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Understanding the temporal trends in the place of death among patients in receipt of home‐based palliative care can help direct health policies and planning of health resources. This paper aims to assess the temporal trends in place of death and its determinants over the past decade for patients receiving home‐based palliative care. This paper also examines the impact of early referral to home‐based palliative care services on patient's place of death. Survey data collected in a home‐based end‐of‐life care program in Toronto, Canada from 2005 to 2015 were analysed using a multivariate logistic model. The results suggest that the place of death for patients in receipt of home‐based palliative care has changed over time, with more patients dying at home over 2006–2015 when compared to 2005. Also, early referral to home‐based palliative care services may not increase a patient's likelihood of home death. Understanding the temporal shifts of place of death and the associated factors is essential for effective improvements in home‐based palliative care programs and the development of end‐of‐life care policies. [ABSTRACT FROM AUTHOR]

Aim: To explore the information‐seeking patterns of care aides who work in nursing homes. Background: Under the direction and supervision of nursing professionals, care aides provide the majority of direct care to nursing home residents. Understanding how, why, when and where they seek information to perform their duties is important for managers, policymakers and stakeholders. Method: Semi‐structured interviews with eight care aides employed in three Canadian nursing homes were analysed using the Braun and Clarke method of thematic analysis. Results: Five prominent information‐seeking patterns emerged as themes. Conclusions: Care aides were motivated to seek information for personal and job‐based reasons that included wanting to avoid mistakes and preparing physically, mentally and emotionally for the work ahead. They described depending on a social hierarchy of verbal information and using personal time (before/after work) to seek the information they needed. Due to time constraints, they relied on established patterns, accessed online information once a day at most and preferred paper‐based sources. Implications for Nursing Management: Programs to enhance care aide communication skills to include the importance of information‐seeking are warranted. Time for formal information‐seeking during working hours should be provided and encouraged. When care aides initiate information‐seeking to improve care this should be recognized and respected by others on the team. Programs to enhance care aide communication skills to include the importance of information‐seeking are warranted. Time for formal information‐seeking during working hours should be provided and encouraged. When care aides initiate information‐seeking to improve care this should be recognized and respected by others on the team. [ABSTRACT FROM AUTHOR]

This qualitative study explored how counsellors who work with women currently or formerly involved in sex work perceive these women's future. From May to July 2016, we conducted semi‐structured interviews with 21 counsellors providing psychosocial services in Canadian agencies with recognized mandates to support such women. The interview protocol was based on the Possible Selves Mapping Interview, adapted to explore the counsellors' hopes and fears for these clients. We subjected the interview transcripts to an interpretive descriptive analysis. Our findings centred on three themes: the counsellors' hopes for their clients' future, in light of their personal and social resources; the counsellors' fears about the cumulative devastating effects that their clients' work environment might have on them; and the counsellors' fears that these women would lose hope for the future. This study clearly demonstrates the importance of addressing the safety and well‐being of women involved in sex work and of recognizing the impacts of social inequalities and structural barriers on these women's life paths. The implications of these findings for policies and practices are discussed at the end of this paper. [ABSTRACT FROM AUTHOR]

Hoarded homes can pose a threat to public safety, with heightened risks of fire hazards, pest infestations and noxious odours in both the home and neighbouring dwellings. Communities across North America are responding to these public safety concerns through a harm reduction approach. This descriptive study explores the implementation and outcomes of the City of Vancouver's approach involving a partnership between fire prevention and public health. Data were collected from the team's 2016–2018 case tracking systems, consisting of health records and team intervention record, as well as notes taken from case briefing meetings. Study objectives included describing the intervention model, providing descriptive statistics on clients and their clutter volume, the interventions undertaken, and exploring predictors of clutter volume and case outcome through exploratory analyses. The sample included 82 cases involving severely hoarded conditions or more moderate hoarding conditions paired with additional client vulnerabilities (e.g. health conditions, frailty). Results from paired samples t‐tests and regression analysis, suggest the Hoarding Action Response Team's (HART) model of a community‐based intervention for hoarding was associated with clutter reduction and tenancy preservation. HART successfully maintained engagement with most clients, and most cases were closed within six home visits. Despite these successes, the team dealt with several barriers including client avoidance and limited resources. This paper provides guidance for communities who are working to develop a coordinated response to problems associated with hoarding and begins to establish expectations for what can be achieved through a community‐based hoarding intervention model. [ABSTRACT FROM AUTHOR]

This is the second in a series of papers that deal with care-giving in Canada, as based on data available from the Canadian General Social Survey (2007). Building on the first paper, which reviewed the differences between short-term, long-term and end-of-life ( EOL) caregivers, this paper uniquely examines the caregiver supports employed by EOL caregivers when compared to non- EOL caregivers (short-term and long-term caregivers combined). Both papers employ data from Statistics Canada's General Social Survey ( GSS Cycle 21: 2007). The GSS includes three modules, where respondents were asked questions about the unpaid home care assistance that they had provided in the last 12 months to someone at EOL or with either a long-term health condition or a physical limitation. The objective of this research paper was to investigate the link between the impact of the care-giving experience and the caregiver supports received, while also examining the differences in these across EOL and non- EOL caregivers. By way of factor analysis and regression modelling, we examine differences between two types of caregivers: (i) EOL and (ii) non- EOL caregivers. The study revealed that with respect to socio-demographic characteristics, health outcomes and caregiver supports, EOL caregivers were consistently worse off. This suggests that although all non- EOL caregivers are experiencing negative impacts from their care-giving role, comparatively greater supports are needed for EOL caregivers. [ABSTRACT FROM AUTHOR]

Aims: This study examines the contribution of top management's transformational leadership behaviors on two targets of nurses' turnover intention (organization and occupation) by focusing on the indirect (through vigor and dedication) and conditional indirect associations (involving autonomous motivation as a moderator). Background: Although the issue of nurse turnover has received growing scientific attention, the research is currently silent about the specific targets of turnover intention and more importantly, the potential pathways through which top management's transformational leadership behaviors relate to each target. Method: Cross‐sectional data from a sample of 426 French–Canadian nurses and structural equation modeling were used to test the proposed model. Results: Top management's transformational leadership behaviors distinctly predicted organizational and occupational turnover intention through specific nurses' states of engagement. While perceived transformational leadership positively predicted vigor, its indirect associations (via dedication) with organizational and occupational turnover intention depend on nurses' level of autonomous motivation at work. Conclusion: In times of nurse shortage, the present findings provide insights into how and when top management's transformational leadership behaviors relate to nurses' organizational and occupational turnover intention. Implications for Nursing Management: Healthcare organizations are advised to foster top management transformational leadership behaviors and autonomous motivation to sustain the nursing workforce. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility and acceptability of a virtual food skills program for children with type 1 diabetes. Methods: Forty‐three patients, aged 6–14 years with type 1 diabetes, participated in an 8‐week online programme, summerlunch+ At Home, that included weekly live cooking classes, asynchronous learning modules, and quizzes accessed through Google Classroom. Grocery delivery or gift cards were provided to all participants to support equitable access to participation. Descriptive results were summarized, and thematic analysis was performed on answers to a post‐intervention questionnaire, parent/caregivers interview transcripts, and facilitators' field notes. Results: Participants reported having a positive experience and would recommend the programme to others. Acceptable elements included the online format, the cooking class demonstrations, and the well‐organized content. Families enjoyed the recipes, expressed an improvement in the families' cooking skills and nutrition knowledge, and noted the program as a way to improve family bonding and reduce participants' sense of social isolation given the opportunity of meeting peers with diabetes. The intervention also appears to increase participants' independence, confidence, and self‐esteem. While grocery cards were easier to coordinate compared with meal kits, both were deemed acceptable by caregivers. Barriers to participation include a distracting home environment and not feeling comfortable on camera. Factors that negatively impacted satisfaction were the large age range of participants and the class timing and duration. Caregivers noted a desire for more diabetes education, enhanced peer‐to‐peer interaction, and incorporation of animal‐based protein recipes in future programmes. Conclusion: The current study demonstrates the feasibility and acceptability of the virtual summerlunch+ At Home cooking and nutrition program that was adapted for children with diabetes. Similar food skills programmes may support the development of food skills imperative to diabetes self‐management long‐term. Further research can continue to assess food literacy skills, glycemic management, and the social benefits of such interventions. [ABSTRACT FROM AUTHOR]

