Rural-Focused Nursing Education: A Summative Evaluation of RNs’ Experiences of the Rural Nursing Certificate Program

Nurses working in rural and remote communities perform multi-dimensional and complex roles. They require education opportunities that support them in providing the best healthcare possible to rural populations. However, the location and content of existing education programs often make them inaccessible and unsuitable to the context of rural nursing practice. In order to address this gap, the Rural Nursing Certificate Program (RNCP) was implemented and evaluated as a pilot project between 2007 and 2010. The RNCP is a provincial program that delivers practice-driven curriculum via e-learning modes and practical experiences to Registered Nurses (RNs) in rural communities throughout British Columbia, Canada. This paper reports on the summative evaluation of the program with respect to learning outcomes. It addresses the following research question: In what ways has the implementation of this practice-driven model of nursing education influenced nursing practice? Participants gave concrete and compelling examples of how RNs’ levels of confidence and competence rose as a result of their education, and evidence obtained from both nurses and their managers indicated that RNs improved their practice, increased their knowledge, and developed important skills around research and evidence, effective communication, and teamwork. In addition to raising their levels of competence and confidence, participants reported that their engagement in the RNCP expanded their opportunities and increased their overall job satisfaction. RNs also experienced some challenges while in the RNCP, the most significant being time-management and workload. We conclude that these learning outcomes bode well for supporting recruitment and retention efforts, and may contribute to improving patient outcomes. _ Résumé Les infirmières travaillant dans des communautés éloignées et rurales jouent des rôles complexes et multidimensionnels. Elles ont besoin d’offres de formation pour les aider à fournir les meilleurs soins de santé possible aux populations rurales. Or, le contenu des programmes de formation existants ainsi que les endroits où ils sont offerts les rendent difficiles d’accès et incompatibles avec la pratique infirmière en milieu rural. Afin de combler cette lacune, le programme de certificat en sciences infirmières en milieu rural (Rural Nursing Certificate Program [RNCP]) a été mis en œuvre et a servi de projet pilote de 2007 à 2010. Le RNCP est un programme provincial qui offre aux infirmières autorisées (IA) des communautés rurales de la Colombie-Britannique (Canada) un programme d’études axé sur la pratique grâce à des modes d’apprentissage en ligne et à des expériences pratiques. Le présent article fait état de l’évaluation sommative du programme en ce qui a trait aux résultats d’apprentissage. La question de recherche était la suivante : En quoi la mise en œuvre de ce modèle de formation en sciences infirmières axé sur la pratique a-t-il influé sur la pratique infirmière? Les participantes ont donné des exemples concrets et convaincants de la mesure dans laquelle se sont accrus les niveaux de compétence et de confiance des IA à la suite de leur formation. Les données obtenues, tant des infirmières que de leurs gestionnaires, ont indiqué que les IA avaient amélioré leur pratique, approfondi leurs connaissances et acquis d’importantes aptitudes en matière de recherche et de données probantes, de communication efficace et de travail en équipe. En plus de renforcer leurs niveaux de compétence et de confiance, les participantes ont indiqué que leur participation au RNCP leur avait permis d’élargir l’éventail de leurs possibilités et d’accroître leur satisfaction générale à l’égard de leur travail. Les IA ont également dû relever quelques défis dans le cadre du RNCP, le plus important étant la gestion du temps et la charge de travail. Nous pouvons conclure que ces résultats d’apprentissage sont très prometteurs pour appuyer les efforts de recrutement et de rétention dans ces milieux et que le programme peut contribuer à l’amélioration des résultats pour les patients

The development of the Canadian rural health research society: Creating capacity through connections

