Methodological approach for the development of terminology subsets ICNP®: an integrative review

Objective To analyze the methodological aspects used for the preparation of terminology subsets of the International Classification for Nursing Practice (ICNP®), in dissertations and theses in the Brazilian nursing. Method This is an integrative review of the Brazilian dissertations and theses defended in the period from 2007 to 2013, which were included seven dissertations. Results The increasing production of studies on the theme by Brazilian nurses shows a concern for a unified language for the profession. However, the results demonstrate the lack of uniformity in the conduct of studies, especially in relation to the stages of content validation. The initiatives of some authors to systematize alternative methods for creating these subsets also stood out. Conclusion We suggest the development of new terminology subsets, following standards of methodological rigor, as well as its application and validation by the selected clientele, to ensure greater reliability of results and desired changes for the profession.

Emancipatory practices of nurses in primary health care: the home visit as an instrument of health needs assessment

Objective Identify nurses’ emancipatory practices in primary care, to contribute to the improvement of health care. Method A case study type social research of qualitative nature, in which nurses of a primary health care service unit in São Paulo were interviewed. Results The home visit was identified as a nursing practice possible to be expanded in order to identify social determinants of health, triggering emancipatory practices in the service. This expansion occurred because the design of health care labour intended by the service team changed its focus from the traditional object of health services, the disease. Conclusion First, it is advocated that social policies lead projects with the purpose of improving health needs. On the other hand, the daily labour needs to provide opportunities for reflection and discussion of healthcare projects, leading workers to propose labour-processes targeted to both the social determinants of health and people’s illness.

Task-shifting in the delivery of hormonal contraceptive methods: Validation of a questionnaire and preliminary results.

Guilbert ER, Morin D, Guilbert AC, Gagnon H, Robitaille J, Richardson M. International Journal of Nursing Practice 2011; 17: 315-321 Task-shifting in the delivery of hormonal contraceptive methods: Validation of a questionnaire and preliminary results In order to palliate the access problem to effective contraceptive methods in Quebec, Canada, as well as to legitimate nurses' practices in family planning, a collaborative agreement was developed that allow nurses, in conjunction with pharmacists, to give hormonal contraceptives to healthy women of reproductive age for a 6 month period. Training in hormonal contraception was offered to targeted nurses before they could begin this practice. A questionnaire, based on Rogers's theory of diffusion of innovations, was elaborated and validated to specifically evaluate this phenomenon. Preliminary results show that the translation of training into practice might be suboptimal. The validated questionnaire can now be used to fully understand the set of factors influencing this new practice.

Expert clinical reasoning and pain assessment in mechanically ventilated patients: A descriptive study.

BACKGROUND: Pain assessment in mechanically ventilated patients is challenging, because nurses need to decode pain behaviour, interpret pain scores, and make appropriate decisions. This clinical reasoning process is inherent to advanced nursing practice, but is poorly understood. A better understanding of this process could contribute to improved pain assessment and management. OBJECTIVE: This study aimed to describe the indicators that influence expert nurses' clinical reasoning when assessing pain in critically ill nonverbal patients. METHODS: This descriptive observational study was conducted in the adult intensive care unit (ICU) of a tertiary referral hospital in Western Switzerland. A purposive sample of expert nurses, caring for nonverbal ventilated patients who received sedation and analgesia, were invited to participate in the study. Data were collected in "real life" using recorded think-aloud combined with direct non-participant observation and brief interviews. Data were analysed using deductive and inductive content analyses using a theoretical framework related to clinical reasoning and pain. RESULTS: Seven expert nurses with an average of 7.85 (±3.1) years of critical care experience participated in the study. The patients had respiratory distress (n=2), cardiac arrest (n=2), sub-arachnoid bleeding (n=1), and multi-trauma (n=2). A total of 1344 quotes in five categories were identified. Patients' physiological stability was the principal indicator for making decision in relation to pain management. Results also showed that it is a permanent challenge for nurses to discriminate situations requiring sedation from situations requiring analgesia. Expert nurses mainly used working knowledge and patterns to anticipate and prevent pain. CONCLUSIONS: Patient's clinical condition is important for making decision about pain in critically ill nonverbal patients. The concept of pain cannot be assessed in isolation and its assessment should take the patient's clinical stability and sedation into account. Further research is warranted to confirm these results.

