A gender-based review of workplace violence amongst the global health workforce-A scoping review of the literature.

Workplace violence (WPV) impacts all levels of the health workforce, including the individual provider, organization, and society. While there is a substantial body of literature on various aspects of WPV against the health workforce, gender-based WPV (GB-WPV) has received less attention. Violence in both the workplace and broader society is rooted in gendered socio-economic, cultural, and institutional factors. Developing a robust understanding of GB-WPV is crucial to explore the differing experiences, responses, and outcomes of GB-WPV with respect to gender. We conducted a scoping review and report on the prevalence and risk factors of GB-WPV in healthcare settings globally. The review followed the Preferred Reporting Items for Systematic and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We registered the scoping review protocol on the Open Science Framework on January 14, 2022, at https://osf.io/t4pfb/. A systematic search was conducted of empirical literature in five health and social science databases. Of 13667, 226 studies were included in the analysis. Across the studies, more women than men experienced non-physical violence, including verbal abuse, sexual harassment, and bullying. Men experienced more physical violence compared to women. Younger age, less experience, shifting duties, specific clinical settings, lower professional status, organizational hierarchy, and minority status were found to be sensitive to gender, reflecting women's structural disadvantages in the workplace. Given the high prevalence and impact of GB-WPV on women, we provided recommendations to address systemic issues in clinical practice, academia, policy, and research.

Abuse in Canadian long-term care homes: a mixed methods study.

OBJECTIVE: To examine reported cases of abuse in long-term care (LTC) homes in the province of Ontario, Canada, to determine the extent and nature of abuse experienced by residents between 2019 and 2022. DESIGN: A qualitative mixed methods study was conducted using document analysis and descriptive statistics. Three data sources were analysed: LTC legislation, inspection reports from a publicly available provincial government administrative database and articles published by major Canadian newspapers. A data extraction tool was developed that included variables such as the date of inspection, the type of inspection, findings and the section of legislation cited. Descriptive analyses, including counts and percentages, were calculated to identify the number of incidents and the type of abuse reported. RESULTS: According to legislation, LTC homes are required to protect residents from physical, sexual, emotional, verbal or financial abuse. The review of legislation revealed that inspectors are responsible for ensuring homes comply with this requirement. An analysis of their reports identified that 9% (781) of overall inspections included findings of abuse. Physical abuse was the most common type (37%). Differences between the frequency of abuse across type of ownership, location and size of the home were found. There were 385 LTC homes with at least one reported case of abuse, and 55% of these homes had repeated incidents. The analysis of newspaper articles corroborated the findings of abuse in the inspection reports and provided resident and family perspectives. CONCLUSIONS: There are substantial differences between legislation intended to protect LTC residents from abuse and the abuse occurring in LTC homes. Strategies such as establishing a climate of trust, investing in staff and leadership, providing standardised education and training and implementing a quality and safety framework could improve the care and well-being of LTC residents.

Work precarity, employment characteristics and health among Canada's long-term care and seniors' home workers during the COVID-19 pandemic.

Background: The COVID-19 pandemic has highlighted several issues among health care workers in Canada's long-term care and seniors' (LTCS) homes, including labour shortages, staff retention difficulties, overcrowding, and precarious working conditions. There is currently a lack of information on the health, well-being and working conditions of health care workers in LTCS homes - many of them immigrants - and a limited understanding of the relationship between them. This paper examines differences between immigrant and non-immigrant workers' health outcomes and precarious working conditions during the pandemic. Data and methods: The data were from the 2021 Survey on Health Care Workers' Experiences During the Pandemic, which collected information on LTCS home health care workers' (n=2,051) health, employment or work experiences, and working environment during the COVID-19 pandemic. Summary statistics and multivariable logistic regressions were conducted to examine the association between precarious work and workers' health (life stress, mental health and general health), stratified by immigrant status. Selected working characteristics were included in the regression models as covariates, namely occupation, number of locations worked, facility ownership status and number of years worked. Results: Immigrant health care workers were more likely than non-immigrant health care workers to experience precarious work in LTCS homes. Precarious work - characterized by income loss, reduced hours of work, and unpaid leave - was associated with stress and poor general health among immigrant and non-immigrant workers in the sector. Employment precarity was also associated with poor mental health for immigrant workers, but there was no association for non-immigrant workers. Interpretation: Employment precarity and the health and well-being of health care workers warrants further attention, in particular among immigrants employed in the LTCS residential care sector.

Innovative nursing employment initiatives to strengthen and sustain the health workforce in Canada.

