Registered nurses' perceptions of factors impacting on their continuing education /

This qualitative study examined the effects of hospital restructuring on a group of nurses at a community hospital. Eleven nurses were asked questions in order to gain insight into their experience in this situation. Ten of these participants were female, and one was male. The intent was to gather information about how restructuring has affected their lives, including, their motivational factors and barriers to participation in continuing education, and their descriptions of their workplace environment. Audiotaped interviews were conducted on two occasions to obtain this data. Emergent themes included the nurses' comments about continuing education, motivational factors, barriers that included geography and time, reactions of co-workers, restructuring, the College of Nurses' Quality Assurance Program including peer feedback, and performance appraisals. The literature review compares the barriers and motivational factors to the previous research findings. Thus, this study gave voice to the experience of this group of nurses, working in a healthcare setting that is involved in restructuring. This information is important to the healthcare system, since many areas are involved in restructuring. The whole process, if it is to be successful, depends on the frontline workers, namely the nurses. Thus, if there is anything to be learned from this group of people, that could be used to improve this progression, everyone would benefit from this information, were it to be implemented. Everyone is a stakeholder in the quality of healthcare in our province. The frontline workers are the ones that hold the vantage point to be able to provide suggestions for the changes needed to successful. These nurses are not just motivated by work issues however, and educating them and motivating them will also improve the care provided through increased knowledge and enhanced self-esteem.

An exploratory study of nurses' perceptions of their action learning experience /

Each year, the College of Nurses of Ontario (CNO) requires all registered nurses and registered practical nurses in Ontario to complete a Reflective Practice learning activity. In doing so, nurses are expected to perform a self- assessment, identify a practice problem or issue, create and implement a personal learning plan, and evaluate the learning and outcomes accomplished. The process and components of CNO's Reflective Practice program are very similar to an Action Learning activity. The purpose of this qualitative research was to explore the perceptions of 1 1 nurses who completed at least 1 Action Learning activity. Data analysis of their comments provided insight into their perceptions of the Action Learning experience, perceptions of the negative and positive characteristics of various activities within the Action Learning process, and perceptions of barriers or challenges within this experience. The author concluded that participants perceived their Action Learning activities to be a positive experience because the process focused on practice problems and issues, enhanced thinking about practice problems, and achieved practice-relevant outcomes. However, the results indicated that self-directed learning and journal writing were difficult activities for some participants, and some experienced negative emotional responses during reflection. The research concluded that barriers to implementation of Action Learning include a lack of understanding of the process and a perceived lack of support from employers.

Sustaining Health Care Practice Change: The Experience of Best Practice Spotlight Organizations Implementing and Sustaining RNAO Best Practice Guidelines

Sustainability of change for improvement initiatives has been widely reported as a global challenge both within and outside health care settings. The purpose of this study was to examine the extent to which factors related to staff training and involvement, staff behaviour, and clinical leaders’ and senior leaders’ engagement and support impact the long term sustainability of practice changes for BPSO health care organizations who have implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines. Semi structured interviews with eleven organizational leaders’ from ten health care organizations were conducted to explore the unique experiences, views and perspectives on factors related to staff, clinical leaders and senior leaders and their involvement and impact on the long term sustainability of clinical practice changes within organizations who had implemented Registered Nursing Association of Ontario’s (RNAO) Best Practice Guidelines (BPGs). The interviews were coded and analyzed using thematic content analysis. Further analysis identified patterns and themes in relation to: 1. The National Health Service (NHS) Sustainability Model which was used as the theoretical framework for this research; and 2. Organizations found to have sustained practice changes longer term verses organizations that did not. Six organizations were found to have sustained practice changes while the remaining four were found to have been unsuccessful in their efforts to sustain the changes. Five major findings in relation to sustainability emerged from this study. First is the importance of early and sustained engagement and frontline staff, managers, and clinical leaders in planning, implementation and ongoing development of BPGs through use of working groups and champions models. Second is the importance of ongoing provision of formal training, tools and resources to all key stakeholders during and after the implementation phase and efforts made to embed changes in current processes whenever possible to ensure sustainability. Third is to ensure staff and management are receptive to the proposed change(s) and/or have been given the necessary background information and rationale so they understand and can support the need for the change. Fourth is the need for early and sustained fiscal and human resources dedicated to supporting BPG implementation and the ongoing use of the BPGs already in place. Fifth is ensuring clinical leaders are trusted, influential, respected and seen as clinical resources by frontline staff. The significance of this study lies in a greater understanding of the influence and impact of factors related to staff on the long term sustainability of implemented practice changes within health care organizations. This study has implications for clinical practice, policy, education and research in relation to sustainability in health care.

