Search

Objective The objective of this scoping review was to describe the characteristics of interventions and programs that support the health and development of infants in foster care who have prenatal substance exposure, their foster care providers, and birth families. Introduction Infants in foster care may have experienced prenatal substance exposure, neglect, and maltreatment, as well as disruptions in their relationships with primary caregivers. Despite multiple vulnerabilities, they also have great capacity for overcoming early adversities. Enhanced foster care has been identified as a key influence on the positive development of infants in the child welfare system. Inclusion criteria This scoping review considered publications that described interventions and programs designed to support foster care providers who care for infants less than 12 months of age with prenatal substance exposure. This review included both research studies and gray literature. This scoping review focused on sources that described caregiving interventions and elements of programs that took place within the context of family or home-based foster care. Methods A three-step search strategy was used to identify publications in the English language from January 2000 to December 2019. A literature search was conducted using MEDLINE, Academic Search Premier, PsycINFO, and CINAHL databases. Titles and abstracts were initially screened to assess if publications met the inclusion criteria, followed by full-text review. Publications that met the inclusion criteria were assessed by two independent reviewers using a data extraction tool developed for this review. Findings were thematically analyzed on the basis of similarity in focus and descriptively presented with tables and figures to support the findings. Results Eighty-one publications were included, including 48 research papers and 33 gray literature sources. Thematic analysis of the focus of each publication resulted in identification of four core themes: i) mental health promotion for infants in care; ii) child welfare program elements; iii) identification of infants and families at risk of requiring foster care; and iv) outcomes for infants in care and their families. The interventions and programs identified during this scoping review were primarily focused on supporting social-emotional development. With the significant focus on infant mental health, supporting birth parents to stay attached to their infants was a key focus of the majority of publications. The concept of being able to proactively identify risk factors that were associated with infants requiring foster care emerged in relation to how family preservation could be supported. Strategies identified as contributing to the development of successful interventions and programs included: having foster care providers participate as collaborators in designing services; designing services that are adaptable to a range of contexts; involving community partners outside child welfare; and having developmentally appropriate programs. Conclusions Infants represent a significant proportion of children in foster care. A developmental perspective is needed for child welfare service planning to address their unique needs. Intervention during the early years holds significant potential for promoting positive developmental pathways and family preservation.

REVIEW QUESTION/OBJECTIVE The objective of this scoping review is to identify and describe caregiving interventions and program elements that support the health and development of infants with prenatal alcohol and/or drug exposure in foster care.

Nurse-Family Partnership is a targeted public health intervention program designed to improve child and maternal health through nurse home visiting. In the context of a process evaluation, we posed the question: “In what ways do Canadian public health nurses explain their experiences with delivering this program across different geographical environments?” The qualitative methodology of interpretive description guided study decisions and data were collected through 10 focus groups with 50 nurses conducted over 2 years. We applied an intersectionality lens to explore the influence of all types of geography on the delivery of Nurse-Family Partnership. The findings from our analysis suggest that the nature of clients’ place and their associated social and physical geography emphasizes inadequacies of organizational and support structures that create health inequities for clients. Geography had a significant impact on program delivery for clients who were living with multiple forms of oppression and it worked to reinforce disadvantage.

REVIEW QUESTION/OBJECTIVES The purpose of this scoping review is to systematically identify and describe literature that uses a health equity-oriented (HEO) approach for preventing and reducing the harms of stigma or overdose for people who use illicit drugs or misuse prescription opioids.The question of the review is: What is currently known about the use of an HEO approach for preventing the harms of stigma or overdose when people use illicit or street drugs, or use prescription opioids for other than their intended purposes?Specifically, the review objectives are.

Background: It has been hypothesised that intrauterine exposures are important for subsequent prostate cancer risk. Prior epidemiological studies have used birthweight as a proxy of cumulative intrauterine exposures to test this hypothesis, but results have been inconsistent partly because of limited statistical power. Methods: We investigated birthweight in relation to prostate cancer in the Medical Research Council (MRC) National Survey of Health and Development (NSHD) using Cox proportional hazards models. We then conducted a meta-analysis of birthweight in relation to total and aggressive/lethal prostate cancer risks, combining results from the NSHD analysis with 13 additional studies on this relationship identified from a systematic search in four major scientific literature databases through January 2015. Results: Random-effects models found that per kg increase in birthweight was positively associated with total (OR=1.02, 95% confidence interval (95% CI)=1.00, 1.05; I2=13%) and aggressive/lethal prostate cancer (OR=1.08, 95% CI=0.99, 1.19; I2=40%). Sensitivity analyses restricted to studies with birthweight extracted from medical records demonstrated stronger positive associations with total (OR=1.11, 95% CI=1.03, 1.19; I2=0%) and aggressive/lethal (OR=1.37, 95% CI=1.09, 1.74; I2=0%) prostate cancer. These studies heavily overlapped with those based in Nordic countries. Conclusions: This study provides evidence that heavier birthweight may be associated with modest increased risks of total and aggressive/lethal prostate cancer, which supports the hypothesis that intrauterine exposures may be related to subsequent prostate cancer risks.

