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Aims and objectives: To describe the documentation of pro re nata (PRN) medication for anxiety and to compare documentation at two hospitals providing similar psychiatric services, one that used paper charts and another that used an electronic health record (EHR). We also assessed congruence between nursing documentation and verbal reports from staff about the PRN administration process. Background: The ability to accurately document patients’ symptoms and the care given is considered a core competency of the nursing profession (Wilkinson, Nursing process and critical thinking, Saddle River, 2007); however, researchers have found poor concordance between nursing notes and verbal reports or observations of events (e.g., Marinis et al., 2010, J Clin Nurs, 19, 1544–1552) and considerable information missing (e.g., Marinis et al., 2010, J Clin Nurs, 19, 1544–1552). Additionally, the administration of PRN medication has consistently been noted to be poorly documented (e.g., Baker et al., 2008, J Clin Nurs, 17, 1122–1131). Design: The project was a mixed‐method, two‐phase study that collected data from two sites. Methods: In phase 1, nursing documentation of PRN medication administrations was reviewed in patient charts; phase 2 included verbal reports from staff about this practice. Results: Nurses using EHR documented more information than those using paper charts, including the reason for PRN administration, who initiated the administration, and effectiveness. There were some differences between written and verbal reports, including whether potential side effects were explained to patients prior to PRN administration. Conclusions: We continue the calls for attention to be paid to improving the quality of nursing documentation. Our results support the shift to using EHR, yet not relying on this method completely to ensure comprehensiveness of documentation. Relevance to clinical practice: Efforts to address the quality of documentation, particularly for PRN administration, are needed. This could be made through training, using structured report templates and by switching to electronic databases. [ABSTRACT FROM AUTHOR]

Introduction: Maternal glycemia is associated with pregnancy outcomes. Thus, supporting the self-management experiences and preferences of pregnant women with type 1 and type 2 diabetes is crucial to optimize glucose control and perinatal outcomes. Research design and methods: This paper describes the mixed methods integration of a sequential comparative case study. The objectives are threefold, as we integrated the quantitative and qualitative data within the overall mixed methods design: (1) to determine the predictors of glycemic control during pregnancy; (2) to understand the experience and diabetes self-management support needs during pregnancy among women with pre-existing diabetes; (3) to assess how self-management and support experiences helpe to explain glycemic control among women with pre-existing diabetes in pregnancy. The purpose of the mixing was to integrate the quantitative and qualitative data to develop rich descriptive cases of how diabetes self-management and support experiences and preferences in women with type 1 and type 2 diabetes during pregnancy help explain glucose control. A narrative approach was used to weave together the statistics and themes and the quantitative results were integrated visually alongside the qualitative themes to display the data integration. Results: The quantitative results found that women achieved "at target" glucose control (mean A1C of the cohort by the third visit: 6.36% [95% Confidence Interval 6.11%, 6.60%]). The qualitative findings revealed that feelings of fear resulted in an isolating and mentally exhausting pregnancy. The quantitative data also indicated that women reported high levels of self-efficacy that increased throughout pregnancy. Qualitative data revealed that women who had worked hard to optimize glycemia during pregnancy were confident in their self-management. However, they lacked support from their healthcare team, particularly around self-management of diabetes during labour and delivery. Conclusions: The achievement of optimal glycemia during pregnancy was motivated by fear of pregnancy complications and came at a cost to women's mental health. Mental health support, allowing women autonomy, and the provision of peer support may improve the experience of diabetes self-management during pregnancy. Future work should focus on developing, evaluating and implementing interventions that support these preferences. [ABSTRACT FROM AUTHOR]

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

Background: There has been a significant uptake in the use of telepractice during the coronavirus SARS‐CoV‐2 (COVID‐19) pandemic. This study explored the experiences of speech and language therapists (SLTs), assistants (SLTAs) and parents with telepractice during the COVID‐19 pandemic. Aims: (1) To identify factors that influenced success of telepractice; and (2) to describe clinicians' and parents' preferences for the future mode of service delivery for preschoolers with communication disorders. Methods & Procedures: The study was conducted in partnership with one publicly funded programme in Ontario, Canada, that offered services to preschoolers with speech, language and communication needs at no cost. SLTs (N = 13), assistants (N = 3) and parents (N = 13) shared their experiences and perspectives during semi‐structured videoconference interviews. Outcomes & Results: Factors that influenced the success of telepractice were reported in three categories: the setting (i.e., where and how telepractice was being delivered); the nature of telepractice (i.e., the services that were provided via telepractice); and the individuals (i.e., who was involved in telepractice). These factors were reported to interact with each other. As the needs for each child and family are unique, parents and clinicians reported a preference for a hybrid and flexible service delivery model in the future. Conclusions & Implications: The themes identified in this study can be used by clinicians and managers to consider factors that influence the success of telepractice for children and families. WHAT THIS PAPER ADDS: What is already known on the subject?: Studies conducted before the COVID‐19 pandemic showed that telepractice was an effective and acceptable service approach. However, some clinicians and parents reported wanting to resume in‐person visits. The provision of telepractice services to families with children with communication disorders increased significantly during COVID‐19. What this paper adds to existing knowledge?: Parents and clinicians shared factors that influenced the success of telepractice during semi‐structured interviews. Factors were identified in three categories: the setting (i.e., where and how telepractice was being delivered); the nature of telepractice (i.e., the services that were provided via telepractice); and the individuals (i.e., who were involved in telepractice). As each child's and family's needs are unique, parents and clinicians reported a preference for a hybrid and flexible service delivery model in the future. What are the potential or actual clinical implications of this work?: SLTs and SLT managers can use the factors identified to discuss with parents and decide whether telepractice may be well suited to the needs of each child and family. [ABSTRACT FROM AUTHOR]

Background: Inflammatory bowel diseases (IBDs) are chronic gastrointestinal diseases that negatively affect the enjoyment of food and engagement in social and cultural gatherings. Such experiences may promote psychosocial challenges, an aspect of IBD often overlooked and under‐supported in clinical settings and research. Objectives: This study explored the psychosocial experiences that young adults with IBD have with food via a qualitative patient‐led research process. Methods: Trained patient researchers conducted this study by engaging peers via semi‐structured interviews and focus groups in a three‐step co‐design process. Participants (n = 9) identified the research topic (SET), explored the topic and identified emerging themes (COLLECT), refined themes and made recommendations for healthcare system change (REFLECT). Results: Themes that emerged included: 'Experimenting with Food', 'Evolution Over Time', 'Diet Changes are Emotional' and 'Role of Stigma'. Participants identified the significance and frustrations of repeated testing and experimenting with food compatibility, and noted nuances in food relationships as they gain knowledge and experience over time. They emphasized the importance of maintaining a sense of hope throughout and wished to impart this to newly diagnosed patients. Conclusion: Participants experience numerous psychosocial challenges as they strive to manage their diet, noting gaps in support available from IBD practitioners. Participants made practical recommendations for healthcare system change to improve patient outcomes, highlighting the importance of sharing stories and collaboratively including patients in the development of new services and protocols. Authors recommend further research in this area to build a body of knowledge and support that helps IBD patients maintain hope while navigating challenges with food. Patient or Public Contribution: The first four authors on this paper were the lead researchers in this study's design and analysis and identify as patients; they conducted the research with this identity at the forefront following a peer‐to‐peer research model. These authors were mentored by patient researchers who also contributed to the manuscript, and the research process itself was co‐lead and directed by other patient participants and consultants. Results and recommendations coming from this paper came directly from patient participants. [ABSTRACT FROM AUTHOR]

