woman's body in similar ways. When choosing between cyclic and continuous oral contraceptives, it is important for women to be informed about the advantages and disadvantages of both continuous and cyclic oral contraceptive pills. Also, over the years, there have been debates between religious groups regarding oral contraceptives. The two religions that have prominent views on this topic are Catholic and Protestant. A few followers from each religion will be chosen to represent the religious group as a whole regarding the topic of oral contraceptives. The Bible will also be used as a source and cited for its writing related to oral contraceptives, marriage, sex, and children.

Childbirth has the potential of being one of the most joyous and fulfilling experiences a woman goes through in her entire life. Being a mom, driving the kids to soccer practice, and sitting around the Christmas tree with the family can easily be seen as an ideal life. Conversely, the negative experiences with childbirth are rarely discussed. There is an overlooked category: moms who conceive but lose the baby in the womb. Not only are these women overlooked, but also the hospital care they receive proves inconsistent with the latest research. Nurses and doctors should be aware of the latest research showing the most effective to way to treat moms and dads who have just experienced a stillbirth. The immense responsibility of being present for the patient physically, emotionally, and spiritually should not be lost on the nurse. A woman is bringing both death and life into the world simultaneously. Whatever the cause of the premature death, the pain remains long after the tragic loss. Although the loss of a neonate is undoubtedly a delicate and uncomfortable situation, it is for these reasons this topic needs to be addressed.

New research has revealed that Celiac disease, an autoimmune illness affecting the small intestine, has more ties with neurological side effects than once was thought. The classic and most well known presentation of Celiac disease is gastrointestinal, including symptoms such as abdominal pains, nausea, diarrhea, and flatulence. Researchers have more recently found a correlation between Celiac disease and neurological illnesses such as epilepsy, depression, dementia, and ADHD. Physician awareness of the disease and the neurological side of the illness should be heightened in order for patients to receive earlier diagnosis and a better quality of life. Because of the difficulty to diagnose this disease when the presentation is neurological, there is indication for mass screening programs to be implemented.

Holistic nursing is care of the whole person, which addresses physical, mental, emotional, spiritual, and relational aspects of health. Historically, nursing has always integrated these aspects into providing care. Nursing developed out of religious orders and was predominantly a way to serve God by serving the poor and the sick. Florence Nightingale believed that nursing was her calling from God and her faith and spirituality influenced every aspect of her care. Nurses today are often fearful of addressing the spiritual needs of their patients, despite research that demonstrates the importance of providing care in these areas. Nurses can use interventions such as prayer, Scripture, active listening and presence, as well as referral to meet the spiritual needs of their patients.

Managing pain in the pediatric oncology population can be a daunting task. Often pain in these patients is severe and often not adequately treated or assessed. Studies have found that the reason for this disconnect is due to the impulse to follow unsubstantiated fears and myths held by healthcare professionals and even by the caregivers of the patients. For this reason, many pediatric oncology patients suffer from unnecessary pain when there are both pharmacological and non-pharmacological means available to intervene. The diagnosis and treatment of childhood cancer is multidimensional; however, it can be managed based on recent research and evidence-based practice. In addition, the family, nurses, and other caregivers play a significant role in the management of pain for these young patients. It is imperative that empirical research is conducted and put into practice when appropriate in order to dissipate the burden of such a complex diagnosis. The synthesis of the existing research will help to identify risks and benefits associated with certain medications and treatments as well as identify where gaps exist and further research is necessary. Pediatric oncology patients are affected by their disease in every facet of their lives and would benefit greatly from adequately managed pain.

Cerebral palsy, the most common cause of physical childhood disability, is a non-progressive disorder that results from an anoxic brain injury to the fetal or newborn brain. Because this disorder can cause disability, ranging from mild to severe effects on motor and cognitive functioning, the diagnosis can vary from one child to another, causing family stress due to vague and unknown predicted outcomes of the disorder. Because the diagnosis of cerebral palsy affects families in different ways depending on coping mechanisms, support systems, and the age and level of functioning of the child, among other factors, it is important to take an individualistic approach to care. Family-centered care has been shown to be beneficial in approaching the care needs of these families. To promote overall quality of life, efforts should be made to evaluate specific family member needs and include the entire family in the education, care planning, and implementation processes.

