Jennifer Blythe

The Use of Triangulation in Qualitative Research

Triangulation refers to the use of multiple methods or data sources in qualitative research to develop a comprehensive understanding of phenomena (Patton, 1999). Triangulation also has been viewed as a qualitative research strategy to test validity through the convergence of information from different sources. Denzin (1978) and Patton (1999) identified four types of triangulation: (a) method triangulation, (b) investigator triangulation, (c) theory triangulation, and (d) data source triangulation. The current article will present the four types of triangulation followed by a discussion of the use of focus groups (FGs) and in-depth individual (IDI) interviews as an example of data source triangulation in qualitative inquiry.

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.

Internationally educated nurses: profiling workforce diversity

AIM Nurses with diverse educational and cultural backgrounds are likely to adapt differently to new workforces. The aim of this study was to provide a profile of nurses educated in different countries who are employed in a major settlement jurisdiction. BACKGROUND Despite difficulties in measuring its magnitude, it is evident that nurse migration has increased as a result of globalization. Major destinations for internationally educated nurses (IENs) include the USA, Canada, the UK, Australia and the Gulf States. Chief donor countries include the Philippines, India and other South Asian countries. Half of all IENs registered in Canada work in the province of Ontario. METHODS Published literature and secondary data were used to profile cohorts of nurses educated in different countries who are employed in the Ontario workforce. FINDINGS Statistics available on IENs in Ontario reveal a largely urban settlement pattern. There are major differences among IEN cohorts in terms of age, gender, work status, and type and place of employment. DISCUSSION AND CONCLUSIONS Although IENs resident in Ontario could not be quantified, a relatively detailed description of IENs in the workforce was possible. Comparison of nurse cohorts indicated that generalizations about IENs should be made with caution. Changes in regulatory conditions have a significant effect on IEN employment. Difficulties associated with international educational and regulatory differences illustrate the need to create global nursing standards. Further investigation of differences in workforce profiles should provide insights leading to improved utilization of IENs.

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.

Evaluation of a system for providing information resources to nurses

The authors describe a study to plan and implement an information system for nurses. The objectives were to (1) determine the clinical information needs of nurses; (2) adapt an existing clinical information system (CLINT) to address their expressed needs; and (3) evaluate nurses’ use of and satisfaction with the enhanced system. Thirty-nine nurses on a medical teaching unit in a tertiary hospital in Canada participated in the project. A needs assessment influenced the design of the nursing interface to CLINT and the development of educational and participatory strategies to promote its use. Data were collected before, after, and throughout the implementation period. Qualitative and quantitative methods, including focus groups, online questionnaires, and automated usage data collection, were used to describe nurses’ use of and satisfaction with the system. The results suggested that peer mentorship, organizational support, and collaboration were the most effective strategies for promoting system use. The hospital information system (IHIS), Netscape, drug information and basic texts were the most frequently used databases. Nurses were satisfied with the system and reported progress in changing clinical practice. CLINT helped them to keep up with educational and professional development. In conclusions, nurses are willing to use information systems that are relevant to their needs and user friendly. There is, however, a paucity of resources available for evidence-based clinical decision making.

Hands-Free Technique in the Operating Room: Reduction in Body Fluid Exposure and the Value of a Training Video

Objectives. This study sought to determine if (1) using a hands-free technique (HFT)—whereby no two surgical team members touch the same sharp item simultaneously—≥75% of the time reduced the rate of percutaneous injury, glove tear, and contamination (incidents); and (2) if a video-based intervention increased HFT use to ≥75%, immediately and over time. Methods. During three and four periods, in three intervention and three control hospitals, respectively, nurses recorded incidents, percentage of HFT use, and other information in 10,596 surgeries. The video was shown in intervention hospitals between Periods 1 and 2, and in control hospitals between Periods 3 and 4. HFT, considered used when ≥75% passes were done hands-free, was practiced in 35% of all surgeries. We applied logistic regression to (1) estimate the rate reduction for incidents in surgeries when the HFT was used and not used, while adjusting for potential risk factors, and (2) estimate HFT use of about 75% and 100%, in intervention compared with control hospitals, in Period 2 compared with Period 1, and Period 3 compared with Period 2. Results. A total of 202 incidents (49 injuries, 125 glove tears, and 28 contaminations) were reported. Adjusted for differences in surgical type, length, emergency status, blood loss, time of day, and number of personnel present for ≥75% of the surgery, the HFT-associated reduction in rate was 35%. An increase in use of HFT of ≥75% was significantly greater in intervention hospitals, during the first post-intervention period, and was sustained five months later. Conclusion. The use of HFT and the HFT video were both found to be effective.

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.

Appreciative inquiry: a strength-based research approach to building Canadian public health nursing capacity

In this paper we evaluate the use of appreciative inquiry in focus groups with public health nurses, managers and policy makers across Canada as part of our project to generate policy recommendations for building public health nursing capacity. The focus group protocol successfully involved participants in data collection and analysis through a unique combination of appreciative inquiry and nominal group process. This approach resulted in credible data for analysis, and the final analysis met scientific research standards. The evaluation revealed that our process was effective in engaging participants when their time available was limited, no matter what their position or public health setting, and in eliciting solution-focused results. By focusing on what works well in an organisation, appreciative inquiry enabled us to identify the positive attributes of organisations that best support public health nursing practice and to develop practical policy recommendations because they were based on participants’ experience. Further, appreciative inquiry was especially effective with public health policy makers and nurses as it is consistent with the strength-based, capacity building approaches inherent in public health nursing practice.

Organizational attributes that assure optimal utilization of public health nurses.

Optimal utilization of public health nurses (PHNs) is important for strengthening public health capacity and sustaining interest in public health nursing in the face of a global nursing shortage. To gain an insight into the organizational attributes that support PHNs to work effectively, 23 focus groups were held with PHNs, managers, and policymakers in diverse regions and urban and rural/remote settings across Canada. Participants identified attributes at all levels of the public health system: government and system-level action, local organizational culture of their employers, and supportive management practices. Effective leadership emerged as a strong message throughout all levels. Other organizational attributes included valuing and promoting public health nursing; having a shared vision, goals, and planning; building partnerships and collaboration; demonstrating flexibility and creativity; and supporting ongoing learning and knowledge sharing. The results of this study highlight opportunities for fostering organizational development and leadership in public health, influencing policies and programs to optimize public health nursing services and resources, and supporting PHNs to realize the full scope of their competencies.

Special Features: Health Policy: Organizational Attributes That Assure Optimal Utilization of Public Health Nurses

Optimal utilization of public health nurses (PHNs) is important for strengthening public health capacity and sustaining interest in public health nursing in the face of a global nursing shortage. To gain an insight into the organizational attributes that support PHNs to work effectively, 23 focus groups were held with PHNs, managers, and policymakers in diverse regions and urban and rural/remote settings across Canada. Participants identified attributes at all levels of the public health system: government and system-level action, local organizational culture of their employers, and supportive management practices. Effective leadership emerged as a strong message throughout all levels. Other organizational attributes included valuing and promoting public health nursing; having a shared vision, goals, and planning; building partnerships and collaboration; demonstrating flexibility and creativity; and supporting ongoing learning and knowledge sharing. The results of this study highlight opportunities for fostering organizational development and leadership in public health, influencing policies and programs to optimize public health nursing services and resources, and supporting PHNs to realize the full scope of their competencies.