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Aim: To describe vaccination roles of primary care nurses during the COVID-19 pandemic in Canada., Design: This analysis was part of a larger mixed-methods case study., Methods: We conducted semi-structured qualitative interviews from May 2022 to January 2023 with primary care nurses across four provinces: British Columbia, Ontario, Newfoundland and Labrador, and Nova Scotia. We asked participants to describe their roles during various stages of the pandemic, facilitators and challenges encountered and possible roles that nurses could have played. We used thematic analysis and analysed codes relevant to vaccination., Results: We interviewed a total of 76 nurses and identified four key functions of primary care nurses' roles in COVID-19 vaccination: (1) education, (2) vaccine administration, (3) outreach and (4) advocacy. Themes outlined nurses' roles with respect to patient education, addressing vaccine hesitancy, partaking in vaccination roles outside of regular primary care practice and supporting accessibility in COVID-19 vaccination. Specific tasks varied by nursing professions., Conclusion: Primary care nurses fostered trust through existing patient-provider relationships to enhance roles and activities related to education, outreach and advocacy in COVID-19 vaccination. Some COVID-19 vaccine-related roles were more easily integrated into primary care, whereas others competed with routine primary care roles., Implications for the Profession and Patient Care: Findings highlight the vital contributions of primary care nurses towards COVID-19 vaccination efforts in Canada. Leveraging nursing expertise can enhance future pandemic response efforts and improve patient care by addressing barriers to vaccination and promoting equitable access to vaccination services., Impact: This study addresses a knowledge gap by describing the vaccination-related roles of primary care nurses during the pandemic. Findings illustrate that nurses demonstrated adaptability through their engagement in vaccine education, administration, outreach and advocacy. This research informs resource allocation, policy development and workforce planning for future vaccination efforts during a pandemic response., Reporting Method: The authors have adhered to the Standards for Reporting Qualitative Research (SRQR) guidelines included in the Empirical Research Qualitative reporting method., Patient or Public Contribution: No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Provides insight into the pivotal roles of primary care nurses during the COVID-19 vaccination efforts in Canada, highlighting their diverse contributions towards education, vaccine administration, outreach and advocacy. Offers implications for future pandemic planning by informing resource allocation, policy development and workforce planning for vaccination efforts., (© 2024 The Author(s). Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Objectives: Due to the rise of the nurse practitioner (NP) role in long-term care settings, it is important to understand the underlying structures and processes that influence NP and physician care models. This scoping review aims to answer the question, "What are the structures, processes, and outcomes of care models involving NPs and physicians in long-term care (LTC) homes?" A secondary aim was to describe the structural enablers and barriers across care models., Research Design and Methods: Seven databases were searched. Studies that described NPs and physicians working in LTC were identified and included in the review. We stratified the findings by care model and synthesized using the Donabedian model, which evaluates health care quality based on 3 dimensions: structure, process, and outcome. We then categorized macro, meso, and micro structural enablers and barriers., Results: Sixty papers were included in the review. The main structural influencers within 5 care models included policies on scope of practice, clarity of role description, and workload. A limited number of papers referred to the process of enabling the development of a working relationship. Thirty-five (49%) studies described resident, staff, and health system outcomes., Conclusions and Implications: Although structural characteristics of NP and physician care models are described in-depth, there is less detail on the processes that occur within the NP and physician care models. We highlight structural barriers and enablers within the care models, allowing for recognition of the importance of organizational influence on the NP and physician relationship. Future work should focus on the processes of the relationships in the models by identifying the drivers and initiators of collaboration between NPs and physicians and how these relationships influence outcomes., Competing Interests: Disclosures The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Aim: To evaluate the impact of an eHealth educational resource about infant procedural pain management, given during the prenatal period, on feasibility, acceptability, knowledge, self-efficacy, and involvement., Background: Routine health care requires newborns to have painful procedures (e.g., intramuscular injection). The impacts of untreated pain in neonates are widely recognised but adoption of effective procedural pain management strategies in clinical practice varies. There is clear evidence supporting the effectiveness of parent-led pain management during procedures (e.g., skin-to-skin care) and reputable resources to raise awareness among parents are warranted. Our team co-created Parenting Pain Away, a website to equip parents with evidence to assist with managing the pain of procedures and empower them to be involved., Methods: A quasi-experimental evaluation using a pre/post intervention design with low-risk expectant parents., Results: Of the 41 participants, before intervention exposure participants were familiar or had used skin-to-skin care (n = 33), breastfeeding (n = 30) and sucrose (n = 13) as pain management. Most participants (n = 38) desired more information on how to be involved. Providing access to Parenting Pain Away during pregnancy was supported and participants ranked the website above average using the System Usability Scale. Parenting Pain Away did not have a statistically significant influence on outcomes. Participants reported variation in clinical support with parent-led pain management., Conclusion: A multifaceted approach is recommended to maintain infant procedural pain management., Implications for the Profession and Patient Care: Equipping parents with knowledge related to infant pain management using an eHealth approach satisfied their information desires. The study findings are important considerations for perinatal care providers, policy makers, and families to finally achieve adequate procedural pain management., Reporting Method: This study used the STROBE checklist, adhering to EQUATOR guidelines., Patient and Public Contribution: A stakeholder group (expectant parents, parents, perinatal researchers, clinicians, and administrators) was created to inform the study design and intervention., (© 2024 The Author(s). Scandinavian Journal of Caring Sciences published by John Wiley & Sons Ltd on behalf of Nordic College of Caring Science.)

Background: Behavior change interventions are critical for the secondary prevention of cardiovascular disease and for reducing the risk of a repeat event or mortality. However, the effectiveness of behavior change interventions is challenged by a lack of spatiotemporal contexts, limiting our understanding of factors that influence the timing and location in which day-to-day activities occur and the maintenance of behavior change. This study explored how behavior change interventions could incorporate spatiotemporal contexts of patient activities for modifying behaviors., Methods: A mixed-methods approach with adapted geo-ethnography techniques was used to solicit detailed descriptions of patients' day-to-day routines, including where, when, and how patients spend time. Data were gathered from patients in one cardiac intervention program in Nova Scotia, Canada, from June to September 2021., Results: A total of 29 individuals (19 men and 10 women) between the ages of 45 and 81 and referred to the program after a cardiac event participated. The results show three key findings: (1) most patients exceeded the minimum guidelines of 30 min of daily physical activity but were sedentary for long periods of time, (2) patient time-use patterns are heterogenous and unique to contexts of individual space-time activity paths, and (3) time-use patterns reveal when, where, and how patients spend significant portions of time and opportunities for adapting patients' day-to-day health activities., Conclusions: This study demonstrates the potential for interventions to integrate tools for collecting and communicating spatial and temporal contexts of patient routines, such as the types of activities that characterize how patients spend significant portions of time and identification of when, where, and how to encourage health-promoting changes in routine activities. Time-use patterns provide insight for tailoring behavior change interventions so that clinic-based settings are generalizable to the contexts of where, when, and how patient routines could be adapted to mitigate cardiovascular risk factors.

Background: Lack of access to health care is a worldwide public health crisis. In primary care it has led to increases in the implementation of nurse practitioners and heightened interest in their patient panel capacity. The aim of this study was to examine factors influencing nurse practitioner patient panel size in team-based primary care in Ontario, Canada., Methods: We used a multiple case study design. Eight team-based primary care practices including rural and urban settings were purposively selected as cases. Each case had two or more nurse practitioners with a minimum of two years experience in the primary care setting. Interviews were conducted in-person, audio recorded, transcribed and analysed using content analysis., Results: Forty participants, including 19 nurse practitioners, 16 administrators (inclusive of executives, managers, and receptionists), and 5 physicians were interviewed. Patient, provider, organizational, and system factors influenced nurse practitioner patient panel size. There were eight sub-factors: complexity of patients' health and social needs; holistic nursing model of care; nurse practitioner experience and confidence; composition and functioning of the multidisciplinary team; clerical and administrative supports, and nurse practitioner activities and expectations. All participants found it difficult to identify the panel size of nurse practitioners, calling it- "a grey area." Establishing and maintaining a longitudinal relationship that responded holistically to patients' needs was fundamental to how nurse practitioners provided care. Social factors such as gender, poverty, mental health concerns, historical trauma, marginalisation and literacy contributed to the complexity of patients' needs. Participants indicated NPs tried to address all of a patient's concerns at each visit., Conclusions: Nurse practitioners have a holistic approach that incorporates attention to the social determinants of health as well as acute and chronic comorbidities. This approach compels them to try to address all of the needs a patient is experiencing at each visit and reduces their panel size. Multidisciplinary teams have an opportunity to be deliberate when structuring their services across providers to meet more of the health and social needs of empanelled patients. This could enable increases in nurse practitioner panel size., (© 2024. The Author(s).)

