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There is a lack of access to culturally safe and individualized cancer survivorship care and awareness of the unique challenges and strengths that Indigenous persons living with cancer (PLCs) face. This study aimed to explore the experiences and needs of First Nations and Métis PLCs across Canada. From 2014 to 2016, we engaged 87 participants who were either PLCs or caregivers (CGs) from five communities across Canada—Gitxsan and Kenora, British Columbia; Ottawa, Ontario; and Akwesasne and Kahnawake, Quebec—using participatory arts-based methods. Following the thematic analysis of participants’ photographs, journal entries, and stories, we created a video exploring the themes of spirituality and ceremony, finding strength together, the land and nature, creating and sharing, and navigating health care. Participants’ feedback on the video supports the use of video as a knowledge translation tool that may promote meaningful dialogue around the cancer experiences of Indigenous peoples in Canada.

Despite scholarly debate on the topic of success, how women define career success remains unclear. For many decades, research on the concept of success has largely used quantitative methods to assess the external aspects of success in a male-dominated culture. Using a total of 18 articles from 1999 to 2020, this qualitative meta-synthesis aims to gain detailed insights into women’s definitions of career success and to capture their perspectives on the barriers they face. A systematic search was conducted across four databases: Sociological Abstracts, SocINDEX, SCOPUS, and Google Scholar. This study is novel in that it is the first synthesized research that qualitatively studies the concept of career success. From this review, three distinct themes regarding women’s definition of career success emerged: (1) having support, (2) having accomplishments, and (3) feeling belonging. This article also establishes three themes regarding the obstacles to women’s career path toward success: (1) work–family/work–life imbalance, (2) gender bias/gender discrimination, and (3) the lack of mentors and role models. In contrast to previous research, the findings of this qualitative meta-synthesis indicate that while women define career success individually, they acknowledge that the professional objective aspects of success are important or even central to them in their life. The limitations of the study are noted, and the implications and future research directions are discussed.

BackgroundGlobal health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally distressing events. The pandemic has provided an opportunity to explore the links between moral distress, moral resilience, and emergence of mental health symptoms in HCWs.MethodsA total of 962 Canadian healthcare workers (88.4% female, 44.6 + 12.8 years old) completed an online survey during the first COVID-19 wave in Canada (between April 3rd and September 3rd, 2020). Respondents completed a series of validated scales assessing moral distress, perceived stress, anxiety, and depression symptoms, and moral resilience. Respondents were grouped based on exposure to patients who tested positive for COVID-19. In addition to descriptive statistics and analyses of covariance, multiple linear regression was used to evaluate if moral resilience moderates the association between exposure to morally distressing events and moral distress. Factors associated with moral resilience were also assessed.FindingsRespondents working with patients with COVID-19 showed significantly more severe moral distress, anxiety, and depression symptoms (F > 5.5,p < .020), and a higher proportion screened positive for mental disorders (Chi-squared > 9.1,p = .002), compared to healthcare workers who were not. Moral resilience moderated the relationship between exposure to potentially morally distressing events and moral distress (p r > .27,p InterpretationElevated moral distress and mental health symptoms in healthcare workers facing a global crisis such as the COVID-19 pandemic call for the development of interventions promoting moral resilience as a protective measure against moral adversities.

Introduction Nurses' use of evidence-based pain treatments for newborns during needle-related procedures in China was unknown. This study aimed to ascertain knowledge and use of pain management strategies and usefulness of a publicly accessible 'BSweet2Babies' video, produced in Mandarin, demonstrating the use of breastfeeding, skin-to-skin care (SSC), and sweet solutions during painful procedures. Methods An online survey was conducted during six nursing conferences in China ascertaining nurses' previous viewing of the video and knowledge and use of the demonstrated strategies. Results 221 nurses participated. Only 25 (11.3%) had previously seen the video. Over half knew that breastfeeding (n = 138, 62.4%) and SSC (n = 173, 78.3%) reduced pain, and 89 (40.3%) knew that sucrose reduced pain, but these strategies were infrequently used. Most intended to use the strategies in the future. Discussion A knowledge-to-action gap for newborn pain management was identified. Future research is needed to improve the implementation of effective pain treatment for newborns.

Author(s): Hu, Jiale; Gifford, Wendy; Ruan, Hong; Harrison, Denise; Li, Qingge; Ehrhart, Mark G; Harrison, Mary-Ann; Barrowman, Nick; Aarons, Gregory A | Abstract: AimThis study aimed to evaluate the validity, reliability and acceptability of the Implementation Leadership Scale in the Chinese nursing context.DesignThis study utilized a cross-sectional design.MethodsThis study was conducted in one general tertiary hospital with 234 nurses (85.3% response rate) from 35 clinical units in China. Content validity, structural validity, convergent validity, reliability (internal consistency), agreement indices and acceptability were evaluated. The data collection was from December 1st, 2017 to June 30th, 2018.ResultsConfirmatory factor analysis demonstrated a good model fit to the four-factor implementation leadership model. The psychometric testing also indicated good convergent validity, high internal consistency and acceptable aggregation. Most participants completed the scale in two minutes or less and agreed or strongly agreed that the questions were relevant to implementation leadership, clear and easy to answer.ConclusionsThis study demonstrated that the Chinese Implementation Leadership Scale is a valid, reliable and pragmatic tool for measuring strategic leadership for implementing evidence-based practices.

This study aimed to synthesize evidence on interventions to improve leadership competencies of managers supervising nurses.In recent years, numerous interventions have been developed to improve the leadership competencies of managers supervising nurses. However, researchers and nursing leaders are unclear about what aspects of interventions are effective for developing which competencies.We conducted a mixed-methods systematic review following the Joanna Briggs Institute (JBI) approach for evidence synthesis. The Medline (Ovid), CINAHL, Embase, Scopus, Nursing and Allied Health Database were reviewed. Data extraction, quality appraisal and narrative synthesis were conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.A total of 69 studies (35 quantitative, 22 mixed methods, 12 qualitative) evaluating 68 interventions were included. Studies showed that interventions used modal activities such as lectures, group work and mentoring that generally had positive effects on improving leadership competencies such as supporting, developing and recognizing nurses. Opportunities to interact with peers increased managers' engagement in the interventions; however, many barriers existed for managers to use the competencies in practice including understaffing, insufficient time and lack of support from supervisors and staff.Leadership interventions were shown to have beneficial effects on developing different competencies. Managers predominately felt positive about participating in leadership interventions; however, they expressed many difficulties applying what they learned in practice.Leadership interventions should include multimodal activities that give managers opportunities for interaction. When considering interventions for developing the leadership of managers, it is imperative to consider the practice environments for managers to be successful in applying the competencies they learned in practice.