Permanent supportive housing (PSH) is the main approach advocated in Western countries for eradicating homelessness. Considering that PSH residents are not a homogeneous group and that their quality of life (QoL) and community integration (CI) might differ in this setting, improving our understanding of these residents' profiles may help stakeholders formulate informed recommendations to improve PSH. This study identified PSH resident profiles based on their QoL, CI, and sociodemographic and clinical characteristics and associated these profiles with housing features and service use. A total of 308 PSH residents were recruited in Montreal (Canada) in 2020–2022. Structured interviews were conducted. PSH resident profiles were produced with cluster analysis and subsequently compared using chi‐square, Fisher's, and t‐tests, taking into account housing features and service use. Three PSH resident profiles were found. Profile 1 residents (22% of the sample) had low QoL and CI, were younger, and had major social and health issues and unmet needs. Showing moderate QoL and CI, Profile 2 residents (27%) were more educated, had little foster care history, were older on their first homelessness episode, and had few co‐occurring MD‐SUD. Profile 3 residents (51%) had the best QoL and CI and mostly included men with little education, affected by co‐occurring MD‐SUD and satisfied with services. More intensive housing support and care coordination may be recommended for Profile 1 PSH residents in response to their diverse needs. Work integration may be beneficial to Profile 2 residents, with programs such as Individual Placement and Support, along with increased rehabilitation activities. A better integration of MD‐SUD treatments may be promoted for Profile 3 residents. Considering most PSH residents had multiple health issues and unmet needs, satisfaction with care could be monitored better, as it was found to be a key variable in measuring care adequation. [ABSTRACT FROM AUTHOR]

Given that 'home' is the major physical-spatial environment of many older adults and that home, social and neighbourhood environments are well-recognised to impact both the ability to age in place and quality of life in this population, a better understanding of the nature of social interactions within seniors' communal living environments is critical for health promotion. This paper describes a two-phase participatory research study examining peer bullying by older adults conducted in April and May, 2016. Responding to needs expressed by tenants, the objectives of this study were to identify the nature, prevalence and consequences of peer bullying for tenants of two low-income senior apartment communities. In collaboration with the local Older Adult Abuse Task Force, a screening survey on bullying was distributed to all tenants. Findings (n = 49) indicated that 39% of tenants had witnessed peer bullying and 29% had experienced bullying by peers. An adapted version of a youth bullying survey was administered in follow-up face-toface interviews with 13 tenants. The most common forms of peer bullying were deliberate social exclusion and hurtful comments. The majority of respondents indicated that bullying was a problem for seniors and that bullies hurt other people. Outcomes of bullying included feelings of dejection and difficulties conducting everyday activities. [ABSTRACT FROM AUTHOR]

Aim This paper seeks to identify gaps within nursing collective agreements for opportunities to implement practices to sustain the nursing workforce. Background Since the majority of nurses in Canada are unionised, some of the strategies recommended in the literature to cope with nursing shortage may not apply to unionised nurses, making collective agreements a potential source for designing practices that can mitigate the impact of ageing nurses. Method Nine major collective agreements for registered nurses in each province governing the nursing employment relationship were analysed to see if different practices were already addressed in the collective agreements. Results Five such practices were identified, including: providing more mentorship opportunities; encouraging nurses who are eligible to retire to remain in the nursing workforce; attracting internationally trained nurses; implementing operational changes that include process improvements or new technologies; and empowering nurses through flexibility in work schedules. Conclusion If collective agreements are silent in any of the strategies identified in the literature, health-care organisations can adopt these practices without violating the collective agreements. Implications for nursing management Non-unionised health-care organisations can also benefit from learning about these policies and practices to assist in managing and sustaining an ageing nursing workforce. [ABSTRACT FROM AUTHOR]

The retention and recruitment of care providers are ongoing concerns in healthcare globally. Examining intention to leave (ITL) as a measure of retention, the existing literature has focused on nurses working in hospitals, with less attention paid to other care providers and other areas of practice. The purpose of this study was to gain a better understanding of the unique factors influencing ITL among three categories of care providers in home care: registered practical nurses, registered nurses, and personal support workers. This study assessed and compared predictors of ITL, including organizational commitment, job satisfaction, perceived supervisor support, burnout, role stress, work/family conflict, and community satisfaction. A convenience sample of home care staff working in one agency in a Canadian province was sent an electronic survey by e-mail in 2021. Responses (n = 185) underwent data analysis including descriptive statistics, analysis of variance, and multiple linear regression, as well as thematic analysis of two open-ended items. The results of the study indicated that 54% (n = 99) of respondents were considering leaving their job, and respondents were dissatisfied with their salary and benefits. Role stress, work-family conflict, and burnout differed significantly between groups. Several themes emerged for strategies to promote employees to stay with the agency, with the overwhelming strategy being higher wages/salary. Themes for why employees stayed with the agency included love for clients and commitment to their care, as well as fondness for the teams within which respondents worked. The findings of the study lead to several important implications and recommendations for the home care sector. Advocating for wage parity among healthcare sectors and other opportunities for compensation for home care workers is necessary. Additional strategies include supportive and innovative approaches for scheduling, teamwork, and working with staff to identify barriers and solutions in home care. [ABSTRACT FROM AUTHOR]

Purpose. The objective of this study was to examine variations in emergency service utilization (ESU) among cancer survivors during the first year after completing primary cancer treatment. Methods. In 2016, the Canadian Partnership Against Cancer collected survey responses from cancer survivors across Canada about self-reported ESU after completing primary cancer treatment. We included survey respondents diagnosed with nonmetastatic breast, hematologic, colorectal, melanoma, or prostate cancer. Multivariable, multinomial logistic regression analysis was used to examine factors associated with cancer survivors' ESU. Results. Of the 5,774 cancer survivors included in our analysis, 22% reported ESU during the first year after completing their primary cancer treatment, 16% reported ESU one to three times, and 6% reported ESU more than three times. Factors significantly associated with frequent ESU included younger age, colorectal and hematologic cancers, more frequent primary care provider and oncology specialist visits, single or retired status, lower income, and self-reported lower quality of life. Conclusion. Our study identified factors associated with more frequent ESU among cancer survivors in the first year after completing primary cancer treatment. These factors highlight differences in cancer survivors' demographics, their ability to access and need for healthcare services, and the complexity of using ESU as a metric for quality improvement in survivorship care. These variations must be considered in quality improvement initiatives. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic has had deleterious effects on individuals experiencing homelessness; yet, less is known about how this global health crisis is impacting service providers that support the homeless population. This qualitative study examined the perceived impacts of the COVID‐19 pandemic on the lives and work experiences of service providers in the homeless service, supportive housing, and harm reduction sectors in Canada. Further analyses were conducted to identify the occupational values that were represented in the work‐related changes experienced by providers. A stratified purposive sample of 40 participants (30 direct service providers and 10 providers in leadership roles) were drawn from a pan‐Canadian study of the mental health of service providers working with individuals experiencing homelessness. Reflexive thematic analysis was used to identify five themes of the work‐related changes experienced by service providers during the pandemic: [1] "Everything was changing every day": Work role and responsibility instability; [2] "How on Earth do we do our job?": Challenges to working relationships with service users; [3] "It used to be a social environment": Transitions to impersonal and isolating workspaces; [4] "It all comes down the chute": Lack of organisational support and hierarchical conflict; and [5] "We've been supported as well as we could have": Positive organisational support and communication. The findings underscored how many of the occupational changes during the pandemic did not align with service providers' occupational values for collaboration, control, effective and safe service provision, and the importance of human relationships, among other values. As pre‐existing sectoral problems were exacerbated by the pandemic, recovery efforts need to address these long‐standing issues in ways that are aligned with service providers' values. Future research is warranted on how organisational approaches can promote supportive workplaces for service providers and improve outcomes for individuals experiencing homelessness. [ABSTRACT FROM AUTHOR]

