1
|
Grant A, Kontak J, Jeffers E, Lawson B, MacKenzie A, Burge F, Boulos L, Lackie K, Marshall EG, Mireault A, Philpott S, Sampalli T, Sheppard-LeMoine D, Martin-Misener R. Barriers and enablers to implementing interprofessional primary care teams: a narrative review of the literature using the consolidated framework for implementation research. BMC Prim Care 2024; 25:25. [PMID: 38216867 PMCID: PMC10785376 DOI: 10.1186/s12875-023-02240-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 12/11/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND Interprofessional primary care teams have been introduced across Canada to improve access (e.g., a regular primary care provider, timely access to care when needed) to and quality of primary care. However, the quality and speed of team implementation has not kept pace with increasing access issues. The aim of this research was to use an implementation framework to categorize and describe barriers and enablers to team implementation in primary care. METHODS A narrative review that prioritized systematic reviews and evidence syntheses was conducted. A search using pre-defined terms was conducted using Ovid MEDLINE, and potentially relevant grey literature was identified through ad hoc Google searches and hand searching of health organization websites. The Consolidated Framework for Implementation Research (CFIR) was used to categorize barriers and enablers into five domains: (1) Features of Team Implementation; (2) Government, Health Authorities and Health Organizations; (3) Characteristics of the Team; (4) Characteristics of Team Members; and (5) Process of Implementation. RESULTS Data were extracted from 19 of 435 articles that met inclusion/exclusion criteria. Most barriers and enablers were categorized into two domains of the CFIR: Characteristics of the Team and Government, Health Authorities, and Health Organizations. Key themes identified within the Characteristics of the Team domain were team-leadership, including designating a manager responsible for day-to-day activities and facilitating collaboration; clear governance structures, and technology supports and tools that facilitate information sharing and communication. Key themes within the Government, Health Authorities, and Health Organizations domain were professional remuneration plans, regulatory policy, and interprofessional education. Other key themes identified in the Features of Team Implementation included the importance of good data and research on the status of teams, as well as sufficient and stable funding models. Positive perspectives, flexibility, and feeling supported were identified in the Characteristics of Team Members domain. Within the Process of Implementation domain, shared leadership and human resources planning were discussed. CONCLUSIONS Barriers and enablers to implementing interprofessional primary care teams using the CFIR were identified, which enables stakeholders and teams to tailor implementation of teams at the local level to impact the accessibility and quality of primary care.
Collapse
Affiliation(s)
- Amy Grant
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Julia Kontak
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elizabeth Jeffers
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Beverley Lawson
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Adrian MacKenzie
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Kelly Lackie
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Building Research for Integrated Primary Care, Halifax, Nova Scotia, Canada
| | - Amy Mireault
- Maritime SPOR Support Unit, 5790 University Avenue, Halifax, Nova Scotia, B3H 1V7, Canada
| | - Susan Philpott
- Nova Scotia Department of Health and Wellness, Halifax, Nova Scotia, Canada
| | | | | | - Ruth Martin-Misener
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.
| |
Collapse
|
2
|
Paynter M, Martin-Misener R, Iftene A, Tomblin-Murphy G. A qualitative case study of pregnancy and early parenting in Canada's federal prisons for women. PLoS One 2023; 18:e0294961. [PMID: 38150436 PMCID: PMC10752509 DOI: 10.1371/journal.pone.0294961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 11/10/2023] [Indexed: 12/29/2023] Open
Abstract
OBJECTIVE The aim of this study was to understand the experiences of pregnant people and new parents in Canadian federal prisons for women, and to better understand their ability to participate in the institutional Mother Child Program. METHODS This qualitative case study used semi-structured interviews with people who experienced federal incarceration during pregnancy or the early parenting years. FINDINGS Major themes in the analysis include: 1) Reasons why- and why not- to participate in the Mother Child Program; 2) Mothering from inside; 3) Health care; and 4) Strategies and survival. KEY CONCLUSIONS Mothers describe multiple reasons for choosing not to participate or being ineligible for the Mother Child Program; separation as common and traumatic; health services as inadequate; and mental health concerns being met with punishment. Alternatives to incarceration are recommended.
Collapse
Affiliation(s)
- Martha Paynter
- Faculty of Nursing, University of New Brunswick, Fredericton, New Brunswick, Canada
| | | | - Adelina Iftene
- Schulich School of Law, Dalhousie University Halifax, Nova Scotia, Canada
| | - Gail Tomblin-Murphy
- Nova Scotia Health Authority Provincial Office, Nova Scotia Health Halifax, Nova Scotia, Canada
| |
Collapse
|
3
|
Lavergne MR, Moravac C, Bergin F, Buote R, Easley J, Grudniewicz A, Hedden L, Leslie M, McKay M, Marshall EG, Martin-Misener R, Mooney M, Palmer E, Tracey J. Understanding and addressing changing administrative workload in primary care in Canada: protocol for a mixed-method study. BMJ Open 2023; 13:e076917. [PMID: 38086593 PMCID: PMC10729089 DOI: 10.1136/bmjopen-2023-076917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION Many Canadians struggle to access the primary care they need while at the same time primary care providers report record levels of stress and overwork. There is an urgent need to understand factors contributing to the gap between a growing per-capita supply of primary care providers and declines in the availability of primary care services. The assumption of responsibility by primary care teams for services previously delivered on an in-patient basis, along with a rise in administrative responsibilities may be factors influencing reduced access to care. METHODS AND ANALYSIS In this mixed-methods study, our first objective is to determine how the volume of services requiring primary care coordination has changed over time in the Canadian provinces of Nova Scotia and New Brunswick. We will collect quantitative administrative data to investigate how services have shifted in ways that may impact administrative workload in primary care. Our second objective is to use qualitative interviews with family physicians, nurse practitioners and administrative team members providing primary care to understand how administrative workload has changed over time. We will then identify priority issues and practical response strategies using two deliberative dialogue events convened with primary care providers, clinical and system leaders, and policy-makers.We will analyse changes in service use data between 2001/2002 and 2021/2022 using annual total counts, rates per capita, rates per primary care provider and per primary care service. We will conduct reflexive thematic analysis to develop themes and to compare and contrast participant responses reflecting differences across disciplines, payment and practice models, and practice settings. Areas of concern and potential solutions raised during interviews will inform deliberative dialogue events. ETHICS AND DISSEMINATION We received research ethics approval from Nova Scotia Health (#1028815). Knowledge translation will occur through dialogue events, academic papers and presentations at national and international conferences.
Collapse
Affiliation(s)
- M Ruth Lavergne
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
- Simon Fraser University, Burnaby, British Columbia, Canada
| | - Catherine Moravac
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Fiona Bergin
- Practice Ready Assessment Program, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Richard Buote
- College of Family Physicians of Canada, Mississauga, Ontario, Canada
| | - Julie Easley
- Family Medicine, Horizon Health Network, Fredericton, New Brunswick, Canada
| | - Agnes Grudniewicz
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Lindsay Hedden
- Simon Fraser University, Burnaby, British Columbia, Canada
| | | | | | - Emily Gard Marshall
- Department of Family Medicine, Dalhousie University Faculty of Medicine, Halifax, Nova Scotia, Canada
| | - Ruth Martin-Misener
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melanie Mooney
- Primary Health Care and Chronic Disease Management, Nova Scotia Health Authority, Yarmoth, Nova Scotia, Canada
| | - Erin Palmer
- Dalhousie University Faculty of Medicine, Saint John, New Brunswick, Canada
| | - Joshua Tracey
- Dalhousie University Faculty of Medicine, Saint John, New Brunswick, Canada
| |
Collapse
|
4
|
Aggarwal M, Katz A, Kokorelias KM, Wong ST, Aghajafari F, Ivers NM, Martin-Misener R, Aubrey-Bassler K, Breton M, Upshur REG, Kwong JC. What are effective vaccine distribution approaches for equity-deserving and high-risk populations during COVID-19? Exploring best practices and recommendations in Canada: protocol for a mixed-methods multiple case codesign study. BMJ Open 2023; 13:e072238. [PMID: 37940159 PMCID: PMC10632871 DOI: 10.1136/bmjopen-2023-072238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 10/18/2023] [Indexed: 11/10/2023] Open
Abstract
INTRODUCTION The WHO has stated that vaccine hesitancy is a serious threat to overcoming COVID-19. Vaccine hesitancy among underserved and at-risk communities is an ongoing challenge in Canada. Public confidence in vaccine safety and effectiveness and the principles of equity need to be considered in vaccine distribution. In Canada, governments of each province or territory manage their own healthcare system, providing an opportunity to compare and contrast distribution strategies. The overarching objective of this study is to identify effective vaccine distribution approaches and advance knowledge on how to design and implement various strategies to meet the different needs of underserved communities. METHODS AND ANALYSIS Multiple case studies in seven Canadian provinces will be conducted using a mixed-methods design. The study will be informed by Experience-Based CoDesign techniques and theoretically guided by the Socio-Ecological Model and the Vaccine Hesitancy Matrix frameworks. Phase 1 will involve a policy document review to systematically explore the vaccine distribution strategy over time in each jurisdiction. This will inform the second phase, which will involve (2a) semistructured, in-depth interviews with policymakers, public health officials, researchers, providers, groups representing patients, researchers and stakeholders and (2b) an analysis of population-based administrative health data of vaccine administration. Integration of qualitative and quantitative data will inform the identification of effective vaccine distribution approaches for various populations. Informed by this evidence, phase 3 of the study will involve conducting focus groups with multiple stakeholders to codesign recommendations for the design and implementation of effective vaccine delivery strategies for equity-deserving and at-risk populations. ETHICS AND DISSEMINATION This study is approved by the University of Toronto's Health Sciences Research Ethics Board (#42643), University of British Columbia Behavioural Research Ethics Board (#H22-01750-A002), Research Ethics Board of the Nova Scotia Health Authority (#48272), Newfoundland and Labrador Health Research Ethics Board (#2022.126), Conjoint Health Research Ethics Board, University of Calgary (REB22-0207), and University of Manitoba Health Research Board (H2022-239). The outcome of this study will be to produce a series of recommendations for implementing future vaccine distribution approaches from the perspective of various stakeholders, including equity-deserving and at-risk populations.
Collapse
Affiliation(s)
- Monica Aggarwal
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alan Katz
- Department of Community Health Sciences, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Family Medicine, Rady Faculty of Health Sciences University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristina Marie Kokorelias
- Rehabiliation Sciences Institute, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Rehabiliation Sciences Institute, University of Toronto Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Sabrina T Wong
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Noah M Ivers
- Department of Family and Community Medicine, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University, St. John's, Newfoundland, Canada
| | - Mylaine Breton
- Department of Community Health Sciences, University of Sherbrooke, Longueuil, Quebec, Canada
| | - Ross E G Upshur
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences (ICES), Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
5
|
Kaasalainen S, Wickson-Griffiths A, Hunter P, Thompson G, Kruizinga J, McCleary L, Sussman T, Venturato L, Shaw S, Boamah SA, Bourgeois-Guérin V, Hadjistavropoulos T, Macdonald M, Martin-Misener R, McClement S, Parker D, Penner J, Ploeg J, Sinclair S, Fisher K. Evaluation of the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme: a protocol of a cluster randomised control trial. BMJ Open 2023; 13:e073585. [PMID: 37880170 PMCID: PMC10603462 DOI: 10.1136/bmjopen-2023-073585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 09/28/2023] [Indexed: 10/27/2023] Open
Abstract
INTRODUCTION Despite the high mortality rates in long-term care (LTC) homes, most do not have a formalised palliative programme. Hence, our research team has developed the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme. The goal of the proposed study is to examine the implementation and effectiveness of the SPA-LTC programme. METHODS AND ANALYSIS A cross-jurisdictional, effectiveness-implementation type II hybrid cluster randomised control trial design will be used to assess the SPA-LTC programme for 18 LTC homes (six homes within each of three provinces). Randomisation will occur at the level of the LTC home within each province, using a 1:1 ratio (three homes in the intervention and control groups). Baseline staff surveys will take place over a 3-month period at the beginning for both the intervention and control groups. The intervention group will then receive facilitated training and education for staff, and residents and their family members will participate in the SPA-LTC programme. Postintervention data collection will be conducted in a similar manner as in the baseline period for both groups. The overall target sample size will be 594 (297 per arm, 33 resident/family member participants per home, 18 homes). Data collection and analysis will involve organisational, staff, resident and family measures. The primary outcome will be a binary measure capturing any emergency department use in the last 6 months of life (resident); with secondary outcomes including location of death (resident), satisfaction and decisional conflict (family), knowledge and confidence implementing a palliative approach (staff), along with implementation outcomes (ie, feasibility, reach, fidelity and perceived sustainability of the SPA-LTC programme). The primary outcome will be analysed via multivariable logistic regression using generalised estimating equations. Intention-to-treat principles will be used in the analysis. ETHICS AND DISSEMINATION The study has received ethical approval. Results will be disseminated at various presentations and feedback sessions; at provincial, national and international conferences, and in a series of manuscripts that will be submitted to peer-reviewed, open access journals. TRIAL REGISTRATION NUMBER NCT039359.
Collapse
Affiliation(s)
- Sharon Kaasalainen
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
- Gladys Sharpe Chair in Nursing, School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | - Julia Kruizinga
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Lynn McCleary
- Department of Nursing, Faculty of Applied Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, Québec, Canada
| | | | - Sally Shaw
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Sheila A Boamah
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | | | | | | | - Susan McClement
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Deborah Parker
- Aged Care, University of Technology Sydney Faculty of Health, Sydney, New South Wales, Australia
| | - Jamie Penner
- College of Nursing, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Shane Sinclair
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Kathryn Fisher
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
6
|
Barber BV, Kephart G, Martin-Misener R, Vallis M, Matthews S, Atkins L, Cassidy C, Curran J, Rainham D. Integrating health geography and behavioral economic principles to strengthen context-specific behavior change interventions. Transl Behav Med 2023:ibad065. [PMID: 37874681 DOI: 10.1093/tbm/ibad065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2023] Open
Abstract
The long-term economic viability of modern health care systems is uncertain, in part due to costs of health care at the end of life and increasing health care utilization associated with an increasing population prevalence of multiple chronic diseases. Control of health care spending and sustaining delivery of health care services will require strategic investments in prevention to reduce the risk of disease and its complications over an individual's life course. Behavior change interventions aimed at reducing a range of harmful and risky health-related behaviors including smoking, physical inactivity, excess alcohol consumption, and excess weight, are one approach that has proven effective at reducing risk and preventing chronic disease. However, large-scale efforts to reduce population-level chronic diseases are challenging and have not been very successful at reducing the burden of chronic diseases. A new approach is required to identify when, where, and how to intervene to disrupt patterns of behavior associated with high-risk factors using context-specific interventions that can be scaled. This paper introduces the need to integrate theoretical and methodological principles of health geography and behavioral economics as opportunities to strengthen behavior change interventions for the prevention of chronic diseases. We discuss how health geography and behavioral economics can be applied to expand existing behavior change frameworks and how behavior change interventions can be strengthened by characterizing contexts of time and activity space.
