Creating a Dual Degree: Nursing Education Goes Global.

A global health human resource crisis has intensified the need for innovative education programs to maximize the supply of nurses worldwide. In response to the current and anticipated shortage of nurses globally, a novel collaborative undergraduate nursing program was developed at the University of New Brunswick in Fredericton, NB, and Manipal Academy of Higher Education in Karnataka, India. The resulting dual degree model is shaped by the contexts of the participating countries and current activities related to the international recruitment and migration of registered nurses. This partnership will increase program capacity and the potential number of graduates and will ease the immigration of internationally educated nurses.

Commentary: The Need for Baccalaureate Education Now More than Ever: Implications for the Role of Nurse Leaders.

Globally, healthcare systems have been pushed to the breaking point. The demands for public health and community-based care - traditionally underfunded - have escalated. Necessity expedited the use of technology for virtual care delivery within the Canadian healthcare system and in post-secondary education, overcoming years of resistance. Now, more than ever, transformation of nursing curricula is critical to the socialization of our professional identity, what nursing values and what it means to be a nurse who can demonstrate capabilities that go far beyond the image of the pandemic proclamations of nurses as heroes (Goodolf and Godfrey 2021). Sustaining the changes that have supported access to healthcare delivery and post-secondary education throughout the pandemic will require vision and leadership. It will mean positioning nursing within the health professions to have a voice of influence, be visible, be recognized as essential to decisions that affect health and inform healthcare directions that are equity oriented and grounded in the social determinants of health and social justice.

Healthcare in Secure Environments: Leading a Collaborative for Forensic Nursing Education.

Atlantic Canada hosts six federal and 18 provincial correctional facilities distributed across the four provinces. All employ nurses and offer significant career opportunities, yet minimal content related to forensic nursing is provided in nursing curricula. Furthermore, there is a paucity of continuing educational offerings for Canadian forensic nurses. This article describes the series of events that brought the practice of forensic nursing to the forefront of provincial news media. Actions taken by nurses in academia and practice addressed the lack of educational opportunities for forensic nurses in Atlantic Canada. One of these actions, a Knowledge Forum, was held to nurture partnerships between nurse leaders responsible for healthcare in correctional services in New Brunswick and nurse educators. The idea was to connect nurse leaders responsible for healthcare in federal and provincial jurisdictions, community liaison nurses and nurse managers working in hospital-based forensic mental health assessment units, and nurse educators, to explore nursing practice within secure environments and the current educational needs of forensic nurses.

Exploring the Delivery of Healthcare in the Police Detention Center Through Remote Presence Technology.

INTRODUCTION: There is overwhelming evidence to support the delivery of high-quality health service at a lower cost with the use of advanced technologies. Implementing remote presence technology to expand clinical care has been fraught with barriers that limit interprofessional collaboration and optimal client outcomes. In Canada, government ministries responsible for correctional services, policing, and health are well positioned to link federal, provincial, and regional services to enhance service delivery at the point of care for individuals detained within the justice system. Using remote presence technology to link the detention center with relevant health services such as the emergency room has the potential to open up a new care pathway. RESEARCH QUESTION: The key research question was how a new intervention pathway for individuals detained in police service detention centers could be implemented. RESEARCH DESIGN: Utilizing an exploratory qualitative research design, interviews were undertaken with 12 police service and six healthcare participants. Data were transcribed and thematically analyzed. FINDINGS: Four main themes emerged and included role conflict, risk management, resource management, and access to services. A number of collaborative learning partnerships were identified by the participants. IMPLICATIONS: These themes reveal important facilitators and barriers to attending to the health needs of detainees within the police detention center through the utilization of remote presence.

Conceptualizing the Role of a Strategist for Outreach and Indigenous Engagement to Lead Recruitment and Retention of Indigenous Students.

A number of universities have introduced Indigenous student-specific programming to improve recruitment. These programs target the needs of Indigenous students and often impart a sense of comfort or belonging that may be more difficult to obtain in a mainstream program. The University of Saskatchewan, College of Nursing, implemented a Learn Where You Live delivery model that challenged the university community to think differently about outreach and engagement. This is best described by redefining distance such that student services and supports would no longer be localized to a main campus but redesigned for distribution across the province. Sustaining this model meant the College leadership had to find new ways to support faculty to engage in teaching and learning opportunities that would be context relevant and aid student recruitment and retention. The new position of Strategist for Outreach and Indigenous Engagement was created to lead opportunities for faculty and staff to gain knowledge and expertise in policy development, negotiation and implementation for success in the distributed delivery model. The framework of Two-Eyed Seeing was adapted to guide the introduction and ongoing implementation (Bartlett et al. 2012).

