Comox Valley Nursing Centre: From Collaboration to Empowerment

Abstract The Comox Valley Nursing Centre was initiated as a two year demonstration project by the Registered Nurses Association of British Columbia (RNABC) and funded by the Ministry of Health. The purpose of the project was to demonstrate innovative nursing practice in a primary health care context. Findings from the project were expected to inform provincial health care planning, nursing scope of practice, and health and nursing policy development. A free standing nursing center was planned and implemented through a collaborative effort by RNABC, nurses and community residents. An external team of researchers evaluated the project using a variety of methods, including participatory action research. During the project an innovative nursing practice, based on principles of collaboration, developed and has continued during the extended provincial and regional funding of the Centre. Drawing from the evaluation findings, case studies and using Henneman, Lee and Cohen's (1995) concept analysis of collaboration, this paper describes how the principles of collaboration were actualized or suppressed. The paper examines how collaboration impacted empowerment for nurses, clients and the community. Lessons learned about the reciprocal relationships between collaboration and empowerment, implications for nursing practice, and how the approach can contribute to a better understanding of the impact of collaborative practice approaches on health care delivery are discussed.     

Lessons from eleven primary health care nursing innovations in New Zealand

Introduction:  In New Zealand in 2003, 11 primary health care (PHC) nursing innovation projects and an evaluation of the initiative were funded by the Ministry of Health to develop and explore the ways new models of nursing practice could help address health inequalities and contribute to PHC.
Design and Methods:  A research-and-development approach was used in the evaluation. Data were gathered from interviews with national stakeholders, workshops with personnel from all projects, visits to each project site and case studies of four projects. Analysis involved assessing each project individually as well as the projects as a whole.
Context:  The initiative was one of many international and local PHC developments in this period designed to reduce health inequalities and improve patient care and health outcomes.
Findings:  Each project was developed from a different starting point; was located in different parts of the health system; and had different levels of funding. Some were principally focused on leading nursing development; others focused on developing nursing practice. Each involved influencing or providing nursing services, nurse education, leadership and service integration. Most projects progressed well, but some had limited success.
Lessons:  Lessons are on many levels, and include those related to: developing successful innovation; the importance of nursing leadership; developing the nursing workforce; and advancing nursing practice.
Conclusion:  The funding of the innovative projects enabled nurses to pioneer developments. Such funding is important, as it paves the way for change and provides an opportunity for reflection and new learnings.     

Effects of health policy reforms on nursing resources and patient outcomes in New Zealand

Health policy reforms in New Zealand during the 1990s impacted on hospital operations, on the nursing workforce, and on patients. This study analyses changes in rates of 20 adverse patient outcomes that are potentially sensitive to nursing (OPSNs) before (1989-1993), during (1993-2000), and after (2000-2006) the policy reforms, using all New Zealand public hospital inpatient discharge data for this period. Comparisons of changes in mean annual rates across periods revealed the expected trajectory of acceleration during the reform period relative to the prereform period, and a subsequent deceleration in the postreform period. This S-shaped pattern was clearly evident in 16 of the 20 OPSNs, and partially evident in the remaining 4. These results are interpreted as evidence that the 1990s policy reforms inspired by managerialism had deleterious effects on patient outcomes, and that these effects coincided with changes in nursing resources and the work environment.     

Development of a PHC nursing information system in Korea.

WHO has established collaborating centres at educational institutions throughout the world to assist with WHO research. In 1988 a WHO Collaborating Centre was inaugurated at Yonsei University College of Nursing in Korea. Since then two important research projects have been completed for establishing a data bank of human resources of nursing for primary health care (PHC) in Korea. Both projects strengthen the PHC nursing information systems in Korea and, as such, are beginning to develop PHC networks throughout Korea, passing on information to an international network system. Below, the rationale behind the two projects, the methodology and the results.     

Family practice/Primary health care nurses in Nova Scotia

The authors describe a study that was designed to explore the current role of family practice/primary health care (FP/PHC) nurses in Nova Scotia. A survey was created and mailed to FP/PHC nurses. Forty-one returned surveys met the criteria of the study. Twenty-two of these nurses were contacted for a followup telephone interview. The findings confirm that FP/PHC nurses working in N.S. are key members of the collaborative health-care team and, although they are often underutilized, they perform key functions such as triage, health education and immunization. Most FP/PHC nurses are underpaid and often work with little or no job security. FP/PHC nurses indicated that they are isolated in their practice and could benefit from networking and educational opportunities with their peers. They are frustrated that they cannot bill the provincial medical insurance plan for basic nursing services. The study results indicate a need to better define scope of practice and highlight the need for leadership and support for the role of FP/PHC nurses in N.S.     