Objective: The objectives of this review were to determine the effectiveness of socially assistive technologies for improving depression, loneliness, and social interaction among residents of long-term care (LTC) homes, and to explore the experiences of residents of LTC homes with socially assistive technologies., Introduction: Globally, the number of older adults (≥ 65 years) and the demand for LTC services are expected to increase over the next 30 years. Individuals within this population are at increased risk of experiencing depression, loneliness, and social isolation. The exploration of the extent to which socially assistive technologies may aid in improving loneliness and depression while supporting social interactions is essential to supporting a sustainable LTC sector., Inclusion Criteria: This mixed methods systematic review included studies on the experiences of older adults in LTC homes using socially assistive technologies, as well as studies on the effectiveness of these technologies for improving depression, loneliness, and social interaction. Older adults were defined as people 65 years of age and older. We considered studies examining socially assistive technologies, such as computers, smart phones, tablets, and associated applications., Methods: A JBI mixed methods convergent, segregated approach was used. CINAHL (EBSCOhost), MEDLINE (Ovid), Embase, APA PsycINFO (EBSCOhost), and Scopus databases were searched on January 18, 2022, to identify published studies. The search for unpublished studies and gray literature included ProQuest Dissertations and Theses Global, Open Access Theses and Dissertations, Google, and the websites of professional organizations associated with LTC. No language or geographical restrictions were placed on the search. Titles, abstracts, and full texts of included studies were screened by 2 reviewers independently. Included studies underwent quality appraisal and data extraction. Quantitative and qualitative data findings were analyzed separately and then integrated. Where possible, quantitative data were synthesized using comparative meta-analyses with a fixed-effects model., Results: From 12,536 records identified through the search, 14 studies were included. Quantitative (n=8), mixed methods (n=3), and qualitative (n=3) approaches were used in the included studies, with half (n=7) using quasi-experimental designs. All studies received moderate to high-quality appraisal scores. Comparative meta-analyses for depression and loneliness scores did not find any significant differences, and narrative findings were mixed. Qualitative meta-aggregation identified 1 synthesized finding (Matching technology functionality to user for enhanced well-being) derived from 2 categories (Enhanced sense of well-being, and Mismatch between technology and resident ability)., Conclusions: Residents' experiences with socially assistive technologies, such as videoconferencing, encourage a sense of well-being, although quantitative findings related to depression and loneliness reported mixed impact. Residents experienced physical and cognitive challenges in learning to use the technology and required assistance. Future work should consider the unique needs of older adults and LTC home residents in the design and use of socially assistive technologies., Review Registration: PROSPERO CRD42021279015., Competing Interests: RMM is an associate editor of JBI Evidence Synthesis , but was not involved in the editorial processing of this manuscript. The other authors declare no conflicts of interest., (Copyright © 2024 JBI.)

Objective: To understand how lack of attachment to a regular primary care provider influences patients' outlooks on primary care, ability to address their health care needs, and confidence in the health care system., Design: Qualitative descriptive study using semistructured interviews., Setting: Canadian provinces of Nova Scotia, Ontario, and Quebec., Participants: Patients aged 18 years or older who were unattached or had become attached within 1 year of being interviewed and who resided in the province in which they were interviewed., Methods: Forty-one semistructured interviews were conducted, during which participants were asked to describe how they had become unattached, their searches to find new primary care providers, their perceptions of and experiences with the centralized waiting list in their province, their experiences seeking care while unattached, and the impact of being unattached on their health and on their perceptions of the health care system. Interviews were transcribed and analyzed using a thematic approach., Main Findings: Two main themes were identified in interviews with unattached or recently attached patients: unmet needs of unattached patients and the impact of being unattached. Patients' perceived benefits of attachment included access to care, longitudinal relationships with health care providers, health history familiarity, and follow-up monitoring and care coordination. Being unattached was associated with negative effects on mental health, poor health outcomes, decreased confidence in the health care system, and greater pre-existing health inequities., Conclusion: Having a regular primary care provider is essential to having access to high-quality care and other health care services. Attachment also promotes health equity and confidence in the public health care system and has broader system-level, social, and policy implications., (Copyright © 2024 the College of Family Physicians of Canada.)

Aim: Identify and map international evidence regarding innovations led by or involving advanced practice nurses in response to COVID-19., Background: COVID-19 necessitated unprecedented innovation in the organization and delivery of healthcare. Although advanced practice nurses have played a pivotal role during the pandemic, evidence of their contributions to innovations has not been synthesized. Evidence is needed to inform policies, practices, and research about the optimal use of advanced practice nurses., Methods: A scoping review was conducted and reported using the PRISMA-ScR checklist. Electronic databases were searched for peer-reviewed articles published between January 2020 and December 2021. Papers were included that focused on innovations emerging in response to COVID-19 and involved advanced practice nurses., Results: Fifty-one articles were included. Four themes were identified including telehealth, supporting and transforming care, multifaceted approaches, and provider education. Half of the articles used brief and mostly noncomparative approaches to evaluate innovations., Conclusion: This is the first synthesis of international evidence examining the contributions of advanced practice nurses during the pandemic. Advanced practice nurses provided leadership for the innovation needed to rapidly respond to healthcare needs resulting from COVID-19. Innovations challenged legislative restrictions on practice, enabled implementation of telehealth and new models of care, and promoted evidence-informed and patient-centered care., Implications for Practice: Advanced practice nurses led, designed, implemented, and evaluated innovations in response to COVID-19. They facilitated the use of telehealth, supported or transformed models of care, and enabled health providers through education, mentorship, and mental health support., Implication for Policy: Advanced practice nurses are a critical resource for innovation and health system improvement. Permanent removal of legislative and regulatory barriers to their full scope of practice is needed., (© 2023 International Council of Nurses.)

As the cracks in our stretched and overburdened healthcare system continue to widen, the downstream pressures on nurses, nurse practitioners (NPs) and other healthcare providers continue to rise. It is stressful and painful for nurses to witness how the weaknesses in our system impact the lives of patients, families and communities. Nurses are there amid the anger, uncertainty, weariness and fear - providing care around the clock. We know that the working conditions are challenging, to say the least, and the needs of the population are growing at the same time that the workforce is shrinking. The picture I am painting is one that is all too familiar - one that we hear about daily., (Copyright © 2024 Longwoods Publishing.)

Background: Interprofessional primary care teams (IPCTs) work together to enhance care. Despite evidence on the benefits of IPCTs, implementation remains challenging. This research aims to 1) identify and prioritize barriers and enablers, and 2) co-develop team-level strategies to support IPCT implementation in Nova Scotia, Canada., Methods: Healthcare providers and staff of IPCTs were invited to complete an online survey to identify barriers and enablers, and the degree to which each item impacted the functioning of their team. Top ranked items were identified using the sum of frequency x impact for each response. A virtual knowledge sharing event was held to identify strategies to address local barriers and enablers that impact team functioning., Results: IPCT members (n = 117), with a mix of clinic roles and experience, completed the survey. The top three enablers identified were access to technological tools to support their role, standardized processes for using the technological tools, and having a team manager to coordinate collaboration. The top three barriers were limited opportunity for daily team communication, lack of conflict resolution strategies, and lack of capacity building opportunities. IPCT members, administrators, and patients attended the knowledge sharing event (n = 33). Five strategies were identified including: 1) balancing patient needs and provider scope of practice, 2) holding regular and accessible meetings, 3) supporting team development opportunities, 4) supporting professional development, and 5) supporting involvement in non-clinical activities., Interpretation: This research contextualized evidence to further understand local perspectives and experiences of barriers and enablers to the implementation of IPCTs. The knowledge exchange event identified actionable strategies that IPCTs and healthcare administrators can tailor to support teams and care for patients., (© 2024. The Author(s).)

The long-term economic viability of modern health care systems is uncertain, in part due to costs of health care at the end of life and increasing health care utilization associated with an increasing population prevalence of multiple chronic diseases. Control of health care spending and sustaining delivery of health care services will require strategic investments in prevention to reduce the risk of disease and its complications over an individual's life course. Behavior change interventions aimed at reducing a range of harmful and risky health-related behaviors including smoking, physical inactivity, excess alcohol consumption, and excess weight, are one approach that has proven effective at reducing risk and preventing chronic disease. However, large-scale efforts to reduce population-level chronic diseases are challenging and have not been very successful at reducing the burden of chronic diseases. A new approach is required to identify when, where, and how to intervene to disrupt patterns of behavior associated with high-risk factors using context-specific interventions that can be scaled. This paper introduces the need to integrate theoretical and methodological principles of health geography and behavioral economics as opportunities to strengthen behavior change interventions for the prevention of chronic diseases. We discuss how health geography and behavioral economics can be applied to expand existing behavior change frameworks and how behavior change interventions can be strengthened by characterizing contexts of time and activity space., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Society of Behavioral Medicine.)

