Canadian public health nurses' job satisfaction.

OBJECTIVES: This study was undertaken to test the applicability of using a standardized questionnaire for measuring public health nurse (PHN) job satisfaction and to determine whether or not scores changed over 30 months. The importance of establishing a method for ongoing measurement of PHN job satisfaction was underscored by changing directions in practice and an emphasis on building public health capacity. METHOD: A 30-month interval, repeated measures descriptive survey design was used. SAMPLE: A randomly selected sample of 87 PHNs employed within 1 Canadian regional health authority participated. MEASUREMENT: The survey questionnaire, the Index of Worklife Satisfaction, was designed to measure the importance of and satisfaction with 6 components of job satisfaction. RESULTS: Pay and autonomy were the most important components; the order of the 4 remaining components changed from first to second surveys. Professional status, autonomy, and interaction were the most satisfying components; PHN satisfaction with professional status and interaction improved significantly over 30 months. A majority of subjects reported that direct client care/client response/making a difference were worklife aspects providing them with most satisfaction. CONCLUSIONS: A valid, reliable questionnaire suitable for ongoing measurement was tested with PHNs, and baseline levels of their job satisfaction were established.

Implementing evidence-based practice: walking the talk.

Russworm and Larrabee's (1999) six-step model for evidence-based practice (EBP) was used by 10 nursing teams to seek answers to clinical questions. These teams, primarily composed of staff nurses, participated in a health region-wide EBP program over 1 year. Overall, the model served as a useful mechanism for examining practice-derived questions. However, additional strategies needed to be incorporated by the project teams. These included making decisions about change/no change at an earlier stage than was suggested by the model; seeking additional evidence including survey data to benchmark "best" practices; and ensuring colleagues' and managers' input, support, and involvement. Four project teams (three of which addressed nursing procedural questions) found insufficient empirical evidence on which to base change; the outlook for directing evidence-based practice was promising for the remaining six projects. The EBP program was judged to be highly satisfactory to participants and their managers.

Implementing evidence-based practice: walking the talk.

Russworm and Larrabee's (1999) six-step model for evidence-based practice (EBP) was used by 10 nursing teams to seek answers to clinical questions. These teams, primarily composed of staff nurses, participated in a health region-wide EBP program over 1 year. Overall, the model served as a useful mechanism for examining practice-derived questions. However, additional strategies needed to be incorporated by the project teams. These included making decisions about change/no change at an earlier stage than was suggested by the model; seeking additional evidence including survey data to benchmark "best" practices; and ensuring colleagues' and managers' input, support, and involvement. Four project teams (three of which addressed nursing procedural questions) found insufficient empirical evidence on which to base change; the outlook for directing evidence-based practice was promising for the remaining six projects. The EBP program was judged to be highly satisfactory to participants and their managers.

Measuring nurse job satisfaction.

Using the Index of Work Satisfaction and nurses' comments, a successful method has been established to provide nurse-sensitive quality indicator data and clarification of work life concerns after restructuring. Findings are being used to direct change for acute care nurses in one large regional health authority. The authors describe the job satisfaction components and their relationship to patient acuity and staff mix.

Evaluation of an evidence-based education program for pressure ulcer prevention.

OBJECTIVE: The purpose of this study was to implement and evaluate a standardized education workshop for 2 levels of nursing staff. DESIGN: The quasi-experimental design required that nurses' knowledge be measured before and after education. SETTING AND SUBJECTS: The convenience sample included registered nurses (N = 595) and licensed practical nurses (N = 59) employed in three acute care hospitals with a total bed capacity of 1,760. INSTRUMENTS: The Pressure Ulcer Knowledge Test, including true-false questions, was selected and compared with updated literature and the evidence-based standards developed for the acute care hospitals. Minor changes resulted in a revised 53-item questionnaire for which content validity and reliability were established. The questionnaire was pilot tested before use. METHODS: The intervention, the standardized education workshop, included risk assessment, prevention, and wound staging, as described in the literature. The dependent variable, knowledge of pressure ulcer prevention and treatment, was measured at 3 time points: immediately before (pre) and after (post 1) the workshop and 3 months later (post 2). Data were analyzed using descriptive statistics and repeated measures. RESULTS: Overall, knowledge scores for the total group were significantly higher from pre to post 1 and from pre to post 2 but significantly lower from post 1 to post 2. Registered nurses' scores were significantly higher than those of licensed practical nurses from pre to post 1. CONCLUSION: The evidence-based pressure ulcer education was effective in increasing registered nurses' and licensed practical nurses' knowledge and was presumed to increase consistency of the knowledge and awareness of practice standards.

Evaluation of an education program for patients with breast cancer receiving radiation therapy.

The acquisition of knowledge is presumed to be part of the coping process for women facing increased stress because of a breast cancer diagnosis. The purpose of this study was to evaluate the impact of an education program on the perceived adequacy of knowledge of patients with breast cancer receiving radiation therapy. Second, the intent was to investigate the patients' preferences regarding involvement in decision making, amount and type of information wanted, and preferred information-seeking activities.A priori quota sampling was planned to ensure that at least 20 subjects were recruited to each of 3 age categories, assumed to represent premenopausal, perimenopausal, and postmenopausal patients with breast cancer receiving radiation therapy. Subjects (N = 79) completed questionnaires before and after the evidence-based education program. The education consisted of a 20-minute interactive video (first session); individualized education, including technical procedures and self-care (second session); and a 1-hour class (third session). Individual teaching as required was provided afterward during radiation therapy.Significant increases in perceived adequacy of knowledge scores indicate that the program was effective, especially with information concerning disease and treatment for postmenopausal subjects. Subjects' participation in 7 of the information-seeking strategies suggests that many had actively sought information before undergoing radiation therapy. Preferences for information that may be indicative of individual coping patterns were similar for more than half of the subjects. The majority preferred as many details as possible, as much information as possible (good and bad), and to participate in decision making. However, not all subjects wanted complete information, except for the information on all side effects. Findings from this study suggest that individual patients' information preferences, priority information needs, and preferred information-seeking activities should be identified early and incorporated within educational programs to target resources and maximize the likelihood that positive patient outcomes will result.

Comparison of one technique of patient-controlled postoperative analgesia with intramuscular meperidine.

We have compared analgesic requirements, perceived pain, and self-assessment of 'health locus of control' for 72 h in 88 subjects after cholecystectomy, randomized to either a standard technique of self-administration of meperidine (patient-controlled analgesia, PCA) or to intramuscular injections on demand (i.m.). Multivariate analysis revealed no statistical differences between group scores for pain (over any 24 h period) and only minor differences in total meperidine administered. However, the PCA group received significantly less analgesic in the first 24 h (P less than 0.01) and described significantly more pain over the first 4 h (P less than 0.01). Assessment of 'health locus of control' did not show any marked changes. Analysis of patient questionnaires suggests more enthusiasm for patient-controlled analgesia, but in this study, it was difficult to clearly demonstrate any significant advantage for pain management or amount of opiate administered.