Development of a bilingual interdisciplinary scale assessing self-efficacy for participating in Medical Assistance in Dying.

Medical Assistance in Dying (MAiD) is a complex process involving the person seeking care and their relatives. MAiD involves physical, psychosocial and spiritual needs, and consequently the involvement of an interdisciplinary team is beneficial. Therefore, updating the knowledge and skills of healthcare and social services professionals is critical. An interdisciplinary team from Laval University (Quebec, Canada) has developed a continuous training program for all health care and social services professionals who could be involved in the care of persons who request MAiD and their loved ones. It is crucial to assess whether the objectives of the continuous training program are being met, especially since this new training addresses several complex issues (legal, ethical, and clinical). Bandura's self-efficacy theory has been widely used to develop scales for assessing the impact of training programs and identifying knowledge gaps. Bandura's theory states that feeling secure in one's self-efficacy leads to self-determined motivation. Although there are various scales intended to measure self-efficacy in palliative care, none include self-efficacy for participating in the process surrounding MAiD. As a result, we aim to create a bilingual (English-French) interdisciplinary scale to assess self-efficacy for participating in the process surrounding MAiD. The scale will allow decision-makers and researchers to identify current knowledge gaps. It will also be useful for assessing the impact of current and future training programs addressing this end-of-life practice. In this work in progress, we briefly introduce the training program and the future steps in the development and validation of the scale.

L'aide médicale à mourir (AMM) est un processus complexe impliquant la personne qui demande le soin et ses proches. L'AMM implique des besoins physiques, psychosociaux et spirituels. Par conséquent, l'implication d'une équipe interdisciplinaire est bénéfique et la mise à niveau des connaissances et des compétences des professionnel.es est essentielle. Une équipe interdisciplinaire de l'Université Laval (Québec, Canada) a développé un programme de formation continue destiné aux professionnelles de la santé et des services sociaux susceptible d'être impliqué es dans ls soins et services des personnes qui demandent l'AMM et de leurs proches. Il est crucial d'évaluer si les objectifs du programme de formation continue sont atteints, d'autant plus que cette nouvelle formation aborde plusieurs questions complexes (juridiques, éthiques et cliniques). La théorie du sentiment d'auto-efficacité de Bandura a été largement utilisée pour développer des échelles permettant d'évaluer l'impact des programmes de formation et d'identifier les lacunes en matière de connaissances. Cette théorie stipule que le fait de se sentir sûre de son efficacité personnelle conduit à une motivation intrinsèque à accomplir le comportement visé. Bien qu'il existe plusieurs échelles destinées à mesurer l'auto-efficacité dans le domaine des soins palliatifs, aucune n'inclut l'auto-efficacité pour la participation au processus entourant l'AMM. Par conséquent, nous développons une échelle interdisciplinaire bilingue (anglais-français) pour évaluer l'auto-efficacité à participer au processus entourant l'AMM. L'échelle permettra aux décideuses, décideurs et aux chercheuses et chercheurs d'identifier les lacunes actuelles en matière de connaissances. Elle sera également utile pour évaluer l'impact des programmes de formation actuels et futurs portant sur cette pratique de fin de vie. Dans cet article, nous présentons brièvement le programme de formation et les étapes futures du développement et de la validation de l'échelle.

Registered nurses' perceptions of their roles in medical-surgical units: A qualitative study.

AIM: The aim of this study was to gain insight into the perception of nurses about their roles in medical-surgical units. BACKGROUND: As a result of ever-changing work environments, medical-surgical nurses find it difficult to know and practice according to the full scope of their roles. DESIGN: A qualitative descriptive study. METHODS: Semi-structured individual interviews were conducted with 21 nurses on three campuses of a large tertiary care hospital located in Quebec, Canada. Thematic analysis was used to construe meaning from the interviews. This research adheres to the Standards for Reporting Qualitative Research guidelines and checklist. RESULTS: The data analysis resulted in three main themes: (i) confusion in nurses' roles and scope of practice; (ii) challenges in the continuity of care and (iii) factors affecting the roles of nurses in medical-surgical units. CONCLUSION: Attention must be paid to the care continuum as it represents a critical element for surgical patients' quality and safety of care. RELEVANCE TO CLINICAL PRACTICE: Medical-surgical nurses should understand their roles and the factors that limit their full scope of practice in order to provide and manage complex care situations. Additionally, an interdisciplinary approach is a strategy that may better respond to patients' clinical needs across the surgical journey.

