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Objective: Medical assistance in dying (MAiD) is the medical provision of substances to end a patient's life at their voluntary request. While legal in several countries, the implementation of MAiD is met with ethical, legislative and clinical challenges, which are often overshadowed by moral discourse. Our aim was to conduct a scoping review to explore key barriers for the integration of MAiD into existing health systems. Methods: We searched electronic databases (CINAHL, Embase, MEDLINE, and PsycINFO) and grey literature sources from 1990 to 2017. Studies discussing barriers and/or challenges to implementing MAiD from a health system's perspective were included. Full-text papers were screened against inclusion/exclusion criteria for article selection. A thematic content analysis was conducted to summarize data into themes to highlight key implementation barriers. Results: The final review included 35 articles (see online Appendix 1). Six categories of implementation challenges emerged: regulatory (n = 26), legal (n = 15), social (n = 9), logistical (n = 9), financial (n = 3) and compatibility with palliative care (n = 3). Within four of the six identified implementation barriers (regulatory, legal, social and logistical) were subthemes, which described barriers related to legalizing MAiD in more detail. Conclusion: Despite multiple challenges related to its implementation, MAiD remains a requested end-of-life option, requiring careful examination to ensure adequate integration into existing health services. Comprehensive models of care incorporating multidisciplinary teams and regulatory oversight alongside improved clinician education may be effective to streamline MAiD services. [ABSTRACT FROM AUTHOR]

Abstract: This paper utilizes Helena Znaniecka Lopata's concept of life frameworks as a lens through which to understand the experience of widowhood amongst elderly Chinese immigrant women living in Toronto, Canada. While Lopata defined life frameworks as including social supports, social relations and social roles, for these widows, personal resources (framed in Chinese cultural context) were also important aspects of life frameworks. In-depth interviews with 20 widows contacted through a Chinese community center were conducted in Mandarin and Cantonese and then transcribed and interpreted through team-based qualitative analyses. These women ranged in age from 69 to 93years and had been in Canada an average of 17years, with over half of them widowed following immigration. Our analysis framed the widows' narratives in terms of four types of supports defined by Lopata: social, service, financial and emotional supports. They had fairly extensive social and service supports focused primarily around family and the Chinese community. Although norms of filial piety traditionally dictate sons as primary supports, daughters predominated as providers of supports to these widows. Interpreted from a life course perspective, financial supports were deemed sufficient, despite overall limited financial means. Emotional support was more nuanced and complex for these widows. Loneliness and feelings of social isolation were prevalent. Nevertheless, themes of acceptance and satisfaction dominated our findings, as did reciprocity and exchange. The narrative accounts of these widows depict a complexity of experience rooted in their biographies as Chinese women and as immigrants, rather than primarily in widowhood itself. [Copyright &y& Elsevier]

The Plainfield Teen Parenting Program, a component of Plainfield High School School-Based Youth Service in Plainfield, New Jersey, provides a comprehensive in-school program to adolescent mothers and their children. The program stresses continued achievement in school, economic self-sufficiency, and positive parenting. Data from 31 mothers who participated in the program and a comparison group indicate that participation was related to improved self-esteem, high school graduation, and postgraduation employment or continued education. The data further suggest that program participation may reduce the frequency of additional births. INSET: Evaluation can be fun. [ABSTRACT FROM AUTHOR]

Aim: To examine factors that influence intrapartum health outcomes among Black childbearing persons, including cisgender women, transmasculine and gender-diverse birthing persons., Background: Black childbearing persons are three to four times (243%) more likely to die while giving birth than any other racial/ethnic group. Black birthing persons are not just dying from complications but also from inequitable care from healthcare providers compared to their white counterparts., Design: Discursive paper., Method: Searching national literature published between 2010 and 2021 in PubMed, CINAHL, Embase and SCOPUS, we explored factors associated with poor intrapartum health outcomes among Black childbearing persons., Discussion: Several studies have ruled out social determinants of health as sufficient causative factors for poor intrapartum health outcomes among Black birthing persons. Recent research has shown that discrimination by race heavily influences whether a birthing person dies while childbearing., Conclusions: There is a historical context for obstetric medicine that includes harmful stereotypes, implicit bias and racism, all having a negative impact on intrapartum health outcomes. The existing health disparity among this population is endemic and requires close attention., Impact on Nursing Practice: Nurses and other healthcare professionals must understand their role in establishing unbiased care that promotes respect for diversity, equity and inclusion., No Patient or Public Contribution: There was no patient or public involvement in the design or drafting of this discursive paper., (© 2022 John Wiley & Sons Ltd.)

