To see the other types of publications on this topic, follow the link: Nursing (0569).
Dissertations / Theses on the topic 'Nursing (0569)'
Create a spot-on reference in APA, MLA, Chicago, Harvard, and other styles
Consult the top 50 dissertations / theses for your research on the topic 'Nursing (0569).'
Next to every source in the list of references, there is an 'Add to bibliography' button. Press on it, and we will generate automatically the bibliographic reference to the chosen work in the citation style you need: APA, MLA, Harvard, Chicago, Vancouver, etc.
You can also download the full text of the academic publication as pdf and read online its abstract whenever available in the metadata.
Browse dissertations / theses on a wide variety of disciplines and organise your bibliography correctly.
1
Harding, Thomas S. "Constructing the "other" : on being a man and a nurse." Thesis, University of Auckland, 2005. http://hdl.handle.net/2292/103.
Full textAbstract:
This study explores the experiences of men who are nurses in Aotearoa New Zealand. Utilising discourse analysis a social constructionist reading of men, masculinity and nursing is provided to offer an alternative reading to much of the extant literature with respect to men in nursing. The study draws upon a number of different sources of "text", including over 600 written works, two films and interviews with eighteen men who currently are, have been or are intending to be, nurses. Drawing primarily upon the "literary" textual sources a number of themes were identified for further exploration in interview with the coresearchers. These themes were the construction of masculinity, the construction of images of the nurse, the reaction to men who are nurses, sexuality issues, career development, and men and caring. The findings of this thesis reveal that the literature pertaining to men in nursing is replete with paradox and contradiction and fails to adequately account for the male experience. It is argued that the images and arguments provided in the literature with respect to men in nursing are based on out-of-date models and understandings of gender relations, masculinity and nursing. It is suggested that rather than enjoying patriarchal privilege, men who enter nursing must contend with being constructed as both an inferior man and inferior nurse. Their careers are not, as is alleged in the literature, based on developing "islands of masculinity" and male privilege, nor upon the avoidance of the emotional labour of nursing but reflect a belief that career is one way of doing care. It is argued in this work that men in nursing have fewer "taken-as-givens" upon which to base work and that they work to develop trusting relationships with their patients that are based on communication and empathy within a context defined by the patients' circumstances.
2
Steele, Patrick W. "Physical activity counseling through Registered Nurses in a hospital setting." Thesis, Kansas State University, 2014. http://hdl.handle.net/2097/17544.
Full textAbstract:
Master of Public HealthDepartment of Kinesiology
Mary McElroy
Background and Purpose: Registered nurses (RN’s) are well positioned to provide physical activity counseling (PA counseling) to their hospital patients. RNs educate during ‘teachable moments” as hospital patients often find themselves in a state of readiness to make lifestyle changes such as increases in regular physical activity. Although the health benefits of physical activity are well documented, PA counseling has not been well studied among the nursing population or in the hospital environment. The main purpose of this study was to identify the percentage of RNs who provide PA counseling to their patients and to explore the factors which contribute to their decisions to provide PA counseling. Methods: A web-based survey was used to gather information from 323 hospital-based RNs employed at five hospitals in four states. The survey gathered information including current physical activity levels, thirteen perceived barriers to physical activity based on the Exercise Benefits and Barriers Scale, and information regarding whether RNs provide PA counseling to their hospital-based patients. Results: RNs reported an average of 3.3 barriers to being physically active. One hundred and eighty- seven RNs provided PA counseling to their patients (57.8%) and 133 did not provide PA counseling (41.1%). The presence of barriers to being physically active was related to PA counseling for nine of the thirteen barriers. The following hypotheses were supported: 1) RNs who report lower levels of perceived barriers to being physical active were more likely to provide PA counseling than those who report higher levels of perceived vigorous physical activity were more likely to provide PA counseling than those who reported lower levels of light, moderate, and vigorous physical activity. Conclusion: The findings from this study revealed RNs who are physically active and report fewer barriers to physical activity were more likely to provide PA counseling to their hospital-based patients. Future research needs to address types and quality of PA counseling as well as utilize theory driven intervention designs.
3
Collins, Anna L. "Inequalities in global health: a world-system analysis, 1945-present." Diss., Kansas State University, 2013. http://hdl.handle.net/2097/15934.
Full textAbstract:
Doctor of PhilosophyDepartment of Sociology, Anthropology, and Social Work
Robert Schaeffer
World-system theorist Immanuel Wallerstein made two theoretical assertions in Historical Capitalism that (a) significant inequalities in the “margin of safety against…endemic dangers and erratic violence” for people in different zones of the world economy persisted over long periods of time and (b) that the “margin of safety” for people in the periphery has actually deteriorated. This study set out to test this theory by examining mortality data for countries in different zones of the world-economy. It identified a set of health-related proxies for “endemic dangers and erratic violence”, infectious diseases (malaria, polio, tuberculosis, and influenza), chronic diseases (cancer, diabetes, and cardiovascular), erratic violence (homicide, suicide, and motor vehicle accidents), and also infant mortality and life expectancy for women and men. It gathered data from the United Nations Statistical Division’s Demographic Yearbook for a select sample of countries in different zones of the world-economy (core, semiperiphery, and periphery) from 1950 to 2010, and examined how mortality from these dangers changed during this period. This study found that mortality data for infectious diseases did not provide much support for Wallerstein’s theoretical assertions. But the mortality data for chronic disease and erratic violence provided strong support for Wallerstein’s assertions. The data on life span provided some support for Wallerstein’s first assertion, but not for his second. Overall, the findings generally support Wallerstein’s theories and suggest ways that health-related inequalities might be addressed.
4
Masterson, Marilyn K. "Chronic sorrow in mothers of adult children with cerebral palsy : an exploratory study." Diss., Manhattan, Kan. : Kansas State University, 2010. http://hdl.handle.net/2097/3906.
Full text
5
Lapeyre, Jaime Patricia. ""The idea of better nursing": The American Battle for Control over Standards of Nursing Education in Europe, 1918–1925." Thesis, 2013. http://hdl.handle.net/1807/43635.
Full textAbstract:
In the midst of the progressive era, American nursing and medical education witnessed tremendous reform. The increase in the number of hospitals during the early twentieth century brought a growing demand for nurses and led to varying standards in admissions and education within hospital training schools. In addition, the rise of the field of public health led to a campaign by a number of American nurse leaders to reform nursing education. This campaign included: the formation of several national professional organizations; gaining the support of prominent medical officials, including those close to the Rockefeller Foundation, an influential philanthropic organization; and successfully arguing against the sending of public health nurses overseas during the First World War. Although these steps were taken prior to the end of the war, the period immediately following the war, and the 1918 pandemic spread of influenza, provided fertile ground for reopening discussions regarding nursing education both nationally and internationally.
Following the war, the involvement of numerous American-backed organizations, including the Rockefeller Foundation (RF), the League of Red Cross Societies (LRCS), and the American Red Cross (ARC), in the training of nurses in Europe highlighted the numerous and conflicting ideals of American nurses in regards to nursing education during this period. In particular, those who had campaigned for the training of public health nurses in the USA — led primarily by the formidable nurse Annie Goodrich — voiced differing ideals for the training of nurses than those American nurses who led the work of the RF, the LRCS and the ARC in Europe following the war.
It will be argued here that, contrary to earlier theses that have suggested the spread of a singular “American gospel” of public health nursing education, in fact there were several hotly contested ideas being conveyed in Europe by several different American individuals and organizations at this time. In particular, the RF’s support of two opposing ideals — that of their own nursing representative, Elisabeth Crowell in Europe, and that of Goodrich in the USA — heightened this conflict. The eventual success of one set of these ideas depended on the alignment of congruent ideals in the training of health care professionals with influential individuals and organizations. Furthermore, this dissertation suggests that the outcome of this debate influenced the future direction of nursing education in both Europe and North America.
6
Boscart, Veronique. "The Development of Nurse-patient Relationship Scales in Chronic Care." Thesis, 2010. http://hdl.handle.net/1807/24691.
Full textAbstract:
Quality of life and well-being of patients living in chronic care (CC) are determined to a considerable extent by the relationships these patients have with nursing personnel caring for them. Given the importance of these relationships, there is an absence of empirical research and measurement tools to assess these relationships from a patient’s perspective. The purpose of this study was to develop and test valid and reliable instruments to determine what qualities of the humanistic relationships between cognitively competent patients and nursing personnel in CC settings were most important to patients and what they experience most. A conceptual framework based on the Humanistic Nursing Theory by Paterson and Zderad (1976) served as a foundation to develop two scales; the Humanistic Relationship Importance Scale (HRIS) assessed what attributes of the relationship are most important, and the Humanistic Relationship Experience Scale (HRES) assessed what attributes of the relationship are experienced. Sixty-nine content relevant items based on six dimensions of the Paterson and Zderad theory were developed and tested for content validity resulting in the deletion of 20 items. Forty patients completed the now 49-item scales to establish their initial internal consistency reliability, test-retest reliability and construct validity. Another 25 items were deleted in the process. The 24-item scales were completed by 249 patients in five CC facilities and the results subjected to a
iii
principal axis analysis (PAA). An oblique rotation resulted in a five factor solution labeled: relational availability, promoting quality of daily life, recognizing and supporting choice, forming connections, and supporting human uniqueness. This was a simplification of the original six dimensions of the Paterson and Zderad theory. A PAA of the 24-item HRES resulted in a one factor solution labeled humanistic connection. Reliability testing of the factors resulted in the deletion of one more item and an HRIS with a Cronbach′s alpha of .87 indicating strong internal reliability and an HRES with a Cronbach′s alpha of .98 suggesting some redundancy of items. Relational availability was rated as the most important factor in the nurse-patient relationship although all factors were important to patients. The mean score of the HRES indicated that patients experience a moderate level of humanistic connection in terms of frequency and intensity with nurses who generally care for them. Findings of this study have contributed to a better understanding of the nurse-patient relationship, and support the care, research, and theoretical knowledge of nurses and patients in these environments.
7
Price, Sheri. "The Experience of Choosing Nursing as a Career: Narratives from Millennial Nurses." Thesis, 2011. http://hdl.handle.net/1807/31905.
Full textAbstract:
The critical and growing shortage of nurses is a global concern. The growth and sustainability of the nursing profession depends on the ability to recruit and retain the upcoming generation of professionals. Understanding the career choice experiences of Millennial nurses is a critical component of recruitment and retention strategies. An interpretive, narrative methodology, was used to understand how Millennial explain, account for, and make sense of their choice of nursing as a career. Individual, face to face interviews were conducted with 12 Millennial Nursing students (born 1980 or after), for whom nursing was their preferred career choice. Participants were interviewed twice and chronicled their career choice experiences within reflective journals. Data was analyzed using Polkinghorne’s method of narrative configuration and emplotment.
The participants’ narratives present a shift from understanding career choice within a virtuous plot to one of social positioning. Career choice was initially emplotted around a traditional and stereotypical understanding of nursing as a virtuous profession: altruistic, noble, caring, and compassionate. The narrative scripts evolved from positioning nursing as virtuous towards understanding the meaning of career choice in relation to one’s position in the social world. The narratives position career choice in relation to the participants’ desire for autonomy, respect and quality of life. Pragmatic considerations such as lifestyle, job security, salary and social status were also emphasized. The narratives represent career choice as a complex consideration of social positioning, fraught with hopes, dreams, doubts and tensions. The participants’ perceptions and expectations in relation to their future nursing careers were influenced by a historical and stereotypical understanding of nursing; an image that remains prevalent in society. Insight gained from this inquiry can inform recruitment, education, socialization and retention strategies for the upcoming and future generations of nurses.
8
Knutson, Glenna. "Nurses' Ethical Problem Solving." Thesis, 2012. http://hdl.handle.net/1807/32793.
Full textAbstract:
A growing body of research has drawn attention to the hierarchical and bureaucratic nature of the hospital organizational environment in which nurses seek to resolve ethical problems related to patient care, whereas other studies have focused on the impact of nurses’ personal or professional qualities on those nurses’ ethical problem solving. This qualitative investigation sought to elucidate the extent to which nurses perceived their personal or professional qualities, as well as organizational characteristics, as influencing their ethical decision making. This investigator interviewed 10 registered nurses in 2 acute-care hospitals that were different in size, location, and type. A relational ethics lens assisted in the analysis of the data, emphasizing ways in which the nurses’ ethical problem solving was socially situated within a complex of relationships with others, including patients, families, physicians, and coworkers. Data analysis revealed key themes, including the nurses’ concern for patients, professional experience, layered relationships with others, interactions within the organization, and situational analysis of contexts and relationships. Subthemes included the nurses’ relationships with patients, physicians, patients’ families, and coworkers. This study revealed a range of ethical problems. Nurses saw their patients as their greatest concern; the nurses worked within a social context of multilayered and complex relationships within a hierarchical, bureaucratic organization with the desire to bring about the best outcomes for patients. The participants described ethical concerns related to the actions or decisions of physicians, patients’ family members, and nurses’ coworkers. The nurses’ deliberation to resolve these ethical problems considered risks and benefits for patients, nurses, and others. The nurses seemed to carry out a contextual assessment, analyzing the presence of mutual respect, the extent of relational engagement, and the potential for opening relational space in order to work together with others to resolve the ethical problem for the patient’s best outcome. The nurses’ ethical actions were socially situated within this complex interpersonal context. This thesis discusses implications of these findings for nursing research, education, and practice.
9
Udod, Sonia. "Seeking Connectivity: An Analysis of Relationships of Power from Staff Nurses' Perspectives." Thesis, 2012. http://hdl.handle.net/1807/32838.
