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Looks at the turnaround safety performance in the Kenora, Ontario pulp and paper mill of Rainy River Forest Products Inc. which used a questionnaire survey technique. Description on the model developed for safety management; Elements assessed in the questionnaire developed; Survey results; Steps taken by the company to improve its safety rules. INSET: Beliefs & Practices for Excellence in Safety on Which the Model.

Background: The use of the Internet to administer questionnaires has many potential advantages over the use of pen-and-paper administration. Yet it is important to validate Internet administration, as most questionnaires were initially developed and validated for pen-and-paper delivery. While some have been validated for use over the Internet, these questionnaires have predominately been used amongst the healthy general population. To date, information is lacking on the validity of questionnaires administered over the Internet in patients with chronic diseases such as heart failure. Objectives: To determine the validity of three heart failure questionnaires administered over the Internet compared to pen-and-paper administration in patients with heart failure. Methods: We conducted a prospective randomized study using test-retest design comparing administration via the Internet to pen-and-paper administration for three heart failure questionnaires provided to patients recruited from a heart failure clinic in Toronto, Ontario, Canada: the Kansas City Cardiomyopathy Questionnaire (KCCQ), the Minnesota Living with Heart Failure Questionnaire (MLHFQ), and the Self-Care Heart Failure Index (SCHFI). Results: Of the 58 subjects enrolled, 34 completed all three questionnaires. The mean difference and confidence intervals for the summary scores of the KCCQ, MLHFQ, and SCHFI were 1.2 (CI -1.5 to 4.0, scale from 0 to 100), 4.0 (CI -1.98 to 10.04, scale from 0 to 105), and 10.1 (CI 1.18 to 19.07, scale from 66.7 to 300), respectively. Conclusions: Internet administration of the KCCQ appears to be equivalent to pen-and-paper administration. For the MLHFQ and SCHFI, we were unable to demonstrate equivalence. Further research is necessary to determine if the administration methods are equivalent for these instruments. [ABSTRACT FROM AUTHOR]

The purpose of this study is to provide an overview of patients' experiences using a precision medicine (PM) clinic that conducts pharmacogenomics-based (PGx) testing for adverse drug reactions. The study aimed to identify the features of the clinic valued most by patients and areas for improvement. A paper survey was used to collect data. Survey questions focused on patients' perceptions of the PM testing and the overall clinic experience. Sixty-seven patients completed the survey. Quantitative data were analyzed using SPSS and frequencies were reported. Open-ended responses were coded and organized thematically. Patients reported that the clinic services increased confidence in their medication usage. Feeling respected by staff, receiving education, and quick appointments were highly valued by patients. Suggested areas for improvement included better communication from the clinic to patients, expansion of clinic services, and education for other healthcare providers. The findings demonstrate that patient experience goes beyond the clinical care provided. Current and potential future providers of PM should invest the time and energy to configure their care delivery system to enhance the patient experience. [ABSTRACT FROM AUTHOR]

This paper describes the findings from a study that explored Professional Quality of Life (ProQoL) among TR practitioners working in long term-care homes in Ontario, Canada. ProQoL incorporates positive (e.g., compassion satisfaction) and negative (e.g., compassion fatigue and burnout) aspects of working in healthcare (Stamm, 2010). Limited research exists exploring ProQoL from the perspective of TR practitioners working in LTC homes. To address this gap, four TR practitioners were interviewed to explore past and present experiences that contribute to ProQoL and write personal narratives that embody moments of compassion satisfaction and compassion fatigue. Narrative thematic analysis revealed three threads of ProQoL among practitioners: fueling the soul through connection and purpose, draining the TR spirit through workplace conflict and role ambiguity, and developing professional valour. Findings suggest that although practitioners derive great fulfillment from their careers, workplace culture and relational conflict are chronic challenges that erode the ProQoL of professionals. Recommendations for future research and practice are offered. [ABSTRACT FROM AUTHOR]

Tenant experience surveys are a key tool for social housing landlords to gauge their success in providing high quality housing. This paper examines feedback from a tenant experience survey facilitated in a low-income housing seniors' housing community to: (1) examine their perceptions of their housing across key domains related to tenant satisfaction; and (2) identify opportunities they felt would improve their housing experience. A total of 1,114 households completed the survey. Results showed that tenants generally had high satisfaction with property management, safety and security, communication with staff, access to services, community support, and tenancy management. However, open-ended comments from tenants highlighted specific situations that negatively impacted their housing, including maintenance issues, safety concerns, and limited access to health and social programs. Findings point to several suggestions for social housing providers to enhance their services to foster inclusive, supportive, and safe housing environments for low-income older adults. [ABSTRACT FROM AUTHOR]

Like other public safety professions, paramedicine has historically been a male-dominated occupation. Although women are increasingly choosing paramedicine as a career, participation in leadership roles remains limited. Drawing on data from a comprehensive mental health survey, we describe the proportion of women in leadership in a single, large, urban paramedic service in Ontario, Canada. We distributed an in-person, paper-based survey during the fall 2019 - winter 2020 continuing medical education sessions. Participating paramedics completed a demographic questionnaire alongside a battery of mental health screening tools. We assessed the demography of the workforce and explored differences in employment classification, educational achievement, clinician level (e.g., primary vs. advanced care), and participation in formal leadership roles along self-reported gender lines. Out of 607 paramedics attending, we received 600 completed surveys, with 11 excluded for missing data, leaving 589 for analysis and a 97% response rate. Women comprised 40% of the active-duty paramedic workforce, with an average of 8 years of experience. Compared to men, women were more than twice as likely to have university degrees (odds ratio [OR] 2.02, 95% compatibility interval [CI] 1.45–2.83), but almost half as likely to practice at the advanced care paramedic level (OR 0.61, 95% CI 0.42–0.88), and potentially less likely to be employed full-time (OR 0.77, 95% CI 0.54–1.09). Women were nearly 70% less likely to hold leadership roles in the service compared to men (OR 0.36, 95% CI 0.14–0.90), occupying 20% of leadership positions. Although paramedicine is witnessing an encouraging shift in the demography of its workforce, our results point to a potential under-representation of women in leadership roles. Future research should focus on identifying and ameliorating barriers to career advancement among women and other historically underrepresented people. [ABSTRACT FROM AUTHOR]

Presently, child-specific tools and instruments related to active school travel (AST) are lacking. This methodological shortcoming often contributes to suboptimal AST behaviour evaluations and intervention programming. The aim of this paper was to develop and validate a theoretically informed child-specific scale regarding multiple perceived barriers and enablers known to impact children's participation in AST. Mixed methods. A mixed-methods and multistudy scale development approach featuring the application of social-ecological theory, a validation pilot study (n = 80), and test-retest study (n = 96) was conducted in collaboration with children in Ontario, Canada. In tandem with completing cognitive interviews and online surveys, multiple analyses, including a qualitative thematic analysis, along with weighted Cohen's kappa, Cronbach's alpha, and confirmatory factor analysis were undertaken. Qualitative analyses of the developed tool addressed face validity concerns related to the response options and definitions of terms used. Following the reliability analyses of 40 items, two confirmatory factor analyses were run to assess the construct validation of perceived AST barriers and enablers, and resulted in the development of the 24-item Perceived Active School Travel Enablers and Barriers – Child (PASTEB-C) questionnaire. The developed PASTEB-C questionnaire may be used to inform the programming and development of AST interventions, as well as conduct child-specific AST research. [ABSTRACT FROM AUTHOR]