Mapping the diagnosis axis of an interface terminology to the NANDA International Taxonomy

Background: Nursing terminologies are designed to support nursing practice but, as with any other clinical tool, they should be evaluated. Cross-mapping is a formal method for examining the validity of the existing controlled vocabularies. Objectives: The study aims to assess the inclusiveness and expressiveness of the nursing diagnosis axis of a newly implemented interface terminology by cross-mapping with the NANDA-I taxonomy. Design/Methods: The study applied a descriptive design, using a cross-sectional, bidirectional mapping strategy. The sample included 728 concepts from both vocabularies. Concept cross-mapping was carried out to identify one-to-one, negative, and hierarchical connections. The analysis was conducted using descriptive statistics. Results: Agreement of the raters" mapping achieved 97%. More than 60% of the nursing diagnosis concepts in the NANDA-I taxonomy were mapped to concepts in the diagnosis axis of the new interface terminology; 71.1% were reversely mapped. Conclusions: Main results for outcome measures suggest that the diagnosis axis of this interface terminology meets the validity criterion of cross-mapping when mapped from and to the NANDA-I taxonomy.

Acceptance and Use of Information Technology among Nurses in Psychiatric Hospitals

Hoitajien informaatioteknologian hyväksyntä ja käyttö psykiatrisissa sairaaloissa Informaatioteknologian (IT) käyttö ei ole ollut kovin merkittävässä roolissa psykiatrisessa hoitotyössä, vaikka IT sovellusten on todettu vaikuttaneen radikaalisti terveydenhuollon palveluihin ja hoitohenkilökunnan työprosesseihin viime vuosina. Tämän tutkimuksen tavoitteena on kuvata psykiatrisessa hoitotyössä toimivan hoitohenkilökunnan informaatioteknologian hyväksyntää ja käyttöä ja luoda suositus, jonka avulla on mahdollista tukea näitä asioita psykiatrisissa sairaaloissa. Tutkimus koostuu viidestä osatutkimuksesta, joissa on hyödynnetty sekä tilastollisia että laadullisia tutkimusmetodeja. Tutkimusaineistot on kerätty yhdeksän akuuttipsykiatrian osaston hoitohenkilökunnan keskuudessa vuosien 2003-2006 aikana. Technology Acceptance Model (TAM) –teoriaa on hyödynnetty jäsentämään tutkimusprosessia sekä syventämään ymmärrystä saaduista tutkimustuloksista. Tutkimus osoitti kahdeksan keskeistä tekijää, jotka saattavat tukea psykiatrisessa sairaalassa toimivien hoitajien tietoteknologiasovellusten hyväksyntää ja hyödyntämistä, kun nämä tekijät otetaan huomioon uusia sovelluksia käyttöönotettaessa. Tekijät jakautuivat kahteen ryhmään; ulkoiset tekijät (resurssien suuntaaminen, yhteistyö, tietokonetaidot, IT koulutus, sovelluksen käyttöön liittyvä harjoittelu, potilas-hoitaja suhde), sekä käytön helppous ja sovelluksen käytettävyys (käytön ohjeistus, käytettävyyden varmistaminen). TAM teoria todettiin käyttökelpoiseksi tulosten tulkinnassa. Kehitetty suositus sisältää ne toimenpiteet, joiden avulla on mahdollista tukea sekä organisaation johdon että hoitohenkilökunnan sitoutumista ja tätä kautta varmistaa uuden sovelluksen hyväksyntä ja käyttö hoitotyössä. Suositusta on mahdollista hyödyntää käytännössä kun uusia tietojärjestelmiä implementoidaan käyttöön psykiatrisissa sairaaloissa.

Nurse-led interpersonal counselling for depressive symptoms in patients with myocardial infarction

