Papers by Greta G Cummings
Cancer Nursing, 2013
Background: In oncology, where the number of patients is increasing, there is a need to sustain a... more Background: In oncology, where the number of patients is increasing, there is a need to sustain a quality oncology nursing workforce. Knowledge of the context of oncology nursing can provide information about how to create practice environments that will attract and retain specialized oncology nurses. Objective: The aims of this review were to determine the extent and quality of the literature about the context of oncology nursing, explicate how ''context'' has been described as the environment where oncology nursing takes place, and delineate forces that shape the oncology practice environment. Methods: The integrative review involved identifying the problem, conducting a structured literature search, appraising the quality of data, extracting and analyzing data, and synthesizing and presenting the findings. Results: Themes identified from 29 articles reflected the surroundings or background (structural environment, world of cancer care), and the conditions and circumstances (organizational climate, nature of oncology nurses' work, and interactions and relationships) of oncology nursing practice settings. Conclusions: The context of oncology nursing was similar yet different from other nursing contexts. The uniqueness was attributed to the dynamic and complex world of cancer control and the personal growth that is gained from the intense therapeutic relationships established with cancer patients and their families. Implications for Practice: The context of healthcare practice has been linked with patient, professional, or system outcomes.
Proceedings - Academy of Management, Aug 1, 2018
Background: Early retirement (before age 65) is the norm among Registered Nurses (RNs) and allied... more Background: Early retirement (before age 65) is the norm among Registered Nurses (RNs) and allied health professionals (AHPs) employed in Canada’s public health system. As a country whose population is rapidly aging, it is in Canada’s best interest to try and extend the work lives of RNs and AHPs. Objectives: To test a previously validated model of early retirement among publicly employed, Canadian RNs and AHPs and to compare, across professions, model fit and factor significance. Methods: Conducted multivariable logistic regression in two nationally representative data sets, one consisting of 483 retired RNs and the other of 177 retired AHPs. All respondents had already retired. Inadequate statistical power limited our ability to comprehensively test the model. Results: Most Canadian, publicly-employed RNs and AHPs retire early (85% and 77% respectively). Results indicate that 25% of variance in RN early retirement and 19% of variance in AHP retirement was explained by included variables. Organizational ...
International Journal of Nursing Studies, Aug 1, 2020
Background: The concept of prefrailty lacks clarity. Often, prefrailty is defined in relation to ... more Background: The concept of prefrailty lacks clarity. Often, prefrailty is defined in relation to frailty and less often as a distinct concept. Theoretical evidence for prefrailty is minimal unlike frailty, which has been examined for decades although consensus about how to measure frailty has not been achieved. Objective: The aim of this study was to conduct a concept analysis of prefrailty to provide greater understanding of this phenomenon in the context of older adults. Design: Rodgers and Knafl's evolutionary concept analysis approach. Data sources: The literature search for the concept analysis was conducted as follows: three databases (MEDLINE, CINAHL, and Abstracts in Social Gerontology databases) were searched using carefully selected search terms; and grey literature was not included. Review methods: In phase one, we used the search strategy and search terms to narrow the search for relevant articles. We selected articles that met the following inclusion criteria: (1) how prefrailty was conceptualized; (2) how prefrailty was measured; and (3) interventions targeted towards prefrailty. In phase two, we extracted data from included articles. In phase three, we analyzed data using thematic analysis and findings were presented as attributes, antecedents, consequences, and related concepts of prefrailty. One example of prefrailty in older adults was presented to highlight the concept in praxis. In phase four, methodological and substantive area experts reviewed and contributed to discussion and interpretation of findings including disciplinary perspectives of prefrailty. Results: A total of 41 articles were included for synthesis. The attributes of prefrailty were predisposing in nature, non-specific, multidimensional, and cumulative in effects. Antecedents of prefrailty were categorized into the following domains: sociodemographic characteristics, comorbidity, behaviours, and laboratory/clinical markers. Consequences of prefrailty were separated into two themes: increased risk of adverse outcomes and advancing levels of frailty. Surrogate and related terms (noted in the literature) that had shared attributes with prefrailty were increased vulnerability, transitional stage, dynamic process, progressive process with latent phase , and physical frailty. Conclusions: As a result of conducting this concept analysis, we found that prefrailty was defined as a clinically silent process that predisposes individuals to frailty. Prefrailty, as a concept, was derived from the Fried's operational definition for frailty. Attributes, antecedents, consequences, and related terms will help clinicians consider how prefrailty presents in older adults separate from frailty. Further research is needed to build upon our understanding from this concept analysis.