This paper explores the perception of African, Caribbean, and Black (ACB) religious leaders on HIV vulnerability and their role in HIV prevention among ACB communities in Windsor, Ontario. We conducted one semi-structured focus group discussion with nine Black religious leaders, most of whose congregants are members of the ACB community. Most religious leaders in the focus group had a negative perception of the transmission of HIV, but they acknowledged their own important role in HIV prevention strategies. This role is collaborative in nature, from the stage of designing HIV prevention strategies to implementing prevention messages. The religious leaders noted, however, that some challenges, such as church doctrine and congregational culture, are likely to impede their HIV prevention efforts. [ABSTRACT FROM AUTHOR]

Background: Measuring, assessing and managing outcomes in school practice environments is difficult due to the complex nature of school communities as well as the recent shift in service‐delivery models towards tiered approaches. In tiered approaches, multiple levels of service are offered to better match students' needs. Each level of service may require different outcomes and management techniques. Research to date on outcomes has focused on measuring outcomes in medical settings, leaving a substantive gap in the literature regarding practice in schools. Aims: The first aim was to explore how school‐based speech–language therapists approached outcomes management as their clinical programmes transitioned to tiered service‐delivery models The second aim was to describe the successes and challenges in outcomes management reported by clinicians in this context. Methods & Procedures: A secondary deductive‐inductive content analysis was performed using qualitative interviews with 24 clinical managers and senior therapists from schools across Ontario, Canada. Using a framework of outcomes measurement, assessment and management in schools based on previous research studies, data were grouped into broad categories deductively, and then the content of each category was further explored using inductive coding. Iterative peer debriefing and reflexive journaling were key strategies to increase the trustworthiness of the results. Findings & Results: Participants reported measuring and qualitatively assessing seven key outcomes for school‐based practice. These included: (1) student progress and achievement, (2) student participation and inclusion in the school community, (3) stakeholder perspectives, (4) 'buy‐in', (5) expanded capacities, (6) responsiveness to needs and (7) accountability to systems. Participants reported more challenges than successes in outcomes management during this transition to tiered services. Challenges were attributed to idiosyncratic organizational barriers, the transition to tiered models and the philosophy of working within the educational system. Conclusions & Implications: School‐based speech–language therapists measure, assess and manage multiple outcomes relevant to school‐based practice in tiered service‐delivery models. Many challenges remain. Solutions to support meaningful, systematic and proactive outcomes management in schools should address the broader set of outcomes relevant to tiered service‐delivery models and the unique practice context of the educational system, while remaining responsive to idiosyncratic organizational factors. Sustained clinical–research collaboration and knowledge exchange is recommended. What This Paper Adds: What is already known on the subject: Systematic, proactive collection and interpretation of outcomes has long been encouraged within speech–language therapy. However, implementing outcomes management in clinical practice remains a substantial challenge. Additionally, research on outcomes to date has focused on medical practice environments, to the exclusion of school‐based practice. What are the potential or actual clinical implications of this work?: Outcomes management is valued in school practice environments; however, the current repertoire of techniques for outcomes management are a poor match for school‐based practice. Clinicians in schools would benefit from the development of contextually relevant, meaningful and feasible outcomes management tools. [ABSTRACT FROM AUTHOR]

This paper explores the connections between parental nonsupport of a young person's trans or gender diverse identity and young trans people's experiences of justiciable legal problems1 as well as access to the legal system to address these issues. Qualitative youth data were drawn from the TRANSforming JUSTICE: Trans Legal Needs Assessment Ontario (TFJ) study. The narratives of 16 young trans people (16–29 years) were analyzed to identify parental factors in relation to encountering legal problems and accessing the legal system. Five themes emerged: parental nonsupport of gender identity, identity documentation issues, accessing medical care, employment legal problems, and housing legal problems. Results indicate that parental nonsupport of a young person's trans or gender diverse identity may render a young person more vulnerable to experiencing justiciable legal problems and may also create barriers to accessing the legal system to address these issues. [ABSTRACT FROM AUTHOR]

Introduction: Due to the increased risk of obesity for boys with Duchenne muscular dystrophy (DMD), recent guidelines recommend that dietary intake is carefully managed. Parents play an important role in the development of their child's eating behaviours and patterns. However, despite what is known about the increased risk of obesity for children with DMD, little is known about parental feeding behaviours in this population. The objective of this study was to qualitatively explore the experiences of parents of children with DMD around their child's weight management and understand what influences their feeding behaviours. Methods: This paper reports a secondary data analysis. Semi‐structured, individual interviews were conducted and analysed using qualitative description. Results: Thirteen parents were interviewed for the study. Three themes were developed: (1) parent responses to healthcare provider interactions, (2) mixed emotions contributing to feeding approach and (3) variable parenting feeding styles. Within the third theme, two subthemes arose including (1) control and preoccupation and (2) striking a balance. Conclusion: Given the potential impact of higher weights on the progression of DMD, it is important that healthcare providers explore feeding behaviours with families. However, it is essential that healthcare providers consider the impact of these conversations on parents, as well as the broader issues that may place additional pressure on the lives of families. [ABSTRACT FROM AUTHOR]

Using a relational approach, we draw on repeated interviews with a group of 30 diverse children from Ontario to share and reflect on their knowledge, experiences and feelings early in the COVID‐19 pandemic. Prioritising relational interdependence and relational agency, this paper illustrates our participants' embedded engagements with the pandemic and their contribution to the co‐production of knowledge. We emphasise their thoughtful responses to the pandemic; their creative, self‐reflexive strategies for managing a difficult time; and their advice to others. We thus prioritise children's viewpoints and emphasise their relational interconnections with others during a time that was marked by social isolation. [ABSTRACT FROM AUTHOR]

Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. While it has generated significant academic interest, the experiences of healthcare workers other than physicians remain understudied. This paper reports on a qualitative study of interprofessional Healthcare Providers (HCPs) involved in the provision of MAiD in order to: (1) characterize providers' views about the care they offer in general; (2) examine whether or not they consider MAiD a form of care; and (3) explore their reasons for viewing or not viewing MAiD as care. Semi-structured qualitative interviews were conducted with ten nurses, eight social workers, and three pharmacists with firsthand experience delivering MAiD at an academic hospital in Toronto, Canada. The study was approved by the hospital's REB. Written informed consent was obtained prior to participation. Codebook thematic analysis and template analysis generated four themes: (1) care as advocacy, (2) care as easing suffering, (3) care as psychosocial, and (4) care as relational. Every participant viewed MAiD as a form of care and drew on these four themes to authenticate MAiD as care. Participants consider MAiD a form of care for patients, families, other healthcare workers, and even themselves. In alternating and composite fashion, they describe MAiD in terms of autonomy, easing suffering, and a kind death for the dying (and those entrusted with their care)—a complex choreography of social discourses and moral logics that refuse to settle into a simple dichotomy of "choice versus care." Participants depict MAiD in many of the same terms and imagery they use to describe the care they offer in general. In light of ongoing social controversies surrounding MAiD, HCPs utilize a range of logics strategically to repel negative attention and enable their participation in what they see as a caring end for their patients. [ABSTRACT FROM AUTHOR]

Introduction: In response to the challenges of the traditional mental health system for youth both in Canada and abroad, models of integrated youth services (IYS) that span the integration of mental health, health, substance use, eucation, employment, peer support, and navigation into ‘one-stop shops’ are being established nationally and internationally. IYS models, however, need to be better described and evaluated to inform the replicability of this approach in other jurisdictions. Description: This paper describes the implementation of an IYS in a small urban city and rural county in Ontario, Canada, including insights from key informants into barriers, facilitators, and lessons learned. Discussion: This evaluation identified a number of barriers and facilitators to the implementation of the IYS model in this specific context. Implementation facilitators included youth and family engagement, network partner collaboration, leadership, governance structure, community enthusiasm and support, and collaborative funding models. Barriers to implementation included the COVID-19 pandemic and related public health restrictions, the diverse needs of youth, change management, sustainable funding, and transportation. Lessons learned: By establishing a shared vision of delivering youth services across the integrated network, and engaging youth early in the process of model development, IYS have the potential to transform the service system for youth and their families. Meeting the diverse needs and challenges of youth who live in rural or small urban communities will enhance service delivery and experience for young people. [ABSTRACT FROM AUTHOR]

Introduction: This paper aims to explore the care processes that best exemplify person‐centred care during physical activity (PA) for long‐term care (LTC) residents with dementia from the perspectives of substitute decision‐makers (SDMs) and LTC home staff. Little is known about how person‐centred care is reflected during PA for residents with dementia, or the barriers and benefits to enacting person‐centred care during PA. Methods: Semistructured interviews were used to collect SDMs and LTC home staffs' perspectives on the importance of person‐centred care during PA from two LTC homes in Canada. The McCormack and McCance person‐centredness framework was used to guide thematic content analysis of responses. Results: SDM (n = 26) and staff (n = 21) identified actions categorized under the sympathetic presence or engagement care processes from the person‐centredness framework as most reflecting person‐centred care. Benefits of person‐centred care during PA were categorized into three themes: functional and physical, behavioural and communication and psychosocial improvements. Barriers to person‐centred care during PA identified were lack of time, opportunities for meaningful activity in LTC setting and staff experiences with resident aggression. Significance: Understanding the care processes that are most recognized as person‐centred care and valued by SDMs and LTC home staff has implications for education and training. Insights into SDMs' care expectations regarding person‐centred care can inform staff about which actions should be prioritized to meet care expectations and can foster relationships to the benefit of residents with dementia. Patient and Public Contribution: Study participants were not involved in the development of research questions, research design or outcome measures of this study. [ABSTRACT FROM AUTHOR]

This paper presents findings of a phenomenological study entitled: Healing from Recurrent Suicide Attempts: The Impact of Being a Peer Facilitator. The study examined the impact of being a peer facilitator (PF) in the Skills for Safer Living: A Psychosocial/Psychoeducational Intervention for People with Recurrent Suicide Attempts (SfSL/PISA) group on the PFs' healing journey. Using eight semi-structured interviews, the study privileged the lived experience of participants. The results identified four themes in survivors' healing: new identity formation, navigating stigma, developing agency in the activation of personhood, and achieving personal mastery: skills and competencies. [ABSTRACT FROM AUTHOR]

This article provides results from interviews and a focus group conducted at two different points in time in the first year of the COVID-19 pandemic, which explored impacts of the pandemic and adaptation among water advocacy organizations in southern Ontario, Canada. Our findings show that despite the destabilizing and sometimes devastating impact of COVID-19 on grassroots organizations and their programs, by disrupting business as usual the pandemic also created the conditions for experimentation, innovation, the establishment of new capacities and strategic foci. In this paper, we share descriptive narratives from water activists in our geographic area about how they adapted and innovated their work despite the challenges of the pandemic. Our findings illustrate and add nuance to themes emerging in the literature about the impacts of the pandemic on environmental advocacy groups and other nonprofit organizations, and generate new themes for further exploration. [ABSTRACT FROM AUTHOR]

Introduction: Health care organizations are increasingly recognizing the need to integrate the health care system to better care for older adults. We partnered with a local health centre to inform the development of a Regional Frail Senior Strategy for Southwestern Ontario, Canada. Methodology: Interviews were conducted with 12 older adults (65+, with chronic conditions) and family caregivers. 44 interviews were also completed with health care providers from across the region. To engage with a range of stakeholders on the strategy, four feedback fairs were hosted. Interviewees emphasized the importance of person and family-centred care, integration of health care services, issues of access, and further training and education for health care professionals. Findings and stakeholder feedback were synthesized into 14 recommendations. Discussion: The data and recommendations outlined in this paper informed the development of the frailty strategy for a region in Ontario. Participatory methods and stakeholder engagement identified pertinent themes related to enhancing care for older adults with frailty. Conclusion: The creation of a frailty strategy is imperative in recognizing and responding to the needs of older adults with complex conditions. Our approach may be relevant to other organizations and health systems interested in developing their own regional frailty strategies. [ABSTRACT FROM AUTHOR]

Drawing on feminist care ethics and political theory (Engster and Hamington, 2015; Held, 2006; Noddings, 2015; Tronto, 2013), this paper examines how educators working in private (Ontario) and public (Denmark) childcare systems think about and practice care. Through interviews with pedagogues (Denmark) and early childhood educators (Ontario), linkages between the public/private positioning of care and the care experiences of educators are explored. The findings reveal differences in how educators think about and practice care in public and private systems. At the same time, notable similarities emerged in how educators resisted neoliberal system requirements. The findings illustrate the complexities of connecting good care practices to the systemic level without diminishing the importance of individual human agency in experiencing/practicing good care in Early Childhood Education and Care (ECEC). Findings suggest that good care and commodification are both theoretically and practically at odds with each other, though neither absolutely precludes the other. Implications for policy makers, particularly relevant in the contemporary COVID context, are discussed. [ABSTRACT FROM AUTHOR]

