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Across Canada, the COVID-19 pandemic placed considerable stress on territorial and provincial healthcare systems. For Nunavut, the need to continue to provide access to critical care to its citizens meant that medical travel to provincial points of care (Edmonton, Winnipeg and Ottawa) had to continue through the pandemic. This complexity created challenges related to the need to keep Nunavut residents safe while accessing care, and to manage the risk of outbreaks in Nunavut resultant from patients returning home. A number of strategies were adopted to mitigate risk, including the expansion of virtual care, self-isolation requirements before returning from Winnipeg, and a level of cross-jurisdictional coordination previously unprecedented. Structural limitations in Nunavut however limited opportunities to expand virtual care, and to allow providers from Manitoba to access the Nunavut's electronic medical records of patients requiring follow up. Thus, known and long-standing issues exacerbated vulnerabilities within the Nunavut healthcare system. We conclude that addressing cross-jurisdictional issues would be well served by the development of a more formal Nunavut-Manitoba agreement (with similar agreements with Ontario and Alberta), outlining mutual obligations and accountabilities.

The COVID-19 pandemic has been harmful to survivors of abuse. Less understood is the impact on staff in the violence against women (VAW) service sector. Using interpretive description methodology, we examined staff experiences during the pandemic in Ontario, Canada, and found four core themes: (1) the emotional toll of the work; (2) remote (doesn't) work; (3) work restructuring; (4) efforts to stay well and subthemes nuancing staff experiences in a sector vulnerable to vicarious trauma. This research underscores the need to mitigate experiences of stress, heavy workloads, and guilt for staff in VAW services during crises and provides action-oriented recommendations.

Shelters for abused women function within a broad context that includes intersecting social structures, policies, and resources, which may constrain and limit the options available to abused women and tacitly reinforce the cycle of abuse. This feminist, qualitative study combined in-depth interviews and focus groups conducted with 37 staff and four executive directors from four shelters in Ontario, Canada, along with a critical discourse analysis of salient policy texts. Together, the interviews and critical discourse analysis formed an integrated analysis of the dialectic between policy as written and enacted. The study findings illuminate the complexity of the system and its impact on women, shelters, and the community and highlight how specific types of social policies and various social system subsystems and structures, and system configuration, shape the day to day reality of shelter service delivery and impact outcomes for abused women and their children. Collectively, these findings offer direction regarding where these policies could be improved and provide a basis for shelters, policy makers, advocates, and the community to strengthen current services and policies, potentially enhancing outcomes for women., (© The Author(s) 2015.)

Shelters for abused women have expanded from "safe havens" to providing a range of residential and outreach services, and face increasing pressure to demonstrate "value for money" by providing evaluation metrics that may or may not reflect what they actually do. We conducted interviews and surveys with 68 shelter directors in Ontario, Canada, and found that differences in service philosophy and how abuse is defined influence decisions about who receives services and the shelter's role in the broader community; these in turn affect how the work of shelters is positioned. Implications for shelter service evaluation are discussed., (© The Author(s) 2014.)

Although intimate partner violence is a significant global health problem, few tested interventions have been designed to improve women's health and quality of life, particularly beyond the crisis of leaving. The Intervention for Health Enhancement After Leaving is a comprehensive, trauma informed, primary health care intervention, which builds on the grounded theory Strengthening Capacity to Limit Intrusion and other research findings. Delivered by a nurse and a domestic violence advocate working collaboratively with women through 6 components (safeguarding, managing basics, managing symptoms, cautious connecting, renewing self, and regenerating family), this promising intervention is in the early phases of testing.

Context: Whether intimate partner violence (IPV) screening reduces violence or improves health outcomes for women is unknown., Objective: To determine the effectiveness of IPV screening and communication of positive results to clinicians., Design, Setting, and Participants: Randomized controlled trial conducted in 11 emergency departments, 12 family practices, and 3 obstetrics/gynecology clinics in Ontario, Canada, among 6743 English-speaking female patients aged 18 to 64 years who presented between July 2005 and December 2006, could be seen individually, and were well enough to participate., Intervention: Women in the screened group (n=3271) self-completed the Woman Abuse Screening Tool (WAST); if a woman screened positive, this information was given to her clinician before the health care visit. Subsequent discussions and/or referrals were at the discretion of the treating clinician. The nonscreened group (n=3472) self-completed the WAST and other measures after their visit., Main Outcome Measures: Women disclosing past-year IPV were interviewed at baseline and every 6 months until 18 months regarding IPV reexposure and quality of life (primary outcomes), as well as several health outcomes and potential harms of screening., Results: Participant loss to follow-up was high: 43% (148/347) of screened women and 41% (148/360) of nonscreened women. At 18 months (n = 411), observed recurrence of IPV among screened vs nonscreened women was 46% vs 53% (modeled odds ratio, 0.82; 95% confidence interval, 0.32-2.12). Screened vs nonscreened women exhibited about a 0.2-SD greater improvement in quality-of-life scores (modeled score difference at 18 months, 3.74; 95% confidence interval, 0.47-7.00). When multiple imputation was used to account for sample loss, differences between groups were reduced and quality-of-life differences were no longer significant. Screened women reported no harms of screening., Conclusions: Although sample attrition urges cautious interpretation, the results of this trial do not provide sufficient evidence to support IPV screening in health care settings. Evaluation of services for women after identification of IPV remains a priority., Trial Registration: clinicaltrials.gov Identifier: NCT00182468.

