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

Background: Improving equity and early access to palliative care for underserved populations in Canada is a priority. Little is known regarding access to palliative and end-of-life care in the Black population. Methods: We undertook a scoping review using the framework by Arksey and O'Malley to identify knowledge, access gaps, and experiences of palliative and end-of-life care among Blacks living with life-limiting illnesses in Canada. Primary studies, discussion papers, books, and reports were considered eligible. We followed a comprehensive search strategy developed by an information scientist. Searches were performed in the following bibliographic databases: Medline, EMBASE, PsycINFO via OVID, CINAHL via EBSCOhost, Scopus and Cochrane Library via Wiley. The search strategy was derived from three main concepts: (1) Black people; (2) Canada and Canadian provinces; (3) Palliative, hospice, or end-of-life care. No publication date or language limits were applied. Titles and abstracts were screened for eligibility by one reviewer and full text by two independent reviewers. Results: The search yielded 233 articles. Nineteen articles were selected for full-text review, and 7 articles met the inclusion criteria. These studies were published between 2010 and 2021, and conducted in the provinces of Ontario and Nova Scotia only. Studies used both quantitative and qualitative methods and included cancer decedents, next of kin, family caregivers and religious leaders. Sample sizes in various studies ranged from 6 − 2,606 participants. Included studies reported a general lack of understanding about palliative and end-of-life care, positive and negative experiences, and limited access to palliative and end-of-life care for Blacks, across all care settings. Conclusion: Findings suggest limited knowledge of palliative care and inequities in access to palliative and end-of-life care for Blacks living with life-limiting illnesses in 2 Canadian provinces. There is an urgent need for research to inform tailored and culturally acceptable strategies to improve understanding and access to palliative care and end-of-life care among Blacks in Canada. [ABSTRACT FROM AUTHOR]

Background Tobacco and non-tobacco-based waterpipe smoking has increased exponentially in many countries in recent decades, particularly among youth and young adults. Although tobacco smoking is banned in many indoor public places, waterpipe smoking, ostensibly non-tobacco, continues in Ontario and other jurisdictions where only tobacco smoking is prohibited. This study assessed air quality and exposure in waterpipe cafes using multiple methods and markers. Methods Indoor (n=12) and outdoor (n=5) air quality was assessed in Toronto, Canada waterpipe cafes from 30 August to 11 October 2012. Real-time measurements of air nicotine, fine particulate matter less than 2.5 microns in diameter (PM2.5) and ambient carbon monoxide (CO) were collected in 2 h sessions. Levels of CO in breath were collected in non-smoking field staff before entering and upon leaving venues. Observations of occupant behaviour, environmental changes and venue characteristics were also recorded. Results In indoor venues, mean values were 1419 mg/m3 for PM2.5, 17.7 ppm for ambient CO, and 3.3 mg/m3 for air nicotine. Levels increased with increasing number of active waterpipes. On outdoor patios, mean values were 80.5 mg/m3 for PM2.5, 0.5 ppm for ambient CO, and 0.6 mg/m3 for air nicotine. Air quality levels in indoor waterpipe cafes are hazardous for human health. Outdoor waterpipe cafes showed less harmful particulate levels than indoors, but mean PM2.5 levels (80.5 mg/m3) were still ‘poor'. Conclusions Staff and patrons of waterpipe cafes are exposed to air quality levels considered hazardous to human health. Results support eliminating waterpipe smoking in hospitality venues indoors and out. [ABSTRACT FROM AUTHOR]

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

This paper addresses an immediate gap in knowledge about community reintegration of previously incarcerated older adults. It presents an exploratory case study of a community residential facility program in Ontario, Canada, focusing on the experiences and perspectives of older residents, staff members, and community stakeholders on the community reintegration of previously incarcerated older men. Findings provide insights into the aging-related reintegration issues such as the older men's ability to access health and medical services upon community reentry, the challenges and opportunities of the continuum of support (or lack thereof) to help ease the reintegration process, and stigma and other barriers the older men face as they attempt to access long-term care upon release from correctional institutions. Emergent questions for research, policy, and practice are highlighted and discussed to set an agenda for expanding the thread of inquiry into the community reintegration of previously incarcerated older adults. Future research calls for further investigation into the diversity of experiences (e.g., gender, race/ethnicity, geographical locale) to advance the field of study as it relates to aging and social policy. [ABSTRACT FROM AUTHOR]

