Exploration of the advanced preparation nurse-mother role in care of children with chronic disease: A narrative inquiry.

AIM: To explore the lived experience of advanced preparation nurses (APNs) who are mothers (APN-mothers) as they seek care in the Emergency Department for a child with a chronic disease. DESIGN: Qualitative, Narrative Inquiry. METHODS: Narrative Inquiry was used to examine critical self-reflections of four (n = 4) APN-mothers. Directed by a question guide, participants engaged in the Narrative Reflective Process through metaphoric and artistic means. RESULTS: Participants identified salient challenges associated with their experiences. Narrative threads that emerged include feelings around being discovered, unfair expectations by healthcare providers, feelings of guilt and the tension from competing roles: APN and mother. CONCLUSION: APN-mothers represent a unique population with enhanced knowledge, skills and judgement; however, they indicate that there is insufficient communication and interprofessional collaboration between parents and Emergency Department staff. Further research is needed to foster and improve therapeutic relationships between APN-mothers and healthcare providers. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Findings can inform the development of family centred care guidelines for healthcare professional parents and their children. IMPACT: This study explores the experiences of an understudied population. This research will impact APN-mothers, healthcare professionals in the Emergency Department as well as nursing students and researchers. REPORTING METHOD: EQUATOR guidelines and SRQR reporting method used. PATIENT OR PUBLIC CONTRIBUTION: APN-mothers, caregivers and support persons of children with chronic disease enacted investigator-participant roles and were involved in each step of the study process. In addition, some patients (participants' children with chronic diseases) were included in data collected.

Using knowledge translation as a framework for the design of a research protocol.

Knowledge translation has been defined as the synthesis, dissemination, exchange and ethically sound application of knowledge to improve health, resulting in a stronger health-care system. Using KT activities to aid in the adoption of evidence into practice can address current health-care challenges such as increasing organizational practice standards, alleviating the risk for adverse events and meeting practitioner needs for evidence at the bedside. Two general forms of KT have been identified. These being integrated KT and end-of-grant KT. Integrated KT involves the knowledge users in the research team and in the majority of stages of the research process. End-of-grant KT relates to the translation of findings through a well-developed dissemination plan. This paper describes the process of using an integrated knowledge translation approach to design a research protocol that will examine the effectiveness of a web-based patient educational intervention. It begins with a description of integrated knowledge translation, followed by the presentation of a specific case example in which integrated knowledge translation is used to develop a nursing intervention. The major elements of integrated knowledge translation pertain to need for a knowledge user who represents the broad target user group, and who is knowledgeable in the area under investigation and who as authority to enact changes to practice. Use of knowledge users as equal partners within the research team; exploring all feasible opportunities for knowledge exchange; and working with knowledge users to identify all outcomes related to knowledge translation are the other major elements of integrated knowledge translation that are addressed throughout this paper. Furthermore, the relevance of psychosocial or educational interventions to knowledge translation is also discussed as a source of knowledge. In summary, integrated knowledge translation is an important tool for the development of new interventions, as it helps to apply science to practice accurately. It supports the elaboration of the design while enhancing the relevance of the intervention through the validation of feasibility and acceptability with clinicians and patients.

The Self-assessment for Organizational Capacity Instrument for evidence-informed health policy: preliminary reliability and validity of an instrument.

BACKGROUND: Health policymakers work in organizations that involve multiple competing demands and limited time to make decisions. Influential international policy organizations continue to publish guidance and recommendations without the use of high-quality research evidence. Few studies have described the process with which governments, including health ministries, use evidence to support health policymaking decisions. Research is needed to better understand the psychometric properties of instruments that assess health policy organizations' capacity to use research evidence. AIM: The purpose of this study was to assess the preliminary psychometric properties of an instrument which assesses organizational capacity for evidence use. METHODS: The instrument was administered by telephone survey from January to June 2011 using a purposeful sample of 57 Canadian health policymakers (policy analyst and senior management levels). Reliability of the instrument was assessed with Cronbach's α coefficient and item-to-total correlation for internal consistency; interitem coefficients were used to identify particular item redundancy. Discriminant validity was assessed using the known-group comparison approach, with the independent sample t-test to assess subscale responses of policy analysts and senior managers. FINDINGS: Cronbach's α indicated acceptable internal consistency across its subscales. Discriminant validity analysis revealed a statistically significant difference between policy analysts and senior managers for one subscale. LINKING EVIDENCE TO ACTION: Our study provides a first look at the Self-assessment for Organizational Capacity Instrument's psychometric properties and demonstrates that this instrument can be useful when evaluating government and other organizations' use of evidence to inform decision making. Further testing of this instrument is needed using large and varied samples of policymakers, from policy analysts to senior managers, across varied policymaking contexts. This instrument can be a starting point for government and related organizations to better understand how well it supports evidence use, including its acquisition, appraisal, and use in health policy decision making.

