A scoping review of incidence and assessment tools for post-intensive care syndrome following cardiac surgery.

BACKGROUND: Post-intensive care syndrome is a new or worsening persistent deterioration in cognitive, mental, and/or physical health following a prolonged admission to an intensive care unit. Post-intensive care syndrome remains underexplored following cardiac surgery, with a lack of understanding of the incidence and tools used to measure the symptoms. A scoping review was conducted to determine the incidence and to identify the tools commonly used to measure symptoms of post-intensive care syndrome following cardiac surgery. METHODS: The electronic databases Medline (Ovid), EMBASE (Ovid), PsycINFO (Ovid), Scopus, and CINAHL (EBSCOhost) and Google Scholar were searched with keywords and controlled vocabulary to describe both cardiac surgery and post-intensive care syndrome (cardiac surgical procedures, heart surgery, and post-intensive care symptoms) and symptoms (delirium, depression, mobility and quality of life). Included were articles written in English and published after 2005 that described cognitive, mental, and physical symptoms of post-intensive care syndrome following cardiac surgery. 3,131 articles were found, with 565 duplicates, leaving 2,566 articles to be screened. Of these, seven unique studies were included. RESULTS: Five studies explored cognitive health, three mental health, one cognitive and mental health, and none physical health. No identified studies reported the overall incidence of post-intensive care syndrome following cardiac surgery. The incidence of cognitive health issues ranged from 21% to 38%, and mental health issues ranged from 16% to 99%. In total, 17 different tools were identified - 14 for cognitive health and three for mental health. No identified studies used the same tools to measure symptoms. No single tool was found to measure all three domains. CONCLUSION: This scoping review identified a literature gap specific to the incidence and inconsistency of assessment tools for post-intensive care syndrome in cardiac surgery patients. CLINICAL IMPLICATIONS: This work impacts clinical practice for the bedside nurse by raising awareness of an emerging health issue.

Gender-affirming care in undergraduate nursing education: a scoping review protocol.

INTRODUCTION: Transgender and gender-diverse (TGD) people face a multitude of barriers to safe, accessible healthcare. One way to overcome access inequities is through the provision of gender-affirming care. Gender-affirming care is culturally safe and engaged care that values TGD identities and is focused on depathologising TGD people. Additionally, gender-affirming care encompasses awareness and support of TGD individuals as unique beings, including supporting gender-affirming medical goals for those who are interested. The discipline of nursing is well situated to advocate for gender-affirming care, however, receives little undergraduate education in the subject. Undergraduate schools of nursing (including faculty and curriculum) are in a crucial position to implement gender-affirming care, though how they have done this is not widely known. Our scoping review aims to understand how Canadian and US undergraduate schools of nursing teach and integrate gender-affirming education. METHODS AND ANALYSIS: Our scoping review will follow the six stages by Arksey and O'Malley and the advancements by Levac et al, reported on as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. The review will be completed in 2023, with the database searches carried out in spring 2023, followed by screening and analysis. ETHICS AND DISSEMINATION: Ethics approval is not required for this protocol. To aid in knowledge translation, a visual representation of the findings will be created. Results from the final scoping review will be published in a peer-reviewed journal, promoted on social media to schools of nursing, and presented at conferences and seminars. PROTOCOL REGISTRATION NUMBER: Open Science Framework (https://doi.org/10.17605/OSF.IO/Q68BD).

A critical exploration of nurses' perceptions of access to oncology care among Indigenous peoples: Results of a national survey.

Inequities in access to oncology care among Indigenous peoples in Canada are well documented. Access to oncology care is mediated by a range of factors; however, emerging evidence suggests that healthcare providers, including nurses, play a significant role in shaping healthcare access. The purpose of this study was to critically examine access to oncology care among Indigenous peoples in Canada from the perspective of oncology nurses. Guided by postcolonial theoretical perspectives, interpretive descriptive and critical discourse analysis methodologies informed study design and data analysis. Oncology nurses were recruited from across Canada to complete an online survey (n = 78). Nurses identified a range of barriers experienced by Indigenous peoples when accessing oncology care, yet located these barriers primarily at the individual and systems levels. Nurses perceived themselves as mediators of access to oncology care; however, their efforts to facilitate access to care were constrained by the dominance of biomedicine within healthcare. Nurses' constructions of access to oncology care highlight the embedded narrative of individualism within nursing practice and the relative invisibility of racism as a determinant of equitable access to care among Indigenous peoples. This suggests a need for oncology nurses to better understand and incorporate structural determinants of health perspectives.