Collapse
Affiliation(s)
| | - George Kephart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stephen Matthews
- Department of Geography, The Pennsylvania State University, University Park, PA, USA
| | - Lou Atkins
- Center for Behaviour Change, University College London, London, UK
| | - Christine Cassidy
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janet Curran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel Rainham
- School of Health and Human Performance, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
7
|
Ziegler E, Martin-Misener R, Rietkoetter S, Baumann A, Bougeault IL, Kovacevic N, Miller M, Moseley J, Wong FKY, Bryant-Lukosius D. Response and innovations of advanced practice nurses during the COVID-19 pandemic: A scoping review. Int Nurs Rev 2023. [PMID: 37737005 DOI: 10.1111/inr.12884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 08/17/2023] [Indexed: 09/23/2023]
Abstract
AIM Identify and map international evidence regarding innovations led by or involving advanced practice nurses in response to COVID-19. BACKGROUND COVID-19 necessitated unprecedented innovation in the organization and delivery of healthcare. Although advanced practice nurses have played a pivotal role during the pandemic, evidence of their contributions to innovations has not been synthesized. Evidence is needed to inform policies, practices, and research about the optimal use of advanced practice nurses. METHODS A scoping review was conducted and reported using the PRISMA-ScR checklist. Electronic databases were searched for peer-reviewed articles published between January 2020 and December 2021. Papers were included that focused on innovations emerging in response to COVID-19 and involved advanced practice nurses. RESULTS Fifty-one articles were included. Four themes were identified including telehealth, supporting and transforming care, multifaceted approaches, and provider education. Half of the articles used brief and mostly noncomparative approaches to evaluate innovations. CONCLUSION This is the first synthesis of international evidence examining the contributions of advanced practice nurses during the pandemic. Advanced practice nurses provided leadership for the innovation needed to rapidly respond to healthcare needs resulting from COVID-19. Innovations challenged legislative restrictions on practice, enabled implementation of telehealth and new models of care, and promoted evidence-informed and patient-centered care. IMPLICATIONS FOR PRACTICE Advanced practice nurses led, designed, implemented, and evaluated innovations in response to COVID-19. They facilitated the use of telehealth, supported or transformed models of care, and enabled health providers through education, mentorship, and mental health support. IMPLICATION FOR POLICY Advanced practice nurses are a critical resource for innovation and health system improvement. Permanent removal of legislative and regulatory barriers to their full scope of practice is needed.
Collapse
Affiliation(s)
- Erin Ziegler
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | | | | | - Andrea Baumann
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | - Ivy Lynn Bougeault
- School of Sociological and Anthropological Studies, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Minna Miller
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Moseley
- School of Nursing, McMaster University, Hamilton, Ontario, Canada
| | | | | |
Collapse
|
8
|
Lukewich J, Mathews M, Poitras ME, Tranmer J, Martin-Misener R, Bryant-Lukosius D, Aubrey-Bassler K, Klassen T, Curnew D, Bulman D, Leamon T, Ryan D. Primary care nursing competencies in Canadian undergraduate nursing programs: A national cross-sectional survey. Nurse Educ Pract 2023; 71:103738. [PMID: 37549469 DOI: 10.1016/j.nepr.2023.103738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/22/2023] [Accepted: 07/26/2023] [Indexed: 08/09/2023]
Abstract
AIM To assess the extent to which Canadian undergraduate baccalaureate nursing programs have incorporated Canadian competencies for Registered Nurses in primary care into their curricula. BACKGROUND Canadian competencies for Registered Nurses in primary care have several benefits, including their ability to inform primary care education in undergraduate nursing programs and to assist in building a robust primary care nursing workforce. DESIGN We conducted a national cross-sectional survey of undergraduate baccalaureate nursing programs (n = 74). METHODS The survey was conducted between April-May 2022. We used a modified version of the "Community Health Nurses' Continuing Education Needs Questionnaire". Respondents indicated their level of agreement on a 6-point Likert scale with 47 statements about the integration of the competencies in their program (1 = strongly disagree; 6 = strongly agree). RESULTS The response rate was 51.4%. The overall mean across the six competency domains was 4.73 (SD 0.30). The mean scores of each domain ranged from 4.23 (SD 1.27) for Quality Assurance, Evaluation and Research to 5.17 (SD 0.95) for Communication. CONCLUSIONS There are gaps in how these competencies are included in undergraduate education programs and opportunities to strengthen education for this growing workforce in Canada.
Collapse
Affiliation(s)
- Julia Lukewich
- Faculty of Nursing, Memorial University, 300 Prince Phillip Drive, St. John's, NL A1B 3V6, Canada.
| | - Maria Mathews
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western Centre for Public Health and Family Medicine, 1465 Richmond St, London, ON N6G 2M1, Canada
| | - Marie-Eve Poitras
- Département de médecine de famille, Et médecine d'urgence, FMSS-Université de Sherbrooke, Campus Saguenay, Sherbrooke, QC J1H 5N4, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, 92 Barrie Street, Kingston, ON K7L 3N6, Canada
| | - Ruth Martin-Misener
- School of Nursing, Faculty of Health, Dalhousie University, Box 15000, 5869 University Ave, Halifax, NS B3H 4R2, Canada
| | - Denise Bryant-Lukosius
- McMaster University, School of Nursing, Health Sciences Centre, 1280 Main Street West, Hamilton, ON L8S 4K1, Canada
| | - Kris Aubrey-Bassler
- Faculty of Medicine, Memorial University, 300 Prince Phillip Drive, St. John's, NL A1B 3V6, Canada
| | - Treena Klassen
- Palliser Primary Care Network, #104, 140 Maple Avenue SE, Medicine Hat, AB T1A 8C1, Canada
| | - Deanne Curnew
- Faculty of Nursing, Memorial University, 300 Prince Phillip Drive, St. John's, NL A1B 3V6, Canada; Centre for Nursing Studies, 100 Forest Rd, St. John's, NL A1A 1E5, Canada
| | - Donna Bulman
- Faculty of Nursing, Memorial University, 300 Prince Phillip Drive, St. John's, NL A1B 3V6, Canada
| | - Toni Leamon
- Faculty of Nursing, Memorial University, 300 Prince Phillip Drive, St. John's, NL A1B 3V6, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University, 300 Prince Phillip Drive, St. John's, NL A1B 3V6, Canada
| |
Collapse
|
9
|
Martin-Misener R. Leading and Learning in Post-COVID Healthcare Systems. Nurs Leadersh (Tor Ont) 2023; 36:1-3. [PMID: 37917340 DOI: 10.12927/cjnl.2023.27208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
As summer slowly gives way to autumn, I find myself reflecting on the activities of the summer. One memory that stands out is attendance at the 29th International Congress of Nurses held in Montreal in July 2023. Cohosted by the International Council of Nurses and the Canadian Nurses Association, it was an amazing opportunity to meet and learn with nurses from all over the world. It was wonderful to be able to get together in person and feel the palpable energy created by more than 6,000 delegates from 123 countries gathered together for a common purpose. Check out the videos at the following link to see what I mean: https://icncongress2023.org/.
Collapse
Affiliation(s)
- Ruth Martin-Misener
- Director and Professor, School of Nursing, Assistant Dean, Research, Faculty of Health, Dalhousie University, Affiliate Scientist, Nova Scotia Health, Affiliate Scientist, Maritime SPOR Support Unit, Halifax, NS, Co-Director, Canadian Centre for Advanced Practice Nursing Research, Hamilton, ON
| |
Collapse
|
10
|
Dunlop M, Martin-Misener R. Educating nurses for a changing world. JBI Evid Synth 2023; 21:1357-1358. [PMID: 37434375 DOI: 10.11124/jbies-23-00275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Affiliation(s)
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Canadian Center for Advanced Practice Nursing Research (CCAPNR), McMaster University, Hamilton, ON, Canada
- Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
11
|
Marshall EG, Stock D, Buote R, Andrew MK, Breton M, Cossette B, Green ME, Isenor JE, Mathews M, MacKenzie A, Martin-Misener R, McDougall B, Mooney M, Moritz LR. Emergency department utilization and hospital admissions for ambulatory care sensitive conditions among people seeking a primary care provider during the COVID-19 pandemic. CMAJ Open 2023; 11:E527-E536. [PMID: 37339790 DOI: 10.9778/cmajo.20220128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Primary care attachment improves health care access and health outcomes, but many Canadians are unattached, seeking a provider via provincial wait-lists. This Nova Scotia-wide cohort study compares emergency department utilization and hospital admission associated with insufficient primary care management among patients on and off a provincial primary care wait-list, before and during the first waves of the COVID-19 pandemic. METHODS We linked wait-list and Nova Scotian administrative health data to describe people on and off wait-list, by quarter, between Jan. 1, 2017, and Dec. 24, 2020. We quantified emergency department utilization and ambulatory care sensitive condition (ACSC) hospital admission rates by wait-list status from physician claims and hospital admission data. We compared relative differences during the COVID-19 first and second waves with the previous year. RESULTS During the study period, 100 867 people in Nova Scotia (10.1% of the provincial population) were on the wait-list. Those on the wait-list had higher emergency department utilization and ACSC hospital admission. Emergency department utilization was higher overall for individuals aged 65 years and older, and females; lowest during the first 2 COVID-19 waves; and differed more by wait-list status for those younger than 65 years. Emergency department contacts and ACSC hospital admissions decreased during the COVID-19 pandemic relative to the previous year, and for emergency department utilization, this difference was more pronounced for those on the wait-list. INTERPRETATION People in Nova Scotia seeking primary care attachment via the provincial wait-list use hospital-based services more frequently than those not on the wait-list. Although both groups have had lower utilization during COVID-19, existing challenges to primary care access for those actively seeking a provider were further exacerbated during the initial waves of the pandemic. The degree to which forgone services produces downstream health burden remains in question.
Collapse
Affiliation(s)
- Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| | - David Stock
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| | - Richard Buote
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| | - Melissa K Andrew
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| | - Mylaine Breton
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| | - Benoit Cossette
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| | - Michael E Green
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| | - Jennifer E Isenor
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| | - Maria Mathews
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| | - Adrian MacKenzie
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| | - Ruth Martin-Misener
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| | - Beth McDougall
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| | - Melanie Mooney
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| | - Lauren R Moritz
- Department of Family Medicine Primary Care Research Unit (Marshall, Stock, Buote, Moritz), Dalhousie University; Nova Scotia Health (Marshall, MacKenzie, McDougall, Mooney); Department of Community Health and Epidemiology (Marshall, Stock, MacKenzie, McDougall), Dalhousie University; Maritime Strategy for Patient-Oriented Research Support for People and Patient-Oriented Research and Trials (SPOR SUPPORT) Unit (Marshall, Andrew, MacKenzie); Division of Geriatric Medicine (Andrew), Department of Medicine, Dalhousie University, Halifax, NS; Department of Community Health Sciences (Breton, Cossette), Université de Sherbrooke, Sherbrooke, Que.; Departments of Family Medicine and Public Health Sciences (Green), Queen's University; ICES Queen's (Green), Kingston, Ont.; College of Pharmacy (Isenor), Dalhousie University, Halifax, NS; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, Western University, London Ont.; School of Nursing (Martin-Misener), Dalhousie University, Halifax, NS
| |
Collapse
|
12
|
Jokiniemi K, Bryant-Lukosius D, Roussel J, Kilpatrick K, Martin-Misener R, Tranmer J, Rietkoetter S, Carr M, Pond GR. Differentiating Specialized and Advanced Nursing Roles: The Pathway to Role Optimization. Nurs Leadersh (Tor Ont) 2023; 36:57-74. [PMID: 37552518 DOI: 10.12927/cjnl.2023.27123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
Aim We aimed to differentiate the practice patterns of nurses in specialized and advanced roles in a cross-sectional study. Method Canadian nurses completed a self-report questionnaire (June 2017-September 2017). Demographic data and time spent in five domains of advanced practice were compared across three nurse groups. Regression analysis examined factors associated with domain involvement. Results Respondents (n = 1,107) represented all provinces/territories, including 396 specialized nurses (SNs), 211 clinical nurse specialists (CNSs) and 490 nurse practitioners (NPs). Nurses across all groups were the most involved in direct comprehensive care and the least involved in research. NPs were more involved in direct comprehensive care compared to CNSs (p < 0.001) and SNs (p < 0.001). CNSs were more involved than SNs and NPs in support of systems, education, research and professional leadership (p < 0.001). Role type, years as an advanced practice nurse and specialist certification were modest predictors of domain involvement. Conclusion Distinguishing how specialized and advanced nursing roles contribute to healthcare can inform policies to support their optimal utilization in healthcare systems.
Collapse
Affiliation(s)
- Krista Jokiniemi
- University Lecturer, Department of Nursing Science, University of Eastern Finland, Kuopio, Finland, Canadian Centre for Advanced Practice Nursing Research, School of Nursing, McMaster University, Hamilton, ON
| | - Denise Bryant-Lukosius
- Professor, Alba DiCenso Chair in Advanced Practice Nurse and Co-Director, Canadian Centre for Advanced Practice Nursing Research, School of Nursing, McMaster University, Hamilton, ON
| | - Josette Roussel
- Deputy Chair, International Council of Nurses Nurse Practitioner/Advanced Practice Nurse Network, Director, Clinical Services, Hôpital Montfort, Ottawa, ON
| | - Kelley Kilpatrick
- Associate Professor and Susan E. French Chair in Nursing, Research and Innovative Practice, Ingram School of Nursing, McGill University, Montreal, QC, Associate Faculty, Canadian Centre for Advanced Practice Nursing Research, School of Nursing, McMaster University, Hamilton, ON
| | - Ruth Martin-Misener
- Director and Professor, School of Nursing, Assistant Dean, Research, Faculty of Health, Dalhousie University, Halifax, NS, Co-Director, Canadian Centre for Advanced Practice, Nursing Research, McMaster University, Hamilton, ON
| | - Joan Tranmer
- Professor, School of Nursing, Queen's University, Kingston, ON, Associate Faculty, Canadian Centre for Advanced Practice Nursing Research, School of Nursing, McMaster University, Hamilton, ON
| | - Sarah Rietkoetter
- Research Coordinator, Canadian Centre for Advanced Practice Nursing Research, School of Nursing, McMaster University, Hamilton, ON
| | - Marcia Carr
- Clinical Nurse Specialist and Nurse Continence Advisor, Fraser Health, Adjunct Professor, School of Nursing University of British Columbia Vancouver, ON
| | - Gregory R Pond
- Associate Professor, Department of Oncology, McMaster University, Hamilton, ON
| |
Collapse
|
13
|
Martin-Misener R. Rising Up to Embrace Multi-Faceted and Dynamic Retention Challenges. Nurs Leadersh (Tor Ont) 2023; 36:1-3. [PMID: 37552513 DOI: 10.12927/cjnl.2023.27128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
This issue is the last of the three-part series focused on the critically important challenge of nurse retention. The articles that we have selected span a range of topics from the personal to political with implications for readers in leadership positions across nursing practice, policy and education. What we are learning is that retention is as multi-faceted and dynamic as the times we are living in. There is no one-size-fits-all solution, no Holy Grail - if we could only find it - that will turn the tide of exodus from the profession. Retention is fundamentally about valuing nurses and demonstrating that worth in concrete tangible ways that are meaningful to nurses as a group and as individuals. It is a tall order that can only be achieved with leadership that embraces the unprecedented challenges we are living through as windows of opportunity to lean into and make transformative changes that will engage nurses and benefit local and global health.
