Create and Sustain a Culture of Curiosity: A Case Study of a Home Healthcare Organization in Toronto.

Increased integration in the healthcare sector requires traditionally non-research-based organizations to contribute to evidence-based decision making as equal partners. This requires a culture and infrastructure that support structured inquiry to improve best practice, quality and safety. We present the roadmap used by one home healthcare organization to create an embedded research unit to drive this transformation. The use of a relevant model and a framework provided structure to guide and sustain the process. We expect that the core strategies and combination of frameworks should be transferrable to others wishing to contribute meaningfully to evidence-based health system transformation.

Understanding transitional care programs for older adults who experience delayed discharge: a scoping review.

BACKGROUND: Many hospitalized older adults cannot be discharged because they lack the health and social support to meet their post-acute care needs. Transitional care programs (TCPs) are designed to provide short-term and low-intensity restorative care to these older adults experiencing or at risk for delayed discharge. However, little is known about the contextual factors (i.e., patient, staff and environmental characteristics) that may influence the implementation and outcomes of TCPs. This scoping review aims to answer: 1) What are socio-demographic and/or clinical characteristics of older patients served by TCPs?; 2) What are the core components provided by TCPs?; and 3) What patient, caregiver, and health system outcomes have been investigated and what changes in these outcomes have been reported for TCPs? METHODS: The six-step scoping review framework and PRISMA-ScR checklist were followed. Studies were included if they presented models of TCPs and evaluated them in community-dwelling older adults (65+) experiencing or at-risk for delayed discharge. The data synthesis was informed by a framework, consistent with Donabedian's structure-process-outcome model. RESULTS: TCP patients were typically older women with multiple chronic conditions and some cognitive impairment, functionally dependent and living alone. The review identified five core components of TCPs: assessment; care planning and monitoring; treatment; discharge planning; and patient, family and staff education. The main outcomes examined were functional status and discharge destination. The results were discussed with a view to inform policy makers, clinicians and administrators designing and evaluating TCPs as a strategy for addressing delayed hospital discharges. CONCLUSION: TCPs can influence outcomes for older adults, including returning home. TCPs should be designed to incorporate interdisciplinary care teams, proactively admit those at risk of delayed discharge, accommodate persons with cognitive impairment and involve care partners. Additional studies are required to investigate the contributions of TCPs within integrated health care systems.

Building Capacity in Health Professionals to Conduct Quality Improvement: Evaluation From a Collaborative Interorganizational Program.

BACKGROUND: The Toronto Academic Health Sciences Network Health Professions Innovation Fellowship Program began in 2014 as a pilot initiative among 4 academic teaching hospitals in Toronto, Ontario. The purpose of the Program was to cultivate applied leadership, interprofessional collaboration, and quality improvement capacity among health professionals. PURPOSE: This article reports on the evaluation findings from the initial year as well as an update on current program status and sustainability. METHODS: A formative evaluation was conducted focused on the impact on clinical practice, participant skill development, participant experience, and cross-organizational partnerships. Data were collected through a focus group, interviews, and pre- and postsurveys. RESULTS: Data from the initial pilot showed increases in leadership practices, project management, and quality improvement knowledge, with changes in leadership practices being significant. Positive changes in clinical practice at both the individual and unit/team levels and capacity for building relationships were also reported. Since the pilot, more than 160 participants from 15 health professions and 9 organizations have participated. Several graduates have taken on leadership roles since their participation in the Program. CONCLUSIONS: Health care organizations wishing to advance academic practice may benefit from implementing a similar collaborative program to reap benefits beyond organizational silos.

Screening for hand dermatitis in healthcare workers: Comparing workplace screening with dermatologist photo screening.

BACKGROUND: Healthcare workers are at increased risk for occupational contact dermatitis, owing to wet work exposure. Early detection and management improves outcomes. Although several diagnostic tools are available, none is appropriate for rapid screening. OBJECTIVES: To assess the validity and feasibility of the Hand Dermatitis Screening Tool in the acute healthcare sector. METHODS: Screening of 508 employees at three hospitals in Ontario, Canada was performed with the Hand Dermatitis Screening Tool either by an occupational health nurse (N = 225) or by self-administration (N = 283). Two occupational dermatologists rated photographs of participants' hands. RESULTS: Of the participants, 30.5% screened positive for hand dermatitis. A positive screen was associated with wet work, history of eczema, dermatitis, or other rash, and currently having a rash. Ninety-four per cent of participants reported that using the tool took <2 minutes, 99% indicated that the tool was easy to use, and 86% stated that workplace screening was very important. Workplace and dermatologist photo screening showed fair agreement. CONCLUSIONS: The prevalence of hand dermatitis and identified risk factors were consistent with the literature. These findings, along with positive feasibility results, support further testing of the tool despite only fair agreement between workplace and dermatologist screening.