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.

Perceived learning needs in staff development of some care providers in five long-term care settings in Southern Ontario /

This exploratory descriptive study described what 20 care providers in 5 long-term care facilities perceived to aid or hinder their learning in a work-sponsored learning experience. A Critical Incident Technique (Woolsey, 1986) was the catalyst for the interviews with the culturally and professionally diverse participants. Through data analysis, as described by Moustakas (1994), I found that (a) humour, (b) the learning environment, (c) specific characteristics of the presenter such as moderate pacing, speaking slowly and with simple words, (d) decision-making authority, (e) relevance to practice, and (f) practical applications best met the study participants' learning needs. Conversely, other factors could hinder learning based on the participants' perceptions. These were: (a) other presenter characteristics such as a program that was delivered quickly or spoken at a level above the participants' comprehension, (b) no perceived relevance to practice, (c), other environmental situations, and (d) the timing of the learning session. One of my intentions was to identify the emic view among cultural groups and professional/vocational affiliations. A surprising finding of this study was that neither impacted noticeably on the perceived learning needs of the participants. Further research with a revised research design to facilitate inclusion of more diverse participants will aid in determining if the lack of a difference was unique to this sample or more generalizable on a case-to-case transfer basis to the study population.

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.

Exploring the Ethical Decision-Making Processes of Community Care Providers

While there has been a recent shift away from isolated, institutionalized living conditions, persons with Intellectual Disabilities (ID) may still experience restricted access to choice when it comes to making decisions about the basic aspects of their lives. A tension remains between protecting individuals from harm and promoting their right to independence and personal liberties. This tension creates complex questions and ethical concerns for care providers supporting persons with ID. This study explored the ethical decision-making processes of care providers and specifically, how care providers describe the balance of protecting supported individuals from harm while promoting their right to self-determination. Semi-structured interviews were conducted with six care providers employed by a local community agency that supports young and older adults with ID. Data were analysed using thematic analysis and broader themes were developed following phases of open and selective coding. Results indicated that care providers described ethical decision-making processes as frequent, complex, subjective, and uncomfortable. All participants described the importance of promoting independent decision-making among the individuals they support and assisting supported individuals to make informed decisions. Participants also reported work colleagues and supervisors as primary sources of information when resolving ethical concerns. This suggests that complex ethical decision-making processes are being taken seriously by care providers and supervising staff. The results of this study are well-positioned to be applied to the development of a training program for frontline care providing staff supporting individuals in community care settings.

Removing Oneself from the Shadows: A Heuristic Inquiry to Understand the Lived Experience of Epilepsy in Young Adult Women and their Epilepsy Disclosure

Epilepsy is a chronic neurological disorder characterized by recurrent seizures (Stein & Kanner, 2009). The purpose of this study was to understand the essence of being a young woman living with epilepsy using heuristic inquiry (Moustakas, 1990). The research was built upon the assumption that each experience is unique, yet commonalities exist. Five women aged 22 to 28 years living with epilepsy were interviewed. Additionally, the researcher described her life with epilepsy. Participants characterized life with epilepsy as a transformative journey. The act of meeting and interacting with another woman living with epilepsy provided an opportunity to remove themselves from the shadows and discuss epilepsy. Three major themes of seizures, medical treatment, and social relationships were developed revealing a complex view of an illness requiring engaged advocacy in the medical system. Respondents frequently make difficult adjustments to accommodate epilepsy. This study provides a complex in-depth view of life with epilepsy.

An exploration of the experience of implementing the second step violence prevention curriculum in one primary general learning disabilities class /

