Doctor of Philosophy in Nursing (PhD)
Improving follow-up care and health related outcomes for children in British Columbia
Aims: This study examined the effect of various components of a model of nursing care delivery, the mode of nursing care delivery and nursing skill mix on (a) quality of nursing care (i.e., nurse reported quality of nursing care and nursing tasks left undone), (b) patient adverse events, and (c) nurse outcomes (i.e., job satisfaction and emotional exhaustion) after controlling for nurse demographic characteristics, work environment and workload factors. This study also explores the moderating effects of mode of nursing care delivery and skill mix on the relationship between workload factors and the five outcome variables. Background: Research into redesigning care delivery has typically focused on only one care delivery component at a time (e.g., skill mix). There exists little research focusing on both components, and controlling for one factor while the other is investigated to determine quality of nursing care delivery and nurse and patient outcomes. Method: This cross-sectional exploratory correlational survey study drew upon secondary data from 416 direct care registered nurses (RNs) from medical-surgical settings.Results: Nurses working in a team-based mode of care delivery reported a greater number of nursing tasks left undone compared to those working in a total patient care mode of delivery. Nurses working in a skill mix with licensed practical nurses (LPNs) reported a higher frequency of patient adverse events compared to those working in a skill mix without LPNs. Two moderating effects were found. At higher levels of acuity, nurses in a team-based mode of care delivery reported a higher frequency of patient adverse events than did nurses in a total patient care mode of delivery. At higher levels of acuity, nurses working in a skill mix with LPNs reported lower levels of emotional exhaustion than nurses in a skill mix without LPNs.Conclusion: Models of nursing care delivery components influenced quality and safety outcomes. Implications: To be effective, a team-based mode of care delivery requires collaborative teamwork. Policy makers, administrators and healthcare providers should work together to clarify and optimize the scopes of practice for RNs and LPNs.
The current international nursing shortage is worsening and is particularly acute in critical care settings. In Canada, there is a rapidly aging nursing workforce and at the same time a significant shortfall in the number of new graduates to replace the large numbers of retiring nurses. Intensive Care Units have been shown to have the highest turnover rates and there is currently limited scientific evidence on how to retain critical care nurses. Studies have shown that one of the most commonly listed incentives for this group of nurses is organizational support in the form of access to educational opportunities and career development. This study tested a theoretical Critical Care Nurse Retention model that consisted of a professional development intervention, two mediator variables (perceived organizational support and critical care self-efficacy) and three moderator variables (work environment, general self-efficacy and transfer of learning) as mechanisms that may influence intent to stay in the organization, unit and nursing profession. A quasi-experimental longitudinal design was used in a random sample of 363 critical care nurses from multiple hospital sites in Ontario. The 374-hour intervention included an online component, high fidelity simulation, and a preceptored clinical component. ANCOVA and hierarchical regression were used to analyze the hypothesized model. Findings showed the professional development intervention had a direct effect on intent to stay in the unit and intent to stay in the profession. In addition, the model demonstrated the influence of perceived organizational support as a mediator between the relationship of professional development and intent to stay in the profession. Final analysis revealed that the model explained 23% of the variance in intent to stay in the profession. This research provides new evidence supporting the relevance and importance of investing in professional development opportunities and its subsequent impact on intent to stay.
This research is comprised of three separate studies which utilized adolescent self-report data from the Canadian National Longitudinal Survey of Children and Youth (NLSCY). The first study evaluated the factor structure and the equality of measurement properties of three parenting behavior scales (i.e., Parental Nurturance, Parental Rejection, and Parental Monitoring) over a four-year period and found that the factor structure of the NLSCY parenting behavior scales did not show a good fit across three age groups. Revised models for Parental Nurturance and Monitoring were tested and confirmed, however, these models exhibited only configural invariance over time. The second study examined the factor structure and the equality of measurement properties of three problem behavior scales (i.e., Indirect Aggression, Direct Aggression, and Property Offence) across gender and three adolescent age groups (10-11, 12-13, and 14-15 years). This study found support for the structure of the three problem behavior scales, but failed to provide evidence for measurement invariance across groups. All three scales achieved configural invariance across gender and age groups. In addition, the Indirect Aggression scale achieved loading invariance across gender and for the 12 versus 14 year-olds; whereas the Direct Aggression scale exhibited loading invariance for only the 10 versus 12 year-olds. The third study investigated the reciprocal relationship between parental nurturance and adolescent aggression (both indirect and direct aggression) over a four-year period and found that, for girls, parental nurturance at age 10 was associated with both indirect and direct aggression at age 12. For boys, parental nurturance at age 12 was associated with both aggressive behaviors at age 14. The implications of these results for the measurement of parenting and problem behaviors and for the examination of the reciprocal influences in transactional models are discussed, with suggestions for future research.
Job satisfaction is one of the most important factors in health care organizations as it is related to organizational effectiveness, quality patient care and other organizational outcomes. Job satisfaction is a multifaceted concept associated with many factors such as leader empowering behaviors, structural empowerment and psychological empowerment. Although recognition of the importance of job satisfaction in health care has led to considerable research on nurses’ job satisfaction, nurses continue to report high-levels of job dissatisfaction. Moreover, there has been limited research on the effects of psychological empowerment on Canadian nurses’ job satisfaction. Hence, this cross-sectional, correlational study was undertaken to answer two research questions; “How is job satisfaction among staff nurses associated with leader empowering behaviors, structural empowerment and psychological empowerment?” and “What are the relationships between the four psychological cognitions of psychological empowerment (Meaning, Competence, Self-determination and Impact) and each of the dimensions of nurses’ job satisfaction after accounting for demographic characteristics, leader empowering behaviors and structural empowerment?” This study was a secondary analysis of data collected between 2007 and 2010 as part of the evaluation of the British Columbia Nursing Leadership Institute. A series of multiple regression analyses were conducted to answer the two research questions. Structural empowerment was found to be the strongest predictor of nurses’ global job satisfaction and each dimension of job satisfaction, followed by the leader’s use of empowering behaviors. Psychological empowerment also helped to predict job satisfaction among nurses, but the relationships were dimension specific. Two dimensions of psychological empowerment (competence and self-determination) helped to predict nurses’ satisfaction with their relationships with colleagues, and their sense of self-determination and impact helped to predict satisfaction with their working conditions. This study suggests that leaders should use strategies that help staff to feel psychologically empowered. For example, nurse leaders should encourage staff to participate in decision-making to help staff have a greater sense of autonomy and impact in the workplace which, in turn, should foster greater job satisfaction.
Pediatric nurses’ exposure to the suffering of young patients and their families, in addition to high workloads and other workplace stressors, can cause stress and lead to burnout. Burnout is a major cause of nursing staff turnover and this is a serious problem in the face of staff shortages. There has been abundant research on the extrinsic variables leading to burnout in nurses, but very little research has been done on intrinsic variables that can moderate the effects of this stress, such as the personality characteristic of hardiness. The purpose of this study was to examine the relationships between job stressors, hardiness, and burnout among pediatric nurses, and to test whether hardiness moderates the effect of job stressors on burnout.