Context: The organization of rural health research in Canada has been a recent development. Over the past 8 years, rural and remote researchers from more than 15 universities and agencies across Canada have engaged in a process of research capacity building through the development of a network, the Canadian Rural Health Research Society (CRHRS) among the scientifically and geographically diverse researchers and their community partners. The purpose of this article is to discuss the development of the CRHRS as well as the challenges and lessons learned about creating networks and building capacity among rural and remote health researchers. Issue: Key elements of network development have included identifying and developing multidisciplinary research groupings, maintaining ongoing connections among researchers, and promoting the sharing of expertise and resources for research training. The focus has been on supporting research excellence among networks of researchers in smaller centres. Activities include a national annual scientific meeting, the informal formation of several regional and national research networks in specific areas, and the development of training opportunities. Challenges have included the issues of sustaining communication, addressing a range of networking and capacity-enhancement needs, cooperating in an environment that rewards competition, obtaining resources to support a secretariat and research activities, and balancing the demands to foster research excellence with the needs to create infrastructure and advocate for adequate research funding. Lessons learned: The CRHRS has learned how to begin to support researchers with diverse interests and needs across sectors and wide geographical areas, specifically by: (1) focusing on research development through creating and supporting trusting connections among researchers; (2) building the science first, followed by infrastructure development; (3) making individual researchers the nodes in the network; (4) being inclusive by accommodating a wide variety of researchers and researcher strengths; (5) emphasizing social exchange, knowledge exchange, and mentoring in annual scientific meetings; (6) taking opportunities to develop separate projects while finding ways to link them; (7) finding a balance between advancing the science and advocating for adequate funding and appropriate peer review; (8) developing a network organizational structure that is both stable and flexible; and (9) maintaining sustained visionary leadership.Jennifer Richmond (production editor for Rural and Remote Health

Experience of Health Leadership in Partnering With University-Based Researchers in Canada – A Call to “Re-imagine” Research

Background: Emerging evidence that meaningful relationships with knowledge users are a key predictor of research use has led to promotion of partnership approaches to health research. However, little is known about health system experiences of collaborations with university-based researchers, particularly with research partnerships in the area of health system design and health service organization. The purpose of the study was to explore the experience and perspectives of senior health managers in health service organizations, with health organization-university research partnerships. Methods: In-depth, semi-structured interviews (n = 25) were conducted with senior health personnel across Canada to explore their perspectives on health system research; experiences with health organization-university research partnerships; challenges to partnership research; and suggested actions for improving engagement with knowledge users and promoting research utilization. Participants, recruited from organizations with regional responsibilities, were responsible for system-wide planning and support functions. Results: Research is often experienced as unhelpful or irrelevant to decision-making by many within the system. Research, quality improvement (QI) and evaluation are often viewed as separate activities and coordinated by different responsibility areas. Perspectives of senior managers on barriers to partnership differed from those identified in the literature: organizational stress and restructuring, and limitations in readiness of researchers to work in the fast-paced healthcare environment, were identified as major barriers. Although the need for strong executive leadership was emphasized, “multi-system action” is needed for effective partnerships. Conclusion: Common approaches to research and knowledge translation are often not appropriate for addressing issues of health service design and health services organization. Nor is the research community providing expertise to many important activities that the healthcare system is taking to improve health services. A radical rethinking of how we prepare health service researchers; position research within the health system; and fund research activities and infrastructure is needed if the potential benefits of research are to be achieved. Lack of response to health system needs may contribute to research and ‘evidence-informed’ practice being further marginalized from healthcare operations. Interventions to address barriers must respond to the perspectives and experience of health leadership

Aboriginal nurses: Insights from a national study

© Canadian Nurses Association. Reproduced with permission. Further reproduction is prohibited.Aboriginal registered nurses have been identified as an essential group in the delivery of health services in First Nations communities. Despite this, there is a lack of information about this group of nurses in Canada. This article presents information about this group taken from two components of a national study, The Nature of Nursing Practice In Rural and Remote Canada: documentary analysis and a national survey of nurses. The Aboriginal nurse participants were predominantly female, between the ages of 40 and 49, diploma prepared and with licensure for less than 10 years. The survey data showed 41.4 per cent returned to their home communities to work. The participants noted how they enjoyed the challenges of rural and remote nursing and wanted to raise their families in these small communities. They have been able to create supportive work environments, particularly with their nursing colleagues. The nurses are committed to working in rural and remote communities

Transitions in a PhD in Nursing Program: A Critical Reflection on Students' Perceptions