Objective: To establish the reliability, validity, and sensitivity to change of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) among Chinese subjects with osteoarthritis (OA) of the knee, living in mainland China.Methods: A multicenter, randomized, double-blind, placebo-controlled, parallel-group study was conducted for validation of the electronic personal digital assistant version of the WOMAC Numerical Rating Scale (NRS) 3.1 Index in China. A total of 287 subjects with OA of the knee were randomized to receive either meloxicam (15 mg) or placebo. Psychometric properties of the WOMAC were evaluated by estimating the reliability, validity, and sensitivity to change. Equivalence of the electronic version was also compared with the paper version.Results: Intraclass correlation coefficients for the WOMAC pain, stiffness, and physical function subscales were 0.81, 0.76, and 0.85, respectively, indicating good test-retest reliability. Similarly, internal consistency was strong (Cronbach's alpha for the 3 WOMAC subscales was 0.84, 0.86, and 0.96, respectively). Pearson's correlation coefficients for WOMAC pain and Short Form 36 health survey (SF-36) bodily pain, as well as WOMAC physical function and SF-36 physical functioning domains were >0.4, indicating convergent validity, whereas the coefficients for all 3 WOMAC domains with SF-36 mental health and mental health component scores were <0.4, indicating divergent validity. There was strong discriminant validity between healthy volunteers and OA patients. The effect sizes of change from baseline to week 12 in WOMAC subscale scores were large, demonstrating sensitivity to change. Equivalence between paper and electronic versions was very high.Conclusion: The culturally and linguistically validated Chinese version of the WOMAC NRS 3.1 for mainland China is psychometrically robust in its validity, reliability, and sensitivity to change for patients with OA of the knee. [ABSTRACT FROM AUTHOR]

Background: Access to high-quality primary care has been identified as a pressing need for adults with intellectual and developmental disabilities (IDD). Adults with IDD live with complex physical and mental health conditions, use health services differently than the general population and continue to face challenges when accessing health services. Interprofessional primary care teams offer comprehensive and coordinated approaches to primary care delivery and are well-positioned to address the needs of adults with IDD and other vulnerable populations. Although interprofessional primary care teams are recommended, there is currently limited understanding of how interprofessional care is delivered and how access to a team of providers improves the health of this population. The aim of this paper is to describe the organizational attributes of interprofessional primary care for adults with IDD within and across models of team-based care in one local health service context. Methods: A multiple case study was conducted with five interprofessional primary care teams in Ontario, Canada. Multiple methods were used to generate data including: a survey, document review, electronic medical record report and qualitative interviews. Pattern matching was the primary analytic approach for the within and across case analysis. Results: Adults with IDD were found to be a small part of the patient population served and this group was poorly identified in three of five teams. Key organizational attributes that support the delivery of interprofessional primary care for adults with IDD were identified. Two examples of targeted programs of care for this group were also found. Despite the presence of interprofessional health providers in all teams, there were limited organizational processes to engage a wide-range of interprofessional services in the care of this group. There was no consistent reporting of outcomes or processes in place to measure the impact of interprofessional services for this population. Conclusions: This study provides important insights into the current state of interprofessional primary care for adults with IDD in Ontario and highlight a critical need for further work in the field to develop organizational structures and processes to engage in team-based care and demonstrate the value of the approach for this population. [ABSTRACT FROM AUTHOR]

Purpose: Burnout has been studied by organizational researchers for nearly 50 years (Maslach and Schaufeli, 2017; Schaufeli et al., 2009); however, little attention is given to burnout experienced by employed students who may be prone to the symptoms of burnout as they juggle multiple demanding roles. Burnout in employed students has previously been conceptualized as a bi-factor model consisting of three dimensions: general burnout, apathy and exhaustion (see Rauti et al., 2019 for further information). The purpose of this paper is to develop and validate a novel and theoretically driven tool to assess burnout in employed students. Design/methodology/approach: A sample of 239 employed undergraduate students from a university in southwestern Ontario completed an online survey which included the University of Windsor Employed Student Burnout Survey. Participants also completed six additional measures for scale validation purposes. Findings: Confirmatory factor analysis supported a four-factor model of the employed student burnout scale: apathy toward employment, exhaustion toward employment, apathy toward academics and exhaustion toward academics. The findings also supported a bi-factor version of the four-factor model. Correlation analyses provided evidence for convergent and divergent validity. Originality/value: The experience of burnout for employed students is unique as employed students balance the demands of work and school simultaneously. This research suggests that experiences of burnout from work and burnout from school may be distinct from one another and that burnout is context specific. [ABSTRACT FROM AUTHOR]

Background: Persons with disabilities (PWD) are more likely to visit the emergency department (ED) and often have complex health needs when accessing care in the ED. Yet there is limited understanding of ED care experiences among PWD, especially in a Canadian context. The aim of this study was to examine the ED care experiences of PWD in contrast to a comparison group in Kingston, Ontario to better understand their health care needs. Methods: A mixed-methods study with a community-based participatory approach examining participants' past ED care experiences (within 24 months) was conducted in Kingston, ON. Quantitative data from those with disabilities and those from the comparison group were compared using chi squared tests to identify differences between groups. An inductive and deductive thematic analysis approach was used to identify themes in the shared qualitative data. Convergence of findings across quantitative and qualitative data was undertaken. Results: A total of 175 participants identified as having a disability. In contrast with the comparison group (N = 949), PWD were more likely to report being given too little attention to their needs (p < 0.001), that it was more important to be treated with kindness/respect than to receive the best possible medical care (p < 0.001), to report feelings of disrespect and/or judgement (p < 0.001), and that better understanding of personal identity/situation/culture and better communication would improve ED care. Qualitative analysis highlighted the following themes: poor communication between PWD and health care providers (HCP), compassionate medical care received, perceived HCP negative attitudes/beliefs related to having a disability and substance misuse, and perceived HCP lack of knowledge/skill to treat the unique health needs of PWD. Conclusion: Findings highlight the need to improve ED care for PWD. Future quality improvement initiatives should focus on incorporating a deeper understanding of disability into medical education and emergency medicine (EM) residency education, designing curricula that emphasize cultural humility, and implementing community-based placements providing opportunities for health professionals to work with and learn from PWD. [ABSTRACT FROM AUTHOR]