Mental and physical health comordibity: political imperatives and practice implications

Insufficient priority is being given to meet the physical health-care needs of people with mental illness. Mental health nurses, as the largest professional group working in mental health care, have a pivotal role in improving the physical health and well-being of people with mental illness. Through health-promotion strategies, alongside recovery-focused support aimed at avoiding deteriorating physical health, mental health nurses can significantly contribute to improving the current rate of premature death experienced by people with enduring mental illness. Drawing from contemporary policy, alongside practical examples taken from the published literature, this paper considers what constitutes recommended best practice in dealing with the physical health-care needs of people with mental illness. The role that UK-based health-care policy plays in shaping care delivery that meets the needs of people with mental illness is explored and placed within the context of global health concerns. Recommendations are made on how mental health nursing can work to provide evidence for a reassertion that nurses are well placed to work across organizational and professional boundaries to deliver person-centred care and a holistic approach to population health and well-being.     

Survey: new grads seek support in the workplace

The relentless nature of the current nurse shortage, in conjunction with ongoing concerns expressed by employers, unions, schools of nursing, and new graduate registered nurses themselves about the issues facing new graduate registered nurses, prompted RNABC to conduct the New Graduate Nurse Project. The project included a mailed survey to, and telephone interviews with, registered nurses who graduated from B.C. nursing education programs in 2001. In 2003, RNABC will conduct a similar survey of 2002 graduates to compare findings.     

Nursing in the public sphere: breaching the boundary between research and policy

Nurses and nursing are associated traditionally with activities in a private sphere. This paper argues that, if clinical care is to be improved, nurses need to take a more active public role in making and implementing health policy at both local and national levels. In the current climate, empirical evidence is one of the most important tools for influencing health policy. This paper discusses contemporary models of the policy-making process before outlining a number of strategies that could be used to increase the policy impact of nursing research. Finally, while the current climate in the United Kingdom health-care arena presents opportunities for researchers to have an impact on policy, the growth of health policy research as a distinct field of scholarship also poses a number of challenges and dangers.     

Bridging the gap. Community partnerships in nursing education: advancing primary health care in practice

An innovative approach to nursing education was piloted by the School of Nursing at Flinders University and Noarlunga Health Services, a generic community health service, in Adelaide, South Australia. The approach, encapsulated in the four-year Community Enrichment Project (CEP), focused on Primary Health Care (PHC) and nursing practice. The CEP developed curriculum and organised student placements, which promoted understanding of PHC in a way that integrated acute and community sectors. This paper considers the impact of splitting the students' third year final practicum, of seven weeks, between acute and community placements. Integral to the overall outcome of the project was the community agencies' cooperation in accepting students for longer clinical placements than had previously been the norm. This resulted in students being engaged in activities and projects in diverse areas. The students were aided in linking PHC theory to practice by the CEP team members who mentored them throughout these placements. Outcomes demonstrated the ability of students to integrate PHC theory to practice, across a variety of health settings. Students moved from a position of little knowledge or understanding of PHC, to an integrated knowledge of PHC principles and the relationship to enhanced nursing practice.     

First-line nurse leaders' health-care change management initiatives

macphee m. & suryaprakash n . (2012) Journal of Nursing Management 20, 249–259
First-line nurse leaders’ health-care change management initiatives Aim To examine nurse leaders’ change management projects within British Columbia, Canada. Background British Columbia Nursing Leadership Institute 2007–10 attendees worked on year-long change management initiatives/projects of importance to their respective health-care institutions. Most leaders were in first-line positions with <3 years’ experience. Method Consenting leaders’ project reports (N = 133) were content analysed for specific themes: types of projects; scope of projects (e.g. unit or local level, departmental, institutional); influence targets or key stakeholder groups targeted by the projects; leadership successes and challenges. Results Of study participants, 77% successfully completed their projects. Staff tool and resource development and existing services improvement were major project types. Care delivery teams were the major influence targets. Only 25% of projects were at the unit level. Many projects had broader scopes, such as institutional levels. Participants cited multiple leadership successes, including enhanced leadership styles and organizational skills. Conclusion First-line nurse leaders were able to successfully manage projects beyond their traditional scope of responsibilities. The majority of projects dealt with staff needs and healthcare restructuring initiatives. Implications for nursing management Constant change is a global reality. Change management, a universal competency, must be included in leadership development programmes.     

传承护理专业发展进程 开展“优质护理服务示范工程”

通过对近30年来护理专业发展进程的思考,剖析护理工作的内涵,从20世纪80年代初李士鸾引入责任制护理,到20世纪90年代中期推行整体护理,一直到今年开展"优质护理服务示范工程"。这一切变化充分体现了具有中国特色的护理专业发展的延续性,阐述了在医药卫生体制改革的形势下如何开展"优质护理服务示范工程"活动,促进整体护理进一步深化。     

The role, responsibilities and educational needs of the non-nurse carer

Non-nurse carers have been a feature of the British health-care system for many years. Changes in the health service, including the loss of nurses from the workforce, have led to the increased use of non-nurse carers being advocated. However, if they are to be employed effectively, issues relating to their role, responsibilities and educational needs must be carefully addressed. This article examines literature on the contribution of non-nurse carers to the nursing profession in acute and primary care settings and the attitudes of qualified nursing staff, and highlights attempts to define the role and its requirements.     