The broad interest of this intervention study is in two worldwide remarkable diseases, myocardial infarction and depression. The purpose of the 18-month follow-up study was to evaluate the outcomes of interpersonal counselling implemented by a psychiatric nurse, and to examine the recovery experienced by the patients after myocardial infarction. The interpersonal counseling consisted of a short-term (max 6 sessions) depression-focused intervention modified for myocardial infarction patients. The main principle of interpersonal counselling is that depressive symptoms relate to interpersonal relations. The measured outcomes of the intervention consisted of changes in depressive symptoms and distress, health-related quality of life and the use of health care services. The data consisted of 103 patients with acute myocardial infarction and with sufficient knowledge of Finnish language, and they were randomized into intervention group (n=51) and control group (n=52) with standard care. Depressive symptoms were measured using Beck Depression Inventory, and distress using Symptom Checklist-25. The instrument to measure health-related quality of life was EuroQol-5 Dimensions. All instruments were used at three measurements: in hospital, at 6 months and at 18 months after hospital discharge. The Use of Health Care Services questionnaire was used during the 6- and 18-month period after hospital discharge. In addition, satisfaction with the intervention and with information received from the health-care professional was evaluated during the follow-up. To examine recovery, the patients kept diaries during a 6-month period and they were interviewed at 18 months after myocardial infarction. The number of patients with depressive symptoms decreased significantly more in the intervention group compared with the control group during 18 months of follow-up. Distress decreased significantly more among patients under 60 years in the intervention group than in the control group, but the difference was not significant between the groups. No differences in the changes of health-related quality of life were found between the groups during follow-up. However, in the group of patients under 60 years, the improvement of health-related quality of life in the intervention was significantly better in the intervention group compared with the control group during the follow-up. During the follow-up period, there was even a decline in the use of somatic specialized health care services in the intervention group and among intervention patients who had no other long-term disease. Considering recovery experienced by the patients, main categories including many supporting and inhibiting factors and subcategories were identified: clinical and physical, psychological, social, functional and professional category. No differences between the groups were found in satisfaction with information received from the professionals. The brief and easy-to-learn intervention, with which the patients were satisfied, seems to decrease depressive symptoms after myocardial infarction. Interpersonal counselling seems to be beneficial especially with younger patients. These results justify adopting depression screening and interpersonal counselling as part of routine care after myocardial infarction. The first stage evaluation of the use of health care services is interesting, and calls for more studies. From the perspective of individual patients, recovery after myocardial infarction seems to consist of many supporting and inhibiting factors. This is something that is important to take into account in developing nursing practice. The results indicate a need for further studies in outcomes of interpersonal counselling and recovery experienced by the patients after myocardial infarction. In addition, the results encourage widening the research perspective to nursing administration and educational level.

Foot Health In Older People - Development of a preventive, evaluative instrument for nurses

Foot health is a part of overall health in every age group and its importance increases during ageing. Health care professionals are in a vital position for preventing foot health problems, and identifying and caring them in older people. Despite the rather high number of studies conducted in the field of foot health in older people, reliable and valid nurse-administered foot health assessment instruments seem to be lacking. By identifying foot health in older people, it is possible to develop nursing interventions to enhance safe, independent living at home. The purpose of this three-phase study was to develop an instrument to assess the level of foot health in older people and evaluate foot care practices from the perspective of older people themselves and nurses in home care. The ultimate goal is to prevent foot health problems by increasing the attention paid to older people’s feet and recognizing those foot health problems which need further care; thus not focus on different foot health problems. The study was conducted in different phases and contexts. In phase 1, a descriptive design with a literature review from the Medline (R) and CINAHL databases to explore foot health in older people and nurses’ role in foot health care and pre-post design intervention study in nursing home with nursing staff (n=16) and older residents (n=43) were conducted. In phase 2, a descriptive and explorative study design was employed to develop an instrument for assessing foot health in older people (N=651, n=309, response rate 47%) and explore the psychometrics of the instrument. The data were collected from sheltered housing and home care settings. Finally, in phase 3, descriptive and explorative as well as cross-sectional correlational survey designs were used to assess foot health and evaluate the foot self-care activities of older people (N=651, n=309, response rate 47%) and to describe foot care knowledge and caring activities of nurses (N=651, n=322, response rate 50%) in home care in Finland. To achieve this, the Foot Health Assessment Instrument (FHAI) developed in phase 2 was used; at the same time, this large sample also was used for the psychometric evaluation of the FHAI. The data analysis methods used in this study were content analysis, descriptive and inferential statistics including factor and multivariate analysis. Many long-term diseases can manifest in feet. Therefore, the FHAI, developed in this study consisted of items relating to skin and nail health, foot structure and foot pain. The FHAI demonstrated acceptable preliminary psychometric properties. A great deal of different foot health problems in older people were found of which edema, dry skin, thickened and discoloured toenails and hallux valgus were the most prevalent foot health problems. Moreover, many older people had difficulties in performing foot self-care. Nurses’ knowledge of foot care was insufficient and revealed a need for more information and continuing education in matters relating to foot care in older people. Instead, nurses’ foot care activities were mainly adequate, though the findings indicate the need for updating foot care activities to correspond with the evidence found in the field of foot care. Practical implications are presented for nursing practice, education and administration. In future, research should focus on developing interventions for older people and nurses to promote foot health in older people and to prevent foot health problems, as well as for further development of the FHAI.