Throughout the history of bareback sex (condomless sex between men), 'subjects' have been created, particularly through scientific literature, to characterise the men who engage in the sexual practice. For example, a gay man who does not use a condom may be framed as a pathologised subject. This paper first presents this history. Afterwards, by relying upon ethnographic data such as interviews collected from fieldwork research done in Toronto in 2014 with young gay men who have bareback sex, it shows exactly how these young gay men related themselves to those subjects. Then, it focuses on the pre-exposure prophylaxis (PrEP) Truvada as a new HIV prevention technology. Although PrEP can allow condomless sex to occur while diminishing the risk of HIV transmission, at the time of the research, none of the young gay men were interested in using this tool despite being the subjects for whom the drug is tailored. This paper argues that PrEP and subjectivity are coproduced and can have conflicting meanings. This contradiction of meanings is a result of the various representations and symbols of bareback sex and the men who engage in the practice that have been produced throughout the history of bareback sex. [ABSTRACT FROM AUTHOR]

Most research on child sexual abuse has been on survivors to the exclusion of service providers. This paper focuses on one group of findings from a larger qualitative study. The aim of the paper is to identify existing services and highlight the gaps in the current programs available for male CSA survivors from the perspective of service providers. Semi-structured interviews were conducted with 11 mental health service providers, recruited from two Southern and Central Ontario cities. Findings presented here report service providers' perspective of gaps in services for male CSA survivors. "Limited Male CSA Programs", "Institutional Barriers", "Attitudinal Barriers", and "Systemic Gaps" emerged as four major themes from the data analysis. Findings demonstrate the need to re-evaluate currently available service and highlights gaps in mental health service available for male CSA survivors. Implications for policy, practice, and research are discussed. [ABSTRACT FROM AUTHOR]

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

Abstract The concept of biographical disruption has now enjoyed nearly 40 years of use in medical sociology. This paper argues that taking an embodied approach to biographical disruption helps to explain the concept's enduring efficacy. Drawing on the work of Maurice Merleau-Ponty and contemporary theories of embodiment inspired by his phenomenology, this paper advances that biographical disruption involves, in the first instance, a disruption to the ability to enact an embodied orientation towards the world. Biographical disruption does not, from this perspective, result from illness as such, but from the ways that illness impinges on one's physical ability to engage with daily life. This paper examines the experiences of solid organ transplant recipients for the purpose of shedding light on the conditions under which biographical disruption arises in experience. The analysis includes interviews with 36 post-operative solid organ transplant recipients (heart, liver, lung, and kidney) living in British Columbia or Ontario, Canada. These participants exhibit a wide range of illness experiences, some of which manifest as biographical disruption and others that do not. Tracing the contours of these experiences, this paper argues that the efficacy of biographical disruption for describing the illness experience depends not only on the illness experience but also, fundamentally, on the content of embodiment prior to the onset of that experience. Highlights • The embodiment perspective improves the efficacy of biographical disruption. • The embodied context of an experience structures the illness experience. • Organ transplant recipients present variable experiences of biographical disruption. [ABSTRACT FROM AUTHOR]

Based on a research project in Toronto, Canada, this article highlights the strengths and resiliency of 12 female Aboriginal Elders and seniors as they age together. For these women, being actively involved in their families and the Aboriginal community gives them a solid grounding in who they are, what their roles are and how they contribute to the whole. Of particular significance is the support and friendship the women offer each other through their commonalities, activities, and sense of humor. [ABSTRACT FROM AUTHOR]

There is limited research exploring the experiences of people living with HIV (PLWH) who have pursued/successfully adopted children. We aimed to gain a deeper understanding of such experiences by analyzing six interviews with PLWH using thematic analysis. In this paper, we highlight three themes: Understanding the Adoption Process, Desire for Caseworker-Client Transparency, and Framing Health and Wellbeing. While most of the findings are relevant for all people navigating the adoption system, there are clear complexities in the process due to HIV stigma. We consider the key takeaways and offer recommendations for adoption service providers, governing bodies, and future research. [ABSTRACT FROM AUTHOR]

Background: The Independent Living Movement seeks to promote independence for people living with disabilities by encouraging them to direct their own care. Programs exist that strive to teach individuals the necessary skills to live independently; however, these programs have not been widely researched. Purpose: The purpose of this paper is to explore alumni perceptions of a long-duration, immersive, independent living program and its influence on community independent living. Methods: Nine individuals who had previously attended the Gage Transition to Independent Living program in urban Toronto were interviewed to ascertain their perceptions on the program and how it assisted with independent community living, as well as their feedback for program improvement. Results: Most participants reported a positive impact from the program, and five main themes were developed: (i) referral source and expectations, (ii) perspectives of program and staff, (iii) navigating housing, (iv) benefits to transition and (v) recommendations for program improvement. Conclusions: Independent living skills education programs seem to have a positive impact on the participants who complete them. Further research should target direct comparisons of program models and effect on quality of life as measured by validated constructs. Incorporating a life skills component for individuals with physical disabilities can improve their transition to independent living. Skills such as self-advocacy, directing attendant services, and completing instrumental activities of daily living are found to be the most efficacious components taught within an independent living skills program. Greater awareness of independent living skills educational programs are needed amongst healthcare professionals to inform individuals who could benefit from such interventions. [ABSTRACT FROM AUTHOR]

Purpose: The main objectives of this study were to learn from youths with intellectual and developmental disabilities about the ways their families were involved in their engagement in community life and to capture how they felt about such involvement. Method: The current study is a secondary analysis of a larger study, the Voices of Youths Research Project, framed by inclusive research methods. Thirty-eight semi-structured interviews that discussed perspectives on friendship, social inclusion, and quality of life from 20 participants (ages 13 to 24 years) were included in this paper. All interviews were video-recorded and coded using NVivo 10. Thematic analysis of the coded segments was guided by a constructivist grounded theory approach. Results: Three major themes emerged from the experiences of youths with intellectual and developmental disabilities on family involvement in their social and community engagement: (1) complex of supports and influences, (2) community engagement with and through family, and (3) points of tension. Conclusions: These thematic findings offer insights into the lived experiences of youths with intellectual and developmental disabilities about engagement in community life. These findings provide an understanding, outside of conventional schemas, of transition into young adulthood for these youths. Rehabilitation professionals often work with youths with intellectual and developmental disabilities who face barriers to reaching transition goals identified either by themselves or others. Family members' views that may focus on goals of maximizing functional independence and/or decreasing caregiver demands can often overshadow the goals or views of youths with intellectual and developmental disabilities themselves. Rehabilitation professionals should find ways to explore with youth their family's roles in engagement and belonging in community life so that they can link youths to appropriate community resources and plan optimal interventions/programs. Rehabilitation professionals need to be aware of and respond to points of tension that can emerge between youths with intellectual and developmental disabilities and their family during transition. [ABSTRACT FROM AUTHOR]

