An examination of retention factors among registered practical nurses in north-eastern Ontario, Canada.

INTRODUCTION: Literature from the past two decades has presented an insufficient amount of research conducted on the nursing practice environments of registered practical nurses (RPNs). The objective of this article was to investigate the barriers and facilitators to sustaining the nursing workforce in north-eastern Ontario (NEO), Canada. In particular, retention factors for RPNs were examined. METHODS: This cross-sectional research used a self-administered questionnaire. Home addresses of RPNs working in NEO were obtained from the College of Nurses of Ontario (CNO). Following a modified Dillman approach with two mail-outs, survey packages were sent to a random sample of RPNs (N=1337) within the NEO region. Logistic regression analyses were used to determine intent to stay (ITS) in relation to the following factor categories: demographic, and job and career satisfaction. RESULTS: Completed questionnaires were received from 506 respondents (37.8% response rate). The likeliness of ITS in the RPNs' current position for the next 5 years among nurses aged 46-56 years were greater than RPNs in the other age groups. Furthermore, the lifestyle of NEO, internal staff development, working in nursing for 14-22.5 years, and working less than 1 hour of overtime per week were factors associated with the intention to stay. CONCLUSIONS: Having an understanding of the work environment may contribute to recruitment and retention strategy development. The results of this study may assist with addressing the nursing shortage in rural and northern areas through improved retention strategies of RPNs.

"Sneaky disease": the body and health knowledge for people at risk for coronary heart disease in Ontario, Canada.

The contribution of modifiable risk factors to the prevalence of coronary heart disease (CHD) has been well documented in the literature. A focus group component of a cardiovascular risk reduction project, The Community Outreach in Heart Health and Risk Reduction Trial was designed to explore issues that facilitate or constrain individual efforts to implement changes to health behaviours. Eight focus groups were conducted in urban, northern and rural sites in Ontario, Canada. In this article, we elaborate on the difficulties all group members experienced as they attempted to interpret their personal candidacy for CHD. For many participants, CHD was an undetectable or "sneaky disease" in its earlier stages, thus coronary risk was to them an abstract concept that could not ordinarily be detected through sensory perception. Participants drew on three possible strategies to determine their candidacy for CHD: they cognitively engaged in weighing risks, they relied on the interpretive powers of medical hermeneutics, or they waited for "the big event". The findings suggest that lay understandings of the body and health differ from those of health professionals and educators, and that lay understandings differ according to SES and gender. This has implications for health literacy and must be considered in devising strategies for health education.

Measuring quality of life in cardiac rehabilitation clients.

Quality of life is being increasingly considered as an expected outcome of cardiac rehabilitation programs. However, few instruments exist that reflect a multidimensional concept of quality of life including disease specific items. This article outlines the method used by researchers to adapt Padilla and Grant's [Padilla, G., Grant, M., 1985. Quality of life as a cancer nursing outcome variable. Adv. Nursing Sci. 8(1), 45-60.] Quality of Life Index for use with a cardiac rehabilitation population. A convenience sample of 222 subjects included three groups: 95 cardiac subjects enrolled in a program; 51 cardiac subjects not enrolled in a program; and 76 healthy individuals. Test-retest reliability yielded a coefficient of 0.81 and an alpha coefficient of 0.87. Exploratory factor analysis resulted in a five factor solution. These factors explained 60.8% of the variance at loadings of 0.43 or greater. Contrasted groups approach to validity showed that the instrument differentiated between healthy subjects and those with cardiac illness (t = 11.57; df = 180; p < 0.0001). As anticipated convergent validity revealed a positive correlation between total scores obtained from Spitzer's [Spitzer, W.O., Dobson, A.J., Hall, A., Chesterman, E., Levy, J., Shepherd, R., Battista, R.N., Catchlove, B.R., 1981. Measuring the quality of life in cancer patients: A concise QL index for use by physicians. J. Chronic Dis. 34, 585-597.] global measure of quality of life and the Cardiac Quality of Life Index (r = 0.67; p < 0.0001). This work is preliminary. Refinement and development of the instrument is ongoing.

The Quality of Life Profile--Adolescent Version: background, description, and initial validation.

PURPOSE: Emerging concepts of adolescent health were considered within a broadened quality of life perspective. Instrumentation examining quality of life-the extent to which a person enjoys the important possibilities of his/her life-in three broad domains of adolescent functioning: being, belonging, and becoming, was developed and validated. METHODS: The 54-item Quality of Life Profile: Adolescent Version (QOLPAV) asks adolescents to rate items for importance and satisfaction. The QOLPAV was administered, together with a range of other measures of adolescent functioning, to 160 Canadian adolescents. RESULTS: QOLPAV scores were reliable and correlated with measures of adolescent personality, self-reported health status, and tobacco and alcohol use. CONCLUSIONS: With further validation, the QOLPAV could be used to assess current states of coping and functioning, identify adolescents' service needs, develop health enhancing environments, and assess the effects of illness and treatments.

A quality-of-life index for clients with ischemic heart disease: establishing reliability and validity.

This article describes the method the authors will use to develop a valid and reliable instrument to measure quality of life as an outcome measure of a cardiac rehabilitation program. A discussion of the difficulties in conceptualizing and measuring quality of life and a summary of the contribution of prior studies to the development of the instrument are presented. Implications for cardiovascular nursing practice are also discussed.

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).

A multifactorial study of test anxiety and coping responses during a challenge examination.

