A nurturing and caring environment to facilitate nursing students' professional development in Rwanda: a focused ethnographic study.

OBJECTIVES: To explore the values, practices, and behaviours that support nursing students' professional development in practice-based learning environments in Rwanda. METHODS: A focused ethnographic approach was used. Nursing students (n=12), nurses (n=11), clinical instructors (n=7) and nurse leaders (n=8) from three teaching hospitals and an educational program participated in the study. Data was collected trough individual interviews and participant observation. RESULTS: Participants embraced a culture of preparing nursing students for their professional roles as a professional responsibility, and a means of securing the nursing profession. Modeling the appropriate behaviours to students and respecting them as learners and humans constituted the caring attributes that sustain a positive learning environment for their professional growth. CONCLUSIONS: Nurturing and caring environments offer students opportunities to integrate caring attitudes into their interactions with patients and to develop professionally. IMPLICATIONS FOR INTERNATIONAL AUDIENCE: Findings underscore the need to enhance caring values within nursing curricula.

Youth Homelessness: The Impact of Supportive Relationships on Recovery.

Background Homeless youth are the fastest growing sub-group within the homeless population. They face impaired access to health services and are often left unsupported. They lack social and family support or relationships with service providers. Unsupported homeless youth often become homeless adults. Purpose To test a model based on Peplau's Theory of Interpersonal Relations, examining the influence of a network of service providers, perceptions of social supports, and family relations on a homeless youth's perceptions of recovery. Methods This study is a secondary analysis and used a sample (n = 187) of data collected as part of the original Youth Matters in London study. A cross-sectional design was used to analyze the relationship between variables. Participants were interviewed at 6-month intervals over a 2.5-year period. Hierarchical multiple regression analysis was used. Results Network of service providers, perceived social supports, and perceived family relations explained 21.8% of the variance in homeless youth perceptions of recovery. Perceived social support and family relations were significantly, positively correlated to perceptions of recovery. Network of service providers was not significantly correlated to perceptions of recovery. Conclusions The findings suggest that stronger social supports and family relations may contribute to increased perceptions of recovery among homeless youth.

Starting Out: qualitative perspectives of new graduate nurses and nurse leaders on transition to practice.

AIM: To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles. BACKGROUND: Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services. METHOD: A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces. RESULTS: New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads. CONCLUSIONS: The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility.

Moving towards a new vision: implementation of a public health policy intervention.

BACKGROUND: Public health systems in Canada have undergone significant policy renewal over the last decade in response to threats to the public's health, such as severe acute respiratory syndrome. There is limited research on how public health policies have been implemented or what has influenced their implementation. This paper explores policy implementation in two exemplar public health programs -chronic disease prevention and sexually-transmitted infection prevention - in Ontario, Canada. It examines public health service providers', managers' and senior managements' perspectives on the process of implementation of the Ontario Public Health Standards 2008 and factors influencing implementation. METHODS: Public health staff from six health units representing rural, remote, large and small urban settings were included. We conducted 21 focus groups and 18 interviews between 2010 (manager and staff focus groups) and 2011 (senior management interviews) involving 133 participants. Research assistants coded transcripts and researchers reviewed these; the research team discussed and resolved discrepancies. To facilitate a breadth of perspectives, several team members helped interpret the findings. An integrated knowledge translation approach was used, reflected by the inclusion of academics as well as decision-makers on the team and as co-authors. RESULTS: Front line service providers often were unaware of the new policies but managers and senior management incorporated them in operational and program planning. Some participants were involved in policy development or provided feedback prior to their launch. Implementation was influenced by many factors that aligned with Greenhalgh and colleagues' empirically-based Diffusion of Innovations in Service Organizations Framework. Factors and related components that were most clearly linked to the OPHS policy implementation were: attributes of the innovation itself; adoption by individuals; diffusion and dissemination; the outer context - interorganizational networks and collaboration; the inner setting - implementation processes and routinization; and, linkage at the design and implementation stage. CONCLUSIONS: Multiple factors influenced public health policy implementation. Results provide empirical support for components of Greenhalgh et al's framework and suggest two additional components - the role of external organizational collaborations and partnerships as well as planning processes in influencing implementation. These are important to consider by government and public health organizations when promoting new or revised public health policies as they evolve over time. A successful policy implementation process in Ontario has helped to move public health towards the new vision.

