Awards & Achievements (12)
Grant · Jun 2016
A Study of Leading Indicators for Occupational Health and Safety Management Systems in Healthcare.
Grant · Mar 2013
The Dorothy Hall Research Initiative, Queen's University School of Nursing
Grant · Mar 2013
Positive and Negative Behaviours in Workplace Relationships: A Scoping Review
Grant · Aug 2012
Research Initiation Grant, Queen's University
Grant · Aug 2012
Research Development Fund, Queen's University School of Nursing
Research Items (39)
Background There is increasing awareness that regardless of the proven value of clinical interventions, the use of effective strategies to implement such interventions into clinical practice is necessary to ensure that patients receive the benefits. However, there is often confusion between what is the clinical intervention and what is the implementation intervention. This may be caused by a lack of conceptual clarity between ‘intervention’ and ‘implementation’, yet at other times by ambiguity in application. We suggest that both the scientific and the clinical communities would benefit from greater clarity; therefore, in this paper, we address the concepts of intervention and implementation, primarily as in clinical interventions and implementation interventions, and explore the grey area in between. Discussion To begin, we consider the similarities, differences and potential greyness between clinical interventions and implementation interventions through an overview of concepts. This is illustrated with reference to two examples of clinical interventions and implementation intervention studies, including the potential ambiguity in between. We then discuss strategies to explore the hybridity of clinical-implementation intervention studies, including the role of theories, frameworks, models, and reporting guidelines that can be applied to help clarify the clinical and implementation intervention, respectively. Conclusion Semantics provide opportunities for improved precision in depicting what is ‘intervention’ and what is ‘implementation’ in health care research. Further, attention to study design, the use of theory, and adoption of reporting guidelines can assist in distinguishing between the clinical intervention and the implementation intervention. However, certain aspects may remain unclear in analyses of hybrid studies of clinical and implementation interventions. Recognizing this potential greyness can inform further discourse.
- Aug 2016
Background: Medication use among Canadian seniors is widespread and increases with the number of comorbidities. Limited evidence exists on medication knowledge among seniors, especially in home care. Purpose: The purpose of this retrospective cohort study was to describe medication knowledge and ability to take medication among seniors admitted to home care in Ontario. Results: Ten percent had little or no knowledge of what medication to take (n = 1,389/14,004) or an understanding of the purpose of their medications (n = 1,396/14,004). Increasing numbers of medications prescribed was associated with decreased knowledge of medications. The strongest predictor of limited knowledge and ability to take medication was dementia (odds ratio > 5.0). Discussion: Among Ontario seniors living at home, knowledge about medications decreases as the number of medications increases. Therefore, this group may be at high risk of medication errors. Conclusion: Better systems are required to allow healthcare professionals to review with patients, any medications with patients and caregivers, to assist in addressing the decreased knowledge of medications. Such a system would provide the capacity to target those individuals at high risk for a medication error, as well as the medications and drug-drug interactions that seem most likely to be harmful among older adults.
- Jan 2016
Aim: To review empirical studies examining antecedents (sources, causes, predictors) in the management and mitigation of interpersonal conflict. Background: Providing quality care requires positive, collaborative working relationships among healthcare team members. In today's increasingly stress-laden work environments, such relationships can be threatened by interpersonal conflict. Identifying the underlying causes of conflict and choice of conflict management style will help practitioners, leaders and managers build an organizational culture that fosters collegiality and create the best possible environment to engage in effective conflict management. Design: Integrative literature review. Data sources: CINAHL, MEDLINE, PsycINFO, Proquest ABI/Inform, Cochrane Library and Joanne Briggs Institute Library were searched for empirical studies published between 2002-May 2014. Review methods: The review was informed by the approach of Whittemore and Knafl. Findings were extracted, critically examined and grouped into themes. Results: Forty-four papers met the inclusion criteria. Several antecedents influence conflict and choice of conflict management style including individual characteristics, contextual factors and interpersonal conditions. Sources most frequently identified include lack of emotional intelligence, certain personality traits, poor work environment, role ambiguity, lack of support and poor communication. Very few published interventions were found. Conclusion: By synthesizing the knowledge and identifying antecedents, this review offers evidence to support recommendations on managing and mitigating conflict. As inevitable as conflict is, it is the responsibility of everyone to increase their own awareness, accountability and active participation in understanding conflict and minimizing it. Future research should investigate the testing of interventions to minimize these antecedents and, subsequently, reduce conflict.