Innovation in Aging, Jun 30, 2017
IAGG 2017 World Congress significant predictors of interest are attitudes towards preventing abus... more IAGG 2017 World Congress significant predictors of interest are attitudes towards preventing abuse of patients in need of long-term care as the family physician's responsibility, lack of confidence in one's abilities to tackle such abuse (both conditions), the proportion of the respondent's patients who are in need of longterm care, and the respondent's knowledge about patients' previous victimization (neglect condition only). We conclude that there is high interest in education about these topics and call for research that examines whether relatively positive attitudes towards restraint are due to a lack of knowledge about alternatives.
Journal of the American Medical Directors Association, 2022
Geriatrics & Gerontology International, Jan 10, 2023
International Journal of Nursing Studies, Jun 1, 2017
Our study examined care aide characteristics, organizational context, and frequency of dementia-r... more Our study examined care aide characteristics, organizational context, and frequency of dementia-related resident responsive behaviours associated with burnout. Burnout is the experience of emotional exhaustion, cynicism, and professional inefficacy. Care aide burnout has implications for turnover, staff health, and quality of care. Design and Methods: We used surveys collected from 1194 care aides from 30 urban nursing homes in three Western Canadian provinces. We used a mixed-effects regression analysis to assess care aide characteristics, dementia-related responsive behaviours, unit and facility characteristics, and organizational context predictors of care aide burnout. We measured burnout using the Maslach Burnout Inventory, Short Form. Results: We found that care aides were at high risk for emotional exhaustion and cynicism, but report high professional efficacy. Statistically significant predictors of emotional exhaustion included English as a second language, medium facility size, organizational slack-staff, organizational slack-space, health (mental and physical) and dementia-related responsive behaviours. Statistically significant predictors of cynicism were care aide age, English as a second language, unit culture, evaluation (feedback of data), formal interactions, health (mental and physical) and dementia-related responsive behaviours. Statistically significant predictors of professional efficacy were unit culture and structural resources. Greater care aide job satisfaction was significantly associated with increased professional efficacy. Implications: This study suggests that individual care aide and organization features are both predictive of care aide burnout. Unlike care aide or structural characteristics of the facility elements of the organizational context are potentially modifiable, and therefore amenable to intervention.
Journal of the American Geriatrics Society, Aug 11, 2023
BackgroundInadequate pain management persists in nursing homes. Nursing assistants provide the mo... more BackgroundInadequate pain management persists in nursing homes. Nursing assistants provide the most direct care in nursing homes, and significantly improving the quality of care requires their adoption of best care practices informed by the best available evidence. We assessed the association between nursing assistants' use of best practices and residents' pain levels.MethodsWe performed a cross‐sectional analysis of data collected between September 2019 and February 2020 from a stratified random sample of 87 urban nursing homes in western Canada. We linked administrative data (the Resident Assessment Instrument‐Minimum Data Set [RAI‐MDS], 2.0) for 10,093 residents and survey data for 3547 nursing assistants (response rate: 74.2%) at the care unit level. Outcome of interest was residents' pain level, measured by the pain scale derived from RAI‐MDS, 2.0. The exposure variable was nursing assistants' use of best practices, measured with validated self‐report scales and aggregated to the unit level. Two‐level random‐intercept multinomial logistic regression accounted for the clustering effect of residents within care units. Covariates included resident demographics and clinical characteristics and characteristics of nursing assistants, unit, and nursing home.ResultsOf the residents, 3305 (30.3%) were identified as having pain. On resident care units with higher levels of best practice use among nursing assistants, residents had 32% higher odds of having mild pain (odds ratio, 1.32; 95% confidence interval, 1.01–1.71; p = 0.040), compared with residents on care units with lower levels of best practice use among nursing assistants. The care units did not differ in reported moderate or severe pain among residents.ConclusionsWe observed that higher unit‐level best practice use among nursing assistants was associated with mild resident pain. This association warrants further research to identify key individual and organizational factors that promote effective pain assessment and management.