Historical and Continued Colonial Impacts on Heart Health of Indigenous Peoples in Canada: What's Reconciliation Got to Do With It?

Colonization and enforced genocidal strategies have collectively fractured and changed Indigenous people by attempting to erase and dismiss their voices and knowledge. Nearly a decade ago, we were reminded by Dr Ku Young of the cardiovascular health disparities, in evidence among Indigenous people in Canada. compared with White people. He went on to say that beyond a biomedical understanding of this health status is the ongoing impact of long-standing marginalization and oppression faced by Indigenous people. Limited attention has been afforded to advance our understanding of these colonial impacts on Indigenous people and their heart health. This article contributes to our collective understanding of Indigenous people and their cardiac health by covering the following topics: layers of foundational truths of relevance to healthcare contexts and Indigenous people; a critical reflection of Western (biomedical) perspectives concerning cardiac health among Indigenous people; and materials from 2 studies, funded by the Canadian Institutes of Health Research, in which Indigenous voices and experiences were privileged concerning the heart and caring for the heart. In the final section, 3 topics are offered as starting points for self-reflection and acts of reconciliation within healthcare practice, decision-making, and research: reflections on self and one's worldview; anti-racist healthcare practice; and 2-eyed seeing approaches to work within healthcare contexts. A common thread is the imperative for "un-silencing" Indigenous people's voices, experiences, and knowledge, which is a requirement if addressing the identified cardiovascular health disparities is truly a health priority.

La colonisation et les stratégies génocidaires mises en œuvre ont concouru à diviser et à transformer les peuples autochtones dans une tentative d'effacement et de rejet de leurs voix et de leurs connaissances. Il y a près d'une décennie, le Dr Ku Young nous a rappelé les disparités en matière de santé cardiovasculaire, mises en évidence chez les peuples autochtones du Canada comparativement aux blanches. Il a ensuite déclaré que, outre la dimension biomédicale de cette situation sanitaire, l'effet de la marginalisation et de l'oppression de longue date des peuples autochtones est en cause et qu'il continue de se faire sentir. Peu d'attention a été accordée à l'avancement de notre compréhension des effets de la colonisation sur les peuples autochtones et leur santé cardiaque. Le présent article contribue à notre compréhension collective des peuples autochtones et de leur santé cardiaque en abordant : les strates de vérités fondamentales importantes dans le contexte des soins de santé et pour les peuples autochtones; les points de vue occidentaux (biomédicaux) sur la santé cardiaque des peuples autochtones, sous l'angle d'une réflexion critique; les données de deux études, financées par les Instituts de recherche en santé du Canada, où les voix et le vécu des autochtones ont été privilégiés en matière de santé cardiaque et au regard de ce qu'elle implique. Dans la dernière partie de notre article, les trois thèmes suivants sont présentés comme autant de points de départ d'une autoréflexion et de gestes de réconciliation en matière de prestation de soins de santé, de prise de décision et de recherche : réflexion sur soi-même et sa vision du monde; prestation de soins de santé antiraciste; approche à double perspective des soins de santé. Il est impératif de briser le silence et de « laisser s'exprimer ¼ les voix, le vécu et les connaissances des peuples autochtones. Ce constat est un des fils conducteurs de notre analyse. Il faut agir en conséquence si tant est que l'élimination des disparités observées en matière de santé cardiovasculaire constitue vraiment une priorité sanitaire.

Nurses as agents of disruption: Operationalizing a framework to redress inequities in healthcare access among Indigenous Peoples.

Health equity is a global concern. Although health equity extends far beyond the equitable distribution of healthcare, equitable access to healthcare is essential to the achievement of health equity. In Canada, Indigenous Peoples experience inequities in health and healthcare access. Cultural safety and trauma- and violence-informed care have been proposed as models of care to improve healthcare access, yet practitioners lack guidance on how to implement these models. In this paper, we build upon an existing framework of equity-oriented care for primary healthcare settings by proposing strategies to guide nurses in operationalizing cultural safety and trauma- and violence-informed care into nursing practice at the individual level. This component is one strategy to redress inequitable access to care among Indigenous Peoples in Canada. We conceptualize barriers to accessing healthcare as intrapersonal, interpersonal, and structural. We then define three domains for nursing action: practicing reflexivity, prioritizing relationships, and considering the context. We have applied this expanded framework within the context of Indigenous Peoples in Canada as a way of illustrating specific concepts and focusing our argument; however, this framework is relevant to other groups experiencing marginalizing conditions and inequitable access to healthcare, and thus is applicable to many areas of nursing practice.

