Olu Awosoga

Competence and competency-based nursing education: finding our way through the issues.

The language of competence is widely utilized in both the regulation of nursing practice and curricular design in nursing education. The notion of competence defines what it means to be a professional, although it is not the only way of describing nursing practice. Unfortunately, there is much confusion about the concepts of competence, competency, and competency-based education. As well, the notion of competence, despite its global popularity, has flaws. In this paper we will disentangle these terms and critique the use of competence frameworks in nursing education.

Social cohesion and resilience across communities that have experienced a disaster

Disasters are unpredictable events that have catastrophic impacts. There is now a focus on disaster resilience and capacity building in the recovery of the community. Resilience literature also suggests a staged model of disaster impacts and likelihood of staged manifestations of resilience. It also points to a potentially important link between place-based social cohesion and resilience. This article reports on comparative findings of cohesion and resilience indices in four Canadian rural communities that experienced disasters and evacuation in potentially different phases of coping and resilience. Buckner’s Index of Cohesion and the Index of Perceived Community Resilience are examined in each community for relationships (correlation) between cohesion and resilience and for differences in the intensity of these variables. Our findings show a consistent significant positive correlation between cohesion and resilience, although the strength of the relationship varies. Findings also show place-specific differentiation in the mean intensity of both cohesion and resilience scores; temporal phases of disaster recovery for each community are also noted. This information can help in disaster recovery planning by ensuring supports are available at key points in time for communities that experience disasters. Other research is needed that compares communities that have experienced different types of disasters and over time periods to document any changes to resilience or cohesion thereby assisting with disaster policy development and programme planning.

Caring in the wake of the rising tide: Moral distress in residential nursing care of people living with dementia

Objective Moral distress is increasingly being recognized as a concern for health care professionals. The purpose of this study was to explore the nature and prevalence of moral distress among nursing staff who care for people living with dementia. Methods This study was focused on nursing staff caring for people with dementia in long-term care and assisted living sites. The Moral Distress in Dementia Care Survey instrument was distributed to 23 sites and nursing staff rated the frequency and severity of situations that were identified as potentially causing moral distress. Results Moral distress is prevalent in the nursing staff who provide dementia care. Nursing staff reported experiencing moral distress at least daily or weekly. Both frequency and severity of moral distress increased with proximity to (amount of time spent at) the bedside. Moral distress had negative psychological and physiological effects on nursing staff, and affected intention to quit.

Development and validation of the Moral Distress in Dementia Care Survey instrument

AIMS To report on the development and validation of the Moral Distress in Dementia Care Survey instrument. BACKGROUND Despite growing awareness of moral distress among nurses, little is known about the moral distress experiences of nursing staff in dementia care settings. To address this gap, our research team developed a tool for measuring the frequency, severity and effects of moral distress in nursing staff working in dementia care. DESIGN The research team employed an exploratory sequential mixed method design to generate items for the moral distress questionnaire. Data were collected between January 2013 - June 2014. In this paper, we report on the development and validation of the Moral Distress in Dementia Care Survey instrument. METHODS The Moral Distress in Dementia Care Survey instrument was piloted with a portion of the target population prior to a broader implementation. Appropriate statistical analyses and psychometric testing were completed. RESULTS The team collected 389 completed surveys from registered nurses, licensed practical nurses and healthcare aides, representing a 43.6% response rate across 23 sites. The Moral Distress in Dementia Care Survey emerged as a reliable and valid instrument to measure the frequency, severity and effects of moral distress for nursing staff in dementia care settings. The relative value of the Moral Distress in Dementia Care Survey as a measurement instrument was superseded by its clinical relevance for dementia care staff. CONCLUSION The Moral Distress in Dementia Care Survey is a potentially useful tool for estimating the frequency, severity and effects of moral distress in nursing staff working in dementia care settings and for the evaluation of measures taken to mitigate moral distress.

Perceived affordances and postures for lifting in child care

ABSTRACT Childcare work appears to be full of the physical and mental risk factors frequently associated with chronic exertion leading to injury of the musculoskeletal system. The purpose of this study was to examine the affordances and mechanics for lifting a child, and to associate those mechanics with physical demands reports provided by experienced childcare workers. Participants perceived a smaller safe reaching distance to a child compared to a conventional handling target, despite the identical load and similar load distribution. This difference may reflect the influence of coupling (suitcase had ‘good’ coupling, child manikin had ‘poor’ coupling), or an increased concern for the safety of the child over the suitcase. While lifting at a smaller affordant distance could contribute to decreasing spinal loading from reactive moments, the greater trunk and knee flexions observed in child lifting may be contributing to childcare workers’ musculoskeletal discomfort and injury in those regions.

A pilot study exploring the relationship between the use of mobile technologies, walking distance, and clinical decision making among rural hospital nurses

Providing evidence-based information at the point of care for time-poor nurses may lead to better clinical care and patient outcomes. Smartphone applications (apps) have the advantage of providing immediate access to information potentially increasing time spent with patients. This small-scale pre-post survey study explored the impact a smartphone app had on the distance nurses walked and their perceived clinical decision-making ability. A total of 20 nurses working in a rural hospital medical/surgical unit participated. The findings suggest that the use of the smartphone app did not decrease nurses’ walking distance. Nor did using the app enhances nurses’ perception of their clinical decision-making ability. However, there was a statistically significant increase in confidence in the app over time (F(1,16) = 5.416, p = 0.033, partial η2 = 0.253), suggesting that providing training opportunities including time to learn how to use smartphone applications has the potential to enhance nurses work.