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OBJECTIVE: To systematically investigate the extent to which patients comply with triage advice from telenurses and to identify factors that potentially influence compliance. METHODS: Findings from 13 studies identified through interdisciplinary research databases (1990-2010) were meta-analyzed. Separate pooled analyses compared patients' compliance rates for emergency services and office care (13 outcomes), emergency services and self care (13 outcomes), and self care and office care (12 outcomes). RESULTS: Overall patient compliance was 62%, but varied by intensity of care recommended with low compliance rates for advice to see a general practitioner. Reasons for noncompliance include patients reporting to have heard a different disposition, patients' intentions and health beliefs. CONCLUSION: Patient compliance to triage recommendations was influenced by the interactive role of patient perceptions and the quality of provider communication, both of which were mediated by access to health services. Further research is needed to clarify whether noncompliance is attributable to poor communication by the nurse or patient misinterpretation. PRACTICE IMPLICATIONS: We highlight the need for communication-skills training in a telephone-consultation context that is patient centered, and specifically addresses building active listening and active advising skills and advantages to structuring the call. [ABSTRACT FROM AUTHOR]

Aims. This study is a meta-ethnography of nurses' experiences with telephone triage and advice and factors that facilitate or impede their decision-making process. Background. Telephone triage and advice services are a rapidly expanding development in health care. Unlike traditional forms of nursing practice, telenurses offer triage recommendations and advice to the general public without visual cues. Data sources. Published qualitative research on telephone triage and advice were sought from interdisciplinary research databases (1980-2008) and bibliographical reviews of retrieved studies. Review methods. Our systematic search identified 16 relevant studies. Two researchers independently reviewed, critically appraised, and extracted key themes and concepts from each study. We followed techniques of meta-ethnography to synthesize the findings, using both reciprocal and refutational translation to compare similar or contradictory findings, and a line-of-arguments synthesis. Results. We identified five major themes that highlight common issues and concerns experienced by telenurses: gaining and maintaining skills, autonomy, new work environment, holistic assessment, and stress and pressure. A line-of-arguments synthesis produced a three-stage model that describes the decision-making process used by telenurses and highlights how assessments largely depend on the ability to 'build a picture' of the patient and the presenting health issue. Conclusion. Telenurses experience a range of common concerns and issues which either impede or facilitate the decision-making process. Although 'building a picture' of the patient is key to making assessments over the telephone, final triage decisions are influenced by balancing the conflicting demands of being both carer and gatekeeper to limited healthcare services. [ABSTRACT FROM AUTHOR]

Objective: The objective of this study was to identify the facilitators and barriers associated with integrating nurse practitioners (NPs) into Canadian emergency departments (EDs) from the perspectives of NPs and ED staff.Methods: We conducted 24 semi-structured interviews with key multidisciplinary stakeholders in 6 Ontario EDs to gain a broad range of perspectives on implementation issues. Data were analyzed using a grounded-theory approach.Results: Qualitative analysis of the interview data revealed 3 major issues associated with NP implementation: organizational context, role clarity and NP recruitment. Organizational context refers to the environment an NP enters and involves issues related to the ED culture, physician reimbursement system and patient volume. Role clarity refers to understanding the NP's function in the ED. Recruitment issues are associated with attracting and retaining NPs to work in EDs. Examples of each issue using respondent's own words are provided.Conclusion: Our study identified 3 issues that illustrate the complex issues involved when implementing NPs in EDs. The findings may inform policy makers and health care professionals in the future development of the role of NPs in Canadian EDs. [ABSTRACT FROM AUTHOR]

Background: Farming is a stressful occupation, and a growing body of research shows that farm stressors are associated with poor mental health. To date, there are few methodologically sound surveys that assess farm stressors, and none have been validated for the Canadian context. Our study aimed to: (a) investigate the types of stressors experienced by farmers, (b) develop a farm stress assessment tool and test its factor structure and internal consistency, and (c) assess its criterion-related validity to self-reported levels of anxiety, depression, burnout, and resilience among farmers., Methods: We developed a 20-item survey based on a review of the literature, examining existing farm stress surveys, and consulting 10 farmers and agricultural industry experts. Then, a convenience sample of farmers living in Alberta, Canada (Sample 1, N = 354) completed a questionnaire containing the 20-item farm stress survey and four validated measures that assessed depression, anxiety, burnout, and resilience. Sample 1 was used to assess the factor structure using exploratory factor analysis (EFA), internal consistency, and criterion-validity of the survey. Next, a convenience sample of farmers living outside of Alberta (Sample 2, N = 138) was used to evaluate the factor structure of the survey using confirmatory factor analysis (CFA)., Results: The results of the EFA revealed five underlying dimensions of farm stressors: Unexpected work disruptions, Agricultural hazards, Farm and financial planning, Isolation, and Regulations and public pressure. The subscales accounted for 61.6% of the variance, and the internal consistency (Cronbach's alpha) ranged from 0.66 to.75. Subscale correlations were below 0.44, indicating evidence of discriminant validity. Correlations between the five subscales and the four mental health outcome variables supported the criterion-related validity of the survey. The results of the CFA indicated that the data fit the model, and fit was further improved by correlating one pair of error terms., Conclusions: Preliminary analysis of our Farmer Stress Assessment Tool (FSAT) suggests it is a reliable and valid instrument for measuring a range of stressors farmers face. Implications for policy and community-based mental health interventions that help farmers manage the enduring stressors of agriculture is discussed., (© 2024. The Author(s).)