The purpose of this descriptive, ex post facto study was to examine possible relationships between demographic, pre-programmatic, and programmatic factors with success in a final Advanced Medical-Surgical nursing course and the National Council Licensure Examination for Registered Nurses, as well as their predictive abilities. Data were obtained from the academic records of 209 full-time and part-time nursing program graduates who completed an upper-division baccalaureate nursing degree at a mid-Atlantic private urban university. Descriptive and inferential analyses were utilized to discover possible relationships between the two dependent variables and the various independent variables in groupings suggested by Carroll's (1963) model of School Learning. Two models were derived to predict success in the nursing program as evidenced by successful completion of the final Advanced Medical-Surgical nursing course and passing the NCLEX-RN on the first attempt. The first model identified age at entrance to the nursing program and repeating a science course as the two factors that explained approximately 49% of the variance in the Advanced Medical-Surgical course performance. The second model was able to predict 97.2% correctly those graduates who would be successful on the NCLEX-RN, and only identify 43.8% of those candidates likely to fail. The overall classification ability by the model was 89%. Implications for nursing educators are that more attention needs to be given to admission policies/procedures, and that students entering nursing programs require routine standardized evaluation, identification and remediation of nursing content gaps in order to be successful throughout their nursing studies and ultimately on the NCLEX-RN.

The purpose of this study was to identify trends in basic diploma nursing programs at the post-secondary level within the provincial systems of education. The first move to the system of education having been initiated in 1964, this study was primarily concerned with the past decade. Areas of research were: forces at the root of the transfer of programs; structural organization and policies governing programs; curricula; students and faculty. Following an overview of diploma nursing education from its inception in 1874, the report presents an analysis of diploma nursing programs in the various provincial settings. The final chapter consists of a comparative analysis of forces, characteristics of programs and trends on a nation-wide basis. Findings indicated that the trend away from hospital-oriented and toward college-centered programs has permeated Canadian diploma nursing education. The process was found to be complete in Saskatchewan, Ontario and Quebec; partial in British Columbia, Alberta and Manitoba; in the Atlantic provinces, it is non-existent but trends point to future changes. Forces at the root of changes were political, economic, social and technical. Forces which tended to promote innovation likewise tended to inhibit change. Evidence points to lines of direction that subsequent events will tend to follow. A first movement is the continued development of nursing programs within the systems of education. The trend spells the demise of a century-old system and the continued growth of a new pattern. A second trend is the continued development of programs in a manner akin to other similar college programs. The move is toward a uni-jurisdictional form of control, programs being subject to the scrutiny of authorized Departments of Education. Nurses associations will progressively lose control over diploma programs, and become exclusively regulatory bodies. A form of national accreditation will become the accepted body for the evaluation of programs across Canada. Licensure examinations will continue to serve as a useful measure in the selection of qualified members, but the trend is away from the present medical model and toward an integrated or nursing model. A third trend is an increased effort to clarify the focus of programs in the light of existing health needs. The present ill-defined dissatisfaction with the product of diploma programs will require clarification. A fourth trend reflects a balance between general and nursing education, although finding adequate learning experiences for students is increasingly problematic. A final trend is the continued penury of qualified faculty members. It is yet too early to determine the outcome of changes which occurred in the past decade, but results clearly demonstrated that the trend toward college-centered programs can no longer be viewed as the result of a fad; rather it was regarded as a process rapidly becoming a fact. The study made no attempt to evaluate or to make value judgments with regard to the new pattern of diploma nursing education in Canada, but suggestions for further research emerged.

The research study explores and analyzes the nature of gifted young people's perceptions in experiencing life-threatening illness and the perceptions of their caregivers. The thesis is interdisciplinary in its framework and methodology. Contemporary issues in giftedness as applied to handicapped children, the nature of pain and the actualization of story-mode in conceptualizing theory are implicit in the work. Two methodologies are used in this study and are related but distinct in their focus, analysis and revelations. The children's case studies are formulated and written as actual stories. Two forms of analysis are applied to the stories. In the first section, a naturalistic inquiry using ethnographic analysis, interwoven literature review and analysis of caregiver perceptions are examined. The caregiver perceptions include illustrative examples from the researchers case studies, as well as gifted life-threatened (within the definitions of this study) children for whom they have cared in their professional work lives. In the second phase of this thesis, the researcher suspends the major themes identified in the naturalistic analysis and explores the essence of the gifted-lifethreatened children's expression and use of humour. (Abstract shortened by UMI.)

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.)

While the phenomenon of grief has received considerable attention and has been researched at length, there is a paucity of literature that has focused on health care professionals' experience of grief. The purpose of this study was to investigate the grief experience of pediatric intensive care nurses when their patients die. A phenomenological method was used in this study in order to obtain rich descriptions of nurses' experience of grief within their workplace. The purposive sample consisted of six registered nurses employed in an intensive care unit in a university-teaching pediatric hospital. In-depth, semi-structured interviews were conducted with the study participants in order to generate the data base. The audio-taped interviews were transcribed and analyzed for recurring themes emerging from the data according to the procedure outlined by Colaizzi. These nurses acknowledged they suffered multiple exposures to children's deaths and experienced grief. The interviews revealed eight themes that included one about their grief responses--hurting; two that described the influencing contextual factors--nurse-family unit relationship and dissonance, and five that related to coping strategies employed to manage their feelings of grief--self-expression, self-nurturance, termination of relationship activities, engaging in control taking activities and self-reflection. Further analysis revealed that managing grief effectively was an experiential learning process for the participants. The resultant themes were compared with the broader literature on grieving the loss of a significant other, grief and the health care professional, and the literature that addressed issues of occupational stress in the care of the critically ill, the dying, and the bereaved. The findings of this study could encourage further research that examines interventions designed to enhance the type of education and support needed in relation to the grief experience of nurses.

