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.

Displaced women professionals: an exploration of perceived learning processes during workplace transition /

This study focused on obtaining a deeper understanding of the perceived learning of female professionals during workplace transition. The women's lived experiences were explored through a feminist interpretive lens (Bloom, 1998). The study also drew upon concepts from adult learning such as barriers and facilitating factors to learning, resistance, transformative learning, and multiple ways of knowing. Five women participated in a 1 -hour interview and a focus group activity. The findings are presented under the 2 broad themes of perceived learning and factors affecting learning. The most common theme of perceived learning was participants' experience of increased self-knowledge. Additionally, while learning was thought of as a struggle, it provided either an opportunity for a reexamination of goals or a reexamination of self. Reflection by participants seemed to follow two orientations and other types of perceived learning included experiential, formal, and informal learning. In the broad theme of factors affecting learning, contradictions and conflict emerged through the examination of participants' multiple subjectivities, and within their naming of many factors as both facilitating factors and barriers to learning. The factors affecting learning themes included personal relationships, professional communities, selfesteem, attitude and emotion, the gendered experience of transition, time, and finances. The final theme explored participants' view of work and their orientations to the future. A proposed model of learning during workplace transition is presented (Figure 1 ) and the findings discussed within this proposed model's framework. Additional developmental theories of women (Josselson, 1987; Levinson & Levinson, 1996), communities of practice theories (Wenger, 1998), and career resilience theories (Pulley, 1995) are discussed within the context of the proposed model. Implications to practice for career counsellors, people going through workplace transition, human resource managers and career coaches were explored. Additionally implications to theory and future areas of research are also discussed.