Voice of the Child Reports have emerged as another method to hear from children involved in their parent's dispute. Until 2016, these Reports had limited use in the province of Ontario. This paper details the content analysis of the Reports written by social workers from interviews conducted with children in the Views of the Child Reports: Ontario Pilot Project. The content analysis was performed of the written text of the interviews with 86 children (38 boys and 48 girls) to describe and gain a richer understanding of children's views and experiences post separation before the court. There was a total of 30 social workers (27 females and 3 males) who wrote the Reports to the court. From a broad perspective, the themes that emerged from the text of the children's interviews included the importance of sibling relationships, the negative impact of interparental conflict and subsequent child–parent relationships, and the appreciation of being listened to about their views and experiences as a result of parental separation. While there is no single best method to obtaining children's views and experiences in parenting disputes, this study provides further evidence of the importance of hearing from children during times of parental separation and divorce. [ABSTRACT FROM AUTHOR]

Research has demonstrated the benefits of mental healthcare interventions that ensure a safe transition of clients throughout the discharge and community integration process. This paper reports on qualitative data from focus groups with health professionals collected as part of a larger a mixed method study designed to examine the effectiveness and sustainability of implementing the transitional discharge model. Data collection involved two sets of focus groups, which were held at six months and one‐year post‐implementation. There were 216 health professional participants from nine (9) hospitals across the Province of Ontario, Canada. Data analysis used a four‐step ethnographic framework by Leininger (1985) to identify descriptors and recurrent and major themes. The study identified four major themes, including healthcare professionals' roles and positive experiences in implementing the transitional discharge model; perceived benefits of the model; challenges to implementing the model; and suggestions for sustaining the model's implementation. Healthcare professionals felt that the implementation of the transitional discharge model has the potential for increasing their awareness of the process of clients' integration, serving as a framework for discharge planning, and reducing hospital readmissions. The study findings may provide healthcare providers with information on pragmatic ways to plan clients' discharge, to bridge the gap between hospital and community care, and to positively impact client health outcomes. [ABSTRACT FROM AUTHOR]

Aims: The aim of this paper is to provide a holistic description of the nature, formation and impact of parents' therapy related expectations. Methods: This qualitative descriptive study drew from initial and follow up interviews with 20 parents of children ≤ 6 years who had a developmental disability or delay and used therapy services at a children's treatment center in Ontario, Canada. Conventional content analysis was used to inductively generate themes and investigator triangulation was completed. Results: Parent's child related expectations focused on whether the child would receive a diagnosis and what they might achieve. Parents held expectations about the availability of service and how it would be offered. Parents' expectations of service providers included their knowledge, skills, relationships and communication with the children and parents. Parents held expectations of themselves related to attendance and roles in therapy sessions and home practice. These expectations are described according to how they are shaped and changed them over time. The impact of matched/mismatched expectations is explored. Conclusion: Service providers can improve family-centred care and collaboration with parents by explicitly discussing parents' expectations when beginning, and throughout, therapy. Parent satisfaction and therapy engagement may improve if parents and service providers negotiate and agree upon expectations. [ABSTRACT FROM AUTHOR]

Background: Many countries are engaged in primary care reforms to support older adults who are living longer in the community. Health Teams Advancing Patient Experience: Strengthening Quality [Health TAPESTRY] is a primary care intervention aimed at supporting older adults that involves trained volunteers, interprofessional teams, technology, and system navigation. This paper examines implementation of Health TAPESTRY in relation to interprofessional teamwork including volunteers. Methods: This study applied Normalization Process Theory (NPT) and used a descriptive qualitative approach [1] embedded in a mixed-methods, pragmatic randomized controlled trial. It was situated in two primary care practice sites in a large urban setting in Ontario, Canada. Focus groups and interviews were conducted with primary care providers, clinical managers, administrative assistants, volunteers, and a volunteer coordinator. Data was collected at 4 months (June–July 2015) and 12 months (February–March 2016) after intervention start-up. Patients were interviewed at the end of the six-month intervention. Field notes were taken at weekly huddle meetings. Results: Overall, 84 participants were included in 17 focus groups and 13 interviews; 24 field notes were collected. Themes were organized under four NPT constructs of implementation: 1) Coherence- (making sense/understanding of the program's purpose/value) generating comprehensive assessments of older adults; strengthening health promotion, disease prevention, and self-management; enhancing patient-focused care; strengthening interprofessional care delivery; improving coordination of health and community services. 2) Cognitive Participation- (enrolment/buy-in) tackling new ways of working; attaining role clarity. 3) Collective Action- (enactment/operationalizing) changing team processes; reconfiguring resources. 4) Reflective Monitoring- (appraisal) improving teamwork and collaboration; reconfiguring roles and processes. Conclusions: This study contributes key strategies for effective implementation of interventions involving interprofessional primary care teams. Findings indicate that regular communication among all team members, the development of procedures and/or protocols to support team processes, and ongoing review and feedback are critical to implementation of innovations involving primary care teams. Trial registration: ClinicalTrials.gov, no. NCT02283723 November 5, 2014. Prospectively registered. [ABSTRACT FROM AUTHOR]

Accessible Summary: What is known on the subject?: The period between hospital discharge and community reintegration is a vulnerable time for people with mental illness due to a lack of continuity of care. They are at a high risk of undesired outcomes, including return to hospital.Many transitional models have been developed. It is important to continue evaluating models for improvement and adaptability to different contexts.The transitional discharge model (TDM) is an intervention that incorporates both continued support from hospital staff after discharge and peer support to facilitate a smooth transition. Previous studies have reported positive outcomes such as increased discharges, decreased readmissions, reduced inpatient length of stay and improved quality of life. What the paper adds to existing knowledge?: Health service use outcomes were examined separately for acute and tertiary care psychiatric units. Previous TDM studies in Canada only examined tertiary care units, but many patients also receive care in acute care units.Although recent studies of different interventions generally reported decreased readmissions, the current study found readmissions increased after TDM and then decreased over time for acute care units, whereas no change was observed for tertiary care units. What are the implications for practice?: Transitional discharge model evidence supports nursing practice based on interpersonal relations and strategies. Nurses need to be aware of peer support resources to facilitate this part of the model.The effectiveness of TDM may be increased by considering the differences in needs of distinct patient groups, such as those discharged from acute versus tertiary care units. Introduction: The transitional discharge model (TDM) bridges hospital discharge and community living for people receiving psychiatric services. TDM, based on Peplau's theory of interpersonal relations, ensures continued support from hospital staff until a therapeutic relationship is established with community providers and formal peer support. Aim: To compare temporal trends in psychiatric health services use before and after TDM implementation within acute and tertiary care psychiatric units in Ontario, Canada. Method: Using health administrative databases, monthly discharges from psychiatric units 3 years prior to 2 years after TDM implementation were identified. Median inpatient length of stay (LOS), psychiatric readmission rates and mental health‐related emergency department visit rates were compared using segmented regression analyses. Results: Among acute care units, median LOS decreased significantly below the projected historical trend following TDM implementation, while readmissions increased significantly and declined thereafter. No significant changes were found for tertiary care units. Discussion: Studies on various interventions have shown decreased readmission rates, whereas the trend differed between acute and tertiary care units in this study. Possible reasons include different patient needs and staff practices. Implications for Practice: Needs of people from different unit types should be considered when implementing TDM. Nurses should recognize the development of therapeutic relationships and availability of peer support resources. [ABSTRACT FROM AUTHOR]

