Maura MacPhee

No abstract available.

No abstract available.

No abstract available.

No abstract available.

No abstract available.

Patients and families want to be in close proximity to one another during the phase of critical illness. This has historically been challenged by restrictive hospital visiting hours. Nurses have played the gatekeeper role and decided who could visit the patient, when, and for how long. A scholarly review of the existing literature was conducted to identify what patients, families and nurses believe about visiting and to determine and suggest best evidence for practice, policy, education and research. Using a Rapid Evidence Assessment (REA) methodology 18 studies were evaluated through the lens of Patient and Family Centred Care. The best evidence is presented as well as the recommendations for best practice, policy, education and future research to help promote family presence in the Intensive Care Unit. Families and patients had improved outcomes, physiological and psychological, when Intensive Care Unit policy supports the presence of the family at the bedside. Nurses felt that working with families was part of their expected practice but struggled with the increased workload. They also struggled with relinquishing control over visitation but when they did patients and families felt empowered. The key recommendations are to create flexible patient controlled visitation policies in the Intensive Care Unit, replicate studies to reinforce the findings from the studies presented, provide education for nurses about family nursing, and education for families and patients regarding the unit policies and events.

View record

Patient handover represents a significant safety risk. At each handover information could be lost, misinterpreted or not well communicated. Patient handover refers to any time responsibility for a patient’s care is transferred from one care provider to another. This process requires succinct communication between the care providers, in this case nurses, to ensure continuity and safety of patient care. A significant handover that occurs daily on any nursing unit is the handover that occurs between nursing shifts: the off-going nurse reports to the oncoming nurse. The purpose of this research was to use an appreciative inquiry process to answer the question: what is the critical information that should be included in a nurse-to-nurse inter-shift report on an acute medical unit at a tertiary, urban teaching hospital? A purposive sample of nurses from the study unit worked together over three separate project group meetings to develop, pilot and refine a new handover form. The 4 D process of the appreciative inquiry method was used including: discover, dream, design and deliver.Thematic analysis was used for each cycle of the apprecitive inquiry process and the main themes found are presented. The central findings from this project include developing a handover form that presents succinct, organized, objective and written information that focuses on the critical events or information from the previous twelve hours and what needs to happen in the next twelve hours. To ensure appropriate use of the form the purpose of the form should be emphasized to all staff and connected to patient safety and continuity of care. In addition, the team discussed implementing a formal and informal feedback process to further encourage appropriate use of the form. Finally, promoting professional accountability to ensure completion of the handover form and accompanying documentation, such as the kardex and careplans.

View record

Aim: To build on previous British Columbia Nursing Leadership Institute (BC NLI) evaluative research by analyzing the perceptions of staff nurses and identifying whether they have seen any behavior differences in their first-line leaders during the one year period following their leaders’ participation in a formal leadership development program.Background: The healthcare system is absorbed with many demands and complexities that are challenging every aspect of the system. To be able to shift away from the current path, the system requires committed and effective nurse leaders that play a fundamental role in healthcare and its necessary system transformations. To assist nurses to become effective leaders it is essential that organizations recognize the role of structured leadership development education, such as the BC NLI, in shaping nurse leaders who have the potential to impact patient, workplace, staff, and organization outcomes. The BC NLI is a collaborative initiative designed to support first-line nurse leaders by employing an empowerment framework.Methods: Staff nurses working with first-line nurse leaders who attended the BC NLI between 2008–2009 were included in one of ten focus group sessions that took place one year after their leaders took part in the institute. A qualitative approach of inductive thematic analysis was utilized to conduct a secondary analysis of the staff focus group data and derive code categories and themes.Results: The BC NLI focus group participants showed support for their first-line leaders. They recognized that leaders face many organizational challenges, possess transformational and transactional qualities, and play a key role in the workplace environment. The importance of organizational support and formal leadership development education were identified as key parts of the leaders’ leadership development. Participants reinforced their support for leadership development education, such as the BC NLI, by attributing their leaders’ growth to their participation in the programme. However, some BC NLI focus group participants also expressed their hesitation regarding the possibility of external factors, such as prior experience, having possible influence on leadership development.Conclusion: This study provides evidence that formal leadership development, such as the BC NLI, is vital for the development of first-line nurse leaders.

View record

Horizontal violence is a reality for many staff nurses; it has been recognized as an issue across the nursing profession for more than three decades, and yet there is very little interventional research on how nurse leaders can, and should, address the problem. This study has assessed the research evidence obtained using the Rapid Evidence Analysis (REA) method. What can be concluded from this analysis is that leaders should use tools such as authentic leadership, education of horizontal violence and cognitive behavioral rehearsal training to influence the presence of horizontal violence among staff nurses. Due to the limited number of studies, and methodologies used in those studies, further interventional research is needed to strengthen the science.