Identifying the most important outcomes for systematic reviews of interventions for rhinosinusitis in adults: working with Patients, Public and Practitioners.

INTRODUCTION: Promoting the assessment of health interventions using outcomes that matter to patients and practitioners is a key principle of Cochrane. Cochrane UK therefore commissioned the OMIPP project: Outcomes that are Most Important for Patients, Public and Practitioners to identify the outcomes they felt most important and should be evaluated in Cochrane reviews of health interventions for Chronic Rhinosinusitis (CRS). METHODOLOGY: Using direct emailing, social media and printed cards, an online survey was distributed to a wide range of people involved in the care of patients with CRS. Patients and practitioners were asked to list the 3 outcomes from treatments most important to them. Responses were analysed through development of a thematic framework based on the data. RESULTS: Two hundred and thirty-five people completed the survey; 155 practitioners and 80 patients. Respondents provided 653 suggestions of important outcomes. 73% concerned symptoms of CRS, (nasal discharge or drip, facial pain, nasal blockage, headache, impaired sense of smell, congestion and breathing difficulties); 9% concerned quality of life, 4% reducing the need for further treatment and 4% side effects of treatment. Objective measurements of disease formed only 3% of responses. There was high level of agreement between patients and practitioners. Of 10 current Cochrane reviews on CRS, 9 include symptomatic outcomes identified by our survey as most important to patients and healthcare practitioners. CONCLUSIONS: We have identified outcomes that both patients and their doctors consider should be included in reviews evaluating treatments of rhinosinusitis. We recommend that primary outcomes in future reviews focus on symptom-based outcomes. The ability to extract these data from relevant trials is dependent upon their inclusion in trials, and so it is important that building on this work a core outcome set for rhinosinusitis research is developed.

The influence of empowerment, authentic leadership, and professional practice environments on nurses' perceived interprofessional collaboration.

AIM: The aim of this study was to examine the influence of structural empowerment, authentic leadership and professional nursing practice environments on experienced nurses' perceptions of interprofessional collaboration. BACKGROUND: Enhanced interprofessional collaboration (IPC) is seen as one means of transforming the health-care system and addressing concerns about shortages of health-care workers. Organizational supports and resources are suggested as key to promoting IPC. METHODS: A predictive non-experimental design was used to test the effects of structural empowerment, authentic leadership and professional nursing practice environments on perceived interprofessional collaboration. A random sample of experienced registered nurses (n = 220) in Ontario, Canada completed a mailed questionnaire. Hierarchical multiple regression analysis was used. RESULTS: Higher perceived structural empowerment, authentic leadership, and professional practice environments explained 45% of the variance in perceived IPC (Adj. R² = 0.452, F = 59.40, P < 0.001). CONCLUSIONS: Results suggest that structural empowerment, authentic leadership and a professional nursing practice environment may enhance IPC. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse leaders who ensure access to resources such as knowledge of IPC, embody authenticity and build trust among nurses, and support the presence of a professional nursing practice environment can contribute to enhanced IPC.

Heterosexual female adolescents' decision-making about sexual intercourse and pregnancy in rural Ontario, Canada.