The development and testing of a tool to assess joint health and safety committee functioning and effectiveness.

BACKGROUND: Concern regarding functioning and effectiveness of joint health and safety committees (JHSCs) in Ontario hospitals was raised following the Severe Acute Respiratory Syndrome outbreak in 2003. A subsequent literature review revealed a lack of studies focused within the healthcare sector. METHODS: A tool to measure JHSC effectiveness was developed by a panel of occupational health and safety experts based on a framework from the healthcare sector. Usability testing was conducted in two phases with members of five hospital JHSCs before, during and after a committee meeting. RESULTS: Usability of the tool was scored high overall with an average of > 4 on a 5 point scale across twelve items. Downward adjustment of self-assessment scores was reported following JHSC meetings. CONCLUSION: Findings demonstrated that the tool was easy to use, effective in supporting discussion and in assisting participants in reaching consensus on rating a large number of JHSC characteristics. Am. J. Ind. Med. 60:368-376, 2017. © 2017 Wiley Periodicals, Inc.

Cancer symptom management in the home: A scoping review.

The aim of this scoping review was to examine interventions used by nurses in the home setting for symptom management of adults with cancer. Databases were searched (CINAHL, Medline, PubMed, EBM Reviews, Joanna Briggs Institute EBP) with key words cancer, home, nursing, symptom, and protocol. Out of 390 identified citations, five met the inclusion criteria. Studies were conducted from 1989 to 2009. Findings revealed that home care nursing services improved symptom management, promoted independence, maintained quality of life, and decreased use of health care services. Two studies used evidence-based guidelines for cancer symptom management. Although few studies have explored nursing interventions for cancer symptom management in the home setting, their evidence suggests some improved client- and system-level outcomes.

Feasibility study of microburst VNS therapy in drug-resistant focal and generalized epilepsy.

BACKGROUND: Vagus nerve stimulation (VNS) at low frequencies (≤30 Hz) has been an established treatment for drug-resistant epilepsy (DRE) for over 25 years. OBJECTIVE: To examine the initial safety and efficacy performance of an investigational, high-frequency (≥250 Hz) VNS paradigm herein called "Microburst VNS" (µVNS). µVNS consists of short, high-frequency bursts of electrical pulses believed to preferentially modulate certain brain regions. METHODS: Thirty-three (33) participants were enrolled into an exploratory feasibility study, 21 with focal-onset seizures and 12 with generalized-onset seizures. Participants were titrated to a personalized target dose of µVNS using an investigational fMRI protocol. Participants were then followed for up to 12 months, with visits every 3 months, and monitored for side-effects at all time points. This study was registered as NCT03446664 on February 27th, 2018. RESULTS: The device was well-tolerated. Reported adverse events were consistent with typical low frequency VNS outcomes and tended to diminish in severity over time, including dysphonia, cough, dyspnea, and implant site pain. After 12 months of µVNS, the mean seizure frequency reduction for all seizures was 61.3% (median reduction: 70.4%; 90% CI of median: 48.9%-83.3%). The 12-month responder rate (≥50% reduction) was 63.3% (90% CI: 46.7%-77.9%) and the super-responder rate (≥80% reduction) was 40% (90% CI: 25.0%-56.6%). Participants with focal-onset seizures appeared to benefit similarly to participants with generalized-onset seizures (mean reduction in seizures at 12 months: 62.6% focal [n = 19], versus 59.0% generalized [n = 11]). CONCLUSION: Overall, µVNS appears to be safe and potentially a promising therapeutic alternative to traditional VNS. It merits further investigation in randomized controlled trials which will help determine the impact of investigational variables and which patients are most suitable for this novel therapy.

Factors Influencing Self-reported Facial Protective Equipment adherence among Home Care Nurses and Personal Support Workers - A multi-site cross-sectional study.

