Knowledge and Attitudes about Pain Management among Canadian Nursing Students.

BACKGROUND: Poorly managed pain is a problem that affects individuals, entire health care systems, and societies worldwide. Nurses are involved in pain management, yet little is known about the knowledge and attitudes of nursing students. AIMS: The aim of this study was to examine preregistration nursing students' knowledge and attitudes about the assessment and management of pain. DESIGN: This was a cross-sectional, descriptive survey. SETTINGS: Four education sites from two post-secondary institutions in Ontario, Canada. PARTICIPANTS/SUBJECTS: A convenience sample of 336 final year Bachelor of Science in Nursing and practical nursing students. METHODS: Participants were recruited in the classroom setting to complete the Knowledge and Attitudes Survey Regarding Pain. A score of eighty percent is considered a pass. RESULTS: Ninety percent of students who were in class on the day of the survey agreed to participate (n = 336/373). Fifteen (4.5%) participants passed the Knowledge and Attitudes Survey Regarding Pain, and the mean score was 66.7% (standard deviation 9.1). English as primary language, institution attended, and prior experience caring for someone with pain were independently associated with higher scores (p < .05). Students were found to have major gaps in knowledge and attitudes related to understanding the risk of respiratory depression after opioid therapy, calculating medication dosages, administrating medication, and understanding pharmacology. CONCLUSIONS: The majority of nursing students in this sample did not have adequate knowledge and positive attitudes about pain assessment and management.

Associations between patient factors and adverse events in the home care setting: a secondary data analysis of two canadian adverse event studies.

BACKGROUND: Early identification of patients at who have a higher risk for the occurrence of harm can provide patient safety improvement opportunities. Patient factors contribute to adverse event occurrence. The study aim was to identify a single, parsimonious model of home care patient factors that, regardless of location and differences in home care program management and design factors, could provide a means of locating patients at higher and lower risk of harm. METHODS: Split modeling using secondary analyses of data from two recent Canadian home care patient safety studies was undertaken. Patient factors from the Minimum Data Set Resident Assessment Instrument (RAI) for Home Care and diagnoses consistent with ICD-10 and RAI-Mental Health assessment were used. Continuous and categorical measures of factors were considered. Adverse events were defined using World Health Organization taxonomy and measured on a dichotomous yes/no scale. Patient factors significantly associated (Pearson's Chi Square, p ≤ .05) with the occurrence of adverse events in both earlier studies were entered in forward selection regression analyses to locate factors predictive of adverse event occurrence. RESULTS: Instrumental activities of daily living dependency and escalating co-morbidity counts are associated with patient vulnerability to adverse events. CONCLUSIONS: Instrumental activities of daily living dependency and burden of illness, both easily identifiable early in the episode of care, are significantly associated with the risk of adverse event occurrence, however there is regional variability in the relationships.

Patient safety in practical nurses' education: A cross-sectional survey of newly registered practical nurses in Canada.

BACKGROUND: Practical nurses have experienced an increasing scope of practice, including an expectation to care for complex patients and function on interdisciplinary teams. Little is known about the degree to which patient safety principles are addressed in practical nursing education. PURPOSE: To examine self-reported patient safety competencies of practical nurses. DESIGN: A cross-sectional online survey (July 2014) and face-to-face interviews (June 2015). SETTING: Ontario, Canada. PARTICIPANTS: Survey participants were practical nurses newly registered with the College of Nurses of Ontario between January 2012 and December 2013. Interview participants were faculty and students in a practical nursing program in Ontario. METHODS: Survey respondents completed the Health Professional Education in Patient Safety Survey online. Self-reported competencies in various patient safety domains were compared between classroom and clinical settings. Faculty members were interviewed about educational preparation of practical nurses and students were interviewed to provide insight into interpretation of survey questions. RESULTS: The survey response rate was 28.4% (n=1104/3883). Mean domain scores indicated a high level of confidence in patient safety competence (<4.0/5.0). Confidence was highest in respondents registered with the College of Nurses of Ontario >2years and in those who obtained their education outside of Canada. Faculty believed their approach to teaching and learning instilled a deep understanding of the limits to practical nurse autonomous practice. CONCLUSIONS: Practical nurses were confident in what they learned about patient safety in their educational programs. The high degree of patient safety competence may be a true reflection of practical nurses understanding of, and comfort with, the limits of their knowledge and, ultimately, the limits of their individual autonomous practice. Further exploration as to whether the questionnaire requires additional modification for use with practical nurse populations is warranted. However, this study provides the first examination of practical nurses' perspectives and perceptions about patient safety education.