The sporting season across post-secondary institutions was canceled in March 2020 due to COVID-19, and student-athletes had to maintain their training at home. It is unclear what personal and contextual factors facilitated student-athletes' ability to maintain their training routines at home when social distancing and lockdown (SD/L) policies were put in place. Our cross-sectional study of 433 student-athletes examined (a) how athletes adapted their training, (b) what training barriers they experienced, (c) whether motivational profiles were associated with differences in training behaviors and mental health, and (d) what variables predicted athletes' motivation to train during this prolonged offseason. Student-athletes across Canada were recruited to complete an online survey between August and September 2020. Results showed that athletes significantly reduced their training load and intensity, with approximately 25% exercising two or fewer days a week. Barriers to training included limited access to fitness resources and equipment, having inconsistent training schedules, and experiencing emotional distractions, with some of these barriers more common among female athletes than male athletes. For motivation profiles, athletes with higher levels of intrinsic motivation tended to maintain the intensity of their workouts and experienced lower mood disturbance. A hierarchical multiple regression revealed that being male, being younger, having higher levels of intrinsic and introjected motivation, having access to fitness resources, maintaining a steady training schedule, having fewer emotional distractions, and lower mood disturbance were significant predictors to being motivated to train during the pandemic. We discuss strategies coaches and trainers can implement to best support their student-athletes., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Purc-Stephenson, Zimmerman and Edwards.)

Objective: To describe the experiences and strategies of employees with arthritis to maintain employment, and to use this information to build a conceptual model., Methods: We conducted a systematic review of qualitative studies that examined the work experiences of employees with arthritis. Published studies on arthritis and employment were searched from electronic databases (1980-2017) and bibliographic reviews of relevant studies. We used meta-ethnography to synthesize the findings., Results: We reviewed 17 studies that reported on the experiences of 873 employees. We identified 11 main themes that highlight common issues experienced by employees with arthritis and grouped these into 4 higher-order categories: changing nature of the disease (emotional issues, cognitive struggles, unpredictable physical symptoms), intrapersonal issues (personal meaning of work, preserving a work identity), interpersonal issues (managing disclosure, gaining coworker support, organizational culture issues), and work-sustainability strategies (making personal adjustments, using social support, using workplace accommodations). Using these themes, we developed the Job Sustainability Model to illustrate how disease, personal, and work-related factors interact to influence what type of coping behaviors are used and when. Initially, employees with arthritis rely on making personal adjustments, using social support, and medical intervention. However, when these coping behaviors fail to be effective, they draw upon workplace accommodations and resources., Conclusion: Arthritis disrupts an employee's work life by impairing his or her capacity to be a productive worker. Our results highlight how employees with arthritis make strategic adaptations to maintain a productive work life for as long as possible. The findings of this study have implications for work-related interventions aimed at preserving employment., (© 2018, American College of Rheumatology.)

Objective: The Posttraumatic Growth Inventory (PTGI) assesses positive changes after a traumatic or serious life crisis. However, there are differing views regarding its factor structure and little understanding if it captures the positive changes experienced among individuals diagnosed with a chronic disease. Using confirmatory factor analysis (CFA), the proposed five-factor structure and measurement invariance of the PTGI was examined using two chronic illness samples: arthritis and inflammatory bowel disease (IBD)., Method: Individuals diagnosed with arthritis (n = 301) or IBD (n = 544) recruited from the community and the Internet completed the PTGI. Using a pooled sample, CFA tested five hypothesized models of the underlying factors structure of the PTGI. A stepwise procedure for testing the measurement invariance across the two groups evaluated the factor structure, factorial invariance, and latent mean invariance., Results: Using the pooled sample, the CFA supported the hypothesized five-factor model, revealing the PTGI is multidimensional. Multigroup CFA supported invariance of the PTGI across the two groups although there were significant differences in latent means., Conclusions: The findings support that the PTGI assesses five related dimensions of PTG and that different chronic disease groups experience different types of positive changes. PTG may therefore be relevant as a meaningful treatment goal for people with chronic diseases as it is for people affected by other traumatic events., (PsycINFO Database Record (c) 2014 APA, all rights reserved.)

