ABSTRACT
PURPOSE: Preoperative pain medicine consultations with opioid-tolerant patients allow for an accurate medication history, patient involvement in the postoperative plan, and realistic goal setting. The purpose of this quality improvement project was to increase attendance at preoperative pain consultations, thereby increasing patient satisfaction. METHODS: Retrospective chart reviews identified patients who had a preoperative pain consultation ordered from May through July 2016. Patient interviews determined reasons for not attending appointments, involvement in goal setting, engagement in pain management planning, and satisfaction with postoperative pain management. RESULTS: Retrospective chart reviews and interviews were conducted after the intervention (May-July 2017). Scheduling changes increased attendance at preoperative pain consultations by 14 percentage points (50% vs 64%). Those who attended consultations were more involved in goal setting and decisions and were more satisfied. CONCLUSIONS: Preoperative pain consultations with opioid-tolerant patients can increase satisfaction through realistic goal setting and involvement in the pain management plan.
Subject(s)
Pain, Postoperative , Personal Satisfaction , Humans , Pain, Postoperative/diagnosis , Pain, Postoperative/drug therapy , Patient Satisfaction , Referral and Consultation , Retrospective StudiesABSTRACT
Canada's rural shortage of health professionals can be offset by employing specially trained, locally-based paraprofessionals to implement professionally developed plans of care. Ontario's Integrated Services for Northern Children Program demonstrated the viability of this option. A review of 327 patient records and interviews with 100 parents, paraprofessionals, and professionals found that there was good continuity of care and satisfaction with care quality because the multidisciplinary professional team of consultants provided constant and consistent monitoring of the paraprofessionals. Ongoing treatment occurred in the community, eliminating the disruption to the children's lives that repeated trips to the city would cause. Rural residents place a premium on care at home. Liability issues for employers and for professionals who delegate caregiving tasks currently restrict the use of paraprofessionals; these can be addressed through certification based on practice standards and improved education programs.
Subject(s)
Allied Health Personnel , Rural Health Services , Canada , Continuity of Patient Care , Humans , Patient Satisfaction , Quality Assurance, Health Care , WorkforceABSTRACT
Many of Canada's northern First Nation communities experience difficulty recruiting and retaining appropriate nursing staff and must rely on relief nurses for short-term coverage. The latter often are not adequately prepared for the demanding nature of the practice. This study examined the consequences of nursing turnover on the continuity of care provided to residents of three Ojibway communities in northern Ontario. The findings are based on a review of 135 charts of oncology, diabetes, and mental health clients, and on interviews with 30 professional and paraprofessional health-care providers who served the communities. Nursing turnover is shown to detrimentally affect communications, medications management, and the range of services offered; it also results in compromised follow-up, client disengagement, illness exacerbation, and an added burden of care for family and community members.
Subject(s)
Community Health Nursing , Continuity of Patient Care/standards , Indians, North American , Medically Underserved Area , Nursing Staff , Personnel Turnover , Attitude of Health Personnel , Communication , Diabetes Mellitus/nursing , Health Services, Indigenous , Humans , Interprofessional Relations , Mental Disorders/nursing , Neoplasms/nursing , Nurse's Role , Nursing Administration Research , Nursing Audit , Nursing Methodology Research , Nursing Staff/psychology , Nursing Staff/supply & distribution , Ontario , Outcome and Process Assessment, Health Care/organization & administration , Personnel Turnover/statistics & numerical data , Quality of Health Care/standards , Surveys and Questionnaires , WorkforceABSTRACT
To address a recurring shortage of nurses in the aboriginal communities of Northwestern Ontario, the First Nations and Inuit Health Branch, Health Canada, commissioned a study to explore the viability of establishing a relief pool among nurses from nearby small industrial towns. An open/close-ended survey completed by a random sample of 237 nurses from the target population documented levels of awareness, willingness, and preparedness for northern practice, as well as recruitment incentives and disincentives. Findings demonstrate an awareness of the overlap between the professional and personal dimensions characteristic of such practices, and suggest support for innovative rotations that would cut across federal/provincial/community jurisdictions. Although complex, given time and willingness, a regional relief system seems viable.
Subject(s)
Nursing Staff/supply & distribution , Personnel Selection/methods , Rural Health Services , Transcultural Nursing , Humans , Indians, North American , Inuit , Ontario , WorkforceABSTRACT
OBJECTIVES: To illustrate how personal choice, or client self-reliance, is a determining factor in the management of cancer patients' care in northern Aboriginal communities. STUDY DESIGN: Multiple-site study done in the northwestern part of the Canadian Province of Ontario. METHOD: In-depth interviews with professionals and paraprofessionals involved in community-based delivery of cancer care. RESULTS: Study details how perceived care options, gender, awareness of disease and treatment, reaction to system-linked problems in care delivery, as well as cultural preferences influence clients' choices and care outcomes. CONCLUSION: The study underlines the interdependence between personal choice and the health care system; "bad" experiences with the system cause clients to disengage from care, while client disengagement results in reduced care options.
Subject(s)
Choice Behavior , Neoplasms/therapy , Population Groups/statistics & numerical data , Female , Humans , Interviews as Topic , Male , Neoplasms/ethnology , Neoplasms/psychology , Ontario , Patient ParticipationABSTRACT
Analysis of calls made to a northern Canadian Inuit crisis line in the territory of Nunavut between 1991 and 2001 revealed that the majority of users were adult females who called to discuss problems primarily related to relationships and loneliness/boredom. Younger callers tended to make prank calls. The volunteer staff used mostly empathetic listening and suggestions. Referral recommendations made were primarily to social services. Although some callers experienced a language barrier, others found the service to be helpful. Results suggest that the crisis line was underused by young Inuit males who represent a group that are most in need of crisis intervention.
Subject(s)
Crisis Intervention , Hotlines/statistics & numerical data , Inuit/psychology , Stress, Psychological , Adolescent , Adult , Age Factors , Canada , Child , Communication Barriers , Female , Humans , Loneliness , Male , Referral and Consultation , Sex Factors , Social Work , Suicidal Ideation , Young AdultABSTRACT
To address a shortage of health professional human resources and to overcome cultural barriers, the interdisciplinary health care teams practicing in most northern Canadian aboriginal communities include a number of paraprofessionals recruited locally. This model has great potential to fill service gaps in many rural contexts; there are challenges, however. Drawing from an extensive program of research in indigenous communities in the northwestern part of the Province of Ontario, we identify factors fundamental to effective team functioning: members' clarity about their own and others' roles, appreciation of their respective 'equal but different' knowledge bases, and confidence in one another's competence. We argue for an extension of the information on interdisciplinary practice included in health science education programs to address these issues, thereby enhancing the utility of paraprofessionals within the health human resource mix in rural areas.
Subject(s)
Allied Health Personnel/education , American Indian or Alaska Native , Health Services, Indigenous/standards , Patient Care Team/standards , Rural Health Services/standards , Canada , Humans , Ontario , Total Quality Management , WorkforceABSTRACT
To address concerns about disruptions in the continuity of health care delivered to residents in three remote aboriginal communities in northern Ontario, Canada, the local health authority initiated a study in collaboration with the department of Health Canada responsible for ensuring that aboriginal reserves receive mandatory health services, and an inter-disciplinary team of researchers from two universities. The study focussed on the delivery of oncology, diabetes and mental health care, specifically, as well as systems issues such as recruitment and retention of health human resources and financial costs. The paper discusses the procedures involved, the benefits derived and the challenges encountered in doing this as a community driven participatory action research project. It also summarizes the findings that led to community formulated policy and program recommendations.