Supporting primary health care nurse practitioners' transition to practice.

OBJECTIVE: To examine role transition and support requirements for nurse practitioner (NP) graduates in their first year of practice from the perspectives of the NPs and coparticipants familiar with the NPs' practices; and to make recommendations for practice, education, and policy. DESIGN: Descriptive qualitative design informed by focused ethnography and narrative analysis using semistructured, in-depth, qualitative interviews. SETTING: Primary health care (PHC) settings in Ontario in which NPs worked. PARTICIPANTS: Twenty-three NPs who had graduated from the Ontario Primary Health Care Nurse Practitioner program, and 21 coparticipants including family physicians, NPs, and managers who were familiar with the NPs' practices. METHODS: Anglophone and francophone NPs in their first year of practice in PHC settings were contacted by e-mail or letter. Participating NPs nominated colleagues in the workplace who could comment on their practice. Interviews were conducted within the first 3 months, at 6 months, and at 12 months of the NPs' first year of practice and were transcribed verbatim and coded. Job descriptions and organizational charts demonstrating the NPs' organization positions were also analyzed. The researchers collaboratively analyzed the interviews using a systematic data analysis protocol. MAIN FINDINGS: Familiarity of colleagues and employers with the NP role and scope of practice was an important element in successful NP role transition. Lack of preparation for integrating NPs into clinical settings and lack of infrastructure, orientation, mentorship, and awareness of the NP role and needs made the transition difficult for many. One-third of the NPs had changed employment, identifying interprofessional conflict or problems with acceptance of their role in new practice environments as reasons for the change. CONCLUSION: The transition of NP graduates in Ontario was complicated by the health care environment being ill-prepared to receive them owing to rapid changes in PHC. Strategies for mentorship and for the integration of new NPs into PHC settings are available and need to be implemented by health professionals and administrators. Recommendations for family physicians to support NP graduate transition into practice are provided.

Concept analysis: the importance of differentiating the ontological focus.

AIM: The aim of this paper is to clarify the philosophical underpinnings of concepts and concept analysis and the implications of their use through the lens of particular ontological perspectives. BACKGROUND: Information on the philosophical foundations of concepts from an ontological and epistemological perspective is not readily identifiable in the international literature. Although some authors have made reference to the ontological perspectives of specific concept analysis processes, none have addressed the implications of the realist or relativist perspective in relation either to the analysis process or the implications of a particular ontological perspective on the meaning and utility of a specific concept. METHOD: We describe the evolution of concept analysis and influence of ontological paradigms on specific analysis methods. Using an historical review of concept development within nursing thought, we decode the language of concepts and processes of concept analysis, outline the importance of the ontological foundation of concept development, and describe the impact of concept use. DISCUSSION: The nursing literature is dominated by concepts created from a realist perspective. Although recent nurse-authors have introduced evidence-based data to facilitate the development of a number of concepts, they have held fast to the perception that the 'best', most adequate or mature concepts transcend context. CONCLUSION: The theoretical shift from context-bound empirical analysis of concepts belies the complexity of nurses' work. Concepts are unapologetically context-bound. A concept that transcends context (based on realist ontology) will remain the same even when the context of praxis changes limiting its utility.

Field notes and theoretical memos in grounded theory.

In this article the authors expose some of the mystique surrounding field notes and theoretical memos in a Glaserian grounded theory study. Definitions, types, and content of field notes and theoretical memos are presented. Exemplars from a study of mothers living with serious mental illness are provided to illustrate how these forms of documentation evolved during the course of the study. The authors argue that, although the processes of field noting and memoing may blur as a study progresses, they nevertheless retain their independent functions. The authors contend that without understanding the complementary function of these two types of documentation, data cannot evolve to a higher interpretive level. This article contributes specific ideas for improving the methods used by qualitative nurse researchers.

Death stories: acute exacerbations of chronic obstructive pulmonary disease.

The underlying premise of narrative research within social science literature is the belief that individuals most effectively make sense of their world by (re)constructing stories. Chronic Obstructive Pulmonary Disease (COPD) is a progressive degenerative respiratory disorder that affects approximately 15% of Canadians annually. Prior to the study discussed in this article, no research had been done to understand the frightening event of an acute exacerbation episode of COPD from the perspective of patients and their family caregivers. Hence, 10 family-nurse units were interviewed during an acute exacerbation event. The participants told a number of near-death and shadow-of-death stories that describe these episodes as life changing and illustrate the centrality of these events in the participants' understanding of their chronic illness.

Finding your way around qualitative methods in nursing research.

The intention of this paper is to assist neophyte and traditionally educated nurse-researchers to navigate the qualitative research literature with understanding. The labelling language describing the central structures of the qualitative paradigm will be discussed as the key element to facilitating insight. The 'trustworthiness' of this research perspective will also be addressed within the context of the nursing research literature.

