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A case study using mixed methods that critically appraises the implementation of a mental health policy in higher education in the absence of evidence to inform the policy using an exemplar case from one mid-sized post-secondary institution was the motivation for this research. Explanation building was used to iteratively analyse data on rival explanations of the implementation of the fall break policy. Analyses from the surveys revealed that overall, only 36.9 per cent of students perceived an increase in workload before the break and only 29.6 per cent of students perceived an increase in workload after the break. However, the focus groups and professor interviews revealed that the timing of the fall break had an impact on how students and professors experienced the break and their perceptions on its impact on student mental health. If baseline data regarding the implementation of the fall break would have been collected prior to its implementation, we could have possibly avoided the implementation issues that arose. While this research provides an exemplar case of a fall break policy at one post-secondary institution, the policy learning is universal.

Attempting to support student mental health, many Canadian universities have implemented a fall break with the assumption it would be helpful in alleviating students' stress and anxiety. However, there is no baseline data regarding stress level or mental illness burden of students to understand its effectiveness. Using case study methodology with mixed methods, this research sought to appraise, given a lack of baseline data, the impact of a fall break on student mental health. While the surveys revealed that students overwhelmingly liked the break and perceived it to reduce their school related stress, the focus groups revealed key insights into understanding stress and coping among university students about how students like to de-stress that have practical implications for any policy aimed at promoting students' mental wellness. This research offers practical policy suggestions to help post-secondary institutions determine whether a fall break week can be effective in addressing students' stress and anxiety.

Work-integrated learning (WIL) is an expanding practice in Canadian non-clinical health-related undergraduate programs. WIL participants frequently encounter failure experiences, yet there is limited literature exploring how students overcome failure and how instructors can support this process. This study aimed to understand how students overcome and learn from failure experiences in a non-clinical undergraduate health-related WIL program. Using a constructivist grounded theory approach, in-depth interviews were conducted with 10 previous students from an established WIL program. Iterative cycles of data analysis and constant comparison generated a theoretical explanation highlighting how students overcome failure by renegotiating their expectations through 1) experiencing and managing the wave of emotion, 2) modifying expectations of self and others, 3) redefining success and moving forward, and 4) building flexibility of expectations. This research presents failure as a tool for learning and a steppingstone toward success. Findings inform a pedagogical framework to optimize student learning from failure.

The mental wellness of university students can be critical for their success. In an attempt to minimize stress for students, many universities have implemented a policy for a fall break with limited evidence to support its intended outcomes. This case study offers a critical appraisal of the formation of the fall break policy at one medium sized comprehensive university using qualitative and quantitative forms of evidence triangulated from (1) University Student Union survey, (2) document analysis and; (3) informant interview. The lack of uniformity on how the fall break is labelled, the timing of the break and its evaluation emerged as design flaws in the creation stage that perhaps, could have been mitigated if faculty and student voices were included in policy creation decisions.

Despite efforts to improve access to palliative care services, a significant number of patients still have unmet needs throughout their continuum of care. As such, this project was conducted to increase recognition of patients who could benefit from palliative care, increase referrals, and connect regional sites. This study utilized Plan-Do- Study-Act cycles through a quality improvement approach to develop and test the Palliative Care Screening Tool and aimed to screen 100% of patients within 24 hours who were admitted to selected units by February 2017. The intervention was implemented in 3 different units, each within community hospitals. Patients 18 years or older were screened if they were admitted to one of the selected units for the project, regardless of their diagnosis, age, or comorbidities. The percentage of newly admitted patients who were screened and the total number of palliative care consults were assessed as outcome measures. The tool was met with varying compliance among the 3 sites. However, there was an overall increase in consults across all hospital sites, and an increase in the proportion of noncancer patients was demonstrated. Although the aim was not reached, the tool helped to create a shift in the demographic of patients identified as palliative. [ABSTRACT FROM AUTHOR]