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

Background: In Canada, Ontario midwives provide care to sexual and gender minority (SGM) people. Published literature shows how midwives' attitudes shape the experiences of lesbians, but research examining midwives' attitudes toward SGM people is lacking. Our study measured the attitudes of Ontario midwives toward SGM clients, hypothesizing that attitudes would be positive overall and that there would be no difference in attitudes across practice settings. Methods: Paper surveys (n = 926) with an option to respond online were sent to Ontario midwifery practices. We measured midwives' attitudes toward sexual minorities (11 questions, scores ranged from 11 to 55) and gender minorities (9 questions, scores ranged from 9 to 45), with higher scores indicating more positive attitudes. Overall and subgroup analyses were performed. Results: The 268 completed surveys indicated that midwives' attitudes were positive toward both sexual (mean score 49.2, maximum possible score of 55, ie, 89.4%) and gender minorities (mean score 38.9, maximum possible score of 45, ie, 86.4%). Analyses showed that attitudes toward SGM were associated with midwives' sexual identity and route of entry into the profession (ie, university‐based vs bridging programs), but not practice setting. Conclusions: Although attitudes of this subset of midwives toward SGM clients were positive, volunteer bias could account for this finding since 32.6% of respondents identified as sexual minorities. Since the attitudes of midwives who entered the profession through the university‐based education program were significantly more positive than those who entered through international bridging programs, future research should examine how SGM‐related content is integrated into midwifery education and training curricula. [ABSTRACT FROM AUTHOR]

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

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

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

Tenant experience surveys are a key tool for social housing landlords to gauge their success in providing high quality housing. This paper examines feedback from a tenant experience survey facilitated in a low-income housing seniors' housing community to: (1) examine their perceptions of their housing across key domains related to tenant satisfaction; and (2) identify opportunities they felt would improve their housing experience. A total of 1,114 households completed the survey. Results showed that tenants generally had high satisfaction with property management, safety and security, communication with staff, access to services, community support, and tenancy management. However, open-ended comments from tenants highlighted specific situations that negatively impacted their housing, including maintenance issues, safety concerns, and limited access to health and social programs. Findings point to several suggestions for social housing providers to enhance their services to foster inclusive, supportive, and safe housing environments for low-income older adults. [ABSTRACT FROM AUTHOR]

We developed and implemented a person-centered navigation model integrated in primary care where patients were referred to the Access to Resources in the Community (ARC) study by their primary care provider (PCP). The purpose of this paper is to explore the lay navigators' learning experience as reflected in their journals and present implications for education and health promotion practice. Sixty-six journal entries from two navigators were analysed. To code the data, we used a newly developed framework based upon the theory-informed lay navigator training programme. Five unique themes were identified: 1) Gaining and Building Trust, 2) Developing Empathy, 3) Experiencing Hope and Optimism, 4) Feeling Helplessness and 5) Celebrating Gains and Successes. The five themes identified paint a sequential picture of the journey of leading individuals from primary care to health and social community resources. This innovative approach has expanded our understanding of how navigators learn in practice, more specifically how they learn from patients and how they develop knowledge and skills in person-centered care. Incorporating reflective journaling as a regular practice provides situational awareness and leads to enhanced learning. Practising person-centered care also develops when a trusting and empathetic relationship is established. [ABSTRACT FROM AUTHOR]

