Pursuit of Equity: Women on a Low Income Navigating Access to Health and Social Services in Canada.

BACKGROUND: Existing research highlights the role of social determinants of health, such as education and housing, in predicting health outcomes and the challenges that arise from deficiencies in these areas, often linked to societal inequities. Gender and income are recognized as social determinants of health, yet the complexities of their interplay, particularly for women with low income seeking health and social services in Canada, need more exploration. OBJECTIVE: This study investigates how gender and income intersect to affect access to health and social services for Canadian women with low income. METHODS: Employing a participatory action approach with arts-based and interpretive methodologies, the study partnered with a non-profit organization to engage five women through photovoice, interviews, and a focus group, aiming to capture their experiences in accessing services. RESULTS: The analysis revealed three primary themes: the labyrinth-like complexity of navigating health and social service systems, the importance of mental health sanctuaries, and the value of supportive networks. Participants reported difficulties and frustrations in system navigation, often feeling ignored by service providers. Contrarily, community agencies provided essential non-judgmental support, including daily necessities and emotional care, with the companionship of pets also being a notable source of comfort. CONCLUSION: The findings advocate for a shift towards more person-centred care in health and social service systems to better serve women in vulnerable positions, emphasizing the need to simplify the process of accessing services and ensuring that service providers recognize and address the unique challenges faced by equity-deserving groups.

Experience of loneliness and depression due to spousal separation by long-term care residents and their spouses: a qualitative systematic review.

OBJECTIVE: The objective of this review was to describe the experiences of loneliness and/or depression for residents and their spouses who are separated by long-term care placement. INTRODUCTION: Loneliness and depression have a pernicious influence on the overall health and well-being of older adults. Older adults' mental health is significantly affected by social relationships, including those between spouses. However, research pertaining to the experience or effect of spousal separation on long-term care residents and community-dwelling spouses' feelings of loneliness and/or depression is limited. INCLUSION CRITERIA: This systematic review included studies that recruited community-dwelling spouses and long-term care residents over 50 years of age with living spouses from whom they are separated due to long-term care placement. Studies on the experiences of loneliness and/or depression due to spousal separation with one or both spouses living in long-term care were included in this review. METHODS: Ovid MEDLINE(R) was used for the initial search. A full search strategy was developed for Ovid MEDLINE(R), CINAHL (EBSCOhost), Embase (Ovid), and PsycINFO (Ovid). The review was conducted using the JBI approach, with 2 independent reviewers performing study selection, critical appraisal, data extraction, assessment of confidence, and data synthesis. RESULTS: Eleven papers were included in this systematic review. Four synthesized findings were extracted from 10 categories and 42 findings: i) Loneliness and depression result from a lack of physical and social connection for separated long-term care residents and community-dwelling spouses; ii) Community-dwelling spouses feel unprepared and upset with spousal separation due to a lack of psychological support; iii) Behavioral strategies can prevent community-dwelling spouses and long-term care residents from developing loneliness and/or depression; and 4) Community-dwelling spouses have differing abilities to adapt and cope with feelings of loneliness and/or depression. CONCLUSION: This review provides a comprehensive synthesis of the feelings of loneliness and/or depression spouses who are separated due to long-term care admission experience. This review has demonstrated that there is a lack of literature inclusive of the voices and perspectives of all spouses affected by spousal separation in long-term care. The limitations of this review include the small number of included studies and the range of quality of included studies. Recommendations include additional research on the lived experience of spousal separation from the perspectives of long-term care residents and their community-dwelling spouses. Further, additional psychological support is needed for separated spouses guided by the suggestions and experiences of long-term care residents and their community-dwelling spouses. REVIEW REGISTRATION: PROSPERO CRD42022333014.

The Current State of Kidney Supportive Care in Nephrology Nursing Practice: A Literature Review.