This study explored health care professionals' perceptions and experiences associated with the role of point-of-care nurses during care transitions from an acute care hospital to a rehabilitation setting to being discharged home. We used a qualitative exploratory design and semistructured interviews. Content analysis revealed 3 themes that point to the ambiguity related to the roles that nurses enact with older patients during care transitions.We suggest ways to better support nurses to engage in quality care transitions. [ABSTRACT FROM AUTHOR]

A qualitative design was used to explore the nature of caregiver involvement in care transitions of patients being transferred from an acute care hospital to a rehabilitation hospital. Participants included older adults (n=13), informal caregivers (n=9) and health care professionals (n=50) from inpatient orthopedic units in two academic health science centers and one orthopedic inpatient rehabilitation unit. Semistructured interviews were conducted, audiotaped and transcribed. Directed content analysis revealed the following four themes: watching, being an active care provider, advocating and navigating the health care system. Participants described being actively involved in the care of their family member, yet they were not actively engaged by health care professionals to be involved in the care of their family member. There is a need to reconcile the tension between the level of involvement of caregivers in the care of family members who are patients and the level of engagement throughout the care transition. By providing relevant information and authentically engaging caregivers as equal partners in the care transition, they are better able to navigate the health care system post-transfer to the rehabilitation setting and discharge to home. [ABSTRACT FROM AUTHOR]

Patient safety has emerged as an important issue in Canadian health care, as reflected in the Canadian Council on Health Services Accreditation's patient/client safety goals. Achieving these goals calls for concerted efforts within health-care organizations. To assist nurse leaders in their efforts in developing a culture of safety that is receptive to reporting and learning from adverse events and near misses, the authors explore the challenges and provide four recommendations for action. By enacting these recommendations, nurse leaders can support the analysis and actions necessary to identify improvements that will create safer health-care environments. [ABSTRACT FROM AUTHOR]

Fever during chemotherapy is a common and potentially severe complication being increasingly evaluated in emergency departments to minimize morbidity and mortality. Streamlining triage of these patients may improve health outcomes and wait times in the health care system. A retrospective chart review of febrile patients undergoing chemotherapy was conducted at a local emergency department to assess the impact of nurse-initiated protocols on wait times. We identified 315 patients undergoing current chemotherapy presenting with fever. Of these, 140 (44%) and 87 (28%) were initiated on the sepsis and febrile neutropenia nurse-initiated protocols, respectively. In total, 197 (63%) were admitted. The febrile neutropenia protocol had a shorter wait time from triage to disposition than the sepsis protocol (403 minutes [SD = 23] vs 329 minutes [SD = 19], t = 1.71, P = 0.01). Furthermore, the febrile neutropenia protocol demonstrated shorter times from both triage to lab results reported, in addition to the physician initial assessment in the admitted patient subgroup. Decreased wait times from triage associated with the use of a febrile neutropenia protocol could be accounted for by a lower number of lab results required through this protocol in addition to shorter physician assessment times in the admitted population. This study shows that nurse-initiated protocols may influence door-to-antibiotic time for patients undergoing chemotherapy. By having a targeted protocol for the cancer population, health care centers may be able to demonstrate decreased health care expenditure and increased resource availability. Furthermore, as the current population of patients undergoing chemotherapy is at a high risk for neutropenia, prompt management is crucial to minimize mortality. [ABSTRACT FROM AUTHOR]

The Manchester Patient Safety Culture Assessment Tool (MaPSCAT) was used to examine the levels of safety culture maturity in four programs across one large healthcare organization. The MaPSCAT is based on a theoretical framework that was developed in the United Kingdom through extensive literature reviews and expert input. It provides a view of safety culture on 10 dimensions (continuous improvement, priority given to safety, system errors and individual responsibility, recording incidents, evaluating incidents, learning and effecting change, communication, personnel management, staff education and teamwork) at five progressive levels of safety maturity. These levels are pathological ("Why waste our time on safety?"), reactive ("We do something when we have an incident"), bureaucratic ("We have systems in place to manage safety"), proactive ("We are always on alert for risks") and generative ("Risk management is an integral part of everything we do"). This article highlights the use of a new tool, the results of a study completed with this tool and how the results can be used to advance safety culture.