Dawn Prentice

Population Trends Toward Increasing Cardiovascular Risk Factors in Canadian Adolescents

OBJECTIVE To determine prevalence and cross-sectional trends over time for cardiovascular risk factors in Canadian adolescents. STUDY DESIGN Cross-sectional trends in cardiovascular risk and lifestyle factors were gathered annually in 14- to 15-year-old students in the Niagara region, Ontario, Canada. RESULTS A total of 20 719 adolescents were screened between 2002 and 2008. The proportion of obese adolescents (>95th percentile for body mass index [BMI]) increased significantly, by +0.34%/year (P = .002). The proportions of adolescents with borderline high cholesterol (4.4-5.1 mmol/L) (+0.57%/year; P <.001) and with high cholesterol (≥5.2 mmol/L) (+0.43%/year; P <.001) both increased significantly over time. The proportion of adolescents with prehypertension decreased by -0.23%/year (P = .02), whereas the proportion of those with stage I hypertension (5%-6%) or stage II hypertension (2%-4%) remained constant. The proportion of adolescents classified as being at high cardiovascular risk increased by +0.67%/year (P <.001). Family history, low levels of physical activity, sedentary behaviors, poor nutrition, and lower socioeconomic status were all independently and negatively associated with all aspects of cardiovascular risk. CONCLUSIONS A significant proportion of 14- to 15-year-old Canadian adolescents have at least one cardiovascular risk factor, and the cross-sectional trends worsened during the period 2002-2008.

The ethics of interprofessional collaboration

Interprofessional collaboration has become accepted as an important component in today’s health care and has been guided by concerns with patient safety, quality health-care outcomes, and economics. It is widely accepted that interprofessional collaboration improves patient outcomes through enhanced communication among health-care providers and increased accessibility to services. Although there is a paucity of research that provides confirmatory evidence, interprofessional competencies continue to be incorporated into the curricula of health-care students. This article examines the ethics of interprofessional collaboration and ethical issues that arise from the mainstream adoption of interprofessional competencies and the potential for moral distress in nursing.

Systematic Review of Clinical Judgment and Reasoning in Nursing

A systematic review was conducted to examine the findings on clinical judgment and reasoning in nursing that have emerged since Tanners review in 2006. Electronic databases were searched to locate primary research studies about clinical judgment and reasoning in nursing. Fifteen studies were extracted and analyzed using the five main conclusions outlined by Tanner. The findings of the systematic review generally support Tanners original model, although the role of experience in clinical reasoning and judgment is still not well understood or fully established. In recent literature, researchers have furthered their knowledge by using tools for improving these skills in both nursing students and practicing nurses, although no one strategy has been identified as being more effective. This is reflected in the consideration of a sixth conclusion on clinical judgment and reasoning in nursing-education strategies to improve clinical judgment may influence what a nurse brings to the situation.

Collaboration: what does it really mean to nurses?

Collaboration has been identified as the cornerstone of effective teamwork and is essential for the delivery of high-quality patient care (D’Amour et al. 2005). Intraprofessional collaboration is an interactional process among colleagues who share common professional education, values, socialisation, identity and experience (College of Registered Nurses of Nova Scotia 2012). While collaboration is a concept widely used in health care, some authors suggest there is confusion regarding the meaning of collaboration that has hindered its usefulness in practice and research (Patel et al. 2012).

Oncology nurses' experience of collaboration: A case study

PURPOSE Changes in the health system have created new models of healthcare delivery such as nurse-led teams. This has resulted in the increased opportunity for enhanced collaboration among nurses. Oncology nurses have a long history of working together, yet little is known about their perceptions about collaboration in the practice setting. This paper aimed to explore and describe the experiences of collaboration among oncology nurses, and to understand the factors that influenced collaboration. METHOD Qualitative, case study design was used to study fourteen oncology nurses from one cancer center in Canada. Participants were registered nurses or nurse practitioners, employed full-time or permanent part-time in an oncology nurse role, and working on an in-patient or out-patient unit. Data were collected in 2013 using individual telephone interviews and document reviews. RESULTS Thematic analysis revealed two themes: Art of dancing together, and the stumbling point. The first theme related to the facilitators of collaboration including having: regular face-to-face interaction, an existing and/or previous relationship, oncology nursing experience, and good interpersonal skills. The second theme related to the barriers to collaboration such as: role ambiguity, organizational leadership, and multi-generational differences. CONCLUSIONS Collaboration is a complex process that does not occur spontaneously. To improve collaboration nursing leadership needs to support and promote opportunities for nurses to build the relationships required to effectively collaborate. It is equally important that individual nurses be willing to collaborate and possess the interpersonal skills required to build and maintain the collaborative relationship despite differences in age, generation, and clinical experience.

