Not Very Welcoming: A Survey of Internationally Educated Nurses Employed in Canada

Countries around the world are struggling to cope with a shortage of nurses and are increasingly relying on internationally educated nurses to fill the gap. Internationally educated nurses represent 9% of the Canadian nursing workforce, but this is expected to grow as the shortage continues. This study aimed to identify and understand the experiences of internationally educated nurses who came to Canada to seek nursing work. Methods: A cross-sectional survey of a random sample of internationally educated nurses was conducted. Descriptive statistics were used to analyze the survey responses. The survey also included an open-ended question about experience with the move to Canada to work as a nurse. Responses to the open-ended question were content analyzed and triangulated with the survey data. Results: A total of 2,107 internationally educated nurses responded to the study (47% response rate). Most were female (95%) and married (80%), and almost half were from the Philippines (49%). Professional (e.g., salary & benefits, 60%) and personal (e.g., quality of life, 56%) reasons drove migration to Canada, but 76% reported no recruitment incentives, and most (56%) relied on friends and family for information about nursing in Canada. Significant barriers to practicing in Canada included the licensure exam (75%), and obtaining information about different types of practice in Canada (56%). Conclusions: The findings from this study provide important information about internationally educated nurses’ perceptions and experiences of coming to Canada to obtain work in nursing. Improving the means for seeking employment by overseas nurses is a key area that regulatory agencies, health managers and policy leaders need to understand and address. Strategies to improve the barriers nurses face, particularly those related to licensure are important considerations

Exploring the role of the nurse manager in supporting point-of-care nurses’ adoption of electronic health records: protocol for a qualitative research study

Introduction: An increasing number of electronic health record (EHR) systems have been implemented in clinical practice environments where nurses work. Findings from previous studies have found that a number of intended benefits of the technology have not yet been realised to date, partially due to poor system adoption among health professionals such as nurses. Previous studies have suggested that nurse managers can support the effective adoption and use of the technology by nurses. However, no known studies have identified what role nurse managers have in supporting technology adoption, nor the specific strategies that managers can employ to support their staff. Therefore, the purpose of this research is to better understand the role of the nurse manager in point-of-care nurses’ use of EHRs, and to identify strategies that may be effective in supporting clinical adoption. Methods and analysis This study will use a qualitative descriptive design. Interviews with both nurse managers and point-of-care nursing staff will be conducted in a Canadian mental health and addiction healthcare organisation where an EHR has been implemented. A semistructured interview guide will be used, and interviews will be audio recorded. Transcripts will be analysed using a directed content analysis technique. Strategies to ensure the trustworthiness of the data analysis procedure and findings will be employed. Ethics and dissemination Ethical approval for this study has been obtained. Dissemination strategies may include a paper submission to a peer-reviewed journal, a conference submission and meetings to share findings with the study site leadership team. Findings from this research will be used to inform a future study which aims to assess levels of competencies and perform a psychometric analysis of the Nursing Informatics Competency Assessment for the Nurse Leader instrument in a Canadian context

Understanding the use of standardized nursing terminology and classification systems in published research : a case study using the International Classification for Nursing Practice®

Background In the era of evidenced based healthcare, nursing is required to demonstrate that care provided by nurses is associated with optimal patient outcomes, and a high degree of quality and safety. The use of standardized nursing terminologies and classification systems are a way that nursing documentation can be leveraged to generate evidence related to nursing practice. Several widely-reported nursing specific terminologies and classifications systems currently exist including the Clinical Care Classification System, International Classification for Nursing Practice®, Nursing Intervention Classification, Nursing Outcome Classification, Omaha System, Perioperative Nursing Data Set and NANDA International. However, the influence of these systems on demonstrating the value of nursing and the professions’ impact on quality, safety and patient outcomes in published research is relatively unknown. Purpose This paper seeks to understand the use of standardized nursing terminology and classification systems in published research, using the International Classification for Nursing Practice® as a case study. Methods A systematic review of international published empirical studies on, or using, the International Classification for Nursing Practice® were completed using Medline and the Cumulative Index for Nursing and Allied Health Literature. Results Since 2006, 38 studies have been published on the International Classification for Nursing Practice®. The main objectives of the published studies have been to validate the appropriateness of the classification system for particular care areas or populations, further develop the classification system, or utilize it to support the generation of new nursing knowledge. To date, most studies have focused on the classification system itself, and a lesser number of studies have used the system to generate information about the outcomes of nursing practice. Conclusions Based on the published literature that features the International Classification for Nursing Practice, standardized nursing terminology and classification systems appear to be well developed for various populations, settings and to harmonize with other health-related terminology systems. However, the use of the systems to generate new nursing knowledge, and to validate nursing practice is still in its infancy. There is an opportunity now to utilize the well-developed systems in their current state to further what is know about nursing practice, and how best to demonstrate improvements in patient outcomes through nursing care