Community paramedic roles are expanding internationally, and no review of the literature could be found to guide services in the formation of community paramedicine programmes. For this reason, the aim of this restricted review was to explore and better understand the successes and learnings of community paramedic programmes across five domains being; education requirements, models of delivery, clinical governance and supervision, scope of roles and outcomes. This restricted review was conducted by searching four databases (CENTRAL, ERIC, EMBASE, MEDLINE and Google Scholar) as well as grey literature search from 2001 until 28/12/2021. After screening, 98 articles were included in the narrative synthesis. Most studies were from the USA (n = 37), followed by Canada (n = 29). Most studies reported on outcomes of community paramedicine programmes (n = 50), followed by models of delivery (n = 28). The findings of this review demonstrate a lack of research and understanding in the areas of education and scope of the role for community paramedics. The findings highlight a need to develop common approaches to education and scope of role while maintaining flexibility in addressing community needs. There was an observable lack of standardisation in the implementation of governance and supervision models, which may prevent community paramedicine from realising its full potential. The outcome measures reported show that there is evidence to support the implementation of community paramedicine into healthcare system design. Community paramedicine programmes result in a net reduction in acute healthcare utilisation, appear to be economically viable and result in positive patient outcomes with high patient satisfaction with care. There is a developing pool of evidence to many aspects of community paramedicine programmes. However, at this time, gaps in the literature prevent a definitive recommendation on the impact of community paramedicine programmes on healthcare system functionality. [ABSTRACT FROM AUTHOR]

How adults with intellectual disability fare in the parenting role depend, to varying degrees, on the adequacy of supports and services provided. The available research suggests that service providers are often ill‐equipped to accommodate their support needs. The purpose of this qualitative descriptive study was to explore the perspectives of Canadian social service workers on what is required to improve services and build systems capacity to more effectively support parents with intellectual disability, their children and families. A total of 39 workers, identified by parents with intellectual disability as their key workers, were interviewed. To build systems capacity to support these parents and families, and to address institutionalised discrimination, key workers highlighted the need for entry‐to‐practice and continuing professional education to develop worker capabilities for reflective practice, relationship‐building and research utilisation; accommodative caseload management, giving workers the time, flexibility and the professional supervision they need to deal with complexity and fashion individualised service responses; and, a common framework, with defined service pathways, to facilitate interagency case planning and, in turn, continuity in service provision. The question is not whether adults with intellectual disability can be effectively supported in the parenting role; the question is whether the political will exists to do what is necessary to ensure they are. [ABSTRACT FROM AUTHOR]

Employment is frequently desired by persons who experience homelessness yet is often elusive. Little is known about the range and effectiveness of employment‐based interventions evaluated in existing literature on key psychosocial outcomes including employment participation, mental well‐being, housing tenure, community integration and substance use. To identify and synthesise existing studies, we conducted a systematic review of effectiveness using the methodology proposed by the Joanna Briggs Institute (JBI) following Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Following the removal of duplicates, we screened 13,398 titles and abstracts, and reviewed 79 studies at the full‐text review stage using two independent raters. A total of 16 studies met criteria for inclusion in a narrative synthesis and were subjected to critical appraisal. The majority of studies were conducted in the US (n = 14; 87.5%) with other studies published in Canada (n = 1; 6.3%) and Australia (n = 1; 6.3%). Interventions evaluated in existing studies included combined substance use and vocational skills interventions (n = 7; 43.8%), supported employment (n = 6; 37.5%), and integrated supports including an employment component (n = 3; 18.8%). The effectiveness of these interventions on employment, mental well‐being, housing tenure, community integration, and substance use is presented. Findings suggest that research evaluating employment interventions for persons who experience homelessness is in an early stage of development. Researchers and practitioners may consider collaborating with persons with lived experiences of homelessness and practitioners in co‐designing and modifying existing approaches to target key outcomes more effectively. Policymakers may consider allocating resources to such initiatives to further the development of practice and research aimed at supporting persons who experience homelessness to secure and sustain employment during and following homelessness. [ABSTRACT FROM AUTHOR]

While policies and practices that promote aging in place have risen in prominence over the last two decades, marginalised older adults have largely been overlooked. 'Aging in the right place' is a concept that recognises the importance of adequate and appropriate age‐related health and psychosocial supports in shelter/housing settings and their impact on the ability of older people to age optimally. To understand the unique shelter/housing challenges and solutions that affect aging in the right place for older people experiencing homelessness (OPEH), we conducted three World Café workshops in three Canadian cities—Montreal, Calgary, and Vancouver. In total, 89 service providers and OPEH engaged in the workshops, which involved guided, small‐table discussions with the goal of stimulating creative ideas and fostering a productive atmosphere. Findings revealed two overarching themes 1) Discrepancies, between the need and availability of housing options and community supports for OPEH, such as affordable transportation, case management, access to healthcare, and system navigation; and 2) Desires, for more peer support, participatory planning, service‐enriched housing, social programming, and policies that promote agency, independence, and choice for OPEH. These findings provide evidence to inform the development or modification of housing and supports for OPEH that promote aging in the right place. [ABSTRACT FROM AUTHOR]

The effects of the coronavirus disease‐2019 (COVID‐19) pandemic on the lives of underserved populations are underexplored. This study aimed to identify the impacts of the COVID‐19 pandemic and associated public health responses on the health and social well‐being, and food security of users of Housing First (HF) services in Toronto (Canada) during the first wave of the COVID‐19 pandemic. This qualitative descriptive study was conducted from July to October 2020 in a subsample of 20 adults with a history of homelessness and serious mental disorders who were receiving HF services in Toronto. A semi‐structured interview guide was used to collect narrative data regarding health and social well‐being, food security and access to health, social and preventive services. A thematic analysis framework guided analyses and interpretation of the data. The COVID‐19 pandemic and response measures had a variable impact on the health, social well‐being and food security of participants. Around 40% of participants were minimally impacted by the COVID‐19 pandemic. Conversely, among the remaining participants (impacted group), some experienced onset of new mental health problems (anxiety, stress, paranoia) or exacerbation of pre‐existing mental disorders (depression, post‐traumatic stress disorder and obsessive‐compulsive disorder). They also struggled with isolation and loneliness and had limited leisure activities and access to food goods. The pandemic also contributed to disparities in accessing and receiving healthcare services and treatment continuity for non‐COVID‐19 health issues for the negatively impacted participants. Overall, most participants were able to adhere to COVID‐19 public health measures and get reliable information on COVID‐19 preventive measures facilitated by having access to the phone, internet and media devices and services. In conclusion, the COVID‐19 pandemic and associated response measures impacted the health, social well‐being, leisure and food security of people with experiences of homelessness and mental disorders who use supportive social and housing services in diverse ways. [ABSTRACT FROM AUTHOR]