This paper presents an institutional ethnography that explored how risk discourse organised the experiences of pregnant women living with HIV and was reproduced in the work of healthcare providers operating in a 'high risk' prenatal clinic in Ontario, Canada. This inquiry began from the standpoint of pregnant women living with HIV, and made connections between women's experiences, the work of healthcare providers delivering prenatal care, and the ruling relations that organised women's experiences and healthcare providers' activities. The study revealed how risk was an omnipresent discourse in women's lives and became visible through the treatments women were prescribed, the prenatal clinic appointment schedule women were expected to follow, and the application of medical interventions. The discourse of risk coordinated the work of healthcare providers and was inextricably linked to practices that prioritised foetal health. Women's daily realities and experiences were overshadowed by the healthcare providers' focus on the foetus and mitigating perinatal risks. As a result, the work women did to organise their lives to participate in care, and the physical and emotional costs they experienced when attending their appointments, taking their medicines, and following clinical procedures were overshadowed within an institutional context where the primary goal was to reduce risks to their babies – even if women shared concerns and aspirations about preventing perinatal HIV transmission. Women's experiences reveal some important consequences regarding the current organisation of prenatal care that emphasises risk and possible ways to enhance prenatal care policies and practices. [ABSTRACT FROM AUTHOR]

We report results from a large qualitative study regarding the process of parents coming to understand the child has autism starting from the time of initial developmental concerns. Specifically, we present findings relevant to understanding how parents become motivated and prepared for engaging in care at this early stage. The study included primary data from 45 intensive interviews with 32 mothers and 9 expert professionals from urban and rural regions of Ontario, Canada. Grounded theory methods were used to guide data collection and analysis. Parents' readiness (motivation and capacity) for engagement develops progressively at different rates as they follow individual paths of meaning making. Four optional steps account for their varied trajectories: forming an image of difference, starting to question the signs, knowing something is wrong, and being convinced it's autism. Both the nature of the information and professional help parents seek, and the urgency with which they seek them, evolve in predictable ways depending on how far they have progressed in understanding their child has autism. Results indicate the need for sensitivity to parents' varying awareness and readiness for involvement when engaging with them in early care, tailoring parent support interventions, and otherwise planning family-centered care pathways. What is already known about the topic? Parents of children with autism often learn about their child's autism before diagnosis and can spend long periods seeking care (including assessment) before receiving a diagnosis. Meanwhile, parents' readiness to engage in care at this early stage can vary from parent to parent. What this paper adds? This study revealed how parents come to understand their child has autism—on their own terms, rather than from just talking to professionals. It also explained how parents' growing awareness of their child's autism leads them to feel more motivated to engage in care by seeking information and pursuing services. Four "optional steps" described how parents' growing readiness to engage in care at this early stage can vary, depending on their personal process. Implications for practice, research, or policy The results suggest ways that professionals can be more sensitive (a) to parents' varying awareness of autism and (b) to their varying readiness for being involved in early care. They also suggest ways to tailor parent supports to their individual situation and design care that is more family centered. Not all parents want high levels of involvement. Depending on their personal process, some parents may need care and support that is directed at them before feeling ready for professionals to engage them in care directed at the child. [ABSTRACT FROM AUTHOR]

Summary Only recently has social work begun to grapple with its place in relation to environmental issues. While considerable progress has been made in bringing environmental considerations into the centre of our profession's scholarship and practice, this project is far from complete. Drawing on environmental literature and based on findings of a qualitative case study of water activism in one Canadian city, this paper argues that the concept of “community resilience” provides both a practical and a conceptual framework for advancing social work's engagement with issues of the natural environment and environmental justice through community praxis. Findings In Guelph, Ontario, Canada, water issues are the focal point of considerable community activism. The case study research reveals, however, that while water is the focus, much of this activism is driven by three broad social priorities that reflect ideas of community resilience and which suggest entry points for social work participation in community-based environmental initiatives: self-reliance and sustainability, localization and direct citizen participation, and community. Applications “Community resilience” is increasingly popular in environmental and community development fields as a conceptual framework for assessing and building the capacity of communities to support wellbeing in the face of environmental change, adversity and risk. While the concept of “resilience” is well established in social work, “community resilience” remains under-examined in social work literature. In this paper, the author draws attention to this arena of resilience thinking, highlighting its potential for the integration of considerations of the natural environment into social work scholarship, education, and practice. [ABSTRACT FROM AUTHOR]

This paper explores the experiences of Chinese immigrant caregiver employees (CEs) residing in Southern Ontario, Canada. Qualitative analysis of participant interviews with thirteen Mandarin Chinese immigrant CEs revealed family conflicts due to cultural differences and an intergenerational gap between CEs and their care recipients. CEs also had future concerns in regards to their own health and the lack of long-term care facilities that offer cultural services for immigrant seniors. These findings provide an opportunity for social workers to collaborate with other service providers to provide ethno-specific and culturally sensitive health, community. and employment services to immigrant ethnic minority CEs. [ABSTRACT FROM AUTHOR]

Walk-in single session counselling is becoming a more widely used model for delivering mental health services across Ontario. This paper reports findings from the qualitative phase of a mixed method study, exploring the experiences of those attending walk-in counselling model compared to the traditional service delivery model employing a wait list. We used a comparative case study design for the qualitative phase. Findings reveal that participant outcomes of the walk-in counselling model are influenced by accessibility, how a participant makes sense of the service and the degree to which a participant is motivated and able to engage in counselling. Walk-in counselling supports the mental health system by reducing wait lists associated with traditional service delivery models and meeting the needs many people identify for immediate consultation. Other participants still perceive themselves as requiring ongoing counselling over time and involving in-depth exploration. This research supports health systems providing access to both models. [ABSTRACT FROM AUTHOR]

The objective of this study was to optimize a planned audit and feedback (A&F) intervention for home and community care through incorporating user-centered design principles. Phase 1 comprised the development of a paper prototype, followed by testing of the prototype using semistructured interviews and focus groups. Phase 2 involved the development of a revised and online prototype based on the results of Phase 1, followed by user testing. A total of 39 participants across Phase 1 (n = 33) and Phase 2 (n = 6) provided input into the design of the A&F intervention. Key changes included improving clarity of the variables, reducing cognitive load, and highlighting opportunities for action. Preliminary findings suggest potential usefulness in this approach to optimize home care management. [ABSTRACT FROM AUTHOR]

Patient safety has been presented as a unifying concern across the health professions. This conceptual connection has been accompanied with efforts towards standardized, interprofessional safety competencies, as well as increased attention towards interprofessional education for systems improvement. Despite numerous program initiatives and research endeavors, progress towards improving patient safety in hospitals is viewed as disappointingly slow. This paper adds to a body of literature that suggests patient safety remains a difficult problem to solve because safety is not simply a technical issue, but is a practice embedded in organizational and professional contexts. In this paper, we explore the differences between the professions, as different professional groups intersect with the ways patient safety is thought about, talked about, and known about in an acute care hospital in Canada. We draw on findings from a critical discourse analysis of documents related to patient safety, as well as transcripts from interviews from (a) formal health care leaders and (b) practicing clinicians from medicine, nursing, occupational therapy, physiotherapy, and social work. This analysis suggests implications for the way different professions may or may not work with one another in the service of patient safety. [ABSTRACT FROM AUTHOR]