Full textAbstract:
Nurse empowerment is a well-researched area of nursing practice yet the quality of work environments continue to be eroded, and interactions between nurses and nurse managers continue to be fragile. Power is integral to empowerment, yet the exercise of power between nurses and their managers have been under-investigated in the nurse empowerment literature. To advance our knowledge in the empowerment literature, the study explored the process of how power is exercised in nurse-manager relationships in the hospital setting.
Strauss and Corbin’s (1998) grounded theory methodology informed the study. Multiple qualitative fieldwork methods were utilized to collect data on staff nurses about how the manager’s role affected their ability to do their work. The researcher conducted semi-structured interviews and participant observations with 26 participants on three units within a tertiary hospital in Western Canada.
Seeking connectivity was the basic social process in which nurses strive to connect with their manager to create a workable partnership in the provision of quality patient care while responding to the demands in the organizational context. Conditions, actions, and consequences formed the theory of seeking connectivity as an extension of nurse empowerment theory. The overarching finding is that the manager plays a critical role in modifying the work environment for nurses and as such, nurses seek connection with their manager to accomplish their work. Institutional policies and practices combined in various ways to influence nurses’ thinking and shaped their actions. The first pattern of the process was characterized by the absence of meaningful engagement with the manager. Power was held over nurses restricting discussions with the manager, and nurses employed a variety of resistance strategies. In the second pattern of the process when managers provided guidance, advocated for nurses, and engaged nurses as collaborators, nurses were better able to problem solve and make decisions with the manager to positively influence patient outcomes. The theory of seeking connectivity is the explanatory framework emerging from the study that reveals how power is exercised in social relations between nurses and managers. Seeking connectivity is a recursive process that continues to evolve. The results of this study advance nurse empowerment primarily from a structural perspective and secondarily from a critical social perspective, suggesting nurses’ perceptions and abilities shape their work role and are foundational to promoting change through collective action. Study implications for research, practice and policy are addressed.
10
Quinlan, Shelley. "The Paradox of Socially Organized Nursing Care Work." Thesis, 2012. http://hdl.handle.net/1807/33673.
Full textAbstract:
As contemporary health care organizations struggle to control costs, yet deliver quality patient-centred care, the concept of care becomes socially transformed through the use of quality improvement models (i.e., Lean methodology) and quality assurance documentation. This research investigates how nurses’ care work is socially organized in a system that defines care through quality management practices. I use Dorothy E. Smith’s Institutional Ethnography as a feminist mode of inquiry and as a guiding framework for my interviews with nurse participants as I explore the complex social relations within the health care system from the vantage point of nurses undertaking care work. I argue that the social reorganization of care work has affected the emotional lives of nurses as they try to balance actual patient-centred care with their reporting obligations under quality management.
11
Bender, Amy Catherine. "The Welcome Intrusions of TB Nurses. An Interpretive Phenomenological Study of Relational Work in Public Health Nursing." Thesis, 2009. http://hdl.handle.net/1807/17728.
Full textAbstract:
Nurse-client relationships are inherently valued in descriptions of the nature of public health practice and require consideration as intentional work that demands knowledge, skill, and personal engagement. They are also matters of place. In public health, they are largely taken-for-granted, particularly in the area of infectious diseases and the tuberculosis (TB) program specifically. TB nursing is structured within an explicit population focus, which challenges such relationship ideals as client-centered care, autonomy, and empowerment in everyday practice. This interpretive phenomenological study (Benner, 1994) of the relational work of TB nurses was undertaken to understand the nature of nurses’ relational work, wherever it happened, and how it was understood within the mix of assigned program tasks. Carried out in one of Canada’s largest TB programs, this study involved observing nine nurses and 24 clients in their respective visits over time, and interviewing 16 participants. Visits happened in homes and cars, and other assorted locations, highlighting how place shows up in these relationships and how nurses help clients to make sense of TB and broader life concerns shaping the experience of it. How they involve themselves interpersonally in these situations is the stuff that relational work is made of. Through the use of thematic analysis (Benner, 1994; Chesla, 1994), notes and transcripts were analyzed. The resulting interpretation of the nature of relational work is that of ‘welcome intrusions’, a notion that along with three key thematic dimensions: ‘getting through the door’, ‘doing TB but more than that’, and ‘beyond a professional’, addresses the central control-care tone of relational work. Together these themes identify key areas of knowledge and skill. That is, honesty and respect for privacy, ‘expertise’ in TB, dismantling the effects of stigma and displacement, and socializing-with-purpose. This emphasizes the value of articulating the everyday practices of nurses in population-focused programs that can contribute to successful treatment, and client healing and well-being. This relational work of TB nurses may be supported and enhanced when framed as the skill of involvement (Benner et al, 1996; Benner et al, 1999) and critically examined as part of providing comfort and enacting surveillance.
12
Simmonds, Anne Harriet. "Understanding the Moral Nature of Intrapartum Nursing: Relationships, Identities and Values." Thesis, 2010. http://hdl.handle.net/1807/26237.
Full textAbstract:
The establishment of effective relationships is fundamental to good nursing practice and the fulfillment of nurses’ moral responsibilities. While intrapartum nurses are uniquely placed to establish relationships that can directly influence the woman’s experience of childbirth, there has been limited investigation of the relationships, identities and values that underlie nurses’ varied approaches and responses to labouring women. The purpose of this study was to explore intrapartum nurses’ understanding of their moral responsibilities from a social-moral perspective, using Margaret Urban Walker’s “expressive-collaborative” model of morality. Interviews were conducted with fourteen registered nurses working in a birthing unit of a Canadian teaching hospital. Four themes were identified that captured nurses’ moral responsibilities, including: organizing and coordinating care, responding to the unpredictable, recognizing limits of responsibilities to others, and negotiating care with women and families. Nurses enacted their moral responsibilities to labouring women in a variety of ways depending on their personal and professional experience, the circumstances, the people involved and the context of care. A key factor influencing responses to women was the degree to which understandings and expectations related to birth were deemed to be reasonable and mutually agreed upon among nurses, physicians, women and their families. Nurses also described limits on their responsibilities to others. Their choice of response to circumstances in which practice was constrained departed from the idealized expectations and ‘expert’ practices often reflected in professional guidelines.
While nurses were able to identify contextual influences that constrained their ability to maintain effective relationships with women, the influence of their own values on the care they provided was less apparent. This suggests a need to challenge normative assumptions related to care of women in childbirth, including the provision of choice and family centred care, in order to create environments that can support and sustain practices that build understanding, mutuality and trust between nurses and birthing woman. In addition, given the contested nature of childbirth and the lack of shared understandings of what constitutes ‘best’ care, there is a need to develop collaborative models of inter-professional maternity care that include the voices of women as a central component.
13
Kavanagh, Patricia. "Appreciative Inquiry: An Interactive Organizational Intervention to Translate Acute Pain Management Evidence into Pediatric Nursing Practice." Thesis, 2010. http://hdl.handle.net/1807/24781.
Full textAbstract:
Despite a substantial evidence-base for pediatric pain management, pain is not always well managed in clinical practice. Appreciative Inquiry (AI) is an innovative knowledge translation (KT) intervention that is compatible with the Promoting Action on Research in Health Services (PARiHS) framework. A prospective, repeated-measures, mixed-methods case study was conducted to (a) explore the implementation process of AI as a KT intervention in pain, (b) examine the beginning effects of AI on pain related outcomes, and (c) describe extraneous factors related to the PARiHS framework. Outcomes were measured at six and three weeks pre-intervention and three and six months post-intervention, ending with a semi-structured interview on the acceptability of the intervention. Data were analyzed using descriptive and inferential statistics, and quantitative and qualitative content analyses.
Twelve nurses (nine staff and three administrative/clinical leaders) from a surgical unit at a pediatric hospital participated in the study. They perceived their context to be relatively complex, with a culture focused on clinical competence, family-centered care, and teamwork, and a transformational leadership style. Overall, participants were satisfied with the intervention structure, which consisted of four three-hour, interactive sessions delivered over two weeks to promote change based on positive examples of pain management on the unit, and suggested only minor refinements. The intervention was delivered with high fidelity and most participants (n = 11) attended all four sessions, where they developed an action plan to enhance evidence-based pain assessment documentation. There was a statistically significant improvement in participants’ pain knowledge and attitudes post-intervention. This outcome was significantly and positively correlated with participants’ attitudes towards research. Both of these factors had a significant relationship with participants’ effort to document pain assessments. Participants named AI a ‘refreshing approach to change’ because it was positive and democratic, with a focus on building on existing practices. They felt the process cultivated a positive reception to change, broadened their horizons around pain, and enhanced their team spirit. The facilitators were considered credible with effective communication skills. Given the promising results of this study, the refinement and evaluation of the AI intervention are warranted in other contexts and for other clinical practices.
14
Mildon, Barbara. "The Concept of Home Care Nursing Workload: Analysis and Significance." Thesis, 2011. http://hdl.handle.net/1807/29508.
Full textAbstract:
The concept of home care nursing workload has not been widely studied and no evidence was found that an analysis of the concept had been undertaken. Consequently, there was a knowledge gap regarding the definition and attributes for the concept of home care nursing workload as it is currently experienced. To address that gap, a descriptive, three-phase, mixed methods (quantitative and qualitative) study was conducted.
In Phase One, Rodgers’ (2000) evolutionary method was used to analyze the concept of home care nursing workload based on the empirical literature. Phase Two was situated within the naturalistic inquiry paradigm and involved observation of ten home care registered nurses during their visits to 61 patients. In Phase three a questionnaire was administered to validate the draft definition and attributes for the concept of home care nursing workload. It was completed by 88 home care nursing experts from clinical practice, education, management and research. Qualitative findings were analyzed using inductive content analysis. Quantitative data were analyzed descriptively using SPSS. Data triangulation was used extensively within and between the study phases.
Of 14 attributes in the phase three draft concept definition, respondents assigned the highest level of relevance to the attribute of cognitive effort and the lowest to physical effort. The final definition contained 20 attributes and includes the following excerpt: “Home care nursing workload is the totality of the cognitive, emotional and physical effort home care nurses expend to meet the expectations of all stakeholders in providing holistic, outcome directed and patient/family focused care within the context of a short or long-term therapeutic relationship.” Respondents reported high levels of agreement with the accuracy and completeness of the definition and the majority indicated the definition would be useful or very useful in their day-to-day work.
The comprehensive concept exemplar that emerged from the study includes each of the identified attributes. The study findings provided evidence of the complexity and challenge inherent in quantitatively measuring home care nursing workload. Accordingly, implications of the findings are shared for the management and monitoring of workload and associated outcomes, as well as for nursing practice, education and research.
15
Squires, Mae Ellen. "The Influence of Perceived Fairness and Relational Leadership on Nursing Safety Climate and Work Environment." Thesis, 2010. http://hdl.handle.net/1807/26385.
Full textAbstract:
Canadian statistics on patient safety in acute care hospitals are alarming. Hospital safety concerns are not isolated to patient safety. Occupational safety is also important. With increasing shortages of nurses, stress in the work place is growing. Nurses report high levels of absenteeism of 14.5 days per year. The importance of a just and fair culture and the role of nurse leaders have been emphasized in safety literature. Although deemed important, studies of nurse leaders and patient outcomes are limited. The influence of interactional justice in the workplace on nurse and patient safety has not been studied.
The purpose of this study was to test and refine a model developed from the literature which explains the impact of perceived interactional justice, relational leadership, and quality of nurse manager – clinical nurse relationships on the nursing work environment and ultimately patient and nurse safety outcomes.
The model was tested on a random sample of 266 Ontario acute care registered nurses. Findings indicated the model reasonably fit the observed data, however could benefit from further refinement. The addition of 2 pathways (span of control to nurses’ intent to leave and number of medication errors to nurse emotional exhaustion) and trimming of the insignificant paths improved the overall model fit.
The resulting model indicates that resonant leadership style and interactional justice improves the quality of nurse leader-nurse relationships which in turn improves quality of the nurses’ work environment and safety climate. A positive safety climate led to a decrease in the number medication errors and nurses’ intentions to leave their unit. A higher quality work environment predicted lower nurse emotional exhaustion. Additionally, higher numbers of medication errors led to an increase in nurse emotional exhaustion. This suggests that distress may be associated with making a medication error or fear of consequences. As well, larger manager spans were associated with less nurse intent to leave. As the span increased, the number of support personnel also increased. Contrary to other research findings, this result suggests that supportive personnel may mitigate the effect of large manager spans of control on nurses’ intent to leave their units.
16
Prakash, Varuna. "Interventions to Mitigate the Effects of Interruptions During High-risk Medication Administration." Thesis, 2010. http://hdl.handle.net/1807/25897.
Full textAbstract:
Research suggests that interruptions are ubiquitous in healthcare settings and have a negative impact on patient safety. However, there is a lack of solutions to reduce harm arising from interruptions. Therefore, this research aimed to design and test the effectiveness of interventions to mitigate the effects of interruptions during medication administration. A three-phased study was conducted. First, direct observation was conducted to quantify the state of interruptions in an ambulatory unit where nurses routinely administered high-risk medications. Secondly, a user-centred approach was used to design interventions targeting errors arising from these interruptions. Finally, the effectiveness of these interventions was evaluated through a high-fidelity simulation experiment. Results showed that medication administration error rates decreased significantly on 4 of 7 measures with the use of interventions, compared to the control condition. Results of this work will help guide the implementation of interventions in nursing environments to reduce medication errors caused by interruptions.