Introduction. Exercise interventions may assist smoking cessation attempts. One such publicly available 10-week program, Walk or Run to Quit (WRTQ), demonstrated success in smoking cessation and physical activity (PA) outcomes. However, initial WRTQ participants (2016-2017) were fairly homogenous in their demographic profile. To increase diversity, subsidies for participation were offered in 2018. This study assessed how the subsidies affected participant demographics, running frequency, smoking cessation, intention to quit, and program attendance and completion. Methods. The $70 registration fee was subsidized for 41% of participants in 2018. A pre-postdesign was used, with participants completing surveys on their demographics and smoking and physical activity behaviours. Descriptive statistics compared the year subsidies were available (2018) and unsubsidized years (2016-2017) and subsidized and unsubsidized participants' data from 2018. Results. The 2018 participants had lower average attendance and program completion rates compared to 2016-2017 and no statistically significant differences in demographics or smoking cessation and PA outcomes. There were no differences in smoking cessation, run frequency, or demographic variables between the subsidized and unsubsidized participants in 2018. Conclusions. Offering subsidies did not diversify the participant profile. Subsidies did not have a negative impact on attendance nor primary outcomes. Subsidies may not have addressed barriers that prevented a more diverse sample from participating in WRTQ, such as program location, timing, and design. Equitable access to smoking cessation programs remains essential. As subsidies may play a role in reducing financial barriers disproportionately faced by marginalized groups, the implementation of, and recruitment for, such subsidized programs requires further investigation. [ABSTRACT FROM AUTHOR]

There is a global need to understand how the quality of home care for persons living with dementia is perceived by their most frequent formal caregivers, personal support workers (PSW), especially given the expected rise in the prevalence of dementia. The aim of this study was to explore the perceptions of PSW regarding what constitutes quality home care for persons with dementia. Qualitative content analysis was undertaken to interpret semi‐structured interviews with PSW (N = 15). Study findings indicate that quality home care is perceived to be (1) person‐centered; (2) provided by PSW with dementia‐specific education and training; (3) facilitated by specific PSW experiences, abilities and characteristics; (4) enhanced by accessible information, services and education for persons with dementia and their caregivers; (5) provided by an inclusive dementia care team; and (6) facilitated by organisational supports and respect. However, findings also indicated differences in what PSW perceive as quality home care versus what they are experiencing when providing care for persons with dementia. Participants advocated for increased supports to them through ongoing dementia‐specific education and training, increased teamwork among care providers, increased wages, sufficient and qualified staffing, and increased exchange of client information. The findings highlight the importance of exploring front‐line workers' perspectives and how they can help revise current healthcare policies and inform future policy development. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe executive skills in clients experiencing social vulnerability in the context of COVID‐19 from the perspective of social service agency staff. COVID‐19 has required transformational changes to livelihood and day‐to‐day living. Socially vulnerable individuals are likely to be disproportionally impacted because many have experienced serious early childhood adversity, which may compromise their executive skills in adulthood. Using a cross‐sectional survey, we collected data between 05 May 2020 and 03 July 2020, for this mixed methods study of 53 staff in two agencies in western Canada serving clients experiencing social vulnerability. The first case of COVID‐19 in this jurisdiction was identified 05 March 2020. Using investigator‐designed survey items, we captured executive skills in five areas: (a) planning tasks of daily living, (b) managing time, (c) keeping track of information and appointments, (d) managing emotions, and (e) managing self‐control. Staff reported their clients struggled with executive skills and these struggles increased during COVID‐19, particularly in the areas of managing daily tasks and emotional regulation. COVID‐19 restrictions overwhelmed clients with the decisions required to maintain health, employment, and childcare. With the loss of structure and routine, clients lost track of time and delayed completion of tasks, which further increased stress. Disrupted goals and uncertainty about the future contributed to hopelessness for clients who were trying to regain control over their lives, which made it difficult to manage emotions. Some clients acted more impulsively because of the added stressors, lack of routine and access to friends and extended family. A better understanding of the impact of COVID‐19 on socially vulnerable clients will inform social service agencies about areas to focus programming to support their socially vulnerable clients. [ABSTRACT FROM AUTHOR]

The objective of this study was to explore the relationship among income and emotional/practical concerns, help‐seeking and unmet needs for cancer survivors aged 18 to 64 years one to three years after treatment. A cross‐sectional survey was mailed in 2016 to 40,790 survivors randomly selected from 10 Canadian provincial cancer registries. Thirty‐three percent responded. A trend analysis was conducted for survivors most likely to be in the workforce exploring the relationship across four income levels and emotional/practical concerns, whether help was sought for identified concerns, and whether help was received. A total of 4,264 respondents, aged 18–64, provided useable data with breast (34.4%) and colo‐rectal (15.0%) accounting for the primary cancer type and 32.0% reporting annual household incomes of <$50,000. More than 94% of respondents indicated having emotional or practical concerns. Between one‐third and one‐half of the respondents sought help for their concerns and, of those, between one‐third and one‐half experienced difficulty finding help or did not obtain assistance. Significant trends across income categories indicated greater percentages of those in lower income categories experienced emotional and practical concerns, rated their concerns as 'big', sought help, and had difficulty finding help to address their concerns. Clearly adult cancer survivors experience emotional and practical concerns. Healthcare professionals have important roles monitoring these concerns and connecting those who desire help to relevant services. Opportunities should be given to individuals, regardless of income level, to indicate if they have concerns and if they would like assistance. [ABSTRACT FROM AUTHOR]

The recovery paradigm is increasingly being adopted within mental health services internationally, to support a process of personal change for affected individuals, with the aim of living a satisfying, hopeful, contributing life within the limitations of mental illness. In efforts to assist the process of recovery, Recovery Education Centres (REC), offering recovery supports through education rather than traditional service models, have been widely implemented; there is limited evidence to date with respect to the experiences and outcomes of disadvantaged populations, such as people experiencing homelessness, with recovery education. This study used qualitative methods to explore the perspectives and experiences of service users and providers of the Supporting Transitions and Recovery (STAR) Learning Centre in Toronto, Canada, focused on supporting the process of recovery for individuals with histories of homelessness. Between July 2017 and June 2018, semistructured interviews with 20 service users, one key informant, and a focus group comprising eight current and former REC staff and volunteers were conducted to explore opportunities to better tailor the curriculum, and key programmatic features, to the needs of the population. Interviews were analysed using inductive thematic analysis. Most participants described favourable experiences with the REC and suggested adding more challenging course content (n = 10) and increasing delivery options (n = 8), highlighting the diversity of participant needs. Others described the importance of improving accessibility through geographic expansion, offering transit subsidies, and using innovative media. In addition, the importance of delivering more courses in partnership with community partners, to maximise reach and impact, was also highlighted (n = 15). This study underscores the importance of engaging service users and providers, including peers, in ongoing adaptations to best serve the target populations. The expertise and lived experience of these key stakeholders offer a unique lens, supporting the process of recovery, through co‐production of curriculum content and joint program planning and improvements. Findings can inform REC development for disadvantaged populations and potentially enhance recovery outcomes for those experiencing multiple barriers to recovery. [ABSTRACT FROM AUTHOR]

