Ellen Rukholm

Physical Activity Behavior, Motivational Readiness and Self-Efficacy among Ontarians with Cardiovascular Disease and Diabetes

This cross-sectional study examined physical activity and its correlates among 355 diabetes, 144 cardiovascular disease, 75 diabetes and cardiovascular disease, and 390 residents with cardiovascular risk factors. Community residents (N=2566) were screened by telephone, and 964 participants completed a self-report survey. Non-diabetes participants participated in a greater range of physical activities (p<.001), more frequently (p=.013). Diabetes participants had lower physical activity readiness and efficacy (ps<.009). In a regression model (p<.001), region and disease, work, marital and smoking status were significant correlates of physical activity frequency. Interventions which increase motivational readiness and efficacy among diabetics are required to prevent and delay complications, particularly in regions with environmental barriers such as cold weather and homogeneous, low-density land use.

Students' perceptions of interprofessional learning through facilitated online learning modules

Background: Asynchronous e-learning is an appealing option for interprofessional education (IPE) as it addresses the geographic and timetabling barriers often encountered when organizing activities across educational programs. Aim: This study examined the extent to which pre-licensure students were able to learn with, from, and about each other through completion of innovative online IPE learning modules. Methods: Seventy-seven students completed e-learning modules developed through a consortium of educational institutions. Evaluation was primarily qualitative through focus groups, interviews, analyses on off-line discussions and an online feedback form. Results: Qualitative analyses of the discussion fora revealed that students were able to solve problems collaboratively, clarify their professional roles, and provide information from their professional perspective. Focus groups and interviews reinforced that students recognized the importance of working together and implicate clinical education as an important venue to reinforce learning about collaborative practice. Analyses of the online feedback form suggest the need for clear processes related to group assignments and deadlines. Conclusion: Students learned about each others role, solved problems together and had positive perceptions of the online modules as a venue for interprofessional learning. Results are encouraging to those interested in using e-learning in IPE as part of an overall curriculum.

Therapeutic benefit of preventive telehealth counseling in the Community Outreach Heart Health and Risk Reduction Trial.

We evaluated whether telehealth counseling augments lifestyle change and risk factor decrease in subjects at high risk for primary or secondary cardiovascular events compared to a recommended guideline for brief preventive counseling. Subjects at high risk or with coronary heart disease (35 to 74 years of age, n = 680) were randomized to active control (risk factor feedback, brief advice, handouts) or telehealth lifestyle counseling (active control plus 6 weekly 1-hour teleconferenced sessions to groups of 4 to 8 subjects). Primary outcome was questionnaire assessment of adherence to daily exercise/physical activity and diet (daily vegetable and fruit intake and restriction of fat and salt) after treatment and at 6-month follow-up. Secondary outcomes were systolic and diastolic blood pressures, ratio of total to high-density lipoprotein cholesterol, and 10-year absolute risk for coronary disease. After treatment and at 6-month follow-up, adherence increased for telehealth versus control in exercise (29.3% and 18.4% vs 2.5% and 9.3%, respectively, odds ratio 1.60, 95% confidence interval 1.2 to 2.1) and diet (37.1% and 38.1% vs 16.7% and 33.3%, respectively, odds ratio 1.41, 95% confidence interval 1.1 to 1.9). Telehealth versus control had greater 6-month decreases in blood pressure (mean ± SE, systolic -4.8 ± 0.8 vs -2.8 ± 0.9 mm Hg, p = 0.04; diastolic -2.7 ± 0.5 vs -1.5 ± 0.6 mm Hg, p = 0.04). Decreases in cholesterol ratio and 10-year absolute risk were significant for the 2 groups. In conclusion, telehealth counseling augments therapeutic lifestyle change in subjects at high risk for cardiovascular events compared to a recommended guideline for brief preventive counseling.

Context and cardiovascular risk modification in two regions of Ontario, Canada: a photo elicitation study.

Cardiovascular diseases, which include coronary heart diseases (CHD), remain the leading cause of death in Canada and other industrialized countries. This qualitative study used photo-elicitation, focus groups and in-depth interviews to understand health behaviour change from the perspectives of 38 people who were aware of their high risk for CHD and had received information about cardiovascular risk modification while participating in a larger intervention study. Participants were drawn from two selected regions: Sudbury and District (northern Ontario) and the Greater Toronto Area (southern Ontario). Analysis drew on concepts of place and space to capture the complex interplay between geographic location, sociodemographic position, and people’s efforts to understand and modify their risk for CHD. Three major sites of difference and ambiguity emerged: 1) place and access to health resources; 2) time and food culture; and 3) itineraries or travels through multiple locations. All participants reported difficulties in learning and adhering to new lifestyle patterns, but access to supportive health resources was different in the two regions. Even within regions, subgroups experienced different patterns of constraint and advantage. In each region, “fast” food and traditional foods were entrenched within different temporal and social meanings. Finally, different and shifting strategies for risk modification were required at various points during daily and seasonal travels through neighbourhoods, to workplaces, or on vacation. Thus health education for CHD risk modification should be place-specific and tailored to the needs and resources of specific communities.

Occupational Stress Management and Burnout Interventions in Nursing and Their Implications for Healthy Work Environments: A Literature Review.

This article reports on a literature review of workplace interventions (i.e., creating healthy work environments and improving nurses’ quality of work life [QWL]) aimed at managing occupational stress and burnout for nurses. A literature search was conducted using the keywords nursing, nurses, stress, distress, stress management, burnout, and intervention. All the intervention studies included in this review reported on workplace intervention strategies, mainly individual stress management and burnout interventions. Recommendations are provided to improve nurses’ QWL in health care organizations through workplace health promotion programs so that nurses can be recruited and retained in rural and northern regions of Ontario. These regions have unique human resources needs due to the shortage of nurses working in primary care.