17
Tomkun, Jonathan. "Mobile Phone-based Telemonitoring as an Aid for Home Care Nurses: A Focus on Design and Implementation." Thesis, 2013. http://hdl.handle.net/1807/42957.
Full textAbstract:
The intent of this project was to integrate an existing mobile phone-based telemonitoring system into a home care nursing environment. Analyses were conducted to examine nursing workflows and home care constraints. User-centric design, development, and testing were used to modify the current telemonitoring system for a home care pilot study with heart failure clients. Interim results show technology acceptance by home care nurses and improved self-awareness in clients; the telehomecare system offers its greatest value as an opportunity for client education following clinical alerts. The pilot study will continue with a focus on increased client recruitment and selectivity towards those most in need of chronic disease management. It is expected that the system will result in an improvement in health outcomes and more efficient delivery of home care visits. The results from this study will provide insight into the impact of a new service delivery model for home care nurses.
18
Covell, Christine Lynn. "The Relationship of Nursing Intellectual Capital to the Quality of Patient Care and the Recruitment and Retention of Registered Nurses." Thesis, 2011. http://hdl.handle.net/1807/29692.
Full textAbstract:
To ensure quality patient care hospitals invest in nursing intellectual capital by allocating financial, human and material resources for nurses to acquire the knowledge and skills necessary to provide safe patient care. This study’s purpose was to test selected propositions of the middle-range theory of nursing intellectual capital which provides a conceptualization of the influence of nurses’ knowledge, skills and experience (nursing human capital) to patient and organizational outcomes. The theory was systematically developed after a critical review of the literature. It proposes that nursing human capital (registered nurses’ experience, and knowledge and skills acquired from continuing professional development including university courses, conferences, workshops, in-services, specialty certification) is related to variables within the work environment (nurse staffing, employer support for nurse continuing professional development), which in turn, is associated with the quality of patient care (adverse events) and the recruitment and retention of nurses. The theory also proposes that nursing structural capital, nursing knowledge available within practice guidelines, is associated with the quality of patient care. A cross-sectional design was used to test the proposed relationships. The study took place in 6 acute care hospitals in two provinces of Canada. Financial, human resource and risk management data were collected from hospital departmental databases and a survey of unit managers. Data from 91 inpatient units were used with structural equation modeling to test the theory’s propositions. The results indicated that nurses’ knowledge and skills represented by the proportion of RNs with degrees and proportion of RNs with specialty certification were directly associated with low hospital-acquired infection rates. Nurse experience, measured as mean years RN professional experience and RN unit tenure, was found to be significantly related to higher RN recruitment and retention. The proportion of RNs with degrees was found to partially mediate the influence of nurse staffing on hospital-acquired infections. The results provide preliminary evidence of the association of nursing intellectual capital with patient and organizational outcomes. The findings may assist administrators with fiscal and human resource decision-making related to the education of nurses within acute care hospitals, and professional organizations with policies governing nursing education and continuing professional development.
19
McLaren, Coralee. "Dancing-bodies-moving-Spaces: An Ethnography of Disabled and Non-disabled Children's Movement in a Kindergarten Classroom." Thesis, 2014. http://hdl.handle.net/1807/65705.
Full textAbstract:
Contemporary neuroscientific evidence indicates that unrestricted movement and gesture enhance children’s physical, social and cognitive development by engaging them with the external properties of their environments. Current understanding of children’s engagement with indoor environments is limited. This knowledge gap matters because children’s health, social abilities and cognitive development may be compromised in physical environments that inhibit rather than enhance their movement capacities. This gap is especially problematic for physically disabled children because their motor impairments, exclusionary societal attitudes, safety concerns and environmental barriers curtail their movement.
In this study, I describe and interpret the relationship between disabled and non-disabled children’s movement and a kindergarten classroom. Their bodies were conceptualized according to Deleuze’s premise that nothing can be known about bodies until they demonstrate what they can do (1988). The classroom was conceptualized according to Gibson’s theory of affordances, which posits that people and environments are inextricably related (1979). I used a choreographic perspective underpinned by Manning’s philosophy of relational movement (2009) to accentuate the dynamic reciprocity between children’s bodies and the classroom.
Eight disabled and 12 non-disabled children participated in this interdisciplinary, ethnographic study. Data were elicited through observations, video recordings and semi-structured interviews. I developed a taxonomy of indoor affordances or ‘compositional elements’ to categorize classroom objects/features that children discovered and actualized through their movement interactions. Subsequently, I observed a dance-in-the-making that led to deeper understandings of the relational and emergent properties of these interactions. Findings suggest that assemblages of bodies, objects and features trigger dynamic movement, and indicate that disabled and non-disabled children alike discover and creatively assemble affordances to facilitate their movement.
Overall, my findings recast children’s body-environment interactions and contribute to understandings about environmental features that enhance or inhibit movement capacities. This knowledge could be used to design i) learning environments that are redolent of movement possibilities, ii) interventions to enhance children’s physical, social and cognitive capacities, and iii) education and rehabilitation strategies that encourage them to explore, navigate and shape their environments.
20
McAllister, Mary. "Acute Care Nurse Practitioners', Physicians' and Staff Nurses' Relationships with Patients: A Descriptive, Comparative Study." Thesis, 2008. http://hdl.handle.net/1807/11233.
Full textAbstract:
Acute care nurse practitioners (ACNPs) are a new addition to the Canadian health care system, having been introduced in the Canadian health care system in the late 1980s. While some authors have suggested that nurse practitioners offer “something special” to patient care, no evidence to date has substantiated this claim. The findings of this grounded theory study offer a theory (Acute Care Health Professional-Patient Relationship (ACHPPR) Theory) to describe how three types of health care professionals establish relationships with patients in acute care settings (Figure 7).
This qualitative study explored relationships that ACNPs, physicians and staff nurses establish with patients in a large urban multi-site university-affiliated hospital. Six quartets (patient, ACNP, physician, staff nurse) were recruited and interviews, using a semi-structured guide were audio-taped and subsequently transcribed verbatim.
Each type of relationship was found to have a unique focus; ACNPs focus on making connections with patients, physicians focus on managing patients’ diseases and staff nurses focus on meeting patients’ needs. In order to establish relationships with patients, readiness conditions must be met. Health professionals use strategies to influence the achievement of readiness conditions as well as to move forward with relationship development. Each type of relationship varies in the range of potential intensity that can be achieved, which is influenced by various dimensions. Relational intensity ranges from the uncommon clinical relationship, which focuses on the patient’s disease, through the more typical professional relationship characterized by a comfortable rapport and then finally to the most relationally intense, but rare, personal relationship. If a relationship reaches professional or personal levels of relational intensity, relational products become evident. When comparing these three health professional-patient relationships, similarities and differences have been identified. Analysis of patient interviews yielded themes that substantiate the ACHPPR theory.
The ACHPPR theory offers a beginning understanding of the complementary nature of three types of health professional-patient relationships in the acute care setting and has the potential to influence practice, education, theory development and future research related to ACNP-patient relationships.
21
Dale, Craig M. "Locating Critical Care Nurses in Mouth Care: An Institutional Ethnography." Thesis, 2013. http://hdl.handle.net/1807/43531.
Full textAbstract:
Intubated and mechanically ventilated patients are vulnerable to respiratory tract infections. In response, the Ontario government has recently mandated surveillance and reporting of ventilator-associated pneumonia (VAP). Serious respiratory infections, and the related costs of additional care can be reduced in part, through oral hygiene. However, the literature asserts that oral care is neglected in busy, high-tech settings. Despite these concerns, little research has examined how mouth care happens in the critical care unit. The purpose of this institutional ethnography (IE) was to explore the social organization of mouth care in one critical care unit in Ontario, Canada. As a reflexive and critical method of inquiry, IE focuses on features of everyday life that often go unnoticed. In paying special attention to texts, the ethnographer traces how institutional forces that arrive from outside the practice setting coordinate experiences and activities. Inquiry began in the field with day/night participant observation to better understand the particularities of nursing care for orally intubated patients. Other data sources included reflexive fieldnotes, stakeholder interviews, and transcripts as well as work documents and artifacts. Over time, the analysis shifted from the critical care unit to the larger social context of Ontario’s Critical Care Transformation Strategy. Analysis traced the discursive and translocal social relations that permeate nursing work. Findings revealed a disjuncture between the ideals of VAP prevention and the actualities of mouth care. Tensions and contradictions emerged as nurses described their location within an expansive accountability network: nursing duties now extend beyond oral care to a controversial project of epidemiological surveillance. Patient comfort and safety now rest upon a hidden nursing agenda to overcome limited time, training and tools in oral care. Nurses worried that the effectiveness of preventative oral care was inhibited by technical problems of application that remain uninvestigated and unresolved. As a counterpoint to assertions that oral care is neglected, this study demonstrates how nursing knowledge and agency is obscured. Because international infection-prevention guidelines increasingly endorse oral care, novel research investigating the practice problems nurses encounter is warranted.
22
Ferron, Era Mae. "Part-time Nurse Faculty Intent to Remain Employed in the Academic Organization." Thesis, 2013. http://hdl.handle.net/1807/43561.
Full textAbstract:
Part-time nurse faculty play an important role in the production and quality of the nursing workforce. However, the shortage of nurse faculty exacerbates current shortages of nurses. In Canada, the shortage is predicted to reach 60,000 full-time equivalent RNs by 2022. Therefore, retaining qualified part-time nurse faculty in academia is a key component in managing the shortage problem. The purpose of this study was to test and refine a model of part-time nurse faculty intent to remain employed in the academic organization. Cross-sectional survey methods were employed. A total of 282 part-time nurse faculty employed within Ontario, Canada colleges or universities were invited to participate. Survey instruments and items measured demographic, workplace, nurse responses to the workplace, and external variables. Correlation and multiple regression analyses were conducted using data from 119 participants (47.6% true response rate). Of the 19 variables hypothesized to affect intent to remain employed in the academic organization, seven influenced intent to remain. The resulting model indicated that the older the part-time nurse faculty member, the lower the level of intent to remain and the more years worked in the organization, the higher the level of intent to remain. The more opportunities perceived to exist outside of the employing organization, the higher the level of intent to remain. Additionally, the more satisfied part-time nurse faculty were with their job overall, the higher their level of intent to remain. In the workplace, the more support from the leader, the more formal or informal recognition received, and the more fair work procedures were perceived to be, the higher levels of part-time nurse faculty intent to remain employed in the academic organization, mediated by job satisfaction. Although age, organizational tenure, and external career opportunities are non-modifiable variables, deans and directors can encourage part-time nurse faculty to remain employed in their academic job by focusing on enhancing overall job satisfaction. Effective strategies may include formal or informal acknowledgement of good performance, consistent verbal and behavioural support, and implementation of procedural practices, such as performance evaluations and pay raises in a fair manner.
23
Maheux, Dubuc Florence. "Les représentations de l’infirmière chez les étudiantes nouvellement inscrites au baccalauréat en sciences infirmières." Thèse, 2016. http://hdl.handle.net/1866/16294.
Full textAbstract:
Certains chercheurs affirment que la principale raison qui pousserait une personne à
devenir infirmière serait attribuable aux aspects vocationnels et non pas du désir d'exercer une
profession qui requiert des connaissances et compétences inhérentes à la complexité des soins
(Prater et McEwen, 2006; Price, McGillis Hall, Angus et Peter, 2013). Un des motifs principal
d’attrition des étudiantes aux programmes de formation en sciences infirmières serait d’ailleurs la
dissonance entre la représentation initiale qu’elles se font de l’infirmière et les exigences de la
profession (AIIC, 2004). Une étude exploratoire a donc été réalisée auprès d’étudiantes
nouvellement inscrites au baccalauréat en sciences infirmières (N=11), afin de mieux comprendre
comment elles se représentent l’infirmière et quelles sont leurs attentes quant à la profession. Le
cadre de référence de la théorie des représentations sociales de Moscovici (1961) soutient cette
recherche.
L’analyse qualitative de ces entretiens semi-dirigés nous renseigne à l’idée que les
étudiantes québécoises se représentent le rôle de l’infirmière d’abord comme celui d’une
personne qui aide, autant les bénéficiaires que les médecins. Les nouvelles étudiantes s’attendent
à devoir faire face à des études exigeantes et à un travail difficile. Elles sont par contre prêtes à
s’y engager par désir d’aider autrui et parce qu’elles se reconnaissent dans les qualités qu’elles
jugent nécessaires à l’exercice de la profession infirmière, c’est-à-dire les habiletés relationnelles
comme l’écoute, l’empathie et la patience. Ce constat laisse donc croire que le contexte
historique dans lequel a évolué la profession infirmière au Québec, en plus des médias qui ne
semblent pas actualiser l’image qu’ils projettent de l’infirmière, pourraient avoir une influence
sur les représentations de l’infirmière de ces nouvelles étudiantes.