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

Over 60 countries criminalise ‘the “willful” transmission of HIV’. Such a law has the potential to hinder public health interventions. There is limited literature discussing the perceptions of this law and the impact, it has had on HIV-positive women. This paper describes the knowledge of and attitudes of this law by HIV-positive women living in Ontario; and their experiences with its application. Three group discussions (n = 10) and 17 in-depth interviews with HIV-positive women age: 21–56 years. Data were analysed using a modified thematic approach. Most of the respondents knew about the law with regard to adult HIV transmission. However, very few knew about any laws related to mother to child HIV transmission, although some reported having had their children taken away because of breastfeeding. Respondents felt that the law could be fair and protective if there were means of providing a priori support to those women who have been disadvantaged social-culturally and structurally. Without this support, the law could potentially lead HIV-positive women into hiding and not accessing services that could help them. There is need for the law implementers to consider these findings if they are to support the public health efforts to control HIV. [ABSTRACT FROM PUBLISHER]

Objective: This paper describes outcome and feasibility findings for a novel, brief intervention to facilitate discharge from lengthy psychiatric hospitalization. The examination of such transitional interventions is important given the suboptimal outcomes for many individuals with severe mental illness at discharge, particularly in the first month. Method: In this study a mixed methods design was used to examine a 6-week peer support worker-provided transitional intervention called the 'Welcome Basket.' The intervention involves contact on hospital wards immediately prior to discharge and 1-1 community contacts along with the provision of a 'welcome basket' of needed/desired items and environmental supports to facilitate greater independence and illness self-management. The study took place in a large Canadian city. Results: Thirty-one individuals with severe mental illness were referred and 23 completed the intervention. Pre-post analysis indicated no change in psychiatric symptoms but improvement in community functioning, community integration, and quality of life. Compared with mean rehospitalization rates for referring inpatient units, significant differences in rates for the study participants were not observed. Qualitative feasibility and process findings were very positive and suggested domains for improvement. Conclusions and Implications for Practice: These findings suggest that this brief transitional intervention is feasible and promising, although further investigation is warranted. Study findings also support the need for transitional interventions to address the service disconnects at the time of discharge for people with severe mental illness. [ABSTRACT FROM AUTHOR]

Each of the antiretroviral drugs that are currently used to stop the progression of HIV infection causes its own specific side effects. Despite the expansion, multiplication, and simplification of treatment options over the past decade, side effects continue to affect people living with HIV. Yet, we see a clear disconnect between the way side effects are normalized, routinized, and framed in clinical practice and the way they are experienced by people living with HIV. This paper builds on the premise that new approaches are needed to understand side effects in a manner that is more reflective of the subjective accounts of people living with HIV. Drawing on the work of Deleuze and Guattari, it offers an original application of the theory of 'assemblage'. This theory offers a new way of theorizing side effects, and ultimately the relationship between the body and antiretroviral drugs (as technologies). Combining theory with examples derived from empirical data, we examine the multiple ways in which the body connects not only to the drugs but also to people, things, and systems. Our objective is to illustrate how this theory dares us to think differently about side effects and allows us to originally (re)think the experience of taking antiretroviral drugs. [ABSTRACT FROM AUTHOR]

In 2006, 3 years after the tragic death of 13-year-old Sabrina Shannon, the Province of Ontario (Canada) passed Sabrina's Law ushering in a new era of focus and concern for severe food allergic children at risk of anaphylaxis. Questions were raised at the time regarding the potential of doing more harm than good with the new legislation. This paper reports the experiences of health-related stigma among food allergic children at risk of anaphylaxis who were required to disclose their health status under this new legislation. In 2008, in-depth interviews were conducted with 20 children and youth and their parents in order to explore the experiences living with a severe food allergy. This particular study explores their experiences of felt and enacted stigma in the school setting as a result of the disclosure process. Interviews were tape recorded with permission and transcribed for subsequent thematic analysis using NVIVO, a qualitative analysis software package. Results indicate that participants were stigmatised as a result of protective school policies under the law, and that created tension between their physical safety and social well-being. Sabrina's Law also led to a cultural shift in awareness of food allergies that resulted in some participants normalising their health status, offering promising directions for the future. [ABSTRACT FROM AUTHOR]

Background: Effectively addressing the social determinants of health and health equity are critical yet still-emerging areas of public health practice. This is significant for contemporary practice as the egregious impacts of health inequities on health outcomes continue to be revealed. More public health organizations seek to augment internal organizational capacity to address health equity while the evidence base to inform such leadership is in its infancy. The purpose of this paper is to report on findings of a study examining key factors influencing the development and implementation of the social determinants of health public health nurse (SDH-PHN) role in Ontario, Canada. Methods: A descriptive qualitative case study approach examined the first Canadian province-wide initiative to add SDH-PHNs to each public health unit. Data sources were documents and staff from public health units (i.e., SDH-PHNs, Managers, Directors, Chief Nursing Officers, Medical Officers of Health) as well as external stakeholders. Data were collected through 42 individual interviews and 226 documents. Interview data were analyzed using framework analysis methods; Prior's approach guided document analysis. Results: Three themes related to the SDH-PHN role implementation were identified: (1) 'Swimming against the tide' to lead change as staff navigated ideological tensions, competency development, and novel collaborations; (2) Shifting organizational practice environments impacted by initial role placement and action to structurally embed health equity priorities; and (3) Bridging policy implementation gaps related to local-provincial implementation and reporting expectations. Conclusions: This study extends our understanding of the dynamic interplay among leadership, change management, ideological tensions, and local-provincial public health policy impacting health equity agendas. Given that the social determinants of health lie outside public health, collaboration with communities, health partners and non-health partners is essential to public health practice for health equity. The study findings have implications for increasing our knowledge and capacity for effective system-wide intervention towards health equity as a critical strategic priority for public health and for broader public policy and community engagement. Appropriate and effective public health leadership at multiple levels and by multiple actors is tantamount to adequately making inroads for health equity. [ABSTRACT FROM AUTHOR]

Background There is limited research investigating the lived experiences of parents raising children with fetal alcohol spectrum disorder (FASD). The aim of this paper is to use qualitative analysis to identify how parents have adapted to the experience of raising their child with FASD. Method Eighty-four parents and caregivers of children with FASD in Ontario, Canada, participated in in-depth, semistructured interviews employing a basic interpretive approach. Results Parents of children with FASD report a number of strategies, supports, and transformational outcomes. Using interpretative phenomenological analysis, 5 themes were identified: understanding FASD and advocating on their child's behalf, day-to-day adaptation, transformational outcomes, as well as the importance of informal and formal supports. Conclusions Understanding what families do in order to facilitate adaptation is important when assisting families who may not be adapting as successfully. Continued research looking at the family experience of raising a child with a developmental disability, such as FASD, is necessary. [ABSTRACT FROM AUTHOR]