Kidney disease is associated with a high physical and psychological symptom burden. For patients whose condition is more compromised, receiving dialysis as a life-sustaining therapy may not improve longevity or quality of life. Palliative care for patients with kidney disease (also termed kidney supportive care [KSC]) is appropriate for this patient population. Nephrology nurses working in dialysis are well positioned to talk with patients about what patients perceive constitutes a meaningful life or death. A literature review was undertaken to find evidence about if and how nephrology nurses engage in KSC with patients receiving dialysis. Based on the 29 articles included in this review, the overarching finding was nephrology nurses working in dialysis are not routinely engaging in KSC. Reasons for this are varied and warrant further investigation.

PROTOCOL: Learner-educator co-creation of student assessment in health professional education courses: A scoping review protocol.

This is a protocol for a Campbell Review following JBI scoping review methodology. The objectives are to answer the following questions: What has been reported in the literature about collaborative learner-educator design, implementation, or evaluation of learner assessment in health professional education? (1) Where is learner-educator co-creation of assessment occurring? (i.e., which disciplines, course types, level of learner, year of study). (2) What course assessment decisions are influenced or being made together? (i.e., assessment instructions and/or grades). (3) How much influence do learners have on decision-making? (i.e., where does it fall on Bovill and Bulley's ladder of participation). (4) How do learners and educators go about making decisions together? (i.e., discussion or voting, with a whole class or portion of the class). (5) What are the perceived benefits, disadvantages, barriers, and/or facilitators reported by the authors?

Increasing access to palliative care for patients with advanced cancer of African and Latin American descent: a patient-oriented community-based study protocol.

BACKGROUND: Cancer disparities are a major public health concern in Canada, affecting racialized communities of Latin American and African descent, among others. This is evident in lower screening rates, lower access to curative, and palliative-intent treatments, higher rates of late cancer diagnoses and lower survival rates than the general Canadian population. We will develop an Access to Palliative Care Strategy informed by health equity and patient-oriented research principles to accelerate care improvements for patients with advanced cancer of African and Latin American descent. METHODS: This is a community-based participatory research study that will take place in two Canadian provinces. Patients and community members representatives have been engaged as partners in the planning and design of the study. We have formed a patient advisory council (PAC) with patient partners to guide the development of the Access to Palliative Care Strategy for people of African and Latin American descent. We will engage100 participants consisting of advanced cancer patients, families, and community members of African and Latin American descent, and health care providers. We will conduct in-depth interviews to delineate participants' experiences of access to palliative care. We will explore the intersections of race, gender, socioeconomic status, language barriers, and other social categorizations to elucidate their role in diverse access experiences. These findings will inform the development of an action plan to increase access to palliative care that is tailored to our study population. We will then organize conversation series to examine together with community partners and healthcare providers the appropriateness, effectiveness, risks, requirements, and convenience of the strategy. At the end of the study, we will hold knowledge exchange gatherings to share findings with the community. DISCUSSION: This study will improve our understanding of how patients with advanced cancer from racialized communities in Canada access palliative care. Elements to address gaps in access to palliative care and reduce inequities in these communities will be identified. Based on the study findings a strategy to increase access to palliative care for this population will be developed. This study will inform ways to improve access to palliative care for racialized communities in other parts of Canada and globally.

Barriers and facilitators to HIV pre-exposure prophylaxis uptake among transgender women in Colombia: A qualitative analysis using the COM-B model.

Transgender women [TGW] in Colombia are disproportionately affected by HIV due to their low sociodemographic conditions, varied risk behaviours, difficulty accessing health services, and discrimination. Offering pre-exposure prophylaxis [PrEP] as part of a combination of prevention strategies is an appropriate option for this population to reduce their risk of HIV infection. However, little is known about how to implement a PrEP program for TGW in Colombia. Between June and October 2020, we conducted individual interviews with 16 TGW from four different cities in Colombia. The interviews assessed contextual influences, knowledge, skills, perceptions, and beliefs. We used qualitative thematic analysis to identify themes and the Capability, Opportunity, Motivation, and Behavior framework to further delineate barriers and possible interventions. After delineating the main themes across the three subdomains of the model, nine barriers were identified: one related to capability, knowledge, and perception of PrEP; six related to opportunity, which includes, family relations, sexual work environment, stable partner relations, interactions with healthcare workers, health service provision, and community interactions and opportunities; and two related to motivation, mental health, and concerns about medication side effects. Mapping barriers with interventions generated the following intervention functions: education, training, enablement, and environmental structure; and the following policy functions: communication/marketing, legislation, and changes in service provision. Examples of possible interventions are presented and discussed.