Les résultats de cette étude pourraient permettre de circonscrire des angles de recherche
future afin de comprendre davantage l’implication des représentations de l’infirmière dans le
phénomène d’attrition des étudiantes, tout en ayant aussi des retombées pour la pratique
infirmière au niveau des politiques et de la formation.Some researchers claim that the main reason why a person would choose to become a nurse is attributable to vocational aspects and not to the desire to exercise a profession that requires knowledge and skills inherent to the complexity of care (Prater & McEwen, 2006; Price, McGillis Hall, Angus & Peter, 2013). One of the main reasons for students attrition in nursing educational programs would be the dissonance between the initial representation they have of a nurse and the profession requirements (CNA, 2004). An exploratory study was conducted among newly enrolled students in a Nursing Bachelor’s degree (N=11), to better understand their representations of nurses and their expectations towards the profession. Moscovici’s Theory of Social Representations (1961) is the framework that supports this study. The qualitative analysis of semi-structured interviews suggests that Quebec students have a representation of nurses as people who help patients as much as doctors. New students expect to work hard through their studies as well as in their future job in health care settings. Nonetheless, they are ready to commit to nursing, because of a desire to help others and because they recognize themselves in the qualities they consider necessary for the practice of nursing such as relational skills, which include listening, empathy and patience. Therefore, these results suggest that the historical context in which nursing has evolved in Quebec, in addition to medias that do not seem to refresh the image they project of nursing, could have an influence on these new students representations of nurses. The results of this study could help define future research perspectives to a better understanding of the involvement of representations of nurses for students attrition, while also having implications for nursing practice, nursing policies and nursing training.
24
Gagné, Marie-Annick. "Étude transversale descriptive de l'expérience au travail des infirmières québécoises." Thèse, 2017. http://hdl.handle.net/1866/20083.
Full text
25
Thériault, Marianne. "Les modèles de dotation en soins infirmiers dans un contexte de soins aigus." Thèse, 2017. http://hdl.handle.net/1866/19452.
Full textAbstract:
Le système de santé québécois fait face à de grands défis de dotation en personnel infirmier, entre autres puisqu’il doit répondre à des demandes croissantes de services, tout en composant avec une diminution de la main-d’oeuvre qui dispense ces services. Les problèmes de dotation peuvent entrainer une baisse de la qualité et de la sécurité des soins offerts aux patients et une hausse des coûts pour les organisations de santé. Bien que la dotation soit une pierre angulaire de la gestion des ressources humaines, il n’y a pas encore de meilleures pratiques claires et établies pour assurer une dotation en personnel infirmier réaliste, optimale et efficiente. Plusieurs études abordent le problème de la dotation avec un angle directeur unique, omettant ainsi d’autres dimensions importantes et déterminantes de la dotation en personnel infirmier, ce qui résulte en une vision fragmentée de celle-ci.
Le but de cette étude était d’identifier les modèles de dotation prévalant en personnel infirmier dans des unités de soins aigus de centres hospitaliers d’une des plus grandes régions au Québec en tenant compte simultanément des trois principales dimensions de la dotation : la quantité de personnel, la composition des équipes de soins et la stabilité des équipes de soins. Basé sur un devis quantitatif descriptif, les variables nécessaires à l’opérationnalisation des dimensions ont été collectées pour 40 unités de soins pour la période du 11 janvier 2016 au 7 mars 2016, auprès de la direction des ressources humaines des quatre centres hospitaliers étudiés. En s’appuyant sur l’approche configurationnelle, c’est à l’aide d’une analyse factorielle multiple et une classification ascendante hiérarchique que des modèles de dotation ont été identifiés.
Les résultats de l’étude constituent une description des caractéristiques de dotation des unités d’hospitalisation de courte durée des centres hospitaliers. Quatre modèles de dotation en personnel infirmier qui prévalent dans les centres hospitaliers étudiés ont émergé : le modèle le moins pourvu, le modèle de base modérément pourvu, le modèle professionnel modérément pourvu et le modèle le plus pourvu.
Ce portrait des modèles de dotation présente des données inédites pour la planification des effectifs infirmiers. Les résultats de l’étude fournissent des données privilégiées pour les
ii
gestionnaires et les décideurs en ressources humaines afin que ceux-ci puissent comparer leur modèle de dotation aux différents modèles identifiés lors de la présente étude ainsi qu’à ceux des autres unités de soins des centres hospitaliers étudiés. Par ailleurs, la présente étude, en dressant un portrait de la situation actuelle, fournit des données importantes pour optimiser la planification des effectifs infirmiers. À la connaissance de l’étudiante-chercheuse, préalablement à cette étude il n’existait aucune classification des modèles de dotation en personnel infirmier qui tenait compte de toutes les dimensions de la dotation.The Quebec health care system faces great challenges when it comes to nurse staffing. Having to provide for a growing demand in services while dealing with a decreasing qualified labor force generates a lower quality and less secure standard of care. This creates extensive costs for health organizations. Staffing is considered a corner stone of human resources management but there is no clear and established practice that ensures optimal, realistic and efficient nurse staffing. Many studies have examined staffing from only a single perspective which has resulted in the overlooking of other important staffing considerations and a narrow vision of nurse staffing. The aim of this study was to identify the staffing models used in hospital acute care units in one of the biggest regions in Quebec while concurrently considering the three dimensions of nurse staffing: resource levels, staff mix and team stability. According to a descriptive quantitative design, the necessary variables for staffing operationalization were collected directly from the human resources departments of the four hospital centers for a total of 40 units of care which were studied for the target period between Janurary 11, 2016 and March 7, 2016. Staffing models were identified with a multiple factorial analysis and a hierarchical ascendant classification, used to generate a limited number of nurse staffing models. based on the configurational approach. This study’s results are a description of nurse staffing characteristics in the short-term hospitalization care units. Four different nurse staffing models emerged from the studied hospital centers: the least resourced model, the moderately resourced basic model, the moderately resourced professional model and the most resourced model. This representation of staffing models introduces new data for nursing workforce planning. The results provide human resources managers with data to compare to their staffing model or to other identified models and to other care units associated models in the studied sample. Moreover, because this study leads to a picture of the actual staffing situation it provides valuable information to optimize nurse staffing planning. Prior to this study, there were to our knowledge no staffing model classifications that considered all staffing dimensions simultaneously.
26
Persaud, Malini. "Pleasure in the Daily Lives of People Living with Advanced Dementia in a Long-term Care Facility: A Multiple Case Study Approach." Thesis, 2009. http://hdl.handle.net/1807/17816.
Full textAbstract:
According to the Canadian Study of Health and Aging most of the 12,630 Canadians living with advanced dementia reside in long-term care facilities. This number is rising due to an aging population. The purpose of this study is to address an identified gap in our knowledge about what creates pleasure in people with advanced dementia, through first understanding family caregivers’ ways of eliciting and interpreting positive emotions in their relatives and then having the personal support worker (PSW) try these same approaches to see if similar responses are achieved. This study used a qualitative multiple case study design. Data collection methods included digitally recorded interviews and video-recorded observations of interactions between residents and caregivers. A case is defined as a resident with moderately to severely advanced dementia. Each case had two informants: a family member and a PSW meeting inclusion criterion. There were seven cases. The resident participants spanned a range from moderately advanced to severely advanced dementia. Data analysis used both inductive and deductive coding with sensitizing concepts of selfhood, personhood, continuity of personality and well-being.
The results of this study centred on four main themes related to the research questions about the sources and indicators of pleasure and the potential for PSWs to replicate what family members did with residents. Some sources of pleasure were lost, some were maintained and new ones developed post-illness in all of the residents. Both family members and PSWs were knowledgeable about sources and indicators of pleasure for the people with dementia they were involved with. The analysis demonstrated that for individuals with very advanced dementia, the concept of pleasure or enjoyment is not applicable. The family members of the two residents with very advanced dementia used music, touch and sweets to elicit a pleasurable response but the resident did not display indicators of pleasure in response; instead, the residents responded with grasping or other responses which require further research to understand fully. Future research should build upon these findings in order to further understand the concept of positive affect: pleasure, interest and enjoyment in people with advanced dementia of the Alzheimer type.
27
Bouchard, Luc. "Les perceptions d’étudiants au baccalauréat en sciences infirmières de l’utilisation du journal d’apprentissage." Thèse, 2011. http://hdl.handle.net/1866/7076.
Full textAbstract:
L’approche par compétences est de plus en plus choisie pour guider les curriculums universitaires de formation professionnelle. Accordant un intérêt primordial au développement des compétences, les responsables des programmes élaborés selon cette approche doivent déterminer les stratégies pédagogiques qui seront les plus efficaces et qui permettront une participation active de l’étudiant. Depuis plus de 30 années (Cameron et Mitchell, 1993; Wellard et Bethune, 1996), le journal d’apprentissage favorise la construction des savoirs en pratique clinique et le développement de la pensée réflexive, une compétence nécessaire à la pratique des infirmières qui s’inspirent d’une vision spécifique de la discipline, comme celle du modèle de McGill (Kravitz et Frey, 1989; Thorpe, 2003). Malgré cela, les études sur les perceptions d’étudiants relativement au journal d’apprentissage sont rares, et ce, surtout au Canada (Epp, 2008). Il importe de s’intéresser aux perceptions d’étudiants afin d’atteindre l’efficacité optimale de l’outil. Le but de cette étude était d’explorer les perceptions d’étudiants au baccalauréat en sciences infirmières de l’utilisation du journal d’apprentissage. Elle a été réalisée auprès d’étudiants de 2e et 3e année, selon un devis de type qualitatif exploratoire. Les participants (n=52) ont rempli un formulaire constitué d’une mise en situation comprenant 5 questions ouvertes. L’analyse des données a fait émerger trois thèmes principaux de l’utilisation du journal soit : un outil personnel, un outil de communication et un outil d’apprentissage de la pratique. Des recommandations pour la formation et la recherche sont formulées.The competency-based approach is increasingly chosen to guide university curriculum. In according an essential interest to the competency development, the responsible for programs developed using this approach must determine the most effective learning strategy. In the last 30 years (Cameron et Mitchell, 1993; Wellard et Bethune, 1996), the learning journal promote the building of clinical knowledge and the development of reflexive thinking, a competency that is necessary to the practice nurses inspired by a specific vision of the discipline, like the McGill model (Kravitz et Frey, 1989; Thorpe, 2003). Despite this, the studies on the student’s perceptions on the learning journal are rare, especially in Canada (Epp, 2008). It is important to look at student’s perceptions to attain the optimal efficacy of the tool. The purpose of this study was to explore the perceptions of undergraduate students in nursing of the utilization of learning journal. It was realized with 2nd and 3rd year undergraduate students in nursing, using a qualitative exploratory research design. The participants (N=52) completed a form presenting a simulated situation that contained 5 open ended questions. The three main themes that emerged during data analysis on the utilization of the learning journal were: a personal tool, a communication tool and a learning practice tool. Recommendations for education and future research are offered.
28
Huot, Valérie. "Adoption d'une intervention systémique visant à faciliter la communication entre les infirmières et les familles dans un contexte de soins intensifs en traumatologie." Thèse, 2010. http://hdl.handle.net/1866/4448.
Full textAbstract:
Le but de cette étude est d’adopter une intervention systémique visant à faciliter la communication entre les infirmières1 et les familles2 dans un contexte de soins intensifs (SI) en traumatologie. Cette recherche prend en compte la réalité et les besoins du milieu à l’étude grâce au devis participatif retenu. Le cadre de référence est composé de l’approche systémique familiale de Wright et Leahey (2005) ainsi que de la théorie du caring de Jean Watson (1979). La collecte des données a été inspirée du parcours de recherche en spirale de Lehoux, Levy et Rodrigue (1995). Cinq entrevues ont été menées auprès de membres de familles ainsi que trois groupes de discussion (focus groups) auprès d’infirmières. L’analyse des données a été effectuée selon le Modèle de Huberman et Miles (2003) qui préconise une démarche analytique continue et interactive. Les résultats obtenus révèlent un changement de pratique selon dix interventions systémiques infirmières spécifiques permettant de faciliter la communication avec les familles aux soins intensifs en traumatologie et soulignent l’importance d’agir sur le plan du contexte, de la relation et du contenu liés au processus de communication. De plus, ils permettent de démontrer un réel changement de pratique dans le milieu retenu pour l’étude.Abstract The purpose on this study was to adopt systemic nursing interventions to enhance communication with families in a context of traumatology intensive cares. This participative study has the benefit of reflecting the real needs expressed by the persons concerned. The terms of reference for this study comprised the conceptual model as well as Wright and Leahey’s (2005) family systems nursing approach and the caring theory of Jean Watson (1979). The data collection was inspired by Lehoux, Levy and Rodrigue (1995) over five family interviews and three nurses’ meetings. The data collection was performed over a period of seven months. All of the interviews and meetings were recorded on audio tape and the verbatim’s were fully transcripted. The data analysis was done according to Huberman and Miles’ (2003) model, where analytical activities and data collection establish a continuous and interactive approach. The results obtained revealed ten specific systemic nursing interventions to enhance communication with families in this context and revealed the importance of the three levels of communication: cognitive, affective and behavioral. Moreover, the results are used to identify well-established interventions and recommend those who have to be improved.
29
Maheux, Dany. "Perceptions d’étudiantes universitaires quant à l’effet d’un programme d’externat en soins infirmiers sur le développement de leurs compétences professionnelles." Thèse, 2011. http://hdl.handle.net/1866/5874.
Full textAbstract:
Au Québec, le programme d’externat en soins infirmiers, permet aux étudiantes infirmières de travailler, à titre d’externes, durant l’été suivant leur 2e année d’étude. Les études portant sur les apprentissages que des étudiantes infirmières font à l’intérieur d’un programme d’externat ne reposent pas sur un cadre théorique définissant la vision de l’apprentissage des auteurs. De plus, aucune n’a fait de lien avec les compétences professionnelles.
