Exploring the effects of change on nursing practice in acute ambulatory care settings : a qualitative study

As a result of the current changes taking place in the delivery of acute care services, the emergence of acute ambulatory care (AAC) settings is expanding. According to a literature review, the volume, acuity, and complexity of patient care in these settings is increasing while the time the patients spend under the care of nurses is decreasing. Two forces, hospital downsizing and advancing technology, are identified as the major contributors to the shift in acute care delivery. The effects that these changes are having on the clinical nursing practice of registered nurses working in AAC settings are not known. Given that AAC settings are rapidly expanding, it can be anticipated that the delivery of nursing care will continue to be compressed into a shorter time frame. Therefore, the following qualitative research question was formulated: What are the problems and issues related to clinical nursing practice in acute ambulatory settings? The purpose of this study was to explore the problems and issues associated with change and clinical nursing practice including the educational needs of nurses working in MC settings. Specific objectives of the study included the following: (a) to explore the problems and issues related to nursing practice in select AAC settings; (b) to explore the similarities and differences in perspectives related to role expectation between nurse managers, nurse educators, and staff nurses; and (c) to develop a conceptual framework that will guide the construction of an instrument needed for further research. This study used semistructured individual interviews and focus group sessions to collect data from the three categories of registered nurses. More specifically, data were collected from one nurse manager, two charge nurses, two nurse educators and fifteen staff nurses, working in three different MC settings of a major teaching hospital. Collected data were separately analyzed by the researcher and an external rater following grounded theory methodology. By using open and axial coding, the problems and issues identified by nurses were grouped into several major and minor themes. In final analysis, by using selective coding, the four core themes (intensification, moderation, frustration, and adaptation) were extracted. Each core theme was presented and discussed in relation to hospital downsizing and advancing technology. The relationships among the four core themes were discussed and depicted in a model termed the "Impact and Consequence Model on Nursing Practice in MC Settings." Implications for further research are discussed and research hypotheses, based on the research findings, are presented.

Parent and Peer Factors Relating to Adolescent Antisocial Behaviour: Investigating the Moderating Role of Temperament

The purpose of this study was to examine whether certain temperament characteristics (fearfulness, surgency, frustration, and effortful control) moderate the association between authoritative parenting dimensions (psychological autonomy granting, acceptance-involvement, and monitoring knowledge) or friends' antisocial behaviour, and self-reported antisocial behaviour among adolescents. Questionnaires on adolescent temperament and authoritative parenting were completed by 484 mothers and their adolescent children (54.8% female). In addition, the adolescents responded to measures regarding friends' antisocial behavior and their own antisocial behaviour. Adolescent participants ranged between 13 and 17 years of age (M = 14.96 years, SD = 1.39) and lived in a region of southern Ontario. As predicted, the results indicated that effortful control moderated the association between parental monitoring knowledge and adolescent antisocial behaviour. Also, as predicted, effortful control moderated the relation between friends' antisocial behaviour and adolescents' self-reports of antisocial behaviour although the relation was sex-specific to girls. Unexpected results included a significant monitoring knowledge by frustration by sex interaction, and a significant friends' antisocial behaviour by age interaction. In general, the findings were consistent with the expectation that the relation of parenting and peer factors to antisocial behaviour would depend on adolescents' temperamental predispositions. However, effortful control, which contributes to individual differences in self-regulation abilities, served this moderating role to a greater extent than the measures of temperamental reactivity, including fearfulness, surgency and frustration-proneness. Implications of these results are discussed with reference to parenting or classroom-based interventions that may be especially helpful for adolescents with poor self-regulation abilities.