Collapse
Affiliation(s)
- Ruth Martin-Misener
- Director and Professor, School of Nursing, Assistant Dean, Research, Faculty of Health, Dalhousie University, Affiliate Scientist, Nova Scotia Health, Affiliate Scientist, Maritime SPOR Support Unit, Halifax, NS, Co-Director, Canadian Centre for Advanced Practice Nursing Research, Hamilton, ON
| |
Collapse
|
14
|
Hughes Née Richardson B, Benoit B, Rutledge K, Dol J, Martin-Misener R, Latimer M, Smit M, McGrath P, Campbell-Yeo M. Impact of parent-targeted eHealth educational interventions on infant procedural pain management: a systematic review. JBI Evid Synth 2023; 21:669-712. [PMID: 36591975 DOI: 10.11124/jbies-21-00435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The objective of this review was to determine whether electronic health (eHealth) educational interventions about infant procedural pain and pain management impact parental outcomes (eg, mental health, knowledge uptake), eHealth outcomes (eg, acceptance, use), and pain management outcomes (eg, parental involvement, infant pain response). INTRODUCTION Pain in infants is a common concern for parents. Routine postpartum care for infants in early life requires them to endure painful procedures, such as immunizations, yet infants often receive little to no pain management. Parents are an essential component of effective pain management, although they may not be aware of the roles they play. Despite the increased number of eHealth resources available to educate parents about infant pain management, their impact has yet to be synthesized. INCLUSION CRITERIA This review considered studies that evaluated eHealth educational interventions targeted at parents during pregnancy and up to 1 year postpartum. Interventions included, but were not limited to, mobile applications, web-based applications, websites, videos, interactive training, hands-on direct simulation, short message service (SMS), and desktop applications. Primary outcomes included parental outcomes (eg, stress or anxiety, self-efficacy, knowledge, attitudes), eHealth outcomes (eg, acceptance, use), and pain management outcomes (eg, parental involvement, infant pain response). Experimental, quasi-experimental, and observational study designs were included. METHODS MEDLINE, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and SciELO were searched for studies published in English up to June 14, 2021. Citation lists of relevant reviews and included studies were also searched for additional peer-reviewed articles. Two independent reviewers conducted critical appraisal using standardized tools from JBI, and data extraction, using a data extraction form designed by the authors. Statistical pooling of quantitative data was not possible due to heterogeneity; thus, the findings were reported narratively. RESULTS A total of 4163 unique studies were screened, with 11 studies ultimately included for synthesis. Five articles were randomized controlled trials, 5 articles were analytical cross-sectional studies, and 1 article was quasi-experimental. Studies reported on 4 unique eHealth educational interventions, all of which used video format and primarily targeted the postnatal period. The findings for all primary outcomes were mixed but suggested either improvements in outcomes or no impact. The certainty of evidence was determined as low or very low across primary outcomes for reasons related to imprecision, risk of bias, and indirectness. CONCLUSIONS Although heterogeneity of findings limited quantitative synthesis of data, this review suggests that short and engaging educational videos have the potential to positively impact parents' knowledge, confidence, and desire to be involved in procedural pain management for their children. Most of the interventions presented in this review describe evidence-based information about procedural pain management strategies that are known to be effective for infant populations. Thus, it is reasonable to assume that infant pain response should be lower when parents appropriately apply the strategies. However, the findings of this review were not able to confirm this assumption. More research is needed to evaluate the impact of parent-targeted pain management education on infant pain response. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020151569.
Collapse
Affiliation(s)
- Brianna Hughes Née Richardson
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- Centre for Transformative Nursing and Health Research, Halifax, NS, Canada
| | - Britney Benoit
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- Centre for Transformative Nursing and Health Research, Halifax, NS, Canada
- Elizabeth and Thomas Rankin School of Nursing, St. Francis Xavier University, NS, Antigonish, Canada
| | - Kallen Rutledge
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
| | - Justine Dol
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- The Mothering Transitions Research Lab, St. Michael's Hospital, Toronto, ON, Canada
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- Centre for Transformative Nursing and Health Research, Halifax, NS, Canada
| | - Margot Latimer
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- Centre for Transformative Nursing and Health Research, Halifax, NS, Canada
| | - Michael Smit
- School of Information Management, Dalhousie University, Halifax, NS, Canada
| | - Patrick McGrath
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- Centre for Transformative Nursing and Health Research, Halifax, NS, Canada
- Division of Neonatal Perinatal Medicine, Department of Pediatrics, Faculty of Medicine, Dalhousie University and IWK Health Centre, Halifax, NS, Canada
| |
Collapse
|
15
|
Splane J, Horvath S, Ziegler E, Savard I, Carter N, Kilpatrick K, Bryant-Lukosius D, Martin-Misener R. Retention of Canadian Advanced Practice Nurses: What Will It Take? Nurs Leadersh (Tor Ont) 2023; 36:16-32. [PMID: 37552515 DOI: 10.12927/cjnl.2023.27126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
The retention of Canada's advanced practice nurses (APNs), including clinical nurse specialists and nurse practitioners, is a national health human resources issue. APNs are essential within the Canadian healthcare workforce for meeting patient and population health needs, often in underserved communities. A shortage of APNs will exacerbate barriers to access to care for patients across sectors, including primary, acute, long-term and transitional care settings. This paper provides highlights from literature reporting on the state of APN human resources in Canada, including influential barriers and facilitators, and recommendations for retaining these important leaders in the healthcare workforce.
Collapse
Affiliation(s)
- Jennifer Splane
- Primary Healthcare Nurse Practitioner, Dalhousie University, Halifax, NS, Trainee, Canadian Centre for Advanced Practice Nursing Research, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Samantha Horvath
- McMaster University, Trainee, Canadian Centre for Advanced Practice Nursing Research, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Erin Ziegler
- Primary Healthcare Nurse Practitioner and Assistant Professor, Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, ON, Faculty, Canadian Centre for Advanced Practice Nursing Research, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Isabelle Savard
- Primary Healthcare Nurse Practitioner, McGill University, Montréal, QC, Trainee, Canadian Centre for Advanced Practice Nursing Research, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Nancy Carter
- Associate Professor, School of Nursing McMaster University, Faculty, Canadian Centre for Advanced Practice Nursing Research, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Kelley Kilpatrick
- Associate Professor and Susan E. French Chair in Nursing Research and Innovative Practice, Ingram School of Nursing, McGill University, Montréal, QC, Faculty, Canadian Centre for Advanced Practice Nursing Research, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Denise Bryant-Lukosius
- Professor and Alba DiCenso Chair in Advanced Practice Nursing, School of Nursing and Department of Oncology, McMaster University, Co-Director, Canadian Centre for Advanced Practice Nursing Research, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - Ruth Martin-Misener
- Director and Professor, School of Nursing, Assistant Dean, Research, Faculty of Health, Dalhousie University, Halifax, NS, Co-Director, Canadian Centre for Advanced Practice Nursing Research, McMaster University, Hamilton, ON
| |
Collapse
|
16
|
Munro S, Di Meglio G, Williams A, Barbic SP, Begun S, Black A, Carson A, Fortin M, Jacob K, Khan Z, Martin-Misener R, Meherali S, Paller V, Seiyad H, Vallée CA, Wahl K, Norman WV. Can youth-engaged research facilitate equitable access to contraception in Canada? The qualitative study protocol for the Ask Us project. BMJ Open 2023; 13:e070904. [PMID: 36863736 PMCID: PMC9990688 DOI: 10.1136/bmjopen-2022-070904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
INTRODUCTION There is little to no evidence in Canada on the barriers that youth face when accessing contraception. We seek to identify the contraception access, experiences, beliefs, attitudes, knowledge, and needs of youth in Canada, from the perspectives of youth and youth service providers. METHODS AND ANALYSIS This prospective, mixed-methods, integrated knowledge mobilisation study, the Ask Us project, will involve a national sample of youth, healthcare and social service providers, and policy makers recruited via a novel relational mapping and outreach approach led by youth. Phase I will centre the voices of youth and their service providers through in-depth one-on-one interviews. We will explore the factors influencing youth access to contraception, theoretically guided by Levesque's Access to Care framework. Phase II will focus on the cocreation and evaluation of knowledge translation products (youth stories) with youth, service providers, and policy makers. ETHICS AND DISSEMINATION Ethical approval was received from the University of British Columbia's Research Ethics Board (H21-01091). Full open-access publication of the work will be sought in an international peer-reviewed journal. Findings will be disseminated to youth and service providers through social media, newsletters, and communities of practice, and to policy makers through invited evidence briefs and face-to-face presentations.
Collapse
Affiliation(s)
- Sarah Munro
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Giuseppina Di Meglio
- Montreal Children's Hospital, McGill University Health Centre, Montreal, Québec, Canada
| | - Aleyah Williams
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Skye Pamela Barbic
- Occupational Science and Occupational Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Amanda Black
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Andrea Carson
- Research, Innovation, and Discovery, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Michelle Fortin
- Options for Sexual Health, Vancouver, British Columbia, Canada
| | - Kaiya Jacob
- Youth Partner, Vancouver, British Columbia, Canada
| | - Zeba Khan
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Salima Meherali
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Victoria Paller
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Carol-Anne Vallée
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Wahl
- Department of Obstetrics and Gynaecology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V Norman
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
- London School of Hygiene and Tropical Medicine Faculty of Public Health and Policy, London, UK
| |
Collapse
|
17
|
Embrett M, Packer TL, Fitzgerald E, Jaswal SK, Lehman MJ, Brown M, Burge F, Christian E, Isenor JE, Marshall EG, Martin-Misener R, Sampalli T, Zed J, Leigh JP. The impact of the COVID-19 pandemic on primary care physicians and nurses in Nova Scotia: a qualitative exploratory study. CMAJ Open 2023; 11:E274-E281. [PMID: 36944428 PMCID: PMC10035666 DOI: 10.9778/cmajo.20210315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has brought immense disruption worldwide, dramatically altering the ways we live, work and learn on a day-to-day basis; however, few studies have investigated this from the perspective of primary care providers. In this study, we sought to explore the experiences of primary care providers in the province of Nova Scotia, with the intention of understanding the impact of the COVID-19 pandemic on primary care providers' ability to provide care, their information pathways, and the personal and professional impact of the pandemic. METHODS We conducted an exploratory qualitative research study involving semistructured interviews conducted via Zoom videoconferencing or telephone with primary care providers (physicians, nurse practitioners and family practice nurses) who self-identified as working in primary health care in Nova Scotia from June 2020 to April 2021. We performed a thematic analysis involving coding and classifying data according to themes. Emergent themes were then interpreted by seeking commonalties, divergence, relationships and overarching patterns in the data. RESULTS Twenty-four primary care providers were interviewed. Subsequent analysis identified 4 interrelated themes within the data: disruption to work-life balance, disruptions to "non-COVID-19" patient care, impact of provincial and centralized policies, and filtering and processing an influx of information. INTERPRETATION Our findings showed that managing a crisis of this magnitude requires coordination and new ways of working, balancing professional and personal life, and adapting to already implemented changes (i.e., virtual care). A specific primary care pandemic response plan is essential to mitigate the impact of future health care crises.
Collapse
Affiliation(s)
- Mark Embrett
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Tanya L Packer
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Emily Fitzgerald
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Sabrena K Jaswal
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Michelle J Lehman
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Marion Brown
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Fred Burge
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Erin Christian
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Jennifer E Isenor
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Emily Gard Marshall
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Ruth Martin-Misener
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Tara Sampalli
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Joanna Zed
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| | - Jeanna Parsons Leigh
- Research, Innovation & Discovery (Embrett), Nova Scotia Health Authority, Queensland, NS; Schools of Health Administration (Packer, Fitzgerald, Jaswal, Lehman), Occupational Therapy (Packer, Jaswal, Lehman) and Social Work (Brown), and Department of Family Medicine (Burge, Marshall), Dalhousie University; Nova Scotia Health Authority (Christian, Sampalli); College of Pharmacy (Isenor), Faculty of Health, and Department of Community Health and Epidemiology (Isenor), Faculty of Medicine, Dalhousie University; Canadian Center for Vaccinology (Isenor); Faculty of Health (Martin-Misener, Zed), Dalhousie University; Faculty of Health Administration (Parsons Leigh), School of Health Administration, Dalhousie University, Halifax, NS
| |
Collapse
|
18
|
McGilton KS, Haslam-Larmer L, Wills A, Krassikova A, Babineau J, Robert B, Heer C, McAiney C, Dobell G, Bethell J, Kay K, Keatings M, Kaasalainen S, Feldman S, Sidani S, Martin-Misener R. Nurse practitioner/physician collaborative models of care: a scoping review protocol. BMC Geriatr 2023; 23:98. [PMID: 36797669 PMCID: PMC9934505 DOI: 10.1186/s12877-023-03798-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 02/03/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Before the COVID-19 pandemic, many long-term care (LTC) homes experienced difficulties in providing residents with access to primary care, typically delivered by community-based family physicians or nurse practitioners (NPs). During the pandemic, legislative changes in Ontario, Canada enabled NPs to act in the role of Medical Directors thereby empowering NPs to work to their full scope of practice. Emerging from this new context, it remains unclear how NPs and physicians will best work together as primary care providers. NP/physician collaborative models appear key to achieving optimal resident outcomes. This scoping review aims to map available evidence on existing collaborative models of care between NPs and physicians within LTC homes. METHODS The review will be guided by the research question, "What are the structures, processes and outcomes of collaborative models of care involving NPs and Physicians in LTC homes?" This scoping review will be conducted according to the methods framework for scoping reviews outlined by Arksey and O'Malley and refined by Levac et al., Colquhoun et al., and Daudt et al., as well as the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Statement. Electronic databases (MEDLINE, Embase + Embase Classic, APA PsycInfo, Cochrane Central Register of Controlled Trials, AMED, CINAHL, Ageline, and Scopus), grey literature, and reference lists of included articles will be searched. English language studies that describe NP and physician collaborative models within the LTC setting will be included. DISCUSSION This scoping review will consolidate what is known about existing NP/physician collaborative models of care in LTC homes. Results will be used to inform the development of a collaborative practice framework for long-term care clinical leadership.