INTRODUCTION: Rural female adolescents experience unique circumstances to sexual health care and information as compared to urban adolescents. These circumstances are largely due to their more isolated geographical location and rural sociocultural factors. These circumstances may be contributing factors to an incidence of adolescent pregnancy that is higher in rural areas than in urban cities. Thus, this higher incidence of pregnancy may be due to the ways in which rural adolescents make decisions regarding engagement in sexual intercourse. However, the rural female adolescent sexual decision-making process has rarely, if ever, been studied, and further investigation of this process is necessary. Focusing on rural female adolescents aged 16-19 years is especially significant as this age range is used for reporting most pregnancy and birth statistics in Ontario. METHODS: Charmaz's guidelines for a constructivist grounded theory methodology were used to gain an in-depth understanding of eight Ontario rural female adolescents' decision-making process regarding sexual intercourse and pregnancy, and how they viewed rural factors and circumstances influencing this process. Research participants were obtained through initial sampling (from criteria developed prior to the study) and theoretical sampling (by collecting data that better inform the categories emerging from the data). Eight participants, aged 16-19 years, were invited to each take part in 1-2-hour individual interviews, and four of these participants were interviewed a second time to verify and elaborate on emerging constructed concepts, conceptual relationships, and the developing process. Data collection and analysis included both field notes and individual interviews in person and over the telephone. Data were analyzed for emerging themes to construct a theory to understand the participants' experiences making sexual decisions in a rural environment. RESULTS: The adolescent sexual decision-making process, Prioritizing Influences, that emerged from the analysis was a complex and non-linear process that involved prioritizing four influences within the rural context. The influences that participants of this study described as being part of their sexual decision-making process were personal values and circumstances, family values and expectations, friends' influences, and community influences. When influences coincided, they strengthened participants' sexual decisions, whereas when influences opposed each other, participants felt conflicted and prioritized the influence that had the most effect on their personal lives and future goals. Although these influences may be common to all adolescents, they impact the rural female adolescent sexual decision-making process by influencing and being influenced by geographical and sociocultural factors that make up the rural context. CONCLUSIONS: This study reveals important new and preliminary information about rural female adolescents' sexual decision-making process and factors that affect it. Findings improve understanding of how rural female adolescents make choices regarding sexual intercourse and pregnancy and can be used to guide future research projects that could facilitate effective development of sexual health promotion initiatives, inform rural health policy and practices, and enhance existing sexual education programs in rural communities.

Legislating interprofessional collaboration: A policy analysis of health professions regulatory legislation in Ontario, Canada.

Changes to Ontario's health professions regulatory system were initiated through various legislative amendments. These amendments introduced a legislative obligation for health regulatory colleges to support interprofessional collaboration (IPC), collaborate where they share controlled acts, and incorporate IPC into their quality assurance programs. The purpose of this policy analysis was to identify activities, strategies, and collaborations taking place within health professions regulatory colleges pertaining to legislative changes related to IPC. A qualitative content analysis of (1) college documents pertaining to IPC (n = 355) and (2) interviews with representatives from 14 colleges. Three themes were identified: ideal versus reality; barriers to the ideal; and legislating IPC. Commitment to the ideal of IPC was evident in college documents and interviews. Colleges expressed concern about the lack of clarity regarding the intent of legislation. In addition, barriers stemming from long-standing issues in practice including scope of practice protection, conflicting legislation, and lack of knowledge about the roles of other health professionals impede IPC. Government legislation and health professional regulation have important roles in supporting IPC; however, broader collaboration may be required to achieve policy objectives.

Primary health care service use among women who have recently left an abusive partner: income and racialization, unmet need, fits of services, and health.

Primary health care (PHC) can improve the health of women who have experienced intimate partner violence; yet, access to and fit of PHC services may be shaped by income and racialization. We examined whether income and racialization were associated with differences in PHC service use, unmet needs, fit with needs, and mental and physical health in a sample of 286 women who had separated from an abusive partner. Mothers, unemployed women, and those with lower incomes used more PHC services and reported a poorer fit of services. Poorer fit of services was related to poorer mental and physical health.

The influence of empowerment and incivility on the mental health of new graduate nurses.

AIM: To test a model based on Kanter's theory of structural empowerment, which examines the relationships between new graduate nurses' perceptions of structural empowerment, workplace incivility and mental health symptoms. BACKGROUND: The initial years of practice can be particularly stressful for new graduate nurses, who may be particularly vulnerable to uncivil behaviour as a result of their status in the work environment. Disempowerment and incivility in the workplace may compound the mental health symptoms experienced by new graduate nurses. METHOD: A predictive, non-experimental design was used to examine the relationship between structural empowerment, workplace incivility and mental health symptoms in a sample of new graduate nurses working in hospital settings in Ontario (n = 394). RESULT: High levels of structural empowerment were significantly associated with fewer negative mental health symptoms in new graduates. However, co-worker incivility and supervisor incivility partially mediated the effect of structural empowerment on new graduate nurses' mental health symptoms. CONCLUSION: The findings suggest that empowering workplaces contribute to lower mental health symptoms in new graduate nurses, an effect that is diminished by incivility. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies that foster empowering work conditions and reduce uncivil behaviour are needed to promote positive mental health in new graduate nurses.

The influence of personal and workplace resources on new graduate nurses' job satisfaction.

