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Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Given the breadth of the data, this paper will focus exclusively on the qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. This paper focuses on the substantive theme of "Breaking Point," in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future. [ABSTRACT FROM AUTHOR]

Aim: This paper highlights a new role of Advanced Practice Nurse/Nurse Practitioner as the clinical planning lead in the development of a unique model of care and service delivery for children living with health complexity, in the context of a LEADS leadership framework and related capabilities. Background: The LEADS in a Caring Environment Framework is an effective tool for leadership development and systems change. An experienced Advanced Practice Nurse/Nurse Practitioner hired into a leadership role contributes to system change for a complex population across a large geographic area. Sources of evidence: World Health Organization, Canadian Nurses Association and other websites, academic databases (PubMed and CINAHL) and relevant books were explored, and the expertise and knowledge of the authors and the redevelopment project team were utilized. Discussion: The Advanced Practice Nurse/Nurse Practitioner (first author) shares and reflects on her own lived experience as a leader in the planning for programmes and services at the new centre utilizing the five LEADS domains and related capabilities. Conclusion: The utilization of the LEADS in a Caring Environment Capabilities Framework showcases the strengths and skills of an Advanced Practice Nurse/Nurse Practitioner shifting from direct clinical care to successfully leading system‐level change. By incorporating the LEADS framework into practice, in any setting or role, Advanced Practice Nurse/Nurse Practitioners can both evaluate and develop their leadership skills while positively effecting system transformation. Implications for nursing practice: The LEADS framework fosters ongoing professional development and can be used to measure the added value of Advanced Practice Nurses within an organization. Implications for nursing policy: Advanced Practice Nurses improve outcomes within the health care system. Leaders must consider this evidence in health workforce planning, ensuring that Advanced Practice Nursing roles become fully integrated and are supported in the context of national and regional health systems. [ABSTRACT FROM AUTHOR]

Topic: Globally, the COVID‐19 pandemic had impacted the health care delivery including inpatient psychiatric facilities. Within psychiatric settings, life of inpatients was profoundly altered. Purpose: This paper aimed to understand if pandemic‐related changes within an inpatient Eating Disorder Unit in a specialized psychiatric hospital in Ontario, Canada impacted incidence of aggression and use of coercive methods among adolescents. Source Used: An exploratory study design was used to examine incidence of aggression, self‐harm, code whites, staff assist, restraints and seclusion, and nasogastric feeding (NGF) among adolescents with eating disorders before and after the modified service delivery within the inpatient unit. Descriptive analyses were conducted. Results: Analyses revealed a complete reduction in episodes of self‐harm, aggression, staff assists, use of restraint and seclusion as well as an 80.14% reduction on average use of NGF. Conclusion: Authors speculate that the change in environment and program delivery method, peer influence, and shift in power relations between patient and staff may have resulted in improved experiences. This report provides insights to adopt a recovery‐oriented service delivery for adolescents with eating disorders in inpatient settings. [ABSTRACT FROM AUTHOR]

Background: Online knowledge translation (KT) approaches are becoming increasingly prevalent within healthcare due to their accessibility and facilitation of international support networks. Online platforms enable timely and far‐reaching dissemination of current evidence and best‐practice recommendations. Although there is potential to improve the uptake of rehabilitation guidelines, it is essential to consider the acceptability of online approaches to healthcare professionals to ensure their successful integration within everyday clinical settings. Aims: To establish the prospective acceptability of a theoretically informed online intervention for speech pathologists, Aphasia Nexus: Connecting Evidence to Practice, that aims to facilitate the implementation of aphasia best practice. Methods & Procedures: A mixed‐methods multinational electronic survey based on the Theoretical Framework of Acceptability (TFA) completed by aphasia researchers and clinicians. Outcomes & Results: A total of 43 participants completed the survey with 91% (n = 39) indicating that they would use Aphasia Nexus. Understanding the intervention and how it works (intervention coherence as per the TFA) was the key factor influencing the likelihood of integration within everyday clinical practice. Participants identified potential areas where the intervention could influence service change and also recommended further design and content changes to improve the intervention. Conclusions & Implications: Aphasia Nexus is an acceptable platform for further feasibility testing in the form of a pilot trial within an Australian‐based health service. The study progresses the theory of TFA as it was a valuable framework facilitating the identification of prominent factors influencing acceptability. The study also informs further intervention refinements in preparation for the next stage of research. WHAT THIS PAPER ADDS: What is already known on the subject: Online strategies have the potential to enhance KT and promote the uptake of rehabilitation guidelines. An online intervention, however, can only be effective if implemented well. For this reason, it is essential to establish the acceptability of online interventions to the intended recipients and therefore increase the likelihood of successful implementation. What this paper adds to existing knowledge: This study used a theoretically based framework to establish the acceptability of an online implementation intervention, Aphasia Nexus, to multinational aphasia clinicians and researchers. It demonstrated the value in identifying the prominent factors influencing acceptability to inform further intervention refinements and warrant continuing research. What are the potential or actual clinical implications of this work?: Speech pathologists should use online platforms to drive the implementation of best practice on an international scale. It is important for clinicians to have an in‐depth understanding of online interventions and how they work to enhance their successful uptake into routine clinical practice. Aphasia Nexus is an acceptable online platform for implementing best practice in aphasia. [ABSTRACT FROM AUTHOR]

