Search

This paper reports qualitative findings from a pilot study that explored the lesbian, gay, bisexual, transgender and queer ( LGBTQ) education needs of home-care service providers working in one large, urban Canadian city. The pilot study builds upon research that has documented barriers to health services for diversely situated LGBTQ people, which function to limit access to good-quality healthcare. LGBTQ activists, organisations and allies have underscored the need for health provider education related to the unique health and service experiences of sexual and gender minority communities. However, the home-care sector is generally overlooked in this important body of research literature. We used purposeful convenience sampling to conduct four focus groups and two individual interviews with a total of 15 professionally diverse home-care service providers. Data collection was carried out from January 2011 to July 2012 and data were analysed using grounded theory methods towards the identification of the overarching theme, 'provider education' and it had two sub-themes: (i) experiences of LGBTQ education; and (ii) recommendations for LGBTQ education. The study findings raise important questions about limited and uneven access to adequate LGBTQ education for home-care service providers, suggest important policy implications for the education and health sectors, and point to the need for anti-oppression principles in the development of education initiatives. [ABSTRACT FROM AUTHOR]

This paper reports on and synthesizes new research that examines how a collaborative community response can promote successful aging in place for older adults with hoarding behaviour. Through interviews with older adults with hoarding behaviour, who used a particular community support and a focus group interview with members of the community collaborative that directed supports for this population, our findings suggest that there were valuable outcomes for both groups. These older adults with hoarding behaviour were able to remain in their own homes, their safety was enhanced, their sense of isolation was minimized, empowerment was fostered, and they gained valuable insight into their behaviour. The members of the community collaborative were able to access the expertise of other professionals, maximize their own expertise, and they generated an enhanced understanding of the experience of older adults living with hoarding behaviour in Edmonton. This study is a significant addition to the much too sparse literature about the community planning needs of older adults with hoarding behaviour. It offers knowledge that is integral to theories and principles of better aging in place but attempts to translate this into practice. [ABSTRACT FROM AUTHOR]

Most implementation frameworks note that a central support unit (CSU) is key to successful implementation and scale‐up of evidence‐based interventions (EBIs). However, few studies investigated core functions of CSUs—such as capacity building—to better understand their essential role in implementing EBIs at scale. Therefore, the aims of our study are to (1) describe the role that a CSU plays to build capacity in delivery partner organisations, to enable implementation and scale‐up of a health‐promoting intervention (Choose to Move [CTM]) for older adults, and (2) identify elements within capacity‐building strategies deemed essential to effectively implement CTM in diverse community contexts. CTM is a flexible, scalable, community‐based health‐promoting physical activity (PA) and social connectedness intervention for older adults. In 2018–2020, eight health and social service societies, rural or remote municipalities or community‐based organisations delivered 22 CTM programmes that served 322 older adults. We conducted in‐depth interviews with delivery partners (n = 23), and a focus group with the central support system (n = 4). CSU provided a sounding board to organisations to create buy‐in (adoption) and plan ahead. Essential elements within capacity‐building strategies included: a support unit champion, enhanced delivery partner skills, self‐efficacy and confidence; interactive assistance to answer questions and clarify materials. There is a key role for capacity‐building under the stewardship of the CSU to promote implementation success. Investigating specific elements within capacity‐building strategies that drive implementation success continues to be a relevant question for implementation science researchers, that deserves further attention. [ABSTRACT FROM AUTHOR]

For the next 30 years, population aging will impact many facets of our society. Of specific concern is future human resources in the aging sector and related health fields. Every year, high school students make decisions related to their future careers, but few express interests in a career in aging. The goal of this study was to explore high school students' interest in and perspectives of a career in the field of aging. The specific objectives of the study were to identify high school students' perspectives of older adults, explore their level of interest in an aging‐related career and understand the reasons for their level of interest for a career in aging. In this qualitative descriptive study, 41 French‐speaking students in Grades 10 and 11 from an eastern Canadian province participated in a total of five focus group discussions where an educational video complemented the semi‐structured interviews. Content analysis produced four common themes: perspectives of aging and older adults, exposure to aging in school, reasons for disinterest and increasing awareness and interest. Results indicate a lack of aging content or intergenerational activities in schools, whereas students made suggestions for better integration of aging content in the school curriculum. Future research with school guidance counsellors or educators would be beneficial in understanding aging content integration and student exposure to aging. Study limitations are also presented. [ABSTRACT FROM AUTHOR]