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.

Asthma is the most common chronic illness of childhood and caring for a child with asthma can affect the parent's well-being and coping resources. The study examined the influence of a home-based asthma health education program on parental quality of life and coping. Hymovich's Contingency Model of Long-Term Care (Hymovich & Hagopian, 1992) guided the study which utilized a pretest-post-test control group design. Forty families were randomly assigned either to receive home-based asthma health education or booklet representing conventional care. Results of the three-month follow-up indicated improvement in the parent's perception of their child's asthma, as measured by the Caregiver Perception of Change (CPC) survey. Reduction in parental need for asthma information, reduction in parental concerns and increased use of coping strategies were observed, as measured by Hymovich's Parent Perception Inventory (PPI). Although no changes were detected by the Paediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ), a significant correlation was seen between parental quality of life and parental coping.

Cette etude descriptive se penche sur la dependance a la nicotine en fonction des differents patterns de consommation (tabac et substituts) aupres de travailleurs de l'Outaouais quebecois ou la cigarette est interdite. En respectant la loi sur la sante des non fumeurs et les nouvelles normes sociales, les personnes qui fument pourraient etre tentees par les substituts nicotiniques afin de maintenir le taux de nicotine. L'echantillon se compose de 38 sujets, selectionnes a partir d'une generation aleatoire de 1738 numeros de telephones. Les questionnaires de Fagerstrom (QTF) et les versions modifiees (QTFM) ont permis de quantifier un taux de dependance aux produits simples ou mixtes: cigarettes, tabac sand fumee, gomme et timbre a la nicotine. Les consommateurs de produits mixtes out obtenu des scores moins eleves aux QTFM (substituts) qu'aux QTF (produits fumes). Les resultats suggere l'importance de conscientiser les professionnels de la sante a la variete de produits nicotiniques disponibles sur le marche et au danger de deplacer la dependance tabagique vers la dependance a la nicotine.

During the winter of 1994/95, a series of 'Healthy Eating' nutrition lessons were piloted in a grade four class in the Ottawa area. The objective of the current research study was to measure the impact of the program and identify the processes involved in the curriculum implementation. The Comprehensive School Health model and the PRECEDE-PROCEED framework were used to direct the study, which involved both quantitative and qualitative methods. The quantitative component of the study followed a quasi-experimental design. The health-related knowledge and attitudes of students who received the curriculum, were measured on three occasions: prior to curriculum implementation, immediately after, and two months post-instruction. The test scores were compared with the test scores from a cohort of students from a comparable classroom, which received no health instruction. A 2 x 2 x 3 mixed multivariate analysis of variance was performed on knowledge and attitude. The between variables were gender and intervention. The occasion of testing was a within subject factor. A preliminary MANCOVA was performed to consider age as a covariate, however age was not found to be a significant factor. The qualitative component of the study incorporated classroom observation, interviews with seven randomly selected students, a parent questionnaire and a teacher questionnaire. (Abstract shortened by UMI.)

Nurses who work in critical care areas must learn how to make effective clinical judgements about patients under a variety of conditions. The process of making clinical judgements includes attending to cues from the patient and integrating prior nursing knowledge. The study examined this process within the context of simulated patient instability, in which there is minimal time for the nurse to reflect upon the judgements made. Registered Nurses from four Intensive Care Units (ICU) within the Regional Municipality of Ottawa-Carleton were randomly selected and invited to participate in the study and twenty-four nurses participated. The study employed a 'think aloud' method and verbal protocol analysis to examine the number and types of patient cues from six case studies, that were attended to by the nurses. The relationship between cue recognition, domain-specific knowledge and clinical judgements was examined. Nurses verbalized a low percentage of the available patient cues, knowledge, and clinical judgements. A significant and moderately positive correlation was found between cue recognition and knowledge verbalized, knowledge verbalized and clinical judgements made and cue recognition and clinical judgements made. The number of knowledge items verbalized were positively correlated with the level of ICU (tertiary or secondary), with higher levels of knowledge items verbalized found in the nurses working in the two tertiary level ICUs. The results of this study have implications for all nurses as well as those in advanced practice roles. Case reviews, as part of ongoing education, can encourage the nurses to examine and improve their clinical judgements. Teaching nurses to become reflective practitioners would provide them with tools to examine and improve their own process of making clinical judgements. Ensuring that nurses have current nursing knowledge can provide a stronger basis for their clinical judgements. Areas for further research are described.

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.)