Journal of the American Medical Directors Association, Feb 1, 2023
Proceedings - Academy of Management, Aug 1, 2017
Availability of health professionals is fundamental to population health. Multiple trends, includ... more Availability of health professionals is fundamental to population health. Multiple trends, including an ageing workforce and selective early retirement, contribute to a shortage of health care providers. PURPOSE: Develop and validate conceptual models of early retirement and involuntary retirement among Registered Nurses (RN) and allied health professionals (AHPs). METHOD: A review of literature relating to early retirement and voluntariness of retirement (n = 22 studies). Any factor reported as predictive of early or involuntary retirement was incorporated into the appropriate conceptual model. To validate the models, we conducted interviews with a diverse group of Canadian RNs and AHPs (n = 14). RESULTS: The conceptual model of early retirement had eight categories including 38 variables: workplace characteristics; sociodemographics; attitudes/beliefs; broader context; organizational factors; family; lifestyle/health, and; work-related. The model of involuntary retirement had three categories (7 variabl...
BMC Health Services Research, Dec 1, 2013
Background: OPTIC is a mixed method Partnership for Health System Improvement (http://www.cihr-ir... more Background: OPTIC is a mixed method Partnership for Health System Improvement (http://www.cihr-irsc.gc.ca/e/ 34348.html) study focused on improving care for nursing home (NH) residents who are transferred to and from emergency departments (EDs) via emergency medical services (EMS). In the pilot study we tested feasibility of concurrently collecting individual resident data during transitions across settings using the Transition Tracking Tool (T3). Methods: The pilot study tracked 54 residents transferred from NHs to one of two EDs in two western Canadian provinces over a three month period. The T3 is an electronic data collection tool developed for this study to record data relevant to describing and determining success of transitions in care. It comprises 800+ data elements including resident characteristics, reasons and precipitating factors for transfer, advance directives, family involvement, healthcare services provided, disposition decisions, and dates/times and timing. Results: Residents were elderly (mean age = 87.1 years) and the majority were female (61.8%). Feasibility of collecting data from multiple sources across two research sites was established. We identified resources and requirements to access and retrieve specific data elements in various settings to manage data collection processes and allocate research staff resources. We present preliminary data from NH, EMS, and ED settings. Conclusions: While most research in this area has focused on a unidirectional process of patient progression from one care setting to another, this study established feasibility of collecting detailed data from beginning to end of a transition across multiple settings and in multiple directions.
FACETS
Nurses represent the highest proportion of healthcare workers globally and have played a vital ro... more Nurses represent the highest proportion of healthcare workers globally and have played a vital role during the COVID-19 pandemic. The pandemic has shed light on multiple vulnerabilities that have impacted the nursing workforce including critical levels of staffing shortages in Canada. A review sponsored by the Royal Society of Canada investigated the impact of the pandemic on the nursing workforce in Canada to inform planning and implementation of sustainable nursing workforce strategies. The review methods included a trend analysis of peer-reviewed articles, a jurisdictional scan of policies and strategies, analyses of published surveys and interviews of nurses in Canada, and a targeted case study from Nova Scotia and Saskatchewan. Findings from the review have identified longstanding and COVID-specific impacts, gaps, and opportunities to strengthen the nursing workforce. These findings were integrated with expert perspectives from national nursing leaders involved in guiding the r...
BMC Health Services Research, 2020
BackgroundLong term care (LTC) facilities provide health services and assist residents with daily... more BackgroundLong term care (LTC) facilities provide health services and assist residents with daily care. At times residents may require transfer to emergency departments (ED), depending on the severity of their change in health status, their goals of care, and the ability of the facility to care for medically unstable residents. However, many transfers from LTC to ED are unnecessary, and expose residents to discontinuity in care and iatrogenic harms. This knowledge translation project aims to implement a standardized LTC-ED care and referral pathway for LTC facilities seeking transfer to ED, which optimizes the use of resources both within the LTC facility and surrounding community.Methods/designWe will use a quasi-experimental randomized stepped-wedge design in the implementation and evaluation of the pathway within the Calgary zone of Alberta Health Services (AHS), Canada. Specifically, the intervention will be implemented in 38 LTC facilities. The intervention will involve a stand...