Elder abuse (EA) is a pervasive problem with serious consequences. Previous population-based EA risk factor research has largely used cross-sectional designs that limit causal inferences, or agency records to identify victims, which threatens external validity. Based on a national, prospective, population-based cohort sample of older adults (n = 23,468) over a 3-year period from the Canadian Longitudinal Study on Aging, the current study sought to estimate the prevalence of EA and identify risk and protective factors. Past-year prevalence of any EA was 10.0%. Older adults with greater vulnerability related to physical, cognitive and mental health, childhood maltreatment and shared living were at higher EA risk, while social support was protective against EA. Older adults identifying as Black or reporting financial need were at heightened EA risk. This longitudinal, population-based study advances our understanding of EA risk/protective factors across several domains and informs the development of EA prevention strategies., (© 2022. The Author(s), under exclusive licence to Springer Nature America, Inc.)

Adverse perinatal outcomes are a significant contributor to neonatal and infant deaths. Mental illness, substance use disorders, and interpersonal trauma are often prevalent within obstetrical populations. Previous literature has documented the individual associations between these psychosocial factors and adverse perinatal outcomes. The co-occurrence of these three psychosocial factors might represent a syndemic among pregnant women, although they have not been described as such in the literature. Analysis of the interrelatedness and aggregate effect of these factors may allow for a more effective screening process that may reduce adverse perinatal outcomes. The objective of this article is to examine whether psychosocial factors (mental illness, substance use disorders, and interpersonal trauma) were independently and synergistically associated with adverse perinatal outcomes. This is a retrospective cohort study of 1,656 pregnant women at a single institution. Perinatal outcome and psychosocial data were abstracted from each participant's electronic medical record. Univariate and bivariate analyses, and multiple logistic regression were performed. Mean age was 27.5 ( SD = 6.2) years. The majority was Black (60.6%) and single (58%). Psychosocial factors were reported in 35% of women. The incidence of adverse perinatal outcomes increased with greater number of psychosocial factors: 21.2% if no psychosocial factor, 27.0% if one psychosocial factor, 27.4% if two, and 35.3% if all three (for trend, p = .01). Women who reported all three psychosocial factors had twice the odds of adverse perinatal outcomes (adjusted odds ratio = 2.04, 95% confidence interval = [1.09, 3.81], p = .03) compared with those who reported none. Our data suggest there is a synergistic relationship between the psychosocial factors that is associated with increased adverse perinatal outcomes. A validated screening tool is needed to stratify patient's risk of adverse perinatal outcomes based on psychosocial factors. Such screening could lead to tailored interventions that could decrease adverse perinatal outcomes.

Background: Intimate partner violence (IPV) is a significant public health issue. Healthcare providers (e.g., nurses, advanced practice nurses, physicians, social workers) have a unique opportunity to prevent and reduce IPV through screening and referral. The objective of this project was to determine the impact of education and a brief screening tool integrated into the electronic medical record (EMR) on readiness to screen for IPV., Methods: An intervention was implemented that included the EMR integration of a screening tool, creation of an automated resource telephone system and healthcare provider IPV screening and response education. Readiness for screening was evaluated pre- and postintervention using the Domestic Violence Health Care Provider Survey Scale (DVHCPSS), which is scored cumulatively and by each of six domains. An unpaired Student's t test was performed., Results: Mean age (31-40 years of age) and years of clinical practice (11-15 years) was the same for pre- (n = 96) and postintervention (n = 83) survey respondents. There was an overall significant increase in screening readiness (p = .003) with significant improvement in "professional role resistance/fear of offending the patient" (p < .0001), "blame victim items" (p = .0029), "perceived self-efficacy" (p = .0064), and "victim/provider safety" (p = .003)., Linking Evidence to Action: Adopting and integrating a validated IPV screening tool into the EMR combined with education was associated with an improvement in overall readiness for IPV screening. Reducing and preventing IPV through universal screening and referral can be accomplished by embedding a standardized readily accessible validated IPV screening tool in the EMR., (© 2019 Sigma Theta Tau International.)

