[Validity 'and Utilities' clinic of a grid observation (PACSLAC-F) to evaluate the pain in seniors with dementia's living in the Long-Term Care ]. / Validité et utilité clinique d'une grille d'observation (PACSLAC-F) pour évaluer la douleur chez des aînés atteints de démence vivant en milieu de soins de longue durée.

This study presents the validation of the French Canadian version (PACLSAC-F) of the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC). Unlike the published validation of the English version of the PACSLAC, which was validated retrospectively, the French version was validated prospectively. The PACSLAC-F was completed by nurses working in long-term care facilities after observing 86 seniors, with severe cognitive impairment, in calm, painful or distressing but non-painful situations. The test-retest and inter-observer reliability, the internal consistency, and the discriminent validity were found to be satisfactory. To evaluate the convergent validity with the DOLOPLUS-2 and the clinical relevance of the PACSLAC, it was also completed by nurses during their work shift, with 26 additional patients, for three days per week during a period of four weeks. These results encourage us to test the PACSLAC in a comprehensive program of pain management targeting this population.

Engaging health care workers in improving their work environment.

AIM: This study describes the perceptions of health care workers who were involved in a participatory approach for the reorganization of care and work, aimed at creating an optimum work environment. BACKGROUND: Quebec's health network has undertaken large-scale organizational changes to ensure the quality of health care and services for the population. METHOD: This participatory research was carried out by means of interviews. The sample consisted of 20 participants involved in the participatory approach for making changes to the organization of care and work in two pilot units. RESULTS: Four main perspectives emerged from the analysis: (1) views on the legitimacy of change, (2) commitment, indifference and resistance, (3) day-to-day concrete changes as signs of hope and (4) the elements of the success of the participatory approach. CONCLUSION: The management team's support and leadership and the participatory approach were significant factors in the success of the project.

Patterns in information strategies used by older men to understand and deal with prostate cancer: an application of the modélisation qualitative research design.

BACKGROUND: The increasing need of older individuals to safely self-manage their chronic illnesses requires that they clearly understand health-related information. Thus, this study examined health literacy as lived by men with prostate cancer (PC), rather than as assessed by professionals. OBJECTIVES: This study aimed to describe, analyse, and understand informational strategies of men with PC. The main objective was to describe these strategies according to self-assessed levels of functional health literacy and thus create an inventory of strategy characteristics. DESIGN: The modélisation qualitative research design framed this inquiry. SETTINGS: Montreal and Laval, province of Québec, Canada. PARTICIPANTS: The purposive sample comprised 15 French-Canadian men aged 61-83, most of whom were enroled in a PC support group. Recruitment and selection was assisted by the support group's chairman and a volunteer recruiter. Selection criteria were medical diagnosis of localised PC, childhood spent in Québec, ability to self-assess functional health literacy, effective oral communication in French, no use of psychotropic drugs, and normal time and space orientation. METHODS: Data collection involved semi-structured interviews and drawing of genograms and ecomaps. The qualitative-data-analysis software Atlas. ti (Version 4.1 for Windows) was used to code the interview data. Findings were also subjected to content analysis. Six volunteers examined and confirmed the authors' interpretation of the findings. RESULTS: Functional health literacy was cultivated throughout participants' lives and nourished by their social and cultural resources. A history of reading at home, interest in learning, supportive family and elementary school environments developed open-minded, critical-information-seeking older men. The findings did not support any association among formal education, level of health literacy, and ways of dealing with PC-related information. The construction of information networks provided participants with knowledge and with emotional and spiritual support to cope with PC. Men with different levels of health literacy had both unique and similar information strategies. CONCLUSIONS: Participants' decisions to adopt specific information strategies were influenced by awareness of impacts of PC on men's lives, construction and maintenance of information networks, as well as participants' critique of health information. Through their information strategies, participants regained decision-making power over their bodies and destinies, and then redefined their social roles.

Reorganizing care and work: process and productivity gains.

A Montreal-area hospital implemented organizational changes to improve the psychosocial environment for patients and health care workers and enhance organizational efficiency. This article describes a participatory approach to improving the organization of care and work, an approach focused on productivity gains in an organization. Productivity gains were analyzed in 13 units of the Department of Nursing, which had introduced a series of organizational changes. Changes introduced in care and work organization led to productivity gains in all units overseen by the Nursing Directorate. A reorganization of care and work based on the psychosocial work environment and staff participation can have positive outcomes, both for employees and for the wider organization.

Validation of the critical-care pain observation tool in adult patients.

BACKGROUND: Little research has been conducted to validate pain assessment tools in critical care, especially for patients who cannot communicate verbally. OBJECTIVE: To validate the Critical-Care Pain Observation Tool. METHODS: A total of 105 cardiac surgery patients in the intensive care unit, recruited in a cardiology health center in Quebec, Canada, participated in the study. Following surgery, 33 of the 105 were evaluated while unconscious and intubated and 99 while conscious and intubated; all 105 were evaluated after extubation. For each of the 3 testing periods, patients were evaluated by using the Critical-Care Pain Observation Tool at rest, during a nociceptive procedure (positioning), and 20 minutes after the procedure, for a total of 9 assessments. Each patient's self-report of pain was obtained while the patient was conscious and intubated and after extubation. RESULTS: The reliability and validity of the Critical-Care Pain Observation Tool were acceptable. Interrater reliability was supported by moderate to high weighted kappa coefficients. For criterion validity, significant associations were found between the patients' self-reports of pain and the scores on the Critical-Care Pain Observation Tool. Discriminant validity was supported by higher scores during positioning (a nociceptive procedure) versus at rest. CONCLUSIONS: The Critical-Care Pain Observation Tool showed that no matter their level of consciousness, critically ill adult patients react to a noxious stimulus by expressing different behaviors that may be associated with pain. Therefore, the tool could be used to assess the effect of various measures for the management of pain.

