Registered nurses (RNs) account for 75 percent of health care professionals. Statistics Canada predicts that demand for nursing services is expected to rise as much as 46 percent by 2011. But new nurses are leaving at an alarming rate: 15 to 21 percent of newly qualified RNs are lost to other careers or immigration. Action is needed to meet projected needs for nursing services, but little is known about the factors that affect nurses’ career decisions. Angela Wolff is surveying student nurses about the individual, educational and organizational factors that influence job satisfaction, social adjustment to the workplace, and career choices. Angela is evaluating whether professional autonomy, nursing control over the practice environment, and open, effective channels of communication are directly related to job satisfaction and commitment. This research will identify barriers to integrating new RNs into the workforce, and ways to develop a supportive work environment for beginning practitioners. Ultimately, these strategies could enhance recruitment and retention of new nurses to help address an impending shortage of nursing staff in Canada.
Research Pillar: Health Services
Pharmacist identification of new, diagnostically confirmed osteoarthritis (PHIND-OA)
Knee osteoarthritis is the most common cause of disability in older adults. There are three million Canadians currently afflicted with this condition, and it’s predicted that this number will increase by 50 per cent by 2020. The costs of medical care, drugs, and lost wages resulting from this disability is a major economic burden in Canada. Several research studies have demonstrated the benefit of non-drug therapy such as education and exercise for people with knee osteoarthritis. However, many individuals remain undiagnosed for their condition and don’t receive appropriate interventions. Dr. Carlo Marra is researching the potential of pharmacists, who are highly accessible health care practitioners, to help identify people with knee osteoarthritis by using a simple screening questionnaire. Next, he will investigate whether pharmacists can initiate an intervention that brings together patient, physiotherapist, and family practitioner to improve physical function, minimize pain, and reduce the economic burden of this disease. In addition, regular follow-ups will occur to assess and encourage compliance with the intervention, assess outcomes and answer any questions. Dr. Marra anticipates his research will demonstrate the value of this innovative, cost-effective strategy to improve outcomes and quality of life for people with knee osteoarthritis.
Primary health care for Chinese and South Asians: continuous, accessible, and timely
Recent years have seen increasing concern about access to and quality of primary health care in Canada. A substantial amount of provincial and federal funding has gone into revitalizing the primary health care system. The current tools used to assess how the primary health care system works for consumers (such as questionnaires) were originally developed primarily with well-educated, English-speaking Whites of European descent. British Columbia is home to the second largest immigrant population in Canada, where approximately 50 per cent of all BC immigrants are from Asia and one in every ten cannot speak, write, or understand English. Currently, little is known about whether current assessment tools are valid across different ethno-cultural groups who may not speak English. In addition, existing assessment tools may not adequately reflect the issues and concerns about primary health care that are important to different ethno-cultural populations. Dr. Sabrina Wong is studying the dimensions of primary health care that are important to adults from two of the largest ethno-cultural groups living in BC: Chinese and South Asians, who speak Cantonese or Punjabi, respectively. Through focus groups and telephone surveys, she is identifying what dimensions are addressed in existing assessment tools, and what needs to be modified for these ethno-cultural groups. Ultimately, Dr. Wong hopes that her research will result in an assessment tool of primary health care that is equally valid and reliable across English, Cantonese, and Punjabi speaking populations.
Nurse Staffing, Interruptions in Practice, and Patient Safety Outcomes: Exploring the Systems Issues
Changes to health care in Canada over the latter part of the 1990s have resulted in a number of new challenges for hospital nurse executives and health care leaders. In response to fiscal constraints and funding reductions, many health care settings restructured and downsized in an effort to reduce costs and improve the efficiency of services provided. These changes, coupled with the nursing shortage, have prompted concern in the nursing community regarding the work environment of nurses, and how this may influence nurse and patient safety outcomes.
Bathing without a battle: organizational and physical environmental features associated with resident agitation during bathing on dementia special care units
Agitation in cognitively impaired individuals is one of the most difficult behaviours for nursing home staff to manage. Research indicates that between 40 percent and 73 percent of long-term care residents with dementia display disruptive behaviour during bathing. This behaviour, which causes distress and sometimes injury for both residents and staff, ranges from verbal and physical resistance, to hostile language, punches, hits and slaps. Both the organizational and physical environments of a long-term care facility are believed to influence resident agitation levels. However, most research on the bathing of individuals with dementia has focused on only one of these environments. Heather Cooke is examining the bathing policies, training of bath staff, staff assignment and physical features of bathing areas in all Dementia Special Care Units in B.C., to explore the role of such features in the occurrence of resident agitation during bathing. Findings from the study will be used to develop standards and best practices designed to reduce resident agitation and to guide health care planners in the appropriate distribution of funds for improving the care facility.
