A qualitative examination of primary care team's participation in the distribution of the COVID-19 vaccination.

BACKGROUND: Primary health care (PHC) has historically led and implemented successful immunization programs, driven by strong relationships with patients and communities. During the COVID-19 pandemic, Canada began its vaccination strategy with mass immunizations that later included local efforts with PHC providers. This study seeks to understand how PHC contributed to the different phases of the COVID-19 vaccination rollouts in Ontario, Canada's most populous province. METHODS: We conducted a descriptive qualitative study with focus groups consisting of PHC providers, administrators, and staff in Ontario. Eight focus groups were held with 39 participants representing geographic diversity across the six Ontario Health regions. Participants reflected a diverse range of clinical, administrative, and leadership roles. Each focus group was audio-recorded and transcribed with transcriptions analyzed using thematic analysis. RESULTS: With respect to understanding PHC teams' participation in the different phases of the COVID-19 vaccination rollouts, we identified five themes: (i) supporting long-term care, (ii) providing leadership in mass vaccinations, (iii) integrating vaccinations in PHC practice sites, (iv) reaching those in need through outreach activities; and (v) PHC's contributions being under-recognized. CONCLUSIONS: PHC was instrumental in supporting COVID-19 vaccinations in Ontario, Canada across all phases of the rollout. The flexibility and adaptability of PHC allowed teams to participate in both large-scale and small-scale vaccination efforts.

Pharmacists' role and experiences with delivering mental health care within team-based primary care settings during the COVID-19 pandemic.

OBJECTIVES: Pharmacists have been increasingly integrated into primary care teams, leading to improved health outcomes for patients. The two objectives of this study were (i) to describe how the COVID-19 pandemic impacted pharmacists' role in mental health care within Canadian primary care teams and (ii) to describe Canadian pharmacists' experiences collaborating with other healthcare providers in the delivery of mental health services during the COVID-19 pandemic. METHODS: Cross-sectional observational study utilizing an online survey consisting of closed-ended and open-ended questions. Primary care pharmacists in Ontario were eligible to participate. Descriptive statistics were collated, and qualitative data underwent thematic analysis. A total of 51 pharmacists participated in the study. KEY FINDINGS: The COVID-19 pandemic has led to the expanding role of pharmacists in attending to the mental health care of patients. Working within a collaborative, interprofessional healthcare environment, pharmacists support patients' mental health in a variety of ways, including medication education and management, non-pharmacologic approaches and supportive conversations, and identification of resources, including referrals, wellness checks, and consulting with physicians. Increasing demand for mental health services has led to higher referrals to pharmacists, which will likely persist and require further education of pharmacists in mental health along with better access to deliver virtual care. CONCLUSION: In response to the increasing mental health care needs of patients since the COVID-19 pandemic, primary care pharmacists reported increased attention spent on mental health care. Building capacity and ensuring support for pharmacists to continue to address the increasing mental health care demands is essential.

Social workers' formal and informal leadership in interprofessional primary care teams in Ontario, Canada.

The development of interprofessional teams in primary care presents opportunities for social workers to take on new leadership positions. This study seeks to describe how social workers engaged in leadership roles in primary care during the COVID-19 pandemic. A cross-sectional on-line survey was disseminated to primary care social workers across Ontario, Canada, with a total of 159 respondents. Most respondents engaged in informal leadership roles and showcased a range of leadership skills promoting team collaboration and consultations, along with adapting to virtual care transitions. Findings suggest there needs to be intentional cultivation of social work leaders through supportive environments and training. Social workers in primary care have leadership capacity and are providing leadership to their primary care teams through formal and informal means. The leadership potential of social workers in primary care teams, however, is being underutilized and can be further developed.

The Benefits and Challenges of Precepting Pharmacy Students Virtually in Interprofessional Primary Care Teams.