Background: Interprofessional primary care teams have been introduced across Canada to improve access (e.g., a regular primary care provider, timely access to care when needed) to and quality of primary care. However, the quality and speed of team implementation has not kept pace with increasing access issues. The aim of this research was to use an implementation framework to categorize and describe barriers and enablers to team implementation in primary care., Methods: A narrative review that prioritized systematic reviews and evidence syntheses was conducted. A search using pre-defined terms was conducted using Ovid MEDLINE, and potentially relevant grey literature was identified through ad hoc Google searches and hand searching of health organization websites. The Consolidated Framework for Implementation Research (CFIR) was used to categorize barriers and enablers into five domains: (1) Features of Team Implementation; (2) Government, Health Authorities and Health Organizations; (3) Characteristics of the Team; (4) Characteristics of Team Members; and (5) Process of Implementation., Results: Data were extracted from 19 of 435 articles that met inclusion/exclusion criteria. Most barriers and enablers were categorized into two domains of the CFIR: Characteristics of the Team and Government, Health Authorities, and Health Organizations. Key themes identified within the Characteristics of the Team domain were team-leadership, including designating a manager responsible for day-to-day activities and facilitating collaboration; clear governance structures, and technology supports and tools that facilitate information sharing and communication. Key themes within the Government, Health Authorities, and Health Organizations domain were professional remuneration plans, regulatory policy, and interprofessional education. Other key themes identified in the Features of Team Implementation included the importance of good data and research on the status of teams, as well as sufficient and stable funding models. Positive perspectives, flexibility, and feeling supported were identified in the Characteristics of Team Members domain. Within the Process of Implementation domain, shared leadership and human resources planning were discussed., Conclusions: Barriers and enablers to implementing interprofessional primary care teams using the CFIR were identified, which enables stakeholders and teams to tailor implementation of teams at the local level to impact the accessibility and quality of primary care., (© 2024. The Author(s).)

As we begin the year 2024, we do so with some very big challenges that have spilled over from 2023 and, indeed, many years before that. Every day, we are confronted with concerning experiential and research-based evidence about worsening access to healthcare, pervasive racism and widening disparities. Clearly, there is a great deal of work to be done in our healthcare system to support and improve the health of the diverse populations that we serve. Yet, along with the challenges come opportunities to reflect, collaborate, innovate, evaluate and learn. When I look at issues of the Canadian Journal of Nursing Leadership (CJNL) from the past 20 years, I am astounded at how some concerns have changed and some have remained the same. Can you believe that there was a time when nursing positions in practice and in education were actually being cut? Of course, many of the big issues we face today were emerging even then, and we have long since passed the tipping point that has put the country into a healthcare crisis., (Copyright © 2024 Longwoods Publishing.)

Objective: The aim of this study was to understand the experiences of pregnant people and new parents in Canadian federal prisons for women, and to better understand their ability to participate in the institutional Mother Child Program., Methods: This qualitative case study used semi-structured interviews with people who experienced federal incarceration during pregnancy or the early parenting years., Findings: Major themes in the analysis include: 1) Reasons why- and why not- to participate in the Mother Child Program; 2) Mothering from inside; 3) Health care; and 4) Strategies and survival., Key Conclusions: Mothers describe multiple reasons for choosing not to participate or being ineligible for the Mother Child Program; separation as common and traumatic; health services as inadequate; and mental health concerns being met with punishment. Alternatives to incarceration are recommended., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Paynter et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Many Canadians struggle to access the primary care they need while at the same time primary care providers report record levels of stress and overwork. There is an urgent need to understand factors contributing to the gap between a growing per-capita supply of primary care providers and declines in the availability of primary care services. The assumption of responsibility by primary care teams for services previously delivered on an in-patient basis, along with a rise in administrative responsibilities may be factors influencing reduced access to care., Methods and Analysis: In this mixed-methods study, our first objective is to determine how the volume of services requiring primary care coordination has changed over time in the Canadian provinces of Nova Scotia and New Brunswick. We will collect quantitative administrative data to investigate how services have shifted in ways that may impact administrative workload in primary care. Our second objective is to use qualitative interviews with family physicians, nurse practitioners and administrative team members providing primary care to understand how administrative workload has changed over time. We will then identify priority issues and practical response strategies using two deliberative dialogue events convened with primary care providers, clinical and system leaders, and policy-makers.We will analyse changes in service use data between 2001/2002 and 2021/2022 using annual total counts, rates per capita, rates per primary care provider and per primary care service. We will conduct reflexive thematic analysis to develop themes and to compare and contrast participant responses reflecting differences across disciplines, payment and practice models, and practice settings. Areas of concern and potential solutions raised during interviews will inform deliberative dialogue events., Ethics and Dissemination: We received research ethics approval from Nova Scotia Health (#1028815). Knowledge translation will occur through dialogue events, academic papers and presentations at national and international conferences., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: The WHO has stated that vaccine hesitancy is a serious threat to overcoming COVID-19. Vaccine hesitancy among underserved and at-risk communities is an ongoing challenge in Canada. Public confidence in vaccine safety and effectiveness and the principles of equity need to be considered in vaccine distribution. In Canada, governments of each province or territory manage their own healthcare system, providing an opportunity to compare and contrast distribution strategies. The overarching objective of this study is to identify effective vaccine distribution approaches and advance knowledge on how to design and implement various strategies to meet the different needs of underserved communities., Methods and Analysis: Multiple case studies in seven Canadian provinces will be conducted using a mixed-methods design. The study will be informed by Experience-Based CoDesign techniques and theoretically guided by the Socio-Ecological Model and the Vaccine Hesitancy Matrix frameworks. Phase 1 will involve a policy document review to systematically explore the vaccine distribution strategy over time in each jurisdiction. This will inform the second phase, which will involve (2a) semistructured, in-depth interviews with policymakers, public health officials, researchers, providers, groups representing patients, researchers and stakeholders and (2b) an analysis of population-based administrative health data of vaccine administration. Integration of qualitative and quantitative data will inform the identification of effective vaccine distribution approaches for various populations. Informed by this evidence, phase 3 of the study will involve conducting focus groups with multiple stakeholders to codesign recommendations for the design and implementation of effective vaccine delivery strategies for equity-deserving and at-risk populations., Ethics and Dissemination: This study is approved by the University of Toronto's Health Sciences Research Ethics Board (#42643), University of British Columbia Behavioural Research Ethics Board (#H22-01750-A002), Research Ethics Board of the Nova Scotia Health Authority (#48272), Newfoundland and Labrador Health Research Ethics Board (#2022.126), Conjoint Health Research Ethics Board, University of Calgary (REB22-0207), and University of Manitoba Health Research Board (H2022-239). The outcome of this study will be to produce a series of recommendations for implementing future vaccine distribution approaches from the perspective of various stakeholders, including equity-deserving and at-risk populations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: Despite the high mortality rates in long-term care (LTC) homes, most do not have a formalised palliative programme. Hence, our research team has developed the Strengthening a Palliative Approach in Long Term Care (SPA-LTC) programme. The goal of the proposed study is to examine the implementation and effectiveness of the SPA-LTC programme., Methods and Analysis: A cross-jurisdictional, effectiveness-implementation type II hybrid cluster randomised control trial design will be used to assess the SPA-LTC programme for 18 LTC homes (six homes within each of three provinces). Randomisation will occur at the level of the LTC home within each province, using a 1:1 ratio (three homes in the intervention and control groups). Baseline staff surveys will take place over a 3-month period at the beginning for both the intervention and control groups. The intervention group will then receive facilitated training and education for staff, and residents and their family members will participate in the SPA-LTC programme. Postintervention data collection will be conducted in a similar manner as in the baseline period for both groups. The overall target sample size will be 594 (297 per arm, 33 resident/family member participants per home, 18 homes). Data collection and analysis will involve organisational, staff, resident and family measures. The primary outcome will be a binary measure capturing any emergency department use in the last 6 months of life (resident); with secondary outcomes including location of death (resident), satisfaction and decisional conflict (family), knowledge and confidence implementing a palliative approach (staff), along with implementation outcomes (ie, feasibility, reach, fidelity and perceived sustainability of the SPA-LTC programme). The primary outcome will be analysed via multivariable logistic regression using generalised estimating equations. Intention-to-treat principles will be used in the analysis., Ethics and Dissemination: The study has received ethical approval. Results will be disseminated at various presentations and feedback sessions; at provincial, national and international conferences, and in a series of manuscripts that will be submitted to peer-reviewed, open access journals., Trial Registration Number: NCT039359., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Aim: To assess the extent to which Canadian undergraduate baccalaureate nursing programs have incorporated Canadian competencies for Registered Nurses in primary care into their curricula., Background: Canadian competencies for Registered Nurses in primary care have several benefits, including their ability to inform primary care education in undergraduate nursing programs and to assist in building a robust primary care nursing workforce., Design: We conducted a national cross-sectional survey of undergraduate baccalaureate nursing programs (n = 74)., Methods: The survey was conducted between April-May 2022. We used a modified version of the "Community Health Nurses' Continuing Education Needs Questionnaire". Respondents indicated their level of agreement on a 6-point Likert scale with 47 statements about the integration of the competencies in their program (1 = strongly disagree; 6 = strongly agree)., Results: The response rate was 51.4%. The overall mean across the six competency domains was 4.73 (SD 0.30). The mean scores of each domain ranged from 4.23 (SD 1.27) for Quality Assurance, Evaluation and Research to 5.17 (SD 0.95) for Communication., Conclusions: There are gaps in how these competencies are included in undergraduate education programs and opportunities to strengthen education for this growing workforce in Canada., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

As summer slowly gives way to autumn, I find myself reflecting on the activities of the summer. One memory that stands out is attendance at the 29th International Congress of Nurses held in Montreal in July 2023. Cohosted by the International Council of Nurses and the Canadian Nurses Association, it was an amazing opportunity to meet and learn with nurses from all over the world. It was wonderful to be able to get together in person and feel the palpable energy created by more than 6,000 delegates from 123 countries gathered together for a common purpose. Check out the videos at the following link to see what I mean: https://icncongress2023.org/., (Copyright © 2023 Longwoods Publishing.)