Violence has always been a part of the human experience, and therefore, a popular topic for research. It is a controversial issue, mostly because the possible sources of violent behaviour are so varied, encompassing both biological and environmental factors. However, very little disagreement is found regarding the severity of this societal problem. Most researchers agree that the number and intensity of aggressive acts among adults and children is growing. Not surprisingly, many educational policies, programs, and curricula have been developed to address this concern. The research favours programs which address the root causes of violence and seek to prevent rather than provide consequences for the undesirable behaviour. But what makes a violence prevention program effective? How should educators choose among the many curricula on the market? After reviewing the literature surrounding violence prevention programs and their effectiveness, The Second Step Violence Prevention Curriculum surfaced as unique in many ways. It was designed to address the root causes of violence in an active, student-centred way. Empathy training, anger management, interpersonal cognitive problem solving, and behavioural social skills form the basis of this program. Published in 1992, the program has been the topic of limited research, almost entirely carried out using quantitative methodologies.The purpose of this study was to understand what happens when the Second Step Violence Prevention Curriculum is implemented with a group of students and teachers. I was not seeking a statistical correlation between the frequency of violence and program delivery, as in most prior research. Rather, I wished to gain a deeper understanding of the impact ofthe program through the eyes of the participants. The Second Step Program was taught to a small, primary level, general learning disabilities class by a teacher and student teacher. Data were gathered using interviews with the teachers, personal observations, staff reports, and my own journal. Common themes across the four types of data collection emerged during the study, and these themes were isolated and explored for meaning. Findings indicate that the program does not offer a "quick fix" to this serious problem. However, several important discoveries were made. The teachers feU that the program was effective despite a lack of concrete evidence to support this claim. They used the Second Step strategies outside their actual instructional time and felt it made them better educators and disciplinarians. The students did not display a marked change in their behaviour during or after the program implementation, but they were better able to speak about their actions, the source of their aggression, and the alternatives which were available. Although they were not yet transferring their knowledge into positive action,a heightened awareness was evident. Finally, staff reports and my own journal led me to a deeper understanding ofhow perception frames reality. The perception that the program was working led everyone to feel more empowered when a violent incident occurred, and efforts were made to address the cause rather than merely to offer consequences. A general feeling that we were addressing the problem in a productive way was prevalent among the staff and students involved. The findings from this investigation have many implications for research and practice. Further study into the realm of violence prevention is greatly needed, using a balance of quantitative and qualitative methodologies. Such a serious problem can only be effectively addressed with a greater understanding of its complexities. This study also demonstrates the overall positive impact of the Second Step Violence Prevention Curriculum and, therefore, supports its continued use in our schools.

The lived experience of women with recurrent ovarian cancer /

The purpose of this study was to understand the Hved experience of 6 women with recurrent ovarian cancer. Six women were interviewed 2-20 weeks after the recurrence of their ovarian cancer. Interview questions focused on the meaning of the recurrence and their communication with others. Women were asked about the information and support that they felt they needed at that time, van Manen's method of reflection and writing guided the inquiry. Analysis of the data revealed the themes of: my cancer is back; it means that I will die; talking about it; we are people, we are not a disease; information; and life has changed/life hasn't changed. This study revealed the perspectives of these 6 women with recurrent ovarian cancer. It provided an understanding and knowledge about the lives of these women. Future research should explore the experiences of a larger group of women with recurrent ovarian cancer in order to address their unique needs.

A qualitative narrative inquiry of the experience of accessing community supports among women who have experienced trauma

Abuse related trauma can have serious consequences on individuals' health and their state of well-being and may result in decreased access to different determinants of health. The purpose of this qualitative narrative inquiry using secondary data was to explore the experience of accessing community supports among eight women who had experienced abuse-related trauma. A conceptual framework drawn from the literature on social inclusion and social exclusion and a narrative inquiry method were used to explore epiphanies, customs, routines, images, and everyday experiences (Clandinin & Connelly, 2000) among the women. A Three-Dimensional Space Narrative Structure was used to explore the participants' personal or internal conditions, feelings, hopes and reaction as well as their social experiences in interaction with others in community. The participants described experiencing the impact of trauma in their past and present circumstances, a lack of accommodation of difference, challenges in maintaining a sense of self in a world of assumption and labels, impact of trauma on the determinants of health, and uncertainty about the future. The findings from the study demonstrate experiences of social exclusion among the participants in the past, further isolation and social exclusion in the present when personal life issues were ignored by community support services, and uncertainty about what the future will bring for them. The findings indicate close relationships between the women's personal lives and their social connections which need to be considered to mitigate social exclusion and enhance social inclusion.

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.