The purpose of this analysis was to understand public health nurses’ experiences in preventing and addressing suspected child maltreatment within the context of home visiting. The principles of interpretive description guided study decisions and data were generated from interviews with 47 public health nurses. Data were analyzed using reflexive thematic analysis. The findings highlighted that public health nurses have an important role in the primary prevention of child maltreatment. These nurses described a six-step process for managing their duty to report suspected child maltreatment within the context of nurse-client relationships. When indicators of suspected child maltreatment were present, examination of experiential practice revealed that nurses developed reporting processes that maximized child safety, highlighted maternal strengths, and created opportunities to maintain the nurse-client relationship. Even with child protection involvement, public health nurses have a central role in continuing to work with families to develop safe and competent parenting skills.

Person-centered care is heavily dependent on effective information exchange among health care team members. We explored the organizational systems that influence resident care attendants’ (RCAs) access to care information in long-term care (LTC) settings. We conducted an institutional ethnography in three LTC facilities. Investigative methods included naturalistic observations, in-depth interviews, and textual analysis. Practical access to texts containing individualized care-related information (e.g., care plans) was dependent on job classification. Regulated health care professionals accessed these texts daily. RCAs lacked practical access to these texts and primarily received and shared information orally. Microsystems of care, based on information exchange formats, emerged. Organizational systems mandated written exchange of information and did not formally support an oral exchange. Thus, oral information exchanges were largely dependent on the quality of workplace relationships. Formal systems are needed to support structured oral information exchange within and between the microsystems of care found in LTC.

REVIEW QUESTION / OBJECTIVE The aim of this review is to identify the experiences of pre-licensure or pre-registration health professional students and their educators of intra-professional teams. The objectives of this review are: 1. To identify the experiences of pre-licensure or pre-registration health professional students about learning how to work in intra-professional teams. 2. To identify the experiences of health professional educators about teaching intra-professional collaboration across categorical and/or regulatory boundaries of professional groups. The specific question for this review is: What are the experiences of health professional students and educators learning to work in intra-professional teams? INCLUSION CRITERIA Types of participants This review will consider studies that investigate pre-licensure health professional students' and educators’ experiences of intra-professional teams. We will define pre-licensure health professional students as those students enrolled in a health-related diploma or degree program leading to the writing of a licensure or registration exam prior to engaging in practice (i.e. regulated health care provider programs). Health related programs that will be included are those that have multiple points of entry-to-practice under one disciplinary domain. This could include (but will not be limited to) disciplines such as dentistry, nursing, medicine, occupational therapy, pharmacy, physiotherapy or social work. Thus, we will consider studies that include experiences of students and educators working in various disciplinary domains (such as dentistry, medicine, nursing, occupational therapy pharmacy or physiotherapy) focusing on regulated health professions which have more than one point of entry into practice for their students (e.g. baccalaureate degree or diploma). TRUNCATED AT 250 WORDS

Background Inter-professional initiatives are prevalent in the healthcare landscape, requiring professionals to collaborate effectively to provide quality patient care. Little attention has been given to intra-professional relationships, where professionals within one disciplinary domain (such as degree and diploma nursing students) collaborate to provide care. New care models are being introduced where baccalaureate and diploma students of a particular discipline (such as nursing, occupational therapy, dentistry or physiotherapy) work closely together in teams to deliver care. Questions thus arise as to how students and educators learn to work on intra-professional teams. Objectives To identify and synthesize evidence regarding experiences of pre-licensure health professional students and their educators on intra-professional teams and to draw recommendations to enhance policy and/or curriculum development. Inclusion criteria types of participants Pre-licensure students and educators, focusing on regulated health professions that have had more than one point of entry into practice. Phenomena of interest Experiences of intra-professional team learning or teaching within various entry-to-practice categories of a particular health-related discipline. Types of studies Eight qualitative studies were included in the review. Seven studies were descriptive in nature; one study was a critical analysis. Search strategy A comprehensive search of various databases was conducted between June 2, 2015 and August 16, 2015, and repeated in March 2016. The search considered all studies reported and published from January 1, 2001 to March 7, 2016. Only studies published in English were included in this review. Methodological quality Included papers were of low-to-moderate quality; however, it is important to consider that post-positivist assumptions underpinned much of the primary research, which could explain why researcher positionality and/or influence on the research would not be addressed. Data extraction Data were extracted using the standardized data extraction tool from the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBI-QARI). The data extracted included descriptive details about the phenomenon of interest, populations and study methods. Data synthesis Research findings were pooled using the JBI-QARI. Sixty-eight findings were organized into nine categories based on similarity in meaning. Results Four synthesized findings reveal how students value intra-professional learning experiences. These experiences build positive collaborative relationships (including trust and respect); however, educator and staff attitudes and conversations create hierarchies in academic and clinical contexts resulting in tension between student groups. Conclusion Despite its challenges, shared learning experiences assist students to understand each other's roles, develop communication and collaborative competencies, develop comprehensive care plans, provide more efficient care and help prepare them for their future roles as healthcare professionals. Various contextual elements could either hinder or facilitate shared learning experiences.