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

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

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

Aim: This study aims to present a general bibliometric overview of the development status of global nursing research from 2000 to 2019. Design: A longitudinal bibliometric analysis of nursing research was conducted. Methods: Nursing research publications (N = 88,665) were obtained from Web of Science. Bibliometric method was used to map the output and citation impact trends of countries/regions, institutions, disciplines, and journals and analyse the research collaboration among countries/regions and institutions. Results: The global paper output in nursing research increased steadily over the past two decades and it varied in different countries/regions with the USA being far ahead of the others. The paper output and cross‐border collaboration are mainly distributed in several developed countries like the USA, the UK, Australia, and Canada. The University of Pennsylvania, Harvard University, University of Toronto, and University of North Carolina at Chapel Hill have high academic influence in the field of nursing. Increasing attention from academic fields has been paid to research on nursing. Journal of Advanced Nursing is the most prolific and most cited journal in nursing field. Conclusion: Nursing research has developed steadily over the last two decades. Both the scientific output and research collaboration are disproportionally distributed between high‐income countries/regions and low‐ and middle‐income countries/regions. Most research and collaboration have taken place in a few developed countries across North America, Europe, and Oceania. Impact: The study highlighted the need for policy makers and funding agencies, especially those from low‐ and middle‐income countries/regions, to allocate research funding that supports the nursing higher education and international cooperation so as to promote the development of high‐quality nursing research in those countries/regions. At the same time, researchers from non‐English‐speaking countries/regions should attach more importance to publishing papers in English, strengthening the academic exchanges with international nursing colleagues and better integrating into the international academic community. [ABSTRACT FROM AUTHOR]

This study assessed the presence, amount, and sensitivity of personally identifiable information and personal health information found in hospital recycling bins in Toronto, Ontario, Canada. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to understand child welfare investigations that involve child custody disputes in Ontario, Canada. Methods: The study used data from the Ontario Incidence Study of Reported Child Abuse and Neglect. The OIS is a cyclical, cross sectional provincial child welfare study conducted every five years. Characteristics of investigations involving child custody disputes were examined by conducting chi-square tests on key variables, and a logistic regression was performed to examine the influence of child custody disputes on transfers to ongoing services. Findings: In 2013 approximately 12% of child welfare investigations involved a child custody dispute. These investigations were predominantly referred by a custodial parent, and the primary maltreatment concern was exposure to emotional violence. Investigations involving custody disputes when controlling for all other predictors of maltreatment, were less likely to be transferred to ongoing child welfare services. Implications: There is a complicated relationship between child custody disputes and investigations involving intimate partner violence. Policy and practice implications are discussed. [ABSTRACT FROM AUTHOR]

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

Volunteers and voluntary organizations can connect preventative health care programs to communities and may play an important role in addressing the health needs of older adults. Despite this, tensions may exist in the structures that drive volunteers and voluntary organizations representing immigrant communities to provide unpaid labour to augment and supplement health care services. Furthermore, organizational challenges may exist for community agencies relying on volunteers to sustain a health screening and education program. The intervention program was led by one voluntary agency specifically for South Asian communities in partnership with the university and five local organizations. This paper draws on volunteer surveys (n = 22) and key informant interviews (n = 12) to detail volunteer experiences providing this intervention. Volunteers were university students and other community volunteers. A total of 810 adults participated in the intervention within the Greater Toronto Area, Ontario, Canada between October 2014 and June 2016. We found that volunteers often used their experience as a 'stepping stone' position to other education or work. They also gained from the knowledge and used it to educate themselves and their family members and friends. This paper provides a critical reflection on the role of volunteers in a preventative and educational healthcare intervention program for older adults from the South Asian community. Tensions exist when relying on volunteer labour for the implementation of preventative community health care programming and must be explored to ensure program sustainability as well as equity within the health care system. [ABSTRACT FROM AUTHOR]

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

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

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

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

Understanding how informal care impacts formal care utilisation for home‐based end‐of‐life patients is an important policy‐ and practice‐relevant question. This paper aims to assess the relationship between informal and formal home care among home‐based end‐of‐life patients and how this relationship has changed over the last decade and over the end‐of‐life trajectory. We focus on informal care provided by family members or friends, and three types of home‐based formal care services: care by personal support workers, physician visits, and nurse visits. Using survey data collected in a home‐based end‐of‐life care programme in Ontario, Canada from 2005 to 2016, we build a two‐part utilisation model analysing both the propensity to use each type of formal care and the amount of formal care received by patients. The results suggest that informal care is a substitute for care by personal support workers, but a complement to physician visits and nurse visits. In the case of nurse visits, an increased complementary effect is observed in more recent years. For home‐based physician and nurse visits, the complementary effect grows with patient's proximity to death. These results highlight the complexity of the relationship between informal and formal care among home‐based end‐of‐life patients. Decision‐makers need to take into account the relationship between informal care and different types of formal services when introducing future policies. [ABSTRACT FROM AUTHOR]