Embedding nursing interventions into the World Health Organization’s International Classification of Health Interventions (ICHI)

Objective: The International Classification of Health Interventions (ICHI) is currently being developed. ICHI seeks to span all sectors of the health system. Our objective was to test the draft classification’s coverage of interventions commonly delivered by nurses, and propose changes to improve the utility and reliability of the classification for aggregating and analyzing data on nursing interventions. Materials and methods: A two-phase content mapping method was used: (1) three coders independently applied the classification to a data set comprising 100 high-frequency nursing interventions; (2) the coders reached consensus for each intervention and identified reasons for initial discrepancies. Results: A consensus code was found for 80 of the 100 source terms: for 34% of these the code was semantically equivalent to the source term, and for 64% it was broader. Issues that contributed to discrepancies in Phase 1 coding results included concepts in source terms not captured by the classification, ambiguities in source terms, and uncertainty of semantic matching between ‘action’ concepts in source terms and classification codes. Discussion: While the classification generally provides good coverage of nursing interventions, there remain a number of content gaps and granularity issues. Further development of definitions and coding guidance is needed to ensure consistency of application. Conclusion: This study has produced a set of proposals concerning changes needed to improve the classification. The novel method described here will inform future health terminology and classification content coverage studies

Identifying best approaches for engaging patients and family members in health informatics initiatives: a case study of the Group Priority Sort technique

Background Patient engagement strategies in health service delivery have become more common in recent years. However, many healthcare organizations are challenged in identifying the best methods to engage patients in health information technology (IT) initiatives. Engaging with important stakeholders to identify effective opportunities can inform the development of a resource that addresses this issue and supports organizations in their endeavors. The purpose of this paper is to share our experience and lessons learned from applying a novel consensus-building technique in order to identify key elements for effective patient engagement in health IT initiatives. This will be done through a case study approach. Methods Patients, family members of patients, health professionals, researchers, students, vendor representatives and individuals who work in health IT roles in health organizations were engaged through a one-day symposium in Toronto, Canada in September, 2018. During the symposium, the Group Priority Sort technique was used to obtain structured feedback from symposium attendees in the context of small group discussions. Descriptive statistics and a content analysis were undertaken to analyze the data collected through the Group Priority Sort as well as participant feedback following the symposium. Results A total of 37 participants attended the symposium from a variety of settings and organizations. Using the Group Priority Sort technique, 30 topics were classified by priority to be included in a future resource. Participant feedback pertaining to the symposium and research methods was largely positive. Several areas of improvement, such as clarity of items, were identified from this case study. Conclusions The Group Priority Sort technique was an efficient method for obtaining valuable suggestions from a diverse group of stakeholders, including patients and family members. The specific priorities and feedback obtained from the symposium will be incorporated into a resource for healthcare organizations to aid them in engaging patients in health IT initiatives. Additionally, five important considerations were identified when conducting future work with the Group Priority Sort technique and are outlined in this paper

The acceptance of the clinical photographic posture assessment tool (CPPAT)