Community-based, integrated, primary care maternity programs for pregnant women affected by problematic substance use are emerging as effective models for engaging women affected by multiple health and social issues. Although addictions services have historically been evaluated by individual achievement of abstinence, new definitions of program success are required as addiction comes to be viewed as a chronic illness. We conducted a mixed-methods study to follow the formative development stages of a community-based program, identifying key evaluation indicators and processes related to this program, program team members, and women and families served. As this program model develops, it is critical that providers, community partners, and health system leaders collaborate to frame definitions of success in ways helpful for guiding program development.

The philosophical framework of family-centered care (FCC) has been promoted consistently since the 1980s in perinatal and neonatal settings as a gold standard approach for developing programs and providing care that supports the meaningful involvement of parents in the care of their infants and children. Recent literature suggests that despite years of promotion, FCC remains an elusive practice. Sources frequently state that FCC is based on principles of communication and empowerment, but the literature overall does not suggest substantial underlying philosophical or theoretical underpinnings. There have been theoretical advances in nursing and other disciplines that hold potential for moving our practice of FCC forward. In this article, we describe the informed advocacy framework and apply the framework to FCC.

Rural nurses play an important role in the provision of maternity care for Canadian women. This care is an important part of how rural nurses safeguard the patients who receive care in small rural hospitals. This study utilized institutional ethnography as an approach for describing rural nursing work and for exploring how nurses' work experiences are socially organized. Rural nurses advocated for safe healthcare environments by ensuring that skilled nurses were available for every shift, day and night, at their local hospital. Rural nurses noted that this work was particularly difficult for the provision of maternity care. This article explores two threads or cues to institutional organization that were identified in our interviews and observations; namely staffing and safety standards, and the need for flexibility in staffing in small rural hospitals. Rural nurses' concerns about ensuring that skilled nurses are available in small rural hospitals do not enter into current management discourses that focus on efficiency and cost savings or find a home within current discourses of patient safety 'competencies'.

Practice-based evidence includes research that is grounded in the everyshift experiences of rural nurses. This study utilized institutional ethnography to reembody the work of rural nurses and to explore how nurses' work experiences are socially organized. Registered nurses who work in small acute care hospitals were observed and interviewed about their work with the focus on their experiences of providing maternity care. The safeguarding work of rural nurses included anticipating problems and emergencies and being prepared; careful watching, surveillance, and vigilance; negotiating safety; being able to act in emergency situations; and mobilizing emergency transport systems. Increased attention to inquiry about safeguarding as an embodied nursing practice and the textual organization of the work of rural nurses is warranted.