Cette étude avait pour but de décrire, selon la perception d’étudiantes universitaires québécoises, l’effet de leur participation à un programme d’externat en soins infirmiers sur le développement de leurs compétences professionnelles et s’est appuyée sur l’approche par compétences de seconde génération développée à la Faculté des sciences infirmières de l’Université de Montréal (Goudreau, Pepin, Dubois, Boyer, Larue et Legault, 2009). Les résultats obtenus reposent sur un devis descriptif qualitatif réalisé auprès de huit étudiantes infirmières universitaires. L’analyse a été réalisée selon la méthode de Miles et Huberman (2003) à partir de la transcription intégrale des entrevues. L’étude a permis d’identifier les principales compétences développées dans le cadre du programme d’externat, soit «Exercer un jugement clinique infirmier», «Collaborer dans des équipes professionnelles» et «Agir avec humanisme en accompagnant les personnes/familles/communautés dans leurs expériences de santé». Elle a également mis en évidence l’importance du développement de la confiance en soi dans l’expérience de travail des participantes. Des recommandations pour la gestion, la formation et la recherche découlent de cette étude.In Quebec, the nursing externship program allows the nursing student to work as an extern the following summer after their second school year. The studies that focused on apprenticeship during the externship program were all realized in United States and they are not supported by any theoretical framework that explains the learning vision of the authors. In addition, these studies did not link their results with professional competencies development. The goal of this study was to describe the effect of the externship, as seen by Quebec university students, on the professional competencies development. This study was base on the second-generation competency approach. The approach was developed by the Nursing Faculty in Montreal University (Goudreau, Pepin, Dubois, Boyer, Larue et Legault, 2009). The results that were obtained rest on a descriptive qualitative study realized among a sampling of eight university nursing students. The analysis has been realized based on the integral transcripts of interviews as per the Miles & Huberman (2003) method. This study has permitted to identify the principal competencies developed during the externship program, as «Development of a nursing clinical judgment», «Collaborated within professional teams» and «Caring for patients and their families». The development of self confidence strongly shows the global perception of the nursing extern. Recommendations for management, formation and research arose from this study.
30
Lampron, Kim. "L'étendue de la pratique chez les infirmières cliniciennes et les infirmières." Thèse, 2010. http://hdl.handle.net/1866/4493.
Full textAbstract:
Dans le cadre de cette étude, nous nous sommes intéressés aux infirmières soignantes qui possèdent un diplôme d’études collégiales ou un baccalauréat. L’infirmière est celle ayant reçu une formation collégiale et la clinicienne, une formation universitaire de premier cycle. Au niveau législatif, selon que l’infirmière soit titulaire ou non d’un baccalauréat, le champ de pratique autorisé demeure le même. Cependant, l’étendue de la pratique pourrait varier selon la formation reçue et le poste occupé. Cette étude descriptive et interprétative de type qualitatif avait pour but de décrire l’étendue de la pratique des infirmières et des infirmières cliniciennes dans une unité de médecine et de chirurgie et d’identifier les facteurs organisationnels influençant l’étendue de la pratique. Le cadre de référence ayant été utilisé est le cadre d’analyse de l’étendue de la pratique conçu pour le Collège des infirmières autorisées de la Nouvelle-Écosse (CRNNS, 2005). Selon ce cadre, l’étendue optimale de la pratique des infirmières se divise en 4 catégories distinctes, soit le processus de soins infirmiers, les pratiques relationnelles, le leadership ainsi que l’enseignement et le transfert des connaissances. La collecte de données a été conduite au moyen d’entrevues individuelles semi-structurées auprès de 8 informateurs clés soit trois infirmières et trois infirmières cliniciennes d’une unité de médecine et de chirurgie et de deux gestionnaires. Les résultats semblent montrer que les différentes composantes de l’étendue de la pratique sont mobilisées tant chez les infirmières que chez les infirmières cliniciennes interviewées. Toutefois, les résultats semblent montrer que certaines composantes, soit le leadership et le transfert des connaissances, semblent davantage mobilisées chez les infirmières cliniciennes. De plus, l’étude a permis d’identifier les différents facteurs organisationnels qui semblent influencer l’étendue de la pratique des infirmières et des infirmières cliniciennes. La charge de travail semble être le principal facteur d’influence. Nous avons aussi pu constater l’influence certaines composantes reliées à l’environnement de travail et à la composition et aux caractéristiques des équipes de soins.The goal of this descriptive and interpretative study was to first describe the scope of nursing practice of registered nurses with a Bachelor’s degree in nursing and those with a nursing diploma in a medical and surgical unit of a regional hospital. The second goal was to identify the organizational factors that influence the scope of nursing practice in that unit. The framework that has been used is the Framework to Analyse Scope of practice, made for the College of Registered Nurses in Nova Scotia (CRNNS, 2005). According to that framework, the full scope of practice of the registered nurse is divided in 4 components: the nursing process, the professional nursing relationships, the leadership and the fonction of teaching and knowledge transfert. For this study, 8 interviews have been realized. The participants were: 3 nurses with a nursing diploma, 3 nurses with a bachelor’s degree and 2 administrators. The results seems to show that all the components of the nursing scope of practice seems to be used by the nurses with a Bachelor’s degree in nursing and those with a nursing diploma. But, the results seem to show that the nursing scope of practice is not fully extended in that unit. We remarked also that two elements of the nursing scope of practice, the leadership and the teaching and knowledge transfert, are more used by nursed with a Bachelor’s degree, compared to those with a nursing diploma. The principal factors which seem to influence the scope of nursing practice in this unit are the nursing workload and some components according to the work environment and to the composition and caracteristics of the nursing teams.
31
Lavallée, Dominique. "La pratique de soins infirmiers en pédopsychiatrie dans un contexte clinique interculturel." Thèse, 2013. http://hdl.handle.net/1866/11265.
Full textAbstract:
Les défis rencontrés dans les soins en santé mentale dans un contexte clinique interculturel sont nombreux, en raison, notamment, des différences de perceptions et de
la stigmatisation culturelle de la maladie mentale (Hwang, Myers, Abe-Kim, & Ting,
2008; Alegria, Atkins, Farmer, Slaton, & Stelk, 2010). Les soins infirmiers en santé mentale ne semblent pas toujours adaptés aux besoins particuliers des adolescents et leur famille issus d’origines culturelles diverses (Alegria, Vallas, & Pumariega, 2010; Dogra & Vostanis, 2007; McKenzie et al., 2009). La pratique de soins infirmiers dans ce contexte est très peu documentée dans les écrits scientifiques pour nous permettre d’adresser en profondeur cette problématique. Le but de cette étude de cas multiples, tel que préconisée par Stake (2005), est de décrire la pratique de soins infirmiers en pédopsychiatrie dans un contexte clinique interculturel. Le cadre de référence de cette étude est celui des six volets de compétences requises pour l’infirmière en santé mentale et en soins psychiatriques émis par l’Ordre des infirmières et des infirmiers du Québec (2009). Les résultats de cette étude qualitative proviennent de l’analyse descriptive d’entretiens individuels (n=7) auprès d’infirmières en pédopsychiatrie qui ont accompagné au moins un adolescent et sa famille dans un contexte clinique interculturel. Les données issues de ces entretiens ont été validées lors de deux entretiens de groupe où un cas prototype, composé à partir des données issues des entretiens individuels, a été soumis à la discussion. Les résultats de cette étude révèlent des perceptions de la pratique de soins infirmiers dans un contexte clinique interculturel et des interventions privilégiées par des infirmières. Des recommandations pour la pratique, la formation et la recherche en sciences infirmières ont été formulées.The challenges in mental health care in an intercultural clinical context are numerous, notably, because of the differences in perceptions and cultural stigma of mental illness (Hwang, Myers, Abe-Kim, & Ting, 2008; Alegria, Atkins, Farmer, Slaton, & Stelk, 2010). Nursing practices in mental health don’t always seem suited to the specific needs of the adolescents and their families from culturally diverse backgrounds (Alegria, Vallas, & Pumariega, 2010; Dogra & Vostanis, 2007; McKenzie et al., 2009). The practice of nursing in this context is poorly documented to address this issue in depth. The purpose of this multiple case study (Stake, 2005), is to describe the practice of nursing in child and adolescent psychiatry in an intercultural clinical context. The six areas of expertise required for the mental health nurses and psychiatric nurses describe by the Quebec Order of nurses (2009) were used as framework. The results of this qualitative study were obtained from descriptive analysis of individual interviews (n=7) with child and adolescent psychiatric nurses who accompanied at least one teenager and his family in an intercultural clinical context. The data from these interviews were validated in two group interviews, where a prototype case, made from data from the individual interviews, was submitted to discussion. The results of this study indicate perceptions of nursing practice in an intercultural clinical context and preferred nursing practices. Recommendations for practice, education and nursing research were made.
32
Lok, Jana Gegus. "Nurses' Awareness of and Intention to Use Music Therapy in Practice." Thesis, 2013. http://hdl.handle.net/1807/43640.
Full textAbstract:
BACKGROUND: Anxiety and pain are prevalent symptoms experienced by inpatients in acute, long-term and rehabilitation care settings. There is a need for effective relief from these symptoms without increasing the risks as a result of the intervention. Empirical evidence supports the use of music as a complementary therapy for the management of anxiety and pain. However, there is limited knowledge of nurses’ awareness of and intention to use music therapy in clinical practice.
AIMS: This study examined nurses’ awareness of and intention to use music therapy for the management of anxiety and pain, and factors that influenced nurses’ intention to implement music therapy in practice. A conceptual framework incorporating elements of the Theory of Planned Behaviour and Triandis’ Theory of Interpersonal Behaviour guided the study.
METHOD: A correlational, survey-type design was used. The sample consisted of 161 Registered Nurses who were currently providing direct care to patients in acute, rehabilitation and long-term care settings in Ontario. Data were collected using adapted instruments that were pilot tested.
RESULTS: Attitudes, subjective norms, perceived behavioural control, moral norms, and awareness were positively and moderately (all β > 0.20, p < .05) associated with nurses’ intention to use music therapy for the management of anxiety and pain. Role beliefs, selected demographic and professional characteristics were not significantly related to nurses’ intention to use music therapy for either anxiety or pain management. Nurse, client and unit factors were additional factors reported by nurses as affecting their use of music therapy in practice.
IMPLICATIONS: The findings suggested the need for strategies to educate nurses about music therapy to facilitate its implementation in clinical practice. Research exploring why nurses are unaware of music therapy as an intervention and revisions to the current conceptual framework to incorporate additional factors influencing intervention use are required.
33
Tessier, Miriam. "Perceptions infirmières quant à la réalisation de la collecte des données auprès de la clientèle à l'urgence, étape préalable à la formulation du jugement clinique infirmier." Thèse, 2011. http://hdl.handle.net/1866/9013.
Full textAbstract:
Depuis l’adoption de la Loi 90 en 2002, la Loi sur les infirmières et infirmiers (LII, article 36) confère une autonomie élargie aux infirmières en reconnaissant, notamment, leur compétence et leur responsabilité à l’égard de l’évaluation clinique qui est représentée dans cette loi comme l’assise de l’exercice infirmier (Pellerin, 2009; OIIQ, 2010). La collecte des données constitue une étape fondamentale du processus d’évaluation clinique (Dillon, 2007; Doyon, Brûlé & Cloutier, 2002; Pellerin, 2009; Weber & Kelley, 2007). L’infirmière d’urgence a une responsabilité majeure à l’égard de la collecte des données. En effet, elle œuvre auprès de clientèles de tous âges qui présentent des problèmes de santé variés, aigus et parfois urgents et doit souvent intervenir, sur la base de son évaluation clinique, avant qu’un diagnostic n’ait été établi ou que le patient n’ait été vu par le médecin (Newberry & Criddle, 2005). Or, malgré toute l’importance que revêtent dorénavant l’évaluation clinique et la collecte des données au sens de la loi, ce rôle de l’infirmière semble tarder à s’actualiser dans la pratique clinique.
Le but de cette étude qualitative descriptive consiste à explorer les perceptions d’infirmières, de gestionnaires en soins infirmiers et d’infirmières ressources cliniques d’urgence relativement à la réalisation de la collecte des données. La norme clinique « collecte des données » (assessment) de l’Emergency Nurses Association (1999) constitue le cadre de référence de l’étude. Cinq entrevues individuelles semi-dirigées de 60 minutes ainsi qu’un groupe de discussion de 90 minutes ont été réalisés auprès d’infirmières d’urgence. Un deuxième groupe de discussion a également réuni deux gestionnaires en soins infirmiers et deux infirmières ressources cliniques de l’urgence. Les données recueillies ont été analysées selon l’approche proposée par Miles et Huberman (2003). Les résultats obtenus démontrent que les infirmières considèrent la collecte des données comme un aspect fondamental de leur pratique à l’urgence, qui contribue à améliorer la qualité et la sécurité des soins dispensés. Or, les résultats révèlent également que leur compréhension de la collecte des données est variable, que leur pratique est aléatoire et largement influencée par le modèle biomédical. Plusieurs facteurs influencent la pratique des infirmières relativement à la collecte des données notamment : la conception individuelle de la collecte des données et du rôle infirmier, les relations et l’interaction avec les membres de l’équipe des soins infirmiers et les autres professionnels ainsi que le soutien de l’organisation et des gestionnaires en soins infirmiers. Ce dernier facteur semble prépondérant dans le contexte de l’urgence et démontre que le soutien des gestionnaires et des infirmières ressources cliniques influence de façon importante la pratique dans les milieux cliniques. Cette étude propose des pistes de réflexion sur la formation académique, la formation continue, l’administration des soins infirmiers et la collaboration interprofessionnelle qui pourraient faciliter l’actualisation du rôle des infirmières à l’égard de la collecte des données et de l’évaluation clinique afin d’améliorer la qualité des soins dispensés à l’urgence.Since the enactment of Bill 90 in 2002, the Nurses Act (section 36) gives nurses greater autonomy by recognizing their competency and responsibility in clinical assessment, featured in this Act as the corner stone of the nursing profession (Pellerin, 2009; OIIQ, 2010). Assessment constitutes a fundamental step in the clinical assessment process (Dillon, 2007; Doyon, Brûlé & Cloutier, 2002; Pellerin, 2009; Weber & Kelley, 2007). The emergency nurses have a major responsibility with regard to patient assessment. In fact, they work with patients of all ages that have various health problems that can be acute and sometimes urgent, and they must intervene, according to their clinical assessment, before a diagnosis has been established or the patient has seen a doctor (Newberry & Criddle, 2005). Yet, despite the importance now conferred by law on clinical assessment, this role has yet to be accepted as an integral part of clinical nursing. The aim of this qualitative descriptive study is to explore the perceptions of nurses, nursing managers and clinical resource nurses with regard to assessment. The clinical standard of the Emergency Nurses Association for patient assessment (1999) is the frame of reference for this study. Five 60-minute individual semi-structured interviews and a 90-minute discussion group were conducted with emergency nurses. A second discussion group included two nursing managers and two emergency clinical resource nurses. The data collected were analysed using the approach proposed by Miles and Huberman (2003). The results obtained show that nurses view patient assessment as a fundamental part of their emergency responsibilities that influences the improvement of the quality and security of the care given. However, the results also revealed that their understanding of assessment varies, and that this practice is random and largely influenced by the biomedical model. Several factors influence nursing practice regarding patient assessment, in particular: individual notions of assessment and the role of nurses, the relations and interactions between members of the nursing team and other professionals, as well as the support of the organisation and the nursing managers. This last is a leading factor in the context of the emergency department and shows that the support of the nursing managers and clinical resource nurses has an important impact on practice in clinical settings. This study proposes further areas of study focused on academic training, continuing professional education, nursing management and inter-professional collaboration that could facilitate the actualisation of nurses’ roles concerning patient assessment to improve the quality of care provided in the emergency department.