Understanding what culturally safe care means to First Nations people is the first step to reimagining how healthcare can be conceived and operationalized. This study explored the meaning of culturally safe cancer care with Algonquins of Pikwakanagan First Nation in Canada, including community members’ perceptions of barriers to receiving it. Two focus groups using journey mapping were held with cancer survivors and family members ( n = 16) and healthcare providers ( n = 12), followed by individual interviews ( n = 13). Discussions were video-recorded, transcribed verbatim, and thematically analysed. Culturally safe cancer care encompassed: (a) family and community, (b) culture as healing, and (c) stories for sharing cultural teachings. Ongoing systemic racism was described as prevalent in cancer care today and a significant barrier to culturally safe care. Further research is needed for health system change to dismantle the systemic and structural factors that continue to make healthcare unsafe and harm Indigenous People.

Street nurses who serve people experiencing homelessness and substance abuse are at risk of vicarious trauma and long-term mental health challenges. These risks have increased during the COVID-19 pandemic due to a concomitant spike in opioid overdoses and deaths in Canada, fewer available support services and worsening social challenges. This article describes innovative interdisciplinary and participatory research currently being undertaken to develop and evaluate a multifaceted support program to promote the holistic well-being of street nurses and their front-line colleagues.

Purpose The purpose of this systematic review is to synthesize the evidence on the types of interventions that have been utilized by Indigenous Peoples living with cancer, and report on their relevance to Indigenous communities and how they align with holistic wellness. Methods A systematic review with narrative synthesis was conducted. Results The search yielded 7995 unique records; 27 studies evaluating 20 interventions were included. The majority of studies were conducted in USA, with five in Australia and one in Peru. Study designs were cross-sectional (n=13); qualitative (n=5); mixed methods (n=4); experimental (n=3); and quasi-experimental (n=2). Relevance to participating Indigenous communities was rated moderate to low. Interventions were diverse in aims, ingredients, and outcomes. Aims involved (1) supporting the healthcare journey, (2) increasing knowledge, (3) providing psychosocial support, and (4) promoting dialogue about cancer. The main ingredients of the interventions were community meetings, patient navigation, arts, and printed/online/audio materials. Participants were predominately female. Eighty-nine percent of studies showed positive influences on the outcomes evaluated. No studies addressed all four dimensions of holistic wellness (physical, mental, social, and spiritual) that are central to Indigenous health in many communities. Conclusion Studies we found represented a small number of Indigenous Nations and Peoples and did not meet relevance standards in their reporting of engagement with Indigenous communities. To improve the cancer survivorship journey, we need interventions that are relevant, culturally safe and effective, and honoring the diverse conceptualizations of health and wellness among Indigenous Peoples around the world.

Few studies examine care as a relational process in long-term care, and still fewer describe the participation of residents with dementia. In this article, our objective was to understand the development of knowledge in this area by means of a meta-ethnography. Our search and selection process resulted in six eligible articles. Each documents a qualitative study of resident–staff interactions during care activities in a residential care setting, and includes participants with dementia. Tronto’s 4 Phases of Care were used to guide the identification of relational care practices within the articles selected. We identified five translatable concepts across the six studies: (1) doing with versus doing for, (2) staff responsiveness, (3) resident agency, (4) inclusive communication, and (5) time. In our new configuration of relational care, we combine these concepts to delineate an “interactive space” in which the agency of residents and initiative of staff are equally visible.

RESUMOObjetivo: evidenciar, a partir do feedback dos usuários, familiares, coordenadores e profissionais do Centro de Atenção Psicossocial Infanto Juvenil (CAPSi), a potencialidade do e-Mental Health na promoção do acesso através de um website.Método: pesquisa com abordagem metodológica qualitativa através de um estudo exploratório, do tipo pesquisa-ação utilizando o Knowledge Translation e a Metodologia da Dinâmica do Espelhamento Digital. A coleta de dados ocorreu entre os meses de agosto e setembro de 2018 no CAPSi da cidade de Pelotas, RS, Brasil. Resultados: o website iCanguru demonstrou ser capaz de melhorar o acesso, atuar na prevenção e promoção em saúde mental infanto-juvenil, aproximar a população rural e dar suporte cidades desassistidas.Conclusão: o website iCanguru pode ser uma excelente estratégia para superar algumas das barreiras de acesso e ser uma porta de entrada para o CAPSi.Descritores: e-Saúde; Serviços comunitários de saúde mental; Intervenção baseada em internet; Acesso a tecnologias em saúde; Avaliação das tecnologias de Saúde.

PurposeThe aim of this study was to describe the experiences of graduate students who participated in the community of practice (CoP) and identify areas for improvement to support academic success.Design/methodology/approachIn total, 19 graduate students engaged in a CoP to facilitate social interactions, knowledge sharing and learning within a culture of scholarship. A descriptive qualitative research study was conducted using semistructured interviews with eight participants who had attended the CoP meeting.FindingsAll participants were from the School of Nursing and perceived the CoP to be beneficial, particularly international students who had challenges in adapting to new academic and social environments. Areas for improvement include creating a group structure that enhances belonging and learning.Originality/valueThis is the first CoP that was implemented at the Faculty of Health Sciences at the authors’ university. It has been the authors’ experience that a CoP can benefit graduate students through networking, knowledge sharing, social support and learning. The finding of this research will be used to inform a new CoP to address the needs of graduate students. The authors will be adapting the CoP to the current context that includes a virtual platform during the COVID-19 pandemic and will include content specific for international students.

Objective To explore nurse managers' perceptions of the frequency and importance of professional activities performed in their daily work in public hospitals in Hunan, China. Background Nurse managers are responsible for the management of almost all nursing activities in Chinese hospitals. Understanding how nurse managers operationalize their role and their perceptions of the importance of each activity is essential for clarification of their role and the competencies required to perform it. Methods A cross-sectional questionnaire survey. Results A total of 1,371 nurse managers in Hunan Province completed the survey. Nursing quality/safety management and patient management were performed most frequently and perceived as most important. Nurse managers performed nursing information management frequently while perceiving it as less important. They seldom performed nursing research management and placed low value on it. Conclusions Patient-centred care remains central to nursing management. Nursing managers can create a leadership culture in their hospital settings that includes the effective management of information and facilitation of research knowledge to benefit nurse managers, staff and patients. Implications for nursing management The results provide evidence for standardization of roles and job descriptions of nurse managers and for developing their knowledge and skills to ensure quality patient care.