Health systems worldwide are at a critical juncture due to an increasing demand for health services and a diminishing pool of health human resources. While COVID-19 exacerbated nursing deficits, the need to strengthen and sustain the health workforce in Canada was evident decades prior and supported by numerous studies that warned of significant shortages. Post pandemic, building health system capacity has become paramount. This article examines innovative nursing employment initiatives in Canada. It provides a snapshot of federal, provincial and territorial approaches, with a particular focus on Internationally Educated Nurses (IENs) due to burgeoning interest in and competition for their skills and services. However, recognizing that health human resource planning is a persistent challenge, further initiatives are suggested. These include complementary policy development to improve retention and policy frameworks that support proactive long-term strategies to address the cyclical shortage of nurses.

Factors associated with pressure ulcer and dehydration in long-term care settings in Ontario, Canada.

Pressure ulcers and dehydration are common conditions among residents of long-term care facilities that result in negative health effects. They have been associated with signs of neglect and increased 30-day mortality among LTC residents. However, they are both preventable and with proper care can be effectively managed and treated. We conducted a retrospective cohort study to examine factors associated with pressure ulcers and dehydration among long-term care residents in the province of Ontario, Canada. Results indicated that close to one-fifth of residents were dehydrated (17.3%) or had a pressure ulcer (18.9%) during the study period. Advanced age was significantly associated with the presence of pressure ulcers and dehydration for both men and women. However, men were more likely to present with a pressure ulcer while women were more likely to exhibit symptoms of dehydration. Study findings also demonstrate the presence of both conditions being higher in municipal and not-for-profit homes compared to for-profit homes. The significant differences observed in relation to home ownership which require further investigation to identify the most relevant factors in explaining these differences. Overall, pressure ulcers and dehydration are preventable conditions that warrant attention from policymakers to ensure quality of care and resident safety are prioritized.

A commentary on the Pan American Network of nursing and midwifery collaborating centres

[ABSTRACT]. This article provides a commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres (PANMCC). The objectives are to present an overview of the formation and evolution of the network, its impact on education, research, policy and communication and the benefits of membership. The advantages of international networks as a mechanism to strengthen nursing and midwifery workforces and improve health systems are also highlighted. The Pan American Health Organization (PAHO), the World Health Organization (WHO) Office in the Americas, oversees collaborating centres in the Region. Established in 1999, PANMCC consists of 17 centres situated in universities and schools of nursing. These centres provide crucial nursing and midwifery input to PAHO/WHO. The network supports global engagement and capacity building via col- laboration, resource sharing and research colloquia. The linkages within the network enhance professional development, increase capacity building and heighten visibility of PANMCC and the work of its members.

[RESUMEN]. En este artículo se presenta un comentario sobre la Red Panamericana de Centros Colaboradores de Enfer- mería y Partería (PANMCC, por su sigla en inglés). Los objetivos son presentar una visión general de la formación y evolución de la red, sus repercusiones en los ámbitos de la educación, la investigación, la política y las comunicaciones, así como los beneficios de pertenecer a la red. También se destacan las ventajas de las redes internacionales como mecanismo para fortalecer al personal de enfermería y partería y mejorar los sistemas de salud. La Organización Panamericana de la Salud (OPS), Oficina Regional de la Organización Mundial de la Salud (OMS) para las Américas, supervisa los centros colaboradores en la Región. Fundada en 1999, la PANMCC consta de 17 centros ubicados en universidades y facultades de enfermería, los cuales proporcionan información crucial sobre enfermería y partería a la OPS/OMS. Esta red respalda el compromiso general y el desarrollo de capacidades mediante la colaboración, el intercambio de recursos y los coloquios de investigación. Los vínculos en la red mejoran el desarrollo profesional, aumentan el desarrollo de capaci- dades y aumentan la visibilidad de la PANMCC y el trabajo de sus miembros.

[RESUMO]. Este artigo traz um comentário sobre a Rede Pan-Americana de Centros Colaboradores de Enfermagem e Obstetrícia (PANMCC). Os objetivos são apresentar uma visão geral da formação e evolução da Rede, seu impacto em educação, pesquisa, políticas e comunicação e os benefícios da filiação. Também são destacadas as vantagens das redes internacionais como mecanismo para valorizar as forças de trabalho em enfermagem e obstetrícia e melhorar os sistemas de saúde. A Organização Pan-Americana da Saúde (OPAS) – o Escritório da Organização Mundial da Saúde (OMS) nas Américas – supervisiona os Centros Colaboradores na região. Criada em 1999, a PANMCC é composta por 17 centros situados em universi- dades e escolas de enfermagem. Esses centros fornecem informações essenciais sobre enfermagem e obstetrícia para a OPAS/OMS. A rede apoia o envolvimento global e o fortalecimento institucional por meio de colaboração, compartilhamento de recursos e colóquios de pesquisa. Os elos dentro da rede aprimoram o desenvolvimento profissional, estimulam o fortalecimento institucional e aumentam a visibilidade da PANMCC e do trabalho dos seus membros.

