Perceptions of Service Climate in a Canadian healthcare system.

Perceptions of Service Climate in healthcare organizations are important because of their linkages to patient and organizational outcomes. This article presents findings from survey data collected from frontline nurses (n = 275) in Canada who were working in a provincial healthcare system that had recently undergone significant structural changes. The findings indicate that frontline nurses held a neutral view of the Service Climate overall but a strong and negative perception of Managerial Service Practices. The results suggest that some service practices existed in nurses' working environments; however, improvements could be made in the areas of recognizing and rewarding those who consistently provide high levels of quality service. This has implications for not only continuous quality improvement but also for the patient and staff experience in healthcare.

Congruence couple therapy for alcohol use and gambling disorders with comorbidities (part I): Outcomes from a randomized controlled trial.

A nonblinded randomized trial was conducted at two Canadian provincial outpatient addiction clinics that tested the effectiveness of a systemic congruence couple therapy (CCT) versus individual-based treatment-as-usual (TAU) on nine clinical outcomes: (1) primary outcomes-alcohol use and gambling, psychiatric symptoms, and couple adjustment; (2) secondary outcomes-emotion regulation, substance use, depression, post-traumatic stress symptoms, and life stress. Data of primary clients and partners (N = 46) were analyzed longitudinally across baseline, posttreatment (5 months), and follow-up (8 months). Alcohol use disorder (95%) and gambling disorder (5%) were in the severe range at baseline, and co-addiction was 27%. Psychiatric comorbidity was 100%, and 18% of couples were jointly addicted. Between-group comparison favored CCT in primary outcomes with medium-to-large effect sizes (Cohen's h = 0.74-1.44). Secondary outcomes were also significantly stronger for CCT (Cohen's h = 0.27-1.53). Within-group, for all primary outcomes, a significant proportion of symptomatic CCT clients and partners improved, converging with ANOVA results of large effect sizes (0.14-0.29). All secondary outcomes improved significantly in CCT with large effect sizes (0.14-0.50). TAU showed significant within-group improvement in alcohol use, other substance use, and life stress with large effect sizes (0.16-0.40). Primary clients and partners made largely equivalent improvement within CCT and within TAU. Results were triangulated with clients' satisfaction ratings and counselors' reports. Overall, significant within-group effects were detected for CCT both clinically and statistically and between-group difference favored CCT. Future trials are required to validate these promising findings.

The Effects of Perceived Gambling Availability on Problem Gambling Severity.

The aim of this study was to determine the moderating effects of sociodemographic characteristics, substance use, and psychosocial problems on the relationship between perceived gambling availability and problem gambling severity. Bivariate and multivariate regression analyses of the 2008 and 2009 Social and Economic Impacts of Gambling in Alberta surveys found problem gambling severity was 1.25-1.39 times higher for those reporting gambling opportunities were 'too widely available'. Factors such as age, gender, place of residence, and psychosocial problems had significant moderating effects. Our findings indicate that the perception of gambling availability has a statistically significant impact on problem gambling severity.

A pilot study exploring the relationship between the use of mobile technologies, walking distance, and clinical decision making among rural hospital nurses.

Providing evidence-based information at the point of care for time-poor nurses may lead to better clinical care and patient outcomes. Smartphone applications (apps) have the advantage of providing immediate access to information potentially increasing time spent with patients. This small-scale pre-post survey study explored the impact a smartphone app had on the distance nurses walked and their perceived clinical decision-making ability. A total of 20 nurses working in a rural hospital medical/surgical unit participated. The findings suggest that the use of the smartphone app did not decrease nurses' walking distance. Nor did using the app enhances nurses' perception of their clinical decision-making ability. However, there was a statistically significant increase in confidence in the app over time (F(1,16) = 5.416, p = 0.033, partial η2 = 0.253), suggesting that providing training opportunities including time to learn how to use smartphone applications has the potential to enhance nurses work.

Development and validation of the Moral Distress in Dementia Care Survey instrument.

AIMS: To report on the development and validation of the Moral Distress in Dementia Care Survey instrument. BACKGROUND: Despite growing awareness of moral distress among nurses, little is known about the moral distress experiences of nursing staff in dementia care settings. To address this gap, our research team developed a tool for measuring the frequency, severity and effects of moral distress in nursing staff working in dementia care. DESIGN: The research team employed an exploratory sequential mixed method design to generate items for the moral distress questionnaire. Data were collected between January 2013 - June 2014. In this paper, we report on the development and validation of the Moral Distress in Dementia Care Survey instrument. METHODS: The Moral Distress in Dementia Care Survey instrument was piloted with a portion of the target population prior to a broader implementation. Appropriate statistical analyses and psychometric testing were completed. RESULTS: The team collected 389 completed surveys from registered nurses, licensed practical nurses and healthcare aides, representing a 43.6% response rate across 23 sites. The Moral Distress in Dementia Care Survey emerged as a reliable and valid instrument to measure the frequency, severity and effects of moral distress for nursing staff in dementia care settings. The relative value of the Moral Distress in Dementia Care Survey as a measurement instrument was superseded by its clinical relevance for dementia care staff. CONCLUSION: The Moral Distress in Dementia Care Survey is a potentially useful tool for estimating the frequency, severity and effects of moral distress in nursing staff working in dementia care settings and for the evaluation of measures taken to mitigate moral distress.

Caring in the wake of the rising tide: Moral distress in residential nursing care of people living with dementia.