Introduction: The purpose of this critical reflection is to share the collective experiences of eight doctoral students transitioning through a PhD nursing program at a Canadian University. Background: Globally, a nursing shortage of over a million nurses threatens to significantly impact patient safety and quality of care. One proposed response to the nursing shortage is to increase enrollment of students in nursing programs, with the aim of graduating more qualified nurses. However, a concurrent shortage of nursing faculty is impacting the profession’s ability to effectively respond to this issue, with fewer nurses completing doctorate degrees than there are existing vacant faculty positions. We propose that one solution to address the nursing faculty shortage, and to ensuring that nursing can respond to the ever-increasing complexity of patient care, is to improve the doctoral student transition process. Method: We used critical reflection to explore our experiences of transitioning into a PhD in Nursing program. Virtual group meetings via an online conferencing platform were conducted using a semi-structured interview format. Using the Bridges Transition Model (BTM) as a theoretical framework, we organized our reflections using the three phases from the BTM framework: ending, neutral zone, and new beginning. As this was a critical reflection, where all participants are also listed as authors, formal ethics approval was not required. Discussion: The ending phase symbolized the transition into the PhD program while still maintaining former professional roles and was characterized by a sense of loss of identity. Moving from the ending phase into the neutral zone phase required realignment of priorities, a shift in self-identity, and recognizing what facilitators are needed to transition. When navigating the neutral zone, we considered new roles and relationships and how they could provide support during this phase. Our transition from the neutral zone to the new beginnings phase extended beyond the PhD program to include the transition to life after the PhD. While some looked forward with hope and anticipation of the new beginning phase, others highlighted the uncertainties of post-PhD life. We identified community building and career mentoring as two strategies that might ease transitions and help PhD students with degree completion. Conclusions: This paper contributes to the literature on doctoral students’ experiences as they transition through a PhD in Nursing program. We recommend that nursing faculties incorporate strategies such as career coaching and formal supports for the development of student-led communities of practice. Helping PhD students navigate transitions associated with completion of the degree may reduce attrition and increase the potential supply of tenure-track nursing faculty. Résumé Introduction : L’objectif de cette réflexion critique est de partager les expériences communes de huit doctorantes et doctorants lors de leur transition dans un programme de PhD en sciences infirmières d’une université canadienne. Contexte : À l’échelle mondiale, il manque plus d’un million d’infirmières et d’infirmiers dans la profession. Cette pénurie représente une menace significative pour la sécurité des patients et la qualité des soins. Une des solutions proposées pour faire face à cette pénurie est d’augmenter le nombre de personnes inscrites aux programmes de sciences infirmières afin de former davantage de personnes qualifiées. Toutefois, la pénurie simultanée de membres du corps professoral dans le domaine limite la capacité de relever efficacement ce défi, car le nombre d’infirmières et infirmiers qui terminent leur doctorat est inférieur au nombre de postes vacants au sein du corps professoral. Afin de remédier à cette pénurie de professeures et professeurs et de garantir que la profession puisse répondre à la complexité croissante des soins aux patients, nous suggérons d’améliorer le processus de transition des étudiantes et étudiants au doctorat. Méthode : L’équipe de recherche a opté pour une approche de réflexion critique afin d’explorer nos expériences de transition vers le programme de PhD en sciences infirmières. Des réunions virtuelles de groupe via une plateforme de visioconférence ont été menées en utilisant le format des entrevues semi-structurées. Le modèle de transition de Bridges (BTM) a servi de cadre théorique pour l’organisation de nos réflexions, nous appuyant sur ses trois phases : la fin, la zone neutre et le nouveau départ. Étant donné qu’il s’agissait d’une réflexion critique où tous les participants agissaient également comme auteures ou auteurs, aucune approbation éthique formelle n’était requise. Discussion : La phase de fin représentait la transition vers le programme de PhD tout en maintenant des rôles professionnels et était caractérisée par un sentiment de perte d’identité. Afin de passer de la phase de fin à la zone neutre, il était nécessaire de réaligner les priorités, de modifier son identité personnelle et de reconnaître les facteurs favorisant la transition. En naviguant dans la zone neutre, de nouveaux rôles et de nouvelles relations étaient explorés en considérant la façon dont ils pourraient apporter du soutien durant cette période. La transition de la zone neutre vers la phase nouveau départ s’étendait au-delà du programme dans le but d’y inclure la transition vers la vie après l’obtention du PhD. Alors que certains d’entre nous entrevoyaient cette phase nouveau départ avec optimisme et enthousiasme, d’autres ont souligné les incertitudes liées à la vie après l’obtention du doctorat. Nous avons cerné deux stratégies pouvant soutenir les transitions et aider les étudiantes et étudiants au doctorat à obtenir leur grade : la création de communautés et le mentorat pour la carrière. Conclusions : Cet article contribue à la littérature sur les expériences des doctorantes et doctorants au sein d’un programme de PhD en sciences infirmières. Nous recommandons vivement aux facultés de sciences infirmières d’intégrer des stratégies telles que le coaching de carrière et la mise en place d’un soutien formel pour favoriser le développement de communautés de pratique menées par la population étudiante. En aidant les étudiantes et étudiants au doctorat à naviguer les transitions liées à l’obtention de leur grade, le taux d’attrition pourrait être réduit et le nombre de potentiels membres du corps professoral occupant des postes menant à la permanence pourrait être augmenté