Resume Objectif Offrir des conseils factuels aux femmes et a leurs fournisseurs de soins de sante quant a la prise en charge de l'oubli ou de la prise differee d'une ou de plusieurs doses de contraceptif hormonal, afin de prevenir les grossesses non souhaitees. Resultats Des recherches ont ete menees dans Medline, PubMed et la base de donnees Cochrane afin d'en tirer les articles, publies en anglais entre 1974 et 2007, qui portaient sur les modes de contraception hormonale disponibles au Canada et pouvant faire l'objet d'un oubli ou d'une prise differee. Les publications et les declarations de principe pertinentes issues d'organisations de planification familiale et de sante genesique competentes ont egalement ete analysees. La qualite des resultats est evaluee au moyen des criteres elabores par le Groupe d'etude canadien sur les soins de sante preventifs. Avantages, desavantages et couts La presente opinion de comite aidera les fournisseurs de soins de sante a offrir des renseignements clairs aux femmes n'ayant pas fait preuve d'observance quant au mode de contraception hormonale qu'elles utilisent, dans le but de prevenir les grossesses non souhaitees. Commanditaire : La Societe des obstetriciens et gynecologues du Canada. Declarations sommaires 1.Les consignes destinees aux femmes qui oublient de prendre une ou plusieurs doses de contraceptif hormonal se sont jusqu'ici averees complexes et ces femmes ne les comprennent pas correctement. (I) 2.Le risque d'ovulation le plus eleve se manifeste lorsque l'intervalle sans hormones se prolonge au-dela de sept jours, que cette prolongation soit attribuable au report de l'utilisation d'un nouvel emballage de contraceptifs hormonaux combines ou a l'oubli de doses d'hormones actives au cours de la premiere ou de la troisieme semaine du cycle d'utilisation de contraceptifs hormonaux combines. (II) Une ovulation survient rarement apres sept jours consecutifs d'utilisation de contraceptifs hormonaux combines. (II) Recommandations 1.Les fournisseurs de soins de sante devraient, dans le cadre du counseling sur la contraception, offrir des consignes claires et simples, tant de vive voix que sous forme ecrite, quant a la prise en charge de l'oubli de doses de contraceptif hormonal. (III-A) 2.Les fournisseurs de soins de sante devraient offrir aux femmes des ressources telephoniques / electroniques auxquelles elles peuvent se referer a la suite de l'oubli ou de la prise differee de doses de contraceptif hormonal. (III-A) 3.Afin d'eviter une hausse du risque de grossesse non souhaitee chez les utilisatrices de contraceptifs hormonaux combines, l'intervalle sans hormones ne devrait pas etre prolonge au-dela de sept jours. (II-A) 4.Une contraception d'appoint devrait etre mise en oeuvre a la suite de l'oubli d'une dose au cours de la premiere semaine du cycle de contraception hormonale, et ce, jusqu'a ce que sept jours consecutifs d'utilisation correcte du contraceptif hormonal en question se soient ecoules. Lorsque l'oubli de doses de contraceptif hormonal combine survient au cours de la deuxieme ou de la troisieme semaine du cycle de contraception hormonale, l'intervalle sans hormones devrait etre elimine en ce qui concerne le cycle en question. (III-A) 5.La mise en oeuvre d'une contraception d'urgence et d'une contraception d'appoint peut s'averer requise dans certains cas d'oubli de doses de contraceptif hormonal, particulierement lorsque l'intervalle sans hormones s'est prolonge au-dela de sept jours. (III-A) 6.Une contraception d'appoint devrait etre mise en oeuvre a la suite de l'oubli de trois doses / jours consecutifs de contraceptif hormonal combine ou plus au cours de la deuxieme et de la troisieme semaine du cycle de contraception, et ce, jusqu'a ce que sept jours consecutifs d'utilisation correcte du contraceptif hormonal en question se soient ecoules. Pour des raisons pratiques, l'intervalle sans hormones prevu devrait etre elimine dans de telles circonstances. (II-A) 7.La mise en oeuvre d'une contraception d'urgence est rarement indiquee a la suite de l'oubli de doses de contraceptif hormonal combine au cours de la deuxieme ou de la troisieme semaine du cycle, a moins que l'on ait affaire a des omissions repetees ou qu'aucune contraception d'appoint n'ait ete mise en oeuvre a la suite des oublis en question. En presence d'omissions repetees, la mise en oeuvre d'une contraception d'urgence peut s'averer requise et une contraception d'appoint devrait etre utilisee. Dans de telles circonstances, les professionnels de la sante devraient conseiller les femmes quant a l'adoption d'un mode de contraception moins exigeant sur le plan de l'observance. (III-A)

