[The nursing labour market in Canada (1985-1999)]. / Le marché du travail en soins infirmiers au Canada (1985-1999).

This literature review analysed both published and unpublished scientific and professional studies on the nursing labour market in Canada within the period of 1985 to 1999. The goal was to conduct a situational analysis utilising statistical data and canvassing all concerned parties to extract their points of view. The analysis revealed significant cyclical variations in the evolution of the workforce, particularly with respect to auxiliary nurses, such as the perceived existence of major problems in recruiting new professionals in the field and retaining existing professionals in their organisations, the lack of homogeneity in educational training programmes, and the co-existence of several operational structures for organising nursing care, of which there is a lack of evaluation on their effectiveness. The results of the literature review identify the necessity to further develop the knowledge base on such a relevant dimension of the nursing labour market.

Transcultural nursing and a care management partnership project.

This paper aims to illustrate how Leininger's Theory of Culture Care Diversity and Universality has influenced the research process of a study that emerged from a care management partnership between Canadian nursing teachers and Tunisian nurses. The purpose of the study was to investigate the meanings of care as viewed by university hospital-based Tunisian nurses. The qualitative analysis of data gathered through observation-participation and interviews highlights recurrent patterns and reveals three major professional care themes. For Tunisian nurses care means to secure the patient's cooperation towards the medical regimen within established rules in the hospital; to contribute to curing the patient by using current technology as well as by maintaining their technical skills and improving their medical knowledge; to take charge of the patient to assist the physician in treating disease. This study showed that Tunisian nurses emphasize curing rather than widely shared community values such as interdependence, intercommunication, understanding, presence and responsibility for others. Discussion of the study's findings draws upon the perspective provided by Freire's Oppressed Group Theory. In order to promote cultural congruence within the Care Management Partnership Project in Tunisia, the three predicted modes of care within Leininger's theory guide the decisions and actions for future nursing research and partnership activities.

[Validation of a model of psychosocial determinants of occupational health of geriatric nurses]. / Validation d'un modèle de déterminants psychosociaux de la santé au travail de l'infirmière en gériatrie.

The purpose of this study was to verify a model of relationships between psychosocial factors and health for 8066 francophone nurses working in geriatric care in Québec. A random sample of 1990 subjects was drawn and a participation rate of 77.9% and 55% was obtained for the two-time study taken twelve months apart. Based on the theory of Maddi and Kobasa (1984), the model was reproduced for the two-time periods with the aid of structural equations. The analyses showed that three variables exert a direct influence on psychological distress: professional burnout, occupational stressors and hardiness. Also, variables have a direct effect on burnout: listed in order of importance, these are hardiness, occupational stressors, work support, active strategies of coping and employment status. In dealing with the work stressors, the nurses who are hardy make use of active strategies of coping and look for support form their colleagues. The results of the study help to better understand the psychological and social resources that best favor adaptation of working women in highly demanding work environments. The fallout of the study converges towards the quality of life of helping professionals and towards the cost and quality of health and social services.

Psychosocial determinants of burnout in geriatric nursing.

The purpose of this study was to identify determinants of burnout using an adapted version of Kobasa's theoretical framework, considering work stressors, work support, coping strategies and hardiness. Data were collected through a questionnaire mailed to 1990 randomly selected geriatric nurses. A participation rate of 77.6% was achieved. T-test, variance analysis and multiple regression analysis were conducted. Hierarchical multiple regression analysis indicated that 49% of the variance was explained by the study variables. Hardiness and work stressors were the most important predictors of burnout. The findings are discussed in relation to Kobasa's framework, focusing on resources that reduce negative effects of geriatric work stressors. Implications for nursing practice, management, education and research are proposed.

Factors related to nursing burnout: a review of empirical knowledge.

It has been observed that nurses are at a high risk of burnout. The initiator variables of burnout appear to be numerous, tenacious, and not isolated; burnout is a complex phenomenon with multiple dimensions. In order to prevent psychosocial dysfunction and promote the mental health of nurses, the predominant factors contributing to nursing burnout should be clear. This article presents a literature review of the existing empirical knowledge regarding factors related to burnout in nurses. Among 300 documents on nursing burnout, 36 pertinent studies were retained. Amid these studies, 15 variables were selected, classified, and critically analyzed. It appears that the best correlates of nursing burnout are role ambiguity, workload, age, hardiness, active coping, and social support. Probable relationships and influences among these factors are discussed and may lead to a better understanding of mutual interactions between the personal and environmental factors contributing to nursing burnout. Implications for practice and further research are proposed.

[The development of a research program based on a conceptual model for the discipline of nursing]. / Développement d'un programme de recherche basé sur une conception de la discipline infirmière.

The purpose of this article was to illustrate the development of a team's research program based on a conceptual model for the nursing discipline: Roy's Adaptation Model. The ongoing research program includes studies of psychosocial factors, theoretically known for their potential for explaining health. Four groups of people are the focus of these studies: aged spouses in the community, family caregivers of ill elderly people, family caregivers of mentally ill people, and nurses as professional caregivers for elderly people in institutions. The studies are articulated using the three-level structure proposed by Fawcett & Downs (1986) and Fawcett (1991): conceptual-theoretical-empirical. This research program aims to renew understanding of the person's adaptation processes to various environmental stimuli, adaptive responses that influence health, and nursing interventions that promote health (i.e., biopsychosocial integrity). In order to specify the research variables and relations to be studied between these variables in the first phase of the program, each research project is also guided by a middle-range theory compatible with Roy's Adaptation Model. Elaborated within related disciplines, these theories are variations of the Stress and Coping theory of Lazarus & Folkman (1984). The results of these studies will be compared and articulated in a model that integrates the patterns of relations between the variables. The resulting empirical model together with Roy's conceptual model will be used to guide the development of nursing interventions intended to promote adaptive responses and biopsychosocial integrity. The second phase of the research program includes the implementation and evaluation of nursing strategies that promote adaptation among the four groups of people. This research program is a nursing contribution to certain social issues recognized as priorities by the governments of Canada and Québec. This article is an illustration of one of the various ways of developing nursing knowledge.