'The solution is we need to have a centre': a study on diabetes in Liberia.

In Liberia, one of the poorest nations in sub-Saharan Africa, the burden of diabetes is a growing concern. The high mortality and morbidity associated with diabetes have significant implications for individuals, families and society at large. The aim of this critical hermeneutic study was to explore what it is like to live with diabetes in Liberia. We recruited 10 participants from Monrovia, Liberia to partake in this study. Photovoice, a well-established participatory data collection approach was used to gather images and stories that represented participants' everyday experiences of living with diabetes. Three major themes were uncovered, highlighting the strengths, challenges and solutions related to living with diabetes in Liberia: strengths-engagement in diabetes self-management practices, focused on participants' commitment to engage in diabetes self-management practices despite the socioeconomic challenges they experienced; challenges-lack of social and economic support, focused on limited access to food, diabetes medications and supplies and diabetes education; and solutions-centre for diabetes education, care and support, focused on participants' recommendations for a community-based diabetes centre, a single point of access for meeting the needs of people with diabetes. A strong commitment to prioritize diabetes on Liberia's national health agenda and increased resources for diabetes care is needed to address the challenges experienced by people living with this chronic disease in Liberia.

Exploring diabetes status and social determinants of health influencing diabetes-related complications in a Northwestern community, Ontario, Canada: A mixed method study protocol.

Diabetes is a common chronic condition affecting the many spheres of individuals' lives. It can also lead to severe complications without continuous management. Accordingly, this paper describes a study protocol aimed at 1) determining the status and prevalence of diabetes complications in a Northwestern Ontario community; 2) exploring the internal (e.g., demographic and clinical variables) and external factors (e.g., access to services and resources) affecting diabetes outcomes (e.g., complications, emergency room visits, hospitalizations); 3) critically exploring how the social determinants of health affect self-management for individuals living with diabetes; and 4) identifying individuals' needs, concerns, and challenges to monitor and regulate diabetes. The study uses a cross-sectional design and a social constructivist approach based on qualitative data collection. The proposed study will include patients with type 1 and type 2 diabetes with or without diabetes complications who have been attending the Centre for Complex Diabetes Care (CCDC) in Thunder Bay, Ontario, Canada, since January 2019. Quantitative data related to diabetes complications and other outcomes, diabetes management, and demographic and clinical status will be retrieved from patients' charts using a data extraction form. Analyses of the quantitative data will include the prevalence of diabetes complications, rate of hospitalizations, and their associations with diabetes management, access to services, and social determinants of health. Additionally, interviews will occur with at least 10 participants with or without diabetes complications to understand their needs, concerns, and struggle to self-manage diabetes daily. The results of this study will generate evidence to support future research and policy on the development and implementation of an educational program to improve self-care management and outcomes for individuals living with diabetes and its complications in Northwestern Ontario.

Diabetes self-management education (DSME) for older persons in Western countries: A scoping review.