BACKGROUND: Facial Protective Equipment (FPE) use increased during the SARS-CoV-2 pandemic. This study explored factors influencing home care personal support workers' (PSWs) and nurses' self-reported adherence to FPE. METHODS: A cross-sectional, electronic, survey was distributed to PSWs and nurses (1108 complete responses) at three home care agencies in Ontario, Canada, in May-June 2022. Descriptive, bivariate, and multivariable analysis were used to assess individual, environmental, and organizational factors influencing adherence. RESULTS: Among participants (786 PSWs, 322 nurses), 64% reported being adherent to both respiratory and eye FPE (Respiratory: 96%, Eye: 64%). Higher adherence was associated with facility-based work; better knowledge of FPE; pre-pandemic FPE use; good availability and convenient access; strong organizational support for health and safety; and Caribbean identity. Lower adherence was found for men; nurses with 2-year diplomas; shorter length of employment; communal transportation; and experiencing negative mental health effects from workplace infectious disease exposure. DISCUSSION: Agencies should prioritize increasing providers' knowledge of FPE, supporting mental well-being, fostering a supportive culture, and ensuring availability of FPE. The influences of gender, ethnicity, and role require further exploration. CONCLUSION: FPE adherence may be improved by addressing modifiable factors and developing population-specific strategies.

Factors influencing nursing professionals' adherence to facial protective equipment usage: A comprehensive review.

BACKGROUND: Facial protective equipment (FPE) adherence is necessary for the health and safety of nursing professionals. This review was conducted to synthesize predisposing, enabling, and reinforcing factors that influence FPE adherence, and thus inform efforts to promote adherence. METHODS: Articles were collected using Cumulated Index to Nursing and Allied Health Literature and MEDLINE and screened for inclusion. Included articles were original studies focused on FPE adherence by nurses to prevent respiratory infection which contained occupation-specific data from at least 10 individuals and were published in English between January 2005 and February 2022. RESULTS: Thirty articles were included, 21 of which reported adherence rates. Adherence ranged from 33% to 100% for respiratory protection and 22% to 100% for eye protection. Predisposing demographic factors influencing adherence included tenure and occupation, while modifiable predisposing factors included knowledge and perception of FPE, infection transmission, and risk. Enabling factors included geography, care settings, and FPE availability. Reinforcing factors included organizational support for health and safety, clear policies, and training. CONCLUSIONS: The identified demographic factors suggest populations that may benefit from targeted interventions, while modifiable factors suggest opportunities to enhance education as well as operational processes and supports. Interventions that target these areas have the potential to promote adherence and thereby improve the occupational safety of nurses.

Determinants of nurse's and personal support worker's adherence to facial protective equipment in a community setting during the COVID-19 pandemic in Ontario, Canada: A pilot study.

BACKGROUND: Appropriate and consistent facial protective equipment (FPE) use is critical for preventing respiratory illness transmission. Little is known about FPE adherence by home care providers. The purpose of this study is to adapt an existing facial protection questionnaire and use it to develop an initial understanding of factors influencing home care providers' adherence to FPE during the COVID-19 pandemic. METHODS: A survey was shared with home care providers during Wave 2 of the COVID-19 pandemic in Ontario. Descriptive statistics and logistic regression by FPE adherence were conducted across individual, organizational, and environmental factors. RESULTS: Of the 199 respondents (140 personal support workers; 59 nurses), 71% reported that they always used FPE as required, with greater adherence to masks (89%) than eye protection (73%). The always-adherent reported greater perceived FPE efficacy, knowledge of recommended use and perceived occupational risk, lower education, and not experiencing personal barriers (including difficulty seeing, discomfort, communication challenges). DISCUSSION: Adherence rates were relatively high. In this context, with participants reporting high levels of organizational support, individual-level factors were the significant predictors of adherence. CONCLUSIONS: Initiatives addressing perceived FPE efficacy, knowledge of recommended use, perception of at-work risk, and personal barriers to use may improve FPE adherence.

Economic Evidence for Home and Community Care Investment: The Case for Ontario Personal Support Workers' Wage Parity.