34
Dutta, Tilak. "Preventing Back Injury in Caregivers." Thesis, 2012. http://hdl.handle.net/1807/32702.
Full textAbstract:
Caregivers injure their backs more than workers in any other industry. Efforts to reduce injuries have been on-going for decades with limited results. Mechanical lift devices have been incorporated into clinical practice over the past 30 years to reduce the risk of injury from patient lifting. Yet injury rates remain high. The use of mechanical lifts may be partly to blame. While these devices assist with lifting patients, they also introduce new activities that result in caregivers experiencing unsafe loading on the spine.
We measured loads on the lower back during manoeuvres of the two most common lift types (overhead and floor) as well as during sling insertion. A new device called SlingSerterTM was evaluated for use in the clinical environment. We also investigated spine shrinkage as a measurement tool for estimating cumulative load.
Caregivers worked alone and in pairs for both lift maneuvering and sling insertion activities. Overhead lift use resulted in much lower loads than floor lift use. We conclude caregivers can safely operate overhead lifts alone, while floor lift use remained unsafe even with two caregivers. Less-experienced caregivers had higher loads than more-experienced counterparts when using floor lifts. There was no corresponding effect of experience with overhead lift use and we found this to be a further benefit of overhead lifts over floor lifts. Most caregivers exceeded the safe limit for spine compression during sling insertion, though a single caregiver was at no higher risk of injury than two caregivers working together.
Clinicians who tested SlingSerterTM agreed the device would be useful in clinical practice, particularly with bariatric patients and other special patient populations that are difficult to roll or turn. Finally, we investigated a novel method for estimating cumulative load based on spine shrinkage. There is growing recognition that excess cumulative load may be responsible for back injury. We found the variability in spine shrinkage was too large to estimate cumulative load directly. However, the technique may still be useful for determining the relative importance of the load from different activities to the cumulative total.
35
Laramée, Marie-Christine. "Perspective d'étudiantes infirmières de leur environnement d'apprentissage de la pratique en contexte de diversité culturelle lors d'une immersion clinique à l'international." Thèse, 2016. http://hdl.handle.net/1866/16293.
Full textAbstract:
Il existe une grande diversité dans les programmes de formation en sciences infirmières concernant l’organisation de stages d’immersion clinique à l’international et le soutien offert aux étudiantes (Kokko, 2011). Cette étude de cas qualitative explore, selon la perspective d’étudiantes infirmières, les éléments de l’environnement d’apprentissage de la pratique en contexte de diversité culturelle dans le cadre d’une immersion clinique à l’international. Le modèle constructiviste de développement de la compétence culturelle de Blanchet Garneau (2013 ; Blanchet Garneau et Pepin, 2015a) a servi de cadre de référence à cette étude. Dix étudiantes ayant participé à l’immersion clinique ont pris part à une entrevue individuelle en profondeur. Suite à une analyse qualitative thématique des données inspirée de Miles, Huberman et Saldana (2014), trois thèmes inter reliés ressortent : accompagnement par de multiples collaborations, trouver sa place dans le milieu d’accueil et écart entre les attentes des étudiantes et l’expérience vécue. Ces thèmes permettent de comprendre l’environnement d’apprentissage des étudiantes dans le développement de leur compétence culturelle, notamment leur capacité de s’ouvrir aux différentes réalités en contexte de diversité culturelle. Puisque peu d’écrits abordent spécifiquement les éléments de l’environnement d’apprentissage liés à la capacité de s’ouvrir aux différentes réalités de la pratique en contexte de diversité culturelle à l’étranger, cette étude contribue à l’approfondissement des éléments de l’environnement d’apprentissage présenté dans le modèle de Blanchet Garneau (2013 ; Blanchet Garneau et Pepin, 2015) et constitue un ajout aux connaissances actuelles liées au développement de la compétence culturelle.There is a wide diversity in nursing education programs concerning the organization of international clinical immersion curricula and the support offered to students (Kokko, 2011). Guided by the constructivist cultural competence development model designed by Blanchet Garneau (2013 ; Blanchet Garneau et Pepin, 2015a), this qualitative case study explored the learning environment that promotes the development of nursing practice in culturally diverse contexts through an international clinical immersion. Ten students who had recently undergone international clinical immersion participated in an individual in depth interview. Thematic qualitative data analysis was inspired by Miles, Huberman and Saldana (2014). Results of this study yield three interrelated themes: support through multiple collaborations, finding one’s place in the host environment and gap between the expectations of the students and the lived experience. These themes develop our understanding of learning environments in students’ cultural competence development, particularly with respect to their capacity to open up to different realities of practice in a culturally diverse context. In summary, this study adds to current knowledge related to cultural competence development and contributes to Blanchet Garneau’s model (2013 ; Blanchet Garneau et Pepin, 2015b).
36
Morin, Marie-Pierre. "Comprendre l'expérience vécue par les patients en oncologie active et leur famille en milieu rural." Thèse, 2017. http://hdl.handle.net/1866/20079.
Full text
37
Khadra, Christelle. "La distraction par la réalité virtuelle pour le soulagement de la douleur de jeunes enfants ayant subi des brûlures." Thèse, 2019. http://hdl.handle.net/1866/23546.
Full textAbstract:
Les brûlures chez les enfants provoquent une douleur sévère surtout durant les procédures de soins. La gestion de la douleur est un rôle principal de l’infirmière œuvrant dans les soins aux brûlés. En plus d’administrer les médicaments et d’en assurer la surveillance, l’infirmière peut initier des interventions non pharmacologiques puisque les médicaments ne procurent souvent pas un soulagement total et ont de nombreux effets secondaires. La distraction par la réalité virtuelle (RV) est une intervention non pharmacologique qui permet de dévier l’attention de l’enfant des stimuli douloureux. Plusieurs études ont montré un effet prometteur de cette technologie pour le soulagement de la douleur procédurale. Cependant, aucune étude n’a exploré son effet auprès de jeunes enfants.
Le but de cette thèse était d’abord, d’évaluer la faisabilité et l’acceptabilité, et ensuite l’effet préliminaire sur la douleur d’un nouveau prototype de RV (projecteur en dôme – RV hybride) développé spécifiquement pour distraire les enfants brûlés âgés entre 6 mois et 7 ans durant les séances d’hydrothérapie.
À cet effet, deux études ont été menées. La première était une étude pilote à un groupe. Les participants étaient 15 enfants âgés en moyenne de 2.2 ± 2.1 ans avec une moyenne de surface corporelle brûlée de 5% ± 4. Ils ont tous reçu la distraction par le projecteur en dôme de RV combiné au traitement pharmacologique standard. Les résultats ont montré que le projecteur était une intervention faisable et adaptée à la salle d’hydrothérapie. Il n'a pas interféré avec la procédure et a été jugé utile pour la gestion de la douleur par la plupart des intervenants. Les mesures de douleur, de confort et de sédation étaient faisables, mais pas celle de l’anxiété compte tenu du jeune âge des participants.
La seconde étude, basée sur la première, concernait un essai clinique d’efficacité intra-sujet auprès de 38 enfants âgés de 1.8 ± 1.3 ans. Chaque participant a reçu, durant la même séance d’hydrothérapie, le traitement pharmacologique seul (intervention contrôle) ainsi que le traitement pharmacologique combiné à la distraction par le projecteur en dôme de RV (intervention expérimentale) selon un ordre randomisé. L’intervention expérimentale a eu un effet bénéfique sur la douleur (mesurée par la FLACC (Face, Legs, Activity, Cry, Consolability scale) statistiquement significatif comparé à l’intervention contrôle pour tous les participants combinés (p= 0.026), ainsi qu’au niveau du confort mesuré par l’OCCEB-BECCO (Échelle d'Observation Comportementale du Confort d'Enfants Brûlés) (p=0.002). Cependant, selon l’analyse par séquences de randomisation, la différence était seulement significative pour le groupe qui a débuté par l’intervention expérimentale suggérant qu’il est plus difficile de distraire l’enfant une fois que les procédures douloureuses sont débutées. Aucun effet secondaire n’a été observé.
Les résultats de cette thèse soulignent l’effet bénéfique de la distraction par la RV hybride chez les jeunes enfants brûlés. Cet outil peut être intégré à la pratique infirmière quotidienne pour offrir de meilleures interventions pour le soulagement de la douleur procédurale sans effets secondaires.Burns in children cause severe pain especially during wound care procedures. Pain management is a primary role of nurses involved in burn care. In addition to administration and monitoring of the medication, the nurse can initiate non-pharmacological interventions since the medication does not provide total relief with this population of patients and has many side effects. Virtual reality (VR) distraction is a non-pharmacological intervention that helps divert the child's attention away from painful stimuli. Several studies have shown a promising effect of this technology for the relief of procedural pain. However, no studies have explored its effect on pain in young children. The purpose of this thesis was two-fold: First to evaluate the feasibility and acceptability, and secondly the preliminary effect on pain of a new VR prototype (projector-based hybrid VR) developed specifically for burned children between 6 months and 7 years of age during hydrotherapy sessions. For this purpose, two studies were conducted. The first study was a single group pilot study. Participants were 15 children aged 2.2 +/- 2.1 years with a mean body surface area of 5% +/- 4%. They all received distraction by the projector-based hybrid VR combined with standard pharmacological treatment. Results showed that the VR projector was a feasible intervention adapted to the treatment room. It did not interfere with the procedure and was found useful for pain management by most care providers. Measurements of pain, comfort, and sedation were feasible, but not the measurement of anxiety given the participants’ age-group. The second study, based on the first one, was an efficacy crossover clinical trial of 38 children aged 1.8 ± 1.3 years. Each participant received, during the same hydrotherapy session, the pharmacological treatment alone (control intervention) as well as the pharmacological treatment combined with the distraction by the projector-based hybrid VR (experimental intervention) in a randomized order. The experimental intervention had a statistically significant beneficial effect compared to the control intervention for all participants combined for pain levels measured by the FLACC (Face, Legs, Activity, Cry, Consolability Scale) (p = 0.026) and comfort levels measured by OCCEB-BECCO (Behavioral Observational Scale of Comfort Level for Child Burn Victims) (p = 0.002). However, according to the analysis by randomization sequences, the difference was only significant for the group for which the sequence started with the experimental intervention suggesting that it is more difficult to distract a child once the painful procedures are started. No side effects were observed. Results of this thesis highlight the beneficial effect of a hybrid VR distraction device with young burned children. This tool could be implemented in daily nursing practice to provide better pain care to young children with no side effects.
38
Ballantyne, Marilyn. "Maternal-infant Predictors of Attendance at Neonatal Follow-up Programs." Thesis, 2010. http://hdl.handle.net/1807/24674.
Full textAbstract:
Attendance at Neonatal Follow-up (NFU) programs is crucial for parents to gain access to timely diagnostic expertise, psychosocial support, and referral to needed services for their infants. Although NFU programs are considered beneficial, up to 50% of parents do not attend these programs with their infants. Non-attending infants have poorer outcomes (e.g., higher rates of disabilities and less access to required services) as compared to attenders.
The purpose was to determine factors that predicted attendance at NFU. Naturally occurring attendance was monitored and maternal-infant factors including predisposing, enabling, and needs factors were investigated, guided by the Socio-Behavioral Model of Health Services Use.
A prospective two-phase multi-site descriptive cohort study was conducted in 3 Canadian Neonatal Intensive Care Units that refer to 2 NFU programs. In Phase 1, standardized questionnaires were completed by 357 mothers (66% response rate) prior to their infant’s (N= 400 infants) NICU discharge. In Phase 2, attendance patterns at NFU were followed for 12 months.