Reshaping Policies to Achieve a Strategic Plan for Indigenous Engagement in Nursing Education.

Canadian universities are developing strategies to address the Truth and Reconciliation Commission (TRC) Calls to Action. There has been much attention paid to the positivist, individualistic and Eurocentric foundations of nursing and its educational curricula, but limited focus on assessing organizational structures or engaging with stakeholders. Without both approaches, the success of new initiatives may be limited. The College of Nursing at the University of Saskatchewan implemented a "Learn Where You Live" model that demonstrated a sense of place by providing access and opportunity in rural, remote and northern regions of the province. Key to this initiative was the creation of the position of Strategist for Outreach and Indigenous Engagement, whose role it is to develop strategic initiatives designed to interpret and influence socio-political and policy-level system changes. This paper shares how adding a political scientist to nursing education created an interprofessional team by introducing new ways of thinking and being that have cultural relevance and understanding for a sustainable future.

Under the Same Sky: Connecting Students and Cultures through Circumpolar Nursing Education.

The recruitment and retention of health professionals in rural, remote, and northern regions is an ongoing challenge. The Northern Nursing Education Network brought together nursing students working in rural and remote regions of the circumpolar north in Innovative Learning Institute on Circumpolar Health (ILICH) events to create opportunities for shared learning and expose both students and faculty to local and traditional knowledge that informs health behaviors specific to regions with Indigenous populations. Using participant experience data extracted from program discussions, evaluations, and reflective notes conducted after ILICH events held in 2015⁻2017, this paper explores how these two-week institutes can contribute to knowledge that is locally relevant yet transferable to rural areas across the circumpolar north. The findings clustered around experiences related to (1) Language as a barrier and an enabler; (2) shared values and traditions across borders; (3) differences and similarities in nursing practice; (4) new perspectives in nursing; and (5) building sustainable partnerships. Students learned more about their own culture as well as others by exploring the importance of language, cultures, and health inequity on different continents. Shared values and traditional knowledge impacted student perspectives of social determinants of health that are highly relevant for nurses working in the circumpolar north.

Caregivers' nutrition knowledge and attitudes are associated with household food diversity and children's animal source food intake across different agro-ecological zones in Ghana.

Caregivers' nutrition knowledge and attitudes may influence the variety of foods available in the household and the quality of children's diets. To test the link, this study collected data on caregivers' (n 608) nutrition knowledge and feeding attitudes as well as the diets of their household and of their 2-5-year-old children in twelve rural communities nested in the three main agro-ecological zones of Ghana. Household foods and children's animal source foods (ASF) consumed in the past 7 d were categorised into one of fourteen and ten groups, respectively. About 28 % of caregivers believed that their children needed to be fed only 2-3 times/d. Reasons for having adult supervision during child meal times, feeding diverse foods, prioritising a child to receive ASF and the perceived child benefits of ASF differed across zones (P<0·001). Households with caregivers belonging to the highest tertile of nutrition knowledge and attitude scores consumed more diverse diets compared with those of caregivers in the lowest tertile group (11·2 (sd 2·2) v. 10·0 (sd 2·4); P<0·001). After controlling for the effect of agro-ecological zone, caregivers' nutrition knowledge and feeding attitudes positively predicted household dietary diversity and the frequency and diversity of children's ASF intakes (P<0·001). The number of years of formal education of caregivers also positively predicted household dietary diversity and children's ASF diversity (P<0·001). A key component to improving child nutrition is to understand the context-specific nutrition knowledge and feeding attitudes in order to identify relevant interventions.

Linking Learners for Life Where They Live (L4): Developing a Global Health Initiative for Student Engagement.

This article describes a graduate student learning experience as part of an international nursing collaborative working together to develop an academic partnership for global health education in the circumpolar north. The experience provided an opportunity to conduct a pilot project in a rural, remote, northern community using an indigenous, global context. Building on the Canadian-Siberian collaboration, the graduate student attended an academic institution in Siberia, where she focused on the sharing of expertise, knowledge, and insights in order to address the challenges facing indigenous people in achieving optimal health and well-being in the circumpolar north. The goal was to create a foundation for "putting health into place" in a northern context, with the hope of creating shared learning opportunities for undergraduate students between the 2 countries.The intent is to share the approach used by the graduate student to use a conceptual model to assess the feasibility of creating a context-relevant global health experience for northern nursing education.