The overall aim of this systematic review is to identify the appropriateness and meaningfulness of maternal-child simulation-based learning for undergraduate or pre-registration nursing students in educational settings to inform curriculum decision-making.1. What are the experiences of nursing or health professional students participating in undergraduate or pre-licensure maternal-child simulation-based learning in educational settings?2. What are the experiences of educators participating in undergraduate or pre-licensure maternal-child simulation-based learning in educational settings?3. What teaching and learning practices in maternal-child simulation-based learning are considered appropriate and meaningful by students and educators?Maternal-child care is one of the pillars of primary health care. Health promotion and illness/ injury prevention begin in the preconception period and continue through pregnancy, birth, the postpartum period and the childrearing years. Thus, lifelong wellness is promoted across the continuum of perinatal and pediatric care which influences family health and early child development. Registered nurses (RNs) are expected to have the knowledge and skills needed to provide evidence-based nursing with childbearing and child-rearing families to promote health and address health inequities in many settings, including inner city, rural, northern, indigenous and global communities. The Canadian Maternity Experiences survey and the Report by the Advisor on Healthy Children and Youth provide information on current shortages of perinatal and child health care providers and stress the importance of the role of nurses as providers of rural and remote care. From a global health perspective, continued concern with both perinatal and child health morbidities and mortalities highlight the importance of maintaining and strengthening the presence of maternal and child health learning opportunities within undergraduate nursing curriculum.Despite this importance, educators in many countries have acknowledged difficulties providing nursing students with maternal-child hospital learning experiencesdue to declining birth rates, women's changing expectations about childbirth (i.e. birth as an intimate experience), increased outpatient and community management of early childhood health conditions, and increased competition for clinical placements. Canadian nurse educators and practice leaders have also identified gaps in recent RN graduates' readiness to provide safe, competent and evidence-based care for childbearing and child-rearing families. Newly graduated RNs working in acute care hospitals and in rural/remote community practice settings report feeling unprepared for providing maternity, neonatal and early childhood care.Recent concerns about the clinical reasoning skills of new graduates and the link to poor patient outcomes (e.g. not recognizing deteriorating patients) have led to calls to reform nursing education. In the Carnegie report, Benner, Sutphen, Leonard and Day identified four essential themes needed in the thinking and approach to nursing education, including: (1) a shift in focus from covering decontextualized knowledge to "teaching for a sense of salience, situated cognition, and identifying action in particular clinical situations"; (2) better integration of classroom and clinical teaching; (3) more emphasis on clinical reasoning; and, (4) an emphasis on identity formation rather than socialization. Brown and Hartrick Doane propose that nurses need to draw on a range of knowledge that enhances the nurse's "sensitivity and ability to be responsive in particular moments of practice". Theoretical or decontextualized knowledge becomes a "pragmatic tool" used to improve nursing practice. Simulation has been identified as a promising pragmatic educational tool for practice learning that can be integrated with theoretical knowledge from nursing and other disciplines.Bland, Topping and Wood conducted a concept analysis and defined simulation in nursing education as:They also proposed that "simulated learning is a dynamic concept that deserves empirical evaluation not merely to determine its effects but to uncover its full potential as a learning strategy".Simulation usually involves student(s) providing nursing care to a simulated patient who might be a manikin or actor based on a standardized scenario. Following the experiential learning opportunity the scenario is debriefed and the clinical situation analyzed with opportunities for reflection on performance. In nursing education, simulation is usually used in a way that complements learning in practice settings. However simulation has also been used: to make up some clinical practice hours, to provide opportunities to practice and assess particular clinical skills, and for remedial learning when students encounter difficulties in practice settings. In addition simulation provides the opportunity to focus on quality and safety competencies (QSEN) that have been identified for nurses. New forms of simulation are being developed with multiple patients so that nursing students can learn to prioritize care needs and delegate care to other team members.Nurse educators have identified several advantages for learners using simulation, including: providing a safe environment to improve nursing competence, allowing learners to become more comfortable with receiving feedback about their clinical performance, providing consistent and comparable experiences for all students, and learning a mix of technical and non-technical skills including communication, teamwork and delegation. Within the Canadian context, students and instructors have reported positive learning experiences with simulation, particularly in understanding complex patient care scenarios, multidisciplinary team scenarios, team-based learning, and reflective debriefing. Furthermore, simulation technology has been proposed as a strategy for developing clinical reasoning skills, enhancing nurses' abilities to build upon previous knowledge and past experiences, and manage new or unfamiliar situations.Simulation has previously been integrated into nursing curricula in a "piecemeal" fashion that lacks an integrative pedagogy or theoretical approach. More recently a number of theoretical and pedagogical frameworks and best practice standards have been published. In April 2014 a preliminary search of literature (in CINAHL, Medline, Academic Search Complete and Web of Science) was conducted with guidance from our library specialist to test the search strategy and ensure that there would be enough qualitative findings to include in the systematic review. A preliminary scan of the abstracts from these searches demonstrated that many experiential case reports with qualitative findings were missed with the use of research limiters (including our search strategy specifically constructed to retrieve qualitative research) so the decision was made to err on the side of caution by searching more broadly and review a larger number of abstracts for inclusion in the study. However, a number of reports with qualitative findings were identified. For example, from a review of the abstracts from a CINAHL search dated April 17, qualitative research papers (including two dissertations), 12 evaluation study reports, six mixed methods studies and nine case reports with qualitative findings were identified. It is timely then to review qualitative studies to better understand the meaningfulness and appropriateness of integrating maternal-child simulation-based learning activities in undergraduate nursing education programs.A search of both the Cochrane Library of Systematic Reviews and the Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports has been conducted. No systematic reviews of qualitative studies of maternal-child simulation-based learning for undergraduate or pre-registration nursing students in educational settings are evident in the literature. Although a systematic review of the meaningfulness and appropriateness of using human patient simulation manikins as a teaching and learning strategy in undergraduate nursing education had been planned and a protocol registered in October 2009, we learned from contacting the lead author that this systematic review was not completed. Currently little is known about how nursing students and/or educators have experienced maternal-child simulation or their understandings of the appropriateness and meaningfulness of particular simulation-based learning practices. Our proposed systematic review therefore fulfills all requirements for the PROSPERO database.For this review we will use the definition of "simulation-based learning experience" adopted by the International Nursing Association for Clinical Simulation and Learning (INACSL):We will include any use of simulation in an educational setting (with pre-registration or pre-licensure or undergraduate nursing or health professional students) with a focus relevant for maternal-child nursing.Maternal-child nursing has been variously defined in literature to include maternity care and pediatric nursing. For the purposes of this review, we will include perinatal, neonatal and pediatric contexts of care that focus on families with children under the age of five. We will exclude studies that focus on school age children, adolescents and/or youth.We have adapted an earlier definition of "appropriateness" as the "best conditions under which simulation can be integrated into undergraduate nursing education". In this review "meaningfulness" refers to the experiences and reflections of undergraduate nursing or health professional students and educators as presented in the studies reviewed.

