Jacinthe Pepin

Cultural Competence A Constructivist Definition

In nursing education, most of the current teaching practices perpetuate an essentialist perspective of culture and make it imperative to refresh the concept of cultural competence in nursing. The purpose of this article is to propose a constructivist definition of cultural competence that stems from the conclusions of an extensive critical review of the literature on the concepts of culture, cultural competence, and cultural safety among nurses and other health professionals. The proposed constructivist definition is situated in the unitary-transformative paradigm in nursing as defined by Newman and colleagues. It makes the connection between the field of competency-based education and the nursing discipline. Cultural competence in a constructivist paradigm that is oriented toward critical, reflective practice can help us develop knowledge about the role of nurses in reducing health inequalities and lead to a comprehensive ethical reflection about the social mandate of health care professionals.

The multidimensionality of caring: a confirmatory factor analysis of the Caring Nurse–Patient Interaction Short Scale

AIM This paper is a report of a study to evaluate the construct validity of the four-dimensional Caring Nurse-Patient Interaction-Short Scale using confirmatory factor analysis. BACKGROUND Validating theoretical structures of caring is an ongoing challenge in the discipline of nursing. Our previous work has contributed to this literature by the exploration of the dimensionality of the Caring Nurse-Patient Interaction Short Scale via an exploratory factor analysis. The Caring Nurse-Patient Interaction Short Scale comprises 23 items reflecting four caring domains: humanistic care, relational care, clinical care and comforting care. METHOD A methodological study was conducted involving a convenience sample of 531 nursing students in a baccalaureate nursing programme (20% were already Registered Nurses). Data were collected in 2002 and 2004. Confirmatory factor analysis of the Caring Nurse-Patient Interaction Short Scale was performed. FINDINGS As expected with large samples and models, the chi-squared-associated P-value was statistically significant (chi2 = 811.43, d.f. = 224, P < 0.01). However, the other indices reached acceptable levels with 0.054 for the standardized root mean-squared residuals, 0.070 for the root mean-square error of approximation, 0.88 for the goodness of fit index, 0.98 for the comparative fit index and 0.97 for the normal fit index. The factor loadings for all items with their hypothesized factor were > or = 0.48 and statistically significant at the 0.01 level. CONCLUSION The Caring Nurse-Patient Interaction Short Scale model was judged to fit the data adequately. Although further testing of the scale with different samples of patients is warranted, our model emerged as a middle-range theory during the construct validity process and still reflects Watsons theory while offering a structure that is testable in clinical research.

Interprofessional patient-centred practice in oncology teams: utopia or reality?

Abstract Studies on interprofessional practice usually report professionals’ viewpoints and document organizational, procedural and relational factors influencing that practice. Considering the importance of interprofessional patient-centred (IPPC) practice, it seems necessary to describe it in detail in an actual context of care, from the perspective of patients, their families and health-care professionals. The goal of this study was to describe IPPC practice throughout the continuum of cancer care. A qualitative multiple case study was completed with two interprofessional teams from a Canadian teaching hospital. Interviews were conducted with patients, their families and professionals, and observation was carried out. Three themes were illustrated by current team practice: welcoming the person as a unique individual, but still requiring the patient to comply; the paradoxical coexistence of patient-centred discourse and professional-centred practice; and triggering team collaboration with the culmination of the patient’s situation. Several influential factors were described, including the way the team works; the physical environment; professionals’ and patients’/family members’ stance on the collaboration; professionals’ stance on patients and their families; and patients’ stance on professionals. Finally, themes describing the desired IPPC practice reflect the wish of most participants to be more involved. They were: providing support in line with the patient’s experience and involvement; respecting patients by not imposing professionals’ values and goals; and consistency and regularity in the collaboration of all members.

The care continuum with interprofessional oncology teams: Perspectives of patients and family

To accompany the individual diagnosed with cancer along the care continuum, teams of professionals have been created based on integrating an interprofessional patient-centred (IPPC) practice. The goal of this article is to present some of the results of a case study documenting IPPC practice carried on by teams within the oncology care continuum. Observations and interviews with patients and their family were conducted. The results suggest that IPPC practice is variable within teams, but optimal at the beginning of treatments or cancer recurrence. However, patients can experience breakdowns in the continuity of care and more difficult transitions between oncology continuum periods (diagnosis, treatment, follow-up).

