Browsing by Author "Milner, Margaret"
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- ItemBreaking from tradition: transforming leadership education in nursing(2015) Symonds-Brown, Holly; Milner, MargaretLeadership development is critical for nurses to be engaged in health system reform and transformation. Trends in nursing practice led to the development of an innovative senior consolidation course in our four year undergraduate nursing program. We hypothesized that providing opportunities for application of theoretical knowledge related to complex adaptive systems and leadership would enhance professional identity formation. We describe our experiences implementing a clinical course wherein nursing students are provided opportunities to explore and develop their leadership acumen within an undergraduate curriculum. We discuss how breaking from curricular tradition involved intentional use of pedagogy (transformational learning theory), innovative instructional design, and the formation of collaborative partnerships to provide a space for students to practice the cognitive, relational, and meaning making skills required for leadership development. We highlight the impact of this journey on students, faculty, and community partners as we forge ahead in planning next steps to determine the level of engagement of our graduates in health system design, advocacy, and stewardship.
- ItemClarifying RN scope of practice(2015) Milner, Margaret; Allen, Brittany; Howe, Nicholas; Toal, KatelynThe Canadian Nurses Association (CNA), provincial and territorial professional associations, and various healthcare organizations call upon registered nurses (RNs) to work to their “full scope of practice”. As a class of fourth year registered nursing students taking a course on future directions in nursing practice, our professor challenged us to define the role of the registered nurse in Canada’s healthcare system.
- ItemClinical nurse educators as agents for change: increasing research utilization(2005) Milner, Margaret; Estabrooks, Carole; Humphrey, C.The purpose of this study was to examine the determinants of research utilization among clinical nurse educators. The primary goal for clinical nurse educators is the facilitation of professional development of practicing nurses. Responsibilities include promoting best practice by mentoring others, acting as an information source, and assisting in the development of policies and procedures based on available research evidence. Using Rogers’ (Diffusion of Innovations, 4th edn., The Free Press, New York) diffusion of innovations theory as a theoretical foundation, we conducted a secondary analysis to test a predictive model of research utilization using linear regression. Results show that educators report significantly higher research use than staff nurses and managers. Predictors of research utilization include attitude toward research, awareness of information based on research, and involvement in research activities. Localite communication predicted conceptual research use and mass media predicted symbolic use, lending support to the idea that overall, instrumental, conceptual, and symbolic research utilization are conceptually different from one another. Our findings show that the research utilization behaviors of clinical nurse educators position them to facilitate evidence-based nursing practice in organizations. We discuss the theoretical, conceptual, and nursing role implications of our findings for nursing practice, education, and research. Suggestions for future research includes studying actual use of research findings of clinical nurse educators and designing intervention studies that assesses the effectiveness of clinical nurse educators as facilitators of research utilization in organizations.
- ItemDisciplining virtue: investigating the discourses of opioid addiction in nursing(2016) Kunyk, Diane; Milner, Margaret; Overend, AlissaTwo nurses diagnosed with opioid addiction launched legal action after being found guilty of unprofessional conduct due to addiction‐related behaviors. When covered by the media, their cases sparked both public and legal controversies. We are curious about the broader discursive framings that led to these strong reactions, and analyze the underlying structures of knowledge and power that shape the issue of opioid addiction in the profession of nursing through a critical discourse analysis of popular media, legal blogs and hearing tribunals. We argue that addiction in nursing is framed as personal choice, as a failure in the moral character of the nurses, as decontextualized from addiction as disease arguments, and as an individualized issue devoid of contextual factors leading to addiction. Our investigation offers a critical case study of a nursing regulatory body that upheld popular assumptions of addiction as an autonomous, rational choice replete with individual‐based consequences – a framing that is inconsistent with evidence‐based practice in health‐care. We put forth this critical interrogation to open up possibilities for counterdiscourses that may promote more nuanced and effective responses to the issue of addiction in nursing.