Assessing sensitivity to unobserved confounders in observational studies: a Bayesian approach
Hospitals and other health care organizations collect data in areas including admissions, diagnostic tests, and hospital discharges. Health services researchers use this information because it is abundant, readily available and inexpensive to access. However, this type of data differs from experimental data, which is collected for the purpose of research. With experimental data, half of participants receive a treatment and the other half receives a placebo based on random allocation, which allows researchers to measure the impact of the treatment in a manner which is unbiased. Results may be less reliable for non-experimental data when comparing groups of patients because uncontrolled circumstances can influence the outcomes in a process known as confounding. Lawrence McCandless is examining whether a new approach to using health care databases, Bayesian sensitivity analysis, can improve the accuracy and reliability of statistical studies. Lawrence is investigating the effectiveness of the approach in studying waitlists for coronary artery bypass surgery in BC. The research could suggest ways to more broadly use health care databases to study and improve the health system.
Developing a computer simulation model for patient flow in health care system: access to coronary revascularization
In response to unprecedented pressure, the health care system has and continues to restructure systems of core delivery to achieve greater efficiency and effectiveness. While this points to the need for research to assess the effects of reorganization, there is a lack of such research, partly because analyzing the flow of patients through the health care system can be extremely complex. In previous research, Dr. Christos Vasilakis developed a computer simulation model capable of evaluating the interactions between the different streams of patient flow in a hospital department. This simulation model was also used to test an alternative hypothesis of the causes of hospital bed crises in England. Now he is developing a computer simulation model to evaluate the effects of proposed organizational changes at BC cardiac care centres that will affect patient access to revascularization procedures, which are used to improve blood flow to the heart. Hospital managers could use the completed model as a tool to manage patient access. Policy-makers could use the model to assess the impact of other proposed changes to the health care system to better inform how these changes should be made.
Exploring and mapping illness self-management in people recently diagnosed with Psychotic Illness
Research has identified certain core abilities that enable people with mental illness to self-manage their condition. This includes the ability of individuals to understand information about their health condition. Studies have shown that providing illness-related information is a fundamental starting point for developing other self-management abilities; but little research has been done on the needs of people in the early stages of illness who are entering the mental health system for the first time. Eric Macnaughton is studying how people newly diagnosed with serious forms of mental illness can learn to successfully live with their conditions. Given the traumatic and confusing nature of a first experience with mental illness, Eric is investigating the idea that stories about people who have successfully coped with their mental illness could help motivate newly diagnosed people to self-manage their condition. The research could contribute to design of programs and tools that help build or strengthen self-management skills.
Access issues for Aboriginal people seeking primary care services in an urban centre
Access to primary care is problematic for large numbers of Aboriginal people in BC and other parts of Canada. Because of these difficulties, many Aboriginal people rely on hospital emergency departments for health care. Since emergency departments are not designed to provide comprehensive primary care, there are concerns about health outcomes and continuity of care for patients who rely on them. To plan effective, responsive services, more must be known about the ongoing use of the emergency department for health concerns that could potentially be addressed elsewhere. Dr. Annette Browne and a team of Aboriginal and non-Aboriginal researchers are exploring the factors and social contexts that influence access to primary care from the perspective of Aboriginal patients who seek care at the emergency department. Learning from the perspectives of Aboriginal peoples will be critical to the design of accessible, culturally safe, primary care services. Dr. Browne is also examining how interactions between Aboriginal patients and health professionals affect decisions about where to seek care. Findings from this research will be discussed with leaders in Aboriginal health, policy makers and health care planners to improve access to effective health care services involving Aboriginal peoples.
Pharmaceutical Outcomes and Policy Innovation
Canada is facing one of the highest growth rates for drug costs among developed nations. As a result, cost is the primary factor leading public policy decisions for drug insurance programs. Researchers in this unit will conduct studies to systematically assess the effectiveness and safety of prescription drugs in tandem with cost-effectiveness. Their studies will help provide an evidence-based platform upon which policy-makers can make rational decisions about drug plan coverage.
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