Collapse
Affiliation(s)
- Katherine S. McGilton
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8 Canada
| | - Lynn Haslam-Larmer
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8 Canada
| | - Aria Wills
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, 155 College Street, Toronto, ON M5T 1P8 Canada
| | - Alexandra Krassikova
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada
| | - Jessica Babineau
- grid.231844.80000 0004 0474 0428Library & Information Services, University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.231844.80000 0004 0474 0428The Institute for Education Research, University Health Network, Toronto, Canada
| | - Ben Robert
- Perley Health, 1750 Russell Road, Ottawa, ON K1G 5Z6 Canada ,grid.28046.380000 0001 2182 2255Faculty of Medicine, University of Ottawa, 451 Smyth Road #2044, Ottawa, ON K1H 8M5 Canada
| | - Carrie Heer
- Brant Community Healthcare System, 200 Terrace Hill Street, Brantford, ON N3R 1G9 Canada ,grid.418792.10000 0000 9064 3333Bruyère Research Institute, 85 Primrose Ave, Ottawa, ON K1R 6M1 Canada
| | - Carrie McAiney
- grid.498777.2Schlegel-UW Research Institute for Aging, Waterloo, ON N2J 0E2 Canada ,grid.46078.3d0000 0000 8644 1405School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1 Canada
| | - Gail Dobell
- Ontario Health, 130 Bloor Street West, Toronto, ON M5S 1N5 Canada
| | - Jennifer Bethell
- grid.231844.80000 0004 0474 0428KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 550 University Avenue, Toronto, ON M5G 2A2 Canada ,grid.17063.330000 0001 2157 2938Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College Street, Toronto, ON M5T 3M7 Canada
| | - Kelly Kay
- Provincial Geriatrics Leadership Ontario, Toronto, Canada ,grid.17063.330000 0001 2157 2938Ontario Institute for Studies in Education and the Institute for Life Course and Aging, University of Toronto, 246 Bloor Street West, Toronto, ON M5S 1V4 Canada
| | - Margaret Keatings
- grid.42327.300000 0004 0473 9646The Hospital for Sick Children, 555 University Ave, Toronto, ON M5G 1X8 Canada
| | - Sharon Kaasalainen
- grid.25073.330000 0004 1936 8227School of Nursing, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Sid Feldman
- Baycrest Health Sciences, 3560 Bathurst Street, Toronto, ON M6A2E1 Canada ,grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, Temerty Medicine, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8 Canada
| | - Souraya Sidani
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, 250 Victoria Street, Toronto, ON M5B 2K9 Canada
| | - Ruth Martin-Misener
- grid.55602.340000 0004 1936 8200School of Nursing, Dalhousie University, Room G26, Forrest Bldg., 5869 University Avenue, Halifax, NS B3H 4R2 Canada
| |
Collapse
|
19
|
Carson A, Cameron ES, Paynter M, Norman WV, Munro S, Martin-Misener R. Nurse practitioners on 'the leading edge' of medication abortion care: A feminist qualitative approach. J Adv Nurs 2023; 79:686-697. [PMID: 36369652 PMCID: PMC10100085 DOI: 10.1111/jan.15487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/09/2022] [Accepted: 10/19/2022] [Indexed: 11/15/2022]
Abstract
AIMS To explore nurse practitioners' experiences of medication abortion implementation in Canada and to identify ways to further support the implementation of medication abortion by nurse practitioners in Canada. DESIGN A qualitative approach informed by feminist theory and integrated knowledge translation. METHODS Qualitative interviews with stakeholders and nurse practitioners between January 2020 and May 2021. Data were analysed using critical feminist theory. RESULTS Participants included 20 stakeholders, 16 nurse practitioner abortion providers, and seven nurse practitioners who did not provide abortions. We found that nurse practitioners conduct educational, communication and networking activities in the implementation of medication abortion in their communities. Nurse practitioners navigated resistance to abortion care in the health system from employers, colleagues and funders. Participants valued making abortion care more accessible to their patients and indicated that normalizing medication abortion in primary care was important to them. CONCLUSION When trained in abortion care and supported by employers, nurse practitioners are leaders of abortion care in their communities and want to provide accessible, inclusive services to their patients. We recommend nursing curricula integrate abortion services in education, and that policymakers and health administrators partner with nurses, physicians, midwives, social workers and pharmacists, for comprehensive provincial/territorial sexual and reproductive health strategies for primary care. IMPACT The findings from this study may inform future policy, health administration and curriculum decisions related to reproductive health, and raise awareness about the crucial role of nurse practitioners in abortion care and contributions to reproductive health equity. PATIENT OR PUBLIC CONTRIBUTION This study focused on provider experiences. In-kind support was provided by Action Canada for Sexual Health & Rights, an organization that provides direct support and resources to the public and is committed to advocating on behalf of patients and the public seeking sexual and reproductive health services.
Collapse
Affiliation(s)
- Andrea Carson
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Martha Paynter
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Wendy V Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Sarah Munro
- Department of Obstetrics & Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | | |
Collapse
|
20
|
Martin-Misener R. Nurse Retention: Multiple Strategies to Change Course in a Sea of Challenges. Nurs Leadersh (Tor Ont) 2023; 35:1-3. [PMID: 37216292 DOI: 10.12927/cjnl.2023.27078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Like the Canadian season of spring, this issue brings fresh ideas and insights about the layers of complexity and potential solutions to the significant challenges associated with the retention of the nursing workforce. As these challenges intensify, nursing leaders - formal and informal - are rallying to redefine the boundaries of what can be done. We are innovators who are transforming this crisis into an opportunity to shift our thinking and do things differently. We are optimizing our roles and expanding our deployment to areas of the system that have previously underutilized nurses and nurse practitioners. The value we bring to the health system is indisputable.
Collapse
Affiliation(s)
- Ruth Martin-Misener
- Director and Professor, School of Nursing Assistant Dean, Research, Faculty of Health, Dalhousie University, Co-Director, Canadian Centre for Advanced Practice Nursing Research Affiliate Scientist, Nova Scotia Health, Affiliate Scientist, Maritime SPOR Support Unit, Halifax, NS
| |
Collapse
|
21
|
Carson A, Stirling-Cameron E, Paynter M, Munro S, Norman WV, Kilpatrick K, Begun S, Martin-Misener R. Barriers and enablers to nurse practitioner implementation of medication abortion in Canada: A qualitative study. PLoS One 2023; 18:e0280757. [PMID: 36701296 PMCID: PMC9879445 DOI: 10.1371/journal.pone.0280757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 01/06/2023] [Indexed: 01/27/2023] Open
Abstract
In this study we explored nurse practitioner-provided medication abortion in Canada and identified barriers and enablers to uptake and implementation. Between 2020-2021, we conducted 43 semi-structured interviews with 20 healthcare stakeholders and 23 nurse practitioners who both provided and did not provide medication abortion. Data were analyzed using interpretive description. We identified five overarching themes: 1) Access and use of ultrasound for gestational dating; 2) Advertising and anonymity of services; 3) Abortion as specialized or primary care; 4) Location and proximity to services; and 5) Education, mentorship, and peer support. Under certain conditions, ultrasound is not required for medication abortion, supporting nurse practitioner provision in the absence of access to this technology. Nurse practitioners felt a conflict between wanting to advertise their abortion services while also protecting their anonymity and that of their patients. Some nurse practitioners perceived medication abortion to be a low-resource, easy-to-provide service, while some not providing medication abortion continued to refer patients to specialized clinics. Some participants in rural areas felt unable to provide this service because they were too far from emergency services in the event of complications. Most nurse practitioners did not have any training in abortion care during their education and desired the support of a mentor experienced in abortion provision. Addressing factors that influence nurse practitioner provision of medication abortion will help to broaden access. Nurse practitioners are well-suited to provide medication abortion care but face multiple ongoing barriers to provision. We recommend the integration of medication abortion training into nurse practitioner education. Further, widespread communication from nursing organizations could inform nurse practitioners that medication abortion is within their scope of practice and facilitate public outreach campaigns to inform the public that this service exists and can be provided by nurse practitioners.
Collapse
Affiliation(s)
- Andrea Carson
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- * E-mail:
| | | | - Martha Paynter
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sarah Munro
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Wendy V. Norman
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Kelley Kilpatrick
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | | |
Collapse
|
22
|
Jefferies K, States C, MacLennan V, Helwig M, Gahagan J, Bernard WT, Macdonald M, Murphy GT, Martin-Misener R. Black nurses in the nursing profession in Canada: a scoping review. Int J Equity Health 2022; 21:102. [PMID: 35871077 PMCID: PMC9308111 DOI: 10.1186/s12939-022-01673-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
With migration occurring over a series of centuries, dating back to the 1600’s, the circumstance regarding Black people in Canada is a complex account. A plethora of social issues and the failure to adequately acknowledge and reconcile historical issues, has resulted in health inequity, disparities and knowledge gaps, related to the Black population in Canada. In nursing, historical records indicate a legacy of discrimination that continues to impact Black nurses. The profession has begun reckoning with anti-Black racism and the residual effects. This scoping review sought to chart the existing evidence on Black nurses in the nursing profession in Canada.
Methods
JBI methodology was used to search peer-reviewed evidence and unpublished gray literature. Sources were considered for inclusion based on criteria outlined in an a priori protocol focusing on: 1) Canada 2) Black nurses and 3) nursing practice. No restrictions were placed on date of publication and language was limited to English and French. All screening and extractions were completed by two independent reviewers.
Results
The database search yielded 688 records. After removing duplicates, 600 titles and abstracts were screened for eligibility and 127 advanced to full-text screening. Eighty-two full-text articles were excluded, for a total of 44 sources meeting the inclusion criteria. Seven sources were identified through gray literature search. Subsequently, 31 sources underwent data extraction. Of the 31 sources, 18 are research (n = 18), six are commentaries (n = 6); one report (n = 1) and six are classified as announcements, memoranda or policy statements (n = 6). The review findings are categorized into five conceptual categories: racism (n = 12); historical situatedness (n = 2); leadership and career progression (n = 7); immigration (n = 4); and diversity in the workforce (n = 4).
Conclusions
This review reveals the interconnectedness of the five conceptual categories. Racism was a prominent issue woven throughout the majority of the sources. Additionally, this review captures how racism is exacerbated by intersectional factors such as gender, class and nationality. The findings herein offer insight regarding anti-Black racism and discrimination in nursing as well as suggestions for future research including the use of diverse methodologies in different jurisdictions across the country. Lastly, the implications extend to the nursing workforce in relation to enhancing diversity and addressing the ongoing nursing shortage.
Collapse
|
23
|
Macdonald M, Weeks L, Moody E, Martin-Misener R, Iduye D, States C, Ignaczak M, Delahunty-Pike A, Caruso J, Simm J, Rothfus M. Experiences of residents of long-term-care homes with the use of socially assistive technologies and the effectiveness of these technologies: a mixed methods systematic review protocol. JBI Evid Synth 2022; 20:2751-2759. [PMID: 36081362 DOI: 10.11124/jbies-21-00409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE The objective of this review is to explore the experiences of residents of long-term-care homes using socially assistive technologies and the effectiveness of these technologies in relation to depression, loneliness, and social interaction. INTRODUCTION Research related to the experiences of residents of long-term-care homes with socially assistive technologies, and their effectiveness, is limited. This population of older adults is projected to steeply increase in the future, as will the need for services, such as long-term care. Older adults (≥65 years) in long-term care are at increased risk of depression, loneliness, and social isolation. Therefore, there is a need to explore the experiences of long-term-care residents with the use of socially assistive technologies and to determine the effectiveness of these technologies in relation to depression, loneliness, and social interaction. INCLUSION CRITERIA This review will include studies about the experiences of older adults in long-term care using socially assistive technologies, and the effectiveness of these technologies. Older adults are defined as people 65 years of age and above. We will consider human-to-human socially assistive technologies, such as computers, smart phones, tablets, and associated applications. We will review quantitative, qualitative, and mixed methods studies. METHODS A JBI mixed methods convergent segregated approach will be used. Select databases and gray literature will be searched for published and unpublished studies, with no date or language limits. Titles, abstracts, and full texts of included studies will be screened by at least two reviewers, and undergo quality appraisal, data extraction, and synthesis of quantitative and qualitative data followed by integration of the two types of evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42021279015.
Collapse
Affiliation(s)
- Marilyn Macdonald
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Lori Weeks
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Elaine Moody
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Ruth Martin-Misener
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Damilola Iduye
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Chelsa States
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Melissa Ignaczak
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Dalhousie University, Halifax, NS, Canada.,Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada
| | - Alannah Delahunty-Pike
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Julie Caruso
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Janet Simm
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health, Halifax, NS, Canada
| | - Melissa Rothfus
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, School of Nursing, Dalhousie University, Halifax, NS, Canada.,Northwood Corporate, Dartmouth, NS, Canada
| |
Collapse
|
24
|
Jefferies K, Martin-Misener R, Murphy GT, Gahagan J, Bernard WT. African Nova Scotian nurses' perceptions and experiences of leadership: a qualitative study informed by Black feminist theory. CMAJ 2022; 194:E1437-E1447. [PMID: 36316018 PMCID: PMC9828880 DOI: 10.1503/cmaj.220019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People of African Nova Scotian (ANS) ancestry are a culturally distinct group who experience numerous socioeconomic inequities and health disparities, secondary to structural and social determinants of health. Understanding the experiences of ANS health practitioners is important in addressing anti-Black racism in health care. We sought to critically examine the leadership experiences of ANS nurses in health care practice. METHODS We used Black feminist theory to guide this qualitative study. We conducted 1-on-1 semistructured telephone interviews with ANS nurses and analyzed interview transcripts using Critical Discourse Analysis. RESULTS We interviewed 18 nurses of ANS ancestry. We conceptualized study findings in 3 overarching areas: People of ANS ancestry as a distinct people, institution of care, and leadership philosophy and practice. Each area, and its corresponding themes and subthemes, illustrated an emergent understanding of factors that influence leadership among ANS nurses, such as socialization, early exposure to care and diversity in health care. Participants perceived and practised leadership in a manner that transcended formal titles or designations. INTERPRETATION African Nova Scotian ancestry is implicated in the perception and practice of leadership among ANS nurses, who considered leadership to be a fundamental component of nursing practice that was grounded in community-oriented care. This study provides new insights that could inform recruitment, retention and representation of ANS people in nursing and other health professions.