AIMS: This study examined the influence of new graduate nurses' personal resources (psychological capital) and access to structural resources (empowerment and staffing) on their job satisfaction. BACKGROUND: Reports suggest that new graduate nurses are experiencing stressful work environments, low job satisfaction, and high turnover intentions. These nurses are a health human resource that must be retained for the replacement of retiring nurses, and to address impending shortages. Supportive workplaces that promote new graduate nurses' job satisfaction may play an important role in the retention of new nurses. METHODS: A secondary analysis of data from a larger study of new graduate nurses was conducted. Data collection was completed using self-reported questionnaires. Hierarchical multiple regression was used to test the hypothesised model. RESULTS: Psychological capital, structural empowerment and perceived staffing adequacy were significant independent predictors of job satisfaction. The final model explained 38% of the variance in job satisfaction. CONCLUSIONS: Both personal and structural workplace factors are important to new graduate nurses' job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Managers should ensure empowerment structures are in place to support new graduate nurses' job satisfaction. Orientation processes and ongoing management support to build psychological capital in new graduate nurses will help create positive perceptions of the workplace, enhancing job satisfaction.

Public health human resources: a comparative analysis of policy documents in two Canadian provinces.

BACKGROUND: Amidst concerns regarding the capacity of the public health system to respond rapidly and appropriately to threats such as pandemics and terrorism, along with changing population health needs, governments have focused on strengthening public health systems. A key factor in a robust public health system is its workforce. As part of a nationally funded study of public health renewal in Canada, a policy analysis was conducted to compare public health human resources-relevant documents in two Canadian provinces, British Columbia (BC) and Ontario (ON), as they each implement public health renewal activities. METHODS: A content analysis of policy and planning documents from government and public health-related organizations was conducted by a research team comprised of academics and government decision-makers. Documents published between 2003 and 2011 were accessed (BC = 27; ON = 20); documents were either publicly available or internal to government and excerpted with permission. Documentary texts were deductively coded using a coding template developed by the researchers based on key health human resources concepts derived from two national policy documents. RESULTS: Documents in both provinces highlighted the importance of public health human resources planning and policies; this was particularly evident in early post-SARS documents. Key thematic areas of public health human resources identified were: education, training, and competencies; capacity; supply; intersectoral collaboration; leadership; public health planning context; and priority populations. Policy documents in both provinces discussed the importance of an educated, competent public health workforce with the appropriate skills and competencies for the effective and efficient delivery of public health services. CONCLUSION: This policy analysis identified progressive work on public health human resources policy and planning with early documents providing an inventory of issues to be addressed and later documents providing evidence of beginning policy development and implementation. While many similarities exist between the provinces, the context distinctive to each province has influenced and shaped how they have focused their public health human resources policies.

Using an integrated knowledge translation approach to build a public health research agenda.

BACKGROUND: Public Health Systems Research is an emerging field of research that is gaining importance in Canada. METHODS: On October 22 and 23, 2012, public health researchers, practitioners, and policy-makers came together at the Accelerating Public Health Systems Research in Ontario: Building an Agenda think tank to develop a research agenda for the province. RESULTS: This agenda included the identification of the six top priorities for research in Ontario: public health performance, evidence-based practice, public health organization and structure, public health human resources, public health infrastructure, and partnerships/linkages. CONCLUSIONS: This paper explores the priorities in detail and hopes to bring more attention to this area of research.

Workplace incivility and new graduate nurses' mental health: the protective role of resiliency.

OBJECTIVE: The aim of this study was to examine the relationships between coworker, physician, and supervisor workplace incivility and new graduate nurses' mental health and the protective role of personal resiliency. BACKGROUND: Positive interpersonal relationships in healthcare work environments are important for new graduate nurses' career transition and commitment. Workplace incivility threatens new graduate nurses' health and well-being. Personal resiliency helps employees to recover from negative stressors and may protect new nurses from the negative effects of workplace incivility. METHODS: We surveyed 272 new graduate nurses in Ontario to explore the influence of 3 forms of workplace incivility and personal resiliency on new nurses' mental health. RESULTS: All sources of incivility were related to poor mental health. Results suggest that personal resiliency may protect nurses from the negative effects of incivility. CONCLUSIONS: New nurses are experiencing workplace incivility from a variety of sources in their work environments, which have detrimental effects on their workplace well-being.

A "Co-CREATES" framework to foster a positive learning environment for nursing students' professional development in Rwanda.