Nurses' work, work psychology, and the evolution & devolution of care provision in nursing homes: A scoping review.

Background: Societal aging is exerting profound impacts on providers of long-term care. Nurses provide much of the direct care in the long-term care sector, and they increasingly provide unit- and facility-level leadership and fill top administrative and clinical roles.The work health and quality of work life of long-term care nurses are emergent concerns and the foci of research across multiple disciplines. Objectives: To enhance our understanding of factors influencing long-term care nurses' work health and quality of work life, we summarize the findings of disparate studies across diverse disciplines, time, and jurisdictions. Eligibility criteria: No restrictions were placed on study date, design, or country. Searches were restricted to English language only or translated studies. Included studies reported associations and relationships between/amongst nurses' work (role and work design), work environments, work attitudes, and work outcomes. Published peer-reviewed studies and reviews were included, as were reports. Editorials and opinion pieces were excluded. The search included publications up to March 2022. Sources of evidence: Medline, CINAHL, PsychINFO, EMBASE, Scopus, PSNet. Charting methods: Data abstraction from full-text articles. Results: The evolution of long-term care nurses' work to include both medical and administrative responsibilities has generally not been managed well, resulting in persistent role ambiguity, job dissatisfaction, and burnout. Nurses are concerned about their capacity to provide resident care and the adequacy of their preparation. Their work environments are under-resourced, and they are at high risk for workplace injury or violence. Supervisory and organizational support can be protective of negative aspects of nurses' work environments. Supervisory support can improve the immediate work environment, assist nurses in fulfilling their roles, and afford greater role clarity, and supervisors can influence their nursing staff's perceptions of the work safety and the value that their organization places on them. Organizational support can reduce work stress, enhance feelings of self-worth, and mitigate some of the self-stigmatization that influences long-term care nurses' attitudes toward themselves and their work, which influences work outcomes, including job performance and quality of resident care. Conclusions: Work stress, burnout, increased turnover, decreased morale and work motivation, increased health and safety concerns, and decreases in job satisfaction accompanied by self-stigmatization are all indicators of a system that has failed nurses, other long-term care staff, and nursing home residents. We consider the implications of our findings for enhancing the work health and quality of life of nurses working in long-term care and identify gaps in knowledge about their psychological health that merit future study. Tweetable Abstract: The long-term care sector is failing nurses globally. This review is a step toward understanding how we can improve the work psychology, including work-related psychological health, of nurses in long-term care.

A commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres / Comentario sobre la Red Panamericana de Centros Colaboradores de Enfermería y Partería / Comentário sobre a Rede Pan-Americana de Centros Colaboradores de Enfermagem e Obstetrícia

ABSTRACT This article provides a commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres (PANMCC). The objectives are to present an overview of the formation and evolution of the network, its impact on education, research, policy and communication and the benefits of membership. The advantages of international networks as a mechanism to strengthen nursing and midwifery workforces and improve health systems are also highlighted. The Pan American Health Organization (PAHO), the World Health Organization (WHO) Office in the Americas, oversees collaborating centres in the Region. Established in 1999, PANMCC consists of 17 centres situated in universities and schools of nursing. These centres provide crucial nursing and midwifery input to PAHO/WHO. The network supports global engagement and capacity building via collaboration, resource sharing and research colloquia. The linkages within the network enhance professional development, increase capacity building and heighten visibility of PANMCC and the work of its members.

RESUMEN En este artículo se presenta un comentario sobre la Red Panamericana de Centros Colaboradores de Enfermería y Partería (PANMCC, por su sigla en inglés). Los objetivos son presentar una visión general de la formación y evolución de la red, sus repercusiones en los ámbitos de la educación, la investigación, la política y las comunicaciones, así como los beneficios de pertenecer a la red. También se destacan las ventajas de las redes internacionales como mecanismo para fortalecer al personal de enfermería y partería y mejorar los sistemas de salud. La Organización Panamericana de la Salud (OPS), Oficina Regional de la Organización Mundial de la Salud (OMS) para las Américas, supervisa los centros colaboradores en la Región. Fundada en 1999, la PANMCC consta de 17 centros ubicados en universidades y facultades de enfermería, los cuales proporcionan información crucial sobre enfermería y partería a la OPS/OMS. Esta red respalda el compromiso general y el desarrollo de capacidades mediante la colaboración, el intercambio de recursos y los coloquios de investigación. Los vínculos en la red mejoran el desarrollo profesional, aumentan el desarrollo de capacidades y aumentan la visibilidad de la PANMCC y el trabajo de sus miembros.