Collapse
Affiliation(s)
- Keisha Jefferies
- School of Nursing (Jefferies, Martin-Misener, Tomblin Murphy), Faculty of Health, Dalhousie University; Research and Innovation (Tomblin Murphy), Nova Scotia Health; Mount Saint Vincent University (Gahagan); School of Social Work (Thomas Bernard), Faculty of Health, Dalhousie University, Halifax, NS
| | - Ruth Martin-Misener
- School of Nursing (Jefferies, Martin-Misener, Tomblin Murphy), Faculty of Health, Dalhousie University; Research and Innovation (Tomblin Murphy), Nova Scotia Health; Mount Saint Vincent University (Gahagan); School of Social Work (Thomas Bernard), Faculty of Health, Dalhousie University, Halifax, NS
| | - Gail Tomblin Murphy
- School of Nursing (Jefferies, Martin-Misener, Tomblin Murphy), Faculty of Health, Dalhousie University; Research and Innovation (Tomblin Murphy), Nova Scotia Health; Mount Saint Vincent University (Gahagan); School of Social Work (Thomas Bernard), Faculty of Health, Dalhousie University, Halifax, NS
| | - Jacqueline Gahagan
- School of Nursing (Jefferies, Martin-Misener, Tomblin Murphy), Faculty of Health, Dalhousie University; Research and Innovation (Tomblin Murphy), Nova Scotia Health; Mount Saint Vincent University (Gahagan); School of Social Work (Thomas Bernard), Faculty of Health, Dalhousie University, Halifax, NS
| | - Wanda Thomas Bernard
- School of Nursing (Jefferies, Martin-Misener, Tomblin Murphy), Faculty of Health, Dalhousie University; Research and Innovation (Tomblin Murphy), Nova Scotia Health; Mount Saint Vincent University (Gahagan); School of Social Work (Thomas Bernard), Faculty of Health, Dalhousie University, Halifax, NS
| |
Collapse
|
25
|
Moody E, Martin-Misener R, Baxter L, Boulos L, Burge F, Christian E, Condran B, MacKenzie A, Michael E, Packer T, Peacock K, Sampalli T, Warner G. Patient perspectives on primary care for multimorbidity: An integrative review. Health Expect 2022; 25:2614-2627. [PMID: 36073315 DOI: 10.1111/hex.13568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Improving healthcare for people with multiple chronic or ongoing conditions is receiving increased attention, particularly due to the growing number of people experiencing multimorbidity (MM) and concerns about the sustainability of the healthcare system. Primary care has been promoted as an important resource for supporting people with MM to live well with their conditions and to prevent unnecessary use of health care services. However, traditional primary care has been criticized for not centring the needs and preferences of people with MM themselves. Our aim was to conduct a review that centred on the perspective of people with MM in multiple ways, including having patient partners co-lead the design, conduct and reporting of findings, and focusing on literature that reported the perspective of people with MM, irrespective of it being experimental or nonexperimental. METHODS We searched for published literature in CINAHL with Full Text (EBSCOhost) and MEDLINE All (Ovid). Findings from experimental and nonexperimental studies were integrated into collaboration with patient partners. RESULTS Twenty-nine articles were included in the review. Findings are described in five categories: (1) Care that is tailored to my unique situation; (2) meaningful inclusion in the team; (3) a healthcare team that is ready and able to address my complex needs; (4) supportive relationships and (5) access when and where I need it. CONCLUSION This review supports a reorientation of primary care systems to better reflect the experiences and perspectives of people with MM. This can be accomplished by involving patient partners in the design and evaluation of primary care services and incentivizing collaboration among health and social supports and services for people with MM. PATIENT OR PUBLIC CONTRIBUTION Patient partners were involved in the design and conduct of this review, and in the preparation of the manuscript. Their involvement is further elucidated in the manuscript text.
Collapse
Affiliation(s)
- Elaine Moody
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Larry Baxter
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Brian Condran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Center for Vaccinology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | | | - Tanya Packer
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada.,School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kylie Peacock
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Center for Vaccinology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| |
Collapse
|
26
|
Martin-Misener R. Leadership for a Reimagined, Thriving and Sustainable Nursing Workforce. Nurs Leadersh (Tor Ont) 2022; 35:1-4. [PMID: 36735385 DOI: 10.12927/cjnl.2022.27007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Almost ten years ago, the World Health Organization published the document A Universal Truth: No Health Without a Workforce (Campbell et al. 2013). At that time, the situation across the world was grim, with millions of people without healthcare and universal health goals a long way from attainment. Today, enabled by a global pandemic, the consequences of climate change and economic recession, that grimness has morphed into a worldwide health human resources and healthcare crisis of unparalleled magnitude.
Collapse
Affiliation(s)
- Ruth Martin-Misener
- Director and Professor, School of Nursing, Assistant Dean, Research, Faculty of Health, Dalhousie University, Co-Director, Canadian Centre for Advanced Practice Nursing Research, Affiliate Scientist, Nova Scotia Health, Affiliate Scientist, Maritime SPOR Support Unit, Halifax, NS
| |
Collapse
|
27
|
Bai I, Isenor JE, Reeve E, Whelan AM, Martin-Misener R, Burgess S, Kennie-Kaulbach N. Corrigendum to "Using the behavior change wheel to link published deprescribing strategies to identified local primary healthcare needs" [Res. Soc. Adm. Pharm. (2022) 3350-3357]. Res Social Adm Pharm 2022; 18:4016. [PMID: 36031528 DOI: 10.1016/j.sapharm.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Isaac Bai
- Faculty of Medicine, Dalhousie University, 5849 University Ave, Halifax, NS, Canada
| | - Jennifer E Isenor
- College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada.
| | - Emily Reeve
- College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada; Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia; Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Anne Marie Whelan
- College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, NS, Canada
| | - Sarah Burgess
- College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada; Pharmacy Department, Nova Scotia Health Authority, Halifax, NS, Canada
| | | |
Collapse
|
28
|
Paynter M, Heggie C, Low C, McKibbon S, Martin-Misener R. Community-based models of health care for women, trans and nonbinary people released from prisons: An international scoping review with implications for Canada. J Clin Nurs 2022. [PMID: 35941807 DOI: 10.1111/jocn.16464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/13/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Abstract
AIMS AND OBJECTIVES To illustrate the scope of different types of transitional, community-based health interventions for formerly incarcerated women, trans and nonbinary people, the eligibility criteria for these interventions, and associated health outcomes. BACKGROUND Meeting the health needs of formerly incarcerated people in community, rather than through the criminal justice system, may prevent further experiences of criminalization. Research is needed to understand what community-based health interventions have been implemented internationally to inform the design of an intervention in Canada. DESIGN Scoping review using the Joanna Briggs Institute scoping review methodology. METHODS In consultation with a medical research librarian, key databases and journals were searched for English language articles, from any country, with no specified date range. Three authors independently screened titles and abstracts to identify articles for full-text review. The study adheres to PRISMA-EQUATOR guidelines. RESULTS Thirty-six studies met the present criteria and were reviewed in full text. Method, setting, participants, sample, relevant outcomes and relevant findings were extracted from each study for synthesis. Included studies had varied methods and were published from 1999 to 2020. Thirty-one studies were based in the United States, one in Puerto Rico and two each in Canada and the United Kingdom. The most common health issue focus was human immunodeficiency virus and/or hepatitis c virus. The most common outcome was uptake of offered services, such as a transitional clinic. CONCLUSIONS Gaps in the research pertain to a lack of attention to clinical outcomes and patient experience, and a lack of consideration of sexual and reproductive health concerns. Women were the minority population in all studies that included both men and women; transgender participants were mentioned in only four of thirty-six studies. The specific needs of women, trans and nonbinary people must be taken into consideration. RELEVANCE TO CLINICAL PRACTICE Nurses must be conscious of the elevated health risks associated with exposure to correctional institutions and the risks associated with the period of transition. PATIENT OR PUBLIC CONTRIBUTION A member of the research team brings lived experience expertise with respect to the criminal justice system.
Collapse
Affiliation(s)
- Martha Paynter
- Faculty of Nursing, University of New Brunswick, Fredericton, Canada
| | | | | | | | | |
Collapse
|
29
|
Ndateba I, Wong ST, Beaumier J, Burge F, Martin-Misener R, Hogg W, Wodchis W, McGrail K, Johnston S. Primary care practice characteristics associated with team functioning in primary care settings in Canada: A practice-based cross-sectional survey. J Interprof Care 2022; 37:352-361. [PMID: 35880781 DOI: 10.1080/13561820.2022.2099359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
Team-based care is recognized as a foundational building block of high-performing primary care. The purpose of this study was to identify primary care practice characteristics associated with team functioning and examine whether there is relationship between team composition or size and team functioning. We sought to answer the following research questions: (1) are primary care practice characteristics associated with team functioning; and (2) does team composition or size influence team functioning. This cross-sectional correlational study was conducted in Fraser East, British Columbia, Eastern Ontario Health Unit, Ontario and Central Zone, Nova Scotia in Canada. Data were collected from primary care practices using an organization survey and the Team Climate Inventory (TCI) as a measure team functioning. The independent variables of interest were: physicians' payment model, internal clinic meetings to discuss clinical issues, care coordination through informal and ad hoc exchange, care coordination through electronic medical records and sharing clinic mission, values and objectives among health professionals. Potentially confounding variables were as follows: team size, composition, and practice panel size. A total of 63 practices were included in these analyses. The overall mean score of team climate was 73 (SD: 10.75) out of 100. Regression analyses showed that care coordination through human interaction and sharing the practice's mission, values, and objectives among health professionals were positively associated with higher functioning teams. Care coordination through electronic medical records and larger team size were negatively associated with team climate. This study provides baseline data on what practice characteristics are associated with highly functioning teams in Canada.
Collapse
Affiliation(s)
- Innocent Ndateba
- School of Nursing, University of British Columbia, Vancouver, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Sabrina T Wong
- School of Nursing, University of British Columbia, Vancouver, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Jonathan Beaumier
- School of Nursing, University of British Columbia, Vancouver, Canada.,Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | | | | | - William Hogg
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Walter Wodchis
- University of Toronto, Institute of Health Policy, Management and Evaluation, Toronto, Canada
| | - Kimberlyn McGrail
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sharon Johnston
- Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
30
|
Lukewich J, Martin-Misener R, Norful AA, Poitras ME, Bryant-Lukosius D, Asghari S, Marshall EG, Mathews M, Swab M, Ryan D, Tranmer J. Correction: Effectiveness of registered nurses on patient outcomes in primary care: a systematic review. BMC Health Serv Res 2022; 22:810. [PMID: 35733195 PMCID: PMC9215076 DOI: 10.1186/s12913-022-08204-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Julia Lukewich
- Faculty of Nursing, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V, Canada.
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, 5869 University Ave. St, Halifax, NS, B3H 4R2, Canada
| | - Allison A Norful
- School of Nursing, Columbia University, 630 West 168th Street, New York, NY, 10032, USA
| | - Marie-Eve Poitras
- Département de Médecine de Famille Et Médecine d'urgence, Université de Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada
| | | | - Shabnam Asghari
- Department of Family Medicine, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western, 1151 Richmond Street, Ontario, London, ON, N6A 5C1, Canada
| | - Michelle Swab
- Health Sciences Library, Faculty of Medicine, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
| | - Dana Ryan
- Faculty of Nursing, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada
| |
Collapse
|
31
|
Lukewich J, Martin-Misener R, Norful AA, Poitras ME, Bryant-Lukosius D, Asghari S, Marshall EG, Mathews M, Swab M, Ryan D, Tranmer J. Effectiveness of registered nurses on patient outcomes in primary care: a systematic review. BMC Health Serv Res 2022; 22:740. [PMID: 35659215 PMCID: PMC9166606 DOI: 10.1186/s12913-022-07866-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/03/2022] [Indexed: 12/22/2022] Open
Abstract
Background Globally, registered nurses (RNs) are increasingly working in primary care interdisciplinary teams. Although existing literature provides some information about the contributions of RNs towards outcomes of care, further evidence on RN workforce contributions, specifically towards patient-level outcomes, is needed. This study synthesized evidence regarding the effectiveness of RNs on patient outcomes in primary care. Methods A systematic review was conducted in accordance with Joanna Briggs Institute methodology. A comprehensive search of databases (CINAHL, MEDLINE Complete, PsycINFO, Embase) was performed using applicable subject headings and keywords. Additional literature was identified through grey literature searches (ProQuest Dissertations and Theses, MedNar, Google Scholar, websites, reference lists of included articles). Quantitative studies measuring the effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN) that reported related outcomes were included. Articles were screened independently by two researchers and assessed for bias using the Integrated Quality Criteria for Review of Multiple Study Designs tool. A narrative synthesis was undertaken due to the heterogeneity in study designs, RN-led interventions, and outcome measures across included studies. Results Forty-six patient outcomes were identified across 23 studies. Outcomes were categorized in accordance with the PaRIS Conceptual Framework (patient-reported experience measures, patient-reported outcome measures, health behaviours) and an additional category added by the research team (biomarkers). Primary care RN-led interventions resulted in improvements within each outcome category, specifically with respect to weight loss, pelvic floor muscle strength and endurance, blood pressure and glycemic control, exercise self-efficacy, social activity, improved diet and physical activity levels, and reduced tobacco use. Patients reported high levels of satisfaction with RN-led care. Conclusions This review provides evidence regarding the effectiveness of RNs on patient outcomes in primary care, specifically with respect to satisfaction, enablement, quality of life, self-efficacy, and improvements in health behaviours. Ongoing evaluation that accounts for primary care RNs’ unique scope of practice and emphasizes the patient experience is necessary to optimize the delivery of patient-centered primary care. Protocol registration ID PROSPERO: International Prospective Register of Systematic Reviews. 2018. ID=CRD42 018090767. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07866-x.
Collapse
|
32
|
Martin-Misener R. Nursing Workforce Challenges: Familiar Territory or Shifting Tides? Nurs Leadersh (Tor Ont) 2022; 35:1-4. [PMID: 35976778 DOI: 10.12927/cjnl.2022.26878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this issue of the Canadian Journal of Nursing Leadership (CJNL), we are pleased to offer a range of articles and perspectives including a leadership profile, a letter to the editor, research-focused articles and invited commentaries. The unifying thread through all of them is the complex maze of challenges and opportunities facing the nursing workforce. This complexity is created by many factors in Canada and around the globe. To be sure, the COVID-19 pandemic is one of them but its effect has not been to create - but rather to accelerate and intensify the impacts of issues that have plagued nursing for decades. There are no easy solutions to what are longstanding challenges; however, that is not a justification for inaction. Improvements to the experiences of nurses in their workplaces is a responsibility we all need to own, beginning with how we treat one another.