To explore what we have learned about informed advocacy from and with nurses working in rural, remote, and northern communities. Focuses on registered nurses who work in geographically isolated communities in Canada. A synthesis of the work of 2 nurse researchers drawing on critical feminist, postcolonial, and social justice theories. The following 4 types of advocacy are discussed: (1) ensuring that people's concerns are heard, (2) contextualizing practices, (3) safeguarding, and (4) addressing systemic health inequities. An informed advocacy perspective helps registered nurses make an important contribution toward improving the health of people living in rural, remote, and northern communities.

A 3-quarter-hour elective course in compounding is offered to third-year pharmacy students. The objective for this course, which involves a lecture component and extensive laboratory experience, is to strengthen students' proficiency in prescription compounding. Dosage forms compounded include troches, lip-balms, suspensions, gels, ointments, suppositories, ophthalmics, and IV admixtures. Topics discussed target the need for compounding, compounding versus manufacturing, and legal aspects involved. Each student is given an independent formulation project. Students utilize library resources to prepare a written report, order required supplies, and compound the product. Approximately 92% of the students surveyed after taking the course felt more competent in their compounding skills and knowledge after taking this course. Students agreed that a combination of lectures, laboratories, and project helped them gain a better understanding of the subject.

The research literature indicates that problematic substance use as a form of health behaviour is poorly understood, being sometimes viewed as deviance, at other times as a disease, and most often as a combination of these states. The use of substances by women who are pregnant or new parents is often conceptualised within an individualised framework. Yet drinking alcohol and using other drugs during pregnancy and early parenthood cuts across social divisions and is shaped by socio-structural contexts including health care. There is a growing body of literature that critically examines public health interventions that are aimed at implementing harm reduction and health promotion techniques in service delivery to help pregnant and early parenting women who are identified as problem substance users. We examine qualitative data from representatives of a recent harm reduction intervention, focusing, in particular, on providers' individual conceptualisations of the problematic behaviour. Our results show that most study participants regard any substance use during pregnancy, birth and the postpartum period as fundamentally unacceptable. This framing of problematic substance use is accomplished via gendered responsibilisation of women as foetal incubators and primary caregivers of infants. We discuss our results in light of the current literature and suggest policy implications.

Objective To review current knowledge about emergency contraception (EC), including available options, their modes of action, efficacy, safety, and the effective provision of EC within a practice setting. Options The combined estradiol-levonorgestrel (Yuzpe regimen) and the levonorgestrel-only regimen, as well as post-coital use of copper intrauterine devices, are reviewed. Outcomes Efficacy in terms of reduction in risk of pregnancy, safety, and side effects of methods for EC and the effect of the means of access to EC on its appropriate use and the use of consistent contraception. Evidence Studies published in English between January 1998 and March 2010 were retrieved though searches of Medline and the Cochrane Database, using appropriate key words (emergency contraception, post-coital contraception, emergency contraceptive pills, post-coital copper IUD). Clinical guidelines and position papers developed by health or family planning organizations were also reviewed. Values The studies reviewed were classified according to criteria described by the Canadian Task Force on Preventive Health Care, and the recommendations for practice were ranked according to this classification (Table 1). Benefits, Harms, and Costs These guidelines are intended to help reduce unintended pregnancies by increasing awareness and appropriate use of EC. Sponsor The Society of Obstetricians and Gynecologists of Canada.