A multifactorial study of test anxiety and coping responses during a challenge examination

Challenge examinations offer registered nurse students enrolled in our baccalaureate nursing programme the opportunity to demonstrate mastery of course content through a testing process. Successful students receive credit for the course while those who are unsuccessful must take the course to proceed in the programme. Faculty observations of registered nurse students during the challenge process suggested this testing was stressful. Therefore, a study was conducted to determine anxiety levels and coping strategies of on-campus and distance education registered nurse students at three different times during the challenge examination process. Differences between the two groups of nursing students on selected demographic variables, past academic performance, anxiety levels and coping strategies were assessed from the perspective of Folkman & Lazaruss (1984) theory of stress and coping. Significant differences were found in anxiety levels, coping strategies and past academic performance by age, marital status, employment and work setting. Several different coping strategies were used. However, problem solving was used extensively by both groups while social support was used more by the on-campus students. The results are discussed in terms of Folkman & Lazaruss theory of stress and coping, and implications for nurse educators are presented.

Measuring quality of life in cardiac rehabilitation clients.

Quality of life is being increasingly considered as an expected outcome of cardiac rehabilitation programs. However, few instruments exist that reflect a multidimensional concept of quality of life including disease specific items. This article outlines the method used by researchers to adapt Padilla and Grants [Padilla, G., Grant, M., 1985. Quality of life as a cancer nursing outcome variable. Adv. Nursing Sci. 8(1), 45-60.] Quality of Life Index for use with a cardiac rehabilitation population. A convenience sample of 222 subjects included three groups: 95 cardiac subjects enrolled in a program; 51 cardiac subjects not enrolled in a program; and 76 healthy individuals. Test-retest reliability yielded a coefficient of 0.81 and an alpha coefficient of 0.87. Exploratory factor analysis resulted in a five factor solution. These factors explained 60.8% of the variance at loadings of 0.43 or greater. Contrasted groups approach to validity showed that the instrument differentiated between healthy subjects and those with cardiac illness (t = 11.57; df = 180; p < 0.0001). As anticipated convergent validity revealed a positive correlation between total scores obtained from Spitzers [Spitzer, W.O., Dobson, A.J., Hall, A., Chesterman, E., Levy, J., Shepherd, R., Battista, R.N., Catchlove, B.R., 1981. Measuring the quality of life in cancer patients: A concise QL index for use by physicians. J. Chronic Dis. 34, 585-597.] global measure of quality of life and the Cardiac Quality of Life Index (r = 0.67; p < 0.0001). This work is preliminary. Refinement and development of the instrument is ongoing.

A heart health survey at the worksite: the first step to effective programming.

1. Cardiovascular disease is the number one killer in Canada, accounting for 42% of all deaths. 2. Workplace policy and health promotion programs can have a significant impact on modifiable risk factors associated with the development of heart disease. 3. This article describes the results of a worksite cardiovascular risk behavior screening of 652 mining employees in Sudbury, Ontario. 4. The theoretical framework for this study is based on the PRECEDE-PROCEED model: to reach the ultimate outcome, improved quality of life changes must be made at both the individual as well as the environmental (workplace) level (Green, 1991).

Partnering with an Aboriginal Community for Health and Education

Cultural awareness is a concept that is gaining much attention in health and education settings across North America. This article describes how the concepts of cultural awareness shaped the process and the curriculum of an online health education project called Interprofessional Collaboration: Culturally-informed Aboriginal Health Care. The exploration focuses on the interactions among faculty members and educational developers from Laurentian University, Elders of the Anishinabek tradition, and members of the Anishinabek community known as the North Shore, an area approximately two hours northwest of Sudbury. The projects curriculum is driven by choices made by the Anishinabek Elders, with support from their cultural community and the local university. The online module developed for this project provides health-care students at Laurentian University, with access to traditional knowledge, including the teachings of the Medicine Wheel and the Seven Grandfathers. Ideally, these teachings will lead to an increase in culturally informed care for Anishinabek clients and their families in northern Ontario. The process used by the university-based team with the Elders and the larger community of the North Shore is recommended as a possible template for university-based teams working with Aboriginal partners. Finally, the Anishinabeks of the North Shore are recognized as a cultural exemplar of a community that appreciates the intersection and potential of traditional knowledge and contemporary health education practices and technologies.

An examination of retention factors among registered nurses in Northeastern Ontario, Canada: Nurses intent to stay in their current position.

BACKGROUND The purpose of the study was to examine factors related to the retention of registered nurses in northeastern Ontario, Canada. OBJECTIVE/METHOD A cross-sectional survey of registered nurses working in northeastern Ontario, Canada was conducted. Logistic regression analyses were used to consider intent to stay in current employment in relation to the following: 1) demographic factors, and 2) occupation and career satisfaction factors. RESULTS A total of 459 (29.8% response rate) questionnaires were completed. The adjusted odds logistic regression analysis of RNs who intended to remain in their current position for the next five years, demonstrated that respondents in the 46 to 56 age group (OR: 2.65; 95% CI: 1.50 to 4.69), the importance of staff development in the organization (OR: 3.04; 95% CI: 1.13 to 8.13) northeastern Ontario lifestyle (OR: 2.61; 95% CI: 1.55 to 4.40), working in nursing for 14 to 22.5 years (OR: 2.55; 95% CI: 1.10 to 5.93), and working between 0 to 1 hour of overtime per week (OR: 1.20; 95% CI: 1.20 to 4.64) were significant factors in staying in their current position for the next five years. CONCLUSIONS This study shows that a further understanding of the work environment could assist with developing retention for rural nurses. Furthermore, employers may use such information to ameliorate the working conditions of nurses, while researchers may use such evidence to develop interventions that are applicable to improving the working conditions of nurses.