In Canada, responsibility for corrections is divided between federal, provincial and territorial governments, with nurses being the largest group of healthcare professionals working in correctional institutions (penitentiaries, jails, prisons, correctional centres and secure correctional treatment centres) across the country. Correctional institutions are among the most challenging workplace settings for nurses, as they face competing tensions between the provision of quality care and strict security requirements for safety. They also experience unique workforce issues with high reports of burnout and emotional exhaustion. Nursing leadership at all levels of the correctional system is critical in creating work environments that optimize workplace well-being and minimize burnout. The purpose of this paper is to discuss the role of nursing leadership in facilitating and enabling a healthy workforce in corrections. Minimal research has examined leadership and healthy work environments in correctional institutions. Several authors have, however, discussed transformational leadership as a strategy to positively influence correctional nursing practice. In this article, we expand on this previous work to describe the full range leadership model and how it can be used to form the foundation of effective leadership and support the creation of healthy work environments in the correctional context.

RÉSUMÉUne recherche interdisciplinaire faisant appel à des méthodes qualitatives a été menée pour étudier les obstacles et les facilitateurs relatifs à la participation culturelle des aînés des Premières Nations qui utilisent la mobilité sur roues et vivent dans des réserves en Ontario (Canada). Les thèmes ont été divisés en trois grandes catégories : (1) l’impact de la participation des aînés à des activités culturelles, (2) l’utilité des aides à la mobilité sur roues et (3) les obstacles freinant la participation à des événements culturels. Les obstacles incluent le manque de transports, l’incapacité de sortir du domicile en toute sécurité et de manière indépendante, l’irrégularité du terrain des réserves ; la stigmatisation associée au handicap, et le sentiment d’être un fardeau. Les résultats suggèrent que la mobilité sur roues peut augmenter la participation active des aînés aux événements culturels, mais démontrent aussi la nécessité de faciliter l’utilisation de cette mobilité dans les réserves en Ontario.

Almost half of all Canadians live with sensory, cognitive, or physical impairment due to injury, illness, or ageing. Yet, research investigating the complex relationship between well-being and impairment is limited. Existing research has largely rendered invisible peoples’ experiences of a good life while living with impairment. In response, researchers are calling for interdisciplinary research that integrates new paradigms. Using innovative qualitative and visual research methods, our team will work with 24 women living with impairment as a result of cancer and/or its treatments to explore how creative practices can contribute to new understandings of a good life. Participants will be invited to complete mixed-media arts workshops during which they will create artwork representing their experiences of well-being while living with impairment. After the workshops, each participant will be asked to complete an individual interview about their experiences and their creative work. Next, a rough cut of a film will be produced from the workshop recordings and participants will be invited to provide feedback at a private screening. The research will culminate in a public screening of the film and an exhibit of participants’ work. Audience members (health professionals, students, participants, and the general public) will participate in a discussion following the screening and will be asked to complete a short survey about the event. This research will enhance public understandings of what it means to live well with impairment. In addition, the research will potentially impact health practices through querying dominant biomedical paradigms focused on curative approaches and distress.

Introduction: Traditional methods of research have frequently failed to accommodate the communication difficulties experienced by a significant proportion of residents living in long-term care. In dementia research, specifically, there is cause for more collaborative, creative ways of working.Methods: The Linking Lives Through Care study is a performance-based narrative inquiry that will take place in a long-term care setting and will bring together all three members of the care triad - residents who are living with dementia, family members and personal support workers - to explore relational care from multiple positions and perspectives.Discussion: In this article, we discuss the design choices and creative measures taken to ensure a more inclusive research environment, specifically for those participants who are cognitively frail and/or may find it difficult to express their views using just words.

Background Nurses are the primary healthcare providers in correctional facilities. A solid knowledge and expertise that includes the use of research evidence in clinical decision making is needed to optimize nursing practice and promote positive health outcomes within these settings. The institutional emphasis on custodial care within a heavily secured, regulated, and punitive environment presents unique contextual challenges for nursing practice. Subsequently, correctional nurses are not always able to obtain training or ongoing education that is required for broad scopes of practice. The purpose of the proposed study is to develop an educational intervention for correctional nurses to support the provision of evidence-informed care. Methods A two-phase mixed methods research design will be used. The setting will be three provincial correctional facilities. Phase one will focus on identifying nurses’ scope of practice and practice needs, describing work environment characteristics that support evidence-informed practice and developing the intervention. Semi-structured interviews will be completed with nurses and nurse managers. To facilitate priorities for the intervention, a Delphi process will be used to rank the learning needs identified by participants. Based on findings, an online intervention will be developed. Phase two will involve evaluating the acceptability and feasibility of the intervention to inform a future experimental design. Discussion The context of provincial correctional facilities presents unique challenges for nurses’ provision of care. This study will generate information to address practice and learning needs specific to correctional nurses. Interventions tailored to barriers and supports within specific contexts are important to enable nurses to provide evidence-informed care.

Public Administration Review published by Wiley Periodicals, Inc. on behalf of The American Society for Public Administration. Drawing on multiple qualitative case studies of evidence-based health care conducted in Sweden, Canada, Australia, and the United Kingdom, the authors systematically explore the composition, circulation, and role of codified knowledge deployed in the organizational enactment of evidence-based practice. The article describes the “chain of codified knowledge,” which reflects the institutionalization of evidence-based practice as organizational business as usual, and shows that it is dominated by performance standards, policies and procedures, and locally collected (improvement and audit) data. These interconnected forms of “evidence by proxy,” which are informed by research partly or indirectly, enable simplification, selective reinforcement, and contextualization of scientific knowledge. The analysis reveals the dual effects of this codification dynamic on evidence-based practice and highlights the influence of macro-level ideological, historical, and technological factors on the composition and circulation of codified knowledge in the organizational enactment of evidence-based health care in different countries.

Aim To translate the Implementation Leadership Scale (ILS) into Chinese and evaluate how Chinese nursing staff and leaders understood and responded to the Chinese ILS. Background Leadership is a critical factor for implementing evidence-based practice. The ILS is a valid and reliable instrument to understand leadership for evidence-based practice; however, this scale or the other similar instrument does not exist in Chinese. Methods We followed the translation and cross-cultural validation guideline developed by Sousa and Rojjanasrirat. Translation included two forward and blind backward translations, and their comparisons. Two rounds of cognitive interview were used to evaluate the linguistic validity. Results The translation process took 12 months. In the forward and backward translations, 24 translation issues were identified, of which semantic equivalence issues were most frequent. Ten nurses participated in each round of cognitive interviews and 33 linguistic issues were found. The final Chinese ILS had seven significant adaptations to the original instrument. Conclusion This study provided a deep understanding of using the ILS in the local context and laid the foundation for future psychometric statistical testing. Implications for nursing management Implementation leadership scale could support organisational leadership development programmes and strategies to facilitate and support EBP implementation and sustainability.