As the number of vehicles in China rapidly increases and there is no child safety seat law, the issue of road safety for children is a growing concern. The purpose of this study was to examine parents' use and knowledge of car safety seats in Beijing, China. Using a convenience sample of 843 parents, survey results showed that only 64.8% of parents used a safety restraint for their children; the remaining 35.2% of children, of which most were toddlers or school-aged children, travelled unrestrained in vehicles. Among parents who used a safety restraint, only 24.2% were using it correctly based on the child's age (for infants), weight and height. Common reasons for not using a safety seat included difficulty finding safety seats (56.6%), cost (26.1%), and a preference to hold the child (18.1%). Moreover, a large proportion of parents prematurely transitioned their child from a safety seat to seat belt. The results highlight the need to develop injury prevention interventions that communicate the benefits and encourage the use of child safety restraints in China.

Objectives: As interest in and use of complementary and alternative medicine (CAM) providers continues to grow, it is important to understand which characteristics incline people to experiment with and become frequent consumers of CAM practitioners. The purpose of this study was to examine how personality, as assessed by the five-factor model, was related to the breadth, frequency, and types of provider-based CAM use. Relationships between the personality factors (Openness, Conscientiousness, Extraversion, Agreeableness, and Neuroticism) and motives for consulting CAM providers were also explored., Methods: A convenience sample of 184 current CAM clients recruited through the offices of 12 conventional medicine and 17 CAM practitioners completed a survey package including measures of health status, CAM use, personality, and motivations for using CAM., Results: Only Openness and Agreeableness were consistently linked to different dimensions of CAM use, with each associated with consultations with CAM practitioners, and homeopaths and naturopaths in particular. After controlling for sociodemographic and health status variables in the stepwise multiple regressions, Openness was associated with the variety of CAM providers tried, whereas Agreeableness was linked to both the breadth and frequency of CAM consultations. Holistic and proactive health motivations were associated with both personality factors, and Agreeableness was also associated with motives reflecting a desire for shared decision-making., Conclusions: Findings indicate that individuals who are open and agreeable, as described by the five-factor model of personality, consult CAM practitioners to a greater extent. The motives involved suggest a congruency between CAM and their own perspectives regarding health and patient-provider interactions, which may have implications for understanding treatment adherence and outcomes.

The aim of this study was to examine the attitudes, behaviours, and intentions to consult complementary and alternative medicine (CAM) providers, of health-care consumers living in a region with low physician availability. A survey was completed by a convenience sample of 235 CAM clients and nonconsumers recruited from an underserved urban centre in Canada. Nearly half had experienced difficulties getting an appointment with a physician when needed, and those who had experienced difficulties were more dissatisfied with conventional health care. Most participants (85.1%) indicated that they would consider consulting a CAM provider should they have difficulty getting an appointment with a physician in the future, including nearly 60% of the CAM nonconsumers. Participants who had more experience with CAM, greater perceived control over their symptoms, and were dissatisfied with conventional health care, were more likely to express intentions to use CAM should they experience access difficulties in the future. By situating the motivations for CAM within the context of physician availability our findings highlight the importance of geographical context, or place, for understanding attitudes towards CAM and its utilisation.

Objective: This study investigates the association between ethnic minority status and receiving a screening mammogram within the past 2 years among American women over 50., Method: The findings from 33 studies identified from interdisciplinary research databases (1980 to 2006) were synthesized. Separate pooled analyses compared white non-Hispanics to African Americans (28 outcomes), Hispanics (18 outcomes), and Asian/Pacific Islanders (10 outcomes)., Results: Using the random effects model, results showed that African Americans were screened less than white non-Hispanics at a marginal level (OR 0.87, 95% CI 0.75, 1.00). Larger and significant discrepancies were observed for Hispanics (OR 0.65, 95% CI 0.50, 0.85) and Asian/Pacific Islanders (OR 0.63, 95% CI 0.39, 0.99) compared to white non-Hispanics. However, among studies controlling for socioeconomic status, ethnic differences in mammography screening were no longer significant for African Americans (OR 1.05, 95% CI 0.71, 1.76), Hispanics (OR 1.08, 95% CI 0.64, 1.93), or Asian/Pacific Islanders (OR 1.08, 95% CI 0.64, 1.93). Subgroup analyses further showed that geographical region, sampling method, and data collection strategy significantly impacted results., Conclusions: This study found evidence that ethnic minority-screening mammography differences exist but were impacted by socioeconomic status. Implications for interpreting existing knowledge and future research needs are discussed.