An integrated microcredit, entrepreneurial training, and nutrition education intervention is associated with better growth among preschool-aged children in rural Ghana.

BACKGROUND: Poor diet quality is a determinant of the high prevalence rates of malnutrition in Ghana. There is little evidence on the effectiveness of a multisector intervention to improve children's diets and nutritional status. OBJECTIVE: The project tested whether participation in an entrepreneurial and nutrition education intervention with microcredit was associated with the nutritional status of children 2-5 y of age. METHODS: A quasi-experimental 16-mo intervention was conducted with microcredit loans and weekly sessions of nutrition and entrepreneurship education for 179 women with children 2-5 y of age [intervention group (IG)]. Nonparticipating women and their children from the same villages (nonparticipant, n = 142) and from similar neighboring villages (comparison, n = 287) were enrolled. Repeated measures linear regression models were used first to examine children's weight-for-age (WAZ), height-for-age (HAZ), and body mass index-for-age (BAZ) z scores at baseline and at 4 follow-up time points ∼4 mo apart. Time, intervention status, time-by-intervention interaction terms, region of residence, household wealth rank, household head occupation, number of children <5 y of age, and child sex and age were included. RESULTS: There was a significant interaction between the IG and time for BAZ (P = 0.02) with significant Bonferroni-corrected pairwise comparisons between the IG and comparison group (CG) at 8 mo (difference of 0.36 ± 0.09 z score, P < 0.0001). The WAZ group difference was significant between 4 and 16 mo (P = 0.01 for interaction) and peaked at 8-12 mo (differences of ∼0.28 z). The HAZ of children in the IG was significantly higher than that in the CG, reaching a 0.19 z difference at 16 mo (P < 0.05). When the fixed effects models were fitted in sensitivity analyses, some group anthropometric differences were of lower magnitude but remained significant. CONCLUSION: An integrated package of microcredit and education may improve nutritional outcomes of children living in poor, rural communities.

Factors influencing job satisfaction of oncology nurses over time.

In this study, we tested a structural equation model to examine work environment factors related to changes in job satisfaction of oncology nurses between 2004 and 2006. Relational leadership and good physician/nurse relationships consistently influenced perceptions of enough RNs to provide quality care, and freedom to make patient care decisions, which, in turn, directly influenced nurses' job satisfaction over time. Supervisor support in resolving conflict and the ability to influence patient care outcomes were significant influences on job satisfaction in 2004, whereas, in 2006, a clear philosophy of nursing had a greater significant influence. Several factors that influence job satisfaction of oncology nurses in Canada have changed over time, which may reflect changes in work environments and work life. These findings suggest opportunities to modify work conditions that could improve nurses' job satisfaction and work life.

The context of oncology nursing practice: an integrative review.

BACKGROUND: In oncology, where the number of patients is increasing, there is a need to sustain a quality oncology nursing workforce. Knowledge of the context of oncology nursing can provide information about how to create practice environments that will attract and retain specialized oncology nurses. OBJECTIVE: The aims of this review were to determine the extent and quality of the literature about the context of oncology nursing, explicate how "context" has been described as the environment where oncology nursing takes place, and delineate forces that shape the oncology practice environment. METHODS: The integrative review involved identifying the problem, conducting a structured literature search, appraising the quality of data, extracting and analyzing data, and synthesizing and presenting the findings. RESULTS: Themes identified from 29 articles reflected the surroundings or background (structural environment, world of cancer care), and the conditions and circumstances (organizational climate, nature of oncology nurses' work, and interactions and relationships) of oncology nursing practice settings. CONCLUSIONS: The context of oncology nursing was similar yet different from other nursing contexts. The uniqueness was attributed to the dynamic and complex world of cancer control and the personal growth that is gained from the intense therapeutic relationships established with cancer patients and their families. IMPLICATIONS FOR PRACTICE: The context of healthcare practice has been linked with patient, professional, or system outcomes. To achieve quality cancer care, decision makers need to understand the contextual features and forces that can be modified to improve the oncology work environment for nurses, other providers, and patients.

Canadian oncology nurse work environments: part II.