Collapse
Affiliation(s)
- Ruth Martin-Misener
- Director and Professor, School of Nursing, Assistant Dean, Research, Faculty of Health, Dalhousie University, Co-Director, Canadian Centre for Advanced Practice Nursing Research, Affiliate Scientist, Nova Scotia Health, Affiliate Scientist, Maritime SPOR Support Unit, Halifax, NS
| |
Collapse
|
33
|
Almukhaini S, Weeks LE, Macdonald M, Martin-Misener R, Ismaili ZA, Macdonald D, Al-Fahdi N, Rasbi SA, Nasaif H, Rothfus MA. Advanced practice nursing roles in Arab countries in the Eastern Mediterranean region: a scoping review. JBI Evid Synth 2022; 20:1209-1242. [PMID: 35066558 DOI: 10.11124/jbies-21-00101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
OBJECTIVE The objectives of this review were to map and summarize evidence regarding advanced practice nursing roles in Arab countries located in the Eastern Mediterranean region. INTRODUCTION Many countries have reported an increase in the number and types of advanced practice nursing roles as research demonstrating their positive impact on patient and health system outcomes continues to accumulate. There is international evidence that the achievement of these outcomes depends on the effective implementation of advanced practice nursing roles at the organizational and country levels. A comprehensive review of the status of advanced practice nursing role implementation in Arab countries in the Eastern Mediterranean region has not been conducted. INCLUSION CRITERIA Eligible studies included advanced practice nursing roles (including, but not limited to, nurse practitioners and clinical nurse specialists) in Arab countries in the Eastern Mediterranean region. Studies were considered if they focused on role development, titles, entry-level education, regulation and scope of practice, and facilitators and barriers to role implementation. METHODS A comprehensive systematic search was completed for both published and non-published literature. The databases searched included CINAHL, PubMed, PsycINFO, Embase, Nursing and Allied Health Database, and Scopus. Gray literature was searched using websites such as Google Scholar, ProQuest Dissertations and Theses, International Council of Nurses, World Health Organization regional office for the Eastern Mediterranean region, and websites of nursing associations and Ministries of Health in Arab countries. The search included literature published in Arabic and English from the inception of the databases to August 2020. RESULTS A total of 35 articles were included, the majority (n = 24) of which were published from 2010 onward. Ten of the included studies were empirical research papers that used qualitative and quantitative research designs. Advanced practice nursing role development is still in its infancy in most of the Arab countries in the Eastern Mediterranean region and can be described as slowly and steadily evolving. The main driving forces for the implementation of the roles in this region included a shortage of physicians both in number and specialties, the emergence of chronic diseases due to lifestyle changes, the desire to have more cost-effective primary care, and to advance nursing as a profession. Clinical nurse specialists and nurse practitioners are the most common titles for the advanced nursing roles practiced in the region. Some advanced practice nursing roles stipulated a master's degree as a minimum requirement, while others required a 12-month in-house training program. Oman is the only Arab country that authorizes nurse practitioners to prescribe pre-set medications. The common barriers to advanced practice nursing role implementation included a lack of recognition of roles at national levels, role ambiguity, lack of clear scope of practice, resistance from male physicians, low involvement of nurses in policy-making, and low status of nursing as a profession. CONCLUSION The successful implementation and sustainment of advanced practice nursing roles in Arab countries in the Eastern Mediterranean region requires foundational work, including development of definitions, educational standards, regulations, and a clear scope of practice. SCOPING REVIEW REGISTRATION NUMBER Open Science Framework: https://osf.io/wyj8a.
Collapse
Affiliation(s)
- Salma Almukhaini
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
- Sultan Qaboos University, Muscat, Oman
| | - Lori E Weeks
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Marilyn Macdonald
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, Halifax, NS, Canada
- Aligning Health Needs and Evidence for Transformative Change: A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | | | - Danielle Macdonald
- School of Nursing, Queen's University, Kingston, ON, Canada
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, Queen's University, Kingston, ON, Canada
| | | | | | - Husain Nasaif
- Royal College of Surgeons in Ireland - Medical University of Bahrain, Bahrain
| | | |
Collapse
|
34
|
Dol J, Boulos L, Somerville M, Saxinger L, Doroshenko A, Hastings S, Reynolds B, Gallant A, Shin HD, Wong H, Crowther D, Macdonald M, Martin-Misener R, McCulloch H, Tricco AC, Curran JA. Health system impacts of SARS-CoV − 2 variants of concern: a rapid review. BMC Health Serv Res 2022; 22:544. [PMID: 35461246 PMCID: PMC9034743 DOI: 10.1186/s12913-022-07847-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 03/21/2022] [Indexed: 01/06/2023] Open
Abstract
Background As of November 25th 2021, four SARS-CoV − 2 variants of concern (VOC: Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2)) have been detected. Variable degrees of increased transmissibility of the VOC have been documented, with potential implications for hospital and health system capacity and control measures. This rapid review aimed to provide a synthesis of evidence related to health system responses to the emergence of VOC worldwide. Methods Seven databases were searched up to September 27, 2021, for terms related to VOC. Titles, abstracts, and full-text documents were screened independently by two reviewers. Data were extracted independently by two reviewers using a standardized form. Studies were included if they reported on at least one of the VOC and health system outcomes. Results Of the 4877 articles retrieved, 59 studies were included, which used a wide range of designs and methods. Most of the studies reported on Alpha, and all except two reported on impacts for capacity planning related to hospitalization, intensive care admissions, and mortality. Most studies (73.4%) observed an increase in hospitalization, but findings on increased admission to intensive care units were mixed (50%). Most studies (63.4%) that reported mortality data found an increased risk of death due to VOC, although health system capacity may influence this. No studies reported on screening staff and visitors or cohorting patients based on VOC. Conclusion While the findings should be interpreted with caution as most of the sources identified were preprints, evidence is trending towards an increased risk of hospitalization and, potentially, mortality due to VOC compared to wild-type SARS-CoV − 2. There is little evidence on the need for, and the effect of, changes to health system arrangements in response to VOC transmission. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07847-0.
Collapse
|
35
|
Breneol S, Curran JA, Macdonald M, Montelpare W, Stewart SA, Martin-Misener R, Vine J. Children With Medical Complexity in the Canadian Maritimes: Protocol for a Mixed Methods Study. JMIR Res Protoc 2022; 11:e33426. [PMID: 35383571 PMCID: PMC9021950 DOI: 10.2196/33426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 02/22/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Ongoing developments in the medical field have improved survival rates and long-term management of children with complex chronic health conditions. While the number of children with medical complexity is small, they use a significant amount of health resources across various health settings and sectors. Research to date exploring this pediatric population has relied primarily on quantitative or qualitative data alone, leaving significant gaps in our understanding of this population. OBJECTIVE The objective of this research is to use health administrative and family-reported data to gain an in-depth understanding of patterns of health resource use and health care needs of children with medical complexity and their families in the Canadian Maritimes. METHODS An explanatory sequential mixed methods design will be used to achieve our research objective. Phase 1 of this research will leverage the use of health administrative data to examine the prevalence and health service use of children with medical complexity. Phase 2 will use case study methods to collect multiple sources of family-reported data to generate a greater understanding of their experiences, health resource use, and health care needs. Two cases will be developed in each of the 3 provinces. Cases will be developed through semistructured interviews with families and their health care providers and health resource journaling. Findings will be triangulated from phase 1 and 2 using a joint display table to visually depict the convergence and divergence between the quantitative and qualitative findings. This triangulation will result in a comprehensive and in-depth understanding into the population of children with medical complexity. RESULTS This study will be completed in May 2022. Findings from each phase of the research and integration of the two will be reported in full in 2022. CONCLUSIONS There is a current disconnect between the Canadian health care system and the needs of children with medical complexity and their families. By combining health administrative and family-reported data, this study will unveil critical information about children with medical complexity and their families to more efficiently and effectively meet their health care needs. Results from this research will be the first step in designing patient-oriented health policies and programs to improve the health care experiences, health system use, and health outcomes of children with medical complexity and their families. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/33426.
Collapse
Affiliation(s)
- Sydney Breneol
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Strengthening Transitions in Care, Izaac Walton Killam Health Centre, Halifax, NS, Canada
| | - Janet A Curran
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Strengthening Transitions in Care, Izaac Walton Killam Health Centre, Halifax, NS, Canada
| | - Marilyn Macdonald
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - William Montelpare
- Department of Applied Human Sciences, University of Prince Edward Island, Charlottetown, PE, Canada
| | - Samuel A Stewart
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Ruth Martin-Misener
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Jocelyn Vine
- Strengthening Transitions in Care, Izaac Walton Killam Health Centre, Halifax, NS, Canada
| |
Collapse
|
36
|
Lukewich J, Asghari S, Marshall EG, Mathews M, Swab M, Tranmer J, Bryant-Lukosius D, Martin-Misener R, Norful AA, Ryan D, Poitras ME. Effectiveness of registered nurses on system outcomes in primary care: a systematic review. BMC Health Serv Res 2022; 22:440. [PMID: 35379241 PMCID: PMC8981870 DOI: 10.1186/s12913-022-07662-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Internationally, policy-makers and health administrators are seeking evidence to inform further integration and optimal utilization of registered nurses (RNs) within primary care teams. Although existing literature provides some information regarding RN contributions, further evidence on the impact of RNs towards quality and cost of care is necessary to demonstrate the contribution of this role on health system outcomes. In this study we synthesize international evidence on the effectiveness of RNs on care delivery and system-level outcomes in primary care. Methods A systematic review was conducted in accordance with Joanna Briggs Institute methodology. Searches were conducted in CINAHL, MEDLINE Complete, PsycINFO, and Embase for published literature and ProQuest Dissertations and Theses and MedNar for unpublished literature between 2019 and 2022 using relevant subject headings and keywords. Additional literature was identified through Google Scholar, websites, and reference lists of included articles. Studies were included if they measured effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN within the context of an independent or interdependent role) and reported outcomes of these interventions. Included studies were published in English; no date or location restrictions were applied. Risk of bias was assessed using the Integrated Quality Criteria for Review of Multiple Study Designs tool. Due to the heterogeneity of included studies, a narrative synthesis was undertaken. Results Seventeen articles were eligible for inclusion, with 11 examining system outcomes (e.g., cost, workload) and 15 reporting on outcomes related to care delivery (e.g., illness management, quality of smoking cessation support). The studies suggest that RN-led care may have an impact on outcomes, specifically in relation to the provision of medication management, patient triage, chronic disease management, sexual health, routine preventative care, health promotion/education, and self-management interventions (e.g. smoking cessation support). Conclusions The findings suggest that primary care RNs impact the delivery of quality primary care, and that RN-led care may complement and potentially enhance primary care delivered by other primary care providers. Ongoing evaluation in this area is important to further refine nursing scope of practice policy, determine the impact of RN-led care on outcomes, and inform improvements to primary care infrastructure and systems management to meet care needs. Protocol registration ID PROSPERO: International prospective register of systematic reviews. 2018. ID=CRD42018090767. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07662-7.
Collapse
Affiliation(s)
- Julia Lukewich
- Faculty of Nursing, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada.
| | - Shabnam Asghari
- Department of Family Medicine, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
| | - Emily Gard Marshall
- Department of Family Medicine Primary Care Research Unit, Dalhousie University, 1465 Brenton Street, Suite 402, Halifax, NS, B3J 3T4, Canada
| | - Maria Mathews
- Department of Family Medicine, Schulich School of Medicine & Dentistry, University of Western, Ontario 1151 Richmond Street, London, ON, N6A 5C1, Canada
| | - Michelle Swab
- Health Sciences Library, Faculty of Medicine, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
| | - Joan Tranmer
- School of Nursing, Queen's University, 92 Barrie Street, Kingston, ON, K7L 3N6, Canada
| | | | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, 5869 University Ave. St, Halifax, NS, B3H 4R2, Canada
| | - Allison A Norful
- School of Nursing, Columbia University, 630 West 168th Street, New York, NY, 10032, USA
| | - Dana Ryan
- Faculty of Nursing, Memorial University, 300 Prince Phillip Drive, St. John's, NL, A1B 3V6, Canada
| | - Marie-Eve Poitras
- Département de médecine de famille et médecine d'urgence, Université de Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada
| |
Collapse
|
37
|
Ennis M, Renner R, Guilbert E, Norman WV, Pymar H, Kean L, Carson A, Martin-Misener R, Dunn S. Provision of First-trimester Medication Abortion in 2019: Results from the Canadian Abortion Provider Survey. Contraception 2022; 113:19-25. [PMID: 35351448 DOI: 10.1016/j.contraception.2022.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To explore the Canadian first-trimester medication abortion (MA) workforce and their clinical care following the introduction of mifepristone in 2017, updated national clinical practice guidelines and government approval of nurse practitioners (NPs) as first-trimester MA providers. STUDY DESIGN We conducted a national, self-administered, cross-sectional survey of abortion providers in 2019. Our bilingual (French/English) survey collected information on demographics, abortion number, and clinical care characteristics. The true number of abortion providers is unknown thus we cannot calculate a survey response rate. To maximize identification of possibly eligible respondents, we widely distributed the survey between July and December 2020 through health professional organizations, using a modified Dillman technique. We used descriptive statistics to characterize the workforce and clinical practices. RESULTS Four-hundred-sixty-five clinicians responded, of whom 388 provided first-trimester MA. Physicians (n=358) and NPs (n=30) reported providing 13,429 first-trimester MAs in 2019 which represented 27.7% of all reported abortions in the survey. The majority of first-trimester MA respondents were primary care physicians (n=245, 63.1%), had less than five years' experience (n=223, 61.3%) and practiced outside of hospitals (n=228, 66.5%). Forty-three percent (n=165) practiced rurally, and 44.0% (n=136) used telemedicine for some abortion care. Ninety-nine percent (n=350) used a guideline-recommended mifepristone/misoprostol regimen while 14.5% (n=51) sometimes used methotrexate. Patients most commonly received mifepristone/misoprostol at community pharmacies (median 100.0%; interquartile range 50.0-100.0%). CONCLUSION Our results suggest that there are many new first-trimester MA providers, an increase in the proportion of MAs since 2012 and a shift to primary care settings. Respondents widely adopted mifepristone. IMPLICATIONS STATEMENT Our results highlight that, following mifepristone introduction, many new primary care practitioners started providing first-trimester medication abortion throughout Canada, including the first non-physicians. This increased access to abortion particularly in rural and underserved communities. These results could inform future directions in policy, guidelines, and abortion access initiatives.
Collapse
Affiliation(s)
- Madeleine Ennis
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Regina Renner
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada.
| | - Edith Guilbert
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Department of Obstetrics, Gynecology and Reproduction, Laval University, Quebec City, Quebec, Canada
| | - Wendy V Norman
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Department of Family Practice, University of British Columbia, Vancouver, BC, Canada; Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Helen Pymar
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Department of Obstetrics, Gynecology and Reproductive Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Lauren Kean
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Carson
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ruth Martin-Misener
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheila Dunn
- Contraception Abortion Research Team, Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
38
|
Martin-Misener R. Leadership in - and Despite - Troubled Times. Nurs Leadersh (Tor Ont) 2022; 35:1-5. [PMID: 35339195 DOI: 10.12927/cjnl.2022.26755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In this issue of CJNL, we read about research being conducted on vitally important leadership capabilities - including followership, administrative leadership, practice leadership and communication with policy makers - required for nurses both during and post pandemic. These are leadership essentials that are part of our toolboxes as nurses.