Background Correctional nursing requires a strong knowledge base with access to continuing education (CE) to maintain and enhance competencies. Nurses working in provincial prisons have reported many challenges in accessing CE, with online learning being identified as a potential solution. Limited research was found, however, which examined the correctional context in the development and delivery of online learning for nurses. The purpose of this study was to develop an online educational intervention tailored to correctional nurses and determine the feasibility and acceptability of implementing the intervention in a provincial prison context. Methods A sequential mixed methods study was conducted. Participants included nurses from three correctional settings in the province of Ontario, Canada. Semistructured interviews examined contextual factors and educational needs. Delphi surveys determined the educational topic. Preintervention and postintervention questionnaires examined the context, educational content, and intervention's acceptability and feasibility. Results The online intervention focused on mental health and addictions with two 30-minute webinars delivered back-to-back over 15 weeks. Respondents expressed satisfaction with the convenience of online learning at work using short webinars, as well as the topics, relevance of information, and teaching materials, but dissatisfaction with presentation style. The feasibility of the intervention was limited by access to technology, time to attend, education space, and comfort with technology. Discussion The findings from this study provide insight to guide the future development of online CE for correctional nurses. If changes are made within correctional facilities in collaboration with nurses and managers, online learning holds the potential to facilitate access to ongoing professional development.

Background: The approach and style of leaders is known to be an important factor influencing the translation of research evidence into nursing practice. However, questions remain as to what types of roles are most effective and the specific mechanisms through which influence is achieved.Objectives: The aim of the study was to enhance understanding of the mechanisms by which key nursing roles lead the implementation of evidence-based practice across different care settings and countries and the contextual factors that influence them.Design: The study employed a qualitative descriptive approach.Settings: Data collection was undertaken in acute care and primary/community health care settings in Australia, Canada, England and Sweden.Participants: 55 individuals representing different levels of the nursing leadership structure (executive to frontline), roles (managers and facilitators), sectors (acute and primary/community) and countries.Methods: Individual semi-structured interviews were conducted with all participants exploring their roles and experiences of leading evidence-based practice. Data were analysed through a process of qualitative content analysis.Results: Different countries had varying structural arrangements and roles to support evidence-based nursing practice. At a cross-country level, three main themes were identified relating to different mechanisms for enacting evidence-based practice, contextual influences at a policy, organisational and service delivery level and challenges of leading evidence-based practice.Conclusions: National policies around quality and performance shape priorities for evidence-based practice, which in turn influences the roles and mechanisms for implementation that are given prominence. There is a need to maintain a balance between the mechanisms of managing and monitoring performance and facilitating critical questioning and reflection in and on practice. This requires a careful blending of managerial and facilitative leadership. The findings have implications for theory, practice, education and research relating to implementation and evidence-based practice.

Symptoms experienced by clients with cancer often occur at home and can become life-threatening, posing serious safety concerns. This study evaluated implementation of evidence-informed symptom practice guides to enhance quality of cancer symptom support by homecare nurses. A comparative case study was conducted using the Knowledge to Action Framework. Case were created for each of six agencies providing nursing care within a regional homecare authority. A team of researchers and knowledge users (e.g., managers, educators, family member): (1) assessed factors influencing practice guide use (survey, interviews) at six agencies, (2) adapted 15 practice guides for local use, (3) implemented with interventions to address barriers, and (4) monitored use. Analysis was within and across cases. Of six nursing agencies, one withdrew and five participated. In the baseline survey, 51% of nurses reported using guidelines but nurses did not describe using them in their current practice during the interviews. To overcome barriers, 489 nurses in five agencies were trained in how to use the practice guides, principles were established for documenting cancer symptom management, and practice guides were made available in various formats. Success with implementation varied across the participating cases. Chart audits conducted in three agencies revealed evidence of practice guide use for 16%, 22%, and 70% client visits, respectively. Implementation of evidence-informed practice guides in nursing required an approach tailored for each agency. Training, integration in documentation, and easy access to practice guides increased use for some nurses but ongoing support and reinforcement from nurse leaders is required.

BACKGROUND Social media has become widely used by individual researchers and professional organizations to translate research evidence into health care practice. Despite its increasing popularity, few social media initiatives consider the theoretical perspectives of how social media works as a knowledge translation strategy to affect research use. OBJECTIVE The purpose of this paper is to propose a conceptual framework to understand how social media works as a knowledge translation strategy for health care providers, policy makers, and patients to inform their health care decision-making. METHODS We developed this framework using an integrative approach that first involved reviewing 5 long-standing social media initiatives. We then drafted the initial framework using a deductive approach by referring to 5 theories on social media studies and knowledge translation. A total of 58 empirical studies on factors that influenced the use of social media and its messages and strategies for promoting the use of research evidence via social media were further integrated to substantiate and fine-tune our initial framework. Through an iterative process, we developed the Social Media for ImpLementing Evidence (SMILE) framework. RESULTS The SMILE framework has six key constructs: developers, messages and delivery strategies, recipients, context, triggers, and outcomes. For social media to effectively enable recipients to use research evidence in their decision-making, the framework proposes that social media content developers respond to target recipients’ needs and context and develop relevant messages and appropriate delivery strategies. The recipients’ use of social media messages is influenced by the virtual–technical, individual, organizational, and system contexts and can be activated by three types of triggers: sparks, facilitators, and signals. CONCLUSIONS The SMILE framework maps the factors that are hypothesized to influence the use of social media messages by recipients and offers a heuristic device for social media content developers to create interventions for promoting the use of evidence in health care decision-making. Empirical studies are now needed to test the propositions of this framework.

Aims To describe strategies nursing leaders use to promote evidence-based practice implementation at point-of-care using data from health systems in Australia, Canada, England and Sweden. Design A descriptive, exploratory case-study design based on individual interviews using deductive and inductive thematic analysis and interpretation. Methods Fifty-five nursing leaders from Australia, Canada, England and Sweden were recruited to participate in the study. Data were collected between September 2015 and April 2016. Results Nursing leaders both in formal managerial roles and enabling roles across four country jurisdictions used similar strategies to promote evidence-based practice implementation. Nursing leaders actively promote evidence-based practice implementation, work to influence evidence-based practice implementation processes and integrate evidence-based practice implementation into everyday policy and practices. Conclusion The deliberative, conscious strategies nursing leaders used were consistent across country setting, context and clinical area. These strategies were based on a series of activities and interventions around promoting, influencing and integrating evidence-based practice implementation. We conjecture that these three key strategies may be linked to two overarching ways of demonstrating effective evidence-based practice implementation leadership. The two overarching modes are described as mediating and adapting modes, which reflect complex, dynamic, relationship-focused approaches nursing leaders take towards promoting evidence-based practice implementation. Impact This study explored how nursing leaders promote evidence-based practice implementation. Acknowledging and respecting the complex work of nursing leaders in promoting evidence-based practice implementation through mediating and adapting modes of activity is necessary to improve patient outcomes and system effectiveness.