Young Registered Nurses’ Intent to Leave the Profession in Finland - A Mixed-Method Study

The purpose of this study was to examine and expand understanding concerning young Finnish registered nurses (RN) with an intention to leave the profession and the related variables, specifically when that intention has emerged before the age of 30. The overall goal of the study was to develop a conceptual model in relation to young RNs’ intention to leave the profession. Suggestions for policymakers, nurse leaders and nurse managers are presented for how to retain more young RNs in the nursing workforce. Suggestions for future nursing research are also provided. Phase I consists of two sequential integrative literature reviews of 75 empirical articles concerning nurses’ intention to leave the profession. In phase II, data had been collected as part of the Nurses’ Early Exit (NEXT) study, using the BQ-12 structured postal questionnaire. A total of 147 young RNs participated in the study. The data were analysed with statistical methods. In phase III, firstly, an in-depth interpretive case study was conducted in order to understand how young RNs explain and make sense of their intention to leave the profession. The data in this study consisted of longitudinal career stories by three young RNs. The data was analysed by using narrative holistic-content and thematic methods. Secondly, a total of 15 young RNs were interviewed in order to explore in-depth their experiences concerning organizational turnover and their intent to leave the profession. The data was analysed using conventional content analysis. Based on earlier research, empirical research on the young RNs intention to leave the profession is scarce. Nurses’ intention to leave the profession has mainly been studied with quantitative descriptive studies, conducted with survey questionnaires. Furthermore, the quality of previous studies varies considerably. Moreover, nurses’ intention to leave the profession seems to be driven by a number of variables. According to the survey study, 26% of young RNs had often considered giving up nursing completely and starting a different kind of job during the course of the previous year. Many different variables were associated with an intention to leave the profession (e.g. personal burnout, job dissatisfaction). According to the in-depth inquiries, poor nursing practice environments and a nursing career as a ‘second-best’ or serendipitous career choice were themes associated with young RNs’ intention to leave the profession. In summary, young RNs intention to leave the profession is a complex phenomenon with multiple associated variables. These findings suggest that policymakers, nurse leaders and nurse managers should enable improvements in nursing practice environments in order to retain more young RNs. These improvements can include, for example, adequate staffing levels, balanced nursing workloads, measures to reduce work-related stress as well as possibilities for advancement and development. Young RNs’ requirements to provide high-quality and ethical nursing care must be recognized in society and health-care organizations. Moreover, sufficient mentoring and orientation programmes should be provided for all graduate RNs. Future research is needed into whether the motive for choosing a nursing career affects the length of the tenure in the profession. Both quantitative and in-depth research is needed for the comprehensive development of nursing-turnover research.

Knowledge and attitudes of Registered Nurses toward pain /

This research provided relevant data to support pain research literature that finds nurses do not have the knowledge base that they require to sufficiently provide effective pain management. The data demonstrated that nurses have mixed attitudes toward pain. These two findings have been observed in the literature for more than 20 years, but were important results for the hospitals and the nurses involved in the study. The purposes of this study were to identify the level of knowledge and attitudes in a sample of nurses fi-om the surgical and medical units in three hospitals, and determine whether a difference between these two groups existed. The institutional resources to support pain relief practices provided by each hospital were also documented. Data were collected using a convenience sample from the medical and surgical units of three hospitals. Ofthe 1 13 nurses who volunteered to participate, 78 worked in surgical units and 35 worked in medical units. Demographic data were collected about the participants. The established instruments used to obtain data about knowledge and attitude included: (a) Nurses Knowledge of Pain Issues Survey, (b)Attitude to Pain Control Scale, and (c) Andrew and Robert Vignette. Data collected were quantitative along with two open-ended questions for a rich, qualitative section. Inadequate knowledge and outdated attitudes were very evident in the responses. Data from the open-ended questions described how nurses assessed pain and the most conmion problems caring for patients in pain. Nursing practice implications for these hospitals involve initiating a process to develop an educational pain program for nurses throughout the hospital. Utilizing findings from other studies, the program should have an interdisciplinary approach to the planning, implementation, evaluation, and ongoing support. This study supports the belief that inadequate pain management has been attributed to many factors, most importantly to a lack of knowledge. Pain is a costly, unnecessary complication for the patient as well as the hospital. It follows then, that it is in the best interest of all involved to implement an educational pain program in order to influence practice.