Objectives. To determine the relationship between exposure to pregestational type 2 diabetes (T2D) and renal size and subcutaneous fat thickness in fetuses during routine obstetrical ultrasound. Methods. This was a case-control study (January 1, 2019 to December 31, 2019). Routine obstetrical ultrasounds performed between 18 and 22 weeks' gestation at a tertiary-care fetal assessment unit were reviewed. "Cases" comprised ultrasounds of fetuses exposed to pregestational T2D in utero. The control group was assembled from ultrasounds of healthy controls. Postprocessing measurements of fetal renal size and abdominal wall thickness from stored images were performed by two independent observers, and findings were compared between groups. Results. There were 54 cases and 428 ultrasounds of healthy controls. The mean maternal age of cases was 32.1 years (SD 6.2) compared to 33.2 years (SD 5.3) for healthy controls, and the majority of ultrasounds were performed in multiparous patients (83%). At the 18 to 22 week ultrasound, there was a significant reduction in renal size amongst fetuses exposed to maternal T2D in utero compared to controls; among cases, the mean renal width was 8.0 mm (95% CI 7.8–8.1) compared to 11.4 mm (95% CI 10.6–12.7) in controls (p < 0.0001); the mean renal thickness among cases was 8.1 mm (95% CI 7.9–8.2) compared to 11.5 mm (95% CI 10.7–12.9) in controls (p = 0.001). There was no obvious difference in estimated fetal weight between groups, yet fetuses exposed to maternal T2D had increased subcutaneous abdominal wall fat thickness at this early gestational age (p = 0.008). Conclusions. Fetal renal size in cases exposed to pregestational T2D is significantly smaller compared to controls, and subcutaneous abdominal wall fat is significantly thicker. Given emerging evidence about the developmental origins of disease, further study is needed to correlate the association between fetal renal size and fat distribution in the fetus and the long-term risk of chronic renal disease and diabetes in these offspring. [ABSTRACT FROM AUTHOR]

In children, the mechanisms implicated in deterioration of glucose homeostasis versus reversion to normal glucose tolerance (NGT) remain uncertain. We aimed to describe the natural history of dysglycemia from childhood to late adolescence and to identify its early determinants. We used baseline (8–10 years, n = 630), 1st follow‐up (10–12 years, n = 564) and 2nd follow‐up (15–17 years, n = 377) data from the QUALITY cohort of White Canadian children with parental obesity. Children underwent a 2‐h oral glucose tolerance test at each cycle with plasma glucose and insulin measured at 0/30/60/90/120 min. American Diabetes Association criteria defined dysglycemia (impaired fasting glucose, impaired glucose tolerance or type 2 diabetes). Longitudinal patterns of insulin sensitivity and beta‐cell function were estimated using generalized additive mixed models. Model averaging identified biological, sociodemographic and lifestyle‐related determinants of dysglycemia. Of the children NGT at baseline, 66 (21%) developed dysglycemia without reverting to NGT. Among children with dysglycemia at baseline, 24 (73%) reverted to NGT. In children with dysglycemia at 1st follow‐up, 18 (53%) later reverted to NGT. Among biological, sociodemographic and lifestyle determinants at 8–10 years, only fasting and 2‐h glucose were associated with developing dysglycemia (odds ratio [95% CI] per 1 mmol/L increase: 4.50 [1.06; 19.02] and 1.74 [1.11; 2.73], respectively). Beta‐cell function decreased by 40% in children with overweight or obesity. In conclusion, up to 75% of children with dysglycemia reverted to NGT during puberty. Children with higher fasting and 2‐h glucose were at higher risk for progression to dysglycemia, while no demographic/lifestyle determinants were identified. [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]

Deficit models of care for clients experiencing social vulnerability have become increasingly unsustainable; and there is a shift towards models of care that promote and protect resiliency for lifelong health. We defined clients as socially vulnerable if they were living with poverty, mental health problems and addictions, disability, and social isolation. Scales to measure outcomes of resiliency‐focused programming have limited reliability and have not been validated with vulnerable populations. The aim of this study was to develop and conduct preliminary psychometric assessment of two measures: CUPS (formerly Calgary Urban Project Society) Resiliency Interview Schedule (RIS) and Resiliency Questionnaire (RQ) for adults experiencing social vulnerability. To engage clients who were seeking integrated services at a social services agency, we developed the RIS and accessed data collected between April 2017 and December 2018. In a structured intake interview, the client and staff prioritised goals and identified resiliency in three domains: (a) economic, (b) social‐emotional, and (c) health. On average, clients (N = 545) who completed the CUPS‐RIS were 45.9 years old (SD = 12.62). For the CUPS‐RIS, Cronbach's alphas at intake and outcome assessments were 0.80. Exploratory factor analysis demonstrated a four‐factor solution with two unexpected results: executive functioning/self‐regulation loaded with mental and physical health, and client education failed to load on any factor. We found significant improvements between client intake and outcome measurement points on eight of 12 sub‐domains. As a brief self‐report measure of resiliency, we developed the CUPS‐RQ and accessed data collected between November 2018 and May 2019. Clients (N = 29) who completed the CUPS‐RQ concurrently with the Resilience Research Centre‐Adult Resilience Measure (RRC‐ARM) were, on average, 42.46 years old (SD = 12.87). The CUPS‐RQ was correlated with RRC‐ARM, r = 0.819. In preliminary psychometric assessment, the CUPS‐RIS and CUPS‐RQ demonstrated satisfactory reliability and validity and show promise as measures of resiliency for agencies serving clients experiencing social vulnerability. [ABSTRACT FROM AUTHOR]

Aim: This study aims at better understanding the relationships between nurses' enacted scope of practice, work environment and work satisfaction, missed care, and organizational indicators of performance. Background: The enacted scope of practice model describes the determinants and consequences of the actual enactment of the nursing scope of practice. Method: A correlational design was used to investigate nurses' enacted scope of practice in five Canadian healthcare centres. Results: Suboptimal enacted scope of practice were found in the current sample. Significant positive correlations were found between the total enacted scope of practice score, use of qualification, control over tasks, decisional latitude and psychological demand as well as role ambiguity. Moreover, a higher enacted scope of practice was correlated with lower organizational indicators of short‐term absenteeism. Conclusion: Results suggest an insufficient deployment of nurses' enacted scope of practice, likely caused by some job characteristics, leading to lower work satisfaction and negative patients and organizational outcomes. Implications for nursing management: Optimizing nurses' enacted scope of practice would be a significant integrated strategy for improving organizational performance, patient care and nurses' satisfaction and well‐being. Nurses and frontline managers must be involved in the decision‐making process necessary to improve nurses' enacted scope of practice. [ABSTRACT FROM AUTHOR]

Working in a stressful environment, child protection workers (CPWs) are often victims of psychological and physical acts of aggression perpetrated by their clients. This can be emotionally distressing for CPWs. Previous authors have suggested that this distress could place CPWs at greater risk for subsequent victimisation if they become emotionally unavailable to their clients. This study sought to investigate whether the distress experienced after an act of client aggression or other types of potentially traumatic events could indeed predict subsequent victimisation over time. Using cross‐lagged panel analysis, researchers administered standardised questionnaires to 173 CPWs who had experienced an act of client aggression or other type of potentially traumatic event in the month prior. Participants were asked to fill out additional questionnaires 2, 6 and then 12 months later. Researchers found that CPW distress did in fact predict subsequent victimisation at the 2‐month time point only. Researchers then conducted a generalised linear model analysis to test the influence of sociodemographic variables and the moderating influence of supervisor support. Supervisor support did not moderate the relationship between initial distress levels and increased aggression 2 months later. The study concludes by examining how the emotional distress of CPWs can negatively impact clients and how organisations can best provide support, in part, by rethinking aggression prevention. [ABSTRACT FROM AUTHOR]