- ItemMeasuring knowledge utilization in health care(2003) Estabrooks, Carole; Wallin, Lars; Milner, MargaretIn this paper we address the need for methodological advances in the research utilization field focusing on the area of measurement. Unresolved measurement challenges present an important and practical problem. An inability to adequately measure research utilization calls into question studies that claim to demonstrate either its causes or its effects. In this paper we: briefly review the concept of research utilization and its meanings, review the requirements of good measurement instruments, review existing research utilization instruments in nursing, and discuss implications and future requirements for scholarship in this field.
- ItemResearch utilization and clinical nurse educators: a systematic review(2006) Milner, Margaret; Estabrooks, Carole; Myrick, FlorenceBackground: Clinical nurse educators and other linking agents such as clinical nurse specialists, advanced nurse practitioners, and nurses working in research leadership positions are an important link in the facilitation of evidence-based practice in health care organizations. Aim: The purpose of this paper is to report the findings of a systematic review of the literature regarding clinical nurse educators and research utilization, using the Promoting Action on Research Implementation in Health Services framework as a backdrop for the analysis. Findings: There is a positive relationship between research utilization and attitude toward research, higher levels of education, and reading professional nursing journals among clinical nurse educators. The authors suggest that not all clinical nurse educators have the necessary critical appraisal skills and research knowledge to use research effectively in practice. Conclusions: Few studies have examined clinical nurse educators and the determinants of their research utilization behaviour in clinical practice. Future research on clinical nurse educators needs to focus on the outcomes of research utilization, including the effectiveness of their role as facilitators and the contexts in which they practice.
- ItemSources of practice knowledge among nurses(2005) Estabrooks, Carole; Rutakumwa, William; O’Leary, Katherine; Profetto McGrath, Joanne; Milner, Margaret; Levers, Merry Jo; Scott Findlay, ShannonSeveral studies have been published listing sources of practice knowledge used by nurses. However, the authors located no studies that asked clinicians to describe comprehensively and categorize the kinds of knowledge needed to practice or in which the researchers attempted to understand how clinicians privilege various knowledge sources. In this article, the authors report findings from two large ethnographic case studies in which sources of practice knowledge was a subsidiary theme. They draw on data from individual and card sort interviews, as well as participant observations, to identify nurses’ sources of practice knowledge. Their findings demonstrate that nurses categorize their sources of practice knowledge into four broad groupings: social interactions, experiential knowledge, documents, and a priori knowledge. The insights gained add new understanding about sources of knowledge used by nurses and challenge the disproportionate weight that proponents of the evidence-based movement ascribe to research knowledge.
- ItemThe prevalence of pressure ulcers in a tertiary care pediatric and adult hospital(2004) Groeneveld, Audrey; Anderson, Marjorie; Allen, Sandy; Bressmer, Sandy; Golberg, Maria; Magee, Bernice; Milner, Margaret; Young, SueAccording to the Agency for Healthcare Research and Quality (AHRQ, formerly the AHCRP), the occurrence of pressure ulcers in acute care facilities continues to be a significant healthcare problem. The frail elderly, the very young, and patients undergoing lengthy operative procedures are especially at risk. Pressure ulcers are costly in terms of patient morbidity and mortality, quality of life, and consumption of healthcare resources. For nurses working in acute care settings, the prevention and treatment of pressure ulcers in their patients remains an important nursing care concern, which will increase as the population of frail elderly in acute care increases.
- ItemThe role of intermediaries: getting evidence into practice(2004) Ferguson, Linda; Milner, Margaret; Snelgrove Clarke, ErnaEhrenberg and Estabrooks' assertion that using research does matter began this series of articles on research utilization (RU) in practice. RU with due consideration of patient preferences, clinical judgment, and available resources can contribute to positive patient outcomes. For many reasons, however, the use of research in nursing practice is limited. We now know that passive diffusion of research has had a limited effect on the use of research to improve patient outcomes. We need better understanding of factors in the practice setting that support research use. Nurses have consistently reported lack of time, lack of access to research, and lack of skill in critiquing research as their main barriers to greater RU. The identification of RU as a social process, coupled with research that demonstrates nurses prefer social mediums over other knowledge sources, suggests that intermediaries may be a necessary link to greater research use. The authors discuss the role of intermediaries and their ability to influence the use of research in clinical practice. They highlight some important points to consider from the literature and suggest strategies that enhance RU within the context of the intermediary role.