La signification de l’expérience d’« être avec » la personne soignée et sa contribution à la réadaptation : la perception d’infirmières

De multiples auteurs de la discipline infirmière réclament la valeur inestimable de la relation de caring et de ses bienfaits pour la clientèle nécessitant des soins et services de réadaptation. En dépit de cette importance, la recherche concernant les bienfaits thérapeutiques de la relation de caring pour la clientèle de réadaptation demeure encore un domaine peu exploité. Actuellement, aucune étude scientifique québécoise, canadienne ou internationale, issue de la discipline infirmière, ne porte sur la compréhension de l’expérience d’« être avec » la personne soignée dans un contexte de réadaptation, aspect qui s’avère central à la relation de caring selon Watson. Au cœur même de la philosophie du Human Caring de Watson, la présente étude vise à explorer, par des entrevues qualitatives auprès de 17 infirmières oeuvrant en contexte de réadaptation, la signification de l’expérience d « être avec » la personne soignée, de même que leur perception de la contribution de cette expérience à la réadaptation de la personne soignée. Cinquante et une entrevues, c’est-à-dire trois entrevues réalisées pour chaque participant de recherche, ont été analysées à l’aide de la méthode phénoménologique intitulée « Relational Caring Inquiry » développée par Cara (1997). Le processus de recrutement des participants a impliqué la direction des soins infirmiers des deux centres de réadaptation ciblés par l’étude. Une attention particulière a été mise afin de favoriser une diversité de participants (par exemple : genre, niveau éducationnel, quart de travail, unité de soins). Le processus d’analyse des données a permis la découverte de cinq eidos-thèmes. Parmi ces eidos-thèmes, quatre se rapportent à la signification de l’expérience d’«être avec» la personne soignée (première question de recherche), à savoir : (a) l’importance des valeurs humanistes au centre du soin, (b) l’investissement de l’infirmière et de la personne soignée, (c) les dimensions réciproque et relationnelle du soin et, finalement, (d) l’expérience de soin irremplaçable d’une complexité contextuelle. De façon plus détaillée, le premier eidos-thème dévoile les fondements humanistes à la base de l’expérience d’« être avec » la personne soignée. Le deuxième manifeste l’implication substantielle de l’infirmière et de la personne soignée. Le troisième eidos-thème met en lumière la réciprocité et la dimension relationnelle comme étant des éléments centraux à l’expérience d’« être avec » la personne soignée. Le quatrième eidos-thème documente les natures fondamentale et complexe de cette expérience de soin unique, de même que les conditions contextuelles qui la facilitent et la contraignent. Le cinquième et dernier eidos-thème ayant émergé de la présente étude, « rehaussement de l’harmonie corps-âme-esprit chez la personne soignée et l’infirmière », illustre la perception des participantes quant à la contribution thérapeutique de l’expérience d’« être avec » la personne soignée à la réadaptation de cette dernière (deuxième question de recherche). Cette contribution se situe en termes de répondre aux besoins du patient, d’optimiser les progrès de réadaptation de la personne soignée, de promouvoir le niveau de bien-être de la personne soignée et de l’infirmière et, finalement, de hausser la croissance intérieure des personnes engagées dans cette expérience de soin extraordinaire. La reconnaissance des cinq eidos-thèmes a favorisé l’émergence de l’essence universelle du phénomène à l’étude qui s’intitule « la rencontre humaine profonde, thérapeutique et transformatrice ». La présente étude contribue de façon novatrice au développement des connaissances, notamment en permettant une meilleure compréhension de ce que signifie l’expérience d’« être avec » la personne soignée, pour des infirmières en réadaptation et en proposant une multitude de résultats probants pouvant servir de guide à la promulgation de soins infirmiers en contexte de réadaptation. En déterminant la signification ontologique de cette expérience de soin, la présente étude permet de préciser la place du phénomène d’« être avec » la personne soignée au centre de la théorie du caring. Ces résultats qui découlent de la deuxième question de recherche participent au développement initial d’un corpus de connaissances. Ces résultats probants serviront de guide au renouvellement de la pratique infirmière en contexte de réadaptation. De plus, en identifiant les bienfaits de cette expérience de soin, la présente étude reconnaît l’élément au cœur de la relation transpersonnelle de caring, qui contribue à rehausser l’harmonie corps-âme-esprit chez la personne soignée et l’infirmière. En plus de la clinique, des recommandations au niveau de la formation et de la recherche en sciences infirmières découlent de la présente étude.