In Canada, publicly funded healthcare provides no‐cost access to a large but not comprehensive suite of services. Dental care is largely funded by private insurance or patients, creating employment‐ and income‐dependent gaps in care access. Difficulties accessing dental care may be amplified among vulnerable populations, including people who use drugs (PWUD), who may experience greater dental need due to side effects of substance use and health comorbidities, as well as barriers to care. Using data collected between 2014 and 2018 from two ongoing prospective cohort studies of PWUD in Vancouver, Canada, the aim of this study was to explore factors associated with dental care access. Among 1,638 participants, 246 participants (15%) reported never or only occasionally accessing adequate dental care. In generalised linear mixed‐effects models, results showed significant negative associations between accessing dental care and using opioids (Adjusted Odds Ratios [AOR] = 0.73, 95% Confidence Interval [CI] = 0.58–0.91), methamphetamine (AOR = 0.75, 95% CI = 0.59–0.95) and cannabis (AOR = 0.78, 95% CI = 0.63–0.97), as well experiencing homelessness (AOR = 0.54, 95% CI = 0.42–0.70) and street‐based income generation (AOR = 0.75, 95% CI = 0.59–0.94). There were significant positive associations between adequate dental care and accessing opioid agonist treatment (OAT) for opioid dependence (AOR = 1.36, 95% CI = 1.07–1.72) and receiving income assistance (AOR = 1.70, 95% CI = 1.05–2.77). These results highlight specific substance use patterns and structural exposures that may hinder dental care access, as well as how direct and indirect benefits of income assistance and OAT may improve access. These findings provide support for recent calls to expand healthcare coverage and address dental care inequities. [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]

Aim: Initial testing of England's Safer Nursing Care Tool for adult in‐patient acute care wards in a university‐affiliated Canadian hospital. Background: Safe‐nursing staffing decisions have significant impacts on patients' safety and quality of care. The Safer Nursing Care Tool was developed in England to provide managers with a validated formula for making appropriate nursing staffing decisions. The tool has been widely used and studied in the UK but has yet to be tested in a Canadian context. Method: Ten high service quality acute care wards from a university‐affiliated Canadian hospital tested the use of the Safer Nursing Care Tool. Service quality, patients' dependency/acuity and staff activity data were benchmarked against information collected in 726 comparable UK wards. Results: Higher bed occupancy and patient dependency/acuity mix were found in the 10 Canadian wards compared to their UK counterparts. Overall staff activity was comparable between UK and Canadian wards. Conclusion: The Safer Nursing Care Tool can be applied in this Canadian hospital, and further testing in other hospitals and specialties is required. Implication for Nursing Management: The Safer Nursing Care Tool is a valid staffing tool to use that, when combined with professional judgement, can help managers to properly establish nursing staff in acute care wards. [ABSTRACT FROM AUTHOR]

Foot care is a common problem for homeless adults in cities, who often receive fragmented foot care services, resulting in increased foot problems, health complications, hospitalisation, limb removal and disabilities. Among the health factors that negatively affect the homeless, foot health is essential, but often neglected. This study employed a descriptive, cross‐sectional research design to assess the foot care of homeless people and develop recommendations for clinical practice. Using Inlow's 60‐s foot screening method, the foot conditions of a purposive sample of 65 homeless adults were examined in British Columbia, Canada, in 2019–2020. Descriptive and inferential statistics were used to analyse the data. Determinants, such as sex and years of homelessness significantly contributed to homeless individuals' risk of developing foot problems. Differences in perceived and observed foot problems were influenced by equitable access to social health and healthcare services. Foot assessment is not well‐covered by homeless health services and should be implemented as part of the standard medical review of homeless patients. Furthermore, foot assessment should be conducted by healthcare professionals, rather than relying on the standard practice of service users' self‐report. Finally, foot care should be based on tailoring assessments and interventions for the individualised needs of homeless service users. Future research must seek ways to integrate homeless individuals' voices in the development, implementation and evaluation of foot care services. [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]

Objectives: Patients adapt to cancer through self‐management, which requires collaboration between patients and their healthcare providers. We aimed to describe patterns of patient–provider collaboration during radiotherapy and examine associations among patient–provider collaboration, self‐management and well‐being. Methods: An observational, cross‐sectional study was conducted at a cancer centre in the province of Ontario, Canada. Cancer patients (N = 130) completed a one‐time questionnaire during their radiotherapy. The questionnaire assessed three variables: collaboration with healthcare providers, self‐management and well‐being. Patterns of collaboration were analysed using descriptive statistics. Associations among study variables were assessed through structural equation modelling (SEM). Separate models were tested for patient–nurse and patient–oncologist collaboration. Results: Participants reported greater collaboration with oncologists than with nurses or radiation therapists. Most participants reported no collaboration with other providers within healthcare teams (e.g. social workers, dietitians). SEM revealed different patterns for the patient–nurse and patient–oncologist collaboration models, where collaboration predicted one self‐management aspect, and both physical and mental well‐being. Conclusion: During radiotherapy, patients collaborated mainly with doctors, nurses and radiation therapists. Collaborative relationships between patients and providers may enhance patient outcomes by fostering their self‐management skills. Initiatives to strengthen patient–provider relationships and support self‐management should be developed and applied to interprofessional‐cancer‐care teams. Impact: This is the first known study to empirically support the links among patient–provider collaboration, self‐management and patient outcomes. The study results can enhance practice, research and education. [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]

Co‐occurring disorders in mental health and addiction present a high prevalence, but services available to prevent and treat them are often fragmented. Cross‐training activities have been used to help minimise breaks in service continuity. This study assesses to what extent positional clarification (a specific type of cross‐training activity) can help bridge fragmented services for co‐occurring disorders by providing information and promoting interactions to help professionals better orient and treat their clientele. A total of 2,107 participations were recorded for 11 positional clarification events taking place within the Montreal Cross‐Training Program for mental health and substance use disorders between 2010 and 2016. The Kirkpatrick four‐level training evaluation model was used to evaluate these activities. Evaluation questionnaires (n = 1,650) and interviews with a convenience sample of 32 participants were analysed using descriptive statistics and thematic analysis. More than three‐quarters of participants reported that the activity met their expectations and was relevant to their practice. Respondents also reported receiving useful information to better orient their clientele, discovering new resources, learning about the functioning of other resources, identifying members of other networks who could orient them when needed, and learning more about the theme of the activity and the different mechanisms for collaboration among the related services. Among those who participated in more than one positional clarification event, roughly three‐quarters reported that they were able to call upon new resources at least once as a result of their participation, and were able to establish referrals towards resources that were unknown or less familiar to them prior to their participation. Results suggest that the programme meets its service integration objectives and that positional clarification events can lead to changes that can help facilitate the integration of fragmented services by improving participants' knowledge of specific themes and available resources to better orient and treat their clientele. [ABSTRACT FROM AUTHOR]

Medical assistance in dying (MAID) was implemented across Canada in June of 2016, after each Canadian province and territory had developed their own MAID processes. Over the first 2 years, just under 300 Alberta citizens received MAID services, a very small proportion (<0.5%) of all 52,000 decedents. An online 2017–2018 survey of Alberta healthcare providers and members of the general public was conducted to assess and compare their knowledge of MAID. A devised brief survey tool was posted online, with broad‐based advertising for voluntary participants. The survey was taken down after 282 Albertans had participated (100+ healthcare professionals and 100+ members of the general public), a non‐representative sample. Through SPSS data analysis, educational needs were clearly evident as only 30.5% knew the correct approximate number of MAID deaths to date, 33.0% correctly identified the point in life when MAID can be done, 48.9% correctly identified the locations where MAID can be performed, 49.3% correctly identified who can stop MAID from being carried out, and 52.8% correctly identified how MAID is performed to end life. Healthcare professionals were significantly more often correct; as were participants born in Canada, university degree holders, working persons, those who identified a religion, had experience with death and dying care, had direct prior experience with death hastening, thought adults had a right to request and receive MAID, had past experience with animal euthanasia, and had hospice/palliative education or work experience. Age, gender, and having previously worked or lived in a country where assisted suicide or euthanasia was performed were not significant for educational needs. These findings indicate new approaches to meet sudden assisted suicide educational needs are needed. [ABSTRACT FROM AUTHOR]