Aims and Objectives: To illustrate the scope of different types of transitional, community-based health interventions for formerly incarcerated women, trans and nonbinary people, the eligibility criteria for these interventions, and associated health outcomes., Background: Meeting the health needs of formerly incarcerated people in community, rather than through the criminal justice system, may prevent further experiences of criminalization. Research is needed to understand what community-based health interventions have been implemented internationally to inform the design of an intervention in Canada., Design: Scoping review using the Joanna Briggs Institute scoping review methodology., Methods: In consultation with a medical research librarian, key databases and journals were searched for English language articles, from any country, with no specified date range. Three authors independently screened titles and abstracts to identify articles for full-text review. The study adheres to PRISMA-EQUATOR guidelines., Results: Thirty-six studies met the present criteria and were reviewed in full text. Method, setting, participants, sample, relevant outcomes and relevant findings were extracted from each study for synthesis. Included studies had varied methods and were published from 1999 to 2020. Thirty-one studies were based in the United States, one in Puerto Rico and two each in Canada and the United Kingdom. The most common health issue focus was human immunodeficiency virus and/or hepatitis c virus. The most common outcome was uptake of offered services, such as a transitional clinic., Conclusions: Gaps in the research pertain to a lack of attention to clinical outcomes and patient experience, and a lack of consideration of sexual and reproductive health concerns. Women were the minority population in all studies that included both men and women; transgender participants were mentioned in only four of thirty-six studies. The specific needs of women, trans and nonbinary people must be taken into consideration., Relevance to Clinical Practice: Nurses must be conscious of the elevated health risks associated with exposure to correctional institutions and the risks associated with the period of transition., Patient or Public Contribution: A member of the research team brings lived experience expertise with respect to the criminal justice system., (© 2022 John Wiley & Sons Ltd.)

Background: Primary care attachment improves health care access and health outcomes, but many Canadians are unattached, seeking a provider via provincial wait-lists. This Nova Scotia-wide cohort study compares emergency department utilization and hospital admission associated with insufficient primary care management among patients on and off a provincial primary care wait-list, before and during the first waves of the COVID-19 pandemic., Methods: We linked wait-list and Nova Scotian administrative health data to describe people on and off wait-list, by quarter, between Jan. 1, 2017, and Dec. 24, 2020. We quantified emergency department utilization and ambulatory care sensitive condition (ACSC) hospital admission rates by wait-list status from physician claims and hospital admission data. We compared relative differences during the COVID-19 first and second waves with the previous year., Results: During the study period, 100 867 people in Nova Scotia (10.1% of the provincial population) were on the wait-list. Those on the wait-list had higher emergency department utilization and ACSC hospital admission. Emergency department utilization was higher overall for individuals aged 65 years and older, and females; lowest during the first 2 COVID-19 waves; and differed more by wait-list status for those younger than 65 years. Emergency department contacts and ACSC hospital admissions decreased during the COVID-19 pandemic relative to the previous year, and for emergency department utilization, this difference was more pronounced for those on the wait-list., Interpretation: People in Nova Scotia seeking primary care attachment via the provincial wait-list use hospital-based services more frequently than those not on the wait-list. Although both groups have had lower utilization during COVID-19, existing challenges to primary care access for those actively seeking a provider were further exacerbated during the initial waves of the pandemic. The degree to which forgone services produces downstream health burden remains in question., Competing Interests: Competing interests: Michael Green reports receiving support from the Canadian Institutes of Health Research (CIHR) for project grant funding; from the Brian Hennen Chair in Family Medicine for research team and work; and from the Ontario Ministry of Health for the INSPIRE-PHC research team through grant funding. Dr. Green also receives research grant funding from Ontario Health, and has received honoraria as an external reviewer from the University of Toronto and University of Western Ontario. Dr. Green participates on the Advisory Board of the Child and Youth Diabetes Strategy of the Lawson Foundation (a not-for-profit foundation) and is a board member and chair of the Grants and Fellowships Committee of AMS Healthcare Inc. and a board member and officer (President-Elect) of the College of Family Physicians of Canada. Dr. Green is also a geographically full-time faculty member of Queen’s University. Ruth Martin-Misener is coinvestigator on a contract funded by the Canadian Council of Nurse Regulators and International Council of Nurses and is principal or coinvestigator on other research grants from CIHR, the Nova Scotia Health Authority, Nova Scotia Research Foundation, SIGMA, Dalhousie Pharmacy Endowment Fund, Faculty of Health, Canadian Nurses Foundation, College of Registered Nurses of Newfoundland & Labrador Research, Faculty of Nursing Research Grant, Memorial University, Dalhousie University Nursing Research Fund, Canadian Nurses Association and the New Brunswick Health Research Fund. Dr. Martin-Misener holds an unpaid position as codirector of the Canadian Centre for Advanced Practice Nursing Research at McMaster University. No other competing interests were declared., (© 2023 CMA Impact Inc. or its licensors.)

Team-based care is recognized as a foundational building block of high-performing primary care. The purpose of this study was to identify primary care practice characteristics associated with team functioning and examine whether there is relationship between team composition or size and team functioning. We sought to answer the following research questions: (1) are primary care practice characteristics associated with team functioning; and (2) does team composition or size influence team functioning. This cross-sectional correlational study was conducted in Fraser East, British Columbia, Eastern Ontario Health Unit, Ontario and Central Zone, Nova Scotia in Canada. Data were collected from primary care practices using an organization survey and the Team Climate Inventory (TCI) as a measure team functioning. The independent variables of interest were: physicians' payment model, internal clinic meetings to discuss clinical issues, care coordination through informal and ad hoc exchange, care coordination through electronic medical records and sharing clinic mission, values and objectives among health professionals. Potentially confounding variables were as follows: team size, composition, and practice panel size. A total of 63 practices were included in these analyses. The overall mean score of team climate was 73 (SD: 10.75) out of 100. Regression analyses showed that care coordination through human interaction and sharing the practice's mission, values, and objectives among health professionals were positively associated with higher functioning teams. Care coordination through electronic medical records and larger team size were negatively associated with team climate. This study provides baseline data on what practice characteristics are associated with highly functioning teams in Canada.

The retention of Canada's advanced practice nurses (APNs), including clinical nurse specialists and nurse practitioners, is a national health human resources issue. APNs are essential within the Canadian healthcare workforce for meeting patient and population health needs, often in underserved communities. A shortage of APNs will exacerbate barriers to access to care for patients across sectors, including primary, acute, long-term and transitional care settings. This paper provides highlights from literature reporting on the state of APN human resources in Canada, including influential barriers and facilitators, and recommendations for retaining these important leaders in the healthcare workforce., (Copyright © 2023 Longwoods Publishing.)

This issue is the last of the three-part series focused on the critically important challenge of nurse retention. The articles that we have selected span a range of topics from the personal to political with implications for readers in leadership positions across nursing practice, policy and education. What we are learning is that retention is as multi-faceted and dynamic as the times we are living in. There is no one-size-fits-all solution, no Holy Grail - if we could only find it - that will turn the tide of exodus from the profession. Retention is fundamentally about valuing nurses and demonstrating that worth in concrete tangible ways that are meaningful to nurses as a group and as individuals. It is a tall order that can only be achieved with leadership that embraces the unprecedented challenges we are living through as windows of opportunity to lean into and make transformative changes that will engage nurses and benefit local and global health., (Copyright © 2023 Longwoods Publishing.)

Aim: We aimed to differentiate the practice patterns of nurses in specialized and advanced roles in a cross-sectional study., Method: Canadian nurses completed a self-report questionnaire (June 2017-September 2017). Demographic data and time spent in five domains of advanced practice were compared across three nurse groups. Regression analysis examined factors associated with domain involvement., Results: Respondents ( n = 1,107) represented all provinces/territories, including 396 specialized nurses (SNs), 211 clinical nurse specialists (CNSs) and 490 nurse practitioners (NPs). Nurses across all groups were the most involved in direct comprehensive care and the least involved in research. NPs were more involved in direct comprehensive care compared to CNSs ( p < 0.001) and SNs ( p < 0.001). CNSs were more involved than SNs and NPs in support of systems, education, research and professional leadership ( p < 0.001). Role type, years as an advanced practice nurse and specialist certification were modest predictors of domain involvement., Conclusion: Distinguishing how specialized and advanced nursing roles contribute to healthcare can inform policies to support their optimal utilization in healthcare systems., (Copyright © 2023 Longwoods Publishing.)