Diabetes mellitus is a chronic metabolic health condition affecting millions globally. Diabetes is a growing concern among aging societies, with its prevalence increasing among those aged 65 and above. Enabling disease self-management via relevant education is part of high-quality care to improve health outcomes and minimize complications for individuals living with diabetes. Successful diabetes self-management education (DSME) programs usually require tailoring for the intended audience; however, there is limited literature about the preferences of older persons in Western countries concerning DSME. As such, a broad overview of DSME for older persons was an identified need. To map the available evidence on DSME for persons aged 65 years and older in Western countries, the JBI methodology for conducting and reporting scoping reviews was used. In this scoping review, we considered all studies about DSME for older persons with T1D and T2D in Western countries where lifestyles, risks, prevention, treatment of diabetes, and approaches to self-management and DSME are similar (e.g., North America, Western and Northern Europe and Australasia). Systematic keyword and subject heading searches were conducted in 10 databases (e.g., MEDLINE, JBI EBP) to identify relevant English language papers published from 2000 to 2022. Titles and abstracts were screened to select eligible papers for full-text reading. Full-text screening was done by four independent reviewers to select studies for the final analysis. The review identified 2,397 studies, of which 1,250 full texts were screened for eligibility. Of the final 44 papers included in the review, only one included participants' understanding of DSME. The education programs differed in their context, design, delivery mode, theoretical underpinnings, and duration. Type of research designs, outcome measures used to determine the effectiveness of DSME, and knowledge gaps were also detailed. Overall, most interventions were effective and improved clinical and behavioural outcomes. Many of the programs led to improvements in clinical outcomes and participants' quality of life; however, the content needs to be adapted to older persons according to their culture, different degrees of health literacy, preference of education (e.g., individualized or group), preference of setting, degree of frailty and independence, and comorbidities. Few studies included the voices of older persons in the design, implementation, and evaluation of DSME programs. Such experiential knowledge is vital in developing educational programs to ensure alignment with this population's preferred learning styles, literacy levels, culture, and needs-such an approach could manifest more substantive, sustained results.

The processes of engagement in information-seeking behavior for individuals with diabetes who developed diabetic foot ulcer: A constructivist grounded theory study.

To describe the process of engagement in information seeking behavior for individuals with type 1 and type 2 diabetes. Methodology: Constructivist grounded theory. The data was gathered through thirty semi-structured interviews of participants attending a wound care clinic in Southeast, Ontario, Canada. The waiting period taken to seek appropriate help varied from weeks to months. Results: "The processes of engagement in information-seeking behavior about diabetes" are organized as follows: 1) discovering diabetes, 2) reactions to the diagnosis, and 3) engaging in self-directed learning. For most participants, the diagnosis of diabetes was unexpected and usually confirmed after a long period of experiencing a diversity of symptoms. The terms used mostly by participants were "I started to wonder" and "Something was wrong with me." After being diagnosed with diabetes, participants sought information to learn about it. Most of them engaged in self-directed learning to acquire knowledge about their illness. Conclusion: Although the Internet is often used to seek information, healthcare providers and support network also played an important role in supporting participants information-seeking behavior learn about diabetes. The unique needs of people with diabetes must be taken into consideration during their diabetes care journey. These findings call for the need to provide education about diabetes from the time they are diagnosed and direct them to reliable resources of information.

Resolutividade no Subsistema de Atenção à Saúde Indígena (SASI-SUS): análise em um serviço de referência no Amazonas, Brasil / Problem-solving in the Indigenous Health Care Subsystem (SASI-SUS): analysis in a reference service in Amazonas, Brazil

Resumo A resolutividade é um dos princípios do Sistema Único de Saúde (SUS) no Brasil, com sua capacidade de resolver os problemas da população nos diferentes níveis de complexidade da saúde. O Subsistema de Atenção à Saúde Indígena (SASI-SUS) integra este sistema, respeitando as especificidades das populações indígenas. O objetivo deste artigo é analisar a percepção dos profissionais e gestores de uma Casa de Saúde Indígena (CASAI) a respeito da resolutividade no subsistema quanto às circunstâncias da pandemia. Pesquisa qualitativa, de caráter descritivo, à luz da Política Nacional de Atenção à Saúde dos Povos Indígenas (PNASPI) e da teoria hermenêutica de Paul Ricoeur. Foram realizadas entrevistas entre os participantes a fim de registrar as experiências no processo de trabalho dos atores que cuidam dos indígenas referenciados à Manaus, Amazonas. Foram identificadas, pelas entrevistas, quatro temáticas essenciais: cuidado cultural; educação permanente em saúde & educação em saúde; negociação & improviso e; acolhimento & infraestrutura. A CASAI é uma instituição que vai além de um centro de apoio ou alojamento, sendo ponto de articulação entre os diferentes níveis de atenção aos indígenas e local de produção de cuidados e de saberes, tal como da construção de suas relações, resultando em um espaço resolutivo.

