Safety and effectiveness of nurse telephone consultation in out of hours primary care: randomised controlled trial

Objective To determine the safety and effectiveness of nurse telephone consultation in out of hours primary care by investigating adverse events and the management of calls.

Women Leaders Resolving Conflict in Higher Education: A Feminist Epistemological Perspective

In an American postsecondary context, conflict is inherent (Gianneschi & Yanagiura, 2006; Valian, 1999). Successful navigation of conflict in the academy is vital for those who aspire to leadership positions (Nadler & Nadler, 1987; Walters, Stuhlmacher, & Meyer, 1998). Presently, however, women face significant barriers to achieving success in higher education administration, including gender expectations for conflict resolution behavior (Bartunek, 1992; Bowles, Babcock, & McGinn, 2005; Gayle, Preiss, & Allen, 2002). While a considerable body of literature exists for understanding gender negotiation, it remains rooted in a masculine paradigm (Kolb & Putnam, 2006; Shuter & Turner, 1997), and, as such, established theories lack a feminist epistemological perspective. Consequently, my primary research question is, How do women leaders experience and perceive conflict in the higher education work environment? I conduct a qualitative study that examines workplace conflict experiences of 15 women leaders from diverse personal and professional backgrounds. Hartsock's (1983) three-tiered gender-sensitive analysis of power, updated to include multicultural perspectives, serves as my theoretical framework. It is a lens through which I evaluate theories, finding multicultural organizational, higher education conflict, and gender negotiation theories most applicable to this study. The framework also creates the foundation upon which I build my study. Specifically, I determine that a feminist research method is most relevant to this investigation. To analyze data obtained through in depth interviews, I employ a highly structured form of grounded theory called dimensional analysis. Based on my findings, I co-construct with study participants a Feminist Conflict Process Theory and Flowchart in which initially the nature of the relationship, and subsequently the level of risk to the relationship, institution, or self, is evaluated. This study supports that which is observed in the conflict resolution practitioner literature, but is unique in its observation of factors that influence decisions within a dynamic conflict resolution process. My findings are significant to women who aspire to serve in leadership positions in higher education, as well as to the academy as a whole, for it expands our knowledge of women's ontological and epistemological perspectives on resolving conflict in postsecondary education.

Factors Affecting Women Leaders in the Denver Group of the Colorado Mountain Club

A study of women leaders in the Colorado Mountain Club (CMC) demonstrated that this group perceived pace as an impediment to leadership growth. This study is an exploratory-quantitative inquiry that assessed the views of 20 of the active women hike leaders in the Denver group. The author designed a survey of factors women hike leaders would rate according to their CMC experiences. Although there are more women members of the Denver group, women leaders comprise only 30% of the leadership group The results from this first ever survey of CMC's women leaders provides a knowledge base for CMC and other interested parties. This study clearly demonstrated the need for more research into its topic of women in leadership positions.

Development and psychometric testing of the clinical learning environment, supervision and nurse teacher evaluation scale (CLES+T): The Spanish version

Background: The Clinical Learning Environment, Supervision and Nurse Teacher scale is a reliable and valid instrument to evaluate the quality of the clinical learning process in international nursing education contexts. Objectives: This paper reports the development and psychometric testing of the Spanish version of the Clinical Learning Environment, Supervision and Nurse Teacher scale. Design: Cross-sectional validation study of the scale. Setting: 10 public and private hospitals in the Alicante area, and the Faculty of Health Sciences (University of Alicante, Spain). Participants: 370 student nurses on clinical placement (January 2011–March 2012). Methods: The Clinical Learning Environment, Supervision and Nurse Teacher scale was translated using the modified direct translation method. Statistical analyses were performed using PASW Statistics 18 and AMOS 18.0.0 software. A multivariate analysis was conducted in order to assess construct validity. Cronbach’s alpha coefficient was used to evaluate instrument reliability. Results: An exploratory factorial analysis identified the five dimensions from the original version, and explained 66.4% of the variance. Confirmatory factor analysis supported the factor structure of the Spanish version of the instrument. Cronbach’s alpha coefficient for the scale was .95, ranging from .80 to .97 for the subscales. Conclusion: This version of the Clinical Learning Environment, Supervision and Nurse Teacher scale instrument showed acceptable psychometric properties for use as an assessment scale in Spanish-speaking countries.

Challenges, Strengths and Opportunities Related to Implementing Comprehensive Evidence-Based Guidelines on Breast Cancer Survivorship Care by Primary Care Physicians and Nurse Practitioners in Southeastern Ontario

Background Many breast cancer survivors continue to have a broad range of physical and psychosocial problems after breast cancer treatment. As cancer centres move forward with earlier discharge of stable breast cancer survivors to primary care follow-up it is important that comprehensive evidence-based breast cancer survivorship care is implemented to effectively address these needs. Research suggests primary care providers are willing to provide breast cancer survivorship care but many lack the knowledge and confidence to provide evidence-based care. Purpose The overall purpose of this thesis was to determine the challenges, strengths and opportunities related to implementing comprehensive evidence-based breast cancer survivorship guidelines by primary care physicians and nurse practitioners in southeastern Ontario. Methods This mixed-methods research was conducted in three phases: (1) synthesis and appraisal of clinical practice guidelines relevant to provision of breast cancer survivorship care within the primary care practice setting; (2) a brief quantitative survey of primary care providers to determine actual practices related to provision of evidence-based breast cancer survivorship care; and (3) individual interviews with primary care providers about the challenges, strengths and opportunities related to provision of comprehensive evidence-based breast cancer survivorship care. Results and Conclusions In the first phase, a comprehensive clinical practice framework was created to guide provision of breast cancer survivorship care and consisted of a one-page checklist outlining breast cancer survivorship issues relevant to primary care, a three-page summary of key recommendations, and a one-page list of guideline sources. The second phase identified several knowledge and practice gaps, and it was determined that guideline implementation rates were higher for recommendations related to prevention and surveillance aspects of survivorship care and lowest related to screening for and management of long-term effects. The third phase identified three major challenges to providing breast cancer survivorship care: inconsistent educational preparation, provider anxieties, and primary care burden; and three major strengths or opportunities to facilitate implementation of survivorship care guidelines: tools and technology, empowering survivors, and optimizing nursing roles. A better understanding of these challenges, strengths and opportunities will inform development of targeted knowledge translation interventions to provide support and education to primary care providers.