The process of implementing a new baby-friendly hospital initiative for nurses: a grounded theory study

Maternity nursing practice is changing across Canada with the movement toward becoming “baby friendly.” The World Health Organization (WHO) recommends the Baby-Friendly Hospital Initiative (BFHI) as a standard of care in hospitals worldwide. Very little research has been conducted with nurses to explore the impact of the initiative on nursing practice. The purpose of this study, therefore, was to examine the process of implementing the BFHI for nurses. The study was carried out using Corbin and Strauss’s method of grounded theory. Theoretical sampling was employed, which resulted in recruiting and interviewing 13 registered nurses whose area of employment included neonatal intensive care, postpartum, and labour and delivery. The data analysis revealed a central category of resisting the BFHI. All of the nurses disagreed with some of the 10 steps to becoming a baby-friendly hospital as outlined by the WHO. Participants questioned the science and safety of aspects of the BFHI. Also, participants indicated that the implementation of this program did not substantially change their nursing practice. They empathized with new mothers and anticipated being collectively reprimanded by management should they not follow the initiative. Five conditions influenced their responses to the initiative, which were (a) an awareness of a pro-breastfeeding culture, (b) imposition of the BFHI, (c) knowledge of the health benefits of breastfeeding, (d) experiential knowledge of infant feeding, and (e) the belief in the autonomy of mothers to decide about infant feeding. The identified outcomes were moral distress and division between nurses. The study findings could guide decision making concerning the implementation of the BFHI.

The impact of income and social status on population health: a scenario based simulation for nursing students

The development of critical thinking and communication skills is an essential part of Baccalaureate and Practical Nursing education. Scenario-based simulation, a form of experiential learning, directly engages students in the learning process. This teaching learning method has been shown to increase students’ understanding of the influence of their personal beliefs and values when working with clients and to improve therapeutic communication and critical thinking skills. Students in both the BN (Collaborative) and PN Programs at the Centre for Nursing Studies demonstrate a strong theoretical understanding of the impact of income and social status on population health but often experience difficulty applying this knowledge to the clinical situations involving clients and families. The purpose of the project was to develop a scenario-based simulation activity to provide nursing students with first-hand experiences of the impact of income and social status on health service accessibility. A literature review and stakeholder consultations were conducted to inform the project. The findings of these initiatives and Kolb’s Experiential Learning Theory were used to guide all aspects of the project. This report is an account of how the income and social status simulation and its accompanying materials were developed. This project provided an excellent learning opportunity that demonstrated the use of advanced nursing competencies.

Improving safety of nursing staff: challenges and solutions regarding safety for nursing staff in acute care psychiatric settings

Workplace violence is defined as an act of abuse, threatening behaviour, intimidation, or assault on a person in his or her place of employment. Unfortunately, such violence is a reality for nurses. These take the form of physical, verbal, and threating behaviours, and harassment. Violence, particularly verbal abuse, is so prevalent that it is often considered “part of the job” and can contribute to many negative professional and personal effects for nurses. Therefore, it is important to understand what influences an individual to become violent in order to suggest and support initiatives to decrease it. A literature review and consultations with key stakeholders were conducted to gather relevant information regarding violence committed by patients and others visiting mental health care settings. Through data analysis, two relevant themes were revealed: reporting and interventions. Reporting incidents of workplace violence is important to track and quantify aggressive episodes, thus emphasizing its seriousness. Nurses may differ in the perception of what constitutes violence, underreport incidents, and feel a sense of futility when reported violence continues. In addition, cumbersome methods of reporting can be a hindrance to the reporting process. Six areas of potential interventions were identified to increase safety for nurses. These are staffing, de-escalation training, environmental considerations, addictions services, organizational support, and consequences. All findings were summarized in a document to be presented to the leadership of the Mental Health and Addictions program within the local health care authority. The goal is to offer recommendations to lead to a decrease in workplace aggression and increased safety for nurses in the acute care psychiatric setting.