Chinese older adults may be at increased risk of social isolation and loneliness, and a fragmented understanding exists about the challenges they face for social participation in their neighbourhoods and communities. A scoping review was undertaken to describe the current knowledge on social isolation and loneliness in urban-dwelling Chinese older adults living in Western societies to inform future research, practice, and policy in Canada. Nineteen articles met the inclusion criteria. The World Health Organization's age-friendly community framework contextualized the study findings. Studies identified issues related to (1) social participation; (2) community support and health services; (3) housing; (4) community and information; (5) respect and social inclusion; (6) outdoor spaces and public buildings; (7) civic participation and employment; and (8) transportation. Social isolation and loneliness is a growing concern in this population in Canada, and additional research is needed to identify its scope and effective interventions.

Resident-to-resident abuse involves aggression and violence that occurs between long-term care (LTC) home residents and can have serious consequences for both aggressors and victims. To date, there has been no attempt to systematically assess the breadth of the problem in Canada. To address this gap, we undertook a scoping review to enhance understanding of resident-to-resident abuse in LTC homes. A redacted Canadian data set on resident-to-resident abuse is also reported on. Nine electronic literature databases were searched; a total of 784 abstracts were identified, but only 32 satisfied the inclusion criteria. The majority of records (75%) were retrospective case studies, qualitative studies, and reviews/commentaries. Of these, only 14 focused exclusively on resident-to-resident abuse. The redacted Canadian data set suggests resident-to-resident abuse makes up approximately one-third of reported abuse cases. Recommendations for future research, clinical practice, and policy are provided to raise awareness of this phenomenon to help decrease its incidence.

Aims and Objectives: To challenge statements made about 'Careful Nursing' as a 'distinctive system' of nursing established by the Irish Sisters of Mercy, prior to Florence Nightingale, and which is said to have influenced her., Background: Numerous publications have appeared claiming the emergence of a 'distinctive system' of nursing as 'Ireland's legacy to nursing', which, it is claimed, influenced Nightingale's system. One paper argues that the Irish system has its philosophical roots in Thomist philosophy. Several papers argue the ongoing relevance of the Irish system, not Nightingale's, for contemporary nursing theory and practice. Nightingale's influence on and legacy to Irish nursing are not acknowledged., Design: A Discursive paper., Methods: Archival and published sources were used to compare the nursing systems of Florence Nightingale and the Irish Sisters of Mercy, with particular attention to nursing during the Crimean War., Results: Claims were challenged of a 'distinctive system' of nursing established by the Irish Sisters of Mercy in the early nineteenth century, and of its stated influence on the nursing system of Florence Nightingale. The contention of great medical satisfaction with the 'distinctive' system is refuted with data showing that the death rate at the Koulali Hospital, where the Irish sisters nursed, was the highest of all the British war hospitals during the Crimean War. Profound differences between the two systems are outlined., Conclusions: Claims for a 'distinctive' Irish system of nursing fail for lack of evidence. Nightingale's principles and methods, as they evolved over the first decade of her school's work, remain central to nursing theory and practice., Relevance to Clinical Practice: Nightingale's insistence on respect for patients and high ethical standards remains relevant to practice no less so as specific practices change with advances in medical knowledge and practice., (© 2014 John Wiley & Sons Ltd.)

