An innovative leap: Embracing new pedagogical approaches for clinical education.

In response to increasingly complex care environments, a mid-sized research-intensive university in Western Canada engaged in an extensive curriculum redesign of the BSN program, including the development of an Innovative Clinical Learning Model. In this article, the authors share their experience of developing and implementing two innovative pedagogical approaches for clinical teaching in the medical surgical context. Program evaluation data indicated that these pedagogical strategies provided increased opportunities for timely application of theory in practice and facilitated students' development of clinical reasoning, skill mastery, and professional identities as accountable, responsible, ethical nurses.

Nursing students' experiences of moral uncertainty in the context of global health practicums.

More students than ever are electing to take part in international practicums from health-related disciplines. With the goal of better understanding the moral experiences and ethical implications of global health practicums (GHPs), the purpose of this Interpretive Descriptive study was to examine the moral uncertainty of nursing students from one university in Canada. Seventeen nurses who had participated in a GHP in their undergraduate nursing program participated in semi-structured interviews.

Radical transformation: Embracing constructivism and pedagogy for an innovative nursing curriculum.

To effectively navigate today's complex and rapidly changing health care environments, nurses require a high level of knowledge, sound psychomotor skills, diverse thinking and reasoning abilities, and a strong professional identity. The evidence showed that programs that offer students focused clinical practice experiences and offer students opportunities to 'think like a nurse' enable them to become sound practitioners. Faculty and staff at one mid-sized research-intensive university in Western Canada, engaged in an iterative process of rethinking the theoretical and pedagogical underpinnings of a BSN curriculum for educating nurses for the complexity of today's practice.

Safety culture in healthcare: mixed method study.

Purpose: Healthcare providers' perceptions of management's effectiveness in achieving safety culture improvements are low, and there is little information in the literature on the subject. Objective: The overall aim of this study was to examine the patient safety culture within an interprofessional team - physicians, nurses, nurse technicians, speech therapist, psychologist, social worker, administrative support - practicing in an advanced neurology and neurosurgery center in Southern Brazil.

Design/methodology/approach: The authors applied the safety attitudes questionnaire (SAQ) in a mixed methods study, with a quan→QUAL sequential explanatory approach.

Use of participatory visual narrative methods to explore older adults' experiences of managing multiple chronic conditions during care transitions.

Background: Older adults with multiple chronic conditions typically have more complex care needs that require multiple transitions between healthcare settings. Poor care transitions often lead to fragmentation in care, decreased quality of care, and increased adverse events. Emerging research recommends the strong need to engage patients and families to improve the quality of their care.

Researching safety culture: deliberative dialogue with a restorative lens.

Safety culture is a key component of patient safety. Many patient safety strategies in health care have been adapted from high-reliability organizations (HRO) such as aviation. However, to date, attempts to transform the cultures of health care settings through HRO approaches have had mixed results.

Characteristics of nursing professionals and the practice of ecologically sustainable actions in the medication processes.

Objectives: to verify the correlation between the characteristics of professionals and the practice of sustainable actions in the medication processes in an ICU, and to determine if interventions such as training and awareness can promote sustainable practices performed by nursing staff in the hospital.

Methods: before-and-after design study using Lean Six Sigma methodology, applied in an intensive care unit. Nursing staff were observed regarding the practice of ecologically sustainable actions during medication processes (n = 324 cases for each group (pre and post-intervention)) through a data collection instrument.

Contributions of the sandwich doctoral program to methodological approaches: an experience report.

Objective To share our experience on theoretical and methodological insights we have gained as researchers working together during the Sandwich Doctoral Program. Method This is a descriptive experience report. Results We have incorporated restoration thinking into a study on patient safety culture and will enhance knowledge translation by applying principles of deliberative dialogue to increase the uptake and implementation of research results.

Engaging Direct Care Providers in Improving Infection Prevention and Control Practices Using Participatory Visual Methods.