Minimizing the risk of intrusion: a grounded theory of intimate partner violence disclosure in emergency departments.

AIMS: To report a study of processes used by women to disclose intimate partner violence to healthcare professionals in urban emergency department settings. BACKGROUND: Women seek emergency care for impairment related to intimate partner violence yet face barriers non-judgmental and supportive care. DESIGN: A two-phase sequential explanatory mixed methods study. METHODS: The study was conducted in Ontario, Canada (May 2006-December 2007). In a sub-analysis of quantitative data with 1182 participants, 15% of women patients reported intimate partner violence, but only 2% disclosed to a healthcare professional. To understand these results, grounded theory with 19 participants was completed. RESULTS/FINDINGS: Participants identified that the basic social problem was the violence 'being found out' by healthcare professionals while receiving care. To address this problem, women undertook a process to minimize intrusion including: deciding to seek care, evaluating the level of trust with the presenting healthcare professional, and establishing personal readiness to disclose. The trajectory of this process was different for each participant with some negotiating all phases leading to violence disclosure. The length of time it took for participants to move through each phase varied across all participants. Common to all participants was the anticipation and the actual experience of intrusion and its influence on women's willingness to disclose intimate partner violence. CONCLUSION: The results suggest nurses may be able to facilitate disclosure of intimate partner violence through limiting intrusion. This can include assessment in a private setting, and fewer professionals who interact with the client.

A new approach to digital health? Virtual COVID-19 care: A scoping review.

Aims: The use of virtual care enabled by digital technologies has increased, prompted by public health restrictions in response to COVID-19. Non-hospitalized persons in the acute phase of COVID-19 illness may have unique health needs while self-isolating in the community. This scoping review aimed to explore the nature of care, the use of digital technologies, and patient outcomes arising from virtual care among community-based self-isolating COVID-19 patients. Methods: Literature searches for peer-reviewed articles were conducted in four bibliographic databases: CINAHL, Medline, Embase and Cochrane Database of Systematic Reviews between January and February 2022, followed by hand-searching reference lists of included articles. Two levels of screening using defined eligibility criteria among two independent reviewers were completed. Results: Of the 773 articles retrieved, 19 were included. Results indicate that virtual care can be safe while enabling timely detection of clinical deterioration to improve the illness trajectory. COVID-19 virtual care was delivered by single health professionals or by multidisciplinary teams using a range of low-technology methods such as telephone to higher technology methods like wearable technology that transmitted physiological data to the care teams for real-time or asynchronous monitoring. Conclusion: The review described the varied nature of virtual care including its design, implementation, and evaluation. Further research is needed for continued exploration on how to leverage digital health assets for the delivery of appropriate and safe virtual COVID-19 community care, which can support patient recovery, control transmission, and prevent intensifying the burden on the health care system, especially during surges.

What are COVID-19 Patient Preferences for and Experiences with Virtual Care? Findings From a Scoping Review.

Virtual care became a routine method for healthcare delivery during the coronavirus disease 2019 (COVID-19) pandemic. Patient preferences are central to delivering patient-centered and high-quality care. The pandemic challenged healthcare organizations and providers to quickly deliver safe healthcare to COVID-19 patients. This resulted in varied implementation of virtual healthcare services. With an increased focus on remote COVID-19 monitoring, little research has examined patient experiences with virtual care. This scoping review examined patient experiences and preferences with virtual care among community-based self-isolating COVID-19 patients. We identified a paucity of literature related to patient experiences and preferences regarding virtual care. Few articles focused on patient experiences and preferences as a primary outcome. Our research suggests that (1) patients view virtual care positively and to be feasible to use; (2) patient access to technology impacts patient satisfaction and experiences; and (3) to enhance the patient experience, healthcare organizations and providers need to support patient use of technology and resolve technology-related issues. When planning virtual care modalities, purposeful consideration of patient experiences and preferences is needed to deliver quality patient-centered care.

Newcomer Women's Experiences with Perinatal Care During the Three-Month Health Insurance Waiting Period in Ontario, Canada.