Patient‐centred care and patient engagement in healthcare and health research are widely mandated by funders, health systems and institutions. Increasingly, shared decision‐making (SDM) is recognised as promoting patient‐centred care. We explore this relationship by studying SDM in the context of integrating novel patient‐centred policies in community rehabilitation. There is little research on SDM in rehabilitation, and less so in the critical community context. Patient co‐investigators led study co‐design. We aimed to describe how patients and providers experience SDM at community rehabilitation sites that adopted a novel, patient‐centred Rehabilitation Model of Care (RMoC). Guided by focused ethnography, we conducted focus groups and interviews. Patient and professional participants were recruited from 10 RMoC early‐adopter community rehabilitation sites. Sites varied in geography, patient population and provider disciplines. Patient and community engagement researchers used a set–collect–reflect method to document patient perspectives. Researchers captured provider perspectives using a semi‐structured question guide. We completed 11 focus groups and 18 interviews (n = 45 providers, n = 17 patients). We found that most early‐adopter providers spoke in a shared, patient‐first language that focused on patient readiness, barriers and active listening. Congruent patient perceptions reflected inclusion in decision‐making, goal setting and positive relationships. Many patients queried how care would become and remain accessible before and after community rehabilitation care respectively. Remaining connected while in the community was described as important to patients. Providers identified barriers like time, team dynamics and lack of clarity on the RMoC aims, which challenged the initiative's long‐term sustainability. Policy innovations can promote SDM and communication through multiple strategies and training to facilitate candid, encouraging conversations. Sustainability of SDM gains is paramount. Most providers moved beyond tokenistic engagement, but competing responsibilities and team member resistance could thwart continuity. Further research is needed to empirically assess respectful and compassionate communication and SDM in community rehabilitation long term. [ABSTRACT FROM AUTHOR]

Aim: To explore emergency nurses' perceptions of how a nurse‐driven patient needs assessment tool, the synergy tool, influenced their workload management. Background: Quadruple Aim, particularly the fourth aim of improved staff work experiences, served as the conceptual framework to engage nurses in a participatory action research project. This project took place between 2017 and 2020 in two tertiary care emergency departments in one large Canadian city. Method: This study employed a qualitative descriptive component, focus group interviews and nurse comments on two open‐ended survey questions. Results: Use of the synergy tool heightened nurses' awareness of patients' holistic care needs. Nurses also stated how patient needs assessment data helped them identify unsafe workloads. Conclusions: The synergy tool, adapted for emergency department use by nurses, was a means to engage and empower nurses. Patient needs assessment data from the tool identified staffing gaps, resulting in additional nursing staff for both emergency departments. Implications for Nursing Management: A focus on patient needs assessment can be an effective way to address nurses' workload concerns. [ABSTRACT FROM AUTHOR]

Transgender (trans) women experience barriers to access to HIV care, which result in their lower engagement in HIV prevention, treatment and support relative to cisgender people living with HIV. Studies of trans women's barriers to HIV care have predominantly focused on perspectives of trans women, while barriers are most often described at provider, organisation and/or systems levels. Comparing perspectives of trans women and service providers may promote a shared vision for achieving health equity. Thus, this qualitative study utilised focus groups and semi‐structured interviews conducted 2018–2019 to understand barriers and facilitators to HIV care from the perspectives of trans women (n = 26) and service providers (n = 10). Barriers endorsed by both groups included: (a) anticipated and enacted stigma and discrimination in the provision of direct care, (b) lack of provider knowledge of HIV care needs for trans women, (c) absence of trans‐specific services/organisations and (d) cisnormativity in sexual healthcare. Facilitators included: (a) provision of trans‐positive trauma‐informed care, (b) autonomy and choice for trans women in selecting sexual health services and (c) models for trans‐affirming systems change. Each theme had significant overlap, yet nuanced perspective, between trans women and service providers. Specific recommendations to improve HIV care access for trans women are discussed. These recommendations can be used by administrators and service providers alike to work collaboratively with trans women to reduce barriers and facilitators to HIV care and ultimately to achieve health equity for trans women. [ABSTRACT FROM AUTHOR]