The concept of social capital shows great promise for its potential to influence individual and population health. Yet challenges persist in defining and measuring social capital, and little is known about the mechanisms that link social capital and health. This paper reports on the quantitative phase of a sequential explanatory mixed methods study using data from Canada's 2013 General Social Survey (data collected 2013–14). An exploratory factor analysis revealed six underlying dimensions of social capital for 7,187 adults living in Ontario, Canada. These factors included trust in people, neighbourhood social capital, trust in institutions, sense of belonging, civic engagement, and social network size. A logistic regression indicated that having high Trust in People and Trust in Institutions were associated with better mental health while high Trust in Institutions, Sense of Belonging, and Civic Engagement were associated with better physical health. When comparing rural and urban residents, there were no differences in their self‐reported health, nor did social capital influence their health any differently, despite rural residents having higher social capital scores. The study findings are important for understanding the nature of social capital and how it influences health, and provide direction for targeted health promotion strategies. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether technology-assisted toilets (TATs) could be used to improve toileting hygiene and independence for geriatric rehabilitation patients. TATs are commercially available toilet seats that use a stream of warm water to clean the user, have a fan for drying and are operated by a remote control. Materials and methods: Twenty-five geriatric rehabilitation in-patients were recruited, six completed the study, and seven partially completed the study. Each participant had two trial bowel movements. One trial involved cleaning themselves with toilet paper; the other involved cleaning themselves with the TAT functions. After each trial, participants received a visual inspection for cleanliness and answered the Psychosocial Impact of Assistive Devices Scale (PIADS), a validated scale, to assess their sense of competence, adaptability and self-esteem in the bathroom. A toileting cleanliness scale, designed for this study, was completed by a nurse after TAT usage. Participants received a score from 1 (completely clean) to 4 (completely soiled) based on a visual inspection after cleaning. Results: TAT and toileting cleanliness scores were similar. PIADS scores showed a trend towards higher scores when using the TAT, but results were not statistically significant. Conclusions: TATs cleaned as well as standard toileting in geriatric rehabilitation inpatients. Participants indicated that TATs improved their sense of competence, adaptability and self-esteem. Geriatricians and rehabilitation professionals should consider prescribing TATs in their practice as an assistive device in order to promote patient independence and dignity and reduce the burden of care for patients requiring toileting assistance. Implications for rehabilitation: Technology-assisted toilets (TATs) are commercially-available toilet seats that could be used to allow rehabilitation patients to clean themselves more independently in the bathroom. Improved toileting independence can reduce burden of care of geriatric rehabilitation and reduce the impact of toileting assistance on patient dignity and self-esteem. Physiatrists should consider recommending TATs to their patients but should take into account whether a patient’s particular set of disabilities will allow them to use a TAT effectively. [ABSTRACT FROM AUTHOR]

The relationships among sedentary time, television viewing time, and dietary patterns in children are not fully understood. The aim of this paper was to determine which of self-reported television viewing time or objectively measured sedentary time is a better correlate of the frequency of consumption of healthy and unhealthy foods. A cross-sectional study was conducted of 9- to 11-year-old children ( n = 523; 57.1% female) from Ottawa, Ontario, Canada. Accelerometers were used to determine total sedentary time, and questionnaires were used to determine the number of hours of television watching and the frequency of consumption of foods per week. Television viewing was negatively associated with the frequency of consumption of fruits, vegetables, and green vegetables, and positively associated with the frequency of consumption of sweets, soft drinks, diet soft drinks, pastries, potato chips, French fries, fruit juices, ice cream, fried foods, and fast food. Except for diet soft drinks and fruit juices, these associations were independent of covariates, including sedentary time. Total sedentary time was negatively associated with the frequency of consumption of sports drinks, independent of covariates, including television viewing. In combined sedentary time and television viewing analyses, children watching >2 h of television per day consumed several unhealthy food items more frequently than did children watching ≤2 h of television, regardless of sedentary time. In conclusion, this paper provides evidence to suggest that television viewing time is more strongly associated with unhealthy dietary patterns than is total sedentary time. Future research should focus on reducing television viewing time, as a means of improving dietary patterns and potentially reducing childhood obesity. [ABSTRACT FROM AUTHOR]