Cancer is a leading cause of death among Inuit. A legacy of colonialism, residential schools, and systemic racism has eroded trust among Inuit and many do not receive culturally safe care. This study aimed to explore the meaning of culturally safe cancer survivorship care for Inuit, and barriers and facilitators to receiving it in an urban setting in Ontario Canada. As Inuit and Western researchers, we conducted a descriptive qualitative study. We held two focus groups (n = 27) with cancer survivors and family members, and semi-structured interviews (n = 7) with health providers. Data were analysed using thematic content analysis. Three broad themes emerged as central to culturally safe care: access to traditional ways of life, communication, and family involvement. Family support, patient navigators, and designated spaces were facilitators; lack of support for traditional ways, like country food, was a barrier. Participants were clear what constituted culturally safe care, but major barriers exist. Lack of direction at institutional and governmental levels contributes to the complexity of issues that prevent Inuit from engaging in and receiving culturally safe cancer care. To understand how to transform healthcare to be culturally safe, studies underpinned by Inuit epistemology, values, and principles are required.

Background: Global health crises, such as the COVID-19 pandemic, confront healthcare workers (HCW) with increased exposure to potentially morally injurious events. The pandemic has provided an opportunity to explore the links between moral distress, moral resilience, and emergence of mental health symptoms in HCWs. Methods: A total of 962 Canadian healthcare workers (88·4% female, 44·6 + 12·8 years old) completed an online survey during the first COVID-19 wave in Canada (between April 3 rd and September 3 rd , 2020). Respondents completed a series of validated scales assessing moral distress, perceived stress, anxiety, and depression symptoms, and moral resilience. Respondents were grouped based on exposure to patients who tested positive for COVID-19. In addition to descriptive statistics and analyses of covariance, multiple linear regressions were used to evaluate association between moral resilience, demographic/professional factors and moral distress and to identify factors associated with moral resilience. Findings: Respondents working with patients with COVID-19 showed significantly more severe moral distress, anxiety and depression symptoms (F > 5·5, p 9·1, p = ·002), compared to healthcare workers who were not. Higher exposure to potentially morally injurious events (B=2·98, 95% CI [2·90, 3·05]) and lower moral resilience (B=3·12, 95% CI [0·04, 6·20]) were associated with worse moral distress. Moral resilience moderated the relationship between exposure to potentially morally injurious events and moral distress (p ·27, p

IntroductionThe negative impacts of COVID-19 have rippled through every facet of society. Understanding the multidimensional impacts of this pandemic is crucial to identify the most critical needs and to inform targeted interventions. This population survey study aimed to investigate the acute phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress between 3 April and 15 May 2020.Methods6040 participants are included in this report. A multivariate linear regression model was used to identify factors associated with stress changes (as measured by the Cohen’s Perceived Stress Scale (PSS)) relative to pre-outbreak retrospective estimates.ResultsOn average, PSS scores increased from low stress levels before the outbreak to moderate stress levels during the outbreak (pConclusionCross-sectional analyses showed a significant increase from low to moderate stress during the COVID-19 outbreak. Identified modifiable factors associated with increased stress may be informative for intervention development.Trial registration numberNCT04369690; Results.

Background The commitment to engage patients as partners in research has been described as a political, moral and ethical imperative. Researchers feel ill-equipped to deal with potential ethical implications of engaging patients as partners. The aim of this study is to identify the ethical considerations related to engaging frail and seriously ill (FSI) patients as partners in research. Methods We conducted a sub-analysis of a prior systematic review of 30 studies that engaged FSI patients as partners in research. Studies were included if they reported ethical considerations associated with partnering. We performed deductive content analysis, data were categorized according to Beauchamp and Childress’ Principles of Biomedical Ethics (2019): autonomy, non-maleficence, beneficence, and justice. Results Twenty-five studies were included. Common ethical considerations reported in relation to the principles were: autonomy – promoting desired level of involvement, addressing relational and intellectual power, facilitating knowledge and understanding of research; non-maleficence – protection from financial burden, physical and emotional suffering; beneficence – putting things right for others, showing value-added, and supporting patient-partners; and, justice – achieving appropriate representation, mutual respect for contributions, and distributing risks and benefits. Conclusions When partnering with FSI patients, research teams need to establish shared values and ensure processes are in place to identify and address ethical issues. Researchers and patients should work together to clarify the intent and outcomes of the partnership, actively address power differentials, recognize and minimize the potential for unintended harm, and strive to maximize the benefits of partnership. Systematic review registration The protocol for the original systematic review has been registered with the International Prospective Register of Systematic Reviews PROSPERO (CRD42019127994).

Background Social media has become widely used by individual researchers and professional organizations to translate research evidence into health care practice. Despite its increasing popularity, few social media initiatives consider the theoretical perspectives of how social media works as a knowledge translation strategy to affect research use. Objective The purpose of this paper is to propose a conceptual framework to understand how social media works as a knowledge translation strategy for health care providers, policy makers, and patients to inform their health care decision-making. Methods We developed this framework using an integrative approach that first involved reviewing 5 long-standing social media initiatives. We then drafted the initial framework using a deductive approach by referring to 5 theories on social media studies and knowledge translation. A total of 58 empirical studies on factors that influenced the use of social media and its messages and strategies for promoting the use of research evidence via social media were further integrated to substantiate and fine-tune our initial framework. Through an iterative process, we developed the Social Media for ImpLementing Evidence (SMILE) framework. Results The SMILE framework has six key constructs: developers, messages and delivery strategies, recipients, context, triggers, and outcomes. For social media to effectively enable recipients to use research evidence in their decision-making, the framework proposes that social media content developers respond to target recipients’ needs and context and develop relevant messages and appropriate delivery strategies. The recipients’ use of social media messages is influenced by the virtual–technical, individual, organizational, and system contexts and can be activated by three types of triggers: sparks, facilitators, and signals. Conclusions The SMILE framework maps the factors that are hypothesized to influence the use of social media messages by recipients and offers a heuristic device for social media content developers to create interventions for promoting the use of evidence in health care decision-making. Empirical studies are now needed to test the propositions of this framework.