Kreis, Georg: Insel der unsicheren Geborgenheit. Die Schweiz in den Kriegsjahren 1914–1918 (Rezension)

Investigations of elemental abundances in the ancient and most metal deficient stars are extremely important because they serve as tests of variable nucleosynthesis pathways and can provide critical inferences of the type of stars that lived and died before them. The presence of r-process elements in a handful of carbon-enhanced metal-poor (CEMP-r) stars, which are assumed to be closely connected to the chemical yield from the first stars, is hard to reconcile with standard neutron star mergers. Here we show that the production rate of dynamically assembled compact binaries in high-z nuclear star clusters can attain a sufficient high value to be a potential viable source of heavy r-process material in CEMP-r stars. The predicted frequency of such events in the early Galaxy, much lower than the frequency of Type II supernovae but with significantly higher mass ejected per event, can naturally lead to a high level of scatter of Eu as observed in CEMP-r stars.Comment: 6 pages, 5 figures, ApJL in press. Revised to include binary-single encounter

Prediction of storm transfers and annual loads with data-based mechanistic models using high-frequency data

Excess nutrients in surface waters, such as phosphorus (P) from agriculture, result in poor water quality, with adverse effects on ecological health and costs for remediation. However, understanding and prediction of P transfers in catchments have been limited by inadequate data and over-parameterised models with high uncertainty. We show that, with high temporal resolution data, we are able to identify simple dynamic models that capture the P load dynamics in three contrasting agricultural catchments in the UK. For a flashy catchment, a linear, second-order (two pathways) model for discharge gave high simulation efficiencies for short-term storm sequences and was useful in highlighting uncertainties in out-of-bank flows. A model with nonlinear rainfall input was appropriate for predicting seasonal or annual cumulative P loads where antecedent conditions affected the catchment response. For second-order models, the time constant for the fast pathway varied between 2 and 15 h for all three catchments and for both discharge and P, confirming that high temporal resolution data are necessary to capture the dynamic responses in small catchments (10–50 km2/. The models led to a better understanding of the dominant nutrient transfer modes, which will be helpful in determining phosphorus transfers following changes in precipitation patterns in the future

Accuracy, acceptability and feasibility of photography for use in trachoma surveys: a mixed methods study in Tanzania

BACKGROUND: Photography could be used to train individuals to diagnose trachomatous inflammation-follicular (TF) as trachoma prevalence decreases and to ensure accurate field TF grading in trachoma prevalence surveys. We compared photograph and field TF grading and determined the acceptability and feasibility of eyelid photography to community members and trachoma survey trainers. METHODS: A total of 100 children ages 1-9 y were examined for TF in two Maasai villages in Tanzania. Two images of the right everted superior tarsal conjunctiva of each child were taken with a smartphone and a digital single-lens reflex (DSLR) camera. Two graders independently graded all photos. Focus group discussions (FGDs) were conducted with community members and Tropical Data trainers. RESULTS: Of 391 photos, one-fifth were discarded as ungradable. Compared with field grading, photo grading consistently underdiagnosed TF. Compared with field grading, DSLR photo grading resulted in a higher prevalence and sensitivity than smartphone photo grading. FGDs indicated that communities and trainers found photography acceptable and preferred smartphones to DSLR in terms of practicalities, but image quality was of paramount importance for trainers. CONCLUSIONS: Photography is acceptable and feasible, but further work is needed to ensure high-quality images that enable accurate and consistent grading before being routinely implemented in trachoma surveys

Identification of Parameters That Predict Sport Climbing Performance

In recent years, extreme sport-related pursuits including climbing have emerged not only as recreational activities but as competitive sports. Today, sport climbing is a rapidly developing, competitive sport included in the 2020 Olympic Games official program. Given recent developments, the understanding of which factors may influence actual climbing performance becomes critical. The present study aimed at identifying key performance parameters as perceived by experts in predicting actual lead sport climbing performance. Ten male (Mage = 28, SD = 6.6 years) expert climbers (7a+ to 8b on-sight French Rating Scale of Difficulty), who were also registered as climbing coaches, participated in semi-structured interviews