BACKGROUND: The three-month health insurance waiting period in Ontario reinforces health inequities for newcomer women and their babies. Little is known about the systemic factors that shape newcomer women's experiences during the OHIP waiting period. PURPOSE: To examine the factors that shaped newcomer women's experiences with perinatal care during the three-month health insurance waiting period in Ontario, Canada. METHODS: This qualitative study was informed by an intersectional framework, and guided by a critical ethnographic method. Individual interviews were conducted with four newcomer women and three perinatal healthcare professionals. Participant observations at recruitment and interview sites were integral to the study design. RESULTS: The key systemic factors that shaped newcomer women's experiences with perinatal care included social identity, migration, and the healthcare system. Social identities related to gender, race, and socio-economic status intersected to form a social location, which converged with newcomer women's experiences of social isolation and exclusion. These experiences, in turn, intersected with Ontario's problematic perinatal health services. Together, these factors form systems of oppression for newcomer women in the perinatal period. CONCLUSIONS: Given the health inequities that can result from these systems of oppression, it is important to adopt an upstream approach that is informed by the Human Rights Code of Ontario to improve accessibility to and the experiences of perinatal care for newcomer women.

How Has COVID-19 Changed the Way We Do Virtual Care? A Scoping Review Protocol.

The coronavirus disease (COVID-19) pandemic created worldwide interest and use of virtual care to support public health measures and reduce the spread of infection. While some forms of virtual care have been used prior to COVID-19 such as telemedicine, little is known about other virtual modalities such as video conferencing, wearables and other digital technologies. The COVID-19 pandemic has presented an opportunity to question the efficacy and safety of virtual care, especially in terms of patient outcomes among those self-isolating. The purpose of this scoping review is to examine the safety of virtual care among active COVID-19 patients in the community and examine the types and dose of virtual care. Finally, this review will examine what patient outcomes are identified from interventions delivered virtually to treat COVID-19. We followed a systematic process guided by the PRISMA checklist for scoping reviews with a comprehensive search strategy across four bibliographic databases and handsearching reference lists. We undertook a blinded, two-stage screening process with eligibility criteria. All citations and screening were managed using the DistillerSR software. Data were extracted using a data extraction tool developed for this project. The conclusions from this review will offer greater understanding for how virtual care can be used among community-based COVID-19 patients.

Commentary: Access to Virtual Care Matters: The Problem with Giving to Some and Not All.

Expedited in the midst of the COVID-19 pandemic, virtualization of healthcare is becoming an inevitable norm. While this conveys hope for improving health systems performance, inequitable access could result in consequences that intensify health disparities and increase the burden on the health system. Nurse leaders are optimally positioned to tactfully influence policy directions on virtual care and shape a comprehensive research agenda that includes virtual nursing care in all domains of practice. With virtual care advancing into the mainstream, it is time to mind the health equity gap and co-design virtualized care that ensures the needs of all are met.

Are clinicians being prepared to care for abused women? A survey of health professional education in Ontario, Canada.

BACKGROUND: The current project undertook a province-wide survey and environmental scan of educational opportunities available to future health care providers on the topic of intimate partner violence (IPV) against women. METHODS: A team of experts identified university and college programs in Ontario, Canada as potential providers of IPV education to students in health care professions at the undergraduate and post-graduate levels. A telephone survey with contacts representing these programs was conducted between October 2005 and March 2006. The survey asked whether IPV-specific education was provided to learners, and if so, how and by whom. RESULTS: In total, 222 eligible programs in dentistry, medicine, nursing and other allied health professions were surveyed, and 95% (212/222) of programs responded. Of these, 57% reported offering some form of IPV-specific education, with undergraduate nursing (83%) and allied health (82%) programs having the highest rates. Fewer than half of undergraduate medical (43%) and dentistry (46%) programs offered IPV content. Postgraduate programs ranged from no IPV content provision (dentistry) to 41% offering content (nursing). CONCLUSION: Significant variability exists across program areas regarding the methods for IPV education, its delivery and evaluation. The results of this project highlight that expectations for an active and consistent response by health care professionals to women experiencing the effects of violence may not match the realities of professional preparation.

Should Nurses Be Knowledge Brokers? Competencies and Organizational Resources to Support the Role.

Registered nurses with graduate preparation are in a unique position to act as knowledge brokers owing to their extensive clinical experience and ability to be seen as a credible and respected resource by their peers. Nurse knowledge brokers can bridge the gap between research producers and those that need evidence for decision-making and support capacity development for evidence-informed decision-making (EIDM). Knowledge broker competencies include graduate-level education with exposure to research methods; experience with the EIDM process; and established networking skills to bring researchers, decision-makers, stakeholders and policymakers together. For the knowledge broker to be successful, the nurse leader can cultivate an organizational culture supportive of evidence use with advocacy for mandates that require evidence for decisions, structures in place for each stage of the EIDM process, and physical resources such as library services for evidence retrieval.