To review current knowledge about emergency contraception (EC), including available options, their modes of action, efficacy, safety, and the effective provision of EC within a practice setting.The combined estradiol-levonorgestrel (Yuzpe regimen) and the levonorgestrel-only regimen, as well as post-coital use of copper intrauterine devices, are reviewed.Efficacy in terms of reduction in risk of pregnancy, safety, and side effects of methods for EC and the effect of the means of access to EC on its appropriate use and the use of consistent contraception.Studies published in English between January 1998 and March 2010 were retrieved though searches of Medline and the Cochrane Database, using appropriate key words (emergency contraception, post-coital contraception, emergency contraceptive pills, post-coital copper IUD). Clinical guidelines and position papers developed by health or family planning organizations were also reviewed.The studies reviewed were classified according to criteria described by the Canadian Task Force on Preventive Health Care, and the recommendations for practice were ranked according to this classification (Table 1).These guidelines are intended to help reduce unintended pregnancies by increasing awareness and appropriate use of EC.The Society of Obstetricians and Gynaecologists of Canada. Summary Statements 1. Hormonal emergency contraception may be effective if used up to 5 days after unprotected intercourse. (II-2) 2. The earlier hormonal emergency contraception is used, the more effective it is. (II-2) 3. A copper IUD can be effective emergency contraception if used within 7 days after intercourse. (II-2) 4. Levonorgestrel emergency contraception regimens are more effective and cause fewer side effects than the Yuzpe regimen. (I) 5. Levonorgestrel emergency contraception single dose (1.5 mg) and the 2-dose levonorgestrel regimen (0.75 mg 12 hours apart) have similar efficacy with no difference in side effects. (I) 6. Of the hormonal emergency contraception regimens available in Canada, levonorgestrel-only is the drug of choice. (I) 7. A pregnancy that results from failure of emergency contraception need not be terminated (I) Recommendations 1. Emergency contraception should be used as soon as possible after unprotected sexual intercourse. (II-2A) 2. Emergency contraception should be offered to women if unprotected intercourse has occurred within the time it is known to be effective (5 days for hormonal methods and up to 7 days for a copper IUD). (II-2B) 3. Women should be evaluated for pregnancy if menses have not begun within 21 days following emergency contraception treatment. (III-A) 4. During physician visits for periodic health examinations or reproductive health concerns, any woman in the reproductive age group who has not been sterilized may be counselled about emergency contraception in advance with detailed information about how and when to use it. (III-C).

This article revisits and reaffirms Patricia Steven's earlier work on access to healthcare as an important arena for nursing action. Many of the conditions that affect access to healthcare, such as racism and oppression, also shape inequities in health outcomes. We propose a conceptualization of social justice that is consistent with addressing the conditions that influence health inequities. We also discuss the implications of a critical and feminist conception of social justice for nursing action, education, practice, research, and policy.

To provide evidence-based guidance for women and their health care providers on the management of missed or delayed hormonal contraceptive doses in order to prevent unintended pregnancy.Medline, PubMed, and the Cochrane Database were searched for articles published in English, from 1974 to 2007, about hormonal contraceptive methods that are available in Canada and that may be missed or delayed. Relevant publications and position papers from appropriate reproductive health and family planning organizations were also reviewed. The quality of evidence is rated using the criteria developed by the Canadian Task Force on Preventive Health Care.This committee opinion will help health care providers offer clear information to women who have not been adherent in using hormonal contraception with the purpose of preventing unintended pregnancy.The Society of Obstetricians and Gynaecologists of Canada. SUMMARY STATEMENTS: 1. Instructions for what women should do when they miss hormonal contraception have been complex and women do not understand them correctly. (I) 2. The highest risk of ovulation occurs when the hormone-free interval is prolonged for more than seven days, either by delaying the start of combined hormonal contraceptives or by missing active hormone doses during the first or third weeks of combined oral contraceptives. (II) Ovulation rarely occurs after seven consecutive days of combined oral contraceptive use. (II) RECOMMENDATIONS: 1. Health care providers should give clear, simple instructions, both written and oral, on missed hormonal contraceptive pills as part of contraceptive counselling. (III-A) 2. Health care providers should provide women with telephone/electronic resources for reference in the event of missed or delayed hormonal contraceptives. (III-A) 3. In order to avoid an increased risk of unintended pregnancy, the hormone-free interval should not exceed seven days in combined hormonal contraceptive users. (II-A) 4. Back-up contraception should be used after one missed dose in the first week of hormones until seven consecutive days of correct hormone use are established. In the case of missed combined hormonal contraceptives in the second or third week of hormones, the hormone-free interval should be eliminated for that cycle. (III-A) 5. Emergency contraception and back-up contraception may be required in some instances of missed hormonal contraceptives, in particular when the hormone-free interval has been extended for more than seven days. (III-A) 6. Back-up contraception should be used when three or more consecutive doses/days of combined hormonal contraceptives are missed in the second and third week until seven consecutive days of correct hormone use are established. For practical reasons, the scheduled hormone-free interval should be eliminated in these cases. (II-A) 7. Emergency contraception is rarely indicated for missed combined hormonal contraceptives in the second or third week of the cycle unless there are repeated omissions or failure to institute back-up contraception after the missed doses. In cases of repeated omissions of combined hormonal contraceptives, emergency contraception may be required, and back-up contraception should be used. Health care professionals should counsel women in these situations on alternative methods of contraception that do not demand such stringent compliance. (III-A).

