Measuring Scope of Practice Enactment among Primary Care Registered Nurses in Ontario

Background: Primary care is the sector of health care in which patients first establish contact with the health system, are provided person-focused care over time for all new or common needs, and receive coordinated integrated health services provided elsewhere by other members of the health care team. Registered Nurses (RNs) in Canada provide care within this sector in varying roles. The extent to which RNs enact their full scope of practice in primary care settings in Canada is not known. The Actual Scope of Practice questionnaire (ASCOP) is a 26 item Likert scale questionnaire developed by researchers in Canada and validated in the acute care setting to measure the extent to which RNs apply the knowledge, skills and competencies of the professional full scope of practice. Similar to the acute care setting, there is a need to measure scope of practice enactment in the primary care setting. Objectives: The overall aim of this thesis was to measure scope of practice enactment in the primary care setting. Two research objectives were addressed: (1) to revise and adapt the ASCOP questionnaire for use in the primary care setting, and (2) to determine internal consistency, construct validity, and sensitivity of the modified instrument, the ASCOP-PC. Methods: To address the first objective, a narrative literature review and synthesis and an expert panel review was conducted. To address the second objective a cross-sectional survey of 178 RNs working in primary care organizations in Ontario was conducted Results: The ASCOP, with few modifications, addressed key attributes of nursing scope of practice in the primary care setting. The ASCOP-PC yielded acceptable alpha coefficients ranging from 0.66 to 0.91 and explained variances from 44.2 to 62.6. Total mean score of 5.16 suggests that RNs within these models of care almost always engage in activities reflected in the ASCOP-PC. Interpretation: Findings from this study support the use of a the modified ASCOP questionnaire as a reliable and valid measure of scope of practice enactment among primary care nurses in the primary care setting.

A HARD PUSH FOR SOFT SKILLS: AN EXAMINATION OF POLICY AND RESEARCH ON NON-COGNITIVE SKILLS IN CANADIAN K-12 SCHOOLING

Non-cognitive skills have caught the attention of current education policy writers in Canada. Within the last 10 years, almost every province has produced a document including the importance of supporting non-cognitive skills in K-12 students in the classroom. Although often called different names (such as learning skills, cross curricular competencies, and 20th Century Skills) and occasionally viewed through different lenses (such as emotional intelligence skills, character skills, and work habits), what unifies non-cognitive skills within the policy documents is the claim that students that are strong in these skills are more successful in academic achievement and are more successful in post-secondary endeavors. Though the interest from policy-makers and educators is clear, there are still many questions about non-cognitive skills that have yet to be answered. These include: What skills are the most important for teacher’s to support in the classroom? What are these skills’ exact contributions to student success? How can teachers best support these skills? Are there currently reliable and valid measures of these skills? These are very important questions worth answering if Canadian teachers are expected to support non-cognitive skills in their classrooms with an already burdened workload. As well, it can begin to untangle the plethora of research that exists within the non-cognitive realm. Without a critical look at the current literature, it is impossible to ensure that these policies are effective in Canadian classrooms, and to see an alignment between research and policy. Upon analysis of Canadian curriculum, five non-cognitive skills were found to be the most prevalent among many of the provinces: Self-Regulation, Collaboration, Initiative, Responsibility and Creativity. The available research literature was then examined to determine the utility of teaching these skills in the classroom (can students improve on these skills, do these skills impact other aspects of students’ lives, and are there methods to validly and reliably assess these skills). It was found that Self-Regulation and Initiative had the strongest basis for being implemented in the classroom. On the other hand, Creativity still requires a lot more justification in terms of its impact on students’ lives and ability to assess in the classroom.