Browsing by Author "Hirst, Sandra P."
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Item Open Access How Does the Workplace Environment Affect the Health and Decision of Registered Nurses to Remain in Critical Care?(2019-04-30) Heistad, Amanda Lynn; Goldsworthy, Sandra; Reilly, Sandra M.; Hirst, Sandra P.Background. Retaining registered nurses (RNs) in critical care environments (CCEs) face many challenges. Firstly, these settings have exceptional demands of staff because of higher environmental stress, higher patient acuity, and higher patient mortality rates relative to other nursing units. Secondly, the combination of stressors in CCEs can have significant effects on providers’ health, which can lead to high voluntary turnover rates. This can aggravate an already difficult situation, which requires, at substantial human and financial cost, the preparation of new, and often less experienced RNs to care for some of the most vulnerable patients. Aim. The study aims to understand the relationship of critical care RNs’ perceived CCEs, workloads, their health, and their intention to stay in their current employment setting. The dearth of research available concerning these relationships leaves the search for solutions without sufficient empirical data to inform strategies that would retain these highly-trained providers. Research Methods. A cross-sectional study assessed the interaction of RNs’ work environment, their health, and their intent to stay in the CCE. Data was obtained from a sample of 302 critical care RNs across Alberta, Canada, which allowed for negative binomial and logistic regression modelling analyses. RNs were also asked what interventions would optimize their work environment and retain their critical care services. Results. Critical care RNs who scored their CCEs higher had lower sick time incidence and decreased intention to leave. Other important factors for RNs’ decision to stay in the CCE included their workload, increased educational opportunities, and increased availability of part-time scheduling. Conclusions. This study results showed strong positive relationships between CCEs, RNs’ health, and RNs’ turnover intention. RNs specifically request workload optimization, increased flexibility with shift rotations, and increased education opportunities on their units to optimize the environment and retain their services. Given the high demands associated with such services, decision-makers should consider these findings when anticipating the needs of RNs and patients. This would, at the very least, assure RNs that hospitals care as much for their health as the patients that RNs serve.Item Open Access The Implementation of Correctional Nursing Practice in Alberta: A Grounded Theory Study(2020-08-10) Dhaliwal, Kirnvir Kaur; Hirst, Sandra P.; King-Shier, Kathryn M.; Kent-Wilkinson, Arlene E.Introduction: In three Canadian provinces, offenders in provincial custody receive healthcare services from health authorities, rather than correctional services. Alberta made the care transition to the health authority in 2010. The governance of correctional healthcare services by health authorities, and not the correctional services, may be advantageous as healthcare professionals are possibly less likely to experience tension between corrections (custody) and health (caring) priorities. There is uncertainty about if and how this tension between custody and caring still exists and is experienced by Canadian registered nurses (RNs) practicing in provincial custody with healthcare governance by health authorities. Therefore, the aim of this doctoral research was to study how RNs implement their nursing practice in the Alberta provincial custody correctional system. Method: Straussian grounded theory approach was used. Simultaneous data collection and analysis were undertaken using theoretical sampling, constant comparison, and memo writing. RNs (n = 13) engaged in semi-structured telephone interviews, focused on the experience of implementing their correctional nursing practice and providing nursing care to offenders. Data were collected until saturation occurred. Analytic coding (open, axial, and final theoretical integration) was performed to identify the core category (Caring Behind Bars) and its six subcategories around which the substantive theory was developed. Findings: The theory of Caring Behind Bars refers to the process of how RNs implemented their correctional nursing practice to care for the offender population. RNs possessed a foundational stance regarding what nursing practice means to them in general. Upon entering the correctional context, RNs experienced tension between custody and caring. RNs engaged in adaptability and advocacy to address this tension and access the offender population. The provision of care required RNs to take numerous actions – interactions to provide care to offenders. The consequences of Caring Behind Bars were challenging and positive outcomes. Significance: The research resulted in the development of foundational knowledge to advance Canadian