- Nov 2015
This is a prospective cohort study using population-level administrative data to describe the scope of pressure ulcers in terms of its prevalence, incidence risk, associating factors and the extent to which best practices were applied across a spectrum of health care settings. The data for this study includes the information of Ontario residents who were admitted to acute care, home care, long term care or continuing care and whose health care data is contained in the resident assessment instrument-minimum data set (RAI-MDS) and the health outcomes for better information and care (HOBIC) database from 2010 to 2013. The analysis included 203 035 unique patients. The overall prevalence of pressure ulcers was approximately 13% and highest in the complex continuing care setting. Over 25% of pressure ulcers in long-term care developed one week after discharge from acute care hospitalisation. Individuals with cardiovascular disease, dementia, bed mobility problems, bowel incontinence, end-stage diseases, daily pain, weight loss and shortness of breath were more likely to develop pressure ulcers. While there were a number of evidence-based interventions implemented to treat pressure ulcers, only half of the patients received nutritional interventions.
Engaging in teamwork requires a clear understanding of positive and negative behaviours that act as facilitators and barriers to collegial workplace relationships. Identifying and correcting underlying barriers, while promoting facilitators, is fundamental to improving care delivery and, ultimately, clinical outcomes. Despite a considerable amount of literature in this area, there is a lack of clarity of the different behaviours as several parallel literatures address similar questions about antecedents, processes and outcomes. The purpose of this study is to synthesise the current state of literature reporting on behaviours in workplace relationships. Using a scoping review methodology, the following research question will be addressed: "What is known about positive and negative behaviours in workplace relationships?" We will employ the methodological frameworks used by Arksey and O'Malley and Levac et al. The search strategy will include numerous electronic databases, grey literature sources and hand-searching of reference lists from 1990 to present with a limit to English language. Search strategies will be developed using controlled vocabulary and keyword terms related to various components of workplace relationships. Two reviewers will independently screen titles and abstracts for inclusion, followed by screening of the full text of potential articles to determine final inclusion. A descriptive numerical analysis will describe characteristics of included studies. A thematic analysis will provide an overview of the literature, including definitions, conceptual frameworks, antecedents, outcomes and interventions. In reviewing a wide range of positive and negative behaviours, then integrating into a manageable, meaningful whole, this study is a critical step in helping policymakers, leaders and healthcare professionals effectively use what is known thus far. Knowledge translation activities will occur throughout the study with dissemination of findings to local, national, and international stakeholders, including a wide range of clinicians, leaders and administrators in all sectors. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Correctional nurses hold a unique position within the nursing profession as their work environment combines the demands of two systems, corrections and health care. Nurses working within these settings must be constantly aware of security issues while ensuring that quality care is provided. The primary role of nurses in correctional health care underscores the importance of understanding nurses' perceptions about their work. The purpose of this study was to examine the work environment of nurses working in provincial correctional facilities. A mixed-methods design was used. Interviews were conducted with 13 nurses and healthcare managers (HCMs) from five facilities. Surveys were distributed to 511 nurses and HCMs in all provincial facilities across the province of Ontario, Canada. The final sample consisted of 270 nurses and 27 HCMs with completed surveys. Participants identified several key issues in their work environments, including inadequate staffing and heavy workloads, limited control over practice and scope of practice, limited resources, and challenging workplace relationships. Work environment interventions are needed to address these issues and subsequently improve the recruitment and retention of correctional nurses.