In the aftermath of healthcare restructuring, it is important to pay attention to nurses' perceptions of workplace and professional practice factors that attract nurses and influence their retention. Continuing constraints on cancer care systems make the issue of health human resources an ongoing priority. This paper presents the findings of a follow-up study of a cohort of Canadian oncology nurses that aimed to compare nurses' perceptions of their work environment, job satisfaction and retention over a two-year period. Participants of the follow-up survey represented 65% (397/615) of the initial cohort. Many similar perceptions about the work environment were found over two years; however, at follow-up a larger proportion of nurses reported an absence of enough RNs to provide quality care and a lack of support for innovative ideas. With respect to career status, only 6% (25/397) of the follow-up sample had left oncology nursing. However, the proportion of nurses declaring an intention to leave their current job increased from 6.4% (39/615) on the initial survey to 26% (102/397) on the follow-up survey. Findings suggest that decision-makers need to use both the growing body of workplace knowledge and the input from staff nurses to implement changes that positively influence nurse recruitment and retention. Future research should focus on the implementation and evaluation of strategies that address workplace issues such as nurse staffing adequacy, leadership and organizational commitment.

Facilitating the implementation of empirically valid interventions in psychosocial oncology and supportive care.

PURPOSE: Over the past two decades, the fields of psychosocial oncology and supportive care have seen clinically effective tools as underutilized despite proven benefits to cancer patients and their families. The purpose of this paper is to discuss the reasons for the failure of psychosocial and supportive care interventions in oncology to realize broad clinical implementation and to demonstrate how a knowledge management framework offers several advantages for increasing the probability of successful implementation. METHODS: This paper is based on a systematic review of the literature pertaining to efforts to implement psychosocial oncology and supportive care interventions. RESULTS: The struggle to develop, implement, and evaluate promising psychosocial oncology and supportive care innovations has moved academic thought toward the development of models and theories concerning the best ways to move new knowledge into clinical practice. There are critical and common barriers to the successful transfer and implementation of promising interventions, and implementation efforts may be maximized by using knowledge management frameworks to systematically identify and address these barriers. CONCLUSIONS: The successful implementation of empirically promising interventions requires research networks and practice groups to work together in a concerted, theory-guided effort to identify and address the contextual factors most relevant to any particular intervention. The growing support of knowledge implementation activities by research funders, policy-makers, opinion leaders, and advocates of psychosocial and supportive care interventions is a positive move in this direction.

Canadian cancer nurses' views on recruitment and retention.

AIM: The purpose of this study was to explore oncology nurses' perceptions about recruitment and retention. BACKGROUND: Competition among healthcare organizations to recruit and retain qualified nurses is a real-life challenge. Focusing attention on human resource planning in oncology is highlighted by both the worsening nursing shortage and cancer incidence. METHODS: A participatory action research approach was used and 12 focus groups with 91 cancer nurses were conducted across Canada to collect data about strategies that could improve recruitment and retention. RESULTS: Four themes emerged reflecting oncology nurses' beliefs and values about organizational practices that attract and retain nurses and they are as follows: (1) recognizing oncology as a specialty, (2) tacit knowledge no longer enough, (3) gratification as a retaining factor, and (4) relationship dependent on environment. CONCLUSIONS: Participants highlighted leadership, recognition and professional and continuing education opportunities as critical to job satisfaction and organizational commitment. IMPLICATIONS FOR NURSING MANAGEMENT: Recruitment and retention were viewed as a continuum where organizational investment begins with a well-developed orientation and ongoing mentorship to ensure knowledge development. The challenge for nurse leaders is to use the evidence generated from this study and previous studies to develop professional practice environments that facilitate the cultural changes needed to build and sustain a quality nursing workforce.

Canadian oncology nurse work environments: part I.

The global nursing shortage and statistics indicating a steady increase in the cancer patient workload suggest that the recruitment and retention of oncology nurses is and will be a serious problem. The purpose of this research study was to examine oncology nursing work environments in Canada and to determine the presence of workplace and professional practice factors. A total of 615 oncology nurses responded to a national survey in 2004. The majority of nurses indicated that positive nurse-physician relations and autonomy in clinical decision-making were factors that contributed to job satisfaction and the desire to remain in oncology nursing. However, the findings identified that nurse staffing, the lack of nursing leadership and inadequate opportunities to participate in policy decisions were areas of concern. Differences in work environment perceptions were seen most often when responses were compared across provincial regions. While the findings support previous research reports that the key to the nursing shortage is attention to nursing work environments, they also emphasize the need for organizations to act now. A follow-up survey was conducted in 2006; analysis of these data will be presented in a future report on nurses' perceptions of their work environments and job satisfaction over time.