The home and community care (HCC) sector is in a health human resource crisis. Particularly concerning is the shortage of personal support workers (PSWs) who provide the majority of HCC. This paper outlines a strategy to mitigate the HCC PSW shortage by applying appropriate funding to HCC and focusing on equal pay between HCC and institutional long-term care facilities' PSWs. Using publicly available data, our calculations estimate substantial government cost-savings from investing in HCC PSWs to increase HCC capacity. Beyond the economic evidence, how such investments would benefit those seeking care are also highlighted.

A Good Investment: Expanding Capacity to Care for Older Adults in the Home and Community Care Sector Through Increased Personal Support Worker Wages.

Most older adults prefer to age in place, which for many will require home and community care (HCC) support. Unfortunately, HCC capacity is insufficient to meet demand due in part to low wages, particularly for personal support workers (PSWs) who provide the majority of paid care. Using Ontario as a case study, this paper estimates the cost and capacity impacts of implementing wage parity between PSWs employed in HCC and institutional long-term care (ILTC). Specifically, we consider the cost of increased HCC PSW wages versus expected savings from avoiding unnecessary ILTC placement for those accommodated by HCC capacity growth. The expected increase in HCC PSW retention would create HCC capacity for approximately 160,000 people, reduce annual health system costs by approximately $7 billion, and provide an 88 per cent return on investment. Updating wage structures to reduce turnover and enable HCC capacity growth is a cost-efficient option for expanding health system capacity.

"You Have to Be Careful About Every Detail" How the COVID-19 Pandemic Shaped the Experiences of Canadian Personal Support Workers Working in Home Care.

OBJECTIVES: Personal support workers (PSWs) are an essential but vulnerable workforce supporting the home care sector in Canada. Given the impact COVID-19 has had on healthcare workers globally, understanding how PSWs have been impacted is vital. METHODS: We conducted a qualitative descriptive study to understand the working experiences of PSWs over the COVID-19 pandemic. Nineteen semistructured interviews were conducted, and analysis was guided by the collaborative DEPICT framework. RESULTS: Personal support workers are motivated by an intrinsic duty to work and their longstanding client relationships despite feeling vulnerable to transmission and infection. They experienced co-occurring occupational stressors and worsening work conditions, which impacted their overall well-being. CONCLUSIONS: Pandemic conditions have contributed to increased occupational stress among PSWs. Employers must implement proactive strategies that promote and protect the well-being of their workforce while advocating for sector improvements.

Occupational Hand Dermatitis in Health Care: Development and Evaluation of an Online Training E-Module.

Background: Occupational hand dermatitis (OHD) is an important health concern for health care workers (HCWs), yet there is a lack of accessible training materials on this topic. Objectives: The objective of this study was to develop and evaluate an OHD training e-module for HCWs. Methods: The e-module was created in collaboration with an expert advisory committee and tested by Ontario HCWs through pre- and post-training OHD knowledge tests, a usability survey, and a survey about intent to change work skin care practices. Analyses of survey results included means and paired t-tests. Results: The 10-minute OHD training e-module for HCWs was tested by 254 HCWs and found to be highly usable, to increase OHD knowledge immediately and sustainably, and to change workplace skin care practices. Average OHD knowledge test scores significantly improved by 19% between the pretest (64.50%) and post-test (83.50%). Most 6-month follow-up survey respondents reported changing their skin care work practices (76.69%). Conclusions: This research addresses the previous lack of accessible OHD training for workers in health care settings. The creation and evaluation of a no-cost accessible OHD training e-module for workers in health care settings showed promising results across knowledge increase, knowledge retention, skin care behavior changes, and usability.

Cardiovascular fitness is associated with altered cortical glucose metabolism during working memory in ɛ4 carriers.

BACKGROUND: The possibility that ɛ4 may modulate the effects of fitness in the brain remains controversial. The present exploratory FDG-PET study aimed to better understand the relationship among ɛ4, fitness, and cerebral metabolism in 18 healthy aged women (nine carriers, nine noncarriers) during working memory. METHODS: Participants were evaluated using maximal level of oxygen consumption, California Verbal Learning Test, and FDG-PET, which were collected at rest and during completion of the Sternberg working memory task. RESULTS: Resting FDG-PET did not differ between carriers and noncarriers. Significant effects of fitness on FDG-PET during working memory were noted in the ɛ4 carriers only. High fit ɛ4 carriers had greater glucose uptake in the temporal lobe than the low fit ɛ4 carriers, but low fit ɛ4 carriers had greater glucose uptake in the frontal and parietal lobes. CONCLUSIONS: We demonstrate that fitness differentially affects cerebral metabolism in ɛ4 carriers only, consistent with previous findings that the effects of fitness may be more pronounced in populations genetically at risk for cognitive decline.