OBJECTIVE: The objective of this study was to identify pharmacists' perspectives on the benefits and challenges of precepting pharmacy students during circumstances that require using virtual care in team-based primary care practices. METHODS: A cross-sectional online survey was disseminated through Qualtrics software from July 5, 2021, to October 13, 2021. We used a convenience sampling technique to recruit a sample of pharmacists working in primary care teams across Ontario, Canada, who were able to complete a web-based survey in English. RESULTS: A total of 51 pharmacists participated in the survey and provided complete responses (response rate of 41%). Participants noted benefits at 3 levels of precepting pharmacy students in primary care during the COVID-19 pandemic: (1) benefits to pharmacists, (2) benefits to patients, and (3) benefits to students. Challenges of precepting pharmacy students were: (1) difficulty training students virtually, (2) students not being ideally prepared to begin a practicum training during a pandemic, and (3) reduced availability and new workload demands. CONCLUSION: Pharmacists in team-based primary care highlighted substantial benefits and challenges for precepting students during a pandemic. Alternative mechanisms of experiential education delivery can provide new opportunities for pharmacy care yet can also restrict immersion into interprofessional team-based primary care and diminish pharmacist capacity. Additional support and resources to facilitate capacity are critical for pharmacy students to succeed in future practice in team-based primary care.

Qualitative examination of collaboration in team-based primary care during the COVID-19 pandemic.

OBJECTIVE: The objective of this study was to describe Ontario primary care teams' experiences with collaboration during the COVID-19 pandemic. Descriptive qualitative methods using focus groups conducted virtually for data collection. SETTING: Primary care teams located in Ontario, Canada. PARTICIPANTS: Our study conducted 11 focus groups with 10 primary care teams, with a total of 48 participants reflecting a diverse range of interprofessional healthcare providers and administrators working in primary care. RESULTS: Three themes were identified using thematic analysis: (1) prepandemic team functioning facilitated adaptation, (2) new processes of team interactions and collaboration, and (3) team as a foundation of support. CONCLUSIONS: Results revealed the importance of collaboration for provider well-being, and the challenges of providing collaborative team-based primary care in the pandemic context. Caution against converting primary care collaboration to predominantly virtual modalities postpandemic is recommended. Further research on team functioning during the COVID-19 pandemic in other healthcare organisations will offer additional insight regarding how primary care teams can work collaboratively in a postpandemic environment.

COVID-19 and social work in health care in Canada: What are the impacts?

The COVID-19 pandemic has profoundly affected the world. In Canada, the impact has been worrisome. Canada is a large, sparsely populated country with a system of universal health care that is decided nationally and enacted by each province and territory. There are variations in health care, as well as in the provision of social work, throughout the country. The aim of this survey is to examine the impact of the COVID-19 pandemic on social workers employed in health care. Participants were recruited for an online survey via social media, professional associations, and social work education programs. Three hundred and seventy-six social workers participated. Analyses were performed to: (1) investigate the changes in workplace conditions indicated by social workers as a result of the COVID-19 pandemic; (2) examine reported levels of distress, social support, quality of professional life, resilience, and posttraumatic growth among respondents during this time; and (3) contextualize these findings by exploring similarities and differences across geographic locations. Many respondents were deemed essential workers. Significant differences across regions were not found. The knowledge generated has important implications for all sectors of the social work profession in Canada.

Preparing social workers to address health inequities emerging during the COVID-19 pandemic by building capacity for health policy: a scoping review protocol.