Objective: The objective of this review was to determine whether electronic health (eHealth) educational interventions about infant procedural pain and pain management impact parental outcomes (eg, mental health, knowledge uptake), eHealth outcomes (eg, acceptance, use), and pain management outcomes (eg, parental involvement, infant pain response)., Introduction: Pain in infants is a common concern for parents. Routine postpartum care for infants in early life requires them to endure painful procedures, such as immunizations, yet infants often receive little to no pain management. Parents are an essential component of effective pain management, although they may not be aware of the roles they play. Despite the increased number of eHealth resources available to educate parents about infant pain management, their impact has yet to be synthesized., Inclusion Criteria: This review considered studies that evaluated eHealth educational interventions targeted at parents during pregnancy and up to 1 year postpartum. Interventions included, but were not limited to, mobile applications, web-based applications, websites, videos, interactive training, hands-on direct simulation, short message service (SMS), and desktop applications. Primary outcomes included parental outcomes (eg, stress or anxiety, self-efficacy, knowledge, attitudes), eHealth outcomes (eg, acceptance, use), and pain management outcomes (eg, parental involvement, infant pain response). Experimental, quasi-experimental, and observational study designs were included., Methods: MEDLINE, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and SciELO were searched for studies published in English up to June 14, 2021. Citation lists of relevant reviews and included studies were also searched for additional peer-reviewed articles. Two independent reviewers conducted critical appraisal using standardized tools from JBI, and data extraction, using a data extraction form designed by the authors. Statistical pooling of quantitative data was not possible due to heterogeneity; thus, the findings were reported narratively., Results: A total of 4163 unique studies were screened, with 11 studies ultimately included for synthesis. Five articles were randomized controlled trials, 5 articles were analytical cross-sectional studies, and 1 article was quasi-experimental. Studies reported on 4 unique eHealth educational interventions, all of which used video format and primarily targeted the postnatal period. The findings for all primary outcomes were mixed but suggested either improvements in outcomes or no impact. The certainty of evidence was determined as low or very low across primary outcomes for reasons related to imprecision, risk of bias, and indirectness., Conclusions: Although heterogeneity of findings limited quantitative synthesis of data, this review suggests that short and engaging educational videos have the potential to positively impact parents' knowledge, confidence, and desire to be involved in procedural pain management for their children. Most of the interventions presented in this review describe evidence-based information about procedural pain management strategies that are known to be effective for infant populations. Thus, it is reasonable to assume that infant pain response should be lower when parents appropriately apply the strategies. However, the findings of this review were not able to confirm this assumption. More research is needed to evaluate the impact of parent-targeted pain management education on infant pain response., Systematic Review Registration Number: PROSPERO CRD42020151569., Competing Interests: RM-M is an associate editor of JBI Evidence Synthesis but was not involved in the editorial processing of this manuscript. The other authors declare no conflicts of interest., (Copyright © 2022 JBI.)

Background: The COVID-19 pandemic has brought immense disruption worldwide, dramatically altering the ways we live, work and learn on a day-to-day basis; however, few studies have investigated this from the perspective of primary care providers. In this study, we sought to explore the experiences of primary care providers in the province of Nova Scotia, with the intention of understanding the impact of the COVID-19 pandemic on primary care providers' ability to provide care, their information pathways, and the personal and professional impact of the pandemic., Methods: We conducted an exploratory qualitative research study involving semistructured interviews conducted via Zoom videoconferencing or telephone with primary care providers (physicians, nurse practitioners and family practice nurses) who self-identified as working in primary health care in Nova Scotia from June 2020 to April 2021. We performed a thematic analysis involving coding and classifying data according to themes. Emergent themes were then interpreted by seeking commonalties, divergence, relationships and overarching patterns in the data., Results: Twenty-four primary care providers were interviewed. Subsequent analysis identified 4 interrelated themes within the data: disruption to work-life balance, disruptions to "non-COVID-19" patient care, impact of provincial and centralized policies, and filtering and processing an influx of information., Interpretation: Our findings showed that managing a crisis of this magnitude requires coordination and new ways of working, balancing professional and personal life, and adapting to already implemented changes (i.e., virtual care). A specific primary care pandemic response plan is essential to mitigate the impact of future health care crises., Competing Interests: Competing interests: None declared., (© 2023 CMA Impact Inc. or its licensors.)

Introduction: There is little to no evidence in Canada on the barriers that youth face when accessing contraception. We seek to identify the contraception access, experiences, beliefs, attitudes, knowledge, and needs of youth in Canada, from the perspectives of youth and youth service providers., Methods and Analysis: This prospective, mixed-methods, integrated knowledge mobilisation study, the Ask Us project, will involve a national sample of youth, healthcare and social service providers, and policy makers recruited via a novel relational mapping and outreach approach led by youth. Phase I will centre the voices of youth and their service providers through in-depth one-on-one interviews. We will explore the factors influencing youth access to contraception, theoretically guided by Levesque's Access to Care framework. Phase II will focus on the cocreation and evaluation of knowledge translation products (youth stories) with youth, service providers, and policy makers., Ethics and Dissemination: Ethical approval was received from the University of British Columbia's Research Ethics Board (H21-01091). Full open-access publication of the work will be sought in an international peer-reviewed journal. Findings will be disseminated to youth and service providers through social media, newsletters, and communities of practice, and to policy makers through invited evidence briefs and face-to-face presentations., Competing Interests: Competing interests: GDM is a member of the Adolescent Health Committee, Canadian Paediatric Society and lead author of the policy statement advocating for universal no-cost access to contraception published by the Canadian Paediatric Society. AB has received Advisory Board consulting fees from Organon, Bayer, Mithra, as well as honoraria for lectures and presentations from Bayer, Organon and Searchlight. AB is also President-Elect and Director of the Board for the Society of Obstetricians and Gynecologists of Canada. ZK is a Board Member with Options for Sexual Health. MF is employed by Options for Sexual Health., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Before the COVID-19 pandemic, many long-term care (LTC) homes experienced difficulties in providing residents with access to primary care, typically delivered by community-based family physicians or nurse practitioners (NPs). During the pandemic, legislative changes in Ontario, Canada enabled NPs to act in the role of Medical Directors thereby empowering NPs to work to their full scope of practice. Emerging from this new context, it remains unclear how NPs and physicians will best work together as primary care providers. NP/physician collaborative models appear key to achieving optimal resident outcomes. This scoping review aims to map available evidence on existing collaborative models of care between NPs and physicians within LTC homes., Methods: The review will be guided by the research question, "What are the structures, processes and outcomes of collaborative models of care involving NPs and Physicians in LTC homes?" This scoping review will be conducted according to the methods framework for scoping reviews outlined by Arksey and O'Malley and refined by Levac et al., Colquhoun et al., and Daudt et al., as well as the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Statement. Electronic databases (MEDLINE, Embase + Embase Classic, APA PsycInfo, Cochrane Central Register of Controlled Trials, AMED, CINAHL, Ageline, and Scopus), grey literature, and reference lists of included articles will be searched. English language studies that describe NP and physician collaborative models within the LTC setting will be included., Discussion: This scoping review will consolidate what is known about existing NP/physician collaborative models of care in LTC homes. Results will be used to inform the development of a collaborative practice framework for long-term care clinical leadership., (© 2023. The Author(s).)