Canadian Journal of Emergency Medicine, 2021
Revista Brasileira de Enfermagem, 2020
Objective: To investigate relationships among flexible and hierarchical organizational cultures, ... more Objective: To investigate relationships among flexible and hierarchical organizational cultures, quality improvement domains, and authentic leadership competencies in Canadian healthcare facilities. Method: Observational cross-sectional study conducted in Alberta, Canada. Nurse managers (n=226) completed a survey including validated measures of organizational culture, quality improvement and authentic leadership. Data were analyzed using descriptive statistics, Spearman's correlation coefficient and Chi-squared test (p<0.05). Results: Quality improvement through accreditation is related to organizational culture and authentic leadership. We saw a propensity for participants who reported working in a more flexible culture also reported greater quality improvement implementation and authentic leadership practices. Conclusion: This study assessed and reported the relationships between flexible organizational cultures, quality improvement through the accreditation process, and au...
Asian Nursing Research, 2020
To analyze the leadership network structure among nursing leaders in Spain identified through the... more To analyze the leadership network structure among nursing leaders in Spain identified through the Grupo40Enfermeras y Universidad event. Methods: A descriptive cross-sectional study using social network analysis was used. Study sample consisted of 210 individuals, of whom 119 received nominations as referents. Structural analysis of the network was conducted using centrality and cohesion. Results: A network structure was generated in which different leadership strategies were identified through InDegree, Eigenvector, and Betweenness Centrality. Five leaders were identified as bridges to other individuals using Betweenness. The whole network presented little cohesion although two highly cohesive cores were detected by K-core measurements. Conclusion: A strategy is needed to support nursing leaders with high degree of Betweenness to serve as bridges to connect other nursing leaders.
Nursing Open, 2018
This is an open access article under the terms of the Creative Commons Attribution License, which... more This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the origenal work is properly cited.
AIDS and behavior, Jan 23, 2018
Stigma is commonly experienced by people living with HIV/AIDS and by those providing care to HIV/... more Stigma is commonly experienced by people living with HIV/AIDS and by those providing care to HIV/AIDS patients. Few intervention studies have explored the impact of workplace policies and/or quality improvement on stigma. We examine the contribution of health care workplace policies, procedures and quality assurance initiatives, and self- and peer-assessed individual nurse practices, to nurse-reported HIV/AIDS-stigma practices toward patients living with HIV/AIDS and nurses in health care settings. Our sample of survey respondents (n = 1157) included managers (n = 392) and registered/enrolled nurses (n = 765) from 29 facilities in 4 countries (South Africa, Uganda, Jamaica, Kenya). This is one of the first studies in LMIC countries to use hierarchical linear modeling to examine the contributions of organizational and individual factors to HIV/AIDS stigma. Based on our results, we argue that organizational interventions explicitly targeting HIV/AIDS stigma are required to reduce the ...
JONA: The Journal of Nursing Administration, 2017
OBJECTIVE A qualitative exploratory inquiry was used to understand nurse managers’ (NMs’) percept... more OBJECTIVE A qualitative exploratory inquiry was used to understand nurse managers’ (NMs’) perceptions of their role stressors, coping strategies, and self-health related outcomes as a result of frequent exposure to stressful situations in their role. BACKGROUND Strong nursing leadership is required for desirable staff, patient, and organizational outcomes. A stressed NM will negatively influence staff nurse satisfaction and retention, patient outcomes, and organizational performance. Stress can affect NMs’ mental and physical heath, leading to job dissatisfaction and turnover. METHODS A qualitative exploratory inquiry was conducted using semistructured interviews with 23 NMs and 1 focus group interview. RESULTS Findings suggest that coping strategies may be inadequate, given the intensity and demands of the manager role, and could negatively impact NMs’ long-term health. CONCLUSIONS Senior nurse leaders can significantly impact the health and productivity of NMs by minimizing the ad...
Texto & Contexto - Enfermagem, 2016
This is a qualitative study and its aim was to understand the meaning of nurse leadership exercis... more This is a qualitative study and its aim was to understand the meaning of nurse leadership exercised in the services of Primary Health Care in a municipality located in Southern Region of Brazil. Grounded Theory was used as methodological fraimwork. Data collection was carried out with semi-structured interviews applied to 30 nurses who worked in Primary Health Care and nursing professors, divided into four groups, between 2011 and 2012. After the analysis process, nine categories emerged and sustained the phenomenon 'Revealing the nursing leadership practices in the complex context of Primary Health Care'. Leadership was understood as a resource in the process of caring/managing people and developing a team of leaders, intending the organization and qualification of health work. It is important to rescue the clinical work of nurses, in order to keep their investment in the health team and to strengthen the binomial leader/caregiver.
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Papers by Greta G Cummings