AIM: The future of the nursing profession in Rwanda in large part depends on the students who join the workforce and the education they have received. Preparing students with the necessary knowledge, values and judgement requires practice settings to be learner-centered. This study aimed at exploring strategies that might improve the current practice-based learning environment. DESIGN: A focused ethnographic approach was used. METHODS: Nursing students, staff nurses, clinical instructors and nurse leaders from three hospitals and an educational program participated in individual interviews. RESULTS: Five key areas of improvement emanated from study data: 1) strengthening institutional support; 2) improving school-hospital collaboration; 3) building the capacity of nurses and clinical instructors; 4) restructuring clinical placement; and 5) reviewing the current supervision model. Based on these findings a "Co-CREATES" framework grounded in the actions of collaboration, care, recognizing, empowering, actively engaging, transforming, enhancement and support was developed. The framework offers a collaborative approach that engages every stakeholder in "cocreating" conditions that build positive practice environments which are conducive to preparing students as professional nurses. CONCLUSION: The positive outcomes stemming from such a collaborative approach can further enhance a positive culture of collaboration in nursing education and practice.

Ready for what? An exploration of the meaning of new graduate nurses' readiness for practice.

Dialogue continues on the "readiness" of new graduates for practice despite significant advancements in the foundational educational preparation for nurses. In this paper, the findings from an exploratory study about the meaning of new graduate "readiness" for practice are reported. Data was collected during focus group interviews with one-hundred and fifty nurses and new graduates. Themes were generated using content analysis. Our findings point to agreement about the meaning of new graduate nurses' readiness for practice as having a generalist foundation and some job specific capabilities, providing safe client care, keeping up with the current realities of nursing practice, being well equipped with the tools needed to adapt to the future needs of clients, and possessing a balance of doing, knowing, and thinking. The findings from this exploratory study have implications for policies and programs targeted towards new graduate nurses entering practice.

Caring Near and Far by Connecting Community-Based Clients and Family Member/Friend Caregivers Using Passive Remote Monitoring: Protocol for a Pragmatic Randomized Controlled Trial.

BACKGROUND: Significant chronic disease challenges exist among older adults. However, most older adults want to remain at home even if their health conditions challenge their ability to live independently. Yet publicly funded home care resources are scarce, private home care is expensive, and family/friend caregivers have limited capacity. Many older adults with chronic illness would require institutional care without the support from family member/friend caregivers. This role raises the risk of physical health problems, stress, burnout, and depression. Passive remote monitoring (RM), the use of sensors that do not require any action by the individual for the system to work, may increase the older adult's ability to live independently while also providing support and peace of mind to both the client and the family member/friend caregiver. OBJECTIVE: This paper presents the protocol of a study conducted in two provinces in Canada to investigate the impact of RM along with usual home care (the intervention) versus usual home care alone (control) on older adults with complex care. The primary outcome for this study is the occurrence of and time to events such as trips to emergency, short-term admission to the hospital, terminal admission to the hospital awaiting admission to long-term care, and direct admission to long-term care. The secondary outcomes for this study are (1) health care costs, (2) client functional status and quality of life in the home, (3) family/friend caregiver stress, and (4) family/friend caregiver functional health status. METHODS: The design for this study is an unblinded pragmatic randomized controlled trial (PRCT) with two parallel arms in two geographic strata (Ontario and Nova Scotia). Quantitative and qualitative methodologies will be used to address the study objectives. This PRCT is conceptually informed by the principles of client-centered care and viewing the family as the client and aims at providing supported self-management. RESULTS: This study is supported by the Canadian Institutes for Health Research. A primary completion date is anticipated in fall 2022. CONCLUSIONS: Findings from this real-world rigorous randomized trial will support Canadian decision-makers, providers, and clients and their caregivers in assessing the health, well-being, and economic benefits and the social and technological challenges of integrating RM technologies to support older adults to stay in their home, including evaluating the impact on the burden of care experienced by family/friend caregivers. With an aging population, this technology may reduce institutionalization and promote safe and independent living for the elderly as long as possible. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Number (ISRCTN) 79884651; http://www.isrctn.com/ISRCTN79884651. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/15027.

Rare musculoskeletal diseases in adults: a research priority setting partnership with the James Lind Alliance.