A systematic review of web-based educational interventions.

A complement to in-hospital educational interventions is web-based patient education accessed during the home recovery period. While findings demonstrate the effectiveness of web-based patient education interventions on patient outcomes, they fall short of identifying the characteristics that are associated with desired outcomes. The purpose of this systematic review was to determine the characteristics of web-based patient education interventions that are associated with producing changes in self-care behaviors. A systematic review involving 19 studies was conducted to determine the most effective components of a web-based intervention. Findings suggest that the most effective form of web-based patient education is one that is interactive and allows patients to navigate the online system on their own. The findings from this systematic review allow for the design of a web-based educational intervention that will promote increased performance of self-care behaviors during the home recovery period.

The Registry of Knowledge Translation Methods and Tools: a resource to support evidence-informed public health.

OBJECTIVES: This paper examines the development of a globally accessible online Registry of Knowledge Translation Methods and Tools to support evidence-informed public health. METHODS: A search strategy, screening and data extraction tools, and writing template were developed to find, assess, and summarize relevant methods and tools. An interactive website and searchable database were designed to house the registry. Formative evaluation was undertaken to inform refinements. RESULTS: Over 43,000 citations were screened; almost 700 were full-text reviewed, 140 of which were included. By November 2012, 133 summaries were available. Between January 1 and November 30, 2012 over 32,945 visitors from more than 190 countries accessed the registry. Results from 286 surveys and 19 interviews indicated the registry is valued and useful, but would benefit from a more intuitive indexing system and refinements to the summaries. User stories and promotional activities help expand the reach and uptake of knowledge translation methods and tools in public health contexts. CONCLUSIONS: The National Collaborating Centre for Methods and Tools' Registry of Methods and Tools is a unique and practical resource for public health decision makers worldwide.

Mixing a grounded theory approach with a randomized controlled trial related to intimate partner violence: what challenges arise for mixed methods research?

Little is known about how to systematically integrate complex qualitative studies within the context of randomized controlled trials. A two-phase sequential explanatory mixed methods study was conducted in Canada to understand how women decide to disclose intimate partner violence in emergency department settings. Mixing a RCT (with a subanalysis of data) with a grounded theory approach required methodological modifications to maintain the overall rigour of this mixed methods study. Modifications were made to the following areas of the grounded theory approach to support the overall integrity of the mixed methods study design: recruitment of participants, maximum variation and negative case sampling, data collection, and analysis methods. Recommendations for future studies include: (1) planning at the outset to incorporate a qualitative approach with a RCT and to determine logical points during the RCT to integrate the qualitative component and (2) consideration for the time needed to carry out a RCT and a grounded theory approach, especially to support recruitment, data collection, and analysis. Data mixing strategies should be considered during early stages of the study, so that appropriate measures can be developed and used in the RCT to support initial coding structures and data analysis needs of the grounded theory phase.

Violence against Women: An Exploration of the Physical and Mental Health Trends among Immigrant and Refugee Women in Canada.

Violence against women is a serious health and social problem for women worldwide. Researchers have investigated the broad physical and mental health consequences of violence against women but few have focused on immigrant and refugee women. We assessed the history of violence and the impairment of physical and mental health among 60 women participants from the Iranian and Sri Lankan Tamil communities in Toronto, Canada. Our survey findings revealed that the participants had experienced various types of violence throughout their lifespan, with psychological abuse by a spouse/partner occurring most frequently in the past 12 months. Commonly reported types of abuse included insulting, criticizing, and intimidation by partner (psychological abuse); slapping, hitting, and shoving (physical abuse); and forced sexual intercourse and sexually degrading acts (sexual abuse) by a partner/spouse. We found that a substantial proportion of the participants also had experienced physical and mental health impairment, which could be a result of the various types of violence they had experienced throughout their lifespan. Research and practice implications are provided.

Identifying the turning point: using the transtheoretical model of change to map intimate partner violence disclosure in emergency department settings.

