Adult health checkup: Update on the Preventive Care Checklist Form©.

OBJECTIVE: To describe updates to the Preventive Care Checklist Form© to help family physicians stay up to date with current preventive health care recommendations. QUALITY OF EVIDENCE: The Ovid MEDLINE database was searched using specified key words and other terms relevant to the periodic health examination. Secondary sources, such as the Canadian Task Force on Preventive Health Care, the Public Health Agency of Canada, the Trip database, and the Canadian Medical Association Infobase, were also searched. Recommendations for preventive health care for average-risk adults were reviewed. Strong and weak recommendations are presented on the form in bold and italic text, respectively. MAIN MESSAGE: Updates were made to the form based on the Canadian Task Force on Preventive Health Care recommendations on screening for obesity (2015), cervical cancer (2013), depression (2013), osteoporosis (2013), hypertension (2012), diabetes (2012, 2013), and breast cancer (2011). Updates were made based on recommendations from other Canadian organizations on screening for HIV (2013), screening for sexually transmitted infections (2013), immunizations (2012 to 2014), screening for dyslipidemia (2012), fertility counseling for women (2011, 2012), and screening for colorectal cancer (2010). Some previous recommendations were removed and others lacking evidence were not included. CONCLUSION: The Preventive Care Checklist Form has been updated with current recommendations to enable family physicians to provide comprehensive, evidence-based care to patients during periodic health examinations.

A renal nursing professional practice model: the next generation.

Professional practice models provide a structure for excellence in nursing practice. Our centre has had a long tradition of working with a professional practice model with proven nursing outcomes such as job satisfaction, empowerment and perceptions of improved patient care. Our model, in place since 1999, has provided an opportunity to discuss and articulate a vision for nursing practice based on the values of accountability, evidence-informed care and empowerment. In order for the model to effectively guide nursing practice, a revision was necessary to keep pace with the changes in the renal program and the health care environment. The revised model needed to address the enhancements in nursing roles, practice environment, corporate requirements and patient care needs. This paper describes a revised professional practice model unique to nephrology nursing.

A hinting strategy for online learning of radiograph interpretation by medical students.

CONTEXT: We examined whether a 'hint' manoeuvre increases the time novice medical learners spend on reviewing a radiograph, thereby potentially increasing their interpretation accuracy. METHODS: Senior year medical students were recruited into a randomised control, three-arm, multicentre trial. Students reviewed an online 50-case learning set that varied in degree of 'hint' intervention. The 'hint' was a dialogue box that appeared after a student submitted an answer, encouraging the student to re-evaluate their interpretation. The students in the control group received no hints. In the weak intervention group, students received 'hints' with 66% of their incorrect interpretations and 33% of those that were correct. In the strong intervention group, the incorrect interpretation hint frequency was 80%, whereas for correct responses it was 20%. All students completed a 20-case post-test immediately and 2 weeks after the 50 cases. The primary outcome was student performance on the immediate post-test, measured as the ability to discriminate between normal and abnormal films (dPrime). Secondary outcomes included the probability of considering the hint, time spent on learning cases and knowledge retention at 2 weeks. RESULTS: We enrolled 117 medical students from three sites into the three study groups: control (36), weak intervention (40) and strong intervention (41) groups. The mean (standard deviation) dPrime in the control, weak and strong groups were 0.4 (1.1), 0.7 (1.1) and 0.4 (0.9), respectively (P = 0.4). In the weak and strong groups, participants reconsidered answers in 556 of 1944 (28.6%) hinting opportunities, and those who reconsidered their answers spent a mean (95% confidence interval) of 13.9 (11.9, 16.0) seconds longer on each case. There were no significant differences in knowledge retention at 2 weeks between the groups (P = 0.2). CONCLUSIONS: Although the implemented hinting strategy did result in students spending more time considering a proportion of the cases, overall it was not effective in improving student performance.

Workplace empowerment and burnout in Canadian nephrology nurses.

