Exploring Self-Perceptions of Anxiety among Nursing Students in the Clinical Setting and Select Demographics.

Clinical learning experiences are essential in nursing education but they are often anxiety provoking for learners. Understanding the factors associated with the anxiety levels of nursing students in clinical placements has become more complex over the years with increasing heterogeneity within the nursing population. A correlational study was conducted to examine the relationships between nursing students' self-perceived anxiety levels, as measured by the State-Trait Anxiety Inventory (STAI), and the students' age, gender, previous employment, and previous education. The findings revealed that nursing students have a higher than average level of anxiety and that male nursing students reported higher levels of anxiety compared to female nursing students. No significant correlations were found between age, previous education, previous employment, and self-perceived anxiety levels. Findings from this study provide an opportunity for discussion by nursing educators and identify a need for future research and practice.

Views from the field: Medical student experiences and perceptions of interprofessional learning and collaboration in rural settings.

Exploring the perceived environment where students are educated, as well as where they practice, is particularly important for educators and practitioners working in situations of interprofessional rural and remote health. In this study, we explored the perceptions of undergraduate medical students regarding interprofessionalism across their four-year undergraduate program which focuses on rural health. A thematic content analysis of the text-data was conducted on a convenience sample of 47 student responses to essay questions across four cohorts of a four-year undergraduate medical program. The medical program has an explicit social accountability mandate for responsiveness to the needs of a rural population and thus students have multiple opportunities to experience interprofessional education and collaboration in rural contexts. Participants reported (a) blurring and flexibility of roles in a primarily positive manner, (b) participating in unstructured interprofessional learning and collaboration, (c) experiencing the importance of social connections to interprofessional collaboration and learning, and (d) realisations that interprofessional collaboration is a means of overcoming barriers in rural areas. We discuss our findings using the socio-material perspective of complexity theory. These findings may be used to inform undergraduate programs in re-defining, re-creating, developing, and fostering interprofessional learning opportunities for medical students in rural communities as well as to support clinical faculty through ongoing professional development.

The top cited articles in occupational therapy: a citation analysis study.

BACKGROUND: The purpose of this study was to identify and review the most cited articles in the occupational therapy field. METHODS: Using the multi-disciplinary Publish or Perish software to extract data, the top 50 lifetime and annual cited articles were examined. Studies were organized according to the following: year of publication, design, topic, number of authors, country of publication, and number of citations for each cohort. RESULTS: We found that randomized control trials were the dominant design type used in papers with the most lifetime (36.0%) and annual (26.0%) citations. Additionally, in both groups, the most frequently cited articles investigated predictors of functional outcome for patients. CONCLUSIONS: This comprehensive citation analysis will inform future research through its identification of major trends and well-established areas of study.

Facilitators and barriers to occupational health and safety in small and medium-sized enterprises: a descriptive exploratory study in Ontario, Canada.

PURPOSE: The purpose of this particular study was to test a newly created instrument in describing the facilitators and barriers to occupational health and safety in small and medium-sized enterprises (SMEs) in Ontario, Canada. METHODS: A cross-sectional design was used to identify the occupational health and safety culture of SMEs in public and private sectors in Ontario. RESULTS: A total of 153 questionnaires were completed. The majority of respondents were female (84%) with a mean age of 49.8 years (SD 10.6). Seventy-four percent were supervisors. Seventy percent of respondents were from the private sector while 30% derived from the public sector including healthcare, community services, and non-profit organizations. Further, conducting regular external safety inspections of the workplace was found to be statistically associated with a safe work environment 2.88 95% CI [1.57, 5.27]. CONCLUSIONS: Strategies and training opportunities that focus on how to adapt occupational health and safety legislation to the nature and diversity of SMEs are recommended. Furthermore, employers may use such information to improve safety in their SMEs, while researchers can hopefully use such evidence to develop interventions that are applicable to meeting the occupational health and safety needs of SMEs.

An examination of retention factors among registered nurses in Northeastern Ontario, Canada: Nurses intent to stay in their current position.

BACKGROUND: The purpose of the study was to examine factors related to the retention of registered nurses in northeastern Ontario, Canada. OBJECTIVE/METHOD: A cross-sectional survey of registered nurses working in northeastern Ontario, Canada was conducted. Logistic regression analyses were used to consider intent to stay in current employment in relation to the following: 1) demographic factors, and 2) occupation and career satisfaction factors. RESULTS: A total of 459 (29.8% response rate) questionnaires were completed. The adjusted odds logistic regression analysis of RNs who intended to remain in their current position for the next five years, demonstrated that respondents in the 46 to 56 age group (OR: 2.65; 95% CI: 1.50 to 4.69), the importance of staff development in the organization (OR: 3.04; 95% CI: 1.13 to 8.13) northeastern Ontario lifestyle (OR: 2.61; 95% CI: 1.55 to 4.40), working in nursing for 14 to 22.5 years (OR: 2.55; 95% CI: 1.10 to 5.93), and working between 0 to 1 hour of overtime per week (OR: 1.20; 95% CI: 1.20 to 4.64) were significant factors in staying in their current position for the next five years. CONCLUSIONS: This study shows that a further understanding of the work environment could assist with developing retention for rural nurses. Furthermore, employers may use such information to ameliorate the working conditions of nurses, while researchers may use such evidence to develop interventions that are applicable to improving the working conditions of nurses.