Accommodating and supporting students with disability in the context of nursing clinical placements: A collaborative action research.

AIM/OBJECTIVE: To examine issues and challenges encountered by university and clinical milieus in addressing the needs of students with disability during their clinical placements; and to identify existing or potential accommodation and support measures to address the challenges encountered. BACKGROUND: The influx of students with learning disabilities, attention deficit disorder [with or without hyperactivity], mental health disorders or on the autism spectrum has caused an increase in the number of students with disabilities of more than 900% in universities in the past decade. This increase is causing added pressures to both the academic services providing student assistance and the personnel responsible for these students' clinical placements. While several studies have focused on measures designed to accommodate students with disabilities during their theoretical courses, only a small number worldwide have focused on student accommodation and support in the context of clinical placements. In the current paper, strategies highlighted in these studies were grouped under three categories: prior, during and post clinical placements. DESIGN: Collaborative action research conducted amidst three learning communities. METHODS: The larger study included learning communities from three disciplines: education, social work and nursing. Three tools helped guide the discussions: 1) brainstorming and classification tool; 2) contribution and feasibility tool; and 3) carrousel tool. The current study focusses solely on the findings from the five meetings of the nursing learning community (n = 14 participants). RESULTS: Six categories of challenges were documented: 1) Poor writing skills; 2) Difficulty adapting to clinical milieus; 3) Difficulty linking theory with practice and setting priorities; 4) Difficulty managing specific and situational needs; 5) Issues with interpersonal skills and overall attitude; and 6) Challenges pertaining to students' professional responsibility to disclose their condition. Several accommodation and support measures were identified for each set of challenges and were also grouped under three categories: prior, during and post clinical placements. CONCLUSIONS: Our study revealed that the issues identified could in fact be faced by any students, albeit their impact and complexity increased considerably when dealing with students with disability. It brought to light that the implementation of some of the measures identified will require changes to the structure of nursing programs. It also highlighted the ever-growing complexity of the clinical instructor role and the fact that clinical instructors do not always feel adequately prepared to support students with disability.

Correlates of career satisfaction in internationally educated nurses: A cross-sectional survey-based study.

BACKGROUND: More and more high-income countries hire internationally educated nurses as part of their workforce. While the factors that push and pull internationally educated nurses to migrate and influence their workforce integration have been widely reported in the literature, little is known about internationally educated nurses' career development and whether they are satisfied with their nursing career in Canada. OBJECTIVE: This study aims to identify the main correlates of internationally educated nurses' career satisfaction. METHODS: A cross-sectional analysis of data from a pan-Canadian survey sample of 1,951 internationally educated nurses, including registered nurses, licensed practical nurses and registered psychiatric nurses, was conducted. Measures of career satisfaction included individual, job and career characteristics as well as organizational-related and integration process factors. Non-parametric Mann-Whitney U and Spearman rank correlation tests were used to examine the association of the various factors with career satisfaction. RESULTS: Overall, internationally educated nurses showed a high degree of career satisfaction. At the same time, career satisfaction varied greatly depending on sociodemographic characteristics, organizational setting, and geographic location. Older and more experienced internationally educated nurses tended to be more satisfied with their career than their younger or less experienced colleagues were. Furthermore, male were inclined to be less satisfied than their female counterparts, and having children tended to make all three groups (men, women and overall) more satisfied. The higher the level of education prior to immigrating the lower the career satisfaction. Internationally educated nurses who identified as White or Asian had the highest level of career satisfaction, whereas those who identified as Black tended to be the least satisfied. Career satisfaction was the highest among those who live in the Prairie Provinces (Alberta, Saskatchewan and Manitoba), and Ontario, the lowest in the Atlantic Provinces (New Brunswick, Nova Scotia, Prince Edward Island, Newfoundland and Labrador). As for organizational characteristics, full-time nurses were more satisfied than those working part-time or with occasional employment. Finally, internationally educated nurses who thought they had achieved their career goals were more satisfied, while those who experienced discrimination were less satisfied with their career. CONCLUSION: Our findings highlight the need for organizations to ensure a healthy work environment for internationally educated nurses, free of discrimination, where they can attain their career goals. Tweetable abstract: More and more countries rely on internationally educated nurses to ease their nursing shortages. This study aims to identify the main correlates of internationally educated nurses' career satisfaction, using non-parametric Mann-Whitney U and Spearman rank correlation tests on data from a pan-Canadian survey sample of 1,951 internationally educated nurses, including registered nurses, licensed practical nurses and registered psychiatric nurses. Overall, internationally educated nurses showed a high degree of career satisfaction. At the same time, career satisfaction varied greatly depending on the internationally educated nurses' sociodemographic characteristics, organizational settings and geographic location. Finally, internationally educated nurses who thought they had achieved their career goals were more satisfied, while those who experienced discrimination were less satisfied with their career. Our findings highlight the need for organizations to ensure environment free of discrimination, where internationally educated nurses can attain their career goals.