Nephrology nurses, like nurses in other areas, are impacted by the stress in their work environment. As recruitment and retention issues become more apparent, research in the area of conditions of work life for nephrology nursing has emerged, as an important area of study. Burnout has been reported as high as one in every three nephrology nurses (Flynn, Thomas-Hawkins, & Clarke, 2009). This cross-sectional study examined the influence of empowerment on burnout. Total empowerment was negatively correlated with emotional exhaustion in the bivariate analysis. Multivariate analysis demonstrated that access to resources and nursing education had an influence on burnout for nephrology nurses. Access to resources was a significant negative predictor of burnout for nephrology nurses. Degree-prepared nurses were more likely to experience burnout. Application of these results by providing access to resources for nephrology nurses may impact on occupational burnout.

Occupational burnout, retention and health outcomes in nephrology nurses.

Occupational burnout can have serious implications on productivity, nurses'health, service usage, and health care costs. This study examined the effect of burnout on nurses' mental and physical health outcomes and job retention. Randomly selected Canadian nephrology nurses completed surveys consisting of the Maslach Burnout Inventory and the Pressure Management Indicator. The nurses also completed questions related to job retention. After controlling for age and years of nephrology nursing experience, the multivariate results demonstrated that almost 40% of mental health symptoms experienced by nephrology nurses could be explained by burnout and 27.5% of physical symptoms could be explained by burnout. Twenty-three per cent of the sample had plans to leave their current position and retention was significantly associated with burnout, mental, and physical symptoms. Organizational strategies aimed at reducing perceptions of burnout are important, as a means to keep nurses healthy and working to their fullest potential.

Chronic kidney disease: what's in a name?

There is a lack of precision and clarity in the terms used to describe chronic kidney disease (CKD). Inconsistent terminology is confusing for both practitioners and patients. The purpose of this article is to review and examine various terms used to label CKD and to propose an evidence-based recommendation to support the use of a standard terminology for CKD.

Work environment, health outcomes and magnet hospital traits in the Canadian nephrology nursing scene.

Nephrology, like others areas of health care, is confronting a nursing shortage. Unless action is taken to address nursing shortages, patient care may be negatively affected (American Nephrology Nurses' Association, 2007). Previous studies have been conducted on magnet hospital traits, quality of nursing worklife, empowerment, job satisfaction, burnout, health outcomes, and their influence on nursing retention in Canada. However, there is little research in this area specific to nephrology nursing. This descriptive study examined whether magnet hospital traits, empowerment, and organizational support contribute to Canadian nephrology nurses' job satisfaction, health outcomes, and perceived quality of patient care. A randomly selected sample of 300 nurse members of the Canadian Association of Nephrology Nurses and Technologists (CANNT) was asked to complete a survey consisting of four instruments: The Nursing Work Index (Lake, 2002), the Conditions of Work Effectiveness Questionnaire II (Laschinger, Finegan, Shamian, & Wilk, 2001), the Pressure Management Indicator (Williams & Cooper, 1998), and the Maslach Burnout Inventory (Maslach, Jackson, & Leiter, 1996). There was a 48.1% response rate. Results demonstrated that some aspects of the Canadian nephrology nursing environment were rated quite favourably (e.g., high standards of care are expected; good working relationships with peers), but areas requiring improvement were evident (e.g., assignments that foster continuity of care). Overall, the nurses felt empowered. The results of the Pressure Management Indicator and Maslach Burnout Inventory indicated that nephrology nurses are generally coping well, but that some of them are struggling. Strategies that improve work environments could promote the recruitment and retention of nephrology nurses. Further research in this area is warranted.

Implementation of a diabetic foot management best practice guideline (BPG) in hemodialysis units.

The aim ofthis study was to examine the impact of introducing the Registered Nurses' Association of Ontario Best Practice Guideline (BPG), Assessment and management of foot ulcers for people with diabetes (2005), on foot ulcer incidence, recurrence, and amputation rate in adult diabetic clients who are undergoing chronic hemodialysis treatments. Fifty-seven individuals from three hemodialysis units participated in the study. Data were collected at three points in time over a 15-month period. A significant reduction in the number of wounds was noted (p < 0.05) from time one to time three, and the grade of wounds (p < 0.01). However, five new amputations were reported Although implementation of the BPG showed a positive patient outcome, further research needs to be conducted with a larger sample size.

Nurses' perceptions of the impact of a renal nursing professional practice model on nursing outcomes, characteristics of practice environments and empowerment--Part II.