Introduction: The COVID‐19 pandemic has had an impact on all aspects of the health system. Little is known about how the activities and experiences of patient, family and caregiver partners, as a large group across a variety of settings within the health system, changed due to the substantial health system shifts catalysed by the pandemic. This paper reports on the results of a survey that included questions about this topic. Methods: Canadian patient, family and caregiver partners were invited to participate in an online anonymous survey in the Fall of 2020. A virtual snowballing approach to recruitment was used. Survey invitations were shared on social media and emailed to health system and governmental organizations with the request that they share the survey with patient partners. This paper focuses on responses to two questions related to patient partner experiences during the COVID‐19 pandemic. Results: The COVID‐19 questions were completed by 533 respondents. Over three quarters of respondents (77.9%, n = 415) indicated their patient engagement activities had been impacted by COVID‐19. The majority (62.5%, n = 230) experienced at least a temporary or partial reduction in their patient engagement activities. Some respondents did see increases in their patient engagement activities (11.4%, n = 42). Many respondents provided insights into their experience with virtual platforms for engagement (n = 194), most expressed negative or mixed experiences with this shift. Conclusions: This study provides a snapshot of Canadian patient, family and caregiver partners' perspectives on the impact of COVID‐19 on their engagement activities. Understanding how engagement unfolded during a crisis is critical for our future planning if patient engagement is to be fully integrated into the health system. Identifying how patient partners were engaged and not engaged during this time period, as well as the benefits and challenges of virtual engagement opportunities, offers instructive lessons for sustaining patient engagement, including the supports needed to engage with a more diverse set of patient, family and caregiver partners. Patient Contribution: Patient partners were important members of the Canadian Patient Partner Study research team. They were engaged from the outset, participating in all stages of the research project. Additional patient partners were engaged to develop and pilot test the survey, and all survey respondents were patient, family or caregiver partners. The manuscript is coauthored by two patient partners. [ABSTRACT FROM AUTHOR]

Pharmacogenomics (PGx)‐based personalized medicine (PM) is increasingly utilized to guide treatment decisions for many drug‐disease combinations. Notably, London Health Sciences Centre (LHSC) has pioneered a PGx program that has become a staple for London‐based specialists. Although implementational studies have been conducted in other jurisdictions, the Canadian healthcare system is understudied. Herein, the multistakeholder perspectives on implementational drivers and barriers are elucidated. Using a mixed‐method qualitative model, key stakeholders, and patients from LHSC's PGx‐based PM clinic were interviewed and surveyed, respectively. Interview transcripts were thematically analyzed in a stepwise process of customer profiling, value mapping, and business model canvasing. Value for LHSC located specialist users of PGx was driven by the quick turnaround time, independence of the PGx clinic, and the quality of information. Engagement of external specialists was only limited by access and awareness, whereas other healthcare nonusers were limited by education and applicability. The major determinant of successful adoption at novel sites were institutional champions. Patients valued and approved of the service, expressed a general willingness to pay, but often traveled far to receive genotyping. This paper discusses the critical pillars of education, awareness, advocacy, and efficiency required to address implementation barriers to healthcare service innovation in Canada. Further adoption of PGx practices into Canadian hospitals is an important factor for advancing system‐level changes in care delivery, patient experiences, and outcomes. The findings in this paper can help inform efforts to advance clinical PGx practices, but also the potential adoption and implementation of other innovative healthcare service solutions. [ABSTRACT FROM AUTHOR]

Resilience is situated at the core of the World Health Organization European policy framework for health and well‐being and the United Nations Sustainable Development Goals. Resilience refers to how effectively a person, group, or system deals with and recovers from challenging situations. In this paper resilience refers to the capacity of a health care professional to manage complex issues and adapt to situations successfully. This brief paper provides explicit knowledge for strengthening personal resilience in health care using the Ottawa Charter framework as a guide. Developing a resilient health care workforce should address all five Ottawa Charter areas of action, should involve multiple stakeholders, and should incorporate resilience strategies into everyday health care activities. The paper presents recommendations for future programs designed to build a resilient workforce that can provide high quality care in a sustainable manner. [ABSTRACT FROM AUTHOR]