A case management experience: implementing best practice guidelines in the community.

This article discusses the implementation of a best practice guideline (BPG) in a community setting using a case management model. The role of the case manager is presented as well as the process of evaluation. Challenges to implementing a BPG in a community setting are also addressed.

Are Benner's expert nurses near extinction?

Patricia Benner’s 1984 From Novice to Expert pushed the boundaries of traditional thought in the area of skill acquisition in nursing. Benner’s understanding of the nature of nursing and particularly skill acquisition stemmed largely from her work as a registered nurse (RN) in the critical care setting (Benner, 2001). From Novice to Expert was a unique addition to the many models and theories already utilized in nursing practice due to its development from a strictly qualitative methodology and utilization of nursing narratives directly from the practice setting (Benner, 2001). What interests me most about Benner’s From Novice to Expert work is her description of the transition from the level of proficient to expert and how nurses achieve and maintain the title of expert (Benner, 2001). Benner (2001) adapted the five levels of skill acquisition described in the Dreyfus Model of Skill Acquisition (Dreyfus & Dreyfus, 1980) to reflect Benner’s understanding of how nurses move from novice, advanced beginner, competent, proficient and expert skill levels. This discussion paper will explore the phenomenon of how registered nurses move from a position of proficient or expert back into a lower level of skill acquisition when faced with a change in scope of practice within their current practice setting. Additionally, the reasons why a nurse may never achieve expert status and why this phenomenon could be unintentionally facilitated by current advancements and changes within nursing practice and the healthcare system in general will be examined. Having been a labour and delivery nurse for eight years, I consider the experience I received on a small six bed unit in a community hospital in Ontario, Canada, extremely valuable in providing me with both the education and experience to move from a novice RN towards proficiency in a short period of time. This setting was unique from larger centres because the unit was staffed by only two RNs with a limited budget, resources, and support staff; but clear and obvious expectations that we needed to function proficiently, effectively and safely for every patient care situation that presented. I was expected to be a high functioning team member from the start of my career. From routine care to crises, even charge nurse responsibilities were situations or roles that I was placed in and expected to handle immediately after my new graduate orientation period was completed. I was fortunate to have worked with a large number of expert nurses, or at least those whom I would identify as that according to Benner’s understanding of the nature of nursing practice (Benner, 2001). Working as part of a pair with these nurses provided me with an excellent learning environment and allowed for a smooth and quick transition from novice to proficient with growing confidence in my knowledge and skills. Benner (2001, p. 31–32) defines the expert nurse as one who:

Staff perceptions of collaboration on a new interprofessional unit using the Assessment of Interprofessional Team Collaboration Scale (AITCS)

ABSTRACT The aim of this study was to obtain baseline information on staff attitudes and perceptions of interprofessional collaboration on a newly formed interprofessional education unit. The Assessment of Interprofessional Team Collaboration Scale (AITCS) was administered to 54 interprofessional team members on a 30-bed medical interprofessional education (IPE) unit. We found that the team members respected each other but felt they needed more organisational support to further develop team skills. Additionally, team members noted that they did not have enough time for team reflection or to make changes to the team processes. The results obtained from this study will help to develop and refine educational strategies to assist the staff working on the IPE unit.

Interprofessional Collaboration: The Experience of Nursing and Medical Students’ Interprofessional Education

In this hermeneutic phenomenological study, we examined the experience of interprofessional collaboration from the perspective of nursing and medical students. Seventeen medical and nursing students from two different universities participated in the study. We used guiding questions in face-to-face, conversational interviews to explore students’ experience and expectations of interprofessional collaboration within learning situations. Three themes emerged from the data: the great divide, learning means content, and breaking the ice. The findings suggest that the experience of interprofessional collaboration within learning events is influenced by the natural clustering of shared interests among students. Furthermore, the carry-forward of impressions about physician–nurse relationships prior to the educational programs and during clinical placements dominate the formation of new relationships and acquisition of new knowledge about roles, which might have implications for future practice.

Adolescent Cardiovascular Risk Factors: A Follow-up Study:

Purpose: To assess the outcomes of a school nurse referral to a family physician for adolescents identified with elevated cholesterol or blood pressure risk factors. Method: Telephone survey interviews were used to collect quantitative and qualitative data. Findings: Data were collected on 178 adolescents through parent and adolescent interviews over a 3-month period. The main theme reported for not complying with the follow-up referral was that respondents did not perceive it as necessary or urgent. Of the approximately 60% who reportedly went to the physician, 58% had further tests, 10% were referred to specialists, and 3% were prescribed medications. Eating and exercise changes were reported by those who went for follow-up. Conclusion: Adolescent health-seeking behaviors can be influenced positively by school programs that involve families in discussion, nurses in risk identification, and referrals to physicians for follow-up.