Management of Primary Central Nervous System Lymphoma Using Intra-Arterial Chemotherapy With Osmotic Blood-Brain Barrier Disruption: Retrospective Analysis of the Sherbrooke Cohort.

BACKGROUND: Primary central nervous system lymphomas (PCNSL) are rare and aggressive CNS tumors. Current management involves high-dose methotrexate (HD-MTX) typically administered intravenously (IV), despite the existence of the blood-brain barrier (BBB), which significantly decreases its bioavailability. Cerebral intra-arterial chemotherapy (CIAC) coupled with osmotic BBB disruption (OBBBD) can theoretically circumvent this issue. METHODS: We performed a retrospective analysis of patients with newly diagnosed PCNSL treated with HD-MTX-based CIAC+OBBBD at our center between November 1999 and May 2018. OBBBD was achieved using a 25% mannitol intra-arterial infusion. Patients were followed clinically and radiologically every month until death or remission. Demographics, clinical and outcome data were collected from the medical record. All imaging studies were reviewed for evidence of complication and outcome assessment. Kaplan-Meier analyses were used to compute remission, progression-free survival (PFS) as well as overall survival times. Subgroup analyses were performed using the log rank test. RESULTS: Forty-four patients were included in the cohort. Median follow-up was 38 months. Complete response was achieved in 34 patients (79%) at a median of 7.3 months. Actuarial median survival and PFS were 45 months and 24 months, respectively. Age, ECOG and lesion location did not impact outcome. Complications included thrombocytopenia (39%), neutropenia (20%), anemia (5%), seizures (11%), stroke (2%), and others (20%). CONCLUSION: CIAC using HD-MTX-based protocols with OBBBD is a safe and well-tolerated procedure for the management of PCNSL. Our data suggests better PFS and survival outcomes compared to IV protocols with less hematologic toxicity and good tolerability, especially in the elderly.

Uncaring Nurses: Mobilizing Power, Knowledge, Difference, and Resistance to Explain Workplace Violence in Academia.

BACKGROUND AND PURPOSE: Violence among nurses and in nursing academia is a significant issue, with attention increasingly focused on damage resulting from psychological violence, such as bullying, harassment, aggression, and incivility. Each workplace's interpretation of violence will impact individual behavior within the organization. Organizational and environmental factors can contribute to violent behaviors becoming normalized in the workplace. When violent behaviors go unconstrained, they become imbedded within the workplace culture. An increased understanding of workplace culture is required to address workplace violence. The purpose of this article is to demonstrate how the use of this theoretical framework can provide greater understanding of the role of workplace culture in sustaining violent behaviors in nursing academia. METHODS: The theoretical perspectives of Gail Mason on interpersonal violence and Michel Foucault on power were utilized to inform the research process and guide data analysis. RESULTS: The framework makes possible the exposure of a dominant discourse perpetuating violence in nursing academia. Power and violence were found to work together to shape knowledge and influence group norms and behaviors. IMPLICATIONS FOR PRACTICE: The framework is useful in providing greater understanding of how the concepts of power, knowledge, difference, and resistance support the enactment of workplace violence. Investigating the influence of these concepts in the development of accepted practices and discourses may allow greater insight into ways violence and power are used to negotiate and enforce organizational rules and norms.

Internationally educated nurses in Canada: predictors of workforce integration.