INTRODUCTION: The COVID-19 pandemic has brought tremendous changes in healthcare delivery and exacerbated a wide range of inequities. Social workers across a broad range of healthcare settings bring an expertise in social, behavioural and mental healthcare needed to help address these health inequities. In addition, social workers integrate policy-directed interventions and solutions in clinical practice, which is a needed perspective for recovery from the COVID-19 pandemic. It remains unclear, however, what the most pressing policy issues are that have emerged during the COVID-19 pandemic. In addition, many social workers in health settings tend to underuse policy in their direct practice. The objectives of this scoping review are to: (1) systematically scope the literature on social work, COVID-19 pandemic and policy; and (2) describe the competencies required by social workers and the social work profession to address the policy issues emerging during the COVID-19 pandemic. METHODS AND ANALYSIS: The scoping review follows Arksey and O'Malley's five-stage framework. Identification of literature published between 1 December 2019 and the search date, 31 March 2021, will take place in two stages: (1) title and abstract review, and (2) full-text review. In partnership with a health science librarian, the research team listed keywords related to social work and policy to search databases including Medline, Embase, PsycINFO, CINAHL, Social Services Abstract and Social Work Abstracts. Two graduate-level research assistants will conduct screening and full-text review. Data will then be extracted, charted, analysed and summarised to report on our results and implications on practice, policy and future research. ETHICS AND DISSEMINATION: Results will help develop a policy practice competence framework to inform how social workers can influence policy. We will share our findings through peer-reviewed publications and conference presentations. This study does not require Research Ethics Board approval as it uses publicly available sources of data.

Primary care teams' experiences of delivering mental health care during the COVID-19 pandemic: a qualitative study.

BACKGROUND: Integrated primary care teams are ideally positioned to support the mental health care needs arising during the COVID-19 pandemic. Understanding how COVID-19 has affected mental health care delivery within primary care settings will be critical to inform future policy and practice decisions during the later phases of the pandemic and beyond. The objective of our study was to describe the impact of the COVID-19 pandemic on primary care teams' delivery of mental health care. METHODS: A qualitative study using focus groups conducted with primary care teams in Ontario, Canada. Focus group data was analysed using thematic analysis. RESULTS: We conducted 11 focus groups with 10 primary care teams and a total of 48 participants. With respect to the impact of the COVID-19 pandemic on mental health care in primary care teams, we identified three key themes: i) the high demand for mental health care, ii) the rapid transformation to virtual care, and iii) the impact on providers. CONCLUSIONS: From the outset of the COVID-19 pandemic, primary care quickly responded to the rising mental health care demands of their patients. Despite the numerous challenges they faced with the rapid transition to virtual care, primary care teams have persevered. It is essential that policy and decision-makers take note of the toll that these demands have placed on providers. There is an immediate need to enhance primary care's capacity for mental health care for the duration of the pandemic and beyond.

Social work education and training in mental health, addictions and suicide: a scoping review protocol.

INTRODUCTION: Social workers are among the largest group of professionals in the mental health workforce and play a key role in the assessment of mental health, addictions and suicide. Most social workers provide services to individuals with mental health concerns, yet there are gaps in research on social work education and training programmes. The objective of this scoping review is to examine literature on social work education and training in mental health, addictions and suicide. METHODS AND ANALYSIS: Using a scoping review framework developed by Arksey and O'Malley, we will search for literature through seven academic databases: PsycINFO, Sociological Abstracts, CINAHL Plus, Social Sciences Abstracts, Education Source, ERIC and Social Work Abstracts. Two independent reviewers will screen articles utilising a two-stage process. Titles and abstracts will be reviewed in the first stage and full texts will be reviewed in the second stage. Selected articles that meet inclusion criteria will be charted to extract key themes and they will be analysed using a qualitative thematic analysis approach. ETHICS AND DISSEMINATION: This review will fill a knowledge gap in social work education and training in mental health, addictions and suicide. Ethics approval is not required for this scoping review. Through dissemination in publications and relevant conferences, the results may guide future research and education in social work.

Interprofessional empathy: A four-stage model for a new understanding of teamwork.