Background: Workplace violence and harassment are commonplace for healthcare workers and most incidents are unreported. Normalization of these experiences, lack of confidence in reporting systems, and fear of the consequences of reporting contribute to the invisibility of these experiences. Challenges are exacerbated in homecare settings and for precarious workforces including Personal Support Workers (PSWs). We created, piloted, and evaluated an intervention to enhance safety culture and encourage reporting of workplace violence and harassment. Methods: A multi-stakeholder steering committee designed an intervention combining policy changes, a pre-visit screening tool, education, and brief end-of-visit reporting. This was piloted with a PSW care team which provided >55,000 client visits during the 32-week intervention. Operational metrics characterized screening, education, and reporting uptake. Pre- and post-intervention surveys characterized PSWs' experiences with workplace violence and harassment, reporting experiences, training history and intervention feedback. Findings: PSWs reported increased comfort discussing workplace violence and harassment, and increased confidence managing client-to-worker incidents. The screening went smoothly with most clients in private homes. Most PSWs (75%) engaged at least once with end-of-visit reporting and nearly half submitted reports regularly. During the pilot, 21% of PSWs reported incidents and 52% of reports shared client-specific strategies for managing these situations. Application to Practice: Changes in comfort and behavior with reporting indicated a shift toward a more open culture surrounding workplace violence and harassment. Tools created for this intervention and lessons for implementation are shared for consideration by occupational health practitioners throughout the homecare sector. [ABSTRACT FROM AUTHOR]

Background: We initially reported on the cost-effectiveness of a 6-month randomized controlled implementation trial which evaluated Health TAPESTRY, a primary care program for older adults, at the McMaster Family Health Team (FHT) site and 5 other FHT sites in Ontario, Canada. While there were no statistically significant between-group differences in outcomes at month 6 post randomization, positive outcomes were observed at the McMaster FHT site, which recruited 40% (204/512) of the participants. The objective of this post-hoc study was to determine the cost-effectiveness of Health TAPESTRY based on data from the McMaster FHT site. Methods: Costs included the cost to implement Health TAPESTRY at McMaster as well as healthcare resource consumed, which were costed using publicly available sources. Health-related-quality-of-life was evaluated with the EQ-5L-5L at baseline and at month 6 post randomization. Quality-adjusted-life-years (QALYs) were calculated under an-area-under the curve approach. Unadjusted and adjusted regression analyses (two independent regression analyses on costs and QALYs, seemingly unrelated regression [SUR], net benefit regression) as well as difference-in-difference and propensity score matching (PSM) methods, were used to deal with the non-randomized nature of the trial. Sampling uncertainty inherent to the trial data was estimated using non-parametric bootstrapping. The return on investment (ROI) associated with Health TAPESTRY was calculated. All costs were reported in 2021 Canadian dollars. Results: With an intervention cost of $293/patient, Health TAPESTRY was the preferred strategy in the unadjusted and adjusted analyses. The results of our bootstrap analyses indicated that Health TAPESTRY was cost-effective compared to usual care at commonly accepted WTP thresholds. For example, if decision makers were willing to pay $50,000 per QALY gained, the probability of Health TAPESTRY to be cost effective compared to usual care varied from 0.72 (unadjusted analysis) to 0.96 (SUR) when using a WTP of $50,000/QALY gained. The DID and ROI analyses indicated that Health Tapestry generated a positive ROI. Conclusion: Health TAPESTRY was the preferred strategy when implemented at the McMaster FHT. We caution care in interpreting the results because of the post-hoc nature of the analyses and limited sample size based on one site. [ABSTRACT FROM AUTHOR]

Understanding how informal care impacts formal care utilisation for home‐based end‐of‐life patients is an important policy‐ and practice‐relevant question. This paper aims to assess the relationship between informal and formal home care among home‐based end‐of‐life patients and how this relationship has changed over the last decade and over the end‐of‐life trajectory. We focus on informal care provided by family members or friends, and three types of home‐based formal care services: care by personal support workers, physician visits, and nurse visits. Using survey data collected in a home‐based end‐of‐life care programme in Ontario, Canada from 2005 to 2016, we build a two‐part utilisation model analysing both the propensity to use each type of formal care and the amount of formal care received by patients. The results suggest that informal care is a substitute for care by personal support workers, but a complement to physician visits and nurse visits. In the case of nurse visits, an increased complementary effect is observed in more recent years. For home‐based physician and nurse visits, the complementary effect grows with patient's proximity to death. These results highlight the complexity of the relationship between informal and formal care among home‐based end‐of‐life patients. Decision‐makers need to take into account the relationship between informal care and different types of formal services when introducing future policies. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether technology-assisted toilets (TATs) could be used to improve toileting hygiene and independence for geriatric rehabilitation patients. TATs are commercially available toilet seats that use a stream of warm water to clean the user, have a fan for drying and are operated by a remote control. Materials and methods: Twenty-five geriatric rehabilitation in-patients were recruited, six completed the study, and seven partially completed the study. Each participant had two trial bowel movements. One trial involved cleaning themselves with toilet paper; the other involved cleaning themselves with the TAT functions. After each trial, participants received a visual inspection for cleanliness and answered the Psychosocial Impact of Assistive Devices Scale (PIADS), a validated scale, to assess their sense of competence, adaptability and self-esteem in the bathroom. A toileting cleanliness scale, designed for this study, was completed by a nurse after TAT usage. Participants received a score from 1 (completely clean) to 4 (completely soiled) based on a visual inspection after cleaning. Results: TAT and toileting cleanliness scores were similar. PIADS scores showed a trend towards higher scores when using the TAT, but results were not statistically significant. Conclusions: TATs cleaned as well as standard toileting in geriatric rehabilitation inpatients. Participants indicated that TATs improved their sense of competence, adaptability and self-esteem. Geriatricians and rehabilitation professionals should consider prescribing TATs in their practice as an assistive device in order to promote patient independence and dignity and reduce the burden of care for patients requiring toileting assistance. Implications for rehabilitation: Technology-assisted toilets (TATs) are commercially-available toilet seats that could be used to allow rehabilitation patients to clean themselves more independently in the bathroom. Improved toileting independence can reduce burden of care of geriatric rehabilitation and reduce the impact of toileting assistance on patient dignity and self-esteem. Physiatrists should consider recommending TATs to their patients but should take into account whether a patient’s particular set of disabilities will allow them to use a TAT effectively. [ABSTRACT FROM AUTHOR]

As our population ages, more seniors will require care in long-term care (LTC) homes, including care from recreation therapists and staff . This study examined recreation therapists and staff 's retrospective views of what would make them better prepared for working in LTC homes. A questionnaire distributed to 290 LTC homes in Ontario was completed by 487 recreation therapists and staff . Data were analyzed using ANOVAS and frequencies. Participants ranked experience as the most important and education as the least important factor for preparing them to work in LTC. Participants indicated increased practicum experience and knowledge of charting and documentation would help prepare them to work in LTC. The results of our study suggest the need for further training in gerontological competences for TR students, such as incorporating interprofessional collaboration and experience into TR curricula. TR practitioners can also enhance their learning by collaborating with others through communities of practice. [ABSTRACT FROM AUTHOR]