Background The expectation to include patients as partners in research has steadily gained momentum. The vulnerability of frail and/or seriously ill patients provides additional complexity and may deter researchers from welcoming individuals from this patient population onto their teams. The aim was to synthesize the evidence on the engagement of frail and/or seriously ill patients as research partners across the research cycle. Methods A systematic review was conducted using PRISMA guidelines. A search strategy included MEDLINE®, EMBASE®, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO from database inception to April, 2019. Eligible studies were peer-reviewed qualitative, quantitative, and mixed methods research reporting on the engagement of frail and/or seriously ill patients as partners on research teams. The Mixed Methods Appraisal Tool was used to appraise study quality. Narrative analysis was conducted. Results Of 8763 citations, 30 were included. Most studies included individuals with cancer on the research team (60%). Barriers included: lack of time and resources (50%), discontinuity in contribution (37%), and concerns for well-being (33%). Facilitators included: trust and mutual respect (60%), structural accessibility (57%), flexibility in timing and methods of engagement (43%), and attention to care and comfort, (33%). Perceived impacts for patients included: renewed personal sense of agency (37%) and emotional/peer support (37%). Impacts for researchers included sensitization to the lived experience of disease (57%) and an increased appreciation of the benefits of patient engagement (23%). Research design, execution, and outcomes, developed with patients, were deemed more suitable, relevant and reflective of patients’ priorities. Conclusions There is emerging evidence to suggest that research partnerships with frail and/or seriously ill patients can be achieved successfully. Patients mostly report benefit from partnering with research teams. Frailty and/or serious illness do present legitimate concerns for their well-being but appear to be successfully mitigated when researchers ensure that the purpose of engagement is well-defined, the timing and methods of engagement are flexible, and the practical and emotional needs of patient partners are addressed throughout the process. Systematic review registration The systematic review protocol was registered with the International Prospective Register of Systematic Reviews PROSPERO (CRD42019127994).

BackgroundUnderstanding the multifaceted impacts of the Coronavirus-19 (COVID-19) outbreak as it unfolds is crucial to identify the most critical needs and to inform targeted interventions.MethodsThis population survey study presents cohort characteristics and baseline observations linked to the acute-mid phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress as measured by the Cohen’s Perceived Stress Scale (PSS) collected cross-sectionally between April 3 and May 15, 2020. A multivariate linear regression model was used to identify factors associated with stress changes relative to pre-outbreak estimates.Findings6,040/6,685 (90·4%) participants filled out at least 1/3 of the survey and were included in the analyses. On average, PSS scores increased from 12·9+6·8 before the outbreak to 14·9+8·3 during the outbreak (pInterpretationCross-sectional analyses showed a significant increase from average low to moderate stress during the COVID-19 outbreak. Identified modifiable factors associated with an increase in stress may be informative for intervention development.

Purpose To explore nurse and physician leaders' perceptions of barriers and facilitators to using evidence-based procedural pain treatments (i.e., sweet solutions, breastfeeding, and topical anesthetics) for hospitalized infants and children in the Chinese context. Design and methods A descriptive qualitative study was conducted at three pediatric inpatient surgical units in one hospital in China. Purposive sampling was used to recruit nurse/physician leaders who were engaged in the clinical management of the 3 units. Data collection included a focus group and individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the analysis of the data. Results Ten participants attended the focus group and 13 took part in individual interviews. The findings highlight 41 implementation determinants, including two neutral influencing factors, 22 barriers, and 17 facilitators. These influencing factors aligned with the four CFIR domains and 25 of the 29 CFIR constructs. Common barriers to using evidence-based pain treatments across different contexts were identified, such as health care professionals' limited knowledge and misconceptions on pediatric pain management, no specific policies, low priority, heavy workload, staff shortage, and limited time. Unique determinants in the Chinese context were also identified, including parents' concerns of these new interventions, parent wrath, hierarchical managerial system, and lower authority of nurses. Conclusions Multiple barriers as well as facilitators to using evidence-based pain management strategies were identified. Practice implications The findings inform further development of implementation strategies and could be used as baseline data for comparing the barriers and facilitators evaluated during and after implementation.

Background: Understanding the multifaceted impacts of the Coronavirus-19 (COVID-19) outbreak as it unfolds is crucial to identify the most critical needs and to inform targeted interventions. Methods: This population survey study presents cohort characteristics and baseline observations linked to the acute-mid phase of the COVID-19 outbreak in terms of perceived threats and concerns, occupational and financial impacts, social impacts and stress as measured by the Cohen's Perceived Stress Scale (PSS) collected cross-sectionally between April 3 and May 15, 2020. A multivariate linear regression model was used to identify factors associated with stress changes relative to pre-outbreak estimates. Findings: 6,040/6,685 (90·4%) participants filled out at least 1/3 of the survey and were included in the analyses. On average, PSS scores increased from 12·9+6·8 before the outbreak to 14·9+8·3 during the outbreak (p

Kislov and colleagues draw on multiple qualitative case studies of evidence-based nursing conducted in Sweden, Canada, Australia and the UK to describe the chain of codified knowledge which reflects the institutionalisation of evidence-based practice as organisational “business as usual”. This chain is dominated by performance standards, policies and procedures and locally collected data, i.e. various forms of “evidence by proxy” which are, at best, informed by research only partly or indirectly, but are nevertheless perceived as credible evidence. This chapter reveals dual effects of this codification dynamic on evidence-based practice and highlights the influence of macro-level ideological, historical and technological factors on the composition and circulation of codified knowledge. It concludes by outlining the practical implications of the study for change agency in health-care reform.

Social media is an emerging tool used by researchers; however, limited information is available on its use for participant recruitment specifically. The purpose of this article is to describe the use of Facebook and LinkedIn social media sites in the recruitment of nurses for an online survey, using a 5-week modified online Dillman approach. Within 3 weeks, we exceeded our target sample size ( n = 170) and within 5 weeks recruited 267 English-speaking nurses ( n = 172, Facebook; n = 95, LinkedIn). Advantages included speed of recruitment, cost-efficiency, snowballing effects, and accessibility of the researcher to potential participants. However, an analysis of the recruited participants revealed significant differences when comparing the sociodemographics of participants recruited through Facebook and LinkedIn, specifically relating to the characteristics of sex, age, and level of education. Differences between Facebook and LinkedIn as recruitment platforms should be considered when incorporating these strategies.

Nurses are instrumental in helping clients safely manage at home and triage potentially life-threatening symptoms from cancer. The purpose of this study was to assess factors influencing home care nurses’ use of 15 evidence-informed symptom practice guides for providing telephone or in-home nursing services to clients with cancer. A mixed-methods descriptive study was guided by the Knowledge-to-Action Framework. All six nursing agencies within a regional home care authority participated. Data collection included retrospective audit of symptom management in 50 patient records, 14 interviews, and barriers survey from 150 of 243 (61.7%) registered nurses and registered practical nurses providing cancer symptom support in home care. Chart audit revealed more than 80% of clients were on chemotherapy and common symptoms were nausea/vomiting (44%), constipation (32%), fatigue (32%), loss of appetite (32%), and pain (20%). Nurses had positive intentions ( M = 5.4 out of 7; SD = 1.3) and felt capable of using the symptom practice guides ( M = 5.4; SD = 1.0), held strong beliefs about the consequences ( M = 5.8; SD = 1.1) and moral norms of using them ( M = 5.7; SD = 1.1), and identified neutral to low social influence ( M = 3.0; SD = 1.6). Common barriers were inadequate time in practice, learning curve, need to integrate into documentation, and competing system changes. Common facilitators were being comprehensive, an evidence-based resource for use in practice, and having consistent symptom management guides across settings. Overall, the symptom guides were well received by the nurses. Interventions nurses identified to overcome barriers were education, clear organizational mandate for implementation, and integration with documentation.