Aims: To explore nurse practitioners' experiences of medication abortion implementation in Canada and to identify ways to further support the implementation of medication abortion by nurse practitioners in Canada., Design: A qualitative approach informed by feminist theory and integrated knowledge translation., Methods: Qualitative interviews with stakeholders and nurse practitioners between January 2020 and May 2021. Data were analysed using critical feminist theory., Results: Participants included 20 stakeholders, 16 nurse practitioner abortion providers, and seven nurse practitioners who did not provide abortions. We found that nurse practitioners conduct educational, communication and networking activities in the implementation of medication abortion in their communities. Nurse practitioners navigated resistance to abortion care in the health system from employers, colleagues and funders. Participants valued making abortion care more accessible to their patients and indicated that normalizing medication abortion in primary care was important to them., Conclusion: When trained in abortion care and supported by employers, nurse practitioners are leaders of abortion care in their communities and want to provide accessible, inclusive services to their patients. We recommend nursing curricula integrate abortion services in education, and that policymakers and health administrators partner with nurses, physicians, midwives, social workers and pharmacists, for comprehensive provincial/territorial sexual and reproductive health strategies for primary care., Impact: The findings from this study may inform future policy, health administration and curriculum decisions related to reproductive health, and raise awareness about the crucial role of nurse practitioners in abortion care and contributions to reproductive health equity., Patient or Public Contribution: This study focused on provider experiences. In-kind support was provided by Action Canada for Sexual Health & Rights, an organization that provides direct support and resources to the public and is committed to advocating on behalf of patients and the public seeking sexual and reproductive health services., (© 2022 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

In this study we explored nurse practitioner-provided medication abortion in Canada and identified barriers and enablers to uptake and implementation. Between 2020-2021, we conducted 43 semi-structured interviews with 20 healthcare stakeholders and 23 nurse practitioners who both provided and did not provide medication abortion. Data were analyzed using interpretive description. We identified five overarching themes: 1) Access and use of ultrasound for gestational dating; 2) Advertising and anonymity of services; 3) Abortion as specialized or primary care; 4) Location and proximity to services; and 5) Education, mentorship, and peer support. Under certain conditions, ultrasound is not required for medication abortion, supporting nurse practitioner provision in the absence of access to this technology. Nurse practitioners felt a conflict between wanting to advertise their abortion services while also protecting their anonymity and that of their patients. Some nurse practitioners perceived medication abortion to be a low-resource, easy-to-provide service, while some not providing medication abortion continued to refer patients to specialized clinics. Some participants in rural areas felt unable to provide this service because they were too far from emergency services in the event of complications. Most nurse practitioners did not have any training in abortion care during their education and desired the support of a mentor experienced in abortion provision. Addressing factors that influence nurse practitioner provision of medication abortion will help to broaden access. Nurse practitioners are well-suited to provide medication abortion care but face multiple ongoing barriers to provision. We recommend the integration of medication abortion training into nurse practitioner education. Further, widespread communication from nursing organizations could inform nurse practitioners that medication abortion is within their scope of practice and facilitate public outreach campaigns to inform the public that this service exists and can be provided by nurse practitioners., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Carson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Like the Canadian season of spring, this issue brings fresh ideas and insights about the layers of complexity and potential solutions to the significant challenges associated with the retention of the nursing workforce. As these challenges intensify, nursing leaders - formal and informal - are rallying to redefine the boundaries of what can be done. We are innovators who are transforming this crisis into an opportunity to shift our thinking and do things differently. We are optimizing our roles and expanding our deployment to areas of the system that have previously underutilized nurses and nurse practitioners. The value we bring to the health system is indisputable., (Copyright © 2023 Longwoods Publishing.)

Introduction: Improving healthcare for people with multiple chronic or ongoing conditions is receiving increased attention, particularly due to the growing number of people experiencing multimorbidity (MM) and concerns about the sustainability of the healthcare system. Primary care has been promoted as an important resource for supporting people with MM to live well with their conditions and to prevent unnecessary use of health care services. However, traditional primary care has been criticized for not centring the needs and preferences of people with MM themselves. Our aim was to conduct a review that centred on the perspective of people with MM in multiple ways, including having patient partners co-lead the design, conduct and reporting of findings, and focusing on literature that reported the perspective of people with MM, irrespective of it being experimental or nonexperimental., Methods: We searched for published literature in CINAHL with Full Text (EBSCOhost) and MEDLINE All (Ovid). Findings from experimental and nonexperimental studies were integrated into collaboration with patient partners., Results: Twenty-nine articles were included in the review. Findings are described in five categories: (1) Care that is tailored to my unique situation; (2) meaningful inclusion in the team; (3) a healthcare team that is ready and able to address my complex needs; (4) supportive relationships and (5) access when and where I need it., Conclusion: This review supports a reorientation of primary care systems to better reflect the experiences and perspectives of people with MM. This can be accomplished by involving patient partners in the design and evaluation of primary care services and incentivizing collaboration among health and social supports and services for people with MM., Patient or Public Contribution: Patient partners were involved in the design and conduct of this review, and in the preparation of the manuscript. Their involvement is further elucidated in the manuscript text., (© 2022 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Objective: The objective of this review is to explore the experiences of residents of long-term-care homes using socially assistive technologies and the effectiveness of these technologies in relation to depression, loneliness, and social interaction., Introduction: Research related to the experiences of residents of long-term-care homes with socially assistive technologies, and their effectiveness, is limited. This population of older adults is projected to steeply increase in the future, as will the need for services, such as long-term care. Older adults (≥65 years) in long-term care are at increased risk of depression, loneliness, and social isolation. Therefore, there is a need to explore the experiences of long-term-care residents with the use of socially assistive technologies and to determine the effectiveness of these technologies in relation to depression, loneliness, and social interaction., Inclusion Criteria: This review will include studies about the experiences of older adults in long-term care using socially assistive technologies, and the effectiveness of these technologies. Older adults are defined as people 65 years of age and above. We will consider human-to-human socially assistive technologies, such as computers, smart phones, tablets, and associated applications. We will review quantitative, qualitative, and mixed methods studies., Methods: A JBI mixed methods convergent segregated approach will be used. Select databases and gray literature will be searched for published and unpublished studies, with no date or language limits. Titles, abstracts, and full texts of included studies will be screened by at least two reviewers, and undergo quality appraisal, data extraction, and synthesis of quantitative and qualitative data followed by integration of the two types of evidence., Systematic Review Registration Number: PROSPERO CRD42021279015., Competing Interests: RMM is an associate editor of JBI Evidence Synthesis, and was not involved in the editorial processing of this manuscript. The other authors declare no conflicts of interest., (Copyright © 2022 JBI.)

Background: People of African Nova Scotian (ANS) ancestry are a culturally distinct group who experience numerous socioeconomic inequities and health disparities, secondary to structural and social determinants of health. Understanding the experiences of ANS health practitioners is important in addressing anti-Black racism in health care. We sought to critically examine the leadership experiences of ANS nurses in health care practice., Methods: We used Black feminist theory to guide this qualitative study. We conducted 1-on-1 semistructured telephone interviews with ANS nurses and analyzed interview transcripts using Critical Discourse Analysis., Results: We interviewed 18 nurses of ANS ancestry. We conceptualized study findings in 3 overarching areas: People of ANS ancestry as a distinct people, institution of care, and leadership philosophy and practice. Each area, and its corresponding themes and subthemes, illustrated an emergent understanding of factors that influence leadership among ANS nurses, such as socialization, early exposure to care and diversity in health care. Participants perceived and practised leadership in a manner that transcended formal titles or designations., Interpretation: African Nova Scotian ancestry is implicated in the perception and practice of leadership among ANS nurses, who considered leadership to be a fundamental component of nursing practice that was grounded in community-oriented care. This study provides new insights that could inform recruitment, retention and representation of ANS people in nursing and other health professions., Competing Interests: Competing interests: Keisha Jefferies is a member of the Registered Nurses’ Association of Ontario’s Black Nurses’ Task Force. No other competing interests were declared., (© 2022 CMA Impact Inc. or its licensors.)

Objective: To explore the Canadian first-trimester medication abortion (MA) workforce and their clinical care following the introduction of mifepristone in 2017, updated national clinical practice guidelines and government approval of nurse practitioners (NPs) as first-trimester MA providers., Study Design: We conducted a national, self-administered, cross-sectional survey of abortion providers in 2019. Our bilingual (French/English) survey collected information on demographics, abortion number, and clinical care characteristics. The true number of abortion providers is unknown thus we cannot calculate a survey response rate. To maximize identification of possibly eligible respondents, we widely distributed the survey between July and December 2020 through health professional organizations, using a modified Dillman technique. We used descriptive statistics to characterize the workforce and clinical practices., Results: Four-hundred-sixty-five clinicians responded, of whom 388 provided first-trimester MA. Physicians (n = 358) and NPs (n = 30) reported providing 13,429 first-trimester MAs in 2019 which represented 27.7% of all reported abortions in the survey. The majority of first-trimester MA respondents were primary care physicians (n = 245, 63.1%), had less than five years' experience (n = 223, 61.3%) and practiced outside of hospitals (n = 228, 66.5%). Forty-three percent (n = 165) practiced rurally, and 44.0% (n = 136) used telemedicine for some abortion care. Ninety-nine percent (n = 350) used a guideline-recommended mifepristone/misoprostol regimen while 14.5% (n = 51) sometimes used methotrexate. Patients most commonly received mifepristone/misoprostol at community pharmacies (median 100.0%; interquartile range 50.0%-100.0%)., Conclusion: Our results suggest that there are many new first-trimester MA providers, an increase in the proportion of MAs since 2012 and a shift to primary care settings. Respondents widely adopted mifepristone., Implications Statement: Our results highlight that, following mifepristone introduction, many new primary care practitioners started providing first-trimester medication abortion throughout Canada, including the first non-physicians. This increased access to abortion particularly in rural and underserved communities. These results could inform future directions in policy, guidelines, and abortion access initiatives., (Copyright © 2022. Published by Elsevier Inc.)