This paper reports on the cross validation of the Gambling Problem Severity Subscale of the Canadian Adolescent Gambling Index (CAGI/GPSS). The CAGI/GPSS was included in a large school based drug use and health survey conducted in 2015. Data from students in grades 9-12 (ages 13-20 years) derived from the (N = 3369 students). The CAGI/GPSS produced an alpha of 0.789. A principle component analysis revealed two eigenvalues greater than one. An oblique rotation revealed these components to represent consequences and over involvement. The CAGI/GPSS indicated that 1% of the students fell into the "red" category indicating a severe problem and an additional 3.3% scored in the "yellow" category indicating low to moderate problems. The CAGI/GPSS was shown to be significantly correlated with gambling frequency (r = 0.36), largest expenditure (r = 0.37), sex (more likely to be male) (r = -0.19), lower school marks (r = -0.07), hazardous drinking, (r = 0.16), problem video game play (r = 0.16), as well as substance abuse. The CAGI/GPSS was cross validated using a shorted version of the short SOGS, r = 0.48. In addition the CAGI/GPSS and short SOGS produced very similar patterns of correlations results. The results support the validity and reliability of the CAGI/GPSS as a measure of gambling problems among adolescents. [ABSTRACT FROM AUTHOR]

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

Aim: Children with medical complexity require multiple providers and services to keep them well and at home. A care map is a patient/family-created diagram that pictorially maps out this complex web of services. This study explored what care maps mean for families and healthcare providers to inform potential for clinical use.Method: Parents (n=15) created care maps (hand drawn n=10 and computer-generated n=5) and participated in semi-structured interviews about the process of developing care maps and their perceived impact. Healthcare providers (n=30) reviewed the parent-created care maps and participated in semi-structured interviews. Data were analysed for themes and emerging theory using a grounded theory analytical approach.Results: Data analysis revealed 13 overarching themes that were further categorized into three domains: features (characteristics of care maps), functions (what care maps do), and emerging outcomes (benefits of care map use). These domains further informed a definition and a theoretical model of how care maps work.Interpretation: Our findings suggest that care maps may be a way of supporting patient- and family-centred care by graphically identifying and integrating experiences of the family as well as priorities for moving forward.What This Paper Adds: Care maps were endorsed as a useful tool by families and providers. They help healthcare providers better understand parental priorities for care. Parents can create care maps to demonstrate the complex burden of care. They are a unique visual way to incorporate narrative medicine into practice. [ABSTRACT FROM AUTHOR]

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

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

The Raising Sexually Healthy Children (RSHC) program is a peer-to-peer leadership training program for immigrant parents in Toronto, Canada. It was established in 1998 with the goal of promoting family sex education and parent–child communication. This evaluative study examined the developmental processes and outcomes of the RSHC program to identify the strengths, challenges and insights that can be used to improve the program. It employed a multi-case study approach to compare the RSHC programs delivered in the Chinese, Portuguese and Tamil communities. Data collection methods included focus groups, individual interviews and document analysis. The cross-case analysis identified both common and unique capacity building processes and outcomes in the three communities. In this paper, we report factors that have enhanced and hindered sustainable capacity building at the individual, group/organizational and community levels, and the strategies used by these communities to address challenges common to immigrant families. We will discuss the ecological and synergetic, but time-consuming processes of capacity building, which contributed to the sustainability of RSHC as an empowering health promotion program for immigrant communities. We conclude the paper by noting the implications of using a capacity building approach to promote family health in ethno-racial-linguistic minority communities. [ABSTRACT FROM AUTHOR]