Abstract Problem-solving is one of the principles of the Unified Health System (SUS) in Brazil, with its ability to solve the health problems of the population at different levels of complexity. The Indigenous Health Care Subsystem (SASI-SUS) is part of this service, respecting the specificities of indigenous populations. The scope of this article is to analyze the perception of professionals and managers of an Indigenous Health Center (CASAI) regarding its ability to cope with the circumstances of the pandemic. It involved qualitative and descriptive research under the National Health Care Policy for Indigenous Peoples (PNASPI) and Paul Ricoeur's hermeneutic theory. Interviews were conducted with participants in order to record the experiences in the work process of the actors who assist the indigenous people housed at CASAI. Four essential themes were identified in the interviews: cultural care; permanent education in health & health education; negotiation & improvisation; and reception & infrastructure. CASAI is an institution that is more than a support center or accommodation, being a crossover point between the different levels of care and knowledge production of the indigenous people, as well as a place for establishing a relationship, resulting in a problem-solving space.

Caring Knowledge as a Strategy to Mitigate Violence against Nurses: A Discussion Paper.

Violence against nurses is a disturbing trend in healthcare that has reached epidemic proportions globally. These violent incidents can result in physical and psychological injury, exacerbating already elevated levels of stress and burnout among nurses, further contributing to absenteeism, turnover, and intent to leave the profession. To ensure the physical and mental well-being of nurses and patients, attention to the development of strategies to reduce violence against nurses must be a priority. Caring knowledge-rooted in the philosophy of care-is a potential strategy for mitigating violence against nurses in healthcare settings. We present what caring knowledge is, analyze its barriers to implementation at the health system and education levels and explore potential solutions to navigate those barriers. We conclude how the application of models of caring knowledge to the nurse-patient relationship has the potential to generate improved patient safety and increased satisfaction for both nurses and patients.

[Problem-solving in the Indigenous Health Care Subsystem (SASI-SUS): analysis in a reference service in Amazonas, Brazil]. / Resolutividade no Subsistema de Atenção à Saúde Indígena (SASI-SUS): análise em um serviço de referência no Amazonas, Brasil.

Problem-solving is one of the principles of the Unified Health System (SUS) in Brazil, with its ability to solve the health problems of the population at different levels of complexity. The Indigenous Health Care Subsystem (SASI-SUS) is part of this service, respecting the specificities of indigenous populations. The scope of this article is to analyze the perception of professionals and managers of an Indigenous Health Center (CASAI) regarding its ability to cope with the circumstances of the pandemic. It involved qualitative and descriptive research under the National Health Care Policy for Indigenous Peoples (PNASPI) and Paul Ricoeur's hermeneutic theory. Interviews were conducted with participants in order to record the experiences in the work process of the actors who assist the indigenous people housed at CASAI. Four essential themes were identified in the interviews: cultural care; permanent education in health & health education; negotiation & improvisation; and reception & infrastructure. CASAI is an institution that is more than a support center or accommodation, being a crossover point between the different levels of care and knowledge production of the indigenous people, as well as a place for establishing a relationship, resulting in a problem-solving space.

A resolutividade é um dos princípios do Sistema Único de Saúde (SUS) no Brasil, com sua capacidade de resolver os problemas da população nos diferentes níveis de complexidade da saúde. O Subsistema de Atenção à Saúde Indígena (SASI-SUS) integra este sistema, respeitando as especificidades das populações indígenas. O objetivo deste artigo é analisar a percepção dos profissionais e gestores de uma Casa de Saúde Indígena (CASAI) a respeito da resolutividade no subsistema quanto às circunstâncias da pandemia. Pesquisa qualitativa, de caráter descritivo, à luz da Política Nacional de Atenção à Saúde dos Povos Indígenas (PNASPI) e da teoria hermenêutica de Paul Ricoeur. Foram realizadas entrevistas entre os participantes a fim de registrar as experiências no processo de trabalho dos atores que cuidam dos indígenas referenciados à Manaus, Amazonas. Foram identificadas, pelas entrevistas, quatro temáticas essenciais: cuidado cultural; educação permanente em saúde & educação em saúde; negociação & improviso e; acolhimento & infraestrutura. A CASAI é uma instituição que vai além de um centro de apoio ou alojamento, sendo ponto de articulação entre os diferentes níveis de atenção aos indígenas e local de produção de cuidados e de saberes, tal como da construção de suas relações, resultando em um espaço resolutivo.