Elevating the uses of storytelling approaches within Indigenous health research: a critical and participatory scoping review protocol involving Indigenous people and settlers.

BACKGROUND: There is a complicated and exploitative history of research with Indigenous peoples and accompanying calls to meaningfully and respectfully include Indigenous knowledge in healthcare. Storytelling approaches that privilege Indigenous voices can be a useful tool to break the hold that Western worldviews have within the research. Our collaborative team of Indigenous and non-Indigenous researchers, and Indigenous patients, Elders, healthcare providers, and administrators, will conduct a critical participatory, scoping review to identify and examine how storytelling has been used as a method in Indigenous health research. METHODS: Guided by two-eyed seeing, we will use Bassett and McGibbon's adaption of Arksey and O'Malley's scoping review methodology. Relevant articles will be identified through a systematic search of the gray literature, core Indigenous health journals, and online databases including Scopus, MEDLINE, Embase, CINAHL, AgeLine, Academic Search Complete, Bibliography of Native North Americans, Canadian Reference Centre, and PsycINFO. Qualitative and mixed-methods research articles will be included if the researchers involved Indigenous participants or their healthcare professionals living in Turtle Island (i.e., Canada and the USA), Australia, or Aotearoa (New Zealand); use storytelling as a research method; focus on healthcare phenomena; and are written in English. Two reviewers will independently screen titles/abstracts and full-text articles. We will extract data, identify the array of storytelling approaches, and critically examine how storytelling was valued and used. An intensive collaboration will be woven throughout all review stages as academic researchers co-create this work with Indigenous patients, Elders, healthcare professionals, and administrators. Participatory strategies will include four relational gatherings throughout the project. Based on our findings, we will co-create a framework to guide the respectful use of storytelling as a method in Indigenous health research involving Indigenous and non-Indigenous peoples. DISCUSSION: This work will enable us to elucidate the extent, range, and nature of storytelling within Indigenous health research, to critically reflect on how it has been and could be used, and to develop guidance for the respectful use of this method within research that involves Indigenous peoples and settlers. Our findings will enable the advancement of storytelling methods which meaningfully include Indigenous perspectives, practices, and priorities to benefit the health and wellbeing of Indigenous communities. SYSTEMATIC REVIEW PROTOCOL REGISTRATION: Open Science Framework ( https://osf.io/rvf7q ).

A scoping approach to systematically review published reviews: Adaptations and recommendations.

Knowledge translation is a central focus of the health research community, which includes strategies to synthesize published research to support uptake within health care practice and policy arenas. Within the literature concerning review methodologies, a new discussion has emerged concerning methods that review and synthesize published review articles. In this paper, our multidisciplinary team from family medicine, nursing, dental hygiene, kinesiology, occupational therapy, physiology, population health, clinical psychology, and library sciences contributes to this discussion by sharing our experiences in conducting 3 scoping reviews of published review studies. A brief discussion of Cochrane Collaboration overview reviews and Joanna Briggs Institute umbrella reviews foreshadows a discussion of insights from our experiences of conducting the 3 scoping reviews of published reviews. We address 6 adaptations along with our recommendations for each, which may guide other researchers with designing scoping review approaches to synthesize published reviews. The ability of researchers to publish research findings is growing, and our ability to effectively transfer findings into useful evidence for health care practice and policy is imperative to our work.

Listening to those who are living with HIV and tobacco dependence and exploring their health care context.

The emergence of antiretroviral therapies extends the life span of people diagnosed with HIV and shifts health priorities toward chronic disease management. People living with HIV (PLWH) who smoke cigarettes are more likely than nonsmokers to develop health conditions such as pneumonia, cancer, emphysema, and heart disease. Our mixed methods study utilized semi-structured interviews (n = 29) to explore PLWH perceptions of tobacco and its role in their lives. We also explored HIV health care services and tobacco dependence treatment. Local HIV clinic staff (n = 4) participated in interview and focus group discussions that examined their practices and clinic services concerning tobacco dependence treatment. A brief survey of Canadian AIDS Society members shed light on trends in clinic-based tobacco dependence treatments (n = 24). The following themes emerged: competing health priorities for PLWH; interest in quitting; and disconnect between tobacco use, health, and living.