Collaboration in healthcare implies that health providers share responsibility and partner with each other in order to provide comprehensive patient care. A review of the empirical literature on teamwork in healthcare settings suggests that the relationships between service providers remain conflictual and variable in commitment to interprofessional collaboration. Recently, social psychologists have given considerable attention to the possibility that empathy could be used to improve intergroup attitudes and relations. Although empathy may be referred to as a means to humanize healthcare practices, few published studies from the healthcare literature focus on the nature of interprofessional empathy. Understanding frameworks different from your own and empathizing with other members of the team is fundamental to collaborative practice. The aim of this study was to understand the nature of empathy among members of interprofessional teams within a hospital environment. This study followed the lived experience of 24 health professionals with their perspective of empathy on interprofessional teams. A two-step procedure was used consisting of semi-structured interviews and depth interviews. Phenomenological data analysis was used to identify common themes and meanings across interviews. From the findings, a four-stage developmental model of interprofessional empathy emerged: Stage 1 is engaging in conscious interactions; Stage 2 requires using dialogical communication; Stage 3 is obtained when healthcare professionals consolidate understanding through negotiating differences between each other; and Stage 4 shows mastery of nurturing the collective spirit. Knowledge of this stage model will provide clinicians with the information necessary to develop awareness of how day-to-day activities within their interprofessional teams influence the development of interprofessional empathy.

Narrative Training as a Method to Promote Nursing Empathy Within a Pediatric Rehabilitation Setting.

PURPOSE: Empathy is deemed essential to nursing, yet interventions that promote and sustain empathy in practicing nurses within healthcare organizations are limited. We tested the feasibility and perceived impact of an arts-based narrative training intervention involving pediatric rehabilitation nurses for the purpose of promoting nursing empathy. DESIGN AND METHODS: One-group qualitative repeated-measures design at an urban Canadian pediatric rehabilitation hospital. Eight nurse participants attended six 90-minute weekly group narrative training sessions and two in-depth interviews pre- and post-intervention. RESULTS: The intervention positively impacted participants in three primary domains: Empathy for Patients and Families, Empathy Within Nursing Team, and Empathy for the Self. Major findings included: increased value placed on patients' and families' backstory, identification of "moral empathic distress" (MED), enhanced sense of collaborative nursing community, and renewal of professional purpose. CONCLUSIONS: This study is the first of its kind conducted in the pediatric rehabilitation nursing context. Results indicate that arts-based narrative training enhances nursing empathy and contributes to a supportive nursing culture. PRACTICE IMPLICATIONS: In addition to enhancing empathy in clinical domains, nurses who participated in narrative training reported improved team collaboration, self-care practices, and renewed professional purpose. The results from the intervention are encouraging and future research needs to explore its utility in other settings with larger and more diverse sample.

Caring for the healthcare professional.

Purpose Hospitals must systematically support employees in innovative ways to uphold a culture of care that strengthens the system. At a leading Canadian academic pediatric rehabilitation hospital, over 90 percent of clinicians viewed Schwartz Rounds™ (SR) as a hospital priority, resulting in its formal implementation as a quality improvement initiative. The purpose of this paper is to describe how the hospital implemented SR to support the socio-emotional impact of providing care. Design/methodology/approach This quantitative descriptive study provides a snapshot of the impact of each SR through online surveys at four assessment points (SR1-SR4). A total of 571 responses were collected. Findings All four SR addressed needs of staff as 92.9-97.6 percent of attendees reported it had a positive impact, and 96.4-100 percent of attendees reported each SR was relevant. Attendees reported significantly greater communication with co-workers after each SR ( p<0.001) and more personal conversations with supervisors after SR2 and SR4 ( p<0.05) compared to non-attendees. Attending SR also increased their perspective-taking capacity across the four SR. Practical implications As evidenced in this quality improvement initiative, SR addresses staff's need for time to process the socio-emotional impacts of care and to help reduce those at risk for compassion fatigue. SR supports and manages the emotional healthcare culture, which has important implications for quality patient care. Originality/value This research details an organization's process to implement SR and highlights the importance of taking care of the care provider.