Copyright of Applied Physiology, Nutrition & Metabolism is the property of Canadian Science Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The Canadian government's plan to support a balanced distribution of immigrants throughout the nation has contributed to newcomers' dispersion to small town communities and rural areas. However, very little work has examined the health experiences of immigrants settling in smaller urban and rural regions. Even less literature exists on the perspectives of service providers working with newcomers in Canada's urban-rural communities. This paper focuses on a part of a larger Community-based study on 'Newcomer Settlement and Integration in Education, Training, Employment, Health and Social Support' in Brantford-a middle-sized urban/rural region in Ontario, Canada-and discusses the findings in the health domain. Data were generated from 212 service providers and 237 newcomers using both qualitative and quantitative research tools. Newcomers identified several barriers in accessing mental and/or physical health services including lack of culturally appropriate services and discrimination. The striking differences between newcomers' and service providers' responses to the survey questionnaires bring to light cultural variations between the newcomers' and the service providers' perceptions of 'health'. The findings reinforce the need for including newcomers in developing more inclusive and culturally-appropriate health services and programs. [ABSTRACT FROM AUTHOR]

Aim: The study aimed to compare the effectiveness of telehealth-based home exercises and conventionally prescribed home exercises in patients with degenerative meniscal tears. Material and Method: A two-armed, randomized controlled study was conducted with 49 participants with degenerative meniscal disease. Patients were randomized into Telerehabilitation (TR=25) and Conventional Home Exercise Rehabilitation (CR=24) groups. The TR group provided video exercises and self-management education via an online platform. The same protocol was given to the CR group in the clinical setting. Pain with Visual Analog Scale, muscle strength with Hand-Held Dynamometer, proprioception with Baseline bubble inclinometer, functional status with Western Ontario and McMaster Universities Osteoarthritis Index, exercise adherence with Exercise Adherence Rating Scale, quality of life with Short Form-12 were evaluated at baseline and after eight weeks of intervention. In addition, satisfaction and usability were assessed with the Telemedicine Satisfaction and Usefulness Questionnaire at week 8. Results: The TR group improved activity pain, proprioception, some parameters of the muscle strength outcomes, and exercise adherence scores (p<0.05). The TR group was not superior to the CR group regarding pain at rest, quality of life and functional status (p>0.05). In addition, 52 percent of the TR group reported high levels of satisfaction and usability. Conclusion: Despite increased participation and satisfaction, the telerehabilitation group noticed improvements in clinician-based measures (proprioception, strength) but not in rest pain, function, and quality of life. As a result, telerehabilitation-based home exercises prescribed to these patient groups are more effective. [ABSTRACT FROM AUTHOR]

Introduction: With our rapidly expanding population of older adults, identifying effective intervention strategies to improve cognitive functioning is an increasing priority. This study sought to examine whether 4 weeks of thrice-weekly meditation training can improve attention in older adults, as well as whether such benefits may extend to other domains of cognition as well as mobility. Methods: Forty-three participants (mean age 68 years) were randomized into either the focused attention meditation group or the music listening control group (Clinicaltrials.gov ID NCT03417635). Participants completed three 20- minute guided group sessions per week for four consecutive weeks. Our primary outcome measure was behavioural performance on the Sustained Attention to Response Task (SART). Secondary and tertiary outcome measures included event-related potentials (ERPs) during the SART task, measures of executive functioning, and measures of mobility. Results: We found that meditation training significantly improved attention, as demonstrated by improved SART accuracy and changes in N2 ERP amplitude and latency. Discussion: These findings suggest that meditation may lead to changes in attention and underlying cognitive processing in older adults, although a fullscale definitive trial is needed. Future research on the long-term benefits with real world applications is warranted. [ABSTRACT FROM AUTHOR]

Background: Continuity is a fundamental tenet of primary care, and highly valued by patients; it may also improve patient outcomes and lower cost of health care. It is thus important to investigate factors that predict higher continuity. However, to date, little is known about the factors that contribute to continuity. The purpose of this study was to analyse practice, provider and patient predictors of continuity of care in a large sample of primary care practices in Ontario, Canada. Another goal was to assess whether there was a difference in the continuity of care provided by different models of primary care. Methods: This study is part of the larger a cross-sectional study of 137 primary care practices, their providers and patients. Several performance measures were evaluated; this paper focuses on relational continuity. Four items from the Primary Care Assessment Tool were used to assess relational continuity from the patient's perspective. Results: Multilevel modeling revealed several patient factors that predicted continuity. Older patients and those with chronic disease reported higher continuity, while those who lived in rural areas, had higher education, poorer mental health status, no regular provider, and who were employed reported lower continuity. Providers with more years since graduation had higher patient-reported continuity. Several practice factors predicted lower continuity: number of MDs, nurses, opening on weekends, and having 24 hours a week or less on-call. Analyses that compared continuity across models showed that, in general, Health Service Organizations had better continuity than other models, even when adjusting for patient demographics. Conclusions: Some patients with greater health needs experience greater continuity of care. However, the lower continuity reported by those with mental health issues and those who live in rural areas is concerning. Furthermore, our finding that smaller practices have higher continuity suggests that physicians and policy makers need to consider the fact that 'bigger is not always necessarily better'. [ABSTRACT FROM AUTHOR]

Participation has a subjective and private dimension, and so it is important to hear directly from youth about their experiences in various activity settings, the places where they “do things” and interact with others. To meet this need, our team developed the Self-Reported Experiences of Activity Settings (SEAS) measure, which demonstrated good-to-excellent measurement properties. To address the needs of youth who could benefit from graphic symbol support, the SEAS-PCSTM,1was created. The purpose of this paper is to describe the development of SEAS-PCS and the preliminary study that explores the equivalency of the SEAS and SEAS-PCS. The SEAS and SEAS-PCS were compared in terms of the equivalency of meaning of stimulus items by 11 professionals and five adults who used augmentative and alternative communication, were familiar with PCS, and were fluent readers. Out of 22 items, 68% were rated as highly similar on a 5-point scale (M = 4.14;SD = .70;mdn = 4; range: 2.81–5.00). Subsequently, the 32% of the SEAS-PCS items that were rated below 4 were modified based on the participants’ specific comments. Further work is required to validate the SEAS-PCS. The next step could involve exploring the views of youth who use AAC. [ABSTRACT FROM PUBLISHER]

This article uses an intersectionality lens to explore how experiences of race, gender, sexuality, class and their intersections are associated with depression and unmet need for mental healthcare in a population of 704 women and transgender/gender liminal people from Ontario, Canada. A survey collecting demographic information, information about mental health and use of mental healthcare services, and data for the Everyday Discrimination Scale and the PHQ-9 Questionnaire for Depression was completed by 704 people via Internet or pen-and-paper between June 2011 and June 2012. Bivariate and regression analyses were conducted to assess group differences in depression and discrimination experiences, and predictors of depression and unmet need for mental healthcare services. Analyses revealed that race, gender, class and sexuality all corresponded to significant differences in exposure to discrimination, experiences of depression and unmet needs for mental healthcare. Use of interaction terms to model intersecting identities and exclusion contributed to explained variance in both outcome variables. Everyday discrimination was the strongest predictor of both depression and unmet need for mental healthcare. The results suggest lower income and intersections of race with other marginalised identities are associated with more depression and unmet need for mental healthcare; however, discrimination is the factor that contributes the most to those vulnerabilities. Future research can build on intersectionality theory by foregrounding the role of structural inequities and discrimination in promoting poor mental health and barriers to healthcare. [ABSTRACT FROM AUTHOR]