Higher maternal stress at the time of the infant’s NICU hospitalization was predictive of attendance at NFU. Parenting alone, more worry about maternal alcohol or drug use, and greater distance to NFU were predictive of non-attendance at NFU. Attendance at NFU decreased over time from 84% at the first appointment to 74% by 12 months. Two distinct attendance patterns emerged: no or minimal attendance (18.5%) and attendance at all or the majority of scheduled appointments (81.5%). The most frequent point of withdrawal from NFU occurred between NICU discharge and the first scheduled appointment; followed by drop-out following the first NFU appointment.
These results provide new insight into patterns of attendance and the maternal-infant factors that characterize attenders/non-attenders at NFU and serve as the critical first step in developing interventions targeted at improving attendance, infant outcomes, and reporting of developmental sequelae.
39
Martel, Kim Jade. "Exploration des facteurs contraignants et facilitants, perçus par des professionnels de la santé, à l’implantation d’une unité collaborative d’apprentissage en milieu clinique." Thèse, 2017. http://hdl.handle.net/1866/20080.
Full text
40
Touchette, Boivin Claudia. "Le soutien du leadership transformationnel des infirmières gestionnaires dans un contexte de changement organisationnel : la perspective des infirmières gestionnaires." Thèse, 2017. http://hdl.handle.net/1866/19453.
Full text
41
Paradis, Véronique. "Évaluation d’une intervention infirmière Motivationnelle Selon les Stades de Changement (MSSC) sur des comportements d’auto-soins chez des patients insuffisants cardiaques." Thèse, 2009. http://hdl.handle.net/1866/6938.
Full textAbstract:
L’insuffisance cardiaque (IC), une maladie chronique caractérisée par un mauvais fonctionnement du muscle cardiaque, entraîne des symptômes comme l’essoufflement, l’œdème et la fatigue. L’IC nécessite l’adoption de comportements d’auto-soins pour prévenir les épisodes de décompensation. Le but de cette recherche est d’évaluer l’intervention infirmière motivationnelle selon les stades de changements (MSSC) sur les comportements d’auto-soins chez des patients IC. Afin de guider l’intervention MSSC, la théorie spécifique aux auto-soins chez les patients IC de Riegel et Dickson (2008) a été retenue ainsi que le modèle d’intervention de Bédard et al. (2006) combinant le modèle transthéorique (Prochaska & DiClemente, 1984) et l’entrevue motivationnelle (Miller & Rollnick, 2006).
Il s’agit d’un devis expérimental randomisé (pré et post-test) avec groupe contrôle (N = 15/groupe). Les patients du groupe contrôle ont reçu les soins usuels et les patients du groupe intervention (GI) ont reçu l’intervention MSSC durant trois entretiens. Les mesures de résultats ont été collectées à un mois suite à la randomisation par une assistante de recherche aveugle à la randomisation. L’effet de l’intervention a été évalué par des analyses de covariance sur cinq mesures de résultats : la réalisation et la gestion (générale et spécifique à l’IC) des auto-soins, la confiance aux auto-soins (générale et spécifique à l’IC) et la conviction. L’acceptabilité et la faisabilité ont été évaluées. Les résultats indiquent un effet significatif sur la mesure de confiance à effectuer les auto-soins spécifiques à l’IC. La majorité des participants du GI ont progressé dans leurs stades de changement. Ces résultats soulignent le potentiel de cette approche pour favoriser l’adoption des auto-soins mais une étude à plus large échelle est proposée afin d’évaluer l’effet de cette approche dans un essai clinique randomisé.Heart failure (HF) is characterized by the heart’s reduced capacity to pump, resulting in symptoms causing respiratory problems and reduced quality of life. HF patients are advised to adopt self-care behaviours to prevent frequent episodes of decompensation. While medication and behaviour change play a major role in maintaining physiological stability, patient adherence to self-care recommendations is not optimal. The goal of this pilot study was to evaluate a Motivational Intervention following the Stages of Change (MISC) on HF patients’ self-care behaviours. To guide the MISC, the situation-specific theory of heart failure self-care (Riegel & Dickson, 2008) was retained as well as Bédard et al. (2006) model of intervention, a combination of Motivational interviewing (MI) (Miller & Rollnick, 2006) and Transtheoretical model (TTM) (Prochaska & DiClemente, 1984). This was a randomized experimental pilot project (pre and post-test, with a control group) (n=15/group). Patients in the control group received usual care from the HF clinic while patients from the experimental group (EG) received 3 MISC interventions. Data were collected at one month post-randomization by a blinded research assistant. The effect of the intervention was assessed on five self-care outcomes using analysis of covariance models: self-care maintenance and management (general and specific to HF), confidence in self-care (general and specific to HF) and conviction. Acceptability and feasibility were assessed. Significant results were obtained regarding the confidence in performing self-care behaviours specific to HF. A majority of patient in the EG did progress in the stages of change. The results suggest that a MISC intervention has potential to improve self-care. A larger study is needed to evaluate the effects of the MISC intervention in a randomized controlled trial.
42
Guay, Martine. "La pratique infirmière en procréation médicalement assistée au sein d’un établissement de santé québécois : une étude autoethnographique." Thesis, 2019. http://hdl.handle.net/1866/24542.
Full textAbstract:
Problématique : L’infertilité – considérée par l’Organisation mondiale de la santé (OMS) comme une maladie du système reproducteur – affecte de plus en plus d’hommes et de femmes, soit un couple sur six en âge de procréer au Canada et au Québec. Elle a un impact sur le bien-être physique et mental des patient.e.s, souvent stigmatisé.e.s et isolé.e.s socialement parce que, pour plusieurs, l’infertilité demeure un sujet tabou. L’infertilité est traitée en procréation médicalement assistée (PMA) où les patient.e.s-familles sont accompagné.e.s par des infirmières dont la pratique est complexe et diversifiée, mais méconnue. But : L’étude avait pour but d’explorer la pratique infirmière en PMA dans un établissement de santé québécois. Méthode : Le devis retenu est une autoethnographie où l’étudiante-chercheuse a mis à profit son expérience comme patiente et comme infirmière en PMA. Des entretiens semi-dirigés, une observation participante et un journal de terrain ont été employés pour la collecte des données. Une analyse thématique a été réalisée. Résultats : L’expérience des patient.e.s-familles en infertilité est au cœur de la pratique infirmière et l’une des principales dimensions de cette pratique est le soin relationnel, peu importe les sphères d’activités auxquelles les infirmières sont affectées au sein de la clinique. Les autres dimensions rapportées sont le leadership/advocacy, l’apprentissage/enseignement, la collaboration et les interventions techniques. Ces résultats correspondent à l’expérience de l’étudiante-chercheuse, tant à titre de patiente que d’infirmière en PMA. Retombées : L’étudiante-chercheuse a documenté la pratique infirmière en PMA, mettant en valeur une méthode peu usitée en sciences infirmières : l’autoethnographie.Problem: Infertility – classified by the World Health Organization (WHO) as a reproductive system disease – affects an ever-increasing number of women and men. Today, one couple out of six of reproductive age struggles with this condition in Canada and in Quebec. It has an impact on the patients’ physical and psychological well-being, often leaving both partners stigmatized and socially isolated as infertility remains a societal taboo for many. Infertility can be treated via Assisted Reproduction Technologies (ART) where the patients-families are cared for by fertility nurses, whose practice is both complex and diversified, but remains little-known. Purpose: This study explores the field of fertility nursing as it is practised in a Quebec healthcare institution. Method: The student-researcher chose to do an autoethnography in order to draw from her own experience as both a fertility nurse and a fertility patient. Semi-directed interviews, participant observation and field journal were used to collect data. A thematic analysis of data then followed. Results: The patients-families’ infertility experience is at the heart of the fertility nurse’s practice and relational care is the main dimension of that practice, regardless of which nursing activities are assigned to them in the clinic. These other dimensions were also reported : leadership/advocacy, learning/teaching, collaboration and technical interventions. These results coincide with the student-researcher’s experience, both as a fertility patient and as a fertility nurse. Impact: The student-researcher documented the practice of fertility nursing and showcased a method rarely used in nursing science: autoethnography.
43
Mekkelholt, Karine. "L'évolution de la conception personnelle de la discipline infirmière d'étudiants en soins infirmiers." Thèse, 2013. http://hdl.handle.net/1866/10999.
Full textAbstract:
Peu d’écrits décrivent la conception personnelle de la discipline infirmière des étudiants ou son évolution. Pourtant, celle-ci guide la pratique des étudiants (Fawcett, 2002; Pepin, Kérouac, & Ducharme, 2010) et a des impacts sur leur persévérance dans leur formation (Spouse, 2000). Le but de cette recherche était d’explorer l’évolution de la conception personnelle de la discipline infirmière d’étudiants pendant leur formation collégiale. Ce mémoire présente une étude qualitative exploratoire fondée sur un cadre de référence liant le constructivisme radical (Glasersfeld, 1994) et le centre d’intérêt de la discipline (Pepin et al., 2010). Des entrevues individuelles ont été menées auprès de onze étudiants de première, troisième et cinquième sessions (n=11). Les données ont été analysées par questionnement analytique (Paillé & Mucchielli, 2010). Selon les participants, un soin « humain » est préalable aux « soins » de l’infirmier. Ils décrivent que l’infirmier guide une personne unique, détenant des capacités afin qu’elle accomplisse ses activités et prenne soin d’elle-même pour maintenir sa santé mentale et physique ; l’environnement hospitalier ne rejoint pas les conditions idéales identifiées par les participants. La compréhension des concepts centraux devient plus complexe durant leur formation. Les participants attribuent surtout ces changements à leurs expériences de stages. Finalement, la présente étude fournit des pistes aux enseignants afin qu’ils puissent soutenir l’apprentissage des conceptions de la discipline et orienter la construction d’une conception personnelle de la discipline infirmière utile à la pratique des étudiants.Few studies describe the nursing students’ personal conceptual framework of the discipline nor its evolution though it influence their pratice and their continuation in the educational program (Fawcett, 2002; Pepin et al., 2010; Spouse, 2000). The goal of this research was to explore the evolution of nursing students’ personal conceptual framework during their nursing educational program. This paper presents a exploratory qualitative study inspired by a theoretical framework linking the radical constructivism (Glasersfeld, 1994) and the center of interest of the discipline (Pepin et al., 2010). Individual interviews were conducted with first, third and fifth semester nursing students (n=11). The data were analysed by analytic questioning (Paillé & Mucchielli, 2010). The participants describe « human » nursing as a precondition of the « nursing activities ». They describe the person has unique having abilities. The nurse guide the person to be able to accomplish his activities and to take care of himself to maintain mental and physical health. The hospital environment is not meeting the ideal conditions set by the participants. Throughout their educational program, the comprehension of the central concepts of nursing seems to get more complex and mature. The participants identify the experience gained through clinical placements as the main factor of influence on their personal conceptual framework. Finally, this research provides new knowledge to the nursing teachers facilitating the learning of the nursing theory and orient the construction of a useful personal framework for the future practice of the nursing students.
44
Connell, Lisa-Ann. "Family members' perceptions of nurse caring behaviours in the intensive care unit." Thèse, 2009. http://hdl.handle.net/1866/3502.
Full textAbstract:
La présence de membres de la famille dans les milieux de soins critiques a augmentée graduellement au cours des dernières années. La présente recherche visait à décrire la perception que les membres de la famille avait eu à l’égard des comportements de caring des infirmières lors de leur visite aux soins intensifs. Plus spécifiquement, ce projet avait pour but d’explorer les différences entre les perceptions de membres de la famille dont le proche était hospitalisé pour une blessure traumatique versus une maladie grave non-traumatique. Les différences ont aussi été examinées selon certaines caractéristiques personnelles d’un membre de la famille soit leur genre, leur expérience antérieure de visites aux soins intensifs, leur âge et leur perception de la gravité du problème de santé de leur proche. Le cadre de référence de cette étude était basé sur les facteurs caratifs proposés par Watson (1985). L’importance et la satisfaction des membres de la famille à l’égard des comportements de caring de la part des infirmières ont été mesurées par les versions française et anglaise adaptées du Caring Behaviors Assessment (CBA) (Cronin & Harrison, 1988). Les données ont été analysées en utilisant les techniques d’analyse MANOVA et des tests de corrélation de Pearson. En général, les résultats indiquent que les membres de la famille rapportent des degrés d’importance et de satisfaction similaires selon que leur proche était hospitalisé pour une blessure traumatique ou une maladie grave non-traumatique. Peu de différences émergent selon les caractéristiques personnelles des membres de la famille. Un coefficient de corrélation significatif (0.36, p = 0.012) existe entre la perception des membres de la famille de la gravité du problème de santé, et l’importance de la dimension ‘réponses aux besoins’. Par ailleurs, les comportements de caring regroupés dans la dimension ‘réponses aux besoins’ ont été perçus comme étant les plus importants et les membres de familles étaient très satisfaits des comportements de caring des infirmières. Cette étude fournit des pistes pour l’enseignement, la clinique et la recherche et met en lumière la perception des membres de la famille des soins infirmiers humains chez des proches hospitalisés dans une unité de soins intensifs.Family member presence in critical care environments has been gradually increasing over recent years. The aim of this study was to evaluate family members’ perceptions with regard to nurse caring behaviours while in the intensive care unit (ICU). Of particular interest were the perceptions of family members of different diagnostic groupings (critically injured “trauma” versus other critical illnesses), and socio-demographic characteristics (gender, previous experience in an ICU, age and perception of illness severity). The conceptual framework was based on Watson’s ‘carative’ factors. Family members rated the importance with nurses’ caring behaviours using English and French versions of The Caring Behaviors Assessment (CBA) (Cronin & Harrison, 1988). The data were analyzed using MANOVA and Pearson Correlation Coefficients. Family members from both groups reported similar degrees of importance and satisfaction with nurse caring behaviours. Few differences emerged based on socio-demographic characteristics. Similar to studies using the CBA on patients, behaviours belonging to the ‘human needs assistance’ dimension were perceived as most important indicators of caring. A significant positive correlation (0.36, p =.012) was found between family members’ perception of illness severity and the importance of the ‘human needs assistance’ dimension . This study provides some indications for critical care nursing (education, training, research) from the unique perspective of the family member, and sheds light on the particular nurse caring behaviours that are important to them during a time of crisis.
