Workplace System Factors of Obstetric Nurses in Northeastern Ontario, Canada: Using a Work Disability Prevention Approach

Background

The purpose of this study was to examine the relationship nursing personal and workplace system factors (work disability) and work ability index scores in Ontario, Canada.

Methods

A total of 111 registered nurses were randomly selected from the total number of registered nurses on staff in the labor, delivery, recovery, and postpartum areas of four northeastern Ontario hospitals. Using a stratified random design approach, 51 participants were randomly selected in four northeastern Ontario cities.

Results

A total of 51 (45.9% response rate) online questionnaires were returned and another 60 (54.1% response rate) were completed using the paper format. The obstetric workforce in northeastern Ontario was predominately female (94.6%) with a mean age of 41.9 (standard deviation = 10.2). In the personal systems model, three variables: marital status (p = 0.025), respondent ethnicity (p = 0.026), and mean number of patients per shift (p = 0.049) were significantly contributed to the variance in work ability scores. In the workplace system model, job and career satisfaction (p = 0.026) had a positive influence on work ability scores, while work absenteeism (p = 0.023) demonstrated an inverse relationship with work ability scores. In the combined model, all the predictors were significantly related to work ability scores.

Conclusion

Work ability is closely related to job and career satisfaction, and perceived control at work among obstetric nursing. In order to improve work ability, nurses need to work in environments that support them and allow them to be engaged in the decision-making processes.

Occupational Stress Management and Burnout Interventions in Nursing and Their Implications for Healthy Work Environments: A Literature Review

This article reports on a literature review of workplace interventions (i.e., creating healthy work environments and improving nurses' quality of work life [QWL]) aimed at managing occupational stress and burnout for nurses. A literature search was conducted using the keywords nursing, nurses, stress, distress, stress management, burnout, and intervention. All the intervention studies included in this review reported on workplace intervention strategies, mainly individual stress management and burnout interventions. Recommendations are provided to improve nurses' QWL in health care organizations through workplace health promotion programs so that nurses can be recruited and retained in rural and northern regions of Ontario. These regions have unique human resources needs due to the shortage of nurses working in primary care.

An examination of retention factors among registered practical nurses in north-eastern Ontario, Canada

INTRODUCTION

Literature from the past two decades has presented an insufficient amount of research conducted on the nursing practice environments of registered practical nurses (RPNs). The objective of this article was to investigate the barriers and facilitators to sustaining the nursing workforce in north-eastern Ontario (NEO), Canada. In particular, retention factors for RPNs were examined.

METHODS

This cross-sectional research used a self-administered questionnaire. Home addresses of RPNs working in NEO were obtained from the College of Nurses of Ontario (CNO). Following a modified Dillman approach with two mail-outs, survey packages were sent to a random sample of RPNs (N=1337) within the NEO region. Logistic regression analyses were used to determine intent to stay (ITS) in relation to the following factor categories: demographic, and job and career satisfaction.

RESULTS

Completed questionnaires were received from 506 respondents (37.8% response rate). The likeliness of ITS in the RPNs' current position for the next 5 years among nurses aged 46-56 years were greater than RPNs in the other age groups. Furthermore, the lifestyle of NEO, internal staff development, working in nursing for 14-22.5 years, and working less than 1 hour of overtime per week were factors associated with the intention to stay.

CONCLUSIONS

Having an understanding of the work environment may contribute to recruitment and retention strategy development. The results of this study may assist with addressing the nursing shortage in rural and northern areas through improved retention strategies of RPNs.

The effect of continuing professional development on public complaints: a case-control study

OBJECTIVES

This study aimed to investigate the relationship between participation in different types of continuing professional development (CPD), and incidences and types of public complaint against physicians.

METHODS

Cases included physicians against whom complaints were made by members of the public to the medical regulatory body in Ontario, Canada, the College of Physicians and Surgeons of Ontario (CPSO), during 2008 and 2009. The control cohort included physicians against whom no complaints were documented during the same period. We focused on complaints related to physician communication, quality of care and professionalism. The CPD data included all Royal College of Physicians and Surgeons of Canada (RCPSC) and College of Family Physicians of Canada (CFPC) CPD programme activities reported by the case and control physicians. Multivariate logistic regression models were used to determine if the independent variable, reported participation in CPD, was associated with the dependent variable, the complaints-related status of the physician in the year following reported CPD activities.