African Canadians comprise 2.5% of the population, but represent 9.5% of federal inmates - an increase of 80% since 2003-2004. Recidivism among federal inmates is high (about 40%). This paper outlines the findings, at 9 months after enrolment during 2011-2012, of a randomised controlled trial testing the effectiveness and cost of Redemption Reintegration Services ( RRS), a culturally specific, multi-level intervention for young African Canadian former inmates. Retention at 9 months was 95% of those randomised ( n = 115 per group) to RRS ( n = 114) or usual reintegration services ( n = 105) offered by the municipality. The primary outcomes were recidivism and service costs. Mediating and moderating measures were Personality Strengths, Developmental Assets, Meaning in Life, the Structured Assessment of Violence Risk in Youth, the Youth Behaviour Checklist and Neighbourhood Vitality. Compared with the usual care group, the RRS group showed significant improvements in: self-reported Personality Strengths, Developmental Assets, the presence and search for Meaning in Life, social and individual risk factors, behaviour, and life events such as obtaining stable housing and enrolling in school. At 9 months, RRS participants generated significantly lower per person per annum expenditures for law enforcement services, housing services and total direct costs. Among RRS participants, 3.5% reported being re-charged for offences in the previous 9 months compared with 45.7% of the usual care group. The 2010-2011 average annual cost per person for incarceration was $114,364. The 48 individuals in the usual care group and 4 in RRS would generate costs of $5,489,472 and $457,456, respectively - a $5 million difference. We conclude that, at 9 months, RRS is more effective and less expensive than usual reintegration services for young African Canadians. [ABSTRACT FROM AUTHOR]

Background: Many community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through lifestyle modifications. However, the evidence for their effectiveness is contradictory and weakened by reliance on single-group designs and/or small samples. Additionally, older adults with multiple chronic conditions (MCC) are often excluded because of recruiting and retention challenges. This paper presents a protocol for a two-armed, multisite, pragmatic, mixed-methods RCT examining the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP), a new 6-month interprofessional, nurse-led program to promote self-management in older adults (aged 65 years or older) with T2DM and MCC and support their caregivers (including family and friends).Methods/design: The study will enroll 160 participants in two Canadian provinces, Ontario and Alberta. Participants will be randomly assigned to the control (usual care) or program study arm. The program will be delivered by registered nurses (RNs) and registered dietitians (RDs) from participating diabetes education centers (Ontario) or primary care networks (Alberta) and program coordinators from partnering community-based organizations. The 6-month program includes three in-home visits, monthly group sessions, monthly team meetings for providers, and nurse-led care coordination. The primary outcome is the change in physical functioning as measured by the Physical Component Summary (PCS-12) score from the short form-12v2 health survey (SF-12). Secondary client outcomes include changes in mental functioning, depressive symptoms, anxiety, and self-efficacy. Caregiver outcomes include health-related quality of life and depressive symptoms. The study includes a comparison of health care service costs for the intervention and control groups, and a subgroup analysis to determine which clients benefit the most from the program. Descriptive and qualitative data will be collected to examine implementation of the program and effects on interprofessional/team collaboration.Discussion: This study will provide evidence of the effectiveness of a community-based self-management program for a complex target population. By studying both implementation and effectiveness, we hope to improve the uptake of the program within the existing community-based structures, and reduce the research-to-practice gap.Trial Registration: ClinicalTrials.gov, Identifier: NCT02158741 . Registered on 3 June 2014. [ABSTRACT FROM AUTHOR]

Copyright of Physiotherapy Canada is the property of University of Toronto Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Canadian Journal of Midwifery Research & Practice is the property of Canadian Association of Midwives and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The current paper introduces the notion of clinically relevant subtypes of emotion regulation behaviours. A new measure of emotion regulation, the Complexity of Emotional Regulation Scale (CERS), was established as psychometrically sound. It was positively correlated with a measure of emotional awareness ( r = 0.28, p < 0.001) and negatively correlated with measures of self-criticism ( r = −0.28, p < 0.001) and depression ( r = −0.35, p = 0.025), among others. Participants were drawn from two samples: clients from a university counselling centre and a non-clinical student sample. Comparisons were conducted between non-clinical and clinical samples to determine the effects of depression and other symptoms of psychopathology on participant's generation of strategies for emotion regulation. Participants in the clinical sample more often identified an intention to soothe but did not follow through as compared with the non-clinical group, F(1, 198) = 4.662, p < 0.04. Furthermore, individuals in the non-clinical sample were more likely to engage in specific, meaning-making strategies when compared with the clinical group, F(1, 198) = 5.875, p < 0.02. Implications from the current studies suggest the possible applicability of the CERS to clinical settings using an interview rather than questionnaire format. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Message: Emotion regulation should be thought of as being on a continuum of complexity, where strategies range from general ('one size fits all') action to specific ('personal and idiosyncratic') meaning. The best emotion regulation strategy depends on a client's presenting difficulty and level of distress. [ABSTRACT FROM AUTHOR]

Although a recovery approach is relevant to older adults, a significant gap exists in social work literature regarding mental health recovery among ethnic/racial minority older adults. This paper explores the meaning of 'recovery' and the applicability of the Wellness Recovery Action Plan (WRAP), a recovery-based programme, to Japanese-Canadian older adults through qualitative data collected as part of an evaluation of two WRAP workshop series in a metropolitan city in Canada, 2010-12. All eight workshop participants (two male and six female, all Japanese speakers, aged sixty-four to eighty-nine years) took part in the study. A strength-based critical social work approach, which incorporates the understanding of resilience and hope and the intersectionality of oppression, was used to facilitate the programme. Qualitative data analysis identified key themes of the participants' workshop experiences, including reaffirming self-worth, being positive (hope), being self-reflective and mindful, supporting each other and advocating for themselves. The participants experienced positive changes in line with Jacobson and Greenley's (2001) internal and external conditions for recovery; in particular, it found an unexpected long-term outcome: the formation of a peer support group by participants. Social work practice in recovery is discussed. [ABSTRACT FROM AUTHOR]

Introduction. The unique demands of firefighting results in acute, recurrent, or chronic pain complications. We aimed to describe the percentage distribution of number and location of painful sites among FFs and determine whether work limitations differed based on the number or location of painful sites, age, and/or sex. Methods. About 325 firefighters completed a work limitation questionnaire (WLQ-26) and a checklist to indicate painful regions of the body using either a paper format or an online survey. A one-way ANOVA was employed to analyze the transformed work limitation scores; this was a two-sided test with a significance level of <0.05, to determine if work limitations differed among firefighters based on the number or location of painful sites, age, and/or sex. Results. The data analyzed consisted of 325 (men = 216 , women = 109) FFs in total. The percentage distribution of the number of painful sites in our study cohort was 43% no pain, 17% one painful site, 19% two painful sites, and 21% three or more painful sites. The percentage distribution of the locations of painful sites was 43% no pain, 41% spine, 9% lower extremity, and 7% upper extremity. An estimated 31% of FFs (n = 102) reported non-MSK comorbidities with 23% (n = 76) reporting at least one non-MSK comorbidity and 8% (n = 26) reported having two or more comorbidities. FFs > 45 years of age experienced more physical work limitations than FFs ≤ 45 years (mean difference: 0.74/10; 95% CI.19-1.29; p = 0.008). Conclusions. The majority of firefighters reported having at least one painful site and indicated the spine as the most common painful location. Age, the number of painful sites, and location of pain were identified as a potential contributor to physical/mental and work output limitations. [ABSTRACT FROM AUTHOR]