In this mixed methods study we examined the strategies rural women use to deal with intimate partner violence (IPV). The Intimate Partner Violence Strategies Index (IPVSI) was used to analyze results from a sample of 43 rural women who had left abusive partners. Qualitative interviews then were conducted with a different sample of nine rural women to explore their perspectives about the findings and their impressions of the influence of rural culture and context on women's experiences of IPV. Findings exposed the degree to which social control acts as a key determinant of health for rural women exposed to IPV.

Enhanced knowledge regarding the factors that influence and support the self-efficacy of emergency department (ED) registered nurses and their provision of care to women who have experienced abuse is necessary for the promotion of optimal health care. The purpose of this study was to examine the self-efficacy of registered nurses with respect to assessing and responding to woman abuse in the ED. Study hypotheses and research questions were derived from Bandura's theory of self-efficacy. A secondary analysis (N = 158) of data from the Violence against Women: Health Care Provider Survey was completed. Originally, survey questions were not developed to operationalize the concepts outlined by Bandura. However, they were found to be good indicators. Four scales were developed from the item pool, validated through factor analysis and used to operationalize study variables. Positive relationships were found between self-efficacy information available to ED registered nurses and their self-efficacy for assessing and responding to woman abuse (r= .73, p < .001), self-efficacy expectations, and actual clinical responses related to woman abuse (r= .55, p < .001) and outcome expectancies related to assessing and responding to woman abuse (r = .56, p < .001). Hierarchical multiple regression examined the extent to which self-efficacy information, self-efficacy expectations and outcome expectancies predicted ED registered nurses' clinical responses to woman abuse. Overall, the model explained 40% of the variance in ED registered nurses' clinical responses to woman abuse. Results provide additional support for Bandura's theory and demonstrate that the clinical responses of ED registered nurses are complex and must be understood in terms of self-efficacy and the factors that support its development.

The purpose of this study was to examine the relationship between stigma and health promotion in families with preschool children headed by adolescent mothers, by: (a) testing hypotheses derived from the Developmental Model of Health and Nursing, and (b) descriptively exploring the experience of stigma in a community sample of 63 adolescent mothers in southwestern Ontario, Canada. The mothers verbally responded to established measures of felt stigma, family health work, healthy lifestyle practices, and a demographic questionnaire during a structured interview. Then their experiences of stigma were explored during a brief dialogic interview. Consistent with the theory, a moderate positive relationship was observed between family health work and mothers' healthy lifestyle (r = .52, p < .001). Felt stigma was not related to either health work or global healthy lifestyle. Stigma did not appear to affect family health promotion efforts directly but influenced other aspects of the participants' lives in both positive and negative ways. Implications for practice and future research are identified.

Although concern for their children's well-being is pivotal in mothers' decisions to leave abusive partners, rarely is lone-parent family life after leaving framed as beneficial for family members' emotional health. In this feminist grounded theory study of family health promotion in the aftermath of intimate partner violence, we learned that families strengthen their emotional health by purposefully replacing previously destructive patterns of interaction with predictable, supportive ways of getting along in a process called regenerating family. These findings add to our knowledge of family development and how families promote their health when they have experienced intimate partner violence.

The Acute Care Nurse Practitioner (ACNP) role is being implemented in many centres in Canada. Administrators need to be aware there are very few universities in Canada that prepare ACNPs for advanced health assessment. Therefore, a need may exist for continuing education in the work environment. The ACNPs in London, Ontario recognized such a need, and developed and implemented an Advanced Health Assessment Course using available resources, and administrators supported participation in the course. A pre-post course evaluation based on Bandura's Self-Efficacy theory (1997) was performed. From pre-test to post-test there were significant increases in: (a) the use of health assessement skills; (b) confidence in performing these skills; and (c) confidence in recognizing abnormalities on health assessment. The reasons most often cited for infrequent skill use were "inappropriate to clinical setting" and "used only if problem suspected". The majority of participants agreed that the course met their needs. Implications for practice include administrative support for continuing education at other centres to enhance health assessment skills of ACNPs.

Although single-parent family life has become mainstream in many ways, knowledge about these families has been focused predominantly on the chronic problems they experience. This study describes the strengths of single-parent families, compares these strengths to those of two-parent families, and describes families' explanations of the effect of self-identified strengths on health. Although single-parent and two-parent families are different structurally, the nature and pattern of strengths are found to be more similar than different between these two groups. These findings challenge stereotypical views of single-parent families that emphasize problems and vulnerability and exclude a consideration of their strengths.