Background: Public health systems in Canada have undergone significant policy renewal over the last decade in response to threats to the public's health, such as severe acute respiratory syndrome. There is limited research on how public health policies have been implemented or what has influenced their implementation. This paper explores policy implementation in two exemplar public health programs -chronic disease prevention and sexually-transmitted infection prevention - in Ontario, Canada. It examines public health service providers', managers' and senior managements' perspectives on the process of implementation of the Ontario Public Health Standards 2008 and factors influencing implementation.Methods: Public health staff from six health units representing rural, remote, large and small urban settings were included. We conducted 21 focus groups and 18 interviews between 2010 (manager and staff focus groups) and 2011 (senior management interviews) involving 133 participants. Research assistants coded transcripts and researchers reviewed these; the research team discussed and resolved discrepancies. To facilitate a breadth of perspectives, several team members helped interpret the findings. An integrated knowledge translation approach was used, reflected by the inclusion of academics as well as decision-makers on the team and as co-authors.Results: Front line service providers often were unaware of the new policies but managers and senior management incorporated them in operational and program planning. Some participants were involved in policy development or provided feedback prior to their launch. Implementation was influenced by many factors that aligned with Greenhalgh and colleagues' empirically-based Diffusion of Innovations in Service Organizations Framework. Factors and related components that were most clearly linked to the OPHS policy implementation were: attributes of the innovation itself; adoption by individuals; diffusion and dissemination; the outer context - interorganizational networks and collaboration; the inner setting - implementation processes and routinization; and, linkage at the design and implementation stage.Conclusions: Multiple factors influenced public health policy implementation. Results provide empirical support for components of Greenhalgh et al's framework and suggest two additional components - the role of external organizational collaborations and partnerships as well as planning processes in influencing implementation. These are important to consider by government and public health organizations when promoting new or revised public health policies as they evolve over time. A successful policy implementation process in Ontario has helped to move public health towards the new vision. [ABSTRACT FROM AUTHOR]

Bisexuality is consistently associated with poor mental health outcomes. In population-based data, this is partially explained by income differences between bisexual people and lesbian, gay, and/or heterosexual individuals. However, the interrelationships between bisexuality, poverty, and mental health are poorly understood. In this paper, we examine the relationships between these variables using a mixed methods study of 302 adult bisexuals from Ontario, Canada. Participants were recruited using respondent-driven sampling to complete an internet-based survey including measures of psychological distress and minority stress. A subset of participants completed a semi-structured qualitative interview to contextualize their mental health experiences. Using information regarding household income, number of individuals supported by the income and geographic location, participants were categorized as living below or above the Canadian Low Income Cut Off (LICO). Accounting for the networked nature of the sample, participants living below the LICO had significantly higher mean scores for depression and posttraumatic stress disorder symptoms and reported significantly more perceived discrimination compared to individuals living above the LICO. Grounded theory analysis of the qualitative interviews suggested four pathways through which bisexuality and poverty may intersect to impact mental health: through early life experiences linked to bisexuality or poverty that impacted future financial stability; through effects of bisexual identity on employment and earning potential; through the impact of class and sexual orientation discrimination on access to communities of support; and through lack of access to mental health services that could provide culturally competent care. These mixed methods data help us understand the income disparities associated with bisexual identity in population-based data, and suggest points of intervention to address their impact on bisexual mental health. [ABSTRACT FROM AUTHOR]

This paper presents a case study that explored and reflected on the relationship between the beliefs and classroom practices of four English as a Second Language (ESL) teachers in a university language school in Canada related to teacher questions. Data gathered consisted of interviews and classroom observations of all four teachers. The findings revealed that although for the most part the teachers implemented their classroom questioning practices in convergence with their stated beliefs, there were some instances of divergence observed for all teachers. Potential factors contributing to the patterns of convergence and divergence are further explored. In addition, this study found that through the reflective process whereby the teachers articulated and reflected on their beliefs about their use of questions, they became more aware of the meaning and impact of these beliefs on their classroom practices. [ABSTRACT FROM PUBLISHER]

Context This paper describes the transition processes experienced by Year 3 medical students during their longitudinal integrated clerkship ( LIC). The authors conceptualise the stages that encompass the transition through a LIC. Objectives The purpose of this study was to understand the perspectives of 12 Northern Ontario School of Medicine ( NOSM) Year 3 medical students about their transition process. Methods Data were collected longitudinally through three conversational interviews with each of these students, occurring before, during and after the clerkship. The authors used a guided walk methodology to explore students' everyday lives and elicit insights about the transition process, prompted by the locations and clinical settings in which the clerkship occurred. Results Participants identified three interconnected stages in the transition process: (i) shifting from classroom to clinical learning; (ii) dealing with disorientation and restoring balance, and (iii) seeing oneself as a physician. Interview data provided evidence for the adaptive strategies the participants developed in response to these stages. Conclusions Based on these findings, the transition process during a LIC can be characterised as one of entering the unfamiliar, with few forewarnings about the changes, of experiencing moments of confusion and burnout, and of eventual gains in confidence and competence in the clinical roles of a physician. Recommendations are made regarding future research opportunities to further scholarship on transitions. [ABSTRACT FROM AUTHOR]

Growing healthcare costs have caused home-care providers to look for more efficient use of healthcare resources. Task shifting is suggested as a strategy to reduce the costs of delivering home-care services. Task shifting refers to the delegation or transfer of tasks from regulated healthcare professionals to home-care workers ( HCWs). The purpose of this paper is to explore the impacts of task shifting on the quality of care provided to older adults from the perspectives of home healthcare workers. This qualitative study was completed in collaboration with a large home and community care organisation in Ontario, Canada, in 2010-2011. Using a purposive sampling strategy, semi-structured telephone interviews were conducted with 46 home healthcare workers including HCWs, home-care worker supervisors, nurses and therapists. Study participants reported that the most common skills transferred or delegated to HCWs were transfers, simple wound care, exercises, catheterisation, colostomies, compression stockings, G-tube feeding and continence care. A thematic analysis of the data revealed mixed opinions on the impacts of task shifting on the quality of care. HCWs and their supervisors, more often than nurses and therapists, felt that task shifting improved the quality of care through the provision of more consistent care; the development of trust-based relationships with clients; and because task shifting reduced the number of care providers entering the client's home. Nurses followed by therapists, as well as some supervisors and HCWs, expressed concerns that task shifting might compromise the quality of care because HCWs lacked the knowledge, training and education necessary for more complex tasks, and that scheduling problems might leave clients with inconsistent care once tasks are delegated or transferred. Policy implications for regulating bodies, employers, unions and educators are discussed. [ABSTRACT FROM AUTHOR]

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