correctional nursing practice and offered potential insights into promoting offender health.Item Open Access Improving Triage to ECG Time in the Emergency Department(2018-03-15) Nosworthy, Sara Eileen; Hirst, Sandra P.; Reay, Gudrun; Mannion, Cynthia A.Background: The ST-segment elevation myocardial infarction (STEMI) team of a large Canadian urban tertiary care hospital identified that best practice recommendations were not being met for walk-in patients diagnosed with STEMI to the Emergency Department (ED). The American Heart Association (AHA) (2013) recommends triage to first-device time should be 90-minutes. However, this target was only achieved 6% of the time for walk-in patients diagnosed with STEMI. It is recommended that the initial electrocardiogram (ECG) be completed within 10-minutes for patients presenting with suspected ischemic chest pain (SICP) to the ED (AHA, 2013). Data analysis, performed by the STEMI quality improvement team, identified a significant delay with the initial ECG, for walk-in patients diagnosed with STEMI. This delay places patients at risk for serious adverse outcomes, such as cardiac arrest. Therefore, it was essential to implement a streamlined process to improve triage to ECG times. Objective: The objectives of this study were to investigate if the implementation of a streamlined process at triage for walk-in patients with SICP decreased triage to ECG times, and secondarily if triage to first-device time for walk-in patients diagnosed with STEMI was decreased. Methods: A retrospective study was conducted at a large Canadian urban tertiary care hospital. A new streamlined process at triage for walk-in patients presenting with SICP was evaluated by comparing daily data from May 2016 to May 2017. The primary outcome measured was triage to ECG time for walk-in patients presenting with SICP, and secondarily triage to first-device time for walk-in patients diagnosed with STEMI. Results: There was a statistically significant difference between May 2016 and May 2017 (U = 28425, Z=-5.01, p <.001). Following the streamlined process there was a significant decrease of 16-minutes in the median triage to ECG time for walk-in patients presenting with SICP compared to those prior to the streamlined process. None of the 288 patients evaluated in May 2016 were diagnosed with STEMI. Four of the 265 patients evaluated in May 2017 were diagnosed with STEMIs. Two of the four patients met the recommended target time of triage to first-device time within 90-minutes (AHA, 2013: Heart and Stroke, 2015). Discussion: The best practice recommendation of triage to ECG time within 10-minutes was not achieved for all walk-in patients presenting with SICP. However, the streamlined process has significantly decreased time in triage to ECG for this patient population. Future interventions directed at decreasing triage to ECG time should focus on early identification of patients with chest pain, examining the streamlined process for further improvements, and ongoing evaluation of triage to ECG data. There was limited data for triage to first-device time as there were no walk-in patients diagnosed with STEMI in May 2016. Therefore, it was not possible to evaluate if the streamlined process improved triage to first-device time. Continual evaluation of the triage to first-device times is needed to see if the streamlined process is making a difference.Item Open Access Let Us Greet our Young, Not Eat our Young: Nursing Preceptors(2018-08-02) Carrington, Kendra Adele Smith; Mannion, Cynthia A.; Hirst, Sandra P.; Seneviratne, Cydnee C.Background: During the final term of nursing education programs, students are placed in clinical learning environments (CLE) with assigned registered nurses (RN) commonly known as preceptors. The experiences within a preceptorship are related to students’ satisfaction, job recruitment and, in the long term, retention in the profession. Despite having participated in preceptorships as students, new nursing graduates often report feeling unprepared to enter the profession. In 2010, Willemsen-McBride estimated 35-65% of new Canadian graduates leave their place of employment within their first year. Students who experience unsatisfactory preceptorships are thought likely to leave the profession altogether. Attributes of preceptors which foster positive CLEs contribute to students’ satisfaction and success in preceptorship experiences. Such attributes include: kindness, patience, commitment, support, effective communication skills, clinical competence, providing clinical exposure, role modeling, and positive coaching. Objective: To investigate nursing students’ perceptions of preceptor attributes as these attributes relate to their satisfaction in the CLE, expectations from before and after their preceptorship, and their perceived preparedness for licensure and nursing practice. Method: A pretest-posttest study was conducted during the 2017 fall term of the Faculty of Nursing at the University of Calgary in Calgary, Alberta. Students were recruited from the final term course (NURS 