- Nov 2013
- National Correctional Services Healthcare Conference: Addressing the Gaps, Promoting Multidisciplinary Care & Improving the Continuum of Care Into the Community
Background: Nurses are the primary healthcare providers in correctional facilities. A solid knowledge and expertise that includes the use of research evidence in clinical decision making is needed to optimize nursing practice and promote positive health outcomes within these settings. The institutional emphasis on custodial care within a heavily secured, regulated, and punitive environment presents unique contextual challenges for nursing practice. Subsequently, correctional nurses are not always able to obtain training or ongoing education that is required for broad scopes of practice. The purpose of the proposed study is to develop an educational intervention for correctional nurses to support the provision of evidence-informed care. Methods: A two-phase mixed methods research design will be used. The setting will be three provincial correctional facilities. Phase one will focus on identifying nurses’ scope of practice and practice needs, describing work environment characteristics that support evidence-informed practice and developing the intervention. Semi-structured interviews will be completed with nurses and nurse managers. To facilitate priorities for the intervention, a Delphi process will be used to rank the learning needs identified by participants. Based on findings, an online intervention will be developed. Phase two will involve evaluating the acceptability and feasibility of the intervention to inform a future experimental design. Discussion: The context of provincial correctional facilities presents unique challenges for nurses’ provision of care. This study will generate information to address practice and learning needs specific to correctional nurses. Interventions tailored to barriers and supports within specific contexts are important to enable nurses to provide evidence-informed care.
Our aim was to investigate direct-care nurses' interests in formal management roles and factors that facilitate their decision-making. Based on a projected shortage of nurses by 2022, the profession could be short of 4200 nurse managers in Canada within the next decade. However, no data are currently available that identify nurses' interests in assuming manager roles. Using focus group methodology, we conducted 18 focus groups with 125 staff nurses and managers in four regions across Canada. Major themes and subthemes influencing nurses' decisions to pursue management roles included personal demographic (education, age, clinical experience and life circumstances), personal disposition (leadership skills, intrinsic rewards and professional commitment) and situation (leadership development opportunities, manager role perceptions and presence of mentors). Although nurses see management roles as positive opportunities, they did not perceive the rewards to be great enough to outweigh their concerns. Findings suggested that organizations need to provide support, leadership development and succession opportunities and to redesign manager roles for optimum success. Leaders need to ensure that they convey positive images of manager roles and actively identify and support staff nurses with leadership potential.
To examine the influence of personal and situational factors on direct-care nurses' interests in pursuing nursing management roles. Nursing managers are ageing and nurses do not appear to be interested in nursing management roles, raising concerns about a nursing leadership shortage in the next decade. Little research has focused on factors influencing nurses' career aspirations to nursing management roles. A national survey of nurses from nine Canadian provinces was conducted (n = 1241). Multiple regression was used to test a model of personal and situational predictors of nurses' career aspirations to management roles. Twenty-four per cent of nurses expressed interest in pursuing nursing management roles. Personal and situational factors explained 60.2% of nurses' aspirations to management roles. Age, educational preparation, feasibility of further education, leadership self-efficacy, career motivation, and opportunity to motivate others were the strongest predictors of aspirations for management roles. Personal factors were more strongly associated with career aspirations than situational factors. There is a steady decline in interest in management roles with increasing age. Nursing leadership training to develop leadership self-efficacy (particularly for younger nurses) and organizational support for pursuing advanced education may encourage nurses to pursue nursing management roles.
- Oct 2011
- Custody and Caring: International Conference on the Nurse's Role in the Criminal Justice System
- Oct 2010
almost j., doran d.m., mcgillis hall l. & spence laschinger h.k. (2010) Journal of Nursing Management 18, 981–992 Antecedents and consequences of intra-group conflict among nurses Aim To test a theoretical model linking selected antecedent variables to intra-group conflict among nurses, and subsequently conflict management style, job stress and job satisfaction. Background A contributing factor to the nursing shortage is job dissatisfaction as a result of conflict among nurses. To develop strategies to reduce conflict, research is needed to understand the causes and outcomes of conflict in nursing work environments. Method A predictive, non-experimental design was used in a random sample of 277 acute care nurses. Structural equation modelling was used to analyse the hypothesised model. Results Nurses’ core self-evaluations, complexity of care and relationships with managers and nursing colleagues influenced their perceived level of conflict. Conflict management style partially mediated the relationship between conflict and job satisfaction. Job stress had a direct effect on job satisfaction and core self-evaluation had a direct effect on job stress. Conclusion Conflict and its associated outcomes is a complex process, affected by dispositional, contextual and interpersonal factors. How nurses manage conflict may not prevent the negative effects of conflict, however, learning to manage conflict using collaboration and accommodation may help nurses experience greater job satisfaction. Implications for nursing management Strategies to manage and reduce conflict include building interactional justice practices and positive interpersonal relationships.