RESULTS

A total of 2792 physicians were included in the study. There was a significant relationship between participation in CPD, type of CPD and type of complaint received. Analysis indicated that physicians who reported overall participation in CPD activities were significantly less likely (odds ratio 0.604; p = 0.028) to receive quality of care-related complaints than those who did not report participating in CPD. Additionally, participation in group-based CPD was less likely (OR 0.681; p = 0.041) to result in quality of care-related complaints.

CONCLUSIONS

The findings demonstrate a positive relationship between participation in the national CPD programmes of the CFPC and RCPSC, and lower numbers of public complaints received by the CPSO. As certification bodies and regulators alike are increasingly mandating CPD, they are encouraged to continually evaluate the effectiveness of their programmes to maximise programme impact on physician performance at the population level.

The Use of Scaffolding and Interactive Learning Strategies in Online Courses for Working Nurses: Implications for Adult and Online Education

This paper reviews the foundational litera- ture of contemporary e-learning, with a focus on scaffolding, instructional design, and engagement. These concepts are then considered in two limited case studies, each involving e-learning and adult learners—in particular, nurse-learners. The first case study describes the use of a scaffolding model called Introduction, Connect, Apply, Reflect, and Extend (ICARE) in e-learning for nursing education. The second is a reflection on the use of engagement strategies for the purposes of discourse and learning in a different online nursing context.Because nursing educators were among the early adopters of e-learning, they are important mentors to others who are adopting e-learning strategies at this time. Additionally, the paper is a crossroads publication: it reminds the reader of the imperative to review theory and emerging evidence related to e-learning and to bring key findings to the actual practice of e-learning in order to benefit the adult student. This commitment to theory and practice will enable the evolution of e-learning for all learners, including returning adult learners and working professionals.Keywords: scaffolding, instructional design, interaction, best practices, engage- ment, adult education, working profes- sionals, e-learning. 

The relationship between physician participation in continuing professional development programs and physician in-practice peer assessments

PURPOSE

To investigate the relationship between physicians' performance, as evaluated through in-practice peer assessments, and their participation in continuing professional development (CPD).

METHOD

The authors examined the predictive effects of participating in the CPD programs of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada one year before in-practice peer assessments conducted by the medical regulatory authority in Ontario, Canada, in 2008-2009. Two multivariate logistic regression models were used to determine whether physicians who reported participating in any CPD and group-based, assessment-based, and/or self-directed CPD activities were more or less likely to receive satisfactory assessments than physicians who had not. All models were adjusted for the effects of sex, age, specialty certification, practice location, number of patient visits per week, hours worked per week, and international medical graduate status.

RESULTS

A total of 617 physicians were included in the study. Analysis revealed that physicians who reported participating in any CPD activities were significantly more likely (odds ratio [OR] = 2.5; P = .021) to have satisfactory assessments than those who had not. In addition, physicians participating in group-based CPD activities were more likely to have satisfactory assessments than those who did not (OR = 2.4; P = .016).

CONCLUSIONS

There is encouraging evidence supporting a positive predictive association between participating in CPD and performance on in-practice peer assessments. The findings have potential implications for policies which require physicians to participate in programs of lifelong learning.

Vertebral fracture assessment (VFA) by lateral DXA scanning may be cost-effective when used as part of fracture liaison services or primary care screening

SUMMARY

We identified that use of VFA may be cost-effective in either selected women from primary care or women attending after a low trauma fracture.

INTRODUCTION

Lateral DXA scanning of the spine for vertebral fracture assessment (VFA) is used for research, but its wider role is unclear. We aimed to establish whether VFA is cost-effective in women based on two different scenarios: following a low-trauma fracture, and after screening of high-risk women identified in primary care.

METHODS

The fracture cohort (FC) consisted of 377 women and the primary care cohort (PCC) of 251. Vertebral fractures were identified on VFA images by quantitative morphometry (QM). Outcome was cost-effectiveness of VFA, based on predicted change in clinical management defined as the identification of a vertebral fracture in a patient who otherwise falls below the threshold for treatment. FRAX treatment thresholds assessed were (1) 20/3 % thresholds and (2) National Osteoporosis Guidelines Group (NOGG) thresholds.