The Impact of Diabetic Foot Ulcer on Individuals' Lives and Daily Routine: A Qualitative Study Informed by Social Constructivism and Symbolic Interactionism Frameworks.

PURPOSE: The purpose of this study was to explore the impact of diabetic foot ulcer (DFU) on individuals' lives and daily routines. DESIGN: Qualitative design informed by social constructivism and symbolic interactionism frameworks. SUBJECTS AND SETTING: The sample comprised 30 individuals attending a wound care clinic in Southeast Ontario, Canada. Most participants (n = 17) were between the ages of 65 and 92 years, were male (n = 20), married (n = 21), living with their family (n = 23), and had completed high school (n = 26). METHODS: One-to-one semistructured interviews were conducted by the first author until saturation of each emerging theme was achieved. Interviews were audio-recorded and lasted from 45 to 90 minutes. Data collection and analysis occurred simultaneously and included intensive semistructured interviews, field notes, and researcher's journal. RESULTS: Participants with DFUs were found to perceive a "sense of life change," impacting their lives across physical, psychological, and social spheres. They reported 4 key themes indicating that DFUs were (1) limiting their outings; (2) restricting leisure activities; (3) impacting personal and social life; and (4) contributing to emotional fluctuations. CONCLUSION: Sense of life changes resulting from DFUs were associated with participant reporting loss of freedom and enjoyment. These findings underscore the need for holistic support for patients with DFUs that simultaneously address physical, psychological, and social needs and areas of impact.

Diabetes self-management education for older adults in Western countries: a scoping review protocol.

OBJECTIVE: This scoping review will map the available evidence on diabetes self-management education programs for older adults in Western countries. INTRODUCTION: Self-management and education are crucial for controlling diabetes and its associated complications. The successful uptake of diabetes self-management education programs is not straightforward, and little is known about diabetes programs for older adults. Within this context, a broad overview of diabetes self-management education for older adults, considering all types of related evidence, is needed. INCLUSION CRITERIA: All studies in English concerning diabetes self-management education for older adults (aged 65 years and older) living with type 1 or 2 diabetes will be included. This review will not be specific to gender, sex, ethnicity, frailty, or other demographic variables. The review will be restricted to Western countries (North America, Western and Northern Europe, and Australasia), where approaches to diabetes self-management education will be similar. Studies including older adults with or without diabetes will not be considered unless they provide separate analyses for the 2 cohorts. METHODS: This scoping review will follow the JBI methodology for scoping reviews. We will conduct searches of electronic databases, including CINAHL, MEDLINE, and PubMed, from January 1, 2000, to the present to capture eligible articles. The review will consider all study designs, including quantitative, qualitative, mixed methods designs, as well as text and opinion papers, and systematic reviews that meet the inclusion criteria. After duplicates are removed, titles and abstracts will be screened independently by 2 reviewers, and the full texts will be reviewed. The screening criteria and data extraction protocol will be pilot-tested by the research team. The results will be summarized in tables accompanied by narrative text.

Access to health and social services by women living on a low income in Canada: a scoping review protocol.

OBJECTIVE: The objective of this scoping review is to map the current evidence about access to health and social services for women living on a low income in Canada. INTRODUCTION: Women, especially those living on a low income, are disproportionately likely to suffer inequities in access to health and social services. There is insufficient understanding of how the interaction of socioeconomic factors and gender can affect women's access to these services. This review will provide an initial picture of what exists in the literature about access to health and social services for women living on a low income in Canada. The results of this scoping review may be used to inform subsequent qualitative and quantitative reviews on this subject. INCLUSION CRITERIA: Literature addressing access to health and social services by women who are 18 years or older and living on a low income in Canada will be considered for inclusion. Health services will include health promotion and disease prevention; treatment of medical conditions; and rehabilitation, palliative, and end-of-life care. Social services are non-medical services designed to help members of a society who may need extra support or are considered to have social or behavioral risk factors. METHODS: We will search relevant electronic databases (eg, MEDLINE, CINAHL, PsycINFO) and gray literature. The review will include all study designs, including qualitative, quantitative, and mixed methods methodologies (excluding economic analyses or clinical practice guideline development documents). Two reviewers will test the screening criteria and data extraction protocol.