Collapse
Affiliation(s)
- Ruth Martin-Misener
- Director and Professor, School of Nursing Assistant Dean, Research, Faculty of Health, Dalhousie University, Co-Director, Canadian Centre for Advanced Practice Nursing Research Affiliate Scientist, Nova Scotia Health, Affiliate Scientist, Maritime SPOR Support Unit, Halifax, NS
| |
Collapse
|
39
|
Carson A, Paynter M, Norman WV, Munro S, Roussel J, Dunn S, Bryant-Lukosius D, Begun S, Martin-Misener R. Optimizing the Nursing Role in Abortion Care: Considerations for Health Equity. Nurs Leadersh (Tor Ont) 2022; 35:54-68. [PMID: 35339200 DOI: 10.12927/cjnl.2022.26750] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Registered nurses (RNs) provide abortion care in hospitals and clinics and support abortion care through sexual health education and family planning care in sexual health clinics, schools and family practice. Nurse practitioners (NPs) improve access to abortion not only as prescribers of medication abortion but also as primary care providers of counselling, resources about pregnancy options and abortion follow-up care in their communities. There is a need to better understand the current status of and potential scope for optimizing nursing roles in abortion care across Canada. In this article, we describe the leadership of nurses in the provision of accessible, inclusive abortion services and discuss barriers to role optimization. We present key insights from a priority-setting meeting held in 2019 with NPs and RNs engaged in medication abortion practice in their communities. As scopes of practice continue to evolve, optimization of nursing roles in abortion care is an approach to enhancing equitable access to comprehensive abortion care and family planning.
Collapse
Affiliation(s)
- Andrea Carson
- Postdoctoral Fellow, School of Nursing, Dalhousie University, Halifax, NS
| | | | - Wendy V Norman
- Associate Professor and Chair, Family Planning and Public Health Research, Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Sarah Munro
- Assistant Professor, Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | | | - Sheila Dunn
- Research Director, Family Practice Health Centre, Women's College Hospital; Associate Professor, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | | | - Stephanie Begun
- Assistant Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON
| | - Ruth Martin-Misener
- Professor and Director, School of Nursing, Dalhousie University, Halifax, NS
| |
Collapse
|
40
|
Wong ST, Johnston S, Burge F, Ammi M, Campbell JL, Katz A, Martin-Misener R, Peterson S, Thandi M, Haggerty J, Hogg W. Comparing the Attainment of the Patient's Medical Home Model across Regions in Three Canadian Provinces: A Cross-Sectional Study. Healthc Policy 2021; 17:19-37. [PMID: 34895408 PMCID: PMC8665731 DOI: 10.12927/hcpol.2021.26659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The aim of this work was to show the feasibility of providing a comprehensive portrait of regional primary care performance. Methods: The TRANSFORMATION study used a mixed-methods concurrent study design where we analyzed survey data and case studies. Data were collected in British Columbia, Ontario and Nova Scotia. Patient's Medical Home (PMH) pillar scores were created by calculating mean clinic-level scores across regions. Scores and qualitative themes were compared. Results: Participation included 86 practices (n = 1,929 patients; n = 117 clinicians). Regions had differential attainment towards PMH orientation with respect to infrastructure; community adaptiveness and accountability; and patient and family partnered care. The lowest PMH attainment for all regions were observed in connected care; accessible care; measurement, continuous quality improvement and research; and training, education and continuing professional development. Conclusions: Comprehensive performance reporting that draws on multiple data sources in primary care is possible. Regional portraits highlighting many of the key pillars of a PMH approach to primary care show that despite differences in policy contexts, achieving a PMH remains elusive.
Collapse
Affiliation(s)
- Sabrina T Wong
- Professor, Centre for Health Services and Health Research, University of British Columbia, School of Nursing, University of British Columbia, Vancouver, BC
| | - Sharon Johnston
- Associate Professor, Department of Family Medicine, University of Ottawa, Ottawa, ON
| | - Fred Burge
- Professor, Department of Family Medicine, Dalhousie University, Halifax, NS
| | - Mehdi Ammi
- Associate Professor, School of Public Policy and Administration, Carleton University, Ottawa, ON
| | - John L Campbell
- Professor, Primary Care Research Group, University of Exeter College of Medicine and Health, Exeter, England
| | - Alan Katz
- Professor, Departments of Community Health Sciences and Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | | | - Sandra Peterson
- Research Analyst, Centre for Health Services and Health Research, University of British Columbia Vancouver, BC
| | - Manpreet Thandi
- Doctoral Student, Centre for Health Services and Health Research, School of Nursing, University of British Columbia, Vancouver, BC
| | - Jeannie Haggerty
- Professor, Department of Family Medicine, McGill University, Montreal, QC
| | - William Hogg
- Co-Investigator, TRANSFORMATION Study, Professor, Department of Family Medicine, University of Ottawa; Vice-président associé recherche et Directeur scientifique, Institut du Savoir Montfort, Ottawa, ON
| |
Collapse
|
41
|
Bai I, Isenor JE, Reeve E, Whelan AM, Martin-Misener R, Burgess S, Kennie-Kaulbach N. Using the behavior change wheel to link published deprescribing strategies to identified local primary healthcare needs. Res Social Adm Pharm 2021; 18:3350-3357. [PMID: 34895842 DOI: 10.1016/j.sapharm.2021.12.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 11/30/2021] [Accepted: 12/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Polypharmacy is a major global problem. Evidence in primary care shows deprescribing can be beneficial. Behaviour change theories such as the Theoretical Domains Framework (TDF) and the Behaviour Change Wheel (BCW) can help develop successful implementation of deprescribing initiatives. OBJECTIVES To link locally identified deprescribing influencers with components of successfully trialed deprescribing strategies, with the aim of informing the development of local deprescribing initiatives. METHODS Two background studies were completed. A qualitative study of interviews and focus groups identified influencers of deprescribing from local primary care physicians, nurse practitioners, and pharmacists. Transcripts were coded using the TDF and mapped to the Intervention Functions of the BCW. A scoping review identified studies that investigated primary care deprescribing strategies, which were mapped to the BCW Intervention Functions and the Behaviour Change Techniques (BCTs). For this analysis, six main TDF domains from the qualitative study were linked to the BCTs identified in the scoping review through the Intervention Functions of the BCW. RESULTS Within the BCW component Capability, one TDF domain identified in the qualitative study, Memory, Attention and Decision Process, was linked to strategies like academic detailing from the scoping review. For the Opportunity component, two TDF domains, Social Influences and Environmental Context and Resources, were linked to strategies such as pharmacist medication reviews, providing patient information leaflets, and evidence-based deprescribing tools. For the Motivation component, three TDF domains, Social/Professional Role and Identity, Intentions, and Beliefs about Consequences, were linked to strategies such as sending deprescribing information to prescribers, using tools to identify eligible patients, and having patients report adverse events of medications. CONCLUSIONS This analysis identified deprescribing strategies that can be used to address influencers related to behaviour change from the perspective of primary care providers, and to assist with future deprescribing initiative development and implementation in the local context.
Collapse
Affiliation(s)
- Isaac Bai
- Faculty of Medicine, Dalhousie University, 5849 University Ave, Halifax, NS, Canada
| | - Jennifer E Isenor
- College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada.
| | - Emily Reeve
- College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada; Quality Use of Medicines and Pharmacy Research Centre, UniSA: Clinical and Health Sciences, University of South Australia, Adelaide, SA, Australia; Geriatric Medicine Research, Faculty of Medicine, Dalhousie University and Nova Scotia Health Authority, Halifax, NS, Canada
| | - Anne Marie Whelan
- College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, 5869 University Avenue, Halifax, NS, Canada
| | - Sarah Burgess
- College of Pharmacy, Dalhousie University, 5968 College Street, Halifax, NS, Canada; Pharmacy Department, Nova Scotia Health Authority, Halifax, NS, Canada
| | | |
Collapse
|
42
|
Somerville M, Curran JA, Dol J, Boulos L, Saxinger L, Doroshenko A, Hastings S, Reynolds B, Gallant AJ, Shin HD, Wong H, Crowther D, Macdonald M, Martin-Misener R, Comeau J, McCulloch H, Tricco AC. Public health implications of SARS-CoV-2 variants of concern: a rapid scoping review. BMJ Open 2021; 11:e055781. [PMID: 34857582 PMCID: PMC8640198 DOI: 10.1136/bmjopen-2021-055781] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/22/2021] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The four SARS-CoV-2 variants of concern (VOC; Alpha, Beta, Gamma and Delta) identified by May 2021 are highly transmissible, yet little is known about their impact on public health measures. We aimed to synthesise evidence related to public health measures and VOC. DESIGN A rapid scoping review. DATA SOURCES On 11 May 2021, seven databases (MEDLINE, Embase, the Cochrane Database of Systematic Reviews, Central Register of Controlled Trials, Epistemonikos' L-OVE on COVID-19, medRxiv, bioRxiv) were searched for terms related to VOC, public health measures, transmission and health systems. No limit was placed on date of publication. ELIGIBILITY CRITERIA Studies were included if they reported on any of the four VOCs and public health measures, and were available in English. Only studies reporting on data collected after October 2020, when the first VOC was reported, were included. DATA EXTRACTION AND SYNTHESIS Titles, abstracts and full-text articles were screened by two independent reviewers. Data extraction was completed by two independent reviewers using a standardised form. Data synthesis and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. RESULTS Of the 37 included studies, the majority assessed the impact of Alpha (n=32) and were conducted in Europe (n=12) or the UK (n=9). Most were modelling studies (n=28) and preprints (n=28). The majority of studies reported on infection control measures (n=17), followed by modifying approaches to vaccines (n=13), physical distancing (n=6) and either mask wearing, testing or hand washing (n=2). Findings suggest an accelerated vaccine rollout is needed to mitigate the spread of VOC. CONCLUSIONS The increased severity of VOC requires proactive public health measures to control their spread. Further research is needed to strengthen the evidence for continued implementation of public health measures in conjunction with vaccine rollout. With no studies reporting on Delta, there is a need for further research on this and other emerging VOC on public health measures.
Collapse
Affiliation(s)
- Mari Somerville
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, IWK Health, Halifax, Nova Scotia, Canada
| | - Janet A Curran
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, IWK Health, Halifax, Nova Scotia, Canada
| | - Justine Dol
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Lynora Saxinger
- Division of Infectious Diseases, Department of Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
| | - Alexander Doroshenko
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie Hastings
- Health Systems Evaluation and Evidence, Alberta Health Services, Calgary, Alberta, Canada
| | - Bearach Reynolds
- Department of Infectious Diseases, St Vincents Hospital, Dublin, Leinster, UK
- Evidence Synthesis Ireland, National University of Ireland, Galway, UK
| | - Allyson J Gallant
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Helen Wong
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel Crowther
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Marilyn Macdonald
- Faculty of Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Jeannette Comeau
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Infectious Diseases, IWK Health, Halifax, Nova Scotia, Canada
| | - Holly McCulloch
- Department of Pediatrics, IWK Health, Halifax, Nova Scotia, Canada
| | - Andrea C Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, School of Nursing, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
43
|
Benoit B, Cassidy C, van Wijlen J, Correll Q, Campbell-Yeo M, Hendra S, Martin-Misener R, MacDougall J, Cameron A. CO-DEVELOPMENT OF IMPLEMENTATION INTERVENTIONS TO SUPPORT PARENT-LED INFANT PAIN CARE: A QUALITATIVE DESCRIPTIVE STUDY PROTOCOL (Preprint). JMIR Res Protoc 2021; 11:e33770. [PMID: 35930339 PMCID: PMC9391977 DOI: 10.2196/33770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Untreated pain in infants is associated with adverse health outcomes. Despite strong evidence for accessible, effective, and low-cost parent-led pain-relieving interventions such as breastfeeding or chestfeeding and skin-to-skin contact, these interventions are not routinely used. Objective The objective of this study is to support the implementation of parent-led pain interventions by identifying barriers to and facilitators of parent-led, evidence-informed pain care in infants during acute procedures. In addition, this study aims to develop theory-informed, contextually relevant implementation interventions for supporting the use of parent-led pain care for infants in hospital and community contexts. Methods This study will consist of 2 phases that follow a systematic, theoretically informed approach guided by the Theoretical Domains Framework and Behavior Change Wheel. In phase 1, we will use a qualitative descriptive design to explore barriers and facilitators to using parent-led pain care in infants from the perspectives of hospital and community-based clinicians, clinical leaders, and families. In phase 2, we will use the Behavior Change Wheel to design tailored implementation interventions that have evidence for effectively addressing identified barriers in collaboration with an advisory committee of administrative, clinical, and family leaders. Results Ethics approval for this study was obtained in December 2020. As of May 2022, a total of 15 participants have been enrolled in phase 1. The results from all phases will be reported in 2023. Conclusions Following the completion of this study, we will have co-designed theoretically informed implementation interventions that can be pilot-tested and experimentally applied. The findings will be used to implement parent-led interventions that improve patient safety and health outcomes for diverse families. International Registered Report Identifier (IRRID) DERR1-10.2196/33770
Collapse
Affiliation(s)
- Britney Benoit
- Rankin School of Nursing, St Francis Xavier University, Antigonish, NS, Canada
| | | | | | - Quinn Correll
- Rankin School of Nursing, St Francis Xavier University, Antigonish, NS, Canada
| | | | - Sionnach Hendra
- Rankin School of Nursing, St Francis Xavier University, Antigonish, NS, Canada
| | | | | | | |
Collapse
|
44
|
Moody E, Ganann R, Martin-Misener R, Ploeg J, Macdonald M, Weeks LE, Orr E, McKibbon S, Jefferies K. Out-of-pocket expenses related to aging in place for frail older people: a scoping review. JBI Evid Synth 2021; 20:537-605. [PMID: 34738979 PMCID: PMC8860225 DOI: 10.11124/jbies-20-00413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: The objective of this scoping review was to map and describe the available evidence reporting out-of-pocket expenses related to aging in place for older people with frailty and their caregivers. Introduction: As the global population ages, there has been increasing attention on supporting older people to live at home in the community as they experience health and functional changes. Older people with frailty often require a variety of supports and services to live in the community, yet the out-of-pockets costs associated with these resources are often not accounted for in health and social care literature. Inclusion criteria: Sources that reported on the financial expenses incurred by older people (60 years or older) with frailty living in the community, or on the expenses incurred by their family and friend caregivers, were eligible for inclusion in the review. Methods: We searched for published and unpublished (ie, policy papers, theses, and dissertations) studies written in English or French between 2001 and 2019. The following databases were searched: CINAHL, MEDLINE, Scopus, Embase, PsycINFO, Sociological Abstracts, and Public Affairs Index. We also searched for gray literature in a selection of websites and digital repositories. JBI scoping review methodology was used, and we consulted with a patient and family advisory group to support the relevance of the review. Results: A total of 42 sources were included in the review, including two policy papers and 40 research papers. The majority of the papers were from the United States (n = 18), with others from Canada (n = 6), the United Kingdom (n = 3), Japan (n = 2), and one each from Australia, Brazil, China, Denmark, Israel, Italy, The Netherlands, Poland, Portugal, Singapore, South Korea, Taiwan, and Turkey. The included research studies used various research designs, including cross-sectional (n = 18), qualitative (n = 15), randomized controlled trials (n = 2), longitudinal (n = 2), cost effectiveness (n = 1), quasi-experimental (n = 1), and mixed methods (n = 1). The included sources used the term “frailty” inconsistently and used various methods to demonstrate frailty. Categories of out-of-pocket expenses found in the literature included home care, medication, cleaning and laundry, food, transportation, medical equipment, respite, assistive devices, home modifications, and insurance. Five sources reported on out-of-pocket expenses associated with people who were frail and had dementia, and seven reported on the out-of-pocket expenses for caregivers of people with frailty. While seven articles reported on specific programs, there was very little consistency in how out-of-pocket expenses were used as outcome measures. Several studies used measures of combined out-of-pocket expenses, but there was no standard approach to reporting aggregate out-of-pocket expenses. Conclusions: Contextual factors are important to the experiences of out-of-pocket spending for older people with frailty. There is a need to develop a standardized approach to measuring out-of-pocket expenses in order to support further synthesis of the literature. We suggest a measure of out-of-pocket spending as a percentage of family income. The review supports education for health care providers to assess the out-of-pocket spending of community-dwelling older people with frailty and their caregivers. Health care providers should also be aware of the local policies and resources that are available to help older people with frailty address their out-of-pocket spending.