The consequences of parallel paper and electronic medical records (EMR) and their impact on informational continuity are examined. An interdisciplinary team conducted a multi-site, ethnographic field study and retrospective documentation review from January 2010 to December 2010. Three case studies from the sample of older patients with hip fractures who were transitioning across care settings were selected for examination. Analysis of data from interviews with care providers in each setting, field observation notes, and reviews of medical records yielded two themes. First, the lack of interoperability between electronic information systems has complicated, not eased providers’ ability to communicate with others. Second, rather than transforming the system, digital records have sustained health care’s ‘culture of documentation’. While some information is more accessible and communications streamlined, parallel paper and electronic systems have added to front line providers’ burden, not lessened it. Implementation of truly interoperable electronic health information systems need to be expedited to improve care continuity for patients with complex health-care needs, such as older patients with hip fractures. [ABSTRACT FROM AUTHOR]

Participation has a subjective and private dimension, and so it is important to hear directly from youth about their experiences in various activity settings, the places where they “do things” and interact with others. To meet this need, our team developed the Self-Reported Experiences of Activity Settings (SEAS) measure, which demonstrated good-to-excellent measurement properties. To address the needs of youth who could benefit from graphic symbol support, the SEAS-PCSTM,1was created. The purpose of this paper is to describe the development of SEAS-PCS and the preliminary study that explores the equivalency of the SEAS and SEAS-PCS. The SEAS and SEAS-PCS were compared in terms of the equivalency of meaning of stimulus items by 11 professionals and five adults who used augmentative and alternative communication, were familiar with PCS, and were fluent readers. Out of 22 items, 68% were rated as highly similar on a 5-point scale (M = 4.14;SD = .70;mdn = 4; range: 2.81–5.00). Subsequently, the 32% of the SEAS-PCS items that were rated below 4 were modified based on the participants’ specific comments. Further work is required to validate the SEAS-PCS. The next step could involve exploring the views of youth who use AAC. [ABSTRACT FROM PUBLISHER]

The purpose of this paper was to describe occupational hazards for nurses working in home care ( HC) and explore how they differ across the rural-to-urban gradient. Responses ( n = 823) from a cross-sectional survey conducted in 2012 of HC nurses registered to practise nursing in the Province of Ontario, Canada were used. Using chi-square analysis and posthoc pairwise tests with a Bonferroni correction, 14 occupational hazards were individually tested for differences between four geographical settings (rural, town, suburban or urban areas). Our study reports that in addition to common occupational hazards that all HC nurses experience, the frequency of experiencing some hazards varies based on geographic setting. These specific hazards include exposure to: aggressive pets, environmental tobacco smoke, oxygen equipment, unsafe neighbourhoods and pests. Findings from this study suggest that a relationship exists between where a patient's home is located and the types of occupational hazards that may be experienced by HC staff. This research is useful for HC organisations in developing staff training programmes to recognise and manage occupational hazards that workers are likely to encounter. Home healthcare and policy leaders may use these findings to develop and implement educational and other strategies to reduce risk and manage exposures across the rural-to-urban gradient. [ABSTRACT FROM AUTHOR]

This article uses an intersectionality lens to explore how experiences of race, gender, sexuality, class and their intersections are associated with depression and unmet need for mental healthcare in a population of 704 women and transgender/gender liminal people from Ontario, Canada. A survey collecting demographic information, information about mental health and use of mental healthcare services, and data for the Everyday Discrimination Scale and the PHQ-9 Questionnaire for Depression was completed by 704 people via Internet or pen-and-paper between June 2011 and June 2012. Bivariate and regression analyses were conducted to assess group differences in depression and discrimination experiences, and predictors of depression and unmet need for mental healthcare services. Analyses revealed that race, gender, class and sexuality all corresponded to significant differences in exposure to discrimination, experiences of depression and unmet needs for mental healthcare. Use of interaction terms to model intersecting identities and exclusion contributed to explained variance in both outcome variables. Everyday discrimination was the strongest predictor of both depression and unmet need for mental healthcare. The results suggest lower income and intersections of race with other marginalised identities are associated with more depression and unmet need for mental healthcare; however, discrimination is the factor that contributes the most to those vulnerabilities. Future research can build on intersectionality theory by foregrounding the role of structural inequities and discrimination in promoting poor mental health and barriers to healthcare. [ABSTRACT FROM AUTHOR]

