Andrea Baumann

Q-methodology in nursing research: A promising method for the study of subjectivity

This article provides an overview and application of Q-methodology for nursing researchers, with an illustration of its appropriate usage. Q-methodology has been identified as a method for the analysis of subjective viewpoints and has the strengths of both qualitative and quantitative methods. It shares with qualitative methodologies the aim of exploring subjectivity; however, statistical techniques are used to reveal the structure of views. This article describes the use of Q-methodology to examine subjectivity systematically, revealing connections between accounts that other techniques may overlook. An example from the literature is presented. Q-methodology is useful in qualitative nursing research concerned with the exploration and comparison of subjectivity and attitudes. It can be used to effectively identify attitudes, perceptions, feelings, and values as well as explore life experiences such as stress, self-esteem, body image, and satisfaction.

Nursing Generations in the Contemporary Workplace

Preserving a viable workforce is contingent upon recruiting and retaining more young people and persuading older workers to remain with the organization. The success of these efforts may depend on offering appropriate incentives to workers in different age cohorts. Although only limited research has been carried out on the topic, findings have consistently shown that the workforce consists of generational groups with different attributes and priorities. This mixed-methodology study uses survey and focus group results to explore some of the differences among age cohorts of nurses in three Canadian hospitals. The research revealed significant differences in career commitment; affective, normative, and continuity commitment to the organization; job satisfaction; stress and emotional exhaustion; depersonalization; personal accomplishment; and propensity to leave the hospital. This article concludes with recommendations for policies that address the needs of nurses of different ages.

Nurse Migration to Canada Pathways and Pitfalls of Workforce Integration

Many internationally educated nurses (IENs) find it difficult to reinstate themselves in their profession after migration. This article explores factors contributing to the success and failure of IENs to reestablish professional careers. The article discusses a study involving 39 IENs in 5 focus groups and 10 interviews. In all, 29 interviews are held with other stakeholders. IENs encounter obstacles at each stage of the migration process. New strategies are required to assist IENs to reenter the workforce. Given the consistent predictions of an extreme nurse shortage, it is important that the brain waste of immigrant nurses be minimized.

The evolving role of health care aides in the long-term care and home and community care sectors in Canada.

Health Care Aides (HCAs) provide up to 80% of the direct care to older Canadians living in long term care facilities, or in their homes. They are an understudied workforce, and calls for health human resources strategies relating to these workers are, we feel, precipitous. First, we need a better understanding of the nature and scope of their work, and of the factors that shape it. Here, we discuss the evolving role of HCAs and the factors that impact how and where they work. The work of HCAs includes role-required behaviors, an increasing array of delegated acts, and extra-role behaviors like emotional support. Role boundaries, particularly instances where some workers over-invest in care beyond expected levels, are identified as one of the biggest concerns among employers of HCAs in the current cost-containment environment. A number of factors significantly impact what these workers do and where they work, including market-level differences, job mobility, and work structure. In Canada, entry into this ‘profession’ is increasingly constrained to the Home and Community Care sector, while market-level and work structure differences constrain job mobility to transitions of only the most experienced workers, to the long-term care sector. We note that this is in direct opposition to recent policy initiatives designed to encourage aging at home. Work structure influences what these workers do, and how they work; many HCAs work for three or four different agencies in order to sustain themselves and their families. Expectations with regard to HCA preparation have changed over the past decade in Canada, and training is emerging as a high priority health human resource issue. An increasing emphasis on improving quality of care and measuring performance, and on integrated team-based care delivery, has considerable implications for worker training. New models of care delivery foreshadow a need for management and leadership expertise - these workers have not historically been prepared for leadership roles. We conclude with a brief discussion of the next steps necessary to generating evidence necessary to informing a health human resource strategy relating to the provision of care to older Canadians.

Clinical reasoning in medicine and nursing: Decision making versus problem solving

The clinical reasoning process includes two broad components: (a) problem solving (searching for the one “right”; answer) and (b) decision making (selecting from several possibilities). Each component requires considerable knowledge and skill; decision making also requires that the values assigned to each potential outcome be ascertained and used. We present a framework for the clinical encounter, with particular emphasis on treatment selection. We then note evidence, including three studies conducted by our research group, to support the view that clinical problem solving is based primarily on pattern recognition following data gathering, rather than on a deterministic rule‐based approach. We suggest that a pattern recognition approach, which stresses the importance of a knowledge base as opposed to a set of learned skills, implies a strong potential role for the computer in both medical practice and medical education.

Migration: a concept analysis from a nursing perspective

AIM   This article is a report of a concept analysis of nurse migration. BACKGROUND   International migration is increasing and nurse migrants are active participants in this movement. Migration is a complex term and can be examined from a range of perspectives. Analysis of nurse migration is needed to guide policy, practice and research. DATA SOURCES   A literature search was undertaken using electronic literature indexes, specific journals and websites, internet search engines and hand searches. No timeframe was placed on the search. Most literature found was published between 2001 and 2009. A sample of 80 documents met the inclusion criteria. METHOD   Walker and Avants approach guided the analysis. DISCUSSION   Nurse migration can be defined by five attributes: the motivation and decisions of individuals; external barriers and facilitators; freedom of choice to migrate; freedom to migrate as a human right, and dynamic movement. Antecedents of migration include the political, social, economic, legal, historical and educational forces that comprise the push and pull framework. The consequences of migration are positive or negative depending on the viewpoint and its affect on the individual and other stakeholders such as the source country, destination country, healthcare systems and the nursing profession. CONCLUSION   This concept analysis clarified the complexities surrounding nurse migration. A nursing-specific middle-range theory was proposed to guide the understanding and study of nurse migration.