[Resources for preventing professional burnout]. / Ressources pour contrer l'épuisement professionnel.

Burnout in the nursing profession has been reported in the literature for the past decade. Yet few studies have identified the causative factors or the recommended resources for prevention and treatment. An exhaustive literature review by the authors produced over 300 articles--40 of which were selected and systematically analyzed. It became apparent that the contributing factors to nursing burnout include stressors relating to the nurse's role, tasks and interpersonal conflicts, and in particular, the lack of management and peer support. The nurse's susceptibility to burnout varied considerably and was dependent upon individual character traits such as hardiness. Hardy individuals demonstrated an ability to deal with life through qualities such as their ability to manage change; their sense of commitment, and their sense of control over their lives. According to the literature, these individuals are less susceptible to burnout manifestations. The article also identifies potential resources available to nurses and positive factors that could improve their adaptation to stressful situations or environments. In light of dwindling financial resources and increased nursing responsibilities, the authors advise steering nurses in a direction that will unite them with their peers, management, and their profession.

Nursing assignment patterns and patient outcomes.

This article analyzes nursing assignment patterns and patient outcomes critically and comprehensively. Synthesizing empirical data over the past eight years, patient outcomes such as patient satisfaction, and quality of care were examined in association with the main nursing assignment patterns encountered in the literature: case, functional, team, primary and modular. The research results examined do not clearly delineate one assignment pattern or another and it remains illusive, from this analysis, to answer the question most often asked of administrators: "What type of organizational mode would best contribute to the quality of care?" However, this analysis should lead towards decisional impetus for the implementation of new systems of delivery of care, in the present context of limited resources and nursing shortage.

[Case management. The nursing business of care or cost]. / La gestion de cas. Question de soins ou de coûts?

Less money spent on health services, cost-effectiveness, better productivity and more efficiency are some of the driving forces of contemporary "neo-liberalism" and political trends. How can nursing services and the profession's human values adapt in this difficult context? The authors describe the newest modality of patient care delivery system: nursing case management. They examine the factors and assumptions that led up to its development and point out the validity of asking some serious questions before embarking on the euphoria of case management.

Perceiving patient assignment methods through a conceptual framework.

For several decades, the nursing process has been the central issue for numerous nursing discussions. Definitions, meanings, sequences and steps as well as their significance have been presented within the context of given clinically oriented conceptual frameworks. On the other hand, the nursing process could be largely influenced by the organizational context in which it is exercised. This article shows how analyzing patient assignment methods through a conceptual framework permits a better understanding of the ways organizational factors impact upon nursing process quality. Nursing care is the central issue of nursing modalities which characterize the organization and provision of its delivery. In this analysis, these modalities are renamed patient assignment methods. They refer to the tasks, roles, policy and structure for allocating nursing personnel to patients for the provision of nursing care in a hospital unit (Kérouac, Duquette & Sandhu, 1990; Nunson, Beckman, Clinton, Kever & Simms, 1980). The synonyms for patient assignment method found in the literature are: nursing assignment patterns, nursing assignment systems, and organization mode of nursing care (McLennan, 1983). Whatever its name, a given modality does not occur by chance but, rather is a product of specific characteristics. Some of these characteristics pertain to the nursing process. These characteristics can be identified and better understood through a conceptual framework. Historically, patient assignment methods have been extensively described in the literature. The descriptions usually focus on their merits and limitations or their comparisons with one and another. To the best of our knowledge, they have not been analysed using a conceptual framework. This article demonstrates how patient assignment methods could be better understood through an analysis using a conceptual framework. This analysis aims to systematically examine the commonly used patient assignment methods: case, functional, team, primary and modular. Particular attention is paid to the variables that influence the patient assignment methods, for instance, patient characteristics, nursing resources and organizational support. Furthermore, the variables related to nursing process quality, such as, comprehensiveness, accountability, continuity, and coordination of care are also examined. This article is addressed to all nurses who wish to examine through new lenses some of the ways they deliver patient care. Knowing more about the patient assignment method one uses implies understanding the contribution of the organizational factors applicable to the nursing process. Moreover, it is a sure way of enhancing quality care when one has the knowledge of the philosophy, values, beliefs and meanings inherent in each assignment method.(ABSTRACT TRUNCATED AT 400 WORDS)

[A support group intended for women victimized by conjugal violence]. / Un groupe de soutien à l'intention des femmes victimes de violence conjugale.

For battered women, leaving the home and spending time in a shelter is only the first step of a long process of change that usually involves periodic crises. A support group has been set up to help these women establish new ways to relate with the outside world, ways that are meant to assist them in successfully going through this difficult phase of their lives. Based on Lifton's principles of affinity, presence and consolidation (1976), the authors highlight the value of reciprocity in the therapeutical relationship. In addition, the authors discuss issues relating to the main points affecting interventions with battered women who have spent time in a shelter.

[Systems for the delivery of health care]. / Les systèmes de prestation des soins.

Re-examining the role of the nurse, the authors remind us of the importance of understanding how our system of health care has evolved, as well as what it holds for the future. Presenting an historical overview of the past 50 years, they discuss concepts related to moving the profession forward and suggest the decade ahead offers key opportunities.