Effect of combined care nursing on patient satisfaction, staff satisfaction, and quality of care /

This research evaluates the effect of combined care nursing on three outcomes: i) patient satisfaction; ii) staff satisfaction; and iii) quality of care. Oakville-Trafalgar Memorial Hospital was in the early planning stages of changing to combined care nursing from the traditional method of providing separate postpartum and nursery care to mothers and babies. The opportunity existed to evaluate formally the change to combined care. There were three hypotheses to be investigated. Data were collected from four sources: patient surveys, staff surveys, informal interviews, and internal hospital documents. Both quantitative and qualitative data were analyzed. The surveys were administered on three different occasions to patients and staff. Other sources of data included informal interviews with patients and staff who responded to the surveys, and chart audits.The study findings revealed that the majority of respondents had increased levels of satisfaction and perceptions of increased quality of care following implementation of combined care. These findings, related to combined care and the role of change in its implementation and evaluation, indicate that there are no right or easy answers about how to make new ideas become reality in a smooth, pleasant way.

Families of the traumatically brian-injured : a case study approach to perceptions of quality of service, degree of satisfaction, and family needs /

The purpose of this qualitative research study was to foster an understanding of the rehabilitation counselling practice offamilies of the brain-injured. Specifically, the study explores the perceptions of stakeholders in regards to the degree of satisfaction with the quality of service received. Questionnaires were administered, and semi-structured, openended interviews were conducted, with six participating families (n=8). Preliminary data were collected via two instruments: (i) the Family Participant Questionnaire, consisting of participants' sample characteristics, information pertaining to the history of the family, details of the injury, and information relating to the type, use, and need offamily services utilized; and (ii) the Community Integration Questionnaire, a measurement of the degree of social displacementllevel of community integration of the injured family member. Utilizing the procedural steps outlined by Colaizzi's (1978) method of protocol analysis, recommendations for a future program based on related and current family needs are discussed in detail. Substantiating and supporting information are offered to rehabilitation practitioners, educational planners, and policymakers alike, concerning the degree of satisfaction with rehabilitative service, and the means of improving upon the overall quality of health care to families of the brain-injured. Implications for clinical practice and research are also raised for discussion.

An empirical study of in-school and out-of-school day care

The purpose of this study was to determine if there were differences between in-school and out-of-school day care centres. Five centres housed in public schools and five housed in other locations were selected for the research. Aquality assessment was administered in each centre which examined the following components - physical environment, adult social structure and socia-emotional environment, children's socia-emotional environment, cognitive stimulation program and toys and equipment. Quantitative analysis using simple t-tests showed a significant difference between in-school and out-of-school day cares for the physical environment variable. Differences approached significance for the children's socia-emotional environment variable as well as overall quality. Qualitative analysis using a triangulated methodology revealed noticeable differences for every variable. The researcher concluded that both the quality of the physical environment and the capabilities of the administrators strongly influence the quality of the day care environment. This study also included an assessment of children's attitude toward learning. No significant difference was found between in-school and out-of-school centres.

Organizational change: implications of culture and leadership in the transformation to a total quality management paradigm

The study was undertaken to investigate organizational readiness for change to a total quality management (TQM) paradigm as the corporate-wide strategy within a long-term care facility. The focus of the study was on leadership values and organizational cultural characteristics that could either accelerate or impede the change process at The Public Hospital. structurally, the ~tudy included 'three distinct components. The first component examined the management philosophy outlined by Deming (1986) and his contemporary Juran (1989) in order to determine what leadership values best support the new Total Quality Management paradigm. Secondly, this information was compared to present leadership values at The Public Hospital with the purpose of identifying opportunities for improvement within the organization's current culture as the hospital moves toward the desired TQM culture. The final component, a roadmap, was developed to reflect the most appropriate direction for organizational change at The Public Hospital.

The effects of day care at the kindergarten level : day care centre versus in-home care

Two groups of nonmaternal day care providers, one made up of in-horne caregivers, and the other of providers of day care in centres, were asked to focus on their goals for the children in their care. A group of kindergarten teachers was asked to consider any differences they noticed in children in· the two types of day care mentioned above. It was found that in-horne caregivers, through flexibility, meet the developmental goals of the children in their care. Providers of tlay care in centres used a more structured and social program in order to meet the overall developmental goals for the children in their care. It was found that the kindergarten teachers noticed differences in the children in their classes in terms of their attitude and social behaviour. The type and quality of care were seen as possible influences on this outlook of young children in kindergarten. The one common element that each group highlighted with respect to the effects of day care at the kindergarten level was the important role of the family in the child's development not only in day care, but also in kindergarten class. There is still a strong need to determine the effects of various types of day care at all levels, and specifically at the kindergarten level. The more the kindergarten teacher is able to understand about the child's day care experience, and his or her own life,the better off these children in day care will be. This study confirmed both the importance of quality in child care, and the important role of the family in the child care decision.

An exploration of the impact of a mandatory quality assurance program on the staff nurse's commitment to professional development /

This study explored experiences in relation to the impact of the College of Nurses of Ontario's (CNO's) mandatory Quality Assurance (QA) program on registered nurses (RNs) working in a clinical setting of an acute care hospital. A qualitative descriptive research design was used and data collection was done in 2 stages. First, a survey with open-ended questions was given to 45 nurses. Second, 8 respondents from the survey were interviewed using a semistructured format. Data were obtained from 2 groups-diploma-prepared and post diploma-prepared RNs. Findings demonstrated that the CNO's QA program had varying influences on the RNs' learning paths, and these differences appeared to be related to the educational background of the individual. The diploma-prepared nurses reported that their commitment to professional development was influenced by their level of internal motivation, the pressures associated with time, and the need for a strong external motivator, namely the obligation of management to conduct formal performance appraisals. They further reported that the QA program played a part in positively altering their commitment to continuing education. The post-diploma baccalaureate nurses reported that the QA program played a positive role in influencing their ongoing learning, along with their level of internal motivation, the work and health care environment, and the element of professionalism. Several implications for nursing practice, theory, and fiirther research also became evident.