People experiencing homelessness are simultaneously socially and physically mobile. Individuals move through periods of housing stability and houselessness and varying degrees of financial (in)stability, and between different geographic spaces. Research concerning homeless mobilities emphasizes moves within cities and reveals seven factors deserving attention: housing; labour markets; social, health, and justice services; personal health; the attributes of different places; interpersonal networks; and how mobility is socially differentiated. However, the extent to which these factors shape homelessness and inter‐regional mobilities is unclear. Addressing this gap, I explore 612 people's moves using data collected from five Canadian cities. By analyzing participants' inter‐regional moves over ten years, I identify ten themes of homeless inter‐regional mobility in Canada including: interpersonal networks, the attributes of different places, labour markets and personal finances, the use of movement for personal growth, health and social services, residential mobilities, legal and health institutions, substance abuse and dependence, personal security, and travel. I find that the structures, institutions, resources, and personal experiences that produce homelessness simultaneously push people between places. Amidst an increasing emphasis aimed at understanding homeless experiences in Canada, this paper provides an overview of the inter‐regional mobilities of people experiencing homelessness in Canada. Key Messages: Examining mobility clarifies why people become and remain homeless.People move between different regions in Canada as a way to cope with housing precarity and homelessness.Social connections, the influence of different places, and personal finances also drive people to move between different locations. [ABSTRACT FROM AUTHOR]

Public health nurses (PHNs) in Canada have the potential to significantly benefit the health and academic outcomes of school age children with its impact lasting into adulthood. Unfortunately, cuts in government funding over the years have diminished the presence of PHNs in schools and their ability to practice to their full scope. In the midst of a pandemic, having a strong nursing presence in schools may facilitate public health efforts and reduce the burden on teachers and administration. This discussion paper will explore the current role of nurses in Canadian schools in relation to school nurses in other parts of the world. An overview of the literature looking at the impact of the school nurse on school health (i.e., student health and academic outcomes) will be presented to provide evidence in support of rebuilding nursing capacity in Canadian schools. Finally, the Framework for 21st Century School Nursing Practice will be introduced as a viable nursing theory to facilitate rebuilding PHN capacity in schools. [ABSTRACT FROM AUTHOR]

Aim: To establish international expert recommendations on clinical features to prompt referral for diagnostic assessment of cerebral palsy (CP).Method: An online Delphi survey was conducted with international experts in early identification and intervention for children with CP, to validate the results obtained in two previous consensus groups with Canadian content experts and knowledge users. We sent two rounds of questionnaires by e-mail. Participants rated their agreement using a 4-point Likert scale, along with optional open-ended questions for additional feedback. Additionally, a panel of experts and knowledge-users reviewed the results of each round and determined the content of subsequent surveys.Results: Overall, there was high-level of agreement on: (1) six clinical features that should prompt referral for diagnosis; (2) two 'warning sign' features that warrant monitoring rather than immediate referral for diagnosis; and (3) five referral recommendations to other healthcare professionals to occur simultaneously with referral for diagnosis.Interpretation: There was high agreement among international experts, suggesting that the features and referral recommendations proposed for primary care physicians for early detection of CP were broadly generalizable. These results will inform the content of educational tools to improve the early detection of CP in the primary care context.What This Paper Adds: International experts provide strong agreement on clinical features to detect cerebral palsy. Consensus on clinical 'warning signs' to monitor over time. Referral recommendations from primary care to specialized health services are identified. [ABSTRACT FROM AUTHOR]

This paper is concerned with the impact of medical inadmissibility provisions in Canada's immigration law on applicants with disabilities. The paper draws on key informant interviews, policy analysis, and Ministry of Immigration data on medical inadmissibility findings. We follow the lead of recent mobilities scholarship to examine how the immigration system is enacted, reproduced, and contested over time. From this perspective, we see that recent court challenges to the statutory provisions have created additional procedural space for applicants to contest findings of inadmissibility. However, the legitimacy of excessive demand as a basis for exclusion remains firmly in place, while recent immigration policy changes signal an intensification of measures to limit the social reproductive costs of immigration. Les personnes handicapées, l'inadmissibilité pour motifs sanitaires et la politique d'immigration sélective Cet article s'intéresse aux effets des dispositions de la législation canadienne en matière d'immigration relatives à l'inadmissibilité pour motifs sanitaires des candidats ayant une incapacité. L'article se fonde sur des entretiens auprès d'informateurs clés, des analyses politiques et des données du ministère sur les décisions d'inadmissibilité pour motifs sanitaires. Les recherches récentes portant sur la mobilité forment le point de départ d'une exploration du mode de fonctionnement du système d'immigration, sa reproduction et sa remise en question au fil du temps. Vues sous cet angle, les contestations actuelles des dispositions légales devant les tribunaux ont permis de dégager un espace de procédure supplémentaire pour les candidats afin de contester les verdicts d'inadmissibilité. Cependant, la légitimité de la demande excessive en tant que motif d'interdiction perdure, tandis que les changements récents apportés à la politique d'immigration annoncent une intensification des mesures visant à limiter les coÛts sociaux de l'immigration. [ABSTRACT FROM AUTHOR]