Integrated Primary Care Teams (IPCT) pilot project in Quebec: a protocol paper

Introduction The overall aim of this project is to help develop knowledge about primary care delivery models likely to improve the accessibility, quality and efficiency of care. Operationally, this objective will be achieved through supporting and evaluating 8 primary care team pilot sites that rely on an expanded nursing role within a more intensive team-based, interdisciplinary setting. Methods and analysis The first research component is aimed at supporting the development and implementation of the pilot projects, and is divided into 2 parts. The first part is a logical analysis based on interpreting available scientific data to understand the causal processes by which the objectives of the intervention being studied may be achieved. The second part is a developmental evaluation to support teams in the field in a participatory manner and thereby learn from experience. Operationally, the developmental evaluation phase mainly involves semistructured interviews. The second component of the project design focuses on evaluating pilot project results and assessing their costs. This component is in turn made up of 2 parts. Part 1 is a pre-and-post survey of patients receiving the intervention care to analyse their care experience. In part 2, each patient enrolled in part 1 (around 4000 patients) will be matched with 2 patients followed within a traditional primary care model, so that a comparative analysis of the accessibility, quality and efficiency of the intervention can be performed. The cohorts formed in this way will be followed longitudinally for 4 years. Ethics and dissemination The project, as well as all consent forms and research tools, have been accepted by 2 health sciences research ethics committees. The procedures used will conform to best practices regarding the anonymity of patients.

Nursing Knowledge in a Mostly French-Speaking Canadian Province: From Past to Present

Quebec, an eastern central province of Canada, comprises more than 6 million French-speaking people and an Englishspeaking community of nearly half a million people. Nursing evolved differently in these two communities, as richly in one as in the other (Cohen, 2000). The purpose of this column is to describe the evolution of nursing knowledge in the Frenchspeaking community of Quebec. Nursing here grew out of a tradition from France with the establishment by religious communities of the first hospitals in Quebec City (1639) and in Montreal (1642), two cities of the new settlement in America, so called la Nouvelle France. In this new French land, the Hospitaller Sisters, with the help of private funds, owned the properties, controlled the salubrity, hired physicians and apothecaries, and devoted themselves to caring for people. Unlike their counterpart in Europe, where wealthy people were cared for in their homes, the Hôtels-Dieu (acute care hospitals) would care for people from all classes of society, and the hôpitaux généraux (general hospitals) would assist the poor and disabled people (Lacourse, 1998).

Nurse-Environment Interactions in the Development of Cultural Competence

Abstract Studies on the development of cultural competence among healthcare providers tend to focus on the clinical encounter, with little attention paid to the environment. In this paper, results from a grounded theory study conducted with nurses and students to understand cultural competence development are presented; with a focus on findings that call particular attention to nurse-environment interactions. Two concurrent processes, as students and nurses develop cultural competence through interactions with their environment, were identified: “dealing with structural constraints” and “mobilizing social resources”. These dynamic interactions between healthcare providers and the larger structures of healthcare systems raise critical questions about the power of healthcare providers to influence the structures that shape their practice. The intersection of nursing theory with social and critical theories is essential to gain a comprehensive understanding of cultural competence development and to transform healthcare providers’ education in the service of social justice and health equity.

A Factorial-Dimensional Structure Of The Caring Nurse-Patient Interaction-Short Scale (CNPI-Short Scale)

2005, Vol. 9, No. 2 Rationale: Assessing caring and its effects on health remains an important challenge in nursing. In a previous study, the authors proposed a new scale to assess caring attitudes that could be linked with health outcomes. The scale was based on Watson’s theory of human caring and comprised 70 items subdivided to reflect attitudes and behaviors reflecting the ten carative factors. The present study seeks to propose a shorter version of the caring nurse-patient interaction scale (CNPI-Scale). The ten carative factors were theoretically grouped into three caring domains: humanism, therapeutic relationship, and clinical care. An exploratory factor analysis was carried out to select items to be retained in the short version. Items selected had to be theoretically grouped with their original theoretical domains and not related to the other two domains. Sample: A sample of 377 nursing students filled out the 70-item scale. The sample is composed mainly of women with a mean age of 26 years. Results: The resulting short scale includes 30 items grouped into three domains. The first factor, explaining 22% of the variance, includes 13 items theoretically related to the therapeutic relationship domain. Factor loading for the 13 items ranged from .42 to .83. The second factor, explaining 20% of the variance, includes 11 items theoretically related to the clinical care domain. Factor loading ranged from .50 to .86. The third factor, explaining 11% of the variance, includes 6 items related to the humanism caring domain. Factor loading ranged from .41 to .71. No items are loading more than .40 on a secondary factor. The three factors are moderately related with Pearson correlation ranging from .48 to .71. Alpha coefficients for the three domains ranged from .68 (humanism domain) to .94 (clinical care domain). Conclusion: The CNPI-Short Scale has potential for use in clinical studies when the length of the questionnaire is an important issue to be addressed. The original CNPIScale (70 items) provides additional information since the ten carative factors are explicitly covered. A Factorial-Dimensional Structure Of The Caring Nurse-Patient Interaction-Short Scale (CNPI-Short Scale)