- Mar 2010
The health system must develop effective solutions to the growing challenges it faces with respect to individuals who suffer with mental health disorders and addictions. The purpose of this study was to evaluate the usability and potential impact on outcomes of a knowledge translation system aimed at improving client-centered, evidence-based care for hospitalized individuals with schizophrenia. A pre-posttest design was used. The e-Volution-TREAT system was implemented on two inpatient units at a large mental health facility. Thirty-seven nurses, allied health workers, and physicians participated from two units. Data collection involved questionnaires, semistructured interviews, and observations. Thirty-eight consenting clients' outcome data were collected from organizational records. Overall, staff participants were very satisfied with the functions of the e-Volution-TREAT system. Barriers to using the system were identified by participants related to the work environment, to understaffing, equipment problems, discomfort with technology, and a focus on short-term rather than long-term goals. There was moderate uptake of guidelines related to social issues, and low uptake of guidelines related to family support and addictions. There were significant improvements in four client outcomes over time, specifically aggressive behavior, depression, withdrawal, and psychosis. In conclusion, users were overall satisfied with the e-Volution-TREAT system, although expressed challenges related to workload that interfered with time to utilize the system. It would be premature to conclude the change in client outcomes was related to the e-Volution-TREAT system without a randomized controlled trial with outcomes compared to a control group. Future research needs to incorporate strategies for modifying the context and engage clinicians who are in a position of influence to model change.
- Dec 2009
To evaluate the usability of mobile information terminals, such as personal digital assistants (PDAs) or Tablet personal computers, to improve access to information resources for nurses and to explore the relationship between PDA or Tablet-supported information resources and outcomes. The authors evaluated an initiative of the Nursing Secretariat, Ontario Ministry of Health and Long-Term Care, which provided nurses with PDAs and Tablet PCs, to enable Internet access to information resources. Nurses had access to drug and medical reference information, best practice guidelines (BPGs), and to abstracts of recent research studies. The authors took place over a 12-month period. Diffusion of Innovation theory and the Promoting Action on Research Implementation in Health Services (PARIHS) model guided the selection of variables for study. A longitudinal design involving questionnaires was used to evaluate the impact of the mobile technologies on barriers to research utilization, perceived quality of care, and on nurses' job satisfaction. The setting was 29 acute care, long-term care, home care, and correctional organizations in Ontario, Canada. The sample consisted of 488 frontline-nurses. Nurses most frequently consulted drug and medical reference information, Google, and Nursing PLUS. Overall, nurses were most satisfied with the Registered Nurses Association of Ontario (RNAO) BPGs and rated the RNAO BPGs as the easiest resource to use. Among the PDA and Tablet users, there was a significant improvement in research awareness/values, and in communication of research. There was also, for the PDA users only, a significant improvement over time in perceived quality of care and job satisfaction, but primarily in long-term care settings. It is feasible to provide nurses with access to evidence-based practice resources via mobile information technologies to reduce the barriers to research utilization.
The purpose of this study was to describe the profile of nursing leadership structures in Canada and to assess relationships among structures, processes and outcomes pertaining to nurse leaders' work. Data were collected from nurse leaders in 28 academic health centres and 38 community hospitals in 10 Canadian provinces (n = 1,164). The results of this study revealed that the current contingent of nursing leaders in Canada see themselves as an empowered and influential group within their organizations. Despite very large spans of control, nurse leaders at all levels were positive about their work life and confident in their ability to provide effective leadership on nursing affairs within their organizations. Structural and process factors significantly affected nurse manager outcomes at all levels. Senior nurse leaders' work-life factors had a significant effect on middle and first-line managers' perceptions of patient care quality in the organization. Nurse leaders averaged 49 years of age highlighting the need for succession planning.