Evidence-informed health policy making (EIHP) is becoming a necessary means to achieving health system reform. Although Canada has a rich and well documented history in the field of evidence-basedmedicine, a concerted effort to capture Canada's efforts to support EIHP in particular has yet to be realized. This paper reports on the development of EIHP in Canada, including promising approaches being used to support the use of evidence in policy making about complex health systems issues. In light of Canada's contributions, this paper suggests that scholars in Canada will continue engaging in the field of EIHP through further study of interventions underway, as well as by sharing knowledge within and beyond Canada's borders about approaches that support EIHP. [ABSTRACT FROM AUTHOR]

Growing awareness of the link between diet and health has spurred growth in the functional food sector. Health Canada regulates allowable health claims on food products, and in recent years has approved health claims linking the consumption of soluble fiber from barley (2012) and psyllium (2011) to reduced/lower low-density lipoprotein (LDL)-cholesterol levels, a major risk factor for heart disease. A health claim linking consumption of soy protein to reduced risk of coronary heart disease (CHD) is still under consideration. Using a cost-of-illness approach, this paper estimates the potential economic benefits of allowing health claims for soluble fiber and soy protein in terms of reductions in the direct and indirect costs of CHD. Parameters for the economic analysis are drawn from a meta-analysis of scientific studies examining the effect of soluble fiber and soy protein on LDL-cholesterol levels, as well as other scientific literature. While a barley soluble fiber health claim yields nontrivial benefits in a base case scenario equal to CAD$105 million annually and ranging from $42 million to $238 million in low and high scenarios, the potential benefits of a soy protein health claim appear to be several magnitudes larger at $549 million annually in the base case and ranging from $220 million to $1.25 billion in low/high scenarios. Given the relatively slow regulatory approval process for new health claims, there may be value in using economic estimates of potential gains to help prioritize health claims approval processes. [ABSTRACT FROM AUTHOR]

Recently, researchers on organizational climate have focused on the 'issue-specific' nature of climate, such as the climate for safety or service, or, in this case, the climate for human resources. This has resulted in a clearer connection between specific climates and relevant outcomes. The purpose of this paper is to present the findings from an exploratory study that was conducted in Canada that served to help us understand the aspects of workplace climate with a focus on human resources ( HR). In this study, interview data was collected from 14 HR managers from across western Canada, some of which were from healthcare organizations. The benefit of this research is to better understand the current climate within organisations and to develop a construct for HR climates that can be used to build capacity in the research, training, and practice of HR within health-care (and other industries) in Canada. [ABSTRACT FROM AUTHOR]

Task shifting, which involves the transfer of care work from regulated health-care professionals to home care workers (HCWs), is a strategy to ensure the efficient delivery of home care services in Canada and internationally. Using a feminist political economy approach, this paper explores the effects of task shifting on HCWs' skills. Task shifting may be understood as a form of downward substitution-and an effort to increase control over workers while minimizing costs-as some of health-care professionals' responsibilities are divided into simpler tasks and transferred to HCWs. Our interviews with 46 home health-care providers in Ontario, which focused explicitly on HCWs' role in care provision, problematize the belief that 'low skilled' care workers have little control over their work. HCWs' skills become more complex when they do transferred tasks, and HCWs sometimes gain greater control over their work. This results in increased autonomy and mastery for many HCWs. In turn, this serves to reinforce the intrinsic rewards of care work, despite the fact that it is low paid and undervalued work. [ABSTRACT FROM AUTHOR]

Medical assistance in dying (MAiD) and palliative sedation (PS) are both legal options in Canada that may be considered by patients experiencing intolerable and unmanageable suffering. A contentious, lively debate has been ongoing in the literature regarding the similarities and differences between MAiD and PS. The aim of this paper is to explore the propositions that MAiD and PS are essentially similar and conversely that MAiD and PS are distinctly different. The relevance of such a debate is apparent for clinicians and patients alike. Understanding the complex and multi‐faceted nuances between PS and MAiD allows patients and caregivers to make more informed decisions pertaining to end‐of‐life care. It is hoped that this paper will also serve to foster further debate and consideration of the issues associated with PS and MAiD with a view to improve patient care and the quality of both living and dying in Canada. [ABSTRACT FROM AUTHOR]