BACKGROUND: Global trends in migration accompanied with recent changes to the immigrant selection process may have influenced the demographic and human capital characteristics of internationally educated nurses (IENs) in Canada and in turn the assistance required to facilitate their workforce integration. This study aimed to describe the demographic and human capital profile of IENs in Canada, to explore recent changes to the profile, and to identify predictors of IENs' workforce integration. METHODS: A cross-sectional, descriptive, correlational survey design was used. Eligible IENs were immigrants, registered and employed as regulated nurses in Canada. Data were collected in 2014 via online and paper questionnaires. Descriptive statistics were used to examine the data by year of immigration. Logistic regression modeling was employed to identify predictors of IENs' workforce integration measured as passing the licensure exam to acquire professional recertification and securing employment. RESULTS: The sample consisted of 2280 IENs, representative of all Canadian provincial jurisdictions. Since changes to the immigrant selection process in 2002, the IEN population in Canada has become more racially diverse with greater numbers emigrating from developing countries. Recent arrivals (after 2002) had high levels of human capital (knowledge, professional experience, language proficiency). Some, but not all, benefited from the formal and informal assistance available to facilitate their workforce integration. Professional experience and help studying significantly predicted if IENs passed the licensure exam on their first attempt. Bridging program participation and assistance from social networks in Canada were significant predictors if IENs had difficulty securing employment. CONCLUSIONS: Nurses will continue to migrate from a wide variety of countries throughout the world that have dissimilar nursing education and health systems. Thus, IENs are not a homogenous group, and a "one size fits all" model may not be effective for facilitating their professional recertification and employment in the destination country. Canada, as well as other countries, could consider using a case management approach to develop and tailor education and forms of assistance to meet the individual needs of IENs. Using technology to reach IENs who have not yet immigrated or have settled outside of urban centers are other potential strategies that may facilitate their timely entrance into the destination countries' nursing workforce.

How nursing managers respond to intraprofessional aggression: novel strategies to an ongoing challenge.

Nursing managers are identified as playing a central role in workplace aggression management. In effect, employees' decisions to report unacceptable behavior is said to be directly influenced by how a manager will respond to their claims. Using principles from critical nursing ethnography, data were collected from interviews, organizational documents, and observation of physical environment. Twenty-three semistructured interviews were conducted in both a university-affiliated psychiatric hospital and a community hospital located in a large metropolitan city in Ontario. The study aimed at broadening the understanding of how nurse managers respond to intraprofessional and interprofessional workplace aggression. Several strategies were described by managers including coaching individuals so they feel capable of addressing the issue themselves, acting as mediator to allow both sides to openly and respectfully talk about the issue, and disciplining employees whose actions warrant harsh consequences. As part of the study, managers reported that dealing with workplace aggression could be difficult and time consuming and admitted that they sometimes came to doubt their abilities to be able to positively resolve such a widespread problem. Conclusions drawn from the study suggest that aggression management is not solely the responsibility of managers but must involve several actors including the aggressive individual, peers, human resources department, and unions.

Mimetic desire and professional closure: toward a theory of intra/ inter-professional aggression.

The purpose of this article is to present a renewed way to theorize intra/inter-professional aggression in nursing. To this end, René Girard's mimetic mechanism and Max Weber's conception of professional closure will be explored. More specifically mimetic mechanism, summarized as a sequence of four distinct but interdependent phases including mimetic desire, mimetic rivalry, mimetic (sacrificial) crisis, and scapegoat, will serve to broaden the understanding ofintra-professional aggression. For its part, professional closure, a strategy designed to limit and control the number of individuals admitted to a specific profession, will provide a fresh perspective to critically examine the issue of inter-professional aggression by drawing attention to hidden practices of dominance and control.

The relationship between organizational justice and workplace aggression.

AIM: This paper is a discussion of the links between organizational justice and workplace aggression. BACKGROUND: Managers have been identified as key players in implementing and maintaining an organizational culture of trust and justice. Employees who perceive themselves to be victims of injustice may rebel, using various means to 'punish' the source of the injustice. DATA SOURCES: Literature review of publications in English and French from the early 1960 to 2009, including books, was conducted. Bibliographic databases searched for journal articles were Cumulative Index to Nursing and Allied Health Literature, Current Content, EMBASE, Medline, PsycINFO and Web of Science. DISCUSSION: The work environment and roles of nursing managers have changed considerably in the last 20 years, resulting in challenging working conditions for nursing managers. These can have an impact on their ability to create a trusting and fair culture, and can mean that they themselves be considered victims of organizational injustice. IMPLICATIONS FOR NURSING: The failure of many re-engineering projects has been linked to a lack of consideration of the impact of perception of justice when implementing change. In addition, perception of organizational justice has the potential to influence many organizational outcomes, such as perception of respect and trust. As justice is a founding principle of biomedical ethics, principles of justice, equity and fairness must be upheld in practice in accordance with the requirements of professional codes of ethics. CONCLUSION: The concept of justice is linked to the founding principles of biomedical ethics, and these must be upheld in order to practise in accordance with professional codes of ethics and conduct.