Patients' Perceptions of Reasons Contributing to Delay in Seeking Help at the Onset of a Diabetic Foot Ulcer: A Grounded Theory Study.

PURPOSE: The purpose of this study was to explore patients' perception of reasons contributing to delay in seeking help and referral to a wound care specialist at the onset of a diabetic foot ulcer (DFU). DESIGN: Constructivist grounded theory study. SUBJECTS AND SETTING: The sample comprised 30 individuals with active DFU attending a wound care clinic in southeastern Ontario, Canada. METHODS: Participants were selected through purposive and theoretical sampling. Semistructured interviews were conducted with participants until no new properties of the patterns emerged. All interviews were transcribed, coded, and analyzed using methods informed by constructivist grounded theory. RESULTS: The reasons contributing to delay to seek help and referral to a wound care specialist were (1) limited knowledge about foot care, (2) unaware of diabetic foot problems, (3) underestimation of ulcer presentation, (4) I thought I could fix it myself, (5) inaccurate diagnosis, and (6) trial and error approach by a nonspecialized wound care provider. CONCLUSIONS: Study findings suggest that patients and primary healthcare providers need additional education regarding the management of diabetic foot disease and DFU.

Revisioning Assessment and Evaluation in Nursing Education Through Critical Caring Pedagogy: Using Authentic Examinations to Promote Critical Consciousness.

Instead of instilling in nursing students critical thinking to challenge injustice and oppression in nursing practice, nurse educators often rely on outdated traditional approaches to education. This situation is certainly true in traditional methods of evaluation that often propagate a banking mode of learning. One of the most commonly used methods of evaluating students is traditional examinations, which have recently become a source of pedagogical conflict among educators. In this article, we outline how educators unknowingly encourage surface learning, uncaring practices, oppression, inequity, and cheating when they rely on traditional examinations. We draw on critical caring pedagogy and universal design for learning to advocate for increased use of authentic assessment in nursing education. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A31.

Redefining Cheating on Written Exams: A Shift Toward Authentic Assessment to Promote Universal Design for Learning in the Context of Critical Caring Pedagogy.

Educators who recognize the value of authentic written exams for promoting student critical thinking may struggle with concerns about cheating. In this article, we explore how educators may use open-web take-home exams to help students develop integrity and evidence-based practice skills. Lang's theory is used to explore why students may cheat. We discuss the importance of caring assessment practices by drawing on critical caring pedagogy and universal design for learning. Throughout the discussion, we illustrate how authentic questions and instruction that is focused on dialogue, collaboration, and resource use may reduce cheating possibilities while improving student learning.

Exploring How Sexual Assault Nurse Examiners Practise Trauma-Informed Care.

BACKGROUND: Sexual violence is a term describing sexual acts where consent is not freely given. Registered nurses employed as sexual assault nurse examiners (SANEs) provide care to address the medical and legal needs of victims/survivors of sexual violence. Trauma-informed care (TIC) is an approach recommended when caring for individuals who have experienced trauma. PURPOSE: The study purpose was to understand how SANEs incorporate trauma-informed approaches in the care of adult and postpubescent adolescent victims/survivors of sexual violence. METHODS: Eight SANEs were purposively recruited to participate in online semistructured interviews. Interview data were analyzed using qualitative interpretive description. RESULTS: Six themes emerged from the analysis: (a) the importance of understanding the patient's experience; (b) personalized connection: developing a safe nurse-patient relationship; (c) choice: the framework of how we do things; (d) rebuilding strengths and skills to support healing and posttraumatic growth; (e) a wonderful way to practise: facilitators and benefits of trauma-informed practice; and (f) challenges to trauma-informed practice. CONCLUSIONS: These findings indicate the perceived value of TIC and the need for enhanced support of providers who deliver TIC. More research is warranted to strengthen the evidence about trauma-informed practice in SANE programs and across healthcare settings.