A narrative review on the effect of economic downturns on the nursing labour market: implications for policy and planning.

Economic downturns and recession lead to budget cuts and service reductions in the healthcare sector which often precipitate layoffs and hiring freezes. Nurses, being the largest professional group in healthcare, are strongly affected by cost reductions. Economic downturns destabilize the nursing labour market with potential negative outcomes, including serious shortages, extending beyond the recessionary period. The objectives of this manuscript are to provide an overview of the potential short- and long-run impact of economic downturns on the supply and demand of nurses, and present healthcare decision makers with a framework to enhance their ability to strategically manage their human resources through economic cycles.A narrative review of the literature on the effects of economic downturns on the nursing labour market in developed countries was carried out with a special focus on studies offering a longitudinal examination of labour force trends. Analysis indicates that economic downturns limit the ability of public payers and institutions to finance their existing health workforce. As salaried healthcare workers, nurses are especially susceptible to institutional budget cuts. In the short run, economic downturns may temporarily reduce the demand for and increase the supply of nurses, thereby influencing nursing wages and turnover rates. These effects may destabilise the nursing labour market in the long run. After economic downturns, the market would quickly display the pre-recessionary trends and there may be serious demand–supply imbalances resulting in severe shortages. Potential long-term effects of recession on the nursing labour market may include a downsized active workforce, difficulty in retaining younger nurses, a decreased supply of nurses and workforce casualisation.Lack of understanding of labour market dynamics and trends might mislead policy makers into making misinformed workforce downsizing decisions that are often difficult and expensive to reverse. In the aftermath of an economic downturn, the costs of attracting nurses back often outweigh the short term cost savings. Effective management should support the nursing workforce by creating attractive and stable work environments to retain nurses at a manageable cost.

Effective retention strategies for midcareer critical care nurses: a Q-method study.

Background:Midcareer nurses continue to be overlooked in the current nursing shortage that is amplified in intensive care units (ICUs) requiring greater numbers of specialized nurses. Objectives:The aim of this study was to discover what midcareer critical care nurses perceive would be effective retention strategies. Methods:As a combination of both qualitative and quantitative approaches, Q methodology was used to allow for the development of innovative strategies as well as to provide an understanding of a population of viewpoints and preferences that can guide retention efforts. Forty ICU nurses between the ages of 25 and 44 years from within a Canadian academic health science corporation completed a 45-item Q sort representing their ideas for increasing staff retention. Data were analyzed using centroid factor extraction and varimax rotation in PQMethod version 2.11. Results:Four viewpoints emerged: The Healthy Workplace and Respect Seeker, The Flexibility and Reward Seeker, The Professional Development and Teamwork Seeker, and The Lifestyle Seeker. Correlations between the factors were appropriately weak, with seemingly distinct demographics characterizing each. Discussion:These findings suggest a possible association between perceptions and both years of nursing experience as well as age. Implications from the study include the need to involve frontline nurses in developing strategies that will retain them. Following further investigation of the nurses’ preferred strategies, it may be necessary for organizations to develop an array of retention strategies rather than implementing a single solution. In future research, generational preferences and the possible dissonance between nurse managers and frontline nurses’ perceptions should be explored.

Downsizing in the Hospital System: A Restructuring Process

In an effort to maintain fiscal viability, hospitals have been undergoing major restructuring. This article reports on a study that examined innovative downsizing strategies used by 20 acute care hospitals in Ontario. The study team reviewed hospital operating plans and analysed the results of interviews conducted with administrators and employees about the downsizing process. Results revealed no uniformity of approach to downsizing. Although many administrators expressed the need for a cooperative approach, downsizing was typically conducted in a top down fashion, and was perceived very differently by staff and administrators. The authors suggest ways to improve restructuring efforts and put forward questions to guide future research.

Perceptions of Professionalism Among Nursing Faculty and Nursing Students

Although there is no consensus about the definition of professionalism, some generally recognized descriptors include knowledge, specialization, intellectual and individual responsibility, and well-developed group consciousness. In this study, Q-methodology was used to identify common viewpoints about professionalism held by nursing faculty and students, and four viewpoints emerged as humanists, portrayers, facilitators, and regulators. The humanists reflected the view that professional values include respect for human dignity, personal integrity, protection of patient privacy, and protection of patients from harm. The portrayers believed that professionalism is evidenced by one’s image, attire, and expression. For facilitators, professionalism not only involves standards and policies but also includes personal beliefs and values. The regulators believed that professionalism is fostered by a workplace in which suitable beliefs and standards are communicated, accepted, and implemented by its staff. The differences indicate that there may be numerous contextual variables that affect individuals’ perceptions of professionalism.