Assessing adverse events among home care clients in three Canadian provinces using chart review.

OBJECTIVES: The objectives of this study were to document the incidence rate and types of adverse events (AEs) among home care (HC) clients in Canada; identify factors contributing to these AEs; and determine to what extent evidence of completion of incident reports were documented in charts where AEs were found. METHODS: This was a retrospective cohort study based on expert chart review of a random sample of 1200 charts of clients discharged in fiscal year 2009-2010 from publicly funded HC programmes in Manitoba, Quebec and Nova Scotia, Canada. RESULTS: The results show that 4.2% (95% CI 3.0% to 5.4%) of HC patients discharged in a 12-month period experienced an AE. Adjusting to account for clients with lengths of stay in HC of less than 1 year, the AE incidence rate per client-year was 10.1% (95% CI 8.4% to 11.8%); 56% of AEs were judged preventable. The most frequent AEs were injuries from falls, wound infections, psychosocial, behavioural or mental health problems and adverse outcomes from medication errors. More comorbid conditions (OR 1.15; 95% CI 1.05 to 1.26) and a lower instrumental activities of daily living score (OR 1.54; 95% CI 1.16 to 2.04) were associated with a higher risk of experiencing an AE. Clients' decisions or actions contributed to 48.4% of AEs, informal caregivers 20.4% of AEs, and healthcare personnel 46.2% of AEs. Only 17.3% of charts with an AE contained documentation that indicated an incident report was completed, while 4.8% of charts without an AE had such documentation. CONCLUSIONS: Client safety is an important issue in HC, as it is in institutionalised care. HC includes the planned delivery of self-care by clients and care provision by family, friends and other individuals often described as 'informal' caregivers. As clients and these caregivers can contribute to the occurrence of AEs, their involvement in the delivery of healthcare interventions at home must be considered when planning strategies to improve HC safety.

The incidence of adverse events among home care patients.

OBJECTIVE: Incidence of adverse events (AEs) among home care patients and preventability ratings were estimated. Risk factors, AE types and factors associated with AEs were identified. DESIGN: This study used a stratified, randomized sample of home care patients discharged in the fiscal year 2004/05. Trained nurse reviewers completed retrospective chart abstractions; charts for cases that were positive for screening criteria suggesting the presence of AEs were reviewed by trained physicians to determine the presence of and preventability of AEs. SETTING: Three publicly funded home care programs in Ontario, Canada. MAIN OUTCOME MEASURES: Prevalence and types of AEs; ratings of preventability. RESULTS: At least one screening criterion was positively identified in 286 (66.5%) of 430 cases. Physician reviewers identified 61 AEs in 55 (19.2%) of the 286 (12.8% of the 430) cases. The AE rate was 13.2 per 100 home care cases [95% confidence interval (CI): 10.4-16.6%, standard error 1.6%]. 32.7% (20 of 61 AEs) of the AEs were rated as having >50% probability of preventability; 6 deaths (10.9% of patients with an AE; 1.4% of all patients) occurred in AE-positive patients. The most common AEs were falls and adverse drug events. CONCLUSIONS: Providing health care through home care programs creates unintended harm to patients. The incidence rate of AEs of 13.2% suggests a significant number of home care patients experience AEs, one-third of which were considered preventable. Improvements in patient and informal caregiver education, skill development and clinical planning may be useful interventions to reduce AEs.

Improving the management of waiting lists for long term care.

Initially prepared for the South East Local Health Integration Network in Ontario, this literature review focuses on interventions to improve the management of waiting lists for admission to long-term care facilities. The review identified studies relating to four types of interventions: (1) different models for prioritizing patients, (2) ways to improve the accuracy of waiting lists, (3) the use of alternative care settings, and (4) altering the level of home care.

Public engagement and the changing face of health system planning.

This paper examines the impact of the emerging citizens' assembly model of public engagement on health system planning and management. The characteristics that distinguish this model from more traditional approaches such as surveys and town hall meetings are elaborated using the case study of the recent Citizens' Regional Health Assembly. The paper concludes by suggesting the possibility of a new type of relationship between health system decision-makers, providers and the community.

Design and application of a theory-based case/care management model for home care: advanced practice for nurses as care managers.

Case management has developed in a variety of health care, social service, and insurance industries. Its historical pattern of development has resulted in practices that are generally administrative and technical in nature as well as being relatively generic and often undifferentiated between being a role and process. Research over the last decade has resulted in the opportunity to move case management practice for home care into a structured theory-based model and practice. Design and implementation of a specialized advanced practice care management model reflective of care management research and theory design by British researchers is beginning to show clinical and systemic results that should be replicable in other regions.