Le processus d'adaptation de conjoints dont la femme est atteinte d'un cancer de l'ovaire

Le but de cette étude est de cerner, à partir de leur propre point de vue, la trajectoire d’adaptation de conjoints dont l’épouse est atteinte d’un cancer de l’ovaire. Une approche qualitative, la théorisation ancrée, a été utilisée dans le cadre de cette recherche. Les données ont été recueillies à l’aide d'entretiens semi-structurés effectués auprès de neuf conjoints qui accompagnaient leur épouse lors de leurs traitements dans une unité montréalaise ultra-spécialisée de soins pour les cancers gynécologiques. Nos résultats font ressortir qu’une fois passé le choc de l’annonce du diagnostic, nos répondants se ressaisissent et élaborent toute une série de stratégies de protection pour leur épouse et eux-mêmes, puis d’attaque de la maladie. Au bilan, pour eux, le cancer se révèle une expérience « transformante» aux plans personnel, conjugal et social. Les contrastes observés entre nos résultats et ceux des études antérieures, qui insistent sur le désarroi de conjoints, peuvent être expliqués par la prise en charge efficace de la femme par le réseau de la santé, qui valorise le rôle du conjoint et qui l’outille pour accompagner son épouse. S’ajoutent à cela la force du lien conjugal, trempé par les épreuves passées, certains traits de personnalité des conjoints et l'action du réseau de soutien personnel. En regard de la pratique infirmière, notre recherche met en évidence le bien-fondé des politiques soutenant l’intégration des familles dans les plans de soins et les retombées positives d’une approche concertée entre tous les intervenants de la santé. Répéter une telle étude dans d'autres institutions du réseau de la santé permettrait de cerner encore plus finement son impact sur l’adaptation de conjoints à la maladie.

L'expérience du dévoilement telle que perçue par des femmes vivant avec le VIH nées au Québec

Le dévoilement de sa séropositivité représente une préoccupation quotidienne des femmes vivant avec le VIH, complexifié par la stigmatisation. L'état des connaissances demeure très fragmenté : les études révèlent des patterns (à qui les femmes dévoilent et à quelle fréquence), les raisons pour dévoiler ou non, les conséquences positives et négatives ainsi que les facteurs liés au dévoilement, limitant une compréhension globale du phénomène. Inspirée de la toile de fond de Parse (1998, 2003), cette présente étude visait à décrire et à mieux comprendre l'expérience du dévoilement, telle que perçue par des femmes vivant avec le VIH nées au Québec. La méthode phénoménologique a été privilégiée afin de recueillir des données auprès de sept participantes, par la tenue d’une entrevue semi structurée. L’analyse des données a reposé sur deux activités de recherche proposées par van Manen (1997), soit la réflexion et l’écriture, permettant d’identifier les sept thèmes suivants : 1) Se respecter tout en considérant les confidents ; 2) Ressentir l’appréhension; 3) Exercer un contrôle pour assurer une protection; 4) S’engager délibérément dans une démarche de révélation-dissimulation; 5) S’exposer au contexte social stigmatisant empreint d’exclusion; 6) Souffrir intérieurement; 7) Bénéficier des retombées positives de sa décision. Ces thèmes ont contribué à la formulation de l’essence du phénomène étudié soit : vivre l’ambivalence d’une démarche paradoxale de révélation-dissimulation, au cœur d’une souffrance profonde intensifiée par la stigmatisation, tout en s’enrichissant des bienfaits recueillis. Il est permis de croire que ces résultats puissent avoir des retombées positives pour guider la pratique infirmière autour du soutien aux femmes dans leur expérience de dévoilement.

Don d'organes et groupes ethniques à Montréal : Le rôle des infirmières dans un contexte de décès neurologique.

Travail dirigé présenté à la Faculté des sciences infirmières en vue de l'obtention du grade de maîtrise en sciences infirmières option expertise-conseil en soins infirmiers