The purpose of this quality improvement project was to determine the feasibility of using provider-led participatory visual methods to scrutinize 4 hospital units' infection prevention and control practices. Methods included provider-led photo walkabouts, photo elicitation sessions, and postimprovement photo walkabouts. Nurses readily engaged in using the methods to examine and improve their units' practices and reorganize their work environment.

Seniors managing multiple medications: using mixed methods to view the home care safety lens.

Background: Patient safety is a national and international priority with medication safety earmarked as both a prevalent and high-risk area of concern. To date, medication safety research has focused overwhelmingly on institutional based care provided by paid healthcare professionals, which often has little applicability to the home care setting. This critical gap in our current understanding of medication safety in the home care sector is particularly evident with the elderly who often manage more than one chronic illness and a complex palette of medications, along with other care needs.

Understanding Perceptions and Practices for Zambian Adults in Western Province at Risk for Hypertension: An Exploratory Descriptive Study.

Hypertension is an important public health issue in Zambia. Despite the need for early detection, treatment, and ongoing monitoring, there is little documented research on hypertension in Zambia. The study aims were to: 1) better understand risk factors for hypertension in urban and rural communities in Mongu and Limulunga Districts, Western Province; 2) identify current health practices for hypertension and prevention in these communities; and 3) explore intersections between culture and hypertension perceptions and practices for study participants.

Development and evaluation of a workshop to support evidence-based practice change in long-term care.

To support evidence-based practice changes in long-term care, we used a practice development approach with interactive workshops to engage teams from 10 organizations in participatory change. Data from postworkshop surveys and subsequent semistructured interviews indicated that participants felt empowered to identify a priority challenge and initiate change. Notably, the workshop intervention enhanced collaboration between professional and unregulated staff, fostered the development of shared vision, and provided the impetus to tackle workplace barriers to change.

Engaging nurses to strengthen medication safety: Fostering and capturing change with restorative photographic research methods.

We used participatory photographic research methods adapted from the field of ecological restoration to engage Brazilian intensive care unit nurses in a critical review of medication safety in their work environment. Using focus groups, practitioner-led photo walkabouts with photo narration, and photo elicitation focus groups in iterative phases of data collection and analysis, nurses developed and implemented several practical and cultural improvements for their unit. Participants focussed on organizing the medication room for efficient workflow and accessible supplies, improving reporting practices, and reconsidering how they could manage safety issues in their unit and in the hospital as a whole.

Exploring safety and quality in a hemodialysis environment with participatory photographic methods: a restorative approach.

This study used principles and methods of good ecological restoration, including participatory photographic research methods, to explore perceptions of safety and quality in one hemodialysis unit. Using a list of potential safety and quality issues developed during an initial focus group, a practitioner-led photo walkabout was conducted to obtain photographs of the patient care unit and nurses' stories (photo narration) about safety and quality in their environment. Following a process of iterative coding, photos were used to discuss preliminary themes in a photo elicitation focus group with four additional unit staff The major themes identified related to clutter, infection control, unit design, chemicals and air quality, lack of storage space, and health and safety hazards (including wet floors, tripping hazards from hoses, moving furniture/chairs).

Using video-elicitation to assess risks and potential falls reduction strategies in long term care.

Purpose: To assess the ability to use and the usefulness of video-elicitation to study risks and potential ways to reduce transfer-related falls in long term care.

Method: A qualitative research study was conducted in a long term care facility and included a purposeful sample of 16 subjects (6 residents, 6 health care providers, and 4 family members). Field observations, interviews, video-recordings of assisted transfers, and video-elicitation sessions were conducted with the participants.

Nursing workload and patient safety--a mixed method study with an ecological restorative approach.

Objective: The aim of this study was to analyze the potential association between nursing workload and patient safety in the medical and surgical inpatient units of a teaching hospital.

Method: a mixed method strategy (sequential explanatory design).

Results: the initial quantitative stage of the study suggest that increases in the number of patients assigned to each nursing team lead to increased rates of bed-related falls, central line-associated bloodstream infections, nursing staff turnover, and absenteeism.