- Jun 2007
The purpose of this study is to test a theoretical model linking nurse managers' perceptions of the quality of the relationship with their supervisors, and empowerment to job satisfaction, and to examine the effect of a personal dispositional variable, core self-evaluation, on the relationships among these variables. Nursing leadership roles have been transformed as a result of dramatic changes within healthcare in the past decade, yet research on the nature of nurse manager work life in current work environments is limited. A nonexperimental, predictive design was used in a sample of 141 hospital-based nurse managers obtained from a provincial registry. Approximately 40.4% of the variance in job satisfaction was explained by leader-member exchange quality (LMX), empowerment, and core self-evaluation. Higher quality relationships with their immediate supervisor were associated with greater manager structural and psychological empowerment and, consequently, greater job satisfaction. Core self-evaluation played a strong significant role, affecting all components of the model. The results suggest that both situational and personal factors are important determinants of satisfying work environments for nurse managers.
- Aug 2006
Prior research on the theory surrounding Perceived Organization Support (POS) asserts that an employee's perception of organizational support is driven by management behaviors and organizational policies and that POS increases when employees perceive that the organization is providing rewards, enrichment opportunities, and a positive workplace. ▶ In this study, nurse managers reported adequate rewards and respect as well as high levels of autonomy. ▶ Despite these positive findings, 58% of managers reported high levels of burnout suggesting perhaps, that a high level of POS increases resistance to job strain. ▶ Organizational characteristics most strongly related to POS were, in rank order, rewards for effort, respect, job security, autonomy, and, lastly, monetary gratification. ▶ Employee attitudes, performance levels, and health outcomes were better in employees with higher POS.
- Mar 2006
The aim of this paper is to examine the concept of conflict in nursing work environments using the evolutionary approach to concept analysis. In nursing work environments, conflict among nurses is becoming a significant issue resulting in job dissatisfaction, absenteeism, and turnover. Although discussed frequently in the nursing literature, nursing research has focused predominantly on conflict management without first understanding the elements, causes and effects of conflict. A literature search was conducted using CINAHL, Proquest, PsychINFO, Social Sciences Index and MEDLINE databases and the keywords conflict and work environment. Articles over the last 25 years from each of these databases were examined to identify major themes, areas of agreement and disagreement across disciplines, changes in the concept over time, and emerging trends. Conflict is a multidimensional construct with both detrimental and beneficial effects. Most definitions agree that conflict is a process involving two or more people, where a person perceives the opposition of the other. Antecedents stem from individual characteristics, interpersonal factors, and organizational factors. Individual effects, interpersonal relationships, and organizational effects are the main consequences of conflict. A theoretical model of the antecedents and consequences is presented, with implications for further development. A more thorough understanding of the sources and outcomes of conflict within nursing work environments would enable the prevention of conflict. If properly understood and managed, conflict can also lead to positive outcomes for nurses and healthcare organizations.
- Jul 2005
Patient satisfaction with nursing care quality is an important indicator of the quality of care provided in hospitals. This study tested a newly developed patient-centered measure of patient satisfaction with nursing care quality within a random sample of 14 hospitals in Ontario, Canada. Results of this study revealed that the newly developed instrument had excellent psychometric properties. Total scores on satisfaction with nursing care were strongly related to overall satisfaction with the quality of care received during hospitalization. The results of this study yielded actionable, patient-focused results that can be used by managers to address areas requiring improvement. PMID: 15965386
- Feb 2005
The aim of this descriptive study was to help policy- and decision-makers enhance the health of the Canadian nursing workforce by highlighting key factors of concern and exploring options for collecting and utilizing nurses' health data. This paper describes the views of 62 nursing stakeholders from a diverse spectrum of professional, labour, management and government perspectives from across Canada, regarding key factors contributing to work-related health problems in the nursing profession, particularly those relating to the work environment and hospital restructuring. The results were combined with a synthesis of existing information sources about the health of nurses in Canada. With respect to the key concerns, musculoskeletal conditions/injuries and stress and burnout were identified as nurses' major work-related health problems. An examination of the data synthesis inventory revealed that no existing data sources can adequately profile nurses' health, especially in relation to the components of the Conceptual Model of Nurses' Health developed in the study. Three strategies for monitoring nurses' health are proposed.