View record

Emergency departments (EDs) in urban settings are experiencing extreme challenges such as overcrowding, long wait times, and patient dissatisfaction (Kelley, Bryant, Cox, & Jolley, 2007). Streaming in the Emergency Department is an innovative care delivery design that is designed to reduce ED overcrowding and improve access to care. Streaming enables moderately acute ambulatory Triage Level 3 patients, who often wait the longest, to be cared for in a separate area embedded within the main ED. These patients receive care to the same standards but sit in a chair for most of their stay, only lying in a bed for examinations, treatments, and tests. This care approach often closely matches the way fast track or minor treatment clinics are run for lower acuity Triage Levels 4 and 5 patients in many urban EDs. This study aims to create a deeper understanding of “streaming.” The research examined what factors influenced the successful streaming of moderately acute ambulatory patients within the streaming unit of Hospital X (British Columbia, Canada). A qualitative descriptive design using a single site case study was employed. The data analysis involved reducing data into meaning units, then reducing them to sub-themes which were finally grouped into four major themes (Graneheim & Lundman, 2003; Yin, 2004). These themes were: “facing health care realities,” “doing it right,” “maintaining flow,” and "what matters?” From this research, it is clear that streaming is improving care, patient outcomes, and staff satisfaction in Hospital X’s emergency department. This innovative care delivery design for moderately acute ambulatory patients is challenging the traditional paradigm of ED care, bringing positive changes in a complex health care environment. Timely care for ED patients, through such innovative models as a streaming unit, can save lives (Devkaran, Parsons, Van Dyke, Drennan, & Rajah, 2009).

View record

The learning initiative called the British Columbia Nursing Administrative Leadership Institute (BCNLI) for first line nurse leaders was developed to address the need for educating and mentoring new nurse leaders. The program was a joint project between the Ministry of Health Services Nursing Directorate, British Columbia’s Chief Nursing Officers and the School of Nursing at UBC. The BCNLI program is evidenced based and included information on leadership, management concepts and relevant issues for leaders, (MacPhee & Bouthillette, 2008). The front line nurse leaders who participated were provided education and mentoring, to increase their skills. The front line nursing leaders selected year long projects as part of the program. This study examined if there was any change to the types and scope of control of projects front line nurse leaders chose as part of learning and mentoring initiative. 211 nurse leaders’ projects from the BCNLI project data web pages were examined for scope of control, type of project, and Donabedian’s (1982) structure process outcomes framework using content analysis (Graneheim & Lundman, 2004). These projects provide a window to the types of issues that were relevant and seen as important to the front line nurse leader participants in each cohort of the BCNLI program from 2007 to 2010. This research found that there was no change between the nine cohorts as to structure or process coding. The majority of the projects were structure coded. The content analysis identified five main themes of recruitment/retenton, communication, education, care delivery evaluation, and tool development. The ability to identify the scope of projects of front line nurse leaders was important as very little research exists on scope of control for front line nurse leaders. Only 61% of the projects are at the nursing unit or front line (level two) position. There are concerns that front line nurse leaders were working beyond the nursing unit level. This research will help to understand if nurse leaders are taking on issues or problems that are beyond their roles and the type of projects that exist in the British Columbia Health Care.

View record

This electronic survey study was designed to examine the perceptions, knowledge and commitment of nursing staff regarding shared governance (Nurse Practice Council) at St. Paul’s Hospital (SPH). A cross-sectional survey design was used in this study. The study was conducted in the summer of 2010 at St. Paul’s Hospital, a tertiary hospital in Vancouver, B.C. A 114 nurses participated in the survey who were eligible and agreed to participate in the study. An electronic standardized SG survey was used to collect data for this study. The survey used Likert-like questions to measure the nurses’ perception, knowledge and commitment to the Nurse Practice Council (NPC). Additionally a small number of open-ended questions were used to verify the data from the Likert-like responses. Descriptive statistics were used to measure the level of perception, knowledge and commitment of nurses toward the Nurse Practice Council.Finally content analysis was employed to analyze the nurses’ responses to the open-ended questions.The SG study findings suggest: (1) Staff at SPH supports NPC and has a positive perception of NPC; (2) Staff members do not have enough knowledge about the NPC; and (3) Staff is not sure if administration at SPH is committed to the work of the NPC.The findings also indicate that staff believes the NPC has the potential to make a difference by increasing frontline nurse staff involvement, through education and awareness. Additionally leaders require education in order to increase administrative support and indirectly improve frontline attendance.Results of the one-way ANOVA showed that knowledge of NPC was statistically significant and varied according to practice area. However, no significant results were identified when examining perceptions and commitment according to practice area.In considering the literature that suggests perceptions, knowledge and commitment are essential in the implementation and sustainment of SG, it is surprising that the only significant result was knowledge. These findings indicated that more work is required to improve nurses’ perceptions of NPC, moreover improving the commitment level of staff to SG and the NPC.

View record

Contemporary nursing education has seen a shift towards student-centred teaching and learning strategies. Team teaching is a student-centred strategy that involves the collaboration of multiple teachers to plan, deliver, and evaluate a course. Team teaching has been used in disciplines outside of nursing education, but there is little literature to support its use within the classroom in undergraduate nursing education. The purpose of this qualitative descriptive study is to examine the experiences of undergraduate nursing students enrolled in a newly revised curriculum at the University of British Columbia School of Nursing (UBC SON) that has adopted team teaching as its main pedagogical teaching and learning strategy. The aim of this research is to provide an evidence-based evaluation of the team teaching strategy with the intent of suggesting ways to improve its delivery. Constructivism and adult learning theory were used to guide this study. Non-randomized convenience sampling produced a study population of 49 third-term undergraduate nursing students enrolled in the UBC Bachelor of Science in Nursing (BSN) program starting in September 2009. Students completed a survey consisting of six open-ended questions designed to describe their experiences with team teaching. Content analysis methodology was used to analyze the data. Findings suggested that students supported the use of team teaching and viewed it as a positive influence on their learning experience. Four positive themes from team teaching emerged from the research: challenging student learning, increasing teacher credibility, teams acting as nursing role models, and promoting student learning. The implications of this research focused primarily on nursing education. Seven recommendations on how team teaching delivery can be improved within the UBC SON curriculum are suggested.

View record