RESULTS

As a result, 9.8 % from FC and 13.9 % from PCC were identified with vertebral fractures. Management was changed in 21 to 22/377 (5.6-5.8 %) in FC and 12 to 26/251 (4.8-10.4 %) from PCC depending on which thresholds were used. Sensitivity analyses identified medication adherence as the assumption which most influenced the model. The best-estimate cost-per-QALY for use of VFA in FC was £3,243 for 20/3 threshold and £2,130 for NOGG; for PCC, this was £7,831 for 20/3 and was cost-saving for NOGG. Further analyses to adjust for potential false-positive vertebral fracture identification with QM showed VFA was no longer cost-effective.

CONCLUSION

VFA appears to be cost-effective in routine clinical practise, particularly when relatively inaccurate methods of identification of vertebral fractures are used such as QM.

Towards equitable commissioning for our multiethnic society: a mixed-methods qualitative investigation of evidence utilisation by strategic commissioners and public health managers

Background

The health-care commissioning cycle is an increasingly powerful determinant of the health services on offer and the care that patients receive. This study focuses on the mobilisation and use of evidence relating to ethnic diversity and inequality.

Objective

To describe the patterns and determinants of evidence use relating to ethnic diversity and inequality by managers within commissioning work and to identify promising routes for improvement.

Methods

In-depth semistructured interviews with 19 national key informants and documentation of good practice across England. Detailed case studies of three primary care trusts involving 70+ interviews with key strategic and operational actors, extensive observational work and detailed analysis of related documentation. A suite of commissioning resources based on findings across all elements were tested and refined through three national workshops of key stakeholders.

Results

Commissioners often lack clarity on how to access, appraise, weight or synthesise diverse sources of evidence and can limit the transformational shaping of services by a narrow conceptualisation of their role. Attention to evidence on ethnic diversity and inequality is frequently omitted at both national and local levels. Understanding of its importance is problematic and there are gaps in this evidence that create further barriers to its use within the commissioning cycle. Commissioning models provide no reward or sanction for inclusion or omission of evidence on ethnicity and commissioning teams or partners are not representative of minority ethnic populations. Neglect of this dimension within national drivers results in low demand for evidence. This organisational context can promote risk-averse attitudes that maintain the status quo. Pockets of good practice exist but they are largely dependent on individual expertise and commitment and are often not shared. Study findings suggested the need for action at three levels: creating an enabling environment; equipping health-care commissioners; and empowering wider stakeholders. Key enabling factors would be attention to ethnicity within policy drivers; senior-level commitment and resource; a diverse workforce; collaborative partnerships with relevant stakeholders; and the creation of local, regional and national infrastructure.

Limitations

It was harder to identify enablers of effective use of evidence in this area than barriers. Including a case study of an organisation that had achieved greater mainstreaming of the ethnic diversity agenda might have added to our understanding of enabling factors. The study was conducted during a period of fundamental restructuring of NHS commissioning structures. This caused some difficulties in gathering data and it is possible that widespread change and uncertainty may have produced more negative narratives from participants than would otherwise have been the case.

Conclusions

Knowledge mobilisation and utilisation within the commissioning cycle occurs in the context of dynamic interactions between individual agency, organisational context and the wider health-care setting, situated within the UK sociopolitical milieu. Our findings highlight isolated pockets of good practice amidst a general picture of limited organisational engagement, low priority and inadequate skills. Findings indicate the need for specific guidance alongside incentives and resources to support commissioning for a multiethnic population. A more comprehensive infrastructure and, most importantly, greater political will is needed to promote practice that focuses on reducing ethnic health inequalities at all stages of the commissioning cycle.

Funding

The National Institute for Health Research Health Services and Delivery Research programme.

Towards generalised reference condition models for environmental assessment: a case study on rivers in Atlantic Canada

Evaluation of the ecological status of river sites in Canada is supported by building models using the reference condition approach. However, geography, data scarcity and inter-operability constraints have frustrated attempts to monitor national-scale status and trends. This issue is particularly true in Atlantic Canada, where no ecological assessment system is currently available. Here, we present a reference condition model based on the River Invertebrate Prediction and Classification System approach with regional-scale applicability. To achieve this, we used biological monitoring data collected from wadeable streams across Atlantic Canada together with freely available, nationally consistent geographic information system (GIS) environmental data layers. For the first time, we demonstrated that it is possible to use data generated from different studies, even when collected using different sampling methods, to generate a robust predictive model. This model was successfully generated and tested using GIS-based rather than local habitat variables and showed improved performance when compared to a null model. In addition, ecological quality ratio data derived from the model responded to observed stressors in a test dataset. Implications for future large-scale implementation of river biomonitoring using a standardised approach with global application are presented.