The prevalence of health scams in Canada is increasing, facilitated by the rise of the Internet as a mass communication medium. However, little is known about the nature of this phenomena. Building on previous work exploring the nature of Internet health scams (IHS), this project sought to better understand the reasons why people engaged with IHS, and if contemporary psychosocial theory can help explain IHS engagement. A mixed‐methods study, involving a web‐based survey incorporating qualitative questions and the Susceptibility to Persuasion‐II Brief psychometric scale (STP‐II Brief), were administered (N = 194) in British Columbia, Canada, in 2017. Results (n = 156) demonstrated that 40% of participants had ever engaged with IHS, but only 1% reported to have actually lost money to a deceptive product/service. Associations between scam engagement, participant demographics and STP‐II Brief scores were explored, with Sex and Employment Status both found to have a significant effect on odds of IHS engagement. STP‐II Brief scores were positively correlated with a likelihood of engagement with IHS, even when adjusting for demographic characteristics. The types of IHS most frequently engaged with were those related to body image products, and social influence appeared to be a dominant psychosocial factor promoting engagement. Participants reported that claims of products being 'natural', the result of scientific breakthroughs, use of pseudoscientific language, use of testimonials, and celebrity or professional endorsement could lead them to engage with a product. These findings can help inform health professionals' understanding of public health‐seeking behaviours with respect to deceptive marketing. [ABSTRACT FROM AUTHOR]

The flipped classroom continues to garner increasing interest in nursing education; however, few research studies fully document faculty experiences with its implementation. This study's purpose was to explore undergraduate nurse educators' transition from traditional teacher‐centered, content‐driven strategies to the flipped classroom and describe perceived successes and challenges during the process. A qualitative approach using interpretive description gave voice to a purposive sample of sixteen undergraduate nurse educators across the United States and Canada. Semistructured interviews, audio‐recorded and transcribed verbatim, yielded a set of experiential themes. Participants revealed marked challenges as they rethought classroom design in relation to evidence‐based educational principles, and met a surprising level of resistance from students and faculty colleagues. Still, faculty observations reflected increased student problem solving, self‐determination and a greater correlation between teacher‐made and standardized test scores. Participants advocated continued integration of flipped classrooms into nursing curricula and recommended greater collegial and administrative support from academic environments. [ABSTRACT FROM AUTHOR]

Background and Objectives: Indications for insulin pump therapy (IPT) in children with type 1 diabetes (T1D) are relatively non‐specific and therefore subject to provider discretion. Health professionals' perceptions of which people will have difficulty with IPT, for example, those with higher hemoglobin A1c (HbA1c), may not be correct. This study examined the effect of IPT on HbA1c, and the role of pre‐pump HbA1c on this effect. Methods: All children with T1D started on IPT at British Columbia Children's Hospital from January 2011 through June 2016 were included if they had HbA1c values available both before and after IPT (n = 125). Generalized estimating equations was used to estimate the effects of IPT on HbA1c, stratified by pre‐pump HbA1c levels (good: <7.5% [<58 mmol/mol], moderate: 7.5%‐9.0% [58‐75 mmol/mol], poor: >9.0% [>75 mmol/mol]). Results: After adjusting for potential confounders, mean HbA1c decreased by 0.48% [5.2 mmol/mol] (95% confidence interval: −0.64, −0.33% [−7.0, −3.6 mmol/mol]; P < 0.0001) after IPT initiation. The adjusted mean HbA1c decreased by 0.14% [1.5 mmol/mol] (−0.35, 0.07% [−3.8, 0.8 mmol/mol]; P = 0.188), 0.54% [5.9 mmol/mol] (−0.74, −0.34% [−8.1, −3.7 mmol/mol]; P < 0.0001), and 1.08% [11.8 mmol/mol] (−1.69, −0.46% [−18.5, −5.0 mmol/mol]; P = 0.0006) after pump initiation in the good, moderate, and poor pre‐pump metabolic control groups, respectively. Conclusions: Pre‐pump HbA1c appears to play a significant role in the effects of IPT on HbA1c, with the largest decrease in HbA1c seen in the poor pre‐pump HbA1c group. Eligibility and consideration for IPT should be expanded to routinely include these children. [ABSTRACT FROM AUTHOR]

Introduction. With community-dwelling elders waiting to adapt their bathroom, Health and Social Services Centers in Quebec (Canada) combined human resources through cross-skilling within interdisciplinary teams. To this end, occupational therapists implemented in-house "tools" to support nonoccupational therapists in selecting bathing equipment. However, unknown psychometric properties of those in-house "tools" cast doubt on the quality of service provided to elders. Little is also known about the best processes to use to support the deimplementation of such nonevidence-based practices. This study presents the effect of a knowledge transfer and exchange intervention designed to deimplement in-house "tools" and replace them with an evidence-based tool (Algo). Methods. Censuses were conducted with the 94 Health and Social Services Centers of Quebec providing homecare services, before and after the knowledge transfer and exchange intervention (2009-2013). In 2013, the deimplementation of in-house "tools" and their replacement by Algo were measured with Knott and Wildavsky's levels of utilization. Results. Cross-skilling within interdisciplinary teams increased between censuses (87% to 98%), as did use of in-house "tools" (67% to 81%). Algo's uptake started during the knowledge transfer and exchange process as 25 Health and Social Services Centers achieved the first level of utilization. Nonetheless, no Health and Social Services Center deimplemented the in-house "tools" to use Algo. Conclusion. The knowledge transfer and exchange process led to the development of a scientifically sound clinical tool (Algo) and challenged the status quo in clinical settings regarding the use of nonevidence-based practices. However, the deimplementation of in-use practices has not yet been observed. This study highlights the need to act proactively on the deimplementation and implementation processes. [ABSTRACT FROM AUTHOR]

Abstract: Prediabetes, a condition characterised by impaired glucose regulation, is on the rise worldwide. This condition puts people at risk for cardiovascular disease, and 50% of people with prediabetes will develop type 2 diabetes (T2D). People with prediabetes can reduce their risk of developing T2D through lifestyle changes such as regular physical activity and healthy eating. However, the experience of health risks can be associated with negative reactions that can undermine people's ability to self‐regulate the health behaviours that would reduce such risk. Self‐compassion, or treating oneself kindly in the face of challenge, is known to help people manage negative emotions and facilitate self‐regulation. Therefore, self‐compassion may be helpful for people with prediabetes who have to manage their health behaviours in the context of a health threat. The purpose of this study was to explore how people, from a small Canadian city who learn that they have prediabetes, react emotionally to their prediabetes diagnosis. We also explored participants' receptivity to applying self‐compassion in the context of their prediabetes. Twenty‐one adults, recently notified by their doctors as having HbA1c scores indicative of prediabetes (Mage = 57.76, SD = 5.43), engaged in a semi‐structured interview between June 2017 and January 2018. Inductive thematic analysis was used to analyse the data and four themes emerged. Participants' reactions to learning that they had prediabetes were characterised by (a) distress and concern, (b) downplay of T2D risks, (c) guilt and shame, and participants were receptive to (d) self‐compassion as a beneficial approach to take in relation to their prediabetes. Findings suggest that people experience negative reactions to their prediabetes diagnosis yet are receptive to self‐compassion, which could mitigate these reactions. These findings can inform lifestyle behaviour change programmes for individuals living with prediabetes by providing a better understanding of their perspectives of disease diagnosis. [ABSTRACT FROM AUTHOR]