Objective To explore the social organization of women’s preterm labor experiences. Design Institutional ethnography investigated how the woman’s experience is socially organized and for patterns of how something is organized to recur. Participants/Setting Eight women who experienced preterm labor while living in one city in Western Canada volunteered to participate. Data Analysis Institutional ethnographic methodology guided the analysis of audiotaped transcribed interviews to understand the work these women do and the complexities of their everyday lives. Results Women spoke about their fear of going home and feeling alone with the responsibility for their work of “keeping the baby in.” Overall, preterm labor was experienced as a profound sense of personal responsibility for preventing preterm birth and was practiced as being “careful.” Conclusions The assumption that the family is privately responsible for care work in the home results in the lack of assessment of resources for managing the medical plan on discharge and the lack of resources available or offered to assist families. The work of keeping the baby in conflicts with family care work responsibilities and can cause significant hardships for some women and families. JOGNN, 35 , 700‐708; 2006. DOI: 10.1111/J.1552‐6909.2006.00097.x

Objective: The purpose of this exploratory study was to develop new understandings of what it means to women in labor for a nurse to be present during childbirth. Design: Hermeneutic inquiry was used to explore the phenomenon of nursing presence during childbirth. The purpose of questioning in hermeneutic phenomenology is to stimulate thoughtful reflection and deeper exploration of the subject's experiences. Participants/Setting: Six women from an urban center in Canada volunteered to share their experiences of childbirth through conversations with the research team. Data Analysis: Audio-taped, transcribed interviews were analyzed along with the reflections of the research team. Results: Women attribute multiple meanings to the care provided by intrapartum nurses. However, what stood out in these women's accounts was that a nurse's presence was the way in which a nurse was "there" for them and was a very important part of their childbirth experience. Conclusions: Women's experiences of a nurse's presence cannot be understood apart from the institutional structures and work processes that shape their experiences. Further research is needed to explicate how hospital procedures, administrative structures, and medical practices enable or constrain the presence of the intrapartum nurse.

Background and purpose Evidence on which to base decisions about the management of radiation skin reactions is lacking. The purpose of this study was to investigate whether sucralfate or aqueous cream reduced acute skin toxicity during radiotherapy to the head and neck, breast or anorectal area (phase A), and to evaluate the effect of hydrogels and dry dressings on moist desquamation (phase B). This paper presents the results of phase A. Patients and methods Three hundred and fifty seven patients were randomised to apply aqueous cream, sucralfate cream or no cream to the irradiated area from day one of radical radiotherapy treatment. All patients were instructed to wash using unperfumed soap. Acute skin toxicity was measured using a modified radiation therapy oncology group (RTOG) score, reflectance spectrophotometry, patient diary card and dermatology life quality index (DLQI). A cost minimisation approach was used to compare the costs of each skin care approach. Results No consistent differences were found in the severity of skin reactions or levels of discomfort suffered by patients in each of the randomised groups. Patients with a higher body mass index, who smoked, received concomitant chemotherapy, boost or bolus during treatment were more likely to develop skin reactions. Conclusions There is no evidence to support the prophylactic application of either of the creams tested for the prevention of radiation skin reactions. Our results show that it is possible to predict which patients are at greatest risk of skin reactions. We suggest that known risk factors should be incorporated into future study protocols.

Eighteen musicians and nine nonmusicians judged the direction of tritone intervals between pairs of octave‐complex (Shepard) tones. The tones in each pair had the same spectral envelope centered on either C or F♯ in one of three octaves. Nine of the musicians sang the intervals on one‐half of the trial blocks instead of making the usual up/down judgments. Monte Carlo analysis revealed that 83% of the musicians and 33% of the nonmusicians showed a significant direction bias for regions of the chroma circle. This corroborates the notion of a chroma‐circle template of definite orientation [Deutsch et al., Mus. Perc. 5 (1987)], but suggests that musical training may play a greater role in either its establishment or access. Biases in upward judgments were toward the C‐chroma region, consistent with Deutsch’s [J. Acoust. Soc. Am. Suppl. 1 88, S139 (1990)] findings for native Californians as opposed to British. With the exception of one musician, envelope peak position had little effect on the results. In general, the two response modes, singing and up/down judgments, produced converging evidence.