Background. The transtheoretical model of change (TTM) was used as a framework to examine the steps that women took to disclose intimate partner violence (IPV) in urban emergency departments. Methods. Mapping methods portrayed the evolving nature of decisions that facilitated or inhibited disclosure. This paper is a secondary analysis of qualitative data from a mixed methods study that explored abused women's decision making process about IPV disclosure. Findings. Change maps were created for 19 participants with movement from the precontemplation to the maintenance stages of the model. Disclosure often occurred after a significant "turning point event" combined with a series of smaller events over a period of time. The significant life event often involved a weighing of options where participants considered the perceived risks against the potential benefits of disclosure. Conclusions. Abused women experienced intrusion from the chaotic nature of the emergency department. IPV disclosure was perceived as a positive experience when participants trusted the health care provider and felt control over their decisions to disclose IPV. Practice Implications. Nurses can use these findings to gauge the readiness of women to disclose IPV in the emergency department setting.

The trainees' perspective on developing an end-of-grant knowledge translation plan.

BACKGROUND: Knowledge translation (KT) is a rapidly growing field that is becoming an integral part of research protocols. METHODS: This meeting report describes one group's experience at the 2009 KT Canada Summer Institute in developing an end-of-grant KT plan for a randomized control trial proposal. RESULTS: Included is a discussion of the process, challenges, and recommendations from the trainee's perspective in developing an end-of-grant KT plan. CONCLUSION: New researchers should consider developing an end-of-grant KT plan with strategies that move beyond passive dissemination to incorporate innovative means of collaboration with the end user to craft the message, package the information, and share the research findings with end users.

How can knowledge brokering be better supported across European health systems?

There is a general lack of support for knowledge brokering across European health systems. Four sets of interrelated issues contribute to this problem: (1) lack of use of health systems information in policy-making; (2) lack of use of promising knowledge-brokering mechanisms and models; (3) lack of support for knowledge brokering; and (4) limited reach of existing efforts to support knowledge brokering. Of the many potential options to inform future initiatives for supporting knowledge brokering across Europe, three exemplars are profiled in this policy brief: option 1: integrate knowledge-brokering incentives into research funding processes; option 2: extend initiatives focused on supporting knowledge brokering; and option 3: pilot a health systems knowledge-brokering partnership. Many implementation strategies could be considered for any given option. However, given that several options could be pursued simultaneously and thatoption elements could be combined in different and creative ways, identifying implementation strategies that cut across options could be an important first step. One possible such strategy could be the development, pilot testing and iterative redevelopment of a package of communication materials that highlight the ways in which knowledge brokering can support policy-making and innovative examples of knowledge-brokering mechanisms and models that others can adopt or adapt. The BRIDGE summaries are a step in this direction.

How can knowledge brokering be advanced in a country’s health system?

There is a general lack of attention given to ‘what to do next’ to advance knowledge brokering in many European countries’ health systems. Four sets of interrelated issues can contribute to this problem within any given country’s health system: (1) untapped potential for health systems information to inform policy-making; (2) missed opportunities to take stock and prioritize advancements in knowledge brokering; (3) lack of alignment of support for knowledge brokering; and (4) limited reach of existing efforts to advance knowledge brokering. Of the many potential options to inform future initiatives for advancing knowledge brokering within a country’s health system, three exemplars are profiled in this policy brief: option 1: establish a portal for knowledge-brokering mechanisms; option 2: convene a dialogue to coordinate advancements in knowledge brokering; and option 3: centralize knowledge-brokering mechanisms in a well designed organization. Many implementation strategies could be considered for any given option. However, given that several options could be pursued simultaneously and that option elements could be combined in different and creative ways, identifying implementation strategies that cut across options could be an important first step. One possible such strategy could be the development, pilot testing and iterative redevelopment of a package of communication materials that highlight the ways in which knowledge brokering can support policy-making and innovative examples of knowledge-brokering mechanisms and models that others can adopt or adapt. The BRIDGE summaries are a step in this direction.

Communicating clearly: enhancing information-packaging mechanisms to support knowledge brokering in European health systems

Policy-makers are faced daily with making decisions and need access to good-quality health systems information. Stakeholders may seek to influence health policy as well as make decisions in their own spheres of responsibility. Both groups want information products that they can easily understand and that are clearly based on systematically conducted and transparently reported research. And researchers want to know how to communicate their findings effectively so that health systems policy-making can make use of the best available health systems information.The purpose of this BRIDGE summary is to encourage debate and innovation about the ways in which information is prepared and packaged for policy-makers and stakeholders as one component of a broader knowledge-brokeringapproach. Current thinking about knowledge brokering is largely driven by anecdotal information; this document presents real-world insights from research on knowledge brokering, primarily from Europe but drawing on globalexperience as well. This summary is intended not only for knowledge brokers whose work is dedicated to this role, but also for funders, researchers, policy-makers and stakeholders, all of whom can help to steer knowledge brokering by helping to set expectations for this work.