Aims: The purpose of this article is to correct inaccurate information about both Mary Seacole and Florence Nightingale, material that promotes Seacole as a pioneer nurse and heroine, while either ignoring Nightingale or trivializing her contribution., Background: Nursing journals have been prominent in promoting inaccurate accounts of the contribution of Seacole to nursing. Some have intermittently published positive material about Nightingale, but none has published redress., Design: Discussion paper., Data: Primary sources from 1855-2012 were found, which contradict some key claims made about Seacole. Further sources - not included here - are identified, with a website reference., Implications for Nursing: It is argued that Nightingale remains relevant as a model for nurses, with the many crises in patient care and continuing challenges of hospital safety., Conclusion: Greater accuracy and honesty are required in reporting about nursing heroes. Without these, great ideas and examples can be lost to nursing and health care., (© 2013 John Wiley & Sons Ltd.)

This article reviews developments in the field of elder abuse and neglect since the publication of Elder Abuse and Neglect in Canada (1991). The arguments made here are twofold: first, we have no idea of the size and nature of the problem of abuse and neglect in the community or in institutions; second, we do not know how to solve these problems or their attendant issues that have been masked by rhetoric and the recycling of information for the past 20 years. It is time to move forward from the "awareness phase". What we must tackle in the future is as obvious now as 20 years ago. Our knowledge is incomplete (i.e., our glass remains half full) because we lack the type of investigations we most urgently need: prevalence studies in the community and institutions, serious theory development, and random clinical trials to test our interventions both socially and legally.

In this article, we raise the question as to whether retirement is lost as we currently know and understand it in Canada. With a selected review, we examine retirement research according to the scope of retirement and the new retirement, possible theoretical developments, the timing of transitions into retirement, and life as a retiree including the quality or lack of pensions. Accordingly, we propose that retirement is undergoing modifications on the basis of several trends that commenced before the 2008 economic downturn. The data would appear to lean towards the emergence of a different type of retirement, insofar as the collective Canadian vision of retirement is lost, notwithstanding the economic meltdown in global markets.

Nightingale's passionate commitment to statistics was based on her faith in a god of order, who created a world that ran by law. God's laws could be known through research, as a result of which suitable interventions to better the world could be applied. Statistics were a vital component in her holistic approach to health care as a system. They served both to indicate serious problems and to assist in policy making, and then again to monitor the effects of the new policies. She pioneered the use of evaluative statistics and saw reforms achieved as a result of her advocacy. This article explores three key aspects selected from Nightingale's more than 40 years of applied statistical work: her adaptation of Quetelet's methodological foundations, the use of statistics in monitoring public health care systems, and her pioneering study of maternal mortality in childbirth.

This study applies a multi-player arms race model to peer contagion in the aggressive and delinquent behaviors of inner-city elementary school students. Because this model of peer contagion differs from the usual model based on positive reinforcement of delinquent behavior, it raises the possibility that the persistent finding of iatrogenic effects of group treatment might not apply to group treatment of elementary school children if the possibility of aggressive behavior in the group is limited. One way of limiting aggressive behavior is to include parents in the groups. The study therefore applies the model to groups of elementary school students assigned to Families and Schools Together (FAST; a group treatment that includes parental participation) or to an intervention focused on individual families. The model effectively describes the relationship between group averages of aggressive behavior in the classroom and aggressive and delinquent behavior outside the classroom for those students assigned to the individual intervention. The model fits those children assigned to FAST less well, suggesting that FAST may make it less likely that aggressive and delinquent behavior is generalized outside of aggressive classroom settings. Editors' Strategic Implications: The authors draw on evolutionary biology, developmental psychology, sociology, and learning theory to present an innovative prevention model and test the promising FAST program. Using longitudinal data from 403 children, their parents, and their teachers, the authors describe how FAST may interfere with the process of escalating aggression.

Although progress has been made over the last 20 years, the burden of a low income in old age is still carried by unattached women. Few researchers, however, have examined exactly where the burden of poverty falls within the category of unattached older women or what the nature of this poverty is. Like any other group of older Canadians, unattached women are not a homogeneous population. The category of unattached includes the separated, divorced, widowed, and ever single, all of whom face different circumstances in old age because of differences over the life course. Using Survey of Labour and Income Dynamics (SLID) data, we examine income and sources of income from 1993 to 1999 to identify differences among these groups. The findings indicate that the separated and divorced are the poorest of all older unattached women in Canada. A key source of the difference is the differential growth in private pension incomes.