Abstract Background There is a lack of evidence-based quantitative clinical methods to adequately assess posture. Our team developed a clinical photographic posture assessment tool (CPPAT) and implemented this tool in clinical practice to standardize posture assessment. The objectives were to determine the level of acceptance of the CPPAT and to document predictors as well as facilitators of and barriers to the acceptance of this tool by clinicians doing posture re-education. Methods This is a prospective study focussing on technology acceptance. Thirty-two clinician participants (physical therapists and sport therapists) received a 3–5 h training workshop explaining how to use the CPPAT. Over a three-month trial, they recorded time-on-task for a complete posture evaluation (photo - and photo-processing). Subsequently, participants rated their acceptance of the tool and commented on facilitators and barriers of the clinical method. Results Twenty-three clinician participants completed the trial. They took 22 (mean) ± 10 min (SD) for photo acquisition and 36 min ± 19 min for photo-processing. Acceptance of the CPPAT was high. Perceived ease of use was an indirect predictor of intention to use, mediated by perceived usefulness. Analysis time was an indirect predictor, mediated by perceived usefulness, and a marginally significant direct predictor. Principal facilitators were objective measurements, visualization, utility, and ease of use. Barriers were time to do a complete analysis of posture, quality of human-computer interaction, non-automation of posture index calculation and photo transfer, and lack of versatility. Conclusion The CPPAT is perceived as useful and easy to use by clinicians and may facilitate the quantitative analysis of posture. Adapting the user-interface and functionality to quantify posture may facilitate a wider adoption of the tool

The Therapeutic Management of Back Pain With and Without Sciatica in the Emergency department: A Systematic review

Introduction An increasing number of patients are attending the Emergency Department (ED) with back pain with or without sciatica. There is evidence to suggest that medical management is varied and inconsistent. Objective The purpose of this study was to review the literature to determine the evidence base for the therapeutic management of adults presenting with back pain with or without sciatica in the ED. Methods A systematic review of the literature included the therapeutic management of patients presenting in the ED. Articles published in peer review journals in English language up to August 2018 were searched for in the following data-bases: MEDLINE, EMBASE, SCOPUS, CINAHL, ZETOC, PubMed, The Cochrane Library (Cochrane Database of Systematic Reviews), Web of Science, Open Grey and ETHOS. A narrative synthesis approach was followed. Results Twenty two studies, including 17 randomised control trials, one randomised control pilot study, two cohort studies, one cohort pilot study and one retrospective audit were included. The Downs and Black methodological quality scores ranged from 16 to 31 with a mean score of 24 out of a possible 32. Conclusion Evidence suggests that Naproxen alone should be considered as first line management in cases of back pain without sciatica. Intra-venous corticosteroids should be considered in the management of cases of severe sciatica. More high quality trials are needed to determine an evidence-based management protocol for the treatment of acute low back pain in the ED, specifically focusing on non-pharmacological management and the first line management of patients presenting with LBP with sciatica

Understanding nurses' perceptions of electronic health record use in an acute care hospital setting

As Canadian healthcare organizations implement electronic health records (EHRs), nurses are expected to use the technology in their practice. Findings of a literature review suggest that usability (ease of use, functionality, navigation and impact on workload), the organizational context (support from leadership, level of training, level of on-going support, physical environment and implementation process) and individual nurse characteristics (sex, age, nursing unit, years of experience as a registered nurse, country of nursing education, years of experience using an EHR, previous EHR use and formal informatics training) influence nurses’ use of these systems. Thus, the purpose of this doctoral research was to better understand the relationships between the variables that make up usability, organizational context, individual nurse characteristics, and nurses’ perceptions of EHR use. This study was conducted using a sequential mixed methods design with two phases. Phase One consisted of a cross sectional survey that was piloted and then administered to nurses in an acute care teaching hospital in Toronto, Canada. The aim of the survey was to obtain information about nurses’ perceptions of the usability of the EHR, the organizational context, their individual nurse characteristics and their use of the system. Phase two involved focus groups to better understand the findings identified in the survey. Multivariable and hierarchical linear regression was conducted. A multivariable model made up of the variables ease of use, navigation and impact on workload, explained 13% of the variance in nurses’ perceptions of EHR use, however navigation was the only significant predictor in the model. In the data from the focus groups, nurses described how they navigated through the EHR, and which functionalities supported or hindered their use of it. Results of this study provide insights into factors that may influence nurses’ use of EHRs in an acute care hospital setting that have implications for research, nurse leaders, vendors, healthcare settings and nursing practice.Ph.D