The purpose of this study was to examine the effect of a renal nursing professional practice model (PPM) on nurses'perceptions of empowerment, characteristics of practice environments and the impact on nursing care outcomes in a university-based teaching hospital in Canada. Quantitative and qualitative methodologies were used. This paper will focus on the qualitative results. Content analysis was the data analysis method used. The following themes emerged: 1) Attunement, familiarity/knowing the patient, going the distance, 2) Patient outcomes, consistency and continuity of care, autonomy/taking the initiative, 3) Nurse rewards: satisfaction and accountability, empowerment/input, and 4) Facilitating systems: communication, support and assignment. The quantitative results had a significant (p = .005) improvement post-PPM implementation in the nursing foundations for quality of care subscale of the Practice Environment Scale of the Nursing Work Index (NWI-PES) and organizational relationships (p =.016) measured by the Conditions of Work Effectiveness II (CWEQ-II) questionnaires. This study provides evidence for PPMs and primary nursing as effective frameworks to positively impact nursing and patient outcomes in a hemodialysis unit.

Nurses' perceptions of the impact of a renal nursing professional practice model on nursing outcomes, characteristics of practice environments and empowerment--Part I.

A transformational nursing professional practice model (PPM) was developed and implemented in the London Health Sciences Centre's renal program. The purpose of this study was to examine the impact of a renal nursing PPM on nurses'perceptions of empowerment, characteristics of practice environments, and nursing outcomes. Quantitative and qualitative methodologies were used in this study. This paper will focus primarily on the quantitative results. The qualitative results are presented in Part II (Harwood, Ridley, Lawrence-Murphy, White, Laschinger, Bevan, & O'Brien, in press). A "then-and-now" design was used. There was a significant (p = .005) improvement post-PPM implementation in the nursing foundations for quality of care subscale of the Nursing Worklife Index-Practice Environment Scale (NWI-PES) and organizational relationships (p = .016) measured by the Conditions of Work Effectiveness II (CWEQ-II) Questionnaires. This study provides evidence for PPMs and primary nursing as effective frameworks to positively impact nursing and patient outcomes in a hemodialysis unit.

Prevalence of risk factors predisposing to foot problems in patients on hemodialysis.

A disturbingly high prevalence of single or bilateral lower extremity amputations in our program prompted us to conduct a study to identify the prevalence of risk factors that predispose patients on hemodialysis (HD) to foot problems. The study consisted of a one-time assessment of subjects' risk for and actual prevalence of amputation. The sample consisted of 232 subjects--56% male, 44% female. Ages ranged from 21-91 years, mean age 65.1 and median age 69 years. The most common comorbidities were hypertension (75%), coronary artery disease (50%), diabetes (42.2%), hyperlipidemia (34.9%), and peripheral vascular disease (27.2%), which are all established risk factors for peripheral arterial occlusive disease. Twenty-one percent of subjects were current smokers; 28% were former smokers. Nearly 13.4% of subjects had undergone amputations ranging from single toes to bilateral above knee amputations. Only 31% of subjects had both bilateral palpable pedal pulses present. Neuropathy, as evidenced by the inability to feel the application of monofilaments to 10 sites on each foot or the presence of symptoms, was present in 74.6% of subjects. Only 2.6% of subjects demonstrated comprehensive self-care behaviors (SCBs). With respect to subjects' ability for self-care, 75% of subjects had adequate vision, 60% adequate dexterity, and 55% adequate flexibility to perform self-care. Study findings confirmed impressions that patients are at considerable risk for foot complications. Implications for nursing practice include regular foot assessment, education for self-care, and referral to specialists when required.

Implementation challenges of a renal nursing professional practice model.

A city-wide steering-committee developed and introduced a program wide renal nursing professional practice model (PPM) using a variety of strategies. The PPM outlines values, practice guidelines, professional relationships, and the care delivery model. Challenges are inherent when implementing changes on multiple sites amidst a city-wide merger. Key challenges included maintenance of the model and measurement of its impact on practice. This paper summarizes the leadership team s learning regarding both the support required to successfully implement the model and the developments that competed against a successful implementation. The authors also discuss qualitative evaluation of the nurses experiences during model implementation.