The relationship between nursing leadership and nurses' job satisfaction in Canadian oncology work environments.

BACKGROUND: Current Canadian oncology work environments are challenged by the same workforce statistics as other nursing specialties: nurses are among the most overworked, stressed and sick workers, and more than 8% of the nursing workforce is absent each week due to illness. AIM: To develop and estimate a theoretical model of work environment factors affecting oncology nurses' job satisfaction. METHODS: The sample consisted of 515 registered nurses working in oncology settings across Canada. The theoretical model was tested as a structural equation model using LISREL 8.54. RESULTS: The final model fitted the data acceptably (chi(2) = 58.0, d.f. = 44, P = 0.08). Relational leadership and physician/nurse relationships significantly influenced opportunities for staff development, RN staffing adequacy, nurse autonomy, participation in policy decisions, support for innovative ideas and supervisor support in managing conflict, which in turn increased nurses' job satisfaction. CONCLUSIONS: These findings suggest that relational leadership and positive relationships among nurses, managers and physicians play an important role in quality oncology nursing environments and nurses' job satisfaction. IMPLICATIONS FOR NURSING MANAGEMENT: Oncology nursing work environments can be improved by focusing on modifiable factors such as leadership, staff development and staffing resources, leading to better job satisfaction and hopefully retention of nurses.

The effects and expense of augmenting usual cancer clinic care with telephone problem-solving counseling.

This study was done to assess the effectiveness and efficiency of individualized, problem-solving counseling provided by baccalaureate nurses over the telephone to prevent the onset of depression in persons with breast, lung, or prostate cancer. Of 175 persons randomized, 149 completed the 8-month follow-up. The primary outcome measures were changes in the Jalowiec Coping Scale, the Centre for Epidemiologic Studies in Depression Scale, and the Derogotis Psychosocial Adjustment to Illness Scale. In addition, expenditures for people's use of all health and social services were computed at baseline and follow-up. Telephone counseling improved the use of more favorable coping behaviors, prevented a clinically important but not statistically significant decline into depression, and poor psychosocial adjustment in a group of people with mixed cancer. These results were associated with a greater total per person per annum expenditure for use of all other health and social services in the community compared with the control group. In a situation of limited resources and a service producing more effect for more costs, one needs either to examine what services to forgo to offer this service or to carefully target the new service to those most likely to benefit.

Incomplete and inconsistent information provided to men making decisions for treatment of early-stage prostate cancer.

OBJECTIVES: To determine whether there is a gap between what patients know about early-stage prostate cancer and what they need to know to make treatment decisions, and whether the information patients receive varies depending on their treating physician. METHODS: Needs assessment was performed using a questionnaire consisting of 41 statements about early-stage prostate cancer. Statements were divided into six thematic subsets. Participants used a 5-point Likert scale to rate statements in terms of knowledge of the information and importance to a treatment decision. Information gaps were defined as significant difference between the importance and knowledge of an item. Descriptive statistics were used to describe demographic subscale scores. The information gap was analyzed by a paired t test for each thematic subset. One-way analyses of variance were used to detect any differences on the basis of treating physician. RESULTS: Questionnaires were distributed to 270 men (135 treated by radical prostatectomy, 135 by external beam radiotherapy). The return rate was 51% (138 questionnaires). A statistically significant information gap was found among all six thematic subsets, with five of the six P values less than 0.0001. Statistically significant variation was observed in the amount of information patients received from their treating physicians among four of the thematic subsets. CONCLUSIONS: There is an information gap between what early-stage prostate cancer patients need to know and the information they receive. Additionally there is a difference in the amount of information provided by different physicians.

The art of nursing: communication and self-expression.

Nursing is considered both an art and a science, yet the nature of art and science has been historically depicted as two distinct fields of inquiry in the health professions. To meet the health challenges of the future, blending science and art through nursing theory, research, and practice is critical. This article describes how nurses in a master's of nursing program at Dalhousie University broke with tradition for the practicum course to articulate and apply the theoretical elements of knowing using aesthetic inquiry. The challenge was in articulating and guiding students through the theory of aesthetic knowing, the linkages with the fine arts, and the conceptualization of nursing art.