Construction sector joint health and safety committees: Can their effectiveness be assessed using the JHSC assessment eTool?

BACKGROUND: Joint health and safety committees (JHSCs) are a legal requirement for most Ontario workplaces. However, few evidence-based tools exist to assess JHSC effectiveness. The JHSC Assessment eTool has been developed and tested in the healthcare and education sectors with positive results. OBJECTIVE: The objective of this study is to test the usability and feasibility of the JHSC Assessment eTool in the construction sector. METHODS: Testing was carried out in two phases using a non-experimental study design. In the first phase, construction sector health and safety experts reviewed the content of the eTool to ensure that it had relevance for the sector. In phase two, a convenience sample of JHSCs from construction sector workplaces were recruited to pilot the eTool and provide feedback. RESULTS: Feedback from six constructor sector health and safety experts and six JHSC committees indicated that the eTool had value and relevance for use in the sector. Additionally, our study identified several minor areas for refinement including the addition of construction-specific resources in the final report. CONCLUSIONS: The results of our study suggest minor modifications to the eTool for use by construction sector workplaces.

Spot It, Prevent It: Evaluation of a Rapid Response Algorithm for Managing Workplace Violence Among Home Care Workers.

BACKGROUND: Workplace violence incidents remain pervasive in health care. Home care workers like personal support workers (PSWs) provide services for clients with dementia, which has been identified as a risk factor for workplace violence. The objective of this study was to evaluate whether the implementation of a rapid response algorithm resolved unsafe working conditions associated with responsive behaviors and decreased perception of risk. METHODS: A nonexperimental pre- and post-evaluation design was utilized to collect data from PSWs and supervisors. PSWs completed an online survey about their experience with workplace violence and perception of risk. Bi-weekly check-ins were conducted with supervisors to track incidents and their level of resolution in the algorithm. Semi-structured interviews were also conducted to gather in-depth feedback about the algorithm in practice. FINDINGS: We found no difference in risk perception among PSWs pre- and post-implementation. However, PSWs who had been employed for less than 1 year had a significantly higher risk perception. Overall, the algorithm was found to be helpful in resolving workplace violence incidents. CONCLUSION AND APPLICATION TO PRACTICE: Opportunity exists to further refine the algorithm and ongoing dissemination, and implementation of the algorithm is recommended to continually address incidents of workplace violence. Newly hired PSWs may require additional supports. Ongoing education and training were identified as key mitigation strategies.

Sources of Cannabis Information and Medical Guidance for Neurologic Use: NARCOMS Survey of People Living With Multiple Sclerosis.

Background and Objectives: As cannabis products become increasingly accessible across the United States, understanding how patients obtain medical information on cannabis and view the role of their health care provider in providing information is important. Methods: Participants with multiple sclerosis (MS) from the North American Research Committee on Multiple Sclerosis registry completed a supplemental survey on Δ9-tetrahydrocannabinol-containing cannabis use between March and April 2020. Participants reported dialogue with health care providers regarding cannabis use, information sources used to make product decisions, and expenditure on cannabis. Findings are reported using descriptive statistics. Results: Overall, 3,249 participants responded (47% response rate), of whom 31% ever used cannabis and 20% currently used cannabis for MS. To determine presumed cannabis contents, respondents who had ever used cannabis (ever users) most often used dispensary-provided information (39%), word of mouth/dealer/friend (29%), and unregulated product labels (24%). For general information on cannabis for MS, ever users most often used dispensary staff (38%) and friends (32%). The primary source of medical guidance among ever users was most often "nobody or myself" (48%), followed by a dispensary professional (21%); only 12% relied on their MS physician, although 70% had discussed cannabis with their MS physician. Most current users (62%) typically sourced their cannabis from a dispensary. The most common factor in selecting a cannabis product was perceived quality and safety (70%). Discussion: Participants most often received information on cannabis for MS from dispensaries, unregulated product labels, and friends; only a small proportion used health care providers. Evidence-based patient and physician education is needed.