Almost ten years ago, the World Health Organization published the document A Universal Truth: No Health Without a Workforce (Campbell et al. 2013). At that time, the situation across the world was grim, with millions of people without healthcare and universal health goals a long way from attainment. Today, enabled by a global pandemic, the consequences of climate change and economic recession, that grimness has morphed into a worldwide health human resources and healthcare crisis of unparalleled magnitude., (Copyright © 2022 Longwoods Publishing.)

Background: Untreated pain in infants is associated with adverse health outcomes. Despite strong evidence for accessible, effective, and low-cost parent-led pain-relieving interventions such as breastfeeding or chestfeeding and skin-to-skin contact, these interventions are not routinely used., Objective: The objective of this study is to support the implementation of parent-led pain interventions by identifying barriers to and facilitators of parent-led, evidence-informed pain care in infants during acute procedures. In addition, this study aims to develop theory-informed, contextually relevant implementation interventions for supporting the use of parent-led pain care for infants in hospital and community contexts., Methods: This study will consist of 2 phases that follow a systematic, theoretically informed approach guided by the Theoretical Domains Framework and Behavior Change Wheel. In phase 1, we will use a qualitative descriptive design to explore barriers and facilitators to using parent-led pain care in infants from the perspectives of hospital and community-based clinicians, clinical leaders, and families. In phase 2, we will use the Behavior Change Wheel to design tailored implementation interventions that have evidence for effectively addressing identified barriers in collaboration with an advisory committee of administrative, clinical, and family leaders., Results: Ethics approval for this study was obtained in December 2020. As of May 2022, a total of 15 participants have been enrolled in phase 1. The results from all phases will be reported in 2023., Conclusions: Following the completion of this study, we will have co-designed theoretically informed implementation interventions that can be pilot-tested and experimentally applied. The findings will be used to implement parent-led interventions that improve patient safety and health outcomes for diverse families., International Registered Report Identifier (irrid): DERR1-10.2196/33770., (©Britney Benoit, Christine Cassidy, Jacqueline van Wijlen, Quinn Correll, Marsha Campbell-Yeo, Sionnach Hendra, Ruth Martin-Misener, Jennifer MacDougall, Ashley Cameron. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 05.08.2022.)

Background: Polypharmacy is a major global problem. Evidence in primary care shows deprescribing can be beneficial. Behaviour change theories such as the Theoretical Domains Framework (TDF) and the Behaviour Change Wheel (BCW) can help develop successful implementation of deprescribing initiatives., Objectives: To link locally identified deprescribing influencers with components of successfully trialed deprescribing strategies, with the aim of informing the development of local deprescribing initiatives., Methods: Two background studies were completed. A qualitative study of interviews and focus groups identified influencers of deprescribing from local primary care physicians, nurse practitioners, and pharmacists. Transcripts were coded using the TDF and mapped to the Intervention Functions of the BCW. A scoping review identified studies that investigated primary care deprescribing strategies, which were mapped to the BCW Intervention Functions and the Behaviour Change Techniques (BCTs). For this analysis, six main TDF domains from the qualitative study were linked to the BCTs identified in the scoping review through the Intervention Functions of the BCW., Results: Within the BCW component Capability, one TDF domain identified in the qualitative study, Memory, Attention and Decision Process, was linked to strategies like academic detailing from the scoping review. For the Opportunity component, two TDF domains, Social Influences and Environmental Context and Resources, were linked to strategies such as pharmacist medication reviews, providing patient information leaflets, and evidence-based deprescribing tools. For the Motivation component, three TDF domains, Social/Professional Role and Identity, Intentions, and Beliefs about Consequences, were linked to strategies such as sending deprescribing information to prescribers, using tools to identify eligible patients, and having patients report adverse events of medications., Conclusions: This analysis identified deprescribing strategies that can be used to address influencers related to behaviour change from the perspective of primary care providers, and to assist with future deprescribing initiative development and implementation in the local context., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: With migration occurring over a series of centuries, dating back to the 1600's, the circumstance regarding Black people in Canada is a complex account. A plethora of social issues and the failure to adequately acknowledge and reconcile historical issues, has resulted in health inequity, disparities and knowledge gaps, related to the Black population in Canada. In nursing, historical records indicate a legacy of discrimination that continues to impact Black nurses. The profession has begun reckoning with anti-Black racism and the residual effects. This scoping review sought to chart the existing evidence on Black nurses in the nursing profession in Canada., Methods: JBI methodology was used to search peer-reviewed evidence and unpublished gray literature. Sources were considered for inclusion based on criteria outlined in an a priori protocol focusing on: 1) Canada 2) Black nurses and 3) nursing practice. No restrictions were placed on date of publication and language was limited to English and French. All screening and extractions were completed by two independent reviewers., Results: The database search yielded 688 records. After removing duplicates, 600 titles and abstracts were screened for eligibility and 127 advanced to full-text screening. Eighty-two full-text articles were excluded, for a total of 44 sources meeting the inclusion criteria. Seven sources were identified through gray literature search. Subsequently, 31 sources underwent data extraction. Of the 31 sources, 18 are research (n = 18), six are commentaries (n = 6); one report (n = 1) and six are classified as announcements, memoranda or policy statements (n = 6). The review findings are categorized into five conceptual categories: racism (n = 12); historical situatedness (n = 2); leadership and career progression (n = 7); immigration (n = 4); and diversity in the workforce (n = 4)., Conclusions: This review reveals the interconnectedness of the five conceptual categories. Racism was a prominent issue woven throughout the majority of the sources. Additionally, this review captures how racism is exacerbated by intersectional factors such as gender, class and nationality. The findings herein offer insight regarding anti-Black racism and discrimination in nursing as well as suggestions for future research including the use of diverse methodologies in different jurisdictions across the country. Lastly, the implications extend to the nursing workforce in relation to enhancing diversity and addressing the ongoing nursing shortage., (© 2022. The Author(s).)

Background: Globally, registered nurses (RNs) are increasingly working in primary care interdisciplinary teams. Although existing literature provides some information about the contributions of RNs towards outcomes of care, further evidence on RN workforce contributions, specifically towards patient-level outcomes, is needed. This study synthesized evidence regarding the effectiveness of RNs on patient outcomes in primary care., Methods: A systematic review was conducted in accordance with Joanna Briggs Institute methodology. A comprehensive search of databases (CINAHL, MEDLINE Complete, PsycINFO, Embase) was performed using applicable subject headings and keywords. Additional literature was identified through grey literature searches (ProQuest Dissertations and Theses, MedNar, Google Scholar, websites, reference lists of included articles). Quantitative studies measuring the effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN) that reported related outcomes were included. Articles were screened independently by two researchers and assessed for bias using the Integrated Quality Criteria for Review of Multiple Study Designs tool. A narrative synthesis was undertaken due to the heterogeneity in study designs, RN-led interventions, and outcome measures across included studies., Results: Forty-six patient outcomes were identified across 23 studies. Outcomes were categorized in accordance with the PaRIS Conceptual Framework (patient-reported experience measures, patient-reported outcome measures, health behaviours) and an additional category added by the research team (biomarkers). Primary care RN-led interventions resulted in improvements within each outcome category, specifically with respect to weight loss, pelvic floor muscle strength and endurance, blood pressure and glycemic control, exercise self-efficacy, social activity, improved diet and physical activity levels, and reduced tobacco use. Patients reported high levels of satisfaction with RN-led care., Conclusions: This review provides evidence regarding the effectiveness of RNs on patient outcomes in primary care, specifically with respect to satisfaction, enablement, quality of life, self-efficacy, and improvements in health behaviours. Ongoing evaluation that accounts for primary care RNs' unique scope of practice and emphasizes the patient experience is necessary to optimize the delivery of patient-centered primary care., Protocol Registration Id: PROSPERO: International Prospective Register of Systematic Reviews. 2018. ID=CRD42 018090767 ., (© 2022. The Author(s).)

In this issue of the Canadian Journal of Nursing Leadership (CJNL), we are pleased to offer a range of articles and perspectives including a leadership profile, a letter to the editor, research-focused articles and invited commentaries. The unifying thread through all of them is the complex maze of challenges and opportunities facing the nursing workforce. This complexity is created by many factors in Canada and around the globe. To be sure, the COVID-19 pandemic is one of them but its effect has not been to create - but rather to accelerate and intensify the impacts of issues that have plagued nursing for decades. There are no easy solutions to what are longstanding challenges; however, that is not a justification for inaction. Improvements to the experiences of nurses in their workplaces is a responsibility we all need to own, beginning with how we treat one another., (Copyright © 2022 Longwoods Publishing.)