Foraging ecology and parental care of common terns (Sterna hirundo) nesting in Windermere Basin, Lake Ontario

The relationships among chick feeding, size and type of prey item, and foraging time away from the brood have not been well studied in seabirds. This study investigated spatial and temporal patterns of foraging and chick-provisioning among 23 radio-tagged male common terns nesting at Hamilton Harbour, Lake Ontario during 1991 and 1992. Telemetry data were collected concurrently with behavioural observations from an elevated blind. Terns fitted with transmitters did not differ from controls with respect to either brood attendance, patterns of chick mortality, species and size distributions of prey delivered to offspring, or chick-provisioning rates. There was a clear separation of parental roles: males were primarily responsible for feeding chicks while females allocated more time to brood attendance. The prey species most commonly delivered to chicks by adults were rainbow smelt (Osmerus mordax) and alewife (A/osa pseudoharengus), followed in importance by larval fish, emerald shiner (Notropis antherinoides), salmonids, and fathead minnows (Pimepha/es prome/as). The relative proportions of various fish speCies delivered to chicks by males differed over the course of each breeding season, and there was also much variability in species composition of prey between years. Sizes of prey delivered to chicks also differed between sampling periods. The modal size of fish brought to chicks during Peak 1991 was 1.5 bill lengths, while the majority of prey in Late 1991 were small larval fish. The reverse trend occurred in 1992 when small fish were delivered to chicks predominantly during the Peak nesting period. During periods when predominantly small fish were delivered to chicks, the foraging activity of radio-tagged males was concentrated within a two kilometer radius of the colony. The observed variation in prey composition and foraging locations during the study likely reflects temporal variation in the availability of prey in the vicinity of the colony. Males delivered fish to chicks at a constant rate, while females 4 increased their feeding frequency over the first six to ten brood days. The mean length of fish delivered to chicks by adults increased significantly with increasing chick age. As a group, within each nesting period, transmittered males either foraged predominantly in the same directional bearing (north during Peak 1991, south during Late 1992), or concentrated foraging activity in the immediate vicinity of the colony (Late 1991, Peak 1992). However, individual radio-tagged males exhibited unique and predictable foraging patterns, often favouring specific locations within these areas and differing in their secondary foraging patterns. Overall, the Lake Ontario shoreline between NCB Bay" (3.5 km south of colony) and the lift bridge canal (4 km north of colony) was the foraging area used most frequently by radiotagged males during the chick-rearing period. Foraging patterns of transmittered males at Windermere Basin are similar to patterns of peak-nesting common terns, but differ from those of late-nesters, at a nearby colony (Port Colborne, Lake Erie). Differences between the foraging patterns of late-nesting terns at these colonies likely reflect differences in annual patterns of fish availability between the two locations. No relationship was found between foraging proficiency of adults and survival of offspring. Stochastic factors, such as predation by black-crowned nightherons (Nycticorax nycticorax) and adverse weather conditions during the early stages of chick rearing, may be more important determinants of common tern breeding success than parental quality or fish availability.

Exploring the Family Context Among Children Adopted From China: Perceptions of Pre-Adoption Factors, Post-Adoption Experiences, and the Quality of Parent-Child Relationships

Within the context of international adoption, previous research has focused on parentchild attachment relationships and various aspects of the adoption process. However, less is known about other aspects of parent-child relationships (e.g., cohesion, conflict) within internationally adoptive families. Additionally, there is a need for research that explores both parent and child perceptions of the process of adoption - including pre- and post-adoptive factors - and its connection to the quality of parent-child relationships. This research utilized a qualitatively-oriented methodology to conduct separate, in-depth interviews with 10 adoptive Canadian mothers and their adopted Chinese children (aged 9 to 11 years). Results highlight parent and child reports of mainly strong, positive relationships. Several pre-adoption experiences are examined, including institutionalization, age at the time of adoption, and parental stress/expectations. A key finding concerns the link that adoptive parents perceive between the quality of their child's pre-adoptive care (i.e., mainly early institutionalized care) and the quality of their relationship. Interestingly, this link is perceived in two different ways - either as a challenge for the parent-child relationship or as a means to strengthen it. Post-adoption experiences are also explored, including cultural socialization, creating a transracial family, discussing adoption, parental stress, and sibling involvement. A key finding involves parent and child reports that cultural socialization efforts (i.e., familiarizing children with Chinese culture) are linked to more positive parent-child relationships. The implications of these findings are discussed in relation to theory and practice within the context of international adoption.

Personal Support Workers' Experience of Collaboration in a Long-Term Care Facility in Rural Ontario

The growing complexity of healthcare needs of residents living in long-term care necessitates a high level of professional interdependence to deliver quality, individualized care. Personal support workers (PSWs) are the most likely to observe, interpret and respond to resident care plans, yet little is known about how they experience collaboration. This study aimed to describe PSWs’ current experiences with collaboration in long-term care and to understand the factors that influenced their involvement in collaboration. A qualitative approach was used to interview eight PSWs from one long-term care facility in rural Ontario. Thematic analysis revealed three themes: valuing PSWs’ contributions, organizational structure, and individual characteristics and relationships. Collaboration was a difficult process for PSWs who felt largely undervalued and excluded. To improve collaboration, management needs to provide opportunities for PSWs to contribute and support the development of relationships required to collaborate.