Collapse
Affiliation(s)
- Elaine Moody
- School of Nursing, Dalhousie University, Halifax, Canada Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, Canada School of Nursing, McMaster University, Hamilton, Canada WK Kellogg Health Sciences Library, Dalhousie University, Halifax, Canada Faculty of Applied Health Sciences, Brock University, St. Catharines, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Barrett C, Mathews M, Poitras ME, Norful AA, Martin-Misener R, Tranmer J, Ryan D, Lukewich J. Job titles and education requirements of registered nurses in primary care: An international document analysis. International Journal of Nursing Studies Advances 2021. [DOI: 10.1016/j.ijnsa.2021.100044] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
|
46
|
Macdonald M, Yu Z, Weeks LE, Moody E, Wilson B, Almukhaini S, Martin-Misener R, Sim M, Jefferies K, Iduye D, Neeb D, McKibbon S. Assistive technologies that support social interaction in long-term care homes: a scoping review. JBI Evid Synth 2021; 19:2695-2738. [PMID: 34264899 DOI: 10.11124/jbies-20-00264] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this review was to chart the literature on assistive technologies (excluding robots) that support social interaction of older adults in long-term care homes, and to advance a definition of socially assistive technologies. INTRODUCTION Loneliness and social isolation have adverse effects on the health and well-being of older adults. Many long-term care homes provide recreational programming intended to entertain or distract residents, yet the evidence of their effectiveness is limited. Absent from the literature are comprehensive reviews of assistive technologies (other than robots) that are used to support social interaction in long-term care homes. INCLUSION CRITERIA The review considered research studies as well as gray literature that included older adults (≥65 years) living in long-term care homes. The concept of interest was the use of assistive technologies (excluding robots) that support social interaction in long-term care homes. METHODS The databases were searched on June 26, 2019, and included CINAHL Full Text (EBSCO), MEDLINE (Ovid), PsycINFO (EBSCO), Sociological Abstracts (ProQuest), Embase (Elsevier), and Web of Science (Clarivate). The search for gray literature was conducted in ProQuest Dissertations and Theses Databases and across 11 websites during September and October 2019. The recommended JBI approach to study selection, data extraction, and data synthesis was used. RESULTS Twenty-five articles were included in this review, with comparable numbers of quantitative (n = 6), qualitative (n = 9), and mixed methods (n = 7) studies, with the remaining articles employing non-empirical designs (n = 3). Technologies were categorized as low (easily recognizable to everyone), medium (more electronics), or high (involves internet). Two studies reported on low-assistive technologies, including videotapes and the telephone. Medium-assistive technologies were identified in nine studies and included videophones; Nintendo Wii; tablet-based games; picture- and video-viewing tools; and CRDL (pronounced "cradle"), a special instrument that translates touch into sound. More than half (n = 14) of the included articles utilized high-assistive technologies, such as computer labs/kiosks, tablet-based applications, social media (eg, Facebook), videoconferencing, and multi-functional systems. Five studies measured whether assistive technologies had an impact on the quantity of long-term care residents' social interaction levels. Qualitative themes were related to residents' social connections and experiences after using various technologies. Four studies systematically incorporated a framework/model, and Social Structuration Theory was considered the most comprehensive. In the absence of a definition of socially assistive technologies, the definition advanced from this review is as follows: Socially assistive technologies are user-appropriate devices and tools that enable real-time connectivity to enhance social interaction. CONCLUSIONS Included literature reported the benefits of technology use, with considerable variability in engagement and no cost estimates. We recommend that future research continue to advance our definition of socially assistive technologies, make promising assistive technologies available in long-term care homes after studies are completed, report the costs of assistive technologies, and include participants with dementia and culturally and linguistically diverse backgrounds.
Collapse
Affiliation(s)
- Marilyn Macdonald
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Ziwa Yu
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Lori E Weeks
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada.,Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
| | - Elaine Moody
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Beth Wilson
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health, Halifax, NS, Canada
| | - Salma Almukhaini
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada.,Sultan Qaboos University, Muscat, Oman
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Meaghan Sim
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada.,Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada.,Nova Scotia Health, Halifax, NS, Canada
| | - Keisha Jefferies
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Damilola Iduye
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - David Neeb
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada
| | - Shelley McKibbon
- Aligning Health Needs with Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Dalhousie University, Halifax, NS, Canada.,WK Kellogg Library, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
47
|
Martin-Misener R, Macleod MLP, Wilson EC, Kosteniuk JG, Penz KL, Stewart NJ, Olynick J, Karunanayake CP. The Mosaic of Primary Care Nurses in Rural and Remote Canada: Results from a National Survey. ACTA ACUST UNITED AC 2021; 15:63-75. [PMID: 32176611 PMCID: PMC7075442 DOI: 10.12927/hcpol.2020.26130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background and objective: Nurses provide essential primary care (PC) in rural and remote Canada. We examined the practice context and responsibilities of this little-known understudied workforce. Method: Data from Nursing Practice in Rural and Remote Canada II, a 2014 to 2015 pan-Canadian survey, were analyzed. Results: Of 3,822 respondents, 192 identified that PC was their only practice focus (PC-Only), and for 111, it was one focus among others (PC-Plus). Proportionally more PC-Only than PC-Plus nurses had graduate education, were employed in larger communities and had experienced higher job resources and lower job demands. Proportionally fewer PC-Only than PC-Plus nurses followed protocols/decision support tools, dispensed medications and provided emergency services. Proportionally more PC-Only than PC-Plus nurses ordered advanced diagnostic tests/imaging, and fewer PC-Only than PC-Plus nurses performed and interpreted laboratory tests and diagnostic imaging on site. Conclusion: Contributions of the rural and remote nursing workforce to PC are rendered invisible by contemporary characterizations of the PC workplace, limiting evaluation and improvement efforts.
Collapse
Affiliation(s)
- Ruth Martin-Misener
- Professor and Director, School of Nursing, and Assistant Dean, Faculty of Health, Dalhousie University, Halifax, NS
| | - Martha L P Macleod
- Professor and the Northern Health - UNBC Knowledge Mobilization Research Chair, School of Nursing, University of Northern British Columbia, Prince George, BC
| | - Erin C Wilson
- Assistant Professor, School of Nursing, University of Northern British Columbia, Prince George, BC
| | - Julie G Kosteniuk
- Professional Research Associate, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK
| | - Kelly L Penz
- Assistant Professor, College of Nursing, University of Saskatchewan, Regina Campus, Regina, SK
| | - Norma J Stewart
- Professor Emerita, College of Nursing, University of Saskatchewan, Saskatoon, SK
| | - Janna Olynick
- Research Associate, School of Nursing, University of Northern British Columbia, Prince George, BC
| | - Chandima P Karunanayake
- Professional Research Associate, Canadian Centre for Health and Safety in Agriculture, University of Saskatchewan, Saskatoon, SK
| |
Collapse
|
48
|
Jefferies K, Richards T, Blinn N, Sim M, Kirk SFL, Dhami G, Helwig M, Iduye D, Moody E, Macdonald M, Tomblin Murphy G, Martin-Misener R. Food security in African Canadian communities: a scoping review. JBI Evid Synth 2021; 20:37-59. [PMID: 34149022 DOI: 10.11124/jbies-20-00394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to chart the evidence relating to food security among African Canadian communities to inform future research and offer insight related to food security in African Canadian communities. INTRODUCTION Achieving food security is of global importance in the attainment of the United Nations Sustainable Development Goals. As a social determinant of health, food security, which refers to the unrestricted physical, economic, and timely access to safe and nutritious foods, impacts over four million Canadians. Yet, little is known about food security and the differential impacts of food insecurity among African Canadians. This scoping review sought to describe the current state of food security among African Canadians. INCLUSION CRITERIA Sources were considered for inclusion if they met the eligibility criteria outlined in the a priori protocol. Specifically, sources were considered if they: i) focused on Canada, ii) involved African Canadians, and iii) examined food security. No restrictions were placed on date of publication and language restrictions were limited to English and French. METHODS This scoping review was conducted in accordance with JBI methodology and comprised a search of published and unpublished sources. Data were extracted independently in Excel by two team members according to data items outlined in the extraction tool. In instances where articles were unavailable, authors of potential sources were contacted at the full-text review phase to request access to the full text of their article. Databases and relevant websites containing peer-reviewed, unpublished, and gray literature were searched. Ancestry searching and forward citation tracing were completed. RESULTS The search of databases yielded a total of 1183 records. Ancestry tracing yielded 287 records. After removing duplicates, 1075 titles and abstracts were screened for eligibility and 80 advanced to full-text screening. Seventy-five full-text articles were excluded based on inclusion criteria, leaving five articles that underwent data extraction. All included studies involved African Canadian participants in Canada (n = 5). All studies focused on adults (n = 5); one study included women and men participants (n = 1), while four focused exclusively on women (n = 4). Importantly, one study involving women participants included cis- and trans women as well as those identifying as queer (n = 1). Study designs reflected qualitative (n = 2), quantitative (n = 1), and mixed methods (n = 2) designs. CONCLUSIONS This review begins to fill a gap in understanding the current evidence available on food security as it impacts African Canadians. The findings of this review represent existing research, describing the type of evidence available and methodologies used, before suggesting implications for research and practice. The inclusion of only five studies reveals the limited evidence regarding the current state of food security among African Canadians. Further, included studies were exclusively conducted in urban settings; predominantly in one province. There is a need for further research in rural communities, in other provinces and territories, as well as with younger and older participants. Lastly, the urgent need to collect race-disaggregated data in Canada is evident.
Collapse
Affiliation(s)
- Keisha Jefferies
- School of Nursing, Dalhousie University, Halifax, NS, Canada Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada School of Health and Human Performance, Dalhousie University, Halifax, NS, Canada Nova Scotia Health, Halifax, NS, Canada Department of Applied Human Nutrition, Mount Saint Vincent University, Halifax, NS, Canada WK Kellogg Library, Dalhousie University, Halifax, NS, Canada
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Jefferies K, Martin-Misener R, Murphy GT, Helwig M, Bernard WT, Gahagan J. African Canadian nurses in the nursing profession in Canada: a scoping review protocol. JBI Evid Synth 2021; 19:883-890. [PMID: 33074986 DOI: 10.11124/jbisrir-d-19-00376] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to synthesize the evidence on African Canadian nurses in the nursing profession in Canada. INTRODUCTION With approximately 1.2 million people of African descent, Canada has committed to addressing the United Nations' decade for people of African descent. Intergenerational racism continues to result in multisectoral discrimination against African Canadians. Studies suggest that African Canadians are under-represented in nursing, and encountering systemic barriers to entering and advancing in the profession. Additionally, African Canadian nurses experience racism from patients and colleagues, as well as systemic racism through hiring and promotion. INCLUSION CRITERIA This review will consider sources that include African Canadian nurses who identify as Black or as of African descent. All levels of professional nursing practice will be included (practical nurses, registered nurses, and advanced practice nurses, including nurse practitioners and clinical nurse specialists). Qualitative, quantitative, and mixed methods studies and gray literature will be searched. METHODS This review will be conducted in accordance with the JBI methodology. Databases to be searched from inception to the present include CINAHL, MEDLINE, Embase, Sociological Abstracts, Gender Studies Database, America: History and Life, PsycINFO, Academic Search Premier, and Scopus. Studies published in English and French will be included. A comprehensive search strategy developed with a librarian will be used to retrieve relevant sources. Two independent screeners will screen titles and abstracts as well as full texts of relevant sources. Data will be extracted by two independent extractors then presented narratively, using appropriate tables and figures. SYSTEMATIC REVIEW REGISTRATION NUMBER Open Science Framework Preregistration October 3, 2019. Open Science Framework Link for Abstract https://osf.io/6a2fe/?view_only=57d86d5b7c1d464182692d0f4bb9b396.
Collapse
Affiliation(s)
- Keisha Jefferies
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Ruth Martin-Misener
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | | | - Melissa Helwig
- W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada
| | - Wanda Thomas Bernard
- Senate of Canada, Ottawa, Canada.,School of Social Work, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Jacqueline Gahagan
- School of Health and Human Performance, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
50
|
Almukhaini S, Martin-Misener R, Weeks LE, Macdonald M, Hussain H, Macdonald D, Al-Ismaili Z, Al-Fahdi N, Rothfus MA. Advanced practice nursing roles in Arab countries in the Eastern Mediterranean region: a scoping review protocol. JBI Evid Synth 2021; 19:891-898. [PMID: 32881729 DOI: 10.11124/jbies-20-00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE The objective of this review is to explore and synthesize evidence regarding the advanced practice nursing roles in Arab countries in the Eastern Mediterranean region. INTRODUCTION Many countries have witnessed an increase in the number and types of advanced practice nursing roles. The literature has documented many positive patient outcomes associated with care provided by advanced practice nurses. The International Council of Nurses claims that advanced practice nursing is country-sensitive. Despite the availability of international literature that explores advanced practice nursing roles globally, little attention has been given to advanced practice nursing roles in Arab countries in the Eastern Mediterranean region. INCLUSION CRITERIA This review will consider studies related to advanced practice nursing roles, such as the historical development, role title, regulations, entry level education, role implementation, and outcomes, in Arab countries in the Eastern Mediterranean region. METHODS A comprehensive systematic search will be completed for both published and non-published literature using CINAHL (EBSCO), PubMed (NLM), PsycINFO, Embase (Elsevier), Nursing and Allied Health (ProQuest), Scopus (Elsevier), and websites such as Google Scholar, ProQuest Dissertations and Theses, International Council of Nurses' Nurse Practitioner/Advanced Practice Nursing Network, World Health Organization regional office for the Eastern Mediterranean, and nursing associations and ministries of health in Arab countries. The search will include literature published in Arabic and English, from the inception of databases to present.
Collapse
Affiliation(s)
- Salma Almukhaini
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Ruth Martin-Misener
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Lori E Weeks
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Marilyn Macdonald
- School of Nursing, Dalhousie University, Halifax, NS, Canada.,Aligning Health Needs and Evidence for Transformative Change (AH-NET-C): A JBI Centre of Excellence, Halifax, NS, Canada
| | - Haifaa Hussain
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | | | | | - Melissa A Rothfus
- W.K. Kellogg Health Sciences Library, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|