Aim To validate a framework of factors that influence the relationship of transformational leadership and safety climate, and to enable testing of safety chain factors by generating hypotheses regarding their mediating and moderating effects. Background Understanding the patient safety chain and mechanisms by which leaders affect a strong climate of safety is essential to transformational leadership practice, education, and research. Methods A systematic review of leadership and safety literature was used to develop an organising framework of factors proposed to influence the climate of safety. A panel of 25 international experts in leadership and safety engaged a three-round modified Delphi study with Likert-scored surveys. Results Eighty per cent of participating experts from six countries were retained to the final survey round. Consensus (>66% agreement) was achieved on 40 factors believed to influence safety climate in the acute care setting. Conclusions Consensus regarding specific factors that play important roles in an organisation's climate of safety can be reached. Generally, the demonstration of leadership commitment to safety is key to cultivating a culture of patient safety. Implications for Nursing Management Transformational nurse leaders should consider and employ all three categories of factors in daily leadership activities and decision-making to drive a strong climate of patient safety. [ABSTRACT FROM AUTHOR]

The purpose of this project was to examine the emotional health and well-being of Canadian caregivers of persons with significant mental health or addictions problems. We assessed the emotional health of caregivers by care-receiver condition type (i.e. mental health or addictions vs. physical or other health problems), levels of caregiver stress and methods particularly for reducing stress among caregivers of persons with mental health or addictions disorders. Weighted cross-sectional data from the 2012 General Social Survey (Caregiving and Care Receiving) were modelled using weighted descriptive and logistic regression analyses to examine levels of stress and the emotional health and well-being of caregivers by care-receiver condition type. Caregivers of persons with mental health or addictions problems were more likely to report that caregiving was very stressful and that they felt depressed, tired, worried or anxious, overwhelmed; lonely or isolated; short-tempered or irritable; and resentful because of their caregiving responsibilities. The results of this study suggest that mental health and addictions caregivers may experience disparate stressors and require varying services and supports relative to caregivers of persons with physical or other health conditions. [ABSTRACT FROM AUTHOR]

Aim The primary aim of this study was to examine the relationships between structural empowerment, psychological empowerment and job satisfaction among staff nurses, after controlling for their leaders' use of empowering behaviours. Background Nurses' job satisfaction is a critical factor in health-care organisations because of its association with nurse turnover and quality of patient care. Nurses continue to report high levels of job dissatisfaction. Methods Cross-sectional data for 1007 Canadian staff nurses were analysed using hierarchical multiple regression. Results Structural empowerment was the strongest independent predictor of job satisfaction, followed by leader empowering behaviours and psychological empowerment. After accounting for the effects of structural empowerment and leader empowering behaviours, the four dimensions of psychological empowerment showed only small independent effects on job satisfaction. Psychological empowerment did not mediate the effects of structural empowerment on job satisfaction. Conclusion Nurses' job satisfaction is most influenced by their access to organisational empowerment structures. Leader empowering behaviours, structural empowerment, and psychological empowerment, operating together, enhance nurses' job satisfaction. Implications for Nursing Management Nurse leaders should use a variety of empowerment strategies that are important to nurses' job satisfaction and potentially to the quality of patient care and nurse turnover. [ABSTRACT FROM AUTHOR]

Breast density notification laws, passed in 19 states as of October 2014, mandate that patients be informed of their breast density. The purpose of this study is to assess the impact of this legislation on radiology practices, including performance of breast cancer risk assessment and supplemental screening studies. A 20-question anonymous web-based survey was emailed to radiologists in the Society of Breast Imaging between August 2013 and March 2014. Statistical analysis was performed using Fisher's exact test. Around 121 radiologists from 110 facilities in 34 USA states and 1 Canadian site responded. About 50% (55/110) of facilities had breast density legislation, 36% of facilities (39/109) performed breast cancer risk assessment (one facility did not respond). Risk assessment was performed as a new task in response to density legislation in 40% (6/15) of facilities in states with notification laws. However, there was no significant difference in performing risk assessment between facilities in states with a law and those without (p < 0.831). In anticipation of breast density legislation, 33% (16/48), 6% (3/48), and 6% (3/48) of facilities in states with laws implemented handheld whole breast ultrasound ( WBUS), automated WBUS, and tomosynthesis, respectively. The ratio of facilities offering handheld WBUS was significantly higher in states with a law than in states without (p < 0.001). In response to breast density legislation, more than 33% of facilities are offering supplemental screening with WBUS and tomosynthesis, and many are performing formal risk assessment for determining patient management. [ABSTRACT FROM AUTHOR]

The article discusses a study which described the practices of occupational therapists in the forensic mental health setting in Canada. Topics include the use of a Canadian Practice Process Framework in an online survey conducted, the responses to the survey which indicated commonalities in workplaces, client caseloads and practice challenges, and study findings which revealed critical areas for the development of Canadian forensic occupational therapy such as education, advocacy and research.

Aims To describe and compare registered nurse ( RN) and licensed practical nurse ( LPN) emotional exhaustion, intention to leave and reasons for leaving. Background Different skill mix/care delivery models are being used to address nurse shortages and rising health-care costs. Skill mix may include RNs and LPNs. More LPNs are being employed in areas, such as acute care, that have been previously staffed by all RNs. Little is known about nurse outcomes since the introduction of LPNs to acute care settings. Methods This study was a cross-sectional correlational design. A stratified, random sample of acute care nurses completed surveys via Fluidsurveys. The survey was modelled after the RN4 CAST nursing workforce survey. Results For both groups of nurses higher levels of emotional exhaustion were associated with intention to leave and workload was the most frequent reason cited for intention to leave. More RNs than LPNs cited career advancement as a reason to leave, and more LPNs than RNs identified poor salary as a reason to leave. Conclusions Emotional exhaustion is linked to intention to leave health care. Implications for nursing management Nurse managers should address work environment factors associated with turnover intentions, such as professional development opportunities and shared decision-making. [ABSTRACT FROM AUTHOR]

Aim To describe how actions of nursing unit leaders influenced the long-term sustainability of a best practice guidelines ( BPG) program on inpatient units. Background Several factors influence the initial implementation of evidence-based practice improvements in nursing, with leadership recognized as essential. However, there is limited knowledge about enduring change, including how frontline nursing leaders influence the sustainability of practice improvements over the long term. Methods A qualitative descriptive case study included 39 in-depth interviews, observations, and document reviews. Four embedded nursing unit subcases had differing levels of program sustainability at 7 years (average) following implementation. Results Higher levels of BPG sustainability occurred on units where formal leadership teams used an integrated set of strategies and activities. Two key strategies were maintaining priorities and reinforcing expectations. The coordinated use of six activities (e.g., discussing, evaluating, integrating) promoted the continuation of BPG practices among staff. These leadership processes, fostering exchange and learning, contributed to sustainability-promoting environments characterized by teamwork and accountability. Conclusions Unit leaders are required to strategically orchestrate several overlapping and synergistic efforts to achieve long-term sustainability of BPG-based practice improvements. Implications As part of managing overall unit performance, unit leaders may influence practice improvement sustainability by aligning vision, strategies, and activities. [ABSTRACT FROM AUTHOR]