RESUMO Este artigo traz um comentário sobre a Rede Pan-Americana de Centros Colaboradores de Enfermagem e Obstetrícia (PANMCC). Os objetivos são apresentar uma visão geral da formação e evolução da Rede, seu impacto em educação, pesquisa, políticas e comunicação e os benefícios da filiação. Também são destacadas as vantagens das redes internacionais como mecanismo para valorizar as forças de trabalho em enfermagem e obstetrícia e melhorar os sistemas de saúde. A Organização Pan-Americana da Saúde (OPAS) - o Escritório da Organização Mundial da Saúde (OMS) nas Américas - supervisiona os Centros Colaboradores na região. Criada em 1999, a PANMCC é composta por 17 centros situados em universidades e escolas de enfermagem. Esses centros fornecem informações essenciais sobre enfermagem e obstetrícia para a OPAS/OMS. A rede apoia o envolvimento global e o fortalecimento institucional por meio de colaboração, compartilhamento de recursos e colóquios de pesquisa. Os elos dentro da rede aprimoram o desenvolvimento profissional, estimulam o fortalecimento institucional e aumentam a visibilidade da PANMCC e do trabalho dos seus membros.

Doctoral education, advanced practice and research: An analysis by nurse leaders from countries within the six WHO regions.

Doctoral education, advanced practice and research are key elements that have shaped the advancement of nursing. Their impact is augmented when they are integrated and synergistic. To date, no publications have examined these elements holistically or through an international lens. Like a three-legged stool they are inter-reliant and interdependent. Research is integral to doctoral education and influential in informing best practice. This significance and originality of this discussion paper stem from an analysis of these three topics, their history, current status and associated challenges. It is undertaken by renowned leaders in 11 countries within the six World Health Organisation (WHO) regions: South Africa, Egypt, Finland, United Kingdom, Brazil, Canada, United States, India, Thailand, Australia, and the Republic of Korea. The first two authors used a purposive approach to identify nine recognized nurse leaders in each of the six WHO regions. These individuals have presented and published papers on one or more of the three topics. They have led, or currently lead, large strategic organisations in their countries or elsewhere. All these accomplished scholars agreed to collect relevant data and contribute to the analysis as co-authors. Doctoral education has played a pivotal role in advancing nurse scholarship. Many Doctor of Philosophy (PhD) prepared nurses become faculty who go on to educate and guide future nurse researchers. They generate the evidence base for nursing practice, which contributes to improved health outcomes. In this paper, the development of nursing doctoral programmes is examined. Furthermore, PhDs and professional doctorates, including the Doctor of Nursing Practice, are discussed, and trends, challenges and recommendations are presented. The increasing number of advanced practice nurses worldwide contributes to better health outcomes. Nonetheless, this paper shows that the role remains absent or underdeveloped in many countries. Moreover, role ambiguity and role confusion are commonplace and heterogeneity in definitions and titles, and regulatory and legislatorial inconsistencies limit the role's acceptance and adoption. Globally, nursing research studies continue to increase in number and quality, and nurse researchers are becoming partners and leaders in interdisciplinary investigations. Nonetheless, this paper highlights poor investment in nursing research and a lack of reliable data on the number and amount of funding obtained by nurse researchers. The recommendations offered in this paper aim to address the challenges identified. They have significant implications for policy makers, government legislators and nurse leaders.

Implementation strategy for advanced practice nursing in primary health care in Latin America and the Caribbean / Estrategia para introducir la enfermería de atención avanzada en la atención primaria de salud en América Latina y el Caribe

Advanced practice nursing (APN) is a term used to describe a variety of possible nursing roles operating at an advanced level of practice. Historically, APN roles haves evolved informally, out of the need to improve access to health care services for at-risk and disadvantaged populations and for those living in underserved rural and remote communities. To address health needs, especially ones related to primary health care, nurses acquired additional skills through practice experience, and over time they developed an expanded scope of practice. More recently, APN roles have been developed more formally through the establishment of graduate education programs to meet agreed-upon competencies and standards for practice. The introduction of APN roles is expected to advance primary health care throughout Latin America and the Caribbean, where few such roles exist. The purpose of the paper is to outline an implementation strategy to guide and support the introduction of primary health care APN roles in Latin America and the Caribbean. The strategy includes the adaptation of an existing framework, utilization of recent research evidence, and application of knowledge from experts on APN and primary health care. The strategy consists of nine steps. Each step includes a national perspective that focuses on direct country involvement in health workforce planning and development and on implementation. In addition, each step incorporates an international perspective on encouraging countries that have established APN programs and positions to collaborate in health workforce development with nations without advanced practice nursing.