Objective Moral distress is increasingly being recognized as a concern for health care professionals. The purpose of this study was to explore the nature and prevalence of moral distress among nursing staff who care for people living with dementia. Methods This study was focused on nursing staff caring for people with dementia in long-term care and assisted living sites. The Moral Distress in Dementia Care Survey instrument was distributed to 23 sites and nursing staff rated the frequency and severity of situations that were identified as potentially causing moral distress. Results Moral distress is prevalent in the nursing staff who provide dementia care. Nursing staff reported experiencing moral distress at least daily or weekly. Both frequency and severity of moral distress increased with proximity to (amount of time spent at) the bedside. Moral distress had negative psychological and physiological effects on nursing staff, and affected intention to quit.

Disconnects in pedagogy and practice in community health nursing clinical experiences: Qualitative findings of a mixed method study.

BACKGROUND: Many baccalaureate schools of nursing are using non-traditional placements for undergraduate community health clinical rotations. These placements occur at agencies not organizationally affiliated with the health care system and they typically do not employ registered nurses (RNs). OBJECTIVES AND DESIGN: In this paper, we describe the qualitative findings of a mixed method study that explored these gaps as they relate to pre-registration nursing students' preparation for community health roles. RESULTS: While non-traditional community health placements offer unique opportunities for learning through carefully crafted service learning pedagogy, these placements also present challenges for student preparation for practice in community health roles. The theory-practice gap and the gap between the expected and actual performance of new graduates are accentuated through the use of non-traditional community clinical experiences. These gaps are not necessarily due to poor pedagogy, but rather due to the perceptions and values of the stakeholders involved: nursing students, community health nursing faculty, and community health nurses. CONCLUSIONS: New ways must be developed between academe and community health practice areas to provide students with opportunities to develop competence for practice.

Congruence Couple Therapy for Pathological Gambling: A Pilot Randomized Controlled Trial.

A multi-site pilot randomized controlled trial of Congruence Couple Therapy (CCT) for problem gambling was conducted in Ontario and Alberta, Canada from 2009 to 2011. The purpose was to assess the feasibility of a full trial and to identify methodological modifications to enhance future trials. The sample (N = 30; 15 couples) consisted of 66% male gamblers and 34% female. Mean age of sample was 49.1 years. Baseline mean DSM-IV gambling score was 8.7/10. Retention of the treatment couples was 89% at 2-month follow-up. Retention of control couples was 78%. A randomized controlled design compared the status of couples in treatment condition to control condition. Treatment couples received 12-week CCT while control couples received three brief check-ins over 12 weeks. No significant difference was found between treatment and control group at baseline on all measures. At (1) week 12 post-treatment, and (2) week 20 follow-up, significant treatment effects were found for gambling symptoms (p = 0.008; p = 0.041), mental distress (p = 0.001; p = 0.035), and family systems function (p = 0.023; p = 0.054) between treatment and control group. Within group changes for treatment couples over time were significant for mental distress (p = 0.000), dyadic adjustment (p = 0.002), and family systems function (p = 0.000). On similar measures, control group showed non-significant improvement. Future methodological changes, advantages and disadvantages of multi-site partnerships with community treatment agencies are discussed. Of interest is that control participants showed unintended improvement. CCT as a treatment was favourably accepted by counselors, problem gamblers and their spouses. Positive outcome trends ranging from small to large effect size on key measures indicate that a full-scaled trial will require approximately 140 couples and is an investment worth pursuing.

Competence and competency-based nursing education: finding our way through the issues.

The language of competence is widely utilized in both the regulation of nursing practice and curricular design in nursing education. The notion of competence defines what it means to be a professional, although it is not the only way of describing nursing practice. Unfortunately, there is much confusion about the concepts of competence, competency, and competency-based education. As well, the notion of competence, despite its global popularity, has flaws. In this paper we will disentangle these terms and critique the use of competence frameworks in nursing education.

Evaluation of undergraduate nursing students' attitudes towards statistics courses, before and after a course in applied statistics.

BACKGROUND: Undergraduate nursing students must often take a course in statistics, yet there is scant research to inform teaching pedagogy. OBJECTIVES: The objectives of this study were to assess nursing students' overall attitudes towards statistics courses - including (among other things) overall fear and anxiety, preferred learning and teaching styles, and the perceived utility and benefit of taking a statistics course - before and after taking a mandatory course in applied statistics. DESIGN AND METHOD: The authors used a pre-experimental research design (a one-group pre-test/post-test research design), by administering a survey to nursing students at the beginning and end of the course. SETTING: The study was conducted at a University in Western Canada that offers an undergraduate Bachelor of Nursing degree. PARTICIPANTS: Participants included 104 nursing students, in the third year of a four-year nursing program, taking a course in statistics. RESULTS: Although students only reported moderate anxiety towards statistics, student anxiety about statistics had dropped by approximately 40% by the end of the course. Students also reported a considerable and positive change in their attitudes towards learning in groups by the end of the course, a potential reflection of the team-based learning that was used. Students identified preferred learning and teaching approaches, including the use of real-life examples, visual teaching aids, clear explanations, timely feedback, and a well-paced course. Students also identified preferred instructor characteristics, such as patience, approachability, in-depth knowledge of statistics, and a sense of humor. Unfortunately, students only indicated moderate agreement with the idea that statistics would be useful and relevant to their careers, even by the end of the course. CONCLUSIONS: Our findings validate anecdotal reports on statistics teaching pedagogy, although more research is clearly needed, particularly on how to increase students' perceptions of the benefit and utility of statistics courses for their nursing careers.