Objective: The objectives of this review were to map and summarize evidence regarding advanced practice nursing roles in Arab countries located in the Eastern Mediterranean region., Introduction: Many countries have reported an increase in the number and types of advanced practice nursing roles as research demonstrating their positive impact on patient and health system outcomes continues to accumulate. There is international evidence that the achievement of these outcomes depends on the effective implementation of advanced practice nursing roles at the organizational and country levels. A comprehensive review of the status of advanced practice nursing role implementation in Arab countries in the Eastern Mediterranean region has not been conducted., Inclusion Criteria: Eligible studies included advanced practice nursing roles (including, but not limited to, nurse practitioners and clinical nurse specialists) in Arab countries in the Eastern Mediterranean region. Studies were considered if they focused on role development, titles, entry-level education, regulation and scope of practice, and facilitators and barriers to role implementation., Methods: A comprehensive systematic search was completed for both published and non-published literature. The databases searched included CINAHL, PubMed, PsycINFO, Embase, Nursing and Allied Health Database, and Scopus. Gray literature was searched using websites such as Google Scholar, ProQuest Dissertations and Theses, International Council of Nurses, World Health Organization regional office for the Eastern Mediterranean region, and websites of nursing associations and Ministries of Health in Arab countries. The search included literature published in Arabic and English from the inception of the databases to August 2020., Results: A total of 35 articles were included, the majority (n = 24) of which were published from 2010 onward. Ten of the included studies were empirical research papers that used qualitative and quantitative research designs. Advanced practice nursing role development is still in its infancy in most of the Arab countries in the Eastern Mediterranean region and can be described as slowly and steadily evolving. The main driving forces for the implementation of the roles in this region included a shortage of physicians both in number and specialties, the emergence of chronic diseases due to lifestyle changes, the desire to have more cost-effective primary care, and to advance nursing as a profession. Clinical nurse specialists and nurse practitioners are the most common titles for the advanced nursing roles practiced in the region. Some advanced practice nursing roles stipulated a master's degree as a minimum requirement, while others required a 12-month in-house training program. Oman is the only Arab country that authorizes nurse practitioners to prescribe pre-set medications. The common barriers to advanced practice nursing role implementation included a lack of recognition of roles at national levels, role ambiguity, lack of clear scope of practice, resistance from male physicians, low involvement of nurses in policy-making, and low status of nursing as a profession., Conclusion: The successful implementation and sustainment of advanced practice nursing roles in Arab countries in the Eastern Mediterranean region requires foundational work, including development of definitions, educational standards, regulations, and a clear scope of practice., Scoping Review Registration Number: Open Science Framework: https://osf.io/wyj8a., Competing Interests: The authors declare no conflict of interest., (Copyright © 2022 JBI.)

Background: As of November 25th 2021, four SARS-CoV - 2 variants of concern (VOC: Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2)) have been detected. Variable degrees of increased transmissibility of the VOC have been documented, with potential implications for hospital and health system capacity and control measures. This rapid review aimed to provide a synthesis of evidence related to health system responses to the emergence of VOC worldwide., Methods: Seven databases were searched up to September 27, 2021, for terms related to VOC. Titles, abstracts, and full-text documents were screened independently by two reviewers. Data were extracted independently by two reviewers using a standardized form. Studies were included if they reported on at least one of the VOC and health system outcomes., Results: Of the 4877 articles retrieved, 59 studies were included, which used a wide range of designs and methods. Most of the studies reported on Alpha, and all except two reported on impacts for capacity planning related to hospitalization, intensive care admissions, and mortality. Most studies (73.4%) observed an increase in hospitalization, but findings on increased admission to intensive care units were mixed (50%). Most studies (63.4%) that reported mortality data found an increased risk of death due to VOC, although health system capacity may influence this. No studies reported on screening staff and visitors or cohorting patients based on VOC., Conclusion: While the findings should be interpreted with caution as most of the sources identified were preprints, evidence is trending towards an increased risk of hospitalization and, potentially, mortality due to VOC compared to wild-type SARS-CoV - 2. There is little evidence on the need for, and the effect of, changes to health system arrangements in response to VOC transmission., (© 2022. The Author(s).)

Background: Ongoing developments in the medical field have improved survival rates and long-term management of children with complex chronic health conditions. While the number of children with medical complexity is small, they use a significant amount of health resources across various health settings and sectors. Research to date exploring this pediatric population has relied primarily on quantitative or qualitative data alone, leaving significant gaps in our understanding of this population., Objective: The objective of this research is to use health administrative and family-reported data to gain an in-depth understanding of patterns of health resource use and health care needs of children with medical complexity and their families in the Canadian Maritimes., Methods: An explanatory sequential mixed methods design will be used to achieve our research objective. Phase 1 of this research will leverage the use of health administrative data to examine the prevalence and health service use of children with medical complexity. Phase 2 will use case study methods to collect multiple sources of family-reported data to generate a greater understanding of their experiences, health resource use, and health care needs. Two cases will be developed in each of the 3 provinces. Cases will be developed through semistructured interviews with families and their health care providers and health resource journaling. Findings will be triangulated from phase 1 and 2 using a joint display table to visually depict the convergence and divergence between the quantitative and qualitative findings. This triangulation will result in a comprehensive and in-depth understanding into the population of children with medical complexity., Results: This study will be completed in May 2022. Findings from each phase of the research and integration of the two will be reported in full in 2022., Conclusions: There is a current disconnect between the Canadian health care system and the needs of children with medical complexity and their families. By combining health administrative and family-reported data, this study will unveil critical information about children with medical complexity and their families to more efficiently and effectively meet their health care needs. Results from this research will be the first step in designing patient-oriented health policies and programs to improve the health care experiences, health system use, and health outcomes of children with medical complexity and their families., International Registered Report Identifier (irrid): DERR1-10.2196/33426., (©Sydney Breneol, Janet A Curran, Marilyn Macdonald, William Montelpare, Samuel A Stewart, Ruth Martin-Misener, Jocelyn Vine. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 06.04.2022.)

Background: Internationally, policy-makers and health administrators are seeking evidence to inform further integration and optimal utilization of registered nurses (RNs) within primary care teams. Although existing literature provides some information regarding RN contributions, further evidence on the impact of RNs towards quality and cost of care is necessary to demonstrate the contribution of this role on health system outcomes. In this study we synthesize international evidence on the effectiveness of RNs on care delivery and system-level outcomes in primary care., Methods: A systematic review was conducted in accordance with Joanna Briggs Institute methodology. Searches were conducted in CINAHL, MEDLINE Complete, PsycINFO, and Embase for published literature and ProQuest Dissertations and Theses and MedNar for unpublished literature between 2019 and 2022 using relevant subject headings and keywords. Additional literature was identified through Google Scholar, websites, and reference lists of included articles. Studies were included if they measured effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN within the context of an independent or interdependent role) and reported outcomes of these interventions. Included studies were published in English; no date or location restrictions were applied. Risk of bias was assessed using the Integrated Quality Criteria for Review of Multiple Study Designs tool. Due to the heterogeneity of included studies, a narrative synthesis was undertaken., Results: Seventeen articles were eligible for inclusion, with 11 examining system outcomes (e.g., cost, workload) and 15 reporting on outcomes related to care delivery (e.g., illness management, quality of smoking cessation support). The studies suggest that RN-led care may have an impact on outcomes, specifically in relation to the provision of medication management, patient triage, chronic disease management, sexual health, routine preventative care, health promotion/education, and self-management interventions (e.g. smoking cessation support)., Conclusions: The findings suggest that primary care RNs impact the delivery of quality primary care, and that RN-led care may complement and potentially enhance primary care delivered by other primary care providers. Ongoing evaluation in this area is important to further refine nursing scope of practice policy, determine the impact of RN-led care on outcomes, and inform improvements to primary care infrastructure and systems management to meet care needs., Protocol Registration Id: PROSPERO: International prospective register of systematic reviews. 2018. ID= CRD42018090767 ., (© 2022. The Author(s).)

Background: Women are the fastest growing population in Canadian prisons. Incarceration can limit access to essential health services, increase health risks and disrupt treatment and supports. Despite legal requirements to provide care at professionally accepted standards, evidence suggests imprisonment undermines sexual and reproductive health. This scoping review asks, "What is known about the sexual and reproductive health of people incarcerated in prisons for women in Canada?", Methods: We use the Joanna Briggs Institute methodology for systematic scoping reviews. Databases searched include MEDLINE, CINAHL, PsycINFO, Gender Studies Abstracts, Google Scholar and Proquest Dissertations and grey literature. The search yielded 1424 titles and abstracts of which 15 met the criteria for inclusion., Results: Conducted from 1994-2020, in provincial facilities in Ontario, British Columbia, Alberta and Quebec as well as federal prisons, the 15 studies included qualitative, quantitative and mixed methods. The most common outcomes of interest were related to HIV. Other outcomes studied included Papanicolaou (Pap) and sexually transmitted infection (STI) testing, contraception, pregnancy, birth/neonatal outcomes, and sexual assault., Conclusion: Incarceration results in lack of access to basic services including contraception and prenatal care. Legal obligations to provide sexual and reproductive health services at professionally acceptable standards appear unmet. Incarceration impedes rights of incarcerated people to sexual and reproductive health.