Background: Many community-based self-management programs have been developed for older adults with type-2 diabetes mellitus (T2DM), bolstered by evidence from randomized controlled trials (RCTs) that T2DM can be prevented and managed through lifestyle modifications. However, the evidence for their effectiveness is contradictory and weakened by reliance on single-group designs and/or small samples. Additionally, older adults with multiple chronic conditions (MCC) are often excluded because of recruiting and retention challenges. This paper presents a protocol for a two-armed, multisite, pragmatic, mixed-methods RCT examining the effectiveness and implementation of the Aging, Community and Health Research Unit-Community Partnership Program (ACHRU-CPP), a new 6-month interprofessional, nurse-led program to promote self-management in older adults (aged 65 years or older) with T2DM and MCC and support their caregivers (including family and friends).Methods/design: The study will enroll 160 participants in two Canadian provinces, Ontario and Alberta. Participants will be randomly assigned to the control (usual care) or program study arm. The program will be delivered by registered nurses (RNs) and registered dietitians (RDs) from participating diabetes education centers (Ontario) or primary care networks (Alberta) and program coordinators from partnering community-based organizations. The 6-month program includes three in-home visits, monthly group sessions, monthly team meetings for providers, and nurse-led care coordination. The primary outcome is the change in physical functioning as measured by the Physical Component Summary (PCS-12) score from the short form-12v2 health survey (SF-12). Secondary client outcomes include changes in mental functioning, depressive symptoms, anxiety, and self-efficacy. Caregiver outcomes include health-related quality of life and depressive symptoms. The study includes a comparison of health care service costs for the intervention and control groups, and a subgroup analysis to determine which clients benefit the most from the program. Descriptive and qualitative data will be collected to examine implementation of the program and effects on interprofessional/team collaboration.Discussion: This study will provide evidence of the effectiveness of a community-based self-management program for a complex target population. By studying both implementation and effectiveness, we hope to improve the uptake of the program within the existing community-based structures, and reduce the research-to-practice gap.Trial Registration: ClinicalTrials.gov, Identifier: NCT02158741 . Registered on 3 June 2014. [ABSTRACT FROM AUTHOR]

Background: The Child and Youth Mental Health (ChYMH) assessment system was developed by interRAI (i.e., an international collective of researchers and clinicians from over thirty countries) in response to the unprecedented need for a coordinated approach to delivery of children's mental health care. Many interRAI instruments are used across Canada and internationally, but the ChYMH represents the first assessment specifically for children and youth. In the present paper, a short overview of the development process of the ChYMH is provided, and then the psychometric properties of several embedded scales on the ChYMH are examined.Methods: Participants included 1297 children and youth and their families who completed the ChYMH after being referred to mental health agencies within Ontario, Canada. In addition, smaller subsets of participants (N = 48-53) completed additional criterion measures, including the Social Skills Improvement System (SSIS), the Child and Adolescent Functional Assessment Scale (CAFAS), the Child Behavior Checklist (CBCL), and the Brief Child and Family Phone Interview (BCFPI).Results: Results demonstrated that the ChYMH subscales had strong internal-consistency (Cronbach's higher than .70), and correlated well with the criterion measures.Conclusions: Findings support the clinical utility of the ChYMH for use among clinically referred children and youth. Implications for children's mental health assessment and practice are discussed. [ABSTRACT FROM AUTHOR]