Towards an integrated approach for the management of ageing nurses.

AIM: The objective of this study is to provide an overview of the ageing of the nursing workforce and to explore retention strategies centred on the entire professional life and on all age groups. BACKGROUND: The presence of an increasing proportion of ageing workers presents a major challenge to the nursing profession. Evaluation Presentation of theories about the development of a healthy workplace leads to the identification of a framework on which managers can base their management decisions. KEY ISSUES: Examples of incentives relating to the framework are presented which were expressed by both nurses under 50 years of age and those over 50. CONCLUSIONS: Introducing incentives centred on all age groups provides an opportunity to create a healthy workplace for all generations of nurses.

New approaches of organizing care and work: giving way to participation, mobilization, and innovation.

Quebec's health network has undertaken large-scale organizational changes to ensure the continuity, accessibility, and quality of health care and services for the population. This article describes the optimal approach for making changes to the organization of care and work for patients, health care workers, and organizations. This participative action research was carried out by means of interviews and document analysis. One hundred participants were involved, describing a total of 34 projects for significant organizational change. Results include an optimal approach broken down into 4 phases, each of which includes steps, facilitating factors, and potential difficulties. The phases of this approach are: (1) sharing the vision, mission, and values of the organization and identifying the purpose and need underlying the change; (2) building alliances and validating the involvement of the various players; (3) conceptualizing and planning the project; and (4) implementing changes and continuing evaluation. It is possible to rise to the challenge of finding new approaches to organize care and work by giving way to participation, mobilization, and innovation.

[Pain indicators in critical care]. / Les indicateurs de la douleur en soins critiques.

In this descriptive/qualitative study, focus groups and individual interviews were completed with 48 critical care nurses and 12 critical care physicians. Results showed that many indicators are used by those clinicians for pain assessment in intubated patients, whatever their level of consciousness. Nurses and physicians mentioned giving weight to the patient's self-assessmen tof pain even when intubated, communication then being by means of signs. Behavioural and physiological indicators also provide clinicians with valuable information for pain assessment. However, for the most part these indicators are not specific to pain, limiting their usefulness in this context. The study aslo suggests recommendations for nursing practice and ideas for nursing resarch.

Improving the psychosocial work environment.

AIM: This paper reports a pilot project to evaluate the effectiveness of a participatory organizational intervention to improve the psychosocial work environment in one long-term care unit. BACKGROUND: Since the early 1990s, health care institutions in Quebec have been constantly changing in order to improve the efficiency of the health care system. These changes have affected the work environment and have contributed to higher rates of burnout and absenteeism among nurses and other health care workers. METHOD: The study participants were health care workers in a long-term care unit (n = 60). The participatory organizational intervention was based on a contract and carried out by a work team. Work constraints were identified, and an action plan implemented, The effectiveness of the intervention was evaluated by pre- and postintervention questionnaires: the Job Content Questionnaire, Effort-Reward Imbalance Questionnaire and Psychiatric Symptom Index. RESULTS: There was a significant increase in reward (P < or = 0.01) and a significant decrease in Effort-Reward Imbalance (P < or = 0.01) following the intervention. Absenteeism rates decreased from 8.26% to 1.86% over the study period, but in the rest of the institution remained the same. However, there was a significant decrease in social support from supervisors (P < 0.05) at post-test. CONCLUSION: Participation by health care workers and action plans targeting problematic aspects of the psychosocial work environment are key elements in interventions to improve their health. However, such interventions present challenges, such as the involvement of managers, involvement of all relevant participants, and re-establishment of trust within work teams. Recognition and respect must be re-established, and supervisors must engage with health care workers and give support at all stages of the intervention.

Pain assessment and management in critically ill intubated patients: a retrospective study.

BACKGROUND: Little research has been done on pain assessment in critical care, especially in patients who cannot communicate verbally. OBJECTIVES: To describe (1) pain indicators used by nurses and physicians for pain assessment, (2) pain management (pharmacological and nonpharmacological interventions) undertaken by nurses to relieve pain, and (3) pain indicators used for pain reassessment by nurses to verify the effectiveness of pain management in patients who are intubated. METHODS: Medical files from 2 specialized healthcare centers in Quebec City, Quebec, were reviewed. A data collection instrument based on Melzack's theory was developed from existing tools. Pain-related indicators were clustered into nonobservable/subjective (patients' self-reports of pain) and observable/objective (physiological and behavioral) categories. RESULTS: A total of 183 pain episodes in 52 patients who received mechanical ventilation were analyzed. Observable indicators were recorded 97% of the time. Patients' self-reports of pain were recorded only 29% of the time, a practice contradictory to recommendations for pain assessment. Pharmacological interventions were used more often (89% of the time) than nonpharmacological interventions (<25%) for managing pain. Almost 40% of the time, pain was not reassessed after an intervention. For reassessments, observable indicators were recorded 66% of the time; patients self-reports were recorded only 8% of the time. CONCLUSIONS: Pain documentation in medical files is incomplete or inadequate. The lack of a pain assessment tool may contribute to this situation. Research is still needed in the development of tools to enhance pain assessment in critically ill intubated patients.

How to facilitate the orientation of new nurses into the workplace.

The orientation of new nursing graduates into the workplace is an impressive challenge. A research study was performed to identify the key elements of a program that would address the various issues regarding this orientation. A team of researchers from Laval University and the Centre Hospitalier Universitaire de Quebec (CHUQ) used a descriptive and participative research method and identified five key elements that must be considered in order for this orientation to succeed.