Exploring the experience of the pioneers of change

The world of work with Western society appears to be undergoing a major change. The literature has described this phenomenon as a change from an industrialbased economy to a knowledge-based economy. This change will represent a complete transformation of the world of work; some suggest that everything we have come to accept and know as normal will change. Our present society seems to be in a period of transition. It is a time with many challenges and problems, many of which cannot be solved with thinking patterns from an old industrial-based economy. A fundamental shift in thinking patterns consistent with a new emerging world of work must take place. This change in thinking represents a fundmental shift from traditional and linear ways of seeing the world (worldview), to more holistic ways of seeing the world. In this investigation the word paradigm was used to define how people see their world. A paradigm shift is defined as a change in how a person sees their world: a change from an old to new or different way of viewing the world. Those individuals who are the first to shift their paradigm are called paradigm pioneers. These individuals do not only shift their ways of seeing the world, but they also begin to act and behave in ways consistent with the new paradigm. Thus far the research literature has adequately described the concepts of paradigms and paradigm shifts. However, little is known regarding how people actually and eventually make a shift. As it will be important for each individual to make a personal paradigm shift, then it will be extremely valuable to learn more about the process itself. The purpose of this investigation was to explore these issues in more detail and specifically, describe the experience of paradigm shifts and explore the experience of paradigm pioneers. A qualitative research methodology involving in-depth interviews was used to investigate the experiences of four participants identified as paradigm pioneers. It is interesting to note that the participants in this study did not describe an allencompassing paradigm shift. In fact, each participant, defined a paradigm shift in several different ways. They did relate several examples of paradigm shifts. However, even among these examples, there was a high degree of variability. The findings of this investigation centered upon the participants' experience as pioneers. Each pioneer shared many of the same qualities, the first quality of which described how these pioneers dealt with change. I called this a change-sense quality. The pioneers viewed change in an open and positive manner, and were also aware of change taking place in their world. Finally, they displayed an understanding of change, and a bias to take positive action in the face it. The participants also shared an inner quality. The four pioneers demonstrated a personal purpose and vision, and were selfdirected individuals. They also had an innate curiosity which translated into a love of learning. They also displayed a quality where relationships with others were highly valued. Relationships were important to the pioneers because they played a support role to help them deal with the challenges of being a pioneer. Pioneers also valued relationships because, they relied on others to make change happen. The above mentioned qualities enabled pioneers to be effective in a changing world of work. The findings from this investigation have many implications for research and practice. First, the concept of paradigms and paradigm shifts must be further researched. A great deal more must be learned in order to better understand the kind of shift individuals must make to be effective in the new world of work. Second, the qualities displayed by pioneers are important for all members of the world of work to develop. The qualities shared by pioneers appeared to represent an enduring set of traits that can possibly help individuals deal more positively with uncertainty and rapid change taking place in today's North American world of work.

Acknowledging mother's lived experience of raising a child with Autism : a phenomenological inquiry

Autism is one of those human ambiguities that forces vigilant open-mindednesssometimes this open-mindedness comes without choice, for example when you become the mother of a child with autism. Recent reports indicate that Pervasive Developmental Disorders affect 1 in 150 children (Centre for Disease Control and Prevention, 2007). This also means that there are many families caring for children with autism. The purpose of this research was to explore the day to day lived experiences of mothers caring for a child with autism. With a drastic increase in children diagnosed with autism, and very little research on mothers themselves, assisting in articulating lived experiences from mothers themselves seemed like an acceptable first step. Mothers were asked to journal for a period of one month, once a week, as well as participate in a focus group. Findings from both of these techniques were analyzed using underpinnings from Amelio Giorgi and Max van Manen. General findings indicate that mothers present poignant narratives about living with their child. It becomes clear that mothers are stressed, and live a complicated and often contradictory existence. Many days are fraught with struggle, anticipation, watchful eyes, judgment and guilt. There is a constant battle waging; the one within themselves, and the one with an uninformed and uncooperative public. Given that this research contributes to an extremely small body of qualitative research on mothers, future research should continue to gain insight from mothers, without classifying or categorizing their words. Their words speak volumes. Professionals may know autism, but mothers know their children.

Retrospective on the Experience of Parental Pressure and Support by Male Participants that Withdrew from Competitive Youth Hockey: A Phenomenological Investigation

The purpose of this study was to gain an in-depth understanding of the lived experiences of parental pressure and support for males who withdrew from competitive youth hockey. A phenomenological approach was used to explore this phenomenon and develop meaning from the participants' experiences. Data for this study was collected by conducting one in-depth interview with each of the seven participants. Fourteen themes emerged as a result of the data analysis. These themes were grouped into three clusters: (1) Description of parental involvement: “I want them to be there and help me”; (2) Perceived impacts of parental involvement: “I felt like he actually cared”; and (3) Impact of parental involvement on commitment: “I kind of miss hockey now”. The descriptions provided by the participants in this study, and the themes that emerged, offer insight into what it is like for young males to experience parental involvement in competitive youth hockey.