Evaluating the effectiveness of a clinical tracking system for undergraduate nursing students

AIM

This study evaluated one commercially available clinical tracking system to determine its appropriateness for use within a school of nursing.

BACKGROUND

Collecting documentation during undergraduate clinical experiences (e.g., type of patient care experience, diagnosis, skills completed, competencies met) is a challenging undertaking for students and faculty. Little research has been conducted to evaluate the effectiveness of clinical tracking systems.

METHOD

A convenience sample of students and faculty completed an end-of-course survey that measured their satisfaction with the clinical tracking system.

RESULTS

Statistically significant (p < .05) differences were found between students and faculty in several areas: utility, technical issues, capacity to identify regulatory body achieved competencies, and usefulness of records generated.There was also a statistically significant (p < .01) difference in overall satisfaction, with faculty much more satisfied with the system than students.

CONCLUSION

The clinical tracking system was found by faculty and students to be user friendly. Faculty overall were more satisfied with the system than students.

Highly Relevant Mentoring (HRM) as a Faculty Development Model for Web-Based Instruction / Highly Relevant Mentoring (HRM) (mentorat haute efficacité), un modèle de formation du corps professoral à l’enseignement en réseau

This paper describes a faculty development model called the highly relevant mentoring (HRM) model; the model includes a framework as well as some practical strategies for meeting the professional development needs of faculty who teach web-based courses. The paper further emphasizes the need for faculty and administrative buy-in for HRM and examines relevant theories that may be used to guide HRM in web-based teaching environments. Of note is that HRM was conceived by the instructional design staff who contributed to this paper before the concept of high impact mentoring appeared in the recent literature (2009). While the model is appropriate in various disciplines and professions, the examples and scenarios provided are drawn from a Canadian university’s experience of using HRM, in conjunction with a pedagogical approach called ICARE, in a variety of nursing courses and programs. Cet article décrit un modèle de formation du personnel enseignant intitulé « highly relevant mentoring (HRM) » (mentorat haute efficacité); ce modèle comprend une structure et des stratégies pratiques visant à combler les besoins en formation du corps professoral d’une faculté offrant des cours en réseau. L’article souligne la nécessité d’un appui facultaire et administratif au HRM et étudie les théories pertinentes pouvant servir à guider le HRM dans des milieux d’enseignement en réseau. On notera que le HRM a été conçu par l’équipe de conception de matériel pédagogique qui a contribué à cet article avant l’apparition, dans les publications récentes (2009), du concept de « high impact mentoring » (mentorat à haut rendement). Bien que ce dernier modèle convienne à diverses disciplines et professions, les exemples et les scénarios fournis ici sont tirés de l’expérience d’utilisation du HRM dans une université canadienne, conjointement à une approche pédagogique appelée ICARE, dans une variété de cours et de programmes de sciences infirmières.

GSK-3beta and control of glucose metabolism and insulin action in human skeletal muscle

The involvement of the beta-isoform of glycogen synthase kinase (GSK-3) in glucose metabolism and insulin action was investigated in cultured human skeletal muscle cells. A 60% reduction in GSK-3beta protein expression was attained by treatment with siRNA; GSK-3alpha expression was unaltered. GSK-3beta knockdown did not influence total glycogen synthase (GS) activity, but increased the phosphorylation-dependent activity (fractional velocity-FV) in the basal state. Insulin responsiveness of GSFV was doubled by GSK-3beta knockdown (p<0.05). Basal rates of glucose uptake (GU) were not significantly influenced by GSK-3beta knockdown, while insulin stimulation of GU was increased. Improvements in insulin action on GS and GU did not involve changes in protein expression of either IRS-1 or Akt 1/2. Maximal insulin stimulation of phosphorylation of Akt was unaltered by GSK-3beta knockdown. Unlike GSK-3alpha, GSK-3beta directly regulates both GS activity in the absence of added insulin and through control of insulin action.