Objective To review the evidence on diagnostic accuracy of ultrasonography for detecting correct nasogastric tube (NGT) placement in adults compared to X-ray as the reference standard. Methods This is a systematic review and meta-analysis of observational studies, searched in the literature between 1961 and 2015. We included studies which compared the diagnostic accuracy of ultrasonography detection for NGT placement with X-ray in adult patients who were undergoing NGT placement for any reason in any care setting. We searched published studies in the following electronic databases: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, CINAHL, Web of Science, WanFang Data, China Journal Net, and the Chinese Biomedical Literature Database. Both English and non-English-language articles were retrieved. Risk of bias was assessed using a standard procedure according to the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) criteria. Results We included five studies involving a total of 420 adult patients undergoing nasogastric tube placement: three trials were undertaken in mechanically ventilated patients in prehospital settings and two involved participants with comma or severe trauma in emergency room or intensive care unit (ICU). Pooled results showed that ultrasonography had a sensitivity of 0.93 (95% CI 0.87 to 0.97), and specificity of 0.97 (95% CI 0. 23 to 1.00), suggesting that diagnostic performance of ultrasound is useful to confirm correct NGT placement, but not optimal to detect incorrect NGT position. This was confirmed through a summary receiver operator characteristics (SROC) curve that showed the area under the curve was 0.96 (95% CI 0.94 to 0.98). Discussion The main limitation of the review is the relatively moderate level of heterogeneity of included studies which may partially undermine the reliability and reproducibility of results. The insufficient studies included did not allow identification of possible sources of heterogeneity and exploration of reporting bias. Due to heterogeneity of studies, the diagnostic performance of ultrasonography could only be drawn cautiously. Physicians and nurses should perform routine X-ray if visualization of NGT is not possible. More well designed studies exploring ultrasound as a diagnostic tool for accuracy of NGT placement are needed to strengthen the current evidence.

Transitioning to breast cancer survivorship can be challenging, yet there are few community-based supports. Writing is a promising psychosocial intervention, but most studies have evaluated independent writing. In contrast, our qualitative study (n=12) explored women’s experiences in a community-based workshop. The analysis of workshop recordings, journals, and interviews resulted in three themes: (a) Sharing in safe spaces, (b) Seeking permission and balance, and (c) Fear and uncertainty. The themes document unmet needs related to the emotional impact of breast cancer, as well as the potential of community-based writing to enhance well-being. Such programs may address gaps in cancer survivorship care by providing safe spaces for emotional expression, while supporting participants in the crafting of new narratives focused on well-being.

Survivre au cancer du sein peut s’avérer difficile vu le peu de soutien communautaire disponible dans ce domaine. En ce sens, l’écriture constitue une intervention psychosociale prometteuse, mais la plupart des études n’ont évalué cette activité que du point de vue individuel. Pour faire contrepoint, notre étude qualitative (n = 12) a analysé l’expérience vécue par des femmes ayant participé à un atelier d’écriture communautaire. L’analyse des entrevues effectuées dans le cadre de l’étude, ainsi que des carnets d’écriture tenus par les participantes et des enregistrements de l’atelier a mis en évidence trois thèmes : a) avoir un endroit rassurant pour se confier; b) se donner le droit de penser à soi et chercher à retrouver son équilibre; c) surmonter ses craintes et combattre l’incertitude. Ces thèmes illustrent les besoins non comblés liés à l’impact émotionnel du cancer du sein, ainsi que le pouvoir de l’écriture en groupe en vue de favoriser le bien-être. Les programmes (communautaires) peuvent pallier aux lacunes présentes dans les soins offerts aux survivants du cancer, en créant des endroits rassurants pour l’expression des émotions, tout en soutenant les participantes dans la rédaction de nouveaux récits axés sur le bien-être et la tenue d’un journal.

Wendy Gifford,1 Ian D Graham,2,3 Mark G Ehrhart,4 Barbara L Davies,5,6 Gregory A Aarons7 1School of Nursing, Faculty of Health Sciences, University of Ottawa, ON, Canada; 2Centre for Practice-Changing Research, Ottawa Hospital Research Institute, 3School of Epidemiology, Public Health and Preventive Medicine, Facility of Medicine, University of Ottawa, Ottawa, ON, Canada; 4Department of Psychology, San Diego State University, San Diego, CA, USA; 5Nursing Best Practice Research Center, University of Ottawa, Ottawa, ON, Canada; 6Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA; 7Child and Adolescent Services Research Center, University of California, San Diego, CA, USA Purpose: Leadership in health care is instrumental to creating a supportive organizational environment and positive staff attitudes for implementing evidence-based practices to improve patient care and outcomes. The purpose of this study is to demonstrate the alignment of the Ottawa Model of Implementation Leadership (O-MILe), a theoretical model for developing implementation leadership, with the Implementation Leadership Scale (ILS), an empirically validated tool for measuring implementation leadership. A secondary objective is to describe the methodological process for aligning concepts of a theoretical model with an independently established measurement tool for evaluating theory-based interventions.Methods: Modified template analysis was conducted to deductively map items of the ILS onto concepts of the O-MILe. An iterative process was used in which the model and scale developers (n=5) appraised the relevance, conceptual clarity, and fit of each ILS items with the O-MILe concepts through individual feedback and group discussions until consensus was reached.Results: All 12 items of the ILS correspond to at least one O-MILe concept, demonstrating compatibility of the ILS as a measurement tool for the O-MILe theoretical constructs.Conclusion: The O-MILe provides a theoretical basis for developing implementation leadership, and the ILS is a compatible tool for measuring leadership based on the O-MILe. Used together, the O-MILe and ILS provide an evidence- and theory-based approach for developing and measuring leadership for implementing evidence-based practices in health care. Template analysis offers a convenient approach for determining the compatibility of independently developed evaluation tools to test theoretical models. Keywords: leadership, implementation, evidence-based practice, template analysis, theoretical models, leadership development, knowledge translation

Objectives: To identify effective aerobic exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, or D-) was used, based on statistical significance ( P < 0.5) and clinical importance (⩾15% improvement). Results: The five high-quality studies included demonstrated that various aerobic training exercises are generally effective for improving knee osteoarthritis within a 12-week period. An aerobic exercise program demonstrated significant improvement for pain relief (Grade B), physical function (Grade B) and quality of life (Grade C+). Aerobic exercise in combination with strengthening exercises showed significant improvement for pain relief (3 Grade A) and physical function (2 Grade A, 2 Grade B). Conclusion: A short-term aerobic exercise program with/without muscle strengthening exercises is promising for reducing pain, improving physical function and quality of life for individuals with knee osteoarthritis.