45
Zahreddine, Jouhayna. "Exploration de la perception de l’interdisciplinarité de la part des infirmières en milieu gériatrique." Thèse, 2010. http://hdl.handle.net/1866/4104.
Full textAbstract:
Problématique : Dans un contexte de vieillissement de la population et de complexification des besoins de santé, travailler en interdisciplinarité est devenu une nécessité pour prodiguer des soins de qualité aux personnes âgées vulnérables. Les avantages de l’interdisciplinarité sont connus mais son intégration dans la pratique des professionnels de la santé se vit parfois difficilement. La compréhension de la perception de l’interdisciplinarité de la part des infirmières est un élément majeur d’une pratique de collaboration interprofessionnelle réussie, mais ce sujet a été peu étudié, encore moins en milieu gériatrique.
Méthodologie : Le but de cette étude était d’explorer la perception de l’interdisciplinarité des infirmières dans le cadre d’une étude qualitative exploratoire. Les données ont été collectées grâce à sept entrevues semi-dirigées et une discussion de groupe. La méthode de Tesch (1990) fut utilisée pour l’analyse des données et une représentation de la perception fut élaborée.
Résultats : Pour les participantes, l’interdisciplinarité est perçue comme un processus d’équilibre parfois difficile entre leur désir d’affirmer leur identité professionnelle et leur désir de collaborer et de travailler en synergie avec les autres intervenants, et ce pour le bien-être de la personne âgée. Elles trouvent que l’apport de l’infirmière à l’équipe interdisciplinaire est indispensable et que sa disponibilité et sa proximité du patient lui donne un statut privilégié pour être le pivot au sein de l’équipe interdisciplinaire. Elles soulignent aussi que la vulnérabilité de la clientèle et l’absence du proche-aidant lors des réunions interdisciplinaires poussent les infirmières à jouer le rôle de porte-parole de la personne âgée. Elles identifient unanimement la communication comme l’élément déterminant d’une collaboration réussie. Elles ajoutent que le leadership, la compétence et l’expérience de l’infirmière sont des déterminants importants pour une interdisciplinarité réussie, alors que la présence du désir de collaborer et le respect mutuel doivent être présents chez tous les intervenants de l’équipe pour collaborer harmonieusement. Par ailleurs, parmi tous les facteurs structurels et organisationnels, seule la pénurie des ressources professionnelles a été identifiée comme un déterminant ayant une incidence sur le travail interdisciplinaire.Problem: In the context of an ageing population and of the complexification of health needs, working in interdisciplinarity became a necessity to give quality care to the vulnerable older people. Advantages of working in interdisciplinarity are known but its integration in the practice of healthcare professionals is sometimes difficult. The understanding of the perception of interdisciplinarity by nurses is an important element for successful interprofessional collaboration, however this subject was little studied in general, even less in a geriatric context. Methodology: The purpose of this exploratory qualitative study was to explore the perception of interdisciplinarity by nurses. Data were collected with seven semi-structured interviews and one group discussion. Tesch’s method (1990) was used to analyze the data and a representation of nurses’s perception was elaborated. Results: Interdisciplinarity is perceived as a fragile balance process between participants’desire to assert their professional identity and their wish to collaborate and to work in synergy with the other professionnals in the interest of older person’s wellbeing. Participants consider nurses’ contribution to the interdisciplinary team indispensable and that their availability and nearness to patients give them a privileged status making them the pivot of the team. They also underline that the vulnerability of older people and the absence of family caregivers during interdisciplinary meetings urge nurses to act as the older person’s spokesman. They unanimously identify communication as the major element of a successful collaboration. They add that the leadership, the competence and the experience of nurses are important determinants of a successful interdisciplinarity, while the desire to collaborate and mutual respect have to be shown by all the team members to work harmoniously. Moreover, among all potential structural and organizational factors, only shortage of professional resources was identified as having an incidence on interdisciplinarity.
46
Nathalus, Aylnide. "Prévention du burnout des infirmières en milieu hospitalier : perception des infirmières gestionnaires." Thèse, 2018. http://hdl.handle.net/1866/21879.
Full text
47
Plante-Blanchette, Stéphanie. "L’expérience d’autosoins des femmes âgées atteintes d’un cancer du sein recevant des traitements de chimiothérapie en clinique ambulatoire." Thèse, 2018. http://hdl.handle.net/1866/21396.
Full text
48
Ménard, Myriam. "Influence de la culture organisationnelle et du type de leadership sur la satisfaction au travail des infirmières soignantes." Thèse, 2014. http://hdl.handle.net/1866/11256.
Full textAbstract:
La moyenne pancanadienne des infirmières qui quittent leur emploi dans la première année d’embauche est de 19,9% (O’Brien-Pallas, 2010). Ce taux représente un coût important puisqu’on estime que l’embauche d’une nouvelle infirmière engendre des frais de formation de l’ordre de 30 000$ (Hayes, 2007). Le présent mémoire repose sur l’idée que le leadership des infirmières chefs et la nature de leurs interventions de gestion jouent un rôle important dans la rétention des infirmières sur les unités ce qui, à son tour, contribue à l’amélioration et au maintien d’un environnement de travail sain qui favorise l’adaptation aux changements organisationnels et opérationnels (Cummings, 2005). Selon une perspective environnementale d’analyse des systèmes organisationnels, cette situation implique que le bon fonctionnement de l’établissement de santé dépend de la capacité à « acquérir et maintenir les ressources », (Pfeffer, 2003 p.2) incluant les ressources humaines.
L’objectif de ce mémoire est d’analyser l’influence de la culture organisationnelle et du type de leadership des infirmières chefs sur deux variables soit l’intention de quitter le poste actuel et la qualité perçue du milieu des infirmières soignantes.
Cette étude quantitative s’appuie sur un devis corrélationnel. Afin d’assurer la représentativité, un échantillonnage probabiliste a été utilisé. Le biostatisticien de l’Ordre des Infirmières et Infirmiers du Québec (OIIQ) a fourni les noms et coordonnées de 1000 infirmières qui travaillent sur les unités de soins des quatre hôpitaux ciblés par l’étude.
L’analyse des données a permis d’identifier quatre relations causales. Une relation a ainsi été établie entre la culture organisationnelle et le type de leadership utilisé. Ensuite une relation a été établie entre la culture organisationnelle et la qualité perçue du milieu. La relation suivante est entre le type de leadership utilisé et la qualité perçue du milieu par les infirmières soignantes. Finalement, l’effet médiateur du leadership résonnant entre la culture organisationnelle et la qualité perçue du milieu a été démontré. Des suggestions d’améliorations aux niveaux organisationnel et académiques ainsi que des recommandations au niveau de la gestion et de la pratique infirmière découlent de l’analyse des données.The national average of nurses leaving their job in the first year of employment is 19,9% (O’Brien-Pallas, 2010). Those changes represent an important training cost as it is estimated that hiring and orienting a nurse on a unit costs 30 000$ (Hayes, 2007). This thesis is based on the idea that nurse managers’ leadership style and their management interventions are playing an important role in nurse retention. In turn, retention contributes in maintaining and improving a healthy work environment where those conditions facilitate organisational and operational adaptation (Cummings, 2005). From an environmental perspective for analysing organisational systems, this implies that good functioning of health care establishment depends on its capacity of “acquiring and maintaining resources” (Pfeffer, 2003 p.2), which includes human resources. The goal of the present master’s thesis is to analyse the influence of organisational culture and nurse managers’ leadership style on bedside nurses’ intent to quit actual position and their perceived environment quality. This quantitative study is based on a correlational design. To ensure representativeness, a probability sampling was used. Biostatistician of the College of Nurses of Quebec (OIIQ) provided the names and addresses of 1,000 nurses working on the wards of four hospitals targeted by the study. Four major relations were detected after data analysis. The first relation was established between organisational culture and the type of leadership used by nurse managers. Second relation was established between organisational culture and its impact on bedside nurses’ perceived environment quality. Third relation was established between the type of leadership used by nurse managers and its impact on bedside nurses’ perceived environment quality. Finally, it was demonstrated that resonant leadership acts as a mediator between organisational culture and perceived environment quality. Suggestions for improvements regarding organizational and academic levels and recommendations at the management and nursing practice levels arising from the analysis.
49
Héon, Marjolaine. "Interventions infirmières relatives à l'allaitement maternel de nouveau-nés prématurés." Thèse, 2011. http://hdl.handle.net/1866/6136.
Full textAbstract:
Problématique. Basée sur les constats effectués lors d’un essai clinique randomisé qui visait à évaluer les effets du lait maternel de fin d’expression sur la croissance et le développement de nouveau-nés prématurés et qui s’est soldé par un recrutement infructueux, une intervention de soutien à la lactation chez les mères de nouveau-nés prématurés a été développée. La mère d’un nouveau-né prématuré est en effet trois fois plus à risque qu’une autre de présenter une production lactée insuffisante. Il est donc crucial de soutenir ces mères dans l’établissement et le maintien d’une production lactée adéquate. Le but de cette étude pilote est d’estimer les effets d’une intervention de soutien à la lactation sur l’expression de lait maternel et la production lactée de mères ayant donné naissance prématurément ainsi que d’évaluer les aspects d’acceptabilité et de faisabilité de l’intervention, de l’étude et de ses procédures.
Hypothèse de recherche. Les mères de nouveau-nés prématurés qui reçoivent une intervention de soutien à la lactation expriment leur lait significativement plus longtemps et plus fréquemment et produisent significativement un plus grand volume de lait à plus grande concentration lipidique sur une base quotidienne que celles qui reçoivent les soins usuels.
Méthode. Devis : Projet-pilote de type essai clinique randomisé. Échantillon: Quarante mères de nouveau-nés prématurés de <30 semaines de gestation admis à une unité de soins intensifs néonatals. Procédures: Les mères du groupe témoin reçoivent les soins usuels alors que celles du groupe expérimental reçoivent une intervention de soutien à la lactation. Cette dernière comporte quatre volets: une séance d’enseignement portant sur l’établissement et le maintien d’une production lactée suffisante, un suivi téléphonique, une ligne d’aide téléphonique et le prêt d’un tire-lait électrique double pompage. Dans les deux groupes, les mères sont amenées à tenir un journal de bord de leurs séances d’expression et du volume de lait maternel exprimé.
Résultats. L’étude et ses procédures de même que l’intervention de soutien sont acceptables et faisables. Les résultats observés en lien avec l’hypothèse de recherche sont orientés dans la même direction que cette dernière à l’exception de la concentration lipidique du lait maternel.
Recommandations. Une étude à plus grande échelle doit être réalisée afin d’évaluer les effets de l’intervention de soutien à la lactation sur la production lactée de mères de nouveau-nés prématurés. Quant à la clinique, des actions concertées doivent être menées afin de créer un contexte propice et des conditions favorables à l’expression de lait maternel chez les mères de nouveau-nés prématurés.Problem statement. Based on observations from an unsuccessful randomized clinical trial that aimed to evaluate the effects of hindmilk on the short-term growth and development of preterm infants, a lactation support intervention for mothers of preterm infants has been developed. Mothers who give birth prematurely are three times more likely to have an insufficient milk output compared to those who give birth at term. It is therefore crucial to support these mothers in order to facilitate the establishment and maintenance of their milk supply. The aim of this pilot study is to estimate the effects of a lactation support intervention on the expression of breast milk and milk output of mothers who gave birth prematurely and assess the acceptability and feasibility of the intervention, study and its procedures. Research hypothesis. A lactation support intervention in mothers who deliver prematurely enables them to express their milk significantly longer and more frequently, and produce a greater milk output with a higher lipid concentration compared to mothers who deliver prematurely and receive usual care. Method. Design: A pilot study of a randomized clinical trial. Sample: Forty mothers of preterm infants born at <30 weeks of gestation and admitted to a neonatal intensive care unit. Procedures: The mothers in the control group receive usual care while those in the experimental group receive a lactation support intervention. The intervention has four components: an education session on the establishment and maintenance of an adequate milk supply, a telephone follow-up, a telephone helpline and the loan of a double electric breast pump. In both the intervention and control groups, mothers kept a logbook of the frequency, duration and volume of their breast milk expressions. Results. Both the study design and the intervention are feasible and acceptable to mothers of preterm infants. With the exception of milk lipid concentration, the results are oriented in the same direction as the research hypothesis. Recommendations. A larger scale study should be conducted to evaluate the effects of the lactation support intervention on the frequency, duration, and volume of breast milk expression among mothers of premature infants. As for the clinical practice, concerted interprofessional actions must be undertaken to create the environment and conditions conducive to breast milk expression in these mothers.
50
Salvat-Plana, Mercè. "L’analyse d’indicateurs de la qualité des soins infirmiers aux personnes ayant subi un AVC en Catalogne." Thèse, 2014. http://hdl.handle.net/1866/11261.
Full text