The relationship between quality of work life and location of cross-training among obstetric nurses in urban northeastern Ontario, Canada: A population-based cross sectional study.

OBJECTIVES: The purpose of this mixed methods study was to examine the quality of work life of registered nurses working in obstetrics at 4 hospitals in northeastern Ontario and explore demographic and occupational factors related to nurses' quality of work life (QWL). MATERIAL AND METHODS: A stratified random sample of registered nurses (N = 111) selected from the 138 eligible registered nurses (80.4%) of staff in the labor, delivery, recovery, and postpartum areas at the 4 hospitals participated. Logistic regression analyses were used to consider QWL in relation to the following: 1) demographic factors, and 2) stress, employment status and educational attainment. RESULTS: In the logistic regression model, the odds of a higher quality of work life for nurses who were cross trained (nurses who can work across all areas of obstetrical care) were estimated to be 3.82 (odds ratio = 3.82, 95% confidence interval: 1.01-14.5) times the odds of a higher quality of work life for nurses who were not cross trained. CONCLUSIONS: This study highlights a relationship between quality of work life and associated factors including location of cross-training among obstetrical nurses in northeastern Ontario. These findings are supported by the qualitative interviews that examine in depth their relationship to QWL. Given the limited number of employment opportunities in the rural and remote regions, it is paramount that employers and employees work closely together in creating positive environments that promote nurses' QWL.

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.

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.

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.

Work ability and work-related stress: A cross-sectional study of obstetrical nurses in urban northeastern Ontario.

BACKGROUND: The aim of this study was to determine: 1) if quality of work life (QWL), location of cross-training, stress variables, and various demographic factors in nurses are associated with work ability, and 2) nursing occupational stress, QWL, and various associated factors are related with nurses' work ability. There is limited research examining the obstetrical nursing environment. Given the amount of time and energy people expend at the workplace, it is crucial for employees to be satisfied with their lives at work. METHODS: This cross sectional study was conducted in 2012 in four hospitals in northeastern Ontario, Canada. A stratified random sample of registered nurses (n= 111) were selected. RESULTS: The majority of participants were female (94.6%) ranging in age from 24 to 64 years (M = 41.9, s.d. = 10.2). For the stress and QWL model, one variable: QWL (home-work support - see Methods for definition) (p= 0.015), cross-trained (see Methods for definition) nurses (p= 0.048), and having more than 4 patients per shift (p= 0.024) significantly contributed to the variance in work ability scores. In the logistic regression model, the odds of a higher work ability for nurses who received home-work support were estimated to be 1.32 (95% CI, 1.06 to 1.66) times the odds of a higher work ability for nurses who did not receive home-work support. CONCLUSIONS: Work ability in the work environment of obstetrical nursing is important. To be high functioning, workplaces should maximize the use of their employees' actual and potential skills.

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.

Nurse practitioners' perceptions of interprofessional team functioning with implications for nurse managers.

AIMS: To determine the perceptions of nurse practitioners (NPs) about the level of functioning of their interprofessional teams. BACKGROUND: Interprofessional teams are a global trend, and nurses play leadership roles in their management. Little is known about the impact of specific barriers to team functioning and the role of the nurse manager on team functioning. METHODS: Ninety-eight NPs at a conference completed the Interprofessional Team Functioning Survey (ITFS). RESULTS: The survey items with the lowest mean scores were related to organisational systems. These items included workplace policies that support interprofessional teamwork, in particular, orientation to the interprofessional team. Items that generated lower mean scores were adequate time to work as a member of the interprofessional team, team dynamics, collaboration among team members and the sharing of responsibility. CONCLUSION: Organisational and team relational issues can be addressed through organisational management strategies. Nurse managers have an important role in facilitating high functioning interprofessional teams. IMPLICATIONS FOR NURSING MANAGEMENT: Strategies for managers to support interprofessional team functioning emerged. These strategies include ensuring that there are appropriate policies, orientation of new members, allocation of time to support interprofessional teamwork, leadership to enhance team collaboration and clear delineation of responsibilities of each member.

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.

Views on unsafe nursing students in clinical learning.

Clinical education is a cornerstone of undergraduate nursing education programs. Although protecting patient safety in clinical learning experiences is a standard of practice, no standard definition of the "unsafe" student exists. The purpose of this study was to describe the viewpoints of undergraduate student nurses and their clinical educators about unsafe clinical student practices. Using Q methodology, 57 students and 14 clinical educators sorted 39 unsafe student practice statements. These statements were generated from an integrated review of nursing and related literature and two undergraduate student focus groups. The use of centroid factor analysis with varimax rotation produced three dimensions of unsafe student practices. An unsafe student was characterized by his/her Compromised Professional Accountability, Incomplete Praxis, and Clinical Disengagement. A shared attribute among these three features was violated professional integrity. While students' affective, cognitive, and praxis competencies were priority elements in the conceptualization of unsafe student practice, this study also identified the salient role of educators as active participants in preparation of safe practitioners.