Aims and objectives The purpose of this research was to examine the lived experiences of women with inflammatory bowel disease, by specifically exploring their management of their illness after diagnosis. Background Inflammatory bowel disease is a chronic autoimmune disease that has no known cause or cure. It is composed of two types of conditions: Crohn's disease and Ulcerative Colitis which have similar signs and symptoms, but have distinct physiological properties. Currently, Canada has the highest reported prevalence and incidence rates of inflammatory bowel disease in the world (Molodecky et al. 2012). Despite these increasing rates, there is a lack of knowledge and understanding of the burdens associated with inflammatory bowel disease, in particular from the participant's perspective. Design & Methods Heuristic phenomenology was the theoretical orientation used for this study. Eight women (aged 30-50 years) with inflammatory bowel disease who resided in Southern Ontario were recruited. Each participant completed background questionnaires and a one-on-one semi-structured interview. Results Several salient themes were identified; however, this paper will solely focus on one theme, balancing my disease. To achieve balance, the women described changing dietary behaviours, adjusting daily routines and managing symptoms through medications. These modifications were described as being important in controlling inflammatory bowel disease symptomatology on a day-to-day basis. Conclusion There are many triggers for inflammatory bowel disease symptomatology. As such, the means in which those with inflammatory bowel disease manage their conditions varies. Participants discussed using a combination of strategies to control their condition. Relevance to clinical practice This information is important for patients living with inflammatory bowel disease, their support people, and healthcare professionals to identify various key strategies to improve the quality of life and well-being of those affected by inflammatory bowel disease. Furthermore, this research provided a voice to women diagnosed with inflammatory bowel disease by allowing them to openly convey their experiences of living with inflammatory bowel disease. [ABSTRACT FROM AUTHOR]

Aims The aims of this paper are to: (1) describe work characteristics that nurse faculty report encourage them to remain in or leave their academic positions; and (2) determine if there are generational differences in work characteristics selected. Background Nurse faculty play key roles in preparing new nurses and graduate nurses. However, educational institutions are challenged to maintain full employment in faculty positions. Design A cross-sectional, descriptive survey design was employed. Methods Ontario nurse faculty were asked to select, from a list, work characteristics that entice them to remain in or leave their faculty positions. Respondent data ( n = 650) were collected using mailed surveys over four months in 2011. Results While preferred work characteristics differed across generations, the most frequently selected incentives enticing nurse faculty to stay were having: a supportive director/dean, reasonable workloads, supportive colleagues, adequate resources, manageable class sizes and work/life balance. The most frequently selected disincentives included: unmanageable workloads, unsupportive organizations, poor work environments, exposure to bullying, belittling and other types of incivility in the workplace and having an unsupportive director/dean. Conclusion This research yields new and important knowledge about work characteristics that nurse faculty report shape their decisions to remain in or leave their current employment. Certain work characteristics were rated as important among all generations. Where similarities exist, broad strategies addressing work characteristics may effectively promote nurse faculty retention. However, where generational differences exist, retention-promoting strategies should target generation-specific preferences. [ABSTRACT FROM AUTHOR]

Background: Demographic, family, and home characteristics play an important role in determining childhood sedentary behaviour. The objective of this paper was to identify correlates of total sedentary time (SED) and correlates of self-reported screen time (ST) in Canadian children. Methods: Child- and parent-reported household, socio-demographic, behavioural, and diet related data were collected; directly measured anthropometric and accelerometer data were also collected for each child. Participants with complete demographic, anthropometric, and either SED (n=524, 41% boys) or ST (n=567, 42% boys) data from the Canadian site of the International Study of Childhood Obesity Lifestyle and the Environment (ISCOLE) were included in analysis. Sixteen potential correlates of SED and ST were examined using multilevel general linear models, adjusting for sex, ethnicity, number of siblings, and socio-economic status. All explanatory variables moderately associated (p<0.10) with SED and/or ST in univariate analyses were included in the final, fully-adjusted models. Variables that remained significant in the final models (p<0.05) were considered correlates of SED and/or ST. Results: Children averaged 8.5hours of daily SED; no differences in total SED, or total ST were seen between girls and boys, but boys reported significantly more video game/computer usage than girls. Boys also had higher waist circumference and BMI z-scores than girls. In the final models, waist circumference and number of TVs in the home were the only common correlates of both SED and ST. SED was also negatively associated with sleep duration. ST was also positively associated with mother's weight status, father's education, and unhealthy eating pattern score and negatively associated with healthy eating pattern score, and weekend breakfast consumption. Few common correlates existed between boys and girls. Conclusion: Several factors were identified as correlates of SED and/or of ST in Canadian children; however, few correlates were common for both SED and ST, and for both boys and girls. This suggests that a single strategy to reduce SED and ST is unlikely to be effective. Future work should examine a variety of other, non-screen based sedentary behaviours and their potential correlates in the hopes of creating tailored public health messages to reduce SED and ST in both boys, and girls. [ABSTRACT FROM AUTHOR]

The last decade has witnessed the movement of immigrants from Canada’s largest urban centers—Toronto, Vancouver, and Montreal—to smaller urban-rural communities. Nevertheless, very little scholarship exists on newcomer integration in these communities. Furthermore, social work literature examining the perspective of service providers who work with newcomers is lacking. Grand Erie is a middle-sized urban/rural region in Ontario, Canada that is experiencing increased migration of newcomers. This paper focuses on a part of a larger Community-based participatory research on ‘Newcomer Settlement and Integration in Education, Training, Employment, Health and Social Support’ in Grand Erie and discusses the findings in the education and training domain. Data were gathered from 212 newcomers (men and women) and 237 service providers using survey questionnaires. [ABSTRACT FROM AUTHOR]

This paper investigates the nature of the relationship between satisfaction with high school sexual health education and the pursuit of a post-secondary human sexuality course. In an initial study, first-year university students who received high school sexual health education in Ontario completed a questionnaire which assessed their satisfaction with sexual health education and asked whether students were pursuing or intended to pursue a human sexuality course in university. Students who were less satisfied with high school sexual health education and, in particular, those who did not rate sexual health education as contributing to their understanding of themselves as sexual beings, were more likely to pursue a university-level course. A second qualitative study investigated potential reasons underlying this correlation. Eleven first-year students enrolled in a human sexuality course were interviewed about (a) their satisfaction with their high school sexual health education and (b) their reasons for taking the course. The findings suggest that dissatisfaction with sexual health education may be a result of students perceiving they had not learned enough personally relevant information and/or received a biased education in high school. These factors, which seem to determine dissatisfaction, may motivate students to pursue additional education in university. [ABSTRACT FROM PUBLISHER]