Facilitators and barriers to safe emergency department transitions for community dwelling older people with dementia and their caregivers: a social ecological study.

Background: Internationally, older adults visit the ED at a rate higher than other age groups. Little attention has been given to ED care for older people with dementia, although concern for such care is growing with the increasing number of individuals worldwide affected by this significant disabling problem. It is critical to understand ED transitional processes and consequences because the complexity of dementia care poses multiple challenges to optimizing safety, effectiveness and quality of care during admission, assessment, and treatment in this setting.

Priority setting and policy advocacy by nursing associations: a scoping review and implications using a socio-ecological whole systems lens.

Objective: We undertook an interpretative scoping review to examine organizational priority setting and policy advocacy and the factors that influence nursing associations' cross-sector public policy choices and actions.

Method: Evidence was drawn from research, narrative, and theoretical sources that described priority setting and policy advocacy undertaken by non-governmental, non-profit, and nursing associations. Text was extracted from selected papers, imported into NVivo 8, coded, and analyzed using a descriptive-analytical narrative method.

Barriers and bridges to infection prevention and control: results of a qualitative case study of a Netherlands' surgical unit.

Objectives: The objectives of the study are to observe the overall work environment including infection prevention and control (IP&C) practices on the target surgical unit; to analyse the policies and procedures in the hospital and unit environments; to analyse the barriers and bridges to IP&C that practitioners identify in visual narratives of their unit environment and to collect monthly specific IP&C-related anonymised data.

Design: In this qualitative case study analysis, a socio-ecological approach on health systems informed the research design and provided a framework to better understand the complexity of implementing effective IP&C.

Setting: The study was conducted on a surgical unit at a Netherlands' hospital that reported successful reductions in the prevalence of targeted multidrug-resistant organisms.

Exploring ethics in practice: creating moral community in healthcare one place at a time.

Examining everyday ethical situations in clinical practice is a vital but often overlooked activity for nursing leaders and practitioners, as well as most other healthcare professionals. In this paper, we share how a series of practitioner-led Ethics in Practice sessions (EIPs), which originated within a busy urban teaching hospital, were adapted and translated, first into home care and more recently, into an EIP session for public health nurses. The success of EIP sessions rests with their focus on issues that are selected by practitioners.

Understanding whole systems change in health care: the case of nurse practitioners in Canada.

Nurse practitioners (NPs) were introduced into the Canadian health system almost half a century ago. Despite early evidence of their effectiveness, it took decades to establish a substantial critical mass of NPs. Using the NP as a case study exemplar, we adopted a whole system change perspective to understand what else besides evidence was needed to ensure the success of desirable health systems innovations.

Medication administration technologies and patient safety: a mixed-method systematic review.

Background: Healthcare leaders need evidence-based information on nursing medication administration technologies to guide the design of improvements to patient safety.

Aim: The aim of this study was to evaluate the research evidence on relationships between the use of medication administration technologies and incidence of medication administration incidents and preventable adverse drug events to inform decision-making about existing technology options.

Data Sources: Thirteen electronic databases and seven relevant patient safety websites were searched for the years 1980-2009.

An integrative review of infection prevention and control programs for multidrug-resistant organisms in acute care hospitals: a socio-ecological perspective.

Background: The infection rates of multidrug-resistant organisms (MDRO) are increasing in Canada and the United States. The prevention and control of MDRO infections remain an important issue in acute care hospitals. Although comprehensive infection prevention and control programs have been recommended, there is little evidence to date of their effectiveness or of what aspects are most important.

Nursing care and patient safety: visualizing medication organization, storage and distribution with photographic research methods.

In this qualitative study, we adapted photographic research methods from earlier nursing research to identify factors related to organization, storage and distribution that could lead to errors in the selection, preparation and administration of medications. The research excerpt presented here was developed in a clinical unit of an urban Brazilian public hospital. The research participants were nurses working at that unit and students from the two final semesters of the Undergraduate Nursing Course.