Developing a Compassionate Culture Within Pediatric Rehabilitation: Does the Schwartz Rounds™ Support Both Clinical and Nonclinical Hospital Workers in Managing Their Work Experiences?

Schwartz Rounds™ offers an interprofessional forum for staff to openly engage in discussions about social-emotional aspects of care. We aimed to assess the perceived impact of Rounds in the health care context of pediatric rehabilitation, as well as a comparative analysis of how Rounds affected clinical versus nonclinical staff. Does effect on perceived outcomes was also investigated. Data were collected from 29 hospital staff (15 clinicians, 14 nonclinicians) who attended one, two, or three+ Rounds via semistructured interviews. Thematic analysis indicated impacts at the personal and social levels (e.g., reduced stress, increased level of approaching behaviors, normalizing and validating emotional experiences, and building bridges within the hospital). Data also revealed the novel finding of Rounds affecting professional knowledge and skills (e.g., interprofessional practice, reflective practice, clinical imagination). These findings elucidate how Schwartz Rounds™ is beneficial in a pediatric rehabilitation setting, albeit somewhat differentially for clinical and nonclinical staff.

Clinical Documentation in an Era of Increasing Transparency: The Impact of Electronic Portals on Care.

Electronic health records (EHRs) and consumer health portals have implications for improving the quality and cost-effectiveness of healthcare and make it much easier for patients and families to access health information in a timely and convenient manner. However, the accessibility of information afforded by EHRs and health portals changes the dynamic of control over health information in very significant ways. Institutions and their clinicians have typically been the caretakers of these documents; therefore, the introduction of portals represents a major cultural shift in healthcare. The efforts of both clinicians and patients are needed to effectively make this shift, as the implementation of new technology is uniquely challenging within a healthcare setting. An interactive workshop was facilitated to understand clinicians' perceived challenges of this shift with a specific focus on the implications of increased transparency and patients' increased access to health information.

Connecting Families to Their Health Record and Care Team: The Use, Utility, and Impact of a Client/Family Health Portal at a Children's Rehabilitation Hospital.

BACKGROUND: Health care portals have the potential to provide consumers with timely, transparent access to health care information and engage them in the care process. OBJECTIVE: The objective was to examine the use, utility, and impact on engagement in care and caregiver-provider communication of a client/family portal providing access to electronic health records (EHRs) and secure, 2-way e-messaging with care providers. METHODS: We conducted a prospective, mixed-methods study involving collection of caregivers' portal usage information over a 14-month period (from portal introduction in January 2015 to the end of the study period in March 2016), a Web-based survey for caregivers administered after a minimum of 2 months' exposure to the portal and repeated 2 months later, and focus groups or individual interviews held with caregivers and service providers at the same points in time. The survey assessed caregivers' perceptions of the utility of and satisfaction with the EHR and e-messaging, and the portal's impact on client engagement and perceptions of caregiver-provider communication. A total of 18 caregivers (parents) completed surveys and 6 also took part in focus groups or interviews. In addition, 5 service providers from different disciplines took part in focus groups or interviews. RESULTS: Although usage patterns varied, the typical pattern was a steady level of use (2.5 times a month over an average of 9 months), which is higher than typically reported use. The portal pages most frequently accessed were the home page, health record main page, appointment main page, and reports main page. The Web-based survey captured caregivers' perceptions of usefulness of and satisfaction with the EHR and portal messaging, as well as the portal's impact on their engagement in care and perceptions of caregiver-provider communication. The surveys indicated a moderate degree of utility of and satisfaction with the portal features, and a low but emerging impact on engagement in care and caregiver-provider communication (survey scales measuring these outcomes displayed excellent internal consistency, with Cronbach alpha ranging from .89 to .95). Qualitative themes from focus groups and interviews supported and extended the survey findings. Caregivers and service providers saw appreciable information benefits and provided recommendations to increase portal use and utility. Caregivers focused on the scope of organizational adoption of the portal system and indicated their hopes for the future of the portal, whereas service providers were concerned about how to best manage their investment of time and effort in preparing client-friendly reports and messaging clients via the portal. CONCLUSIONS: Overall, the findings show the promise of the portal and the need for ongoing evaluation to show the portal's ultimate potential in enhancing engagement in care and communication with care providers.