Volunteers support health and social care worldwide, yet there is little research on integrating these unpaid community members into primary care. 'Health Teams Advancing Patient Experience, Strengthening Quality through Health Connectors for Diabetes Management' (Health TAPESTRY‐HC‐DM) integrates volunteer 'health connectors' into a community‐ and primary care‐based program supporting client self‐management in Hamilton, Canada. Volunteers supported clients through goal setting, motivation, education and connections to community resources and primary care. This study aimed to create and apply a volunteer program evaluation framework to explore: (a) volunteer training effectiveness (learning online content, in‐person training, self‐efficacy in role tasks, training overall); (b) feasibility of program implementation (process measures, reflections on client encounters, understanding of volunteer roles/responsibilities, client perspectives on volunteer program); and (c) effects of volunteering on volunteers (health outcomes, self‐efficacy, value of volunteering). A concurrent triangulation, mixed‐methods design was used. Data were collected in 2016, sources included: volunteer online training quizzes, focus groups, self‐efficacy survey, Veterans RAND 12‐Item (VR‐12) survey, in‐person training feedback forms and narratives of client visits; client interviews; and quantitative implementation data. Quantitative data analysis included descriptive statistics, paired samples t tests, and effect size (Cohen's d). Qualitative data used descriptive thematic analysis. Nineteen volunteers and 12 clients participated in this evaluation. Findings demonstrate the volunteer program evaluation framework in action. Online training increased knowledge. In‐person training received largely positive evaluations. Self‐efficacy was high post‐training and higher after volunteering. VR‐12 sub‐scale means increased descriptively. Volunteers understood themselves as healthcare system connectors, feeling fulfilled with their contributions and learning new skills. They identified barriers including not having the resources and skills of healthcare professionals. Clients found volunteers were a major program strength, appreciating their company and regular goals follow‐up. Using a volunteer program evaluation framework generated rich and comprehensive data demonstrating the feasibility of bringing volunteers into primary care. [ABSTRACT FROM AUTHOR]

Aim To describe new graduate nurses' transition experiences in Canadian healthcare settings by exploring the perspectives of new graduate nurses and nurse leaders in unit level roles. Background Supporting successful transition to practice is key to retaining new graduate nurses in the workforce and meeting future demand for healthcare services. Method A descriptive qualitative study using inductive content analysis of focus group and interview data from 42 new graduate nurses and 28 nurse leaders from seven Canadian provinces. Results New graduate nurses and nurse leaders identified similar factors that facilitate the transition to practice including formal orientation programmes, unit cultures that encourage constructive feedback and supportive mentors. Impediments including unanticipated changes to orientation length, inadequate staffing, uncivil unit cultures and heavy workloads. Conclusions The results show that new graduate nurses need access to transition support and resources and that nurse leaders often face organisational constraints in being able to support new graduate nurses. Implications for Nursing Management Organisations should ensure that nurse leaders have the resources they need to support the positive transition of new graduate nurses including adequate staffing and realistic workloads for both experienced and new nurses. Nurse leaders should work to create unit cultures that foster learning by encouraging new graduate nurses to ask questions and seek feedback without fear of criticism or incivility. [ABSTRACT FROM AUTHOR]

Aim Our aim was to investigate direct-care nurses' interests in formal management roles and factors that facilitate their decision-making. Background Based on a projected shortage of nurses by 2022, the profession could be short of 4200 nurse managers in Canada within the next decade. However, no data are currently available that identify nurses' interests in assuming manager roles. Methods Using focus group methodology, we conducted 18 focus groups with 125 staff nurses and managers in four regions across Canada. Results Major themes and subthemes influencing nurses' decisions to pursue management roles included personal demographic (education, age, clinical experience and life circumstances), personal disposition (leadership skills, intrinsic rewards and professional commitment) and situation (leadership development opportunities, manager role perceptions and presence of mentors). Although nurses see management roles as positive opportunities, they did not perceive the rewards to be great enough to outweigh their concerns. Conclusions Findings suggested that organizations need to provide support, leadership development and succession opportunities and to redesign manager roles for optimum success. Implications for nursing management Leaders need to ensure that they convey positive images of manager roles and actively identify and support staff nurses with leadership potential. [ABSTRACT FROM AUTHOR]

In this study, we document cancer healthcare professionals' views of patients' use of cancer‐related Internet information (CRII) and their views on how it informs the ways patients interact with healthcare professionals and services from the point of view of health professionals. We used an interpretive descriptive approach, conducting interviews and focus groups with oncology healthcare professionals (n = 21) at a University‐affiliated western Canadian cancer treatment centre. Data were analysed using thematic analysis. We present an initial understanding of how CRII alters, informs and modulates patients' cancer experience and relates to their interactions with healthcare professionals and services. Findings were synthesised into two thematic categories: pragmatic concerns and priorities; and processes and practices. Healthcare professionals were supportive of patients' needs for more information, particularly at key points in the cancer trajectory when information may be lacking. Participants concurred that CRII could positively benefit patients and, if shared with their healthcare professional, could benefit the patient–healthcare professional relationship. Oncology healthcare professionals provide pivotal information to patients; thus, they are well situated to engage patients in discussions about CRII and incorporate this into patient encounters. These actions may open new lines of communication with patients, strengthen the patient–professional relationship and empower patients to be engaged in their own care. [ABSTRACT FROM AUTHOR]