Students' perceptions of interprofessional learning through facilitated online learning modules.

BACKGROUND: Asynchronous e-learning is an appealing option for interprofessional education (IPE) as it addresses the geographic and timetabling barriers often encountered when organizing activities across educational programs. AIM: This study examined the extent to which pre-licensure students were able to learn with, from, and about each other through completion of innovative online IPE learning modules. METHODS: Seventy-seven students completed e-learning modules developed through a consortium of educational institutions. Evaluation was primarily qualitative through focus groups, interviews, analyses on off-line discussions and an online feedback form. RESULTS: Qualitative analyses of the discussion fora revealed that students were able to solve problems collaboratively, clarify their professional roles, and provide information from their professional perspective. Focus groups and interviews reinforced that students recognized the importance of working together and implicate clinical education as an important venue to reinforce learning about collaborative practice. Analyses of the online feedback form suggest the need for clear processes related to group assignments and deadlines. CONCLUSION: Students learned about each other's role, solved problems together and had positive perceptions of the online modules as a venue for interprofessional learning. Results are encouraging to those interested in using e-learning in IPE as part of an overall curriculum.

Stroke education for nurses through a technology-enabled program.

Today's nurse faces many challenges in the workplace. Required to keep up in a constantly changing knowledge-based environment, he or she must balance complex professional responsibilities, staffing shortages, and increased acuity among the patient population. Continuing education must, therefore, be highly flexible and responsive to the personal and professional needs of the nurse learner. Technology-supported continuing education is suggested to be an appropriate way of meeting the learning needs of busy working nurses. The Stroke Best Practices for Nursing project used three complementary and integrated educational technologies-a-Web-based learning site, Web casting (live and archived), and two-way interactive videoconferencing--to deliver a minicourse focused on best practice stroke care to nurses working in northeastern and northwestern Ontario, a geographical area of approximately 600 km. In total, 96 nurses participated in the educational part of the program; 46 of the 96 (47%) took part in the assessment of the program. On the basis of this assessment strategy and the nurses' requests for other programs that do not use traditional face-to-face classrooms and lecture, the value of using educational technologies in health-based continuing education was strongly identified. This article describes key components of the project and celebrates the partnership among the organizing stakeholders: faculty in the school of nursing at the Laurentian University, the West Greater Toronto Area Stroke Network, and the Ontario Telemedicine Network. The article further describes findings related to the program's impact on participants' perceptions of competence as caregivers for stroke patients, participants' confidence using technology for educational purposes, and participants' satisfaction with the overall program.

Online interprofessional health sciences education: From theory to practice.

Online learning (e-learning) has a nascent but established history. Its application to interprofessional education (IPE), however, is relatively new. Over the past 2 decades the Internet has been used increasingly to mediate education. We have come past the point of "should we use the Internet for education" to "how should we use the Internet for education." Research has begun on the optimal development of online learning environments to support IPE. Developing online IPE should follow best practices in e-learning generally, though there are some special considerations for acknowledging the interprofessional context and clinical environments that online IPE is designed to support. The design, development, and deployment of effective online IPE must therefore pay special attention to the particular constraints of the health care worker educational matrix, both pre- and postlicensure. In this article we outline the design of online, interprofessional health sciences education. Our work has involved 4 educational and 4 clinical service institutions. We establish the context in which we situate our development activities that created learning modules designed to support IPE and its transfer into new interprofessional health care practices. We illustrate some best practices for the design of effective online IPE, and show how this design can create effective learning for IPE. Challenges exist regarding the full implementation of interprofessional clinical practice that are beginning to be met by coordinated efforts of multiple health care education silos.

Integrative thinking and learning in undergraduate nursing education: three strategies.

This article describes three learning activities used in the undergraduate nursing degree program at a mid-sized university in northeastern Ontario, Canada. Each activity, a reflective writing assignment, scenario testing, and an OSCE experience, is considered in terms of integrative thinking. Formal and informal evaluation of the activities is also discussed.Based on the authors' experiences, integrative thinking including habits of mind and cognitive skills can be directed and enhanced. To maximize students' growth as integrative thinkers, they should be exposed to many kinds of activities that target this growth. Generally, such activities tend to be case-based and interactive in nature. They also require a level of scaffolding or directedness. To develop and implement such activities, teachers are encouraged to work with educational researchers and instructional designers.

A study of critical thinking, teacher-student interaction, and discipline-specific writing in an online educational setting for registered nurses.

Based on work conducted by Laurentian University's School of Nursing and Centre for Continuing Education in Sudbury, Ontario, Canada, working in conjunction with community partners, this article looks at the findings of an analysis of nurses' writing activity in a university-level web-based module for evidence of critical thinking using Johns' Model of Structured Reflection (1995). Also considered are student-teacher interactions and discipline-specific writing. The findings suggest that high levels of critical thinking by nurse learners and growth in thinking and writing competence over time can occur in an online setting. Further highlighted are the role of the instructor, assignment design, and support in fostering such development.