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

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

Background Person-directed planning ( PDP) is an approach to planning supports that aims to redistribute power from the service system to individuals with intellectual and developmental disabilities ( IDD) and natural supports, improve relationships and build community. To do this, the right people with the right attitudes engaging in the right actions are needed. This paper examines how key elements in PDP contribute to successes in planning. Materials/Methods Researchers worked with three planning teams from different community service agencies using participatory action research techniques (i.e. free list and pile sort, Socratic wheel, whys/hows exercise). Results Most key elements of PDP were relevant to each team. Perceptions of which had most contributed to planning successes differed. Conclusions The various elements of PDP are used by and useful to planning teams, although some may be more relevant to some successes than others because of specific goals, or the person's strengths and needs. [ABSTRACT FROM AUTHOR]

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

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

This paper offers a brief introduction to the Canadian Social Sciences and Humanities Research Council (SSHRC) sponsored research on the role of African, Caribbean, and South Asian traditional healers and their healing practices in Toronto. Ethnic minority groups, especially in the large metropolitan cities in North America, have been accessing and practicing traditional healing since the days of slavery using healing practices such as Animism, Voodoo, Orisha, Santeria and Espiritismo to support their health and wellbeing. However, the healers and their practices have been excluded from mainstream culture, and are forced underground as a result of the hegemony of Western medical models. This paper discusses the background, rationale and the context of the Toronto traditional healers project. The results and analysis of the Caribbean and the South Asian traditional healers are presented in this special issue following this introductory paper. [ABSTRACT FROM AUTHOR]

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

Canadian studies have examined patterns of sexual behaviour and health based on age, gender, and geographical regions, but typically ignored the increasing ethnic diversity in Canada's population. In large part this is because sampling techniques tend to produce insufficient numbers of youth in specific ethnic groups for detailed analysis. This paper presents a profile of the sexual experiences of African, Caribbean, and Black (ACB) youth using data collected in a survey (n = 510) with ACB youth age 16-25 years living in the Windsor/Essex County region of Ontario, Canada. Data were examined for differences among the three ethno-racial groups in combination with differences between Muslims and Christiana, and males and females. In this predominantly heterosexual sample (95%), nearly 3/4 of the Black and Caribbean youth reported sexual intercourse experience compared to well under 1/2 of the African youth. Overall, African were less experienced than Caribbean and Black youth and, within the African group, Muslim less than Christian youth. This included age of initiating various sexual activities, number of partners, use of condoms, and experiences of either non-volitional or non-relational sex. Alcohol in connection with sexual activity and multiple partners within a single month were rare. The Black and Caribbean participants reported sexual experiences and had a sexual profile that was closest to that of Canadian youth. Given the increasingly multicultural profile of Canada, these findings support the importance of research on distinct ethno-racial groups in Canada to inform the delivery of sexual education and health policy and programming. [ABSTRACT FROM AUTHOR]

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

Aims The aims of this paper are to: (1) describe work characteristics that nurse faculty report encourage them to remain in or leave their academic positions; and (2) determine if there are generational differences in work characteristics selected. Background Nurse faculty play key roles in preparing new nurses and graduate nurses. However, educational institutions are challenged to maintain full employment in faculty positions. Design A cross-sectional, descriptive survey design was employed. Methods Ontario nurse faculty were asked to select, from a list, work characteristics that entice them to remain in or leave their faculty positions. Respondent data ( n = 650) were collected using mailed surveys over four months in 2011. Results While preferred work characteristics differed across generations, the most frequently selected incentives enticing nurse faculty to stay were having: a supportive director/dean, reasonable workloads, supportive colleagues, adequate resources, manageable class sizes and work/life balance. The most frequently selected disincentives included: unmanageable workloads, unsupportive organizations, poor work environments, exposure to bullying, belittling and other types of incivility in the workplace and having an unsupportive director/dean. Conclusion This research yields new and important knowledge about work characteristics that nurse faculty report shape their decisions to remain in or leave their current employment. Certain work characteristics were rated as important among all generations. Where similarities exist, broad strategies addressing work characteristics may effectively promote nurse faculty retention. However, where generational differences exist, retention-promoting strategies should target generation-specific preferences. [ABSTRACT FROM AUTHOR]