Commitment and Care: The benefits of a healthy workplace for nurses, their patients and the system

The Canadian healthcare system is facinga nursing shortage that threatens patientcare. Many nurses, physically and mentallyexhausted, quit; employers can t fill thosevacancies, while paradoxically other nursescan t find secure jobs with hours that suitthem. Meanwhile, nursing schools can't keepup with the demand for new recruits.While caring for the sick and dying hasalways been demanding, many of the problemsfacing nurses today seem to arise fromwork environments that have grown increasinglydifficult through the cutbacks andupheavals of the 1990s. This paper was commissionedto answer two questions:What is the impact of the working environmenton the health of the nursing workforce(and hence, potentially, on patient outcomes)?What effective solutions could be implementedto improve the quality of the nursingwork environment (and hence, potentially,patient outcomes)?Research has made it clear that problemswith nurses work and work environments,including stress, heavy workloads, long hours,injury and poor relations with other professionscan affect their physical and psychologicalhealth. Research across occupations hasshown long periods of job strain affect personalrelationships and increase sick time,turnover and inefficiency.To prepare this report, we did a wide-rangingsurvey of peer-reviewed research on nursingand work in general; read a vast array ofother writing on the state of nursing; andinterviewed or held focus groups with healthsystemmanagers, nurses, governmentemployees, educators, representatives of nursesassociations and unions.From these sources, we outlined the problemsfacing nurses and defined them as issuesof work pressure, job security, workplace safety,support from managers and colleagues,control over practice, scheduling andthrough stronger leadership roles for nursesand rewards. There is no denying the seriousnessof the challenges facing nursing, but wefound many solid ideas for improving the situation.There are clear reasons why those runningthe healthcare system from the largest hospitalto a small community clinic as well asthe ministries who set their budgets and shapepolicy at the federal and provincial level, needto act. Organizations that do not create qualityenvironments to attract new recruits and retainexperienced nurses risk shortages that mayendanger patients.What can be done? Nurses, like most people,need some basic predictability in theirlives. That means they need to get back asense of job security and feel that the risk ofinjury and workplace violence has beenreduced. Longer budget cycles would helpemployers ensure that jobs won t disappear.Better equipment and more staff can helpreduce the risk of injuries, which increaseswhen there is no one to help turn a patient orwhen a nurse gets so busy and overextendedthat she pricks herself with a used needle.Studies show good relations among caregiversbenefit patients, even to the point ofreducing mortality. We believe that meansnurses need more support on the job, frommanagers who understand their work, respecttheir expertise and can offer a sense of securityand community. It means rebuilding a teamapproach to nursing where the focus can be onthe patient and not on inter-professional conflict.It means ensuring a manageable workload;it means offering educational and careeropportunities and the time to pursue them.One study found that nurses job satisfactionis the strongest determinant of clientsoverall satisfaction. Like most people, nurseswork best when they have a sense of controlover their jobs and their lives. That sense ofcontrol can be created by giving nurses morevoice in patient-care planning, more voice inpolicy-making and more say over the waythey work (such as being able to set their ownhours or not making them work mandatoryovertime).A demoralized worker is not a productiveworker, and nurses have a sense they are notvalued by the healthcare system for whichthey work so hard. Despite the increasing shiftof care into the home and other non-hospitalsettings, community nurses are often paid lessthan their hospital counterparts. Some casualnurses have more say in their hours than fulltimeemployees. Money isn t everything, but itis an important measure of worth. Incrementalpay increases recognizing expertise and experience,combined with more opportunities inmanagement and a clearer voice in runningthe system, would improve the status of nursesin their own eyes and throughout the system.This summary outlines some ideas forimproving working conditions in healthcare.There are many more in the report itself, rangingfrom finding more positions for nursepractitioners to including standards for healthyworkplaces in hospital accreditation. Some are simple to act on locally; others will requireco-operation. If better patient outcomes are tobe attained, governments, employers, educatorsand nurses must work together to create ahealthy nursing work environment.