Objective: To identify effective mind-body exercise programs and provide clinicians and patients with updated, high-quality recommendations concerning non-traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with mind-body exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+, D-) was used, based on statistical significance ( P < 0.5) and clinical importance (⩾15% improvement). Results: The four high-quality studies identified demonstrated that various mind-body exercise programs are promising for improving the management of knee osteoarthritis. Hatha Yoga demonstrated significant improvement for pain relief (Grade B) and physical function (Grade C+). Tai Chi Qigong demonstrated significant improvement for quality of life (Grade B), pain relief (Grade C+) and physical function (Grade C+). Sun style Tai Chi gave significant improvement for pain relief (Grade B) and physical function (Grade B). Conclusion: Mind-body exercises are promising approaches to reduce pain, as well as to improve physical function and quality of life for individuals with knee osteoarthritis.

Objective: To identify effective strengthening exercise programs and provide rehabilitation teams and patients with updated, high-quality recommendations concerning traditional land-based exercises for knee osteoarthritis. Methods: A systematic search and adapted selection criteria included comparative controlled trials with strengthening exercise programs for patients with knee osteoarthritis. A panel of experts reached consensus on the recommendations using a Delphi survey. A hierarchical alphabetical grading system (A, B, C+, C, D, D+ or D-) was based on statistical significance ( p Results: The 26 high-quality studies identified demonstrated that various strengthening exercise programs with/without other types of therapeutic exercises are generally effective for improving knee osteoarthritis management within a six-month period. Strengthening exercise programs demonstrated a significant improvement for pain relief (four Grade A, ten Grade B, two Grade C+), physical function (four Grade A, eight Grade B) and quality of life (three Grade B). Strengthening in combination with other types of exercises (coordination, balance, functional) showed a significant improvement in pain relief (three Grade A, 11 Grade B, eight Grade C+), physical function (two Grade A, four Grade B, three Grade C+) and quality of life (one Grade A, one Grade C+). Conclusion: There are a variety of choices for strengthening exercise programs with positive recommendations for healthcare professionals and knee osteoarthritis patients. There is a need to develop combined behavioral and muscle-strengthening strategies to improve long-term maintenance of regular strengthening exercise programs.

Indigenous women experience a disproportionate burden of intimate partner violence (IPV) compared to other women in post-colonial countries such as Canada. Intersections between IPV and other forms of structural violence including racism and gender-based discrimination create a dangerous milieu where ‘help seeking’ may be deterred and poor health outcomes occur. The aim of this review was to explore the perspectives of First Nations, Métis and Inuit (FNMI) women living in Canada about how violence influenced their health and wellbeing. This systematic review of qualitative research used thematic analysis to produce a configurative synthesis. A comprehensive search of electronic databases was conducted. Two reviewers screened studies for relevance and congruence with eligibility criteria. Sixteen studies were included in the review. Four themes with subthemes emerged: 1) ruptured connections between family and home, 2) that emptiness… my spirit being removed, 3) seeking help and being unheard, and 4) a core no one can touch. Together these themes form complex pathways that influenced health among women exposed to violence. Findings from this review highlight the need for collaboration with FNMI women and their communities to prevent IPV and ensure access to trauma and violence informed care (TVIC). The strength and resiliency of FNMI women is fundamental to healing from violence. Working with FNMI women and their communities to build effective interventions and promote culturally meaningful care will be important directions for researchers and policy makers.

INTRODUCTION: The objective was to evaluate diagnostic performance of multiple methods used to assess gastric tube placement verification in neonates, infants, and children. METHODS: A systematic review using the methods outlined in the Cochrane Handbook for Reviews of Diagnostic Test Accuracy was conducted. Eight databases were searched. Studies on neonates, infants, and children in which researchers compared different methods for gastric tube placement verification with x-ray reference standard were eligible in the review. RESULTS: Eight studies involving 911 participants that evaluated 9 index tests for gastric tube placement verification were included. Most studies were of moderate methodological quality, and most index tests were assessed in small individual studies. pH testing with cutoff values ≤ 6 for gastric tube position confirmation was the only index test subjected to meta-analysis, with the summary sensitivity and specificity being 0.77 (95% confidence interval [CI] 0.56-0.90) and 0.42 (95% CI 0.16-0.73). Other tests for gastric tube placement verification showed great variations in sensitivities and specificities. DISCUSSION: pH ≤ 6 is not sufficiently accurate to be recommended for gastric tube placement verification in neonates, infants, and children. Diagnostic performance of pH ≤ 4 or 5 and other methods cannot be determined because of the paucity of data and methodological variations in studies. Clinical practice related to the diagnostic tests used will continue to be dictated by local preferences and cost factors, until stronger evidence becomes available.

Background Leadership is critical to supporting and facilitating the implementation of evidence-based practices in health care. Yet, little is known about how to develop leadership capacity for this purpose. The aims of this study were to explore the (1) feasibility of delivering a leadership intervention to promote implementation, (2) usefulness of the leadership intervention, and (3) participants’ engagement in leadership to implement evidence-based fall prevention practices in Canadian residential care. Methods We conducted a mixed-method before-and-after feasibility study on two units in a Canadian residential care facility. The leadership intervention was based on the Ottawa model of implementation leadership (O-MILe) and consisted of two workshops and two individualized coaching sessions over 3 months to develop leadership capacity for implementing evidence-based fall prevention practices. Participants (n = 10) included both formal (e.g., managers) and informal (e.g., nurses and care aids leaders). Outcome measures were parameters of feasibility (e.g., number of eligible candidates who attended the workshops and coaching sessions) and usefulness of the leadership intervention (e.g., ratings, suggested modifications). We conducted semi-structured interviews guided by the Implementation Leadership Scale (ILS), a validated measure of 12-item in four subcategories (proactive, supportive, knowledgeable, and perseverant), to explore the leadership behaviors that participants used to implement fall prevention practices. We repeated the ILS in a focus group meeting to understand the collective leadership behaviors used by the intervention team. Barriers and facilitators to leading implementation were also explored. Results Delivery of the leadership intervention was feasible. All participants (n = 10) attended the workshops and eight participated in at least one coaching session. Workshops and coaching were rated useful (≥ 3 on a 0–4 Likert scale where 4 = highly useful) by 71% and 86% of participants, respectively. Participants rated the O-MILe subcategories of supportive and perseverant leadership highest for individual leadership, whereas supportive and knowledgeable leadership were rated highest for team leadership. Conclusions The leadership intervention was feasible to deliver, deemed useful by participants, and fostered engagement in implementation leadership activities. Study findings highlight the complexity of developing implementation leadership and modifications required to optimize impact. Future trials are now required to test the effectiveness of the leadership intervention on developing leadership for implementing evidence-based practices.