Exploring Parents' Perceptions and How Physiotherapy Supports Transition from Rehabilitation to School for Youth with an ABI.

AIMS: To explore parents' perceptions of their youth's transition from rehabilitation to school following an Acquired Brain Injury (ABI) and how physiotherapy influenced the youth's participation and physical function during the transition. METHODS: The study utilized phenomenological qualitative methodology using semi-structured interviews with 11 parents of youth 10 to 18 years of age recruited from one pediatric rehabilitation hospital in Ontario. Each interview was audiotaped, transcribed verbatim, and thematically analyzed. RESULTS: Parents valued physiotherapy and highlighted potential areas of improved service delivery to promote participation in an active lifestyle during this transition. In addition to being parents, they had to assume new roles and responsibilities in order to motivate their youth to continue with therapy and physical activity and had to facilitate their participation in school, recreational and social activities. CONCLUSION: For youth following an ABI, the transition back to school is complex and strategies should be supportive and responsive. Implications for physiotherapists include improved collaboration with community partners to motivate youth and promote physical activity; engage youth with their peers early in the rehabilitation process; and ongoing support for parents.

It just feels weird!: a qualitative study of how children aged 10-18 years describe neuropathic pain.

PURPOSE: The aim of this study was to explore how children aged 10-18 years describe their neuropathic pain (NP). METHOD: This is a qualitative descriptive study using inductive content analysis. Semi-structured interviews were conducted with eight children, aged 10-18 years with varying diagnoses, who were experiencing NP. RESULTS: All children were able to describe their NP using a variety of strategies, including use of literal and figurative language. While some sensory descriptors commonly reported by adults were used, descriptions of NP pattern and impact were also integral to their narratives. Children were able to differentiate NP from nociceptive pain. Parents clarified and gave context to pain reports. CONCLUSIONS: NP is a complex experience necessitating consideration of the different ways that children describe their symptoms. Involvement of parents is invaluable to the process of taking a pain history with a child who is being screened for NP. Implications for Rehabilitation The findings of the study may inform the screening process for NP in children to facilitate earlier identification. Clinicians should consider the variety of ways that children may express their NP symptoms and the resulting impact. Clinicians should probe further when children report that symptoms are hard to describe or "weird". Presence of a parent during the child's pain assessment may assist with gathering a more complete picture.

Supporting Client and Family Engagement in Care Through the Planning and Implementation of an Online Consumer Health Portal.

Web-based portals and electronic health records are making it easier for clients and families to access health information. This improved transparency and access to information has the potential to promote activation and improve outcomes, but to realize these benefits, the information needs to be valuable, meaningful, and understandable. Engagement of the end users in the planning and implementation will ensure that the product meets the needs of the consumers. The purpose of this case study is to describe the client and family engagement strategies that were employed to support the process of planning and implementing an online consumer health portal at a pediatric rehabilitation hospital to support the successful launch of this new information-sharing technology platform.

Understanding the patients' perspective of emotional support to significantly improve overall patient satisfaction.

This article presents the results of a research study that laid out important considerations for organizations to improve their patient satisfaction scores. It addresses a dimension of patient satisfaction that appears to garner little attention in healthcare contexts: emotional support. Though the literature strongly suggests that emotional support is correlated to overall patient satisfaction, few organizations have systematically attempted to understand the elements of outstanding emotional support. Research at a community teaching hospital in Ontario has shed light on the essential components of emotional support. In this article, a typology of emotional support is offered. With a better understanding of the components of emotional support, organizations may be able to undertake actions that could potentially improve patient satisfaction scores and, in turn, the overall quality of patient care.