Managing nurses through disciplinary power: a Foucauldian analysis of workplace violence.

AIMS: This paper describes discipline as a specific technique of power which constitutes, in our view, a form of institutional violence. BACKGROUND: The need to create and maintain safe and healthy work environments for healthcare professionals is well documented. EVALUATION: Foucault's concept of disciplinary power was used to explore institutional violence from a critical perspective. KEY ISSUE: Violence is identified as an important factor in the recruitment and retention of healthcare professionals. Given the shortage of such professionals, there is an urgent need to take a fresh look at their working environments and working conditions. CONCLUSION: Power, surveillance and disciplinary techniques are used at all levels of hospital management to control and contain both human resources and costs. IMPLICATIONS FOR NURSING MANAGEMENT: By associating common workplace practices with institutional violence, employers who have a policy of zero tolerance toward workplace violence will need to re-examine their current ways of operating.

Policies and procedures: a tool to support the implementation of clinical guidelines?

OBJECTIVES: To explore the use of policies and procedures as a tool to support the implementation of clinical guidelines and to determine the relationship between organizational support and stability with nurses' perception of policy change. DESIGN: Secondary analysis of qualitative and quantitative data collected in the post-intervention phase of the study entitled Evaluation of the Dissemination and Utilization of Best Practice Guidelines by Registered Nurses in Ontario. SETTING: Eleven agencies across Ontario, Canada. PARTICIPANTS: Fifty nursing staff, 32 nurse administrators and 22 clinical resource nurses (90% response) participated in semi-structured interviews. A total of 316 randomly selected nursing staff from 23 participating units in 11 agencies completed questionnaires (65% response). METHODS: Qualitative data from semi-structured interviews were examined to determine whether participants had modified their policies and procedures as part of the implementation of clinical guidelines. Using SPSS 11.0 for Windows, the authors assessed, using independent t-tests, the relationship between the perception of modification of policies and procedures and the perceptions of organizational support an organisational stability. RESULTS: While modifications to policies and procedures were made at each agency as part of the implementation of clinical guidelines, 27% of staff disagreed that modifications had been made. Nursing staff who agreed that changes had been made to policies and procedures were significantly more likely to report positive organizational support for clinical guideline implementation. CONCLUSION: Findings suggest the need to increase nursing staffs' awareness of changes to policies and procedures during clinical guideline implementation. Furthermore, results indicate that organizational support may have a positive influence on modifications to policies and procedures that are guided by research-based clinical guideline recommendations.

Hormonal and spatial regulation of nitric oxide synthases (NOS) (neuronal NOS, inducible NOS, and endothelial NOS) in the oviducts.

Nitric oxide (NO) is a free radical produced by the action of NO synthases (NOS) and is known to be involved in the regulation of many reproductive events that occur in the oviducts. The oviducts are highly specialized organs that play crucial roles in reproduction by providing an optimal environment for the final maturation of gametes, fertilization, and early embryo development. In this study, we analyzed the expression, hormonal regulation, and cellular distribution of neuronal, inducible, and endothelial NOS in different bovine oviduct segments to better understand the roles played by these enzymes in oviductal functions in vivo. Quantitative RT-PCR analysis revealed that NOS isoforms are hormonally regulated and differentially expressed along the oviduct throughout the estrous cycle. All NOS were highly expressed around the time of estrus, and immunohistochemistry studies determined that neuronal NOS, inducible NOS (iNOS), and endothelial NOS are differentially distributed in cells along the oviduct. Interestingly, our results showed that estradiol selectively up-regulates iNOS expression in the oviduct during the periovulatory period corresponding to the window of ovulation, oocyte transport, and fertilization. The resulting NO production by this high-output NOS may be of crucial importance for reproductive events that occur in the oviduct. This study provided the first demonstration that NO production is hormonally regulated in the mammalian oviducts in vivo. Our results suggest that neuronal NOS, iNOS, and endothelial NOS contribute to oviductal functions in a timely and site-specific manner.