- Dec 2004
Although nursing leadership roles have been greatly transformed as a result of dramatic changes within healthcare over the past decade, there is little research on the nature of nurse manager work life in current work environments. The purpose of this study was to test a theoretical model derived from Kanter's theory of organizational empowerment: linking nurse managers' perceptions of structural and psychological empowerment to burnout, job satisfaction and physical and mental health. A descriptive, correlational design was used in a sample of 286 first-line (n=202) and middle-level (n=84) hospital-based nurse managers obtained from a provincial registry. Ironically, managers reported high levels of burnout, but good mental and physical health. Middle managers were more empowered and satisfied with their jobs than first-line managers. In both groups, approximately 45% of the variance in job satisfaction and 18-52% of the variance in physical and mental health was explained by empowerment and burnout. Empowered work environments were associated with lower nurse manager burnout and better physical and mental health. The results suggest that creating work environments that provide access to empowerment structures may be a fruitful strategy for creating healthy work environments for nurse managers. PMID: 15656251
- Aug 2003
To test a theoretical model linking nurses' perceptions of workplace empowerment, magnet hospital characteristics, and job satisfaction in 3 independent studies of nurses in different work settings. Strategies proposed in Kanter's structural empowerment theory have the potential to result in work environments that are described in terms of magnet hospital characteristics. Identifying factors that contribute to work conditions that attract and retain highly qualified committed nurses, such as those found in magnet hospitals, that can be put in place by nursing administrators is extremely important for work redesign to promote professional nursing practice. Secondary analyses of data from 3 studies were conducted--2 of staff nurses and 1 with acute care nurse practitioners working in Ontario, Canada. The Conditions of Work Effectiveness Questionnaire-II, the NWI-R, and measures of job satisfaction were used to measure the major study variables.RESULTS The results of all 3 studies support the hypothesized relationships between structural empowerment and the magnet hospital characteristics of autonomy, control over practice environment, and positive nurse-physician relationships. The combination of access to empowering work conditions and magnet hospital characteristics was significantly predictive of nurses' satisfaction with their jobs. These findings suggest that nursing leaders' efforts to create empowering work environments can influence nurses' ability to practice in a professional manner, ensuring excellent patient care quality and positive organizational outcomes. PMID: 12909793
- Sep 2002
PurposeTo test a theoretical model linking nurse practitioners’ (NPs) perceptions of workplace empowerment, collaboration with physicians and managers, and job strain.Data SourcesA predictive, nonexperimental design was used to test a model in a sample of 63 acute care NPs and 54 primary care NPs working in Ontario, Canada. The Conditions of Work Effectiveness Questionnaire, the Collaborative Behaviour Scale - Parts A (physicians) and B (managers), and the Job Content Questionnaire were used to measure the major study variables.Conclusions The results of this study support the proposition that the extent to which NPs have access to information, support, resources, and opportunities in their work environment has an impact on the extent of collaboration with physicians and managers, and ultimately, the degree of job strain experienced in the work setting. Primary care NPs have significantly higher levels of workplace empowerment, collaboration with managers, and lower levels of job strain than acute care NPs.ImplicationsThese findings will benefit NPs and nursing leaders in their efforts to create empowering work environments that enable NPs to provide excellent quality patient care and achieve organizational outcomes.
- Jun 2001
Job strain among staff nurses has become an increasingly important concern in relationship to employee performance and commitment to the organization in current restructured healthcare settings. The purpose of this study was to test Karasek's Demands-Control Model of job strain by examining the extent to which the degree of job strain in nursing work environments affects staff nurses' perceptions of structural and psychological empowerment, work satisfaction, and organizational commitment. A predictive, nonexperimental design was used to test these relationships in a random sample of 404 Canadian staff nurses. Karasek's Job Content Questionnaire, the Conditions of Work Effectiveness Questionnaire-II, Spreitzer's Psychological Empowerment Questionnaire, Meyer and Allen's Organizational Commitment Questionnaire, and the Global Satisfaction Scale were used to measure the major study variables. Nurses with higher level of job strain were found to be significantly more empowered, more committed to the organization, and more satisfied with their work. Support for Karasek's Demands/Control theory was established in this study.