Background: There is a significant proportion of workers with mental disorders who either are struggling at work or who are trying to return to work from a disability leave. Objective: Using a population-based survey of working adults in Ontario, Canada, this paper examines the perceptions of workers towards mental disorders in the workplace. Methods: Data are from a sample of 2219 working adults identified through random digit dialing who either completed a telephone questionnaire administered by professional interviewers or a web-based survey. Results: A third of workers would not tell their managers if they experienced mental health problems. Rather than a single factor, workers more often identified a combination of factors that would encourage disclosure to their managers. One of the most identified disincentives was the fear of damaging their careers. The most pervasive reasons for concerns about a colleague with a mental health problem included safety and the colleague's reliability. Conclusion: Although critical for workers who experience a mental disorder and who find work challenging, a significant proportion do not seek support. One barrier is fear of negative repercussions. Organizations' policies can create safe environments and the provision of resources and training to managers that enable them to implement them. By making disclosure safe, stigma and the burden of mental disorders in the workplace can be decreased. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Oncology Nursing Journal is the property of Pappin Communications and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To understand the postpartum care received by birthing people with disabilities and their newborns, from their own perspectives. Design: A qualitative study with semi‐structured interviews. Methods: Between July 2019 and February 2020, in‐person and virtual interviews were conducted with 31 people with physical, sensory, and intellectual/developmental disabilities in Ontario, Canada, about the formal inpatient and outpatient services and supports they used in the first few months after they gave birth. Thematic analysis was used identify common themes. Results: We identified three overall themes concerning participants' postpartum care experiences and the different types of formal services received in and out of hospital: (1) lack of adequate care, (2) lack of provider awareness of disability and disability accommodations, and (3) fear of judgement, discrimination, and intrusive surveillance. The identified themes were applicable across disability groups. However, most comments on disability accommodations came from participants with physical or sensory disabilities, while participants with intellectual/developmental disabilities most commonly reported concerns about lack of adequate care and fear of judgement, discrimination, and intrusive surveillance. Conclusion: Findings indicate that postpartum care often fails people with disabilities. This could contribute to negative health consequences for them and their newborns. Impact: Birthing people with disabilities need multidisciplinary, proactive, and strengths‐based postpartum care to mitigate risk for health complications. Further, disability‐related training and guidelines for health and social service providers is required. Reporting method: Consolidated criteria for reporting qualitative research (COREQ). Patient or Public contribution: Our research team included two peer researchers with physical disabilities who served as co‐interviewers and participated in data analysis, contributing their lived experience of disability and interactions with the health care system. All stages of the study were also informed by feedback from the study's Advisory Committee, which comprised women with disabilities (many of whom are parents), disability organization staff, clinicians, and policy representatives. [ABSTRACT FROM AUTHOR]

The article presents a research paper that discusses the emerging role of occupational therapy in Family Health Teams, a model of inter professional primary care. The topics discussed include methods for enhancing access to occupational therapy, factors affecting the role of occupational therapy, and the challenges faced while managing case load involved in the study. It also discusses the occupational therapy assessment tools and its frequency of usage reported by participants.

Background: The provision of complementary therapy in palliative care is rare in Canadian hospitals. An Ontario hospital's palliative care unit developed a complementary therapy pilot project within the interdisciplinary team to explore potential benefits. Massage, aromatherapy, Reiki, and Therapeutic Touch™ were provided in an integrated approach. This paper reports on the pilot project, the results of which may encourage its replication in other palliative care programs. Objectives: The intentions were (1) to increase patients'/families' experience of quality and satisfaction with end-of-life care and (2) to determine whether the therapies could enhance symptom management. Results: Data analysis ( n=31) showed a significant decrease in severity of pain, anxiety, low mood, restlessness, and discomfort ( p<0.01, 95% confidence interval); significant increase in inner stillness/peace ( p<0.01, 95% confidence interval); and convincing narratives on an increase in comfort. The evaluation by staff was positive and encouraged continuation of the program. Conclusions: An integrated complementary therapy program enhances regular symptom management, increases comfort, and is a valuable addition to interdisciplinary care. [ABSTRACT FROM AUTHOR]

Objectives: Aging is associated with deterioration in health and well-being, but previous research suggests that this can be attenuated by maintaining group memberships and the valued social identities associated with them. In this regard, religious identification may be especially beneficial in helping individuals withstand the challenges of aging, partly because religious identity serves as a basis for a wider social network of other group memberships. This paper aims to examine relationships between religion (identification and group membership) and well-being among older adults. The contribution of having and maintaining multiple group memberships in mediating these relationships is assessed, and also compared to patterns associated with other group memberships (social and exercise). Method: Study 1 (N = 42) surveyed older adults living in residential care homes in Canada, who completed measures of religious identity, other group memberships, and depression. Study 2 (N = 7021) longitudinally assessed older adults in the UK on similar measures, but with the addition of perceived physical health. Results: In Study 1, religious identification was associated with fewer depressive symptoms, and membership in multiple groups mediated that relationship. However, no relationships between social or exercise groups and mental health were evident. Study 2 replicated these patterns, but additionally, maintaining multiple group memberships over time partially mediated the relationship between religious group membership and physical health. Conclusion: Together these findings suggest that religious social networks are an especially valuable source of social capital among older adults, supporting well-being directly and by promoting additional group memberships (including those that are non-religious). [ABSTRACT FROM AUTHOR]

A randomized controlled trial evaluated the effect of telephone-based peer support (mother-to-mother) on preventing postpartum depression among high-risk mothers. This paper reports volunteers' perceptions, which showed that peer support is an effective preventative intervention. Two-hundred and five (205) volunteers were recruited and trained to provide peer support to 349 mothers randomized to the intervention group. Volunteers' perceptions were measured at 12 weeks using the Peer Volunteer Experience Questionnaire, completed by 69% (121) of the 175 volunteers who provided support to at least one mother. Large majorities felt that the training session had prepared them for their role (94.2%), that volunteering did not interfere with their lives (81.8%) and that providing support helped them grow as individuals (87.8%). Over 90% stated that they would become a peer volunteer again, given the opportunity. Recruitment and retention of effective volunteers is essential to the success of any peer-support intervention. Results from this study can assist clinicians and program planners to provide effective training, sufficient on-going support and evaluation and appropriate matching of volunteers to mothers who desire peer support and are at high risk of postpartum depression. [ABSTRACT FROM PUBLISHER]

An evolving body of literature suggests that the implementation of evidence based clinical and professional guidelines and strategies can improve patient care. However, gaps exist in our understanding of the effect of implementation of guidelines on outcomes, particularly patient outcomes. To address this gap, a measurement framework was developed to assess the impact of an organization-wide implementation of two nursing-centric best-practice guidelines on patient, nurse and organizational level outcomes. From an implementation standpoint, we anticipate that our data will show improvements in the following: (i) patient satisfaction scores and safety outcomes; (ii) nurses ability to value and engage in evidence based practice; and (iii) organizational support for evidence-informed nursing care that results in quality patient outcomes. Our measurement framework and multifaceted methodological approach outlined in this paper might serve as a blueprint for other organizations in their efforts to evaluate the impacts associated with implementation of clinical and professional guidelines and best practices. [ABSTRACT FROM AUTHOR]

