Sharolyn Mossey

Chronic Obstructive Pulmonary Disease as Disability: Dilemma Stories

The purpose of this work was to develop an understanding of the meaning of disability for individuals living with chronic obstructive pulmonary disease (COPD) in a Canadian midwestern community from an emic perspective. A focused ethnographic design was used. Fifteen individuals participated in interviews. Narrative analysis was used to examine the interview data. Data analysis revealed 65 dilemma stories consisting of two structural components: the impairment, and the justification/explanation of the impairment. Participants’ impairment might or might not have been known to others. In both situations, individuals were faced with choices of whether to explain/justify or attempt to conceal the impairment. Participants told these dilemma stories to convey the meaning of COPD as a disability invisible to others, and at times, to themselves. The information gained from this research will serve as an essential complement to the existing knowledge about this important yet often invisible chronic illness.

Unsafe clinical practices as perceived by final year baccalaureate nursing students: Q methodology.

BackgroundNursing education necessitates vigilance for clinical safety, a daunting challenge given the complex interchanges between students, patients and educators. As active learners, students offer a subjective understanding concerning safety in the practice milieu that merits further study. This study describes the viewpoints of senior undergraduate nursing students about compromised safety in the clinical learning environment.MethodsQ methodology was used to systematically elicit multiple viewpoints about unsafe clinical learning from the perspective of senior students enrolled in a baccalaureate nursing program offered at multiple sites in Ontario, Canada. Across two program sites, 59 fourth year students sorted 43 theoretical statement cards, descriptive of unsafe clinical practice. Q-analysis identified similarities and differences among participant viewpoints yielding discrete and consensus perspectives.ResultsA total of six discrete viewpoints and two consensus perspectives were identified. The discrete viewpoints at one site were Endorsement of Uncritical Knowledge Transfer, Non-student Centered Program and Overt Patterns of Unsatisfactory Clinical Performance. In addition, a consensus perspective, labelled Contravening Practices was identified as responsible for compromised clinical safety at this site. At the other site, the discrete viewpoints were Premature and Inappropriate Clinical Progression, Non-patient Centered Practice and Negating Purposeful Interactions for Experiential Learning. There was consensus that Eroding Conventions compromised clinical safety from the perspective of students at this second site.ConclusionsSenior nursing students perceive that deficits in knowledge, patient-centered practice, professional morality and authenticity threaten safety in the clinical learning environment. In an effort to eradicate compromised safety associated with learning in the clinical milieu, students and educators must embody the ontological, epistemological and praxis fundamentals of nursing.

The novice objective structured clinical evaluation tool: psychometric testing

AIM This paper is a report of a study of the psychometric properties of the Novice Objective Structured Clinical Evaluation Tool. BACKGROUND A collaborative undergraduate nursing programme is currently using an objective structured clinical evaluation at the conclusion of the first nursing clinical course to determine student competence as a component of quality and safety education. However, the reliability and validity of the assessment tool has not been established. METHODS Psychometric testing was conducted with a convenience sample of 565 nursing students. Data were collected during three consecutive years from 2002 to 2004. Exploratory factor analysis and reliability testing were conducted on this 25-item tool. RESULTS Principal axis factoring method identified two factors through the orthogonal, oblimin and promax rotations: Factor 1 Safety and Factor 2, Anticipation. Spearman-Browns result for Factor 1 was 0·93 and for Factor 2 was 0·77. Cronbachs alpha was.94 for Factor 1 and 0·71 for Factor 2. CONCLUSION The tool was found to have adequate construct validity and reliability. Its stability should be tested by conducting test-retest analysis. Equivalency dimensions of reliability should be evaluated by looking at interrater reliability. This tool shows merit for assessing elements of quality and safety education.

Sheltering Aboriginal Women with Mental Illness in Ontario, Canada: BeingâKickedâ and Nurtured

Objective: For individuals living with mental health challenges, the provision of homeless shelters can offer a temporary respite in overwhelming life circumstances. There is, however, limited evidence regarding the subjective experiences associated with shelter services by Aboriginal women in Canada. The purpose of this study was to develop an understanding of the day-to-day experiences of Aboriginal women as they seek and provide safety, comfort, health, and healing in the context of mental illness and insecure housing. Methods: The study design was a secondary qualitative analysis of data collected in a primary mixed method study involving persons faced with mental health and housing challenges in southern Ontario, Canada. Narrative analysis was used to identify common experiences among 11 shelter service users and 10 shelter service providers, all of whom where Aboriginal women. Results: Regardless of whether the women received or provided shelter services, they consistently described experiences about being “kicked” and nurtured. Their stories about being “kicked” described experiences associated with compounding losses. Juxtaposed to this reality, were accounts about being nurtured or “lifting each other up.” Nurturing relations were essential to address the pervasive health and social disparities experienced by the women. Relationships within homeless shelters were directed towards supporting the health and well-being of individual women and their broader community. Conclusion: This study’s findings extend the community mental health body of nursing literature regarding Aboriginal women living with mental illness and homelessness. Despite the protective and restorative components of nurturing within shelter services, cooperative networks need to be developed to build communities that eradicate the pervasive losses experienced by Aboriginal women who continue to be “kicked.”

Emergency department boarding times for patients admitted to intensive care unit: Patient and organizational influences

INTRODUCTION Critically ill patients can be subject to prolonged stays in the emergency department following receipt of an order to admit to an intensive care unit. The purpose of this study was to explore patient and organizational influences on the duration of boarding times for intensive care bound patients. METHODS This exploratory descriptive study was situated in a Canadian hospital in northern Ontario. Through a six-month retrospective review of three data sources, information was collected pertaining to 16 patient and organizational variables detailing the emergency department boarding time of adults awaiting transfer to the intensive care unit. Data analysis involved descriptive and non-parametric methods. RESULTS The majority of the 122 critically ill patients boarded in the ED were male, 55 years of age or older, arriving by ground ambulance on a weekday, and had an admitting diagnosis of trauma. The median boarding time was 34 min, with a range of 0-1549 min. Patients designated as most acute, intubated, and undergoing multiple diagnostic procedures had statistically significantly shorter boarding times. DISCUSSION The study results provide a profile that may assist clinicians in understanding the complex and site-specific interplay of variables contributing to boarding of critically ill patients.