A Conceptual Framework of Organizational Capacity for Public Health Equity Action (OC-PHEA).

The Canadian public health sector's foundational values of social justice and equity, and its mandate to promote population health, make it ideally situated to take a strong lead in addressing persistent and unacceptable inequities in health between socially disadvantaged, marginalized or excluded groups and the general population. There is currently much attention paid to improving understanding of pathways to health equity and development of effective population health interventions to reduce health inequities. Strengthening the capacity of the public health sector to develop, implement and sustain equity-focused population health initiatives - including readiness to engage in a social justice-based equity framework for public health - is an equally essential area that has received less attention. Unfortunately, there is evidence that current capacity of the Canadian public health sector to address inequities is highly variable. The first step in developing a sustained approach to improving capacity for health equity action is the identification of what this type of capacity entails. This paper outlines a Conceptual Framework of Organizational Capacity for Public Health Equity Action (OC-PHEA), grounded in the experience of Canadian public health equity champions, that can guide research, dialogue, reflection and action on public health capacity development to achieve health equity goals.

The tobacco control community of tomorrow: a vision for training.

OBJECTIVE: Current and emerging public health challenges require a new approach to research training. The purpose of the CIHR-Strategic Training Program in Tobacco Research (STPTR) is to equip the next generation of scientific leaders with the knowledge, skills and experiences that will enhance their ability to conduct tobacco research that will have a positive impact on the health of the population. PARTICIPANTS: Graduate students or post-doctoral fellows from any university in Canada who are working with a STPTR Mentor in the broad area of tobacco control. SETTING: Mentors at three universities: University of British Columbia, University of Toronto, and University of Waterloo. INTERVENTION: The STPTR currently has four elements: a video course linking STPTR trainees and mentors across universities; an annual meeting; stipend awards that free CIHR STPTR fellows to concentrate on research; and personal, cross-disciplinary research mentoring. OUTCOMES: Feedback solicited from current and past trainees at the three-year point of the program suggests that there are four key value-added benefits associated with being a trainee in the STPTR: transdisciplinary connectedness, community building, capacity building, and exposure. CONCLUSION: Feedback from trainees at different stages in their training experience, different academic institutions, and different academic disciplines will inform the ongoing framing of the STPTR and may inform future training programs in other disciplines of chronic disease prevention, health promotion, and the emerging science of population-level intervention.

Knowledge development and evidence-based practice: insights and opportunities from a postcolonial feminist perspective for transformative nursing practice.

Although not without its critics, evidence-based practice is widely espoused as supporting professional nursing practice. Engaging with the evidence-based practice discourse from a vantage point offered by the critical perspectives of postcolonial feminism, the incomplete epistemologies and limitations of the standardization characteristic of the evidences-based movement are analyzed. Critical analysis of evidence is suggested, such that it recognizes the evidence generated from multiple paradigms of inquiry, along with contextual interpretation and application of this evidence. We examine how broader interpretations of evidence might contribute to nursing knowledge development and translation for transformative professional nursing practice, and ultimately to address persistent health disparities within the complex context of healthcare delivery.

An ethnographic study of tobacco control in hospital settings.

BACKGROUND: Tobacco control in hospital settings is characterised by a focus on protection strategies and an increasing expectation that health practitioners provide cessation support to patients. While practitioners claim to have positive attitudes toward supporting patient cessation efforts, missed opportunities are the practice norm. OBJECTIVE: To study hospital workplace culture relevant to tobacco use and control as part of a mixed-methods research project that investigated hospital-based registered nurses' integration of cessation interventions. DESIGN: The study was conducted at two hospitals situated in British Columbia, Canada. Data collection included 135 hours of field work including observations of ward activities and designated smoking areas, 85 unstructured conversations with nurses, and the collection of patient-care documents on 16 adult in-patient wards. RESULTS: The findings demonstrate that protection strategies (for example, smoking restrictions) were relatively well integrated into organisational culture and practice activities but the same was not true for cessation strategies. An analysis of resources and documentation relevant to tobacco revealed an absence of support for addressing tobacco use and cessation. Nurses framed patients' tobacco use as a relational issue, a risk to patient safety, and a burden. Furthermore, conversations revealed that nurses tended to possess only a vague awareness of nicotine dependence. CONCLUSION: Overcoming challenges to extending tobacco control within hospitals could be enhanced by emphasising the value of addressing patients' tobacco use, raising awareness of nicotine dependence, and improving the availability of resources to address addiction issues.