Uncertainty is a key contingency in the relationship between work characteristics and outcomes such as employee performance and well-being. In this paper, we specify and test a self-report measure of work uncertainty for use in any setting to facilitate research and decision making regarding the design of work. Using data collected from three diverse samples, analyses found support for a multi-dimensional model that corresponds to resource, task, and input/output sources of uncertainty. The scales showed discriminant validity, and task uncertainty was found to moderate the relationship between job control and intrinsic job satisfaction in a form consistent with theoretical predictions. Practitioner Points The self-report measure of work uncertainty may be used to evaluate existing work design and facilitate its redesign., As research demonstrates, it is critical that the level of job control afforded to employees is congruent with the level of uncertainty they experience. Failure to consider the role of uncertainty in linking job control to outcomes (e.g., performance, well-being) can undermine work redesign investment. [ABSTRACT FROM AUTHOR]

Objective This paper explores the lessons learned from a series of three randomized controlled trials that included 498 community-living frail older adults (≥65 years) using home care services in Southern Ontario, Canada. Each study was designed to evaluate the effectiveness of different multi-component nurse-led health promotion and disease prevention (HPDP) interventions. Methods The nurse-led HPDP interventions were 6- or 12-month multi-component and evidence-based strategies targeting known risk factors for functional decline and frailty. Across the three studies, a common approach was used to measure the change in health-related quality of life (HRQOL) (SF-36) and the costs of use of health services (Health and Social Services Utilization Inventory) from baseline to the end of the intervention. Results The main lesson learned from the three studies is that nurse-led HPDP interventions for frail older home care clients provide greater improvements in HRQOL compared with usual home care. Such approaches are highly acceptable to this population and can be implemented using existing home care resources. Nurse-led HPDP interventions should include multiple home visits, multidimensional screening and assessment, multi-component evidence-based HPDP strategies, intensive case management, inter-professional collaboration, providers with geriatric training and experience, referral to and coordination of community services, and theory use. Conclusion The results of the three trials underscore the need to reinvest in nurse-led HPDP interventions in home care to optimize HRQOL and promote ageing in place in the target population of frail older adults. More studies are needed to evaluate the effectiveness of additional nurse-led HPDP interventions in other contexts and settings. [ABSTRACT FROM AUTHOR]

Background: Nurses' recognition of their own level of skills and abilities (that is, perceived competence) is a prerequisite for ensuring they can practise in a safe manner. The demand for competence in the operating room (OR) may vary between clinical environments. It is,however, unclear what competency levels migrating nurses need in order to be deemed safe.Aim: This paper describes Canadian and Australian nurses' levels of perceived perioperative competence and discusses these results in the context of nurse migration.Method: A survey was distributed to OR nurses in six hospital sites (three in Canada and three in Australia). Perioperative competence was measured with a 40-item self-report survey which consisted of six domain subscales: foundational knowledge and skills; leadership; collaboration; proficiency; empathy; and professional development. Non-parametric tests were used to describe differences between groups based on country of origin, years of experience, and speciality qualifications.Results: Canadian and Australian nurses reported their overall competency levels as high across all domains. Significant differences were found, between countries, in three of the six competency domains: foundational knowledge and skills (p<.001); collegiality (p=.023); andempathy (p<.0001).Conclusions: Describing perioperative competence cross-nationally represents the first step in generating international dialogue around educational preparation for migrating nurses. The increasing global mobility of nurses makes it imperative to further standardise, with an international perspective, knowledge and practice expectations in perioperative settings. [ABSTRACT FROM AUTHOR]

Abstract: This paper provides an overview of an on-going ‘research-to-practice synthesis’ project that explores the education and learning supports provided to youth in residential group care in Ontario. The project is focused on how group care programs support the education and learning of youth in the context of the residential program itself, since there is already much evidence that support for education in the everyday living environment from direct care givers strongly impacts on education and learning performance. The project synthesizes input from a range of stakeholders that include executive leadership of agencies, front line staff as well as youth. In addition, the project provides for a detailed review of policies and procedures for residential group care programs and their relevance to the promotion of education and learning. One outcome of the project is a Self Assessment Tool attached to this paper that allows group care providers to monitor their performance with respect to supporting the education of youth living in their programs. Although the project at the time of writing is not entirely completed, it is already apparent that there is a need for systematic and broad change in the purpose and design of residential group care across service sectors. [Copyright &y& Elsevier]

Rationale: Volunteers are essential to the functioning of palliative care programs and serve as important members of the hospice team. They devote much time, effort, and diverse skills and talent to enhance the quality of care at Roger's House - a pediatric palliative care hospice. Objectives: To evaluate volunteering in a pediatric palliative care hospice and to assess the level of satisfaction from the perspective of hospice volunteers. Methods: A survey was sent to all active Roger's House volunteers. Questions were related to their demographics, their overall impression of their volunteering experience, and 47 closed (fixed-choice) statements, divided into 6 parts: 1) Orientation; 2) Training; 3) Feedback / Performance; 4) Communication; 5) Social Contacts; and 6) Value and Respect. Each statement was rated by the participants using a six-point Likert rating scale. Results: Volunteers fully completing the survey were 159 online and 4 on paper, giving a response rate of 66%. The greater number (66, 40.5%) of respondents were 50 years or older and they were mostly female (141, 86.5%). Successes identified included the volunteers' orientation, training, and feedback and performance. Challenges identified included certain aspects of communication, social contacts, and respect/value for the volunteer. Conclusion: Volunteers at Roger's House are generally satisfied with their volunteer position and the environment in which they work. Greater insight into volunteer satisfaction and factors that bring feelings of reward and/or dissatisfaction to the volunteers have allowed Roger's House to identify informed and effective interventions to improve the quality of and satisfaction with the hospice volunteer program. [ABSTRACT FROM AUTHOR]

Background: The primary purpose of this exploratory autism research was to examine the lived experiences of female primary caregivers of children with an autism spectrum disorder (ASD). Methods: Specifically the costs and benefits of the primary caregivers' experiences were examined through semi-structured one-one-one interviews. The specific focus of this paper was to examine the costs of caring for a child with an ASD, whereby costs did not refer solely to monetary costs, but were related to all aspects of the caregivers' lives. Interviews were completed with 8 mothers of children that had been formally diagnosed with an ASD. Results: Undoubtedly all family members within the family unit were affected by a child's diagnosis with ASD as evidenced by the costs revealed by mothers. The subthemes derived from the theme of costs included the following: financial and work costs, costs to the health of family, social costs, and costs to overall family life. The results from this research provide evidence of the challenges associated with caring for a child with an ASD. Conclusions: It is anticipated that the insights provided by these mothers can act as a source of support for others faced with a similar situation. Additionally health care professionals may be able to use the knowledge gained from such qualitative endeavors in order to help parents cope more effectively with their caregiving responsibilities associated with children with ASDs. The mothers within this study are remarkable women that, for the most part, were able to rise above the negatives/costs associated with caring for a child with an ASD and find the silver linings amidst the turmoil. As remarkable as these women are in the daily struggles they face with their children, it is evident that more resources and support are required to assist these women and their families. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Community Mental Health is the property of Canadian Periodical for Community Studies Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)