Assuring quality in narrative analysis.

Many nurse-researchers using qualitative strategies have been concerned with assuring quality in their work. The early literature reveals that the concepts of validity and reliability, as understood from the positivist perspective, are somehow inappropriate and inadequate when applied to interpretive research. More recent literature suggests that because of the positivist and interpretive paradigms are epistemologically divergent, the transfer of quality criteria from one perspective to the other is not automatic or even reasonable. The purpose of this article, therefore, is to clarify what the terms quality, trustworthiness, credibility, authenticity, and goodness mean in qualitative research findings. The process of assuring quality, validation, in qualitative research will be discussed within the context of the interpretive method, narrative analysis. A brief review of quality in narrative analysis nursing research will also be presented.

Tobacco use in northeastern Ontario teenagers: prevalence of use and associated factors.

Although health risks associated with the use of tobacco have been identified, little is known about tobacco use in Northeastern Ontario. Boys and girls aged 11 to 19 were located using a random telephone survey method. Of particular interest was the use of smokeless tobacco, since prevalence of use has increased in other Canadian locales. Respondents were assessed regarding demographic data, tobacco use, leisure interests and locus of control. Results indicated that current use of snuff and chewing tobacco is negligible in this population, although many teens (20.7%) are unaware of dangers associated with smokeless tobacco use. Cigarette smoking continues at a rate of 16.7%, even when dangers associated with smoking are known. Smoking was significantly associated with living in a two-parent household, teen employment and peer pressure.

A heart health survey at the worksite: the first step to effective programming.

1. Cardiovascular disease is the number one killer in Canada, accounting for 42% of all deaths. 2. Workplace policy and health promotion programs can have a significant impact on modifiable risk factors associated with the development of heart disease. 3. This article describes the results of a worksite cardiovascular risk behavior screening of 652 mining employees in Sudbury, Ontario. 4. The theoretical framework for this study is based on the PRECEDE-PROCEED model: to reach the ultimate outcome, improved quality of life changes must be made at both the individual as well as the environmental (workplace) level (Green, 1991).

Combined mother and baby care: does it meet the needs of families?

Combined mother/baby care is thought to be an effective way to prepare a family for the changing roles and added responsibilities that the arrival of a new baby entails, but few studies have evaluated this care delivery system. Therefore, the postpartum staff at Sudbury General Hospital conducted a post-test control group study design with a self-selected sample of postpartum mothers when the unit was changing from traditional to combined mother/baby care. One hundred and three mothers who received traditional care and 102 who had combined mother/baby care completed a questionnaire to assess perceptions of their own competence and satisfaction with the type of care administered. There were no significant differences between the two study groups. Factors that may have confounded the results include: insufficient time between institution of the program and its evaluation, and the quality of prenatal education received. Multiparous mothers scored higher on self care, infant care, and maternal competence than did primiparous mothers regardless of the care delivery system. Maternal concerns related to immediate needs. Future research should take the differences between primiparas and multiparas into account, and focus on the less immediate needs of mothers.

Anxiety and family needs of the relatives of cardiac medical-surgical ICU patients.

The purpose of this study was to seek information on the perceived needs of family members visiting a patient in a critical care unit (ICU) of two hospitals located in Sudbury, Ontario. The sample included fifty-one family members visiting cardiovascular surgical patients (CVS) and forty-four family members visiting cardiovascular medicine patients (CVM). The study was part of a larger project conducted on a convenience sample of 166 subjects visiting an ICU patient. Data was gathered using a self-report questionnaire, the Critical Care Family Needs Inventory (CCFNI) (Molter and Leske, 1983), and Spielberger's (1983) State Trait Anxiety Inventory (STAI). Information was also collected about worries, knowledge, spiritual needs and the distance of subjects' residence from the site of hospitalization. The sample for both groups was predominantly female. The State Anxiety Scale of the STAI yielded mean scores for both groups which were significantly higher than those obtained by Spielberger (1983) (CVS: z = -3.28, p less than .0001; CVM: z = -3.41, p less than .0001).

Evaluation of long-term sensory changes following mandibular augmentation procedures.

Having undergone mandibular augmentation using several osteotomy techniques, 12 patients were evaluated for long-term sensory changes in the mental nerve distribution. The mean follow-up period was 32 months. The evaluation included both subjective and objective testing. Objectivity was achieved via the two-alternative forced-choice technique in testing light touch, thermal, and brush directional discrimination. All patients reported persistent subjective neurosensory alteration at the mental nerve distribution, four of which were judged as dysesthetic. Objective sensory alteration was observed in all three modalities tested, with brush directional discrimination most greatly affected, followed by light touch and then thermal discrimination. It was concluded that mandibular augmentation procedures requiring repositioning of the inferior alveolar neurovascular bundle lead to both subjective and objective neurosensory alteration, which were shown to be persistent at long-term follow up.