Challenge examinations offer registered nurse students enrolled in our baccalaureate nursing programme the opportunity to demonstrate mastery of course content through a testing process. Successful students receive credit for the course while those who are unsuccessful must take the course to proceed in the programme. Faculty observations of registered nurse students during the challenge process suggested this testing was stressful. Therefore, a study was conducted to determine anxiety levels and coping strategies of on-campus and distance education registered nurse students at three different times during the challenge examination process. Differences between the two groups of nursing students on selected demographic variables, past academic performance, anxiety levels and coping strategies were assessed from the perspective of Folkman & Lazarus's (1984) theory of stress and coping. Significant differences were found in anxiety levels, coping strategies and past academic performance by age, marital status, employment and work setting. Several different coping strategies were used. However, problem solving was used extensively by both groups while social support was used more by the on-campus students. The results are discussed in terms of Folkman & Lazarus's theory of stress and coping, and implications for nurse educators are presented.

Understanding post operative psychosis and sleep deprivation: a case approach.

The care of a critically ill, intensive care unit patient dangerously out of touch with reality, is a challenge requiring exceptional problem solving skills. This article will discuss the nursing management of a distressing, unusual case of post-operative psychosis. Specifically, this case involved a patient who suddenly became psychotic on his first post-operative day after having an atrial septal defect repair. The patient's self-destructive actions and the innovative strategies used by nursing staff to effectively intervene are described. Discussion of the complex interrelationship of factors that contributed to this patient's erratic behaviour is highlighted. Questions about the effects of sleep deprivation are raised.

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).

Hassles, uplifts, and anxiety reported by Post-RN students in a BScN programme.

This study examined the daily hassles, uplifts and anxiety of registered nurse students (Post-RN) during a Community Health Nursing challenge examination in a baccalaureate nursing programme. The objectives of the first phase of this study were 1) to identify the daily hassles, uplifts and anxiety experienced by distance education and on-campus students and 2) to examine relationships among these variables and selected sociodemographic factors. Spielberger's (1983) State and Trait Anxiety Inventory (STAI) and Folkman and Lazarus' (1989) Hassles and Uplifts questionnaire were utilised. State anxiety levels were found to be higher than those of female working adults (Spielberger 1983). As well, on-campus students had higher state anxiety levels than distance education students. Trait anxiety differed significantly by age. Except for employment status, sociodemographic factors had no impact on hassles or uplifts. Unemployed subjects experienced significantly greater intensity of uplifts than subjects employed in a hospital setting. Hassles contributed significantly to the anxiety expressed by registered nurse students. As anticipated for women fulfilling multiple family, work and student roles, time pressure emerged as the most important hassle factor. Future research is planned to further explore hassles, uplifts and anxiety as Post-RN students progress through a baccalaureate nursing programme.

Needs and anxiety levels in relatives of intensive care unit patients.

The purpose of this study was to explore the perceived needs and anxiety levels of adult family members of intensive care unit (ICU) patients. The study was conducted over a 3-month period, on a convenience sample of 166 subjects selected from the total adult population of family members visiting an ICU patient in three Sudbury hospitals. Data were gathered using a self-report questionnaire, the Critical Care Family Needs Inventory (CCFNI) and Spielberger's State Trait Anxiety Inventory (STAI). Interviews were conducted in French or English according to the subject's preference. The major variables examined were: family needs; state and trait anxiety; on-site sources of worry; spiritual needs; level of knowledge of ICU from past experience or pre-surgery education; sociodemographic data. The Situational Anxiety Scale yielded a mean score of 45.24 and the Trait Anxiety Scale a mean score of 37.3. Inferential statistics demonstrated that family needs and situational anxiety were significantly related (P less than 0.0002). Furthermore, worries, trait anxiety, age and family needs explained 38% of the variation of situational anxiety. As well, spiritual needs and situational anxiety explained 33% of the variation of family needs.

[Transcultural validation of a measurement scale]. / Validation transculturelle d'un outil de mesure.

This monography presents the validation study results of a new scale to measure family needs: The Family Needs Inventory (IBF) (Chartier and Coutu-Wakulczyk, 1988). The scale is available in both French and English from the Departement des sciences infirmières of the Université de Sherbrooke. Based on a perceptual framework, the IBF is a self-report scale composed of 33 items. It offers three different subscores of the importance of needs: the global score of needs, the intensity need index and the total number of needs. The IBF was validated on a sample of 400 subjects. These subjects were drawn from the adult population of immediate family members visiting a patient in surgical or medical intensive care units in three different geographical regions, in Québec, northeast Ontario and France. The reliability yielded a 0.90 Cronback Alpha coefficient and the homogeneity coefficient for Spearman-Brown and Guttman procedures were 0.88 respectively. The principal component factor analysis and factorial matrices lead to examine the conceptual structure of five independent factors.

Perceived mood and exercise behaviors of cardiac rehabilitation program referrals.

The objective of this study was to examine how 65 clients referred to a cardiac rehabilitation program perceived their current mood, severity of illness, exercise behaviors, and hence, quality of life. The theoretical perspective for this study was derived from King's (1981) theory of goal attainment. The individual's perceptions are a fundamental element of goal attainment. A telephone survey was developed to gather data on demographics, exercise intensity and participation, severity of illness at time of hospital discharge and time of interview as well as responses to a mood adjective check list (Lubin, 1981). Analysis indicated that exercise was a valued behavior for the majority of subjects. All subjects perceived that the severity of their heart condition had changed from more to less severe. Furthermore, those who exercised felt healthy and merry, while those who did not exercise felt miserable.