BACKGROUND: Osteogenesis imperfecta, fibrous dysplasia/McCune-Albright syndrome and X-linked hypophosphatemia are three rare musculoskeletal diseases characterised by bone deformities, frequent fractures and pain. Little high-quality research exists on appropriate treatment and long-term management of these conditions in adults. This is further worsened by limited research funding in rare diseases and a general mismatch between the existing research priorities and those of the patients. This partnership adopted the James Lind Alliance approach to identify the top 10 research priorities for rare musculoskeletal diseases in adults through joint patient, carer and healthcare professional collaboration. RESULTS: The initial survey for question collection recruited 198 respondents, submitting a total of 988 questions. 77% of the respondents were patients with a rare musculoskeletal disease. Following out-of-scope question exclusion, repeating query grouping and scientific literature check for answers, 39 questions on treatment and long-term management remained. In the second public survey, 220 respondents, of whom 85% were patients with a rare musculoskeletal disease, their carers, relatives or friends, prioritised these uncertainties, which allowed selection of the top 25. In the last stage, patients, carers and healthcare professionals gathered for a priority setting workshop to reach a consensus on the final top 10 research priorities. These focus on the uncertainties surrounding appropriate treatment and holistic long-term disease management, highlighting several aspects indirect to abnormal bone metabolism, such as extra-skeletal symptoms, psychological care of both patients and their families and disease course through ageing. CONCLUSIONS: This James Lind Alliance priority setting partnership is the first to investigate rare bone diseases. The priorities identified here were developed jointly by patients, carers and healthcare professionals. We encourage researchers, funding bodies and other stakeholders to use these priorities in guiding future research for those affected by rare musculoskeletal disorders.

Patient perspectives on primary health care in rural communities: effects of geography on access, continuity and efficiency.

INTRODUCTION: Examining how to deliver primary health care (PHC) services and increase their accessibility (regardless of geographic location) from the patient's perspective is needed. We conducted seven focus groups with people (n = 50) living in rural communities, in British Columbia, Canada, as they reflected on priorities for and use of PHC. METHODS: In addition to discussing their priorities for PHC services, participants completed a brief questionnaire designed to collect information regarding socio-demographics, health status and utilization of primary healthcare providers. Descriptive statistics were obtained from questionnaire data. Focus group data were coded using an evaluation framework specifically developed for PHC; a thematic content analysis was then conducted on the coded data. RESULTS: In total, 80% of participants had been patients of the same provider for more than one year and had an average of two chronic conditions. Participants described the challenges posed by geographical location in terms of: (1) making tradeoffs; (2) management, information, and relationship continuity of care; and (3) efficiency with health care delivery. Additional out-of-pocket expenses were associated with traveling to regional centers for health services. Those living in rural communities, especially people needing additional health services to manage their health problems, made tradeoffs between their safety of having to travel during times of poor road conditions and having their healthcare needs met. CONCLUSION: Challenges to timely access to a regular healthcare provider, continuity of information and management of people's chronic disease conditions, and linkages to specialist services and diagnostic tests pose challenges for those living in rural communities. The geographic location of rural communities compounds the extent to which these people are able to access timely and continuous PHC.

Predicting Registered Nurses' Behavioural Intention to Use Electronic Documentation System in Home Care: Application of an Adapted Unified Theory of Acceptance and Use of Technology Model.

The use of electronic documentation systems (EDS) has the potential to ensure timely, up-to-date and comprehensive patient health-related information is available and accessible to nurses regardless of their physical location. Despite the benefits of EDS, nurses' low intention to use such systems is well documented, which may predict behavioural usage. Further, limited knowledge exists about nurses' intention to use EDS in the context of home care. The aim of the study was to examine factors that influence nurses' intention of using EDS in home care practice. The conceptual model framing this study is adapted from the Unified Theory of Acceptance and Use of Technology (UTAUT). A cross-sectional design was used. Nurses (N = 217) currently practicing within the home care sector in Ontario participated in the study. An online survey using adapted and psychometrically sound quantitative instruments was administered. Data were analyzed with descriptive statistics and hierarchical linear regression. Performance expectancy, attitude, social influence and facilitating conditions had significant, positive and direct effects on nurses' behavioural intention. Effort expectancy and nurses' individual characteristics (i.e., age, level of education and technology experience) were not found to have a direct and/or moderating influence on nurses' intention to use EDS in home care practice. Theory, practice and research implications for the findings are presented and discussed.