599). Participants (n=74) were tested prior to commencing their preceptorship experience and 55 participants were tested at the end of their preceptorship. Demographic data were gathered and participants were asked to complete the Preceptor Attributes survey, the Clinical Learning Environment Inventory (CLEI), and the My Preceptorship tool. Results: Two attributes of preceptors were identified as contributing to students’ satisfaction with their preceptor and with the CLE. The attribute of providing exposure significantly affected students’ satisfaction when compared to the influence of the preceptor in the CLE (t = 3.77, p = .000, [CI 95%: 4.57, 14.91]). Providing exposure also significantly affected students’ satisfaction when compared to the influence of the CLE (t = 3.59, p = .001, [CI 95%: 3.86, 13.64]). The attribute of clear communicator significantly affected students’ satisfaction when compared to the influence of the preceptor in the CLE (t = 3.56, p = .001, [CI 95%: 3.21, 11.47]). Clear communicator also significantly affected students’ satisfaction when compared to the influence of the CLE (t = 3.04, p = .004, [CI 95%: 2.05, 9.99]). Students’ expectations pretest to posttest were not met for CLE aspects of innovation (t = 3.36, p = .002, [CI 95%: 0.85, 3.38]), student involvement (t = 2.96, p = .010, [CI 95%: 0.43, 2.98]), task orientation (t = 2.82, p = .007, [CI 95%: 0.56, 3.33]), or satisfaction (t = 2.64, p = .011, [CI 95%: 0.42, 3.07]) as measured by the CLEI. Approximately half of the students (41%, n=25) reported they did not feel prepared for their licensing exam. Many students reported feeling prepared to practice (92%, n=56) because of their preceptor. Most students were satisfied with their preceptor (95%, n=58) and 53 (87%) wanted to return to the CLE to work post-graduation. No significant difference was reported in students’ perception of preceptor attributes (t = -0.06, p = .956, [CI 95%: -4.59, 4.53]) or of the six CLE aspects (p>.05) for students having two preceptors as opposed to those having only one. Discussion: Students’ satisfaction with their preceptorship in the CLE is highly dependent upon specific attributes of preceptors. Preceptors with effective communication skills who provide exposure to learning opportunities in the CLE are highly prized by students and contribute to their satisfaction throughout preceptorships.Item Open Access Older People’s Resilience in the Context of Climate-Disasters: A Single Instrumental Case Study of Older Women in Poverty who are Widowed, Head of Household, and Living in a Disaster-Affected Community in the Philippines(2018-08-01) Kwan, Crystal; Walsh, Christine Ann; Drolet, Julie; Hirst, Sandra P.; Lenters, Kimberly Ann; Dominelli, LenaWhile disasters are not a new phenomenon, the intensity and frequency of them have increased and are projected to continue to escalate due to climate change, globalization, rapid urbanization, and environmental degradation. Older people living in poverty represent a vulnerable group who require special attention because often their limited access to social, economic, political, and environmental resources increase their risk to the impacts of disasters. The purpose of my study was to identify the key factors and processes (specifically during the mitigation phase of the disaster management cycle or non-disaster times) that shape and influence older people’s resilience within the context of disasters, with a focus on older women living in poverty. My research design was primarily informed by case study methodology, and it included participatory action research (PAR) elements. Purposive sampling was conducted in Apitong, a community in Tacloban City, Philippines that was deeply affected by the 2013 typhoon Haiyan. Four participants were recruited as key informants of the case: a group of older women living in poverty, who are widowed, head of household, and living in a disaster-affected community in the Philippines. The following data collection methods were used: Photovoice (PV)/Videovoice (VV), semi-structured interviews (including one-to-one, focus group, and peer interviews), observation, and document review. The participants were involved in data collection, as they were trained in basic camera use, the PV/VV process, and how to conduct peer interviews. A translator was used in all the interviews, training workshops, and transcriptions. I conducted analysis (using thematic analysis) continuously and recursively, alongside data collection. Utilizing a socio-ecological conceptual framework of resilience, I identified seven environmental and one individual factor and processes that shape and influence the participants’ resilience. My study findings contribute to the paucity of literature regarding older people’s resilience within the context of disasters, specifically the need for more case-specific and context-based knowledge. Additionally, within the discipline of social work, my study informs education, research, and practice in two overlooked but critical areas: green and gerontological social work.