Status of costing hospital nursing work within Australian casemix activity-based funding policy

Australia has a long history of patient level costing initiated when casemix funding was implemented in several states in the early 1990s. Australia includes, to some extent, hospital payment based on nursing intensity adopted within casemix funding policy and the Diagnostic Related Group system. Costing of hospital nursing services in Australia has not changed significantly in the last few decades despite widespread introduction of casemix funding policy at the state level. Recent Commonwealth of Australia National Health Reform presents change to the management of the delivery of health care including health-care costing. There is agreement for all Australian jurisdictions to progress to casemix-based activity funding. Within this context, nurse costing infrastructure presents contemporary issues and challenges. An assessment is made of the progress of costing nursing services within casemix funding models in Australian hospitals. Valid and reliable Australian-refined nursing service weights might overcome present cost deficiencies and limitations.     

What's been done? What's to come?

Since October 17, 2000, when the Registered Nurses Association of British Columbia (RNABC) released its 10-Point Plan to Solve B.C.'s Nurse Shortage, the Association has continued to lobby for action on the recommendations in the plan. Here's a look at what's happened so far. In addition to the actions outlined here, RNABC sponsored the Western Canadian Forum for Senior Nurse Leaders in October. This sold-out conference brought together nurse experts from across North America to discuss ways to improve practice environments that encourage retention and recruitment of nurses.     

Stress,Fatigue, and Burnout in Nursing

The purpose of raising awareness about the topics of stress, fatigue, and nurse burnout is twofold: (1) to recognize it exists and (2) to explore the options for mitigation strategies. The profession of nursing is prone to experience stress due to the intense nature of the work. Immense pressures from both internal and external sources add to the complexity of nearly every professional role in nursing. Recognizing and addressing the potentially negative impact of stress and the signs of overwork is imperative so stress, fatigue and burnout are not the result. A more intentional approach to nursing work relative to the thoughtful design of systems, forming efficient work processes, attaining more reasonable workloads, and establishing boundaries for work-life balance are key attributes for success. Care and compassion are foundational to nursing practice. However, caring for oneself to be at their best to care for others is rarely a priority in today's world. Nurses must especially be mindful of the consequences of their work, must strive to lead healthy lives, and be an example for those they may have the privilege to lead in health-care organizations and others.     

Collaborating for International Research Development in Malawi, Africa

Purpose: To describe a collaborative research effort by a U.S. school of nursing, an African school of nursing, and the Malawian Ministry of Health. Providing assistance to women leaders in Malawi to develop and conduct research to improve the health of women and infants in villages is necessary.
Scope: This 5-year project, 1990-1995, included organizing a workshop on the research process, developing and testing pilot projects, developing and conducting two full-scale studies, and disseminating findings.
Results: Two full-scale studies, one examining maternal mortality and one examining the effects of teen pregnancy, were completed with important health policy implications for Malawi.
Conclusions : Successful international collaborative research yields increased knowledge for all participants and important health information. lnternational research requires continuous communication, people skilled in group work, sensitivity to cultural differences, patience, persistence, and commitment.     

Evidence-based pressure-ulcer practice: the Ottawa model of research use.

Developing evidence-based nursing practice among diverse health-care settings is a particular challenge in the face of current health-care restructuring. This paper describes application of the Ottawa Model of Research Use (OMRU) to increase evidence-based practice across 3 health-care settings during a time of multiple restructuring changes. The initiative was part of a provincial demonstration project to develop centers of nursing excellence with a view to improving continuity of care across the health continuum. Three Ottawa health-care agencies formed one of 4 participating sites in the Province-Wide Nursing Project (PWNP), a 3-year initiative funded by the Ontario Ministry of Health. The goal of the Ottawa-Carleton site was to increase evidence-based decision-making with a focus on pressure ulcers. The barriers and supports encountered, and the strategies used, in striving to meet this goal in a community-care, tertiary-care, and long-term-care setting are described. Multiple research transfer approaches were used, with an emphasis on education. Implementor consensus and achievements of the project support the OMRU's utility as a guide to implementing research findings in these health-care settings.     

A reflective discussion: questions about globalization and multiculturalism in nursing as revealed during a student/staff exchange programme

The purpose of this paper is to present elements of a discussion on the discipline of nursing that arose from a student–faculty exchange programme, as a reflection of the experiences the students and faculty had during the 3-year exchange. It suggests that the globalization of health and the international migration of nurses might prove to be an opportunity for nurses to learn more about nursing practice. It became apparent to the participants that the phenomenon of nursing, although understood by them all, was not easy to describe, and words used in Swedish, Finnish or British or American English were often not easy to interpret or explain. These reflections were noted by the authors when the group came together to plan the programme and design experiences for the participants. We were concerned how nursing could contribute to health-care improvement globally if it wasn't universally understood within the four countries concerned.