What features of drug treatment programs help, or not, with access? a qualitative study of the perspectives of family members and community-based organization staff in Atlantic Canada.

BACKGROUND: Withdrawal management and opioid agonist treatment (OAT) programs help to reduce some of the harms experienced by people who use substances (PWUS). There is literature on how features of drug treatment programs (e.g., policies and practices) are helpful, or not helpful, to PWUS when seeking access to, or in, treatment. There is, however, relatively little literature based on the perspectives of family members/family of choice of PWUS and community-based organization staff within the context of Atlantic Canada. This paper explored the perspectives of these two groups on what was helpful, or not, about drug treatment programs in Atlantic Canada in terms of supporting access to, and retention in, treatment. METHODS: One-on-one qualitative telephone interviews were conducted in 2020 with the two groups. Interviews focused on government-funded withdrawal management and OAT programs. Data were coded using a qualitative data management program (ATLAS.ti) and analyzed inductively for key themes/subthemes using grounded theory techniques. RESULTS: Fifteen family members/family of choice and 16 community-based organization staff members participated (n = 31). Participants spoke about features of drug treatment programs in various places, and noted features that were perceived as helpful (e.g., quick access), as well as not helpful (e.g., wait times, programs located far from where PWUS live). Some participants provided their perceptions of how PWUS felt when seeking or accessing treatment. A number of participants reported taking various actions to help support access to treatment, including providing transportation to programs. A few participants also provided suggestions for change to help support access and retention such as better alignment of mental health and addiction systems. CONCLUSIONS: Participants highlighted several helpful and not helpful features of drug treatment programs in terms of supporting treatment access and retention. Previous studies with PWUS and in other places have reported similar features, some of which (e.g., wait times) have been reported for many years. Changes are needed to reduce barriers to access and retention including the changes recommended by study participants. It is critical that the voices of key groups, (including PWUS) are heard to ensure treatment programs in all places support access and retention.

Registered Nurses and Practical Nurses Working Together: An Institutional Ethnography.

In Canada, different categories of nursing professionals, including registered nurses and practical nurses, often "collaborate" to provide care to patients. How their collaboration is currently conceptualized in the literature varies; and these conceptualizations are not always contextualized by the complex sociopolitical environment in which nursing professionals work. The purpose of this study was to explicate how different categories of nursing professionals (registered nurses and practical nurses) worked together to provide patient care after a provincial health authority implemented a new nursing care delivery model to "optimize" patient care. The authors used Smith's institutional ethnography to guide the study, and data collection methods included observing, conducting interviews, and identifying the texts activated through the nursing professionals' work. Data analysis focused on the social organization of the nursing professionals collaboration, while keeping the complex contexts within they completed their daily work in view. The article concludes with recommendations for future research.

Addressing the Shortage of Health Professionals in Official Language Minority Communities to Strengthen Retention Strategies for the Benefit of New Brunswick Francophone and Acadian Communities: Protocol for a Mixed Methods Design.

BACKGROUND: COVID-19 has highlighted already existing human resource gaps in health care systems. New Brunswick health care services are significantly weakened by a shortage of nurses and physicians, affecting regions where Official Language Minority Communities (OLMCs) reside. Since 2008, Vitalité Health Network (the "Network"), whose work language is French (with services delivered in both official languages, English and French), has provided health care to OLMCs in New Brunswick. The Network currently needs to fill hundreds of vacant physician and nurse positions. It is imperative to strengthen the network's retention strategies to ensure its viability and maintain adequate health care services for OLMCs. The study is a collaborative effort between the Network (our partner) and the research team to identify and implement organizational and structural strategies to upscale retention. OBJECTIVE: The aim of this study is to support one of New Brunswick health networks in identifying and implementing strategies to promote physician and registered nurse retention. More precisely, it wishes to make 4 important contributions to identify (and enhance our understanding of) the factors related to the retention of physicians and nurses within the Network; determine, based on the "Magnet Hospital" model and the "Making it Work" framework, on which aspects of the Network's environment (internal or external) it should focus for its retention strategy; define clear and actionable practices to help the Network replenish its strength and vitality; and improve the quality of health care services to OLMCs. METHODS: The sequential methodology combines quantitative and qualitative approaches based on a mixed methods design. For the quantitative part, data collected through the years by the Network will be used to take stock of vacant positions and examine turnover rates. These data will also help determine which areas have the most critical challenges and which ones have more successful approaches regarding retention. Recruitment will be made in those areas for the qualitative part of the study to conduct interviews and focus groups with different respondents, either currently employed or who have left it in the last 5 years. RESULTS: This study was funded in February 2022. Active enrollment and data collection started in the spring of 2022. A total of 56 semistructured interviews were conducted with physicians and nurses. As of manuscript submission, qualitative data analysis is in progress and quantitative data collection is intended to end by February 2023. Summer and fall 2023 is the anticipated period to disseminate the results. CONCLUSIONS: Applying the "Magnet Hospital" model and the "Making it Work" framework outside urban settings will offer a novel outlook to the knowledge of professional resource shortages within OLMCs. Furthermore, this study will generate recommendations that could contribute to a more robust retention plan for physicians and registered nurses. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41485.

Community Social Paediatrics Approach, an Innovative Healthcare Intervention: Implementation Fidelity in Atlantic Canada.

The Community Social Paediatrics approach (CSPA) is a comprehensive and personalized approach to care that is becoming more widely used throughout Canada. However, data on its implementation fidelity remain scarce. The purpose of this research was to assess the implementation fidelity of a CSPA established in 2017 in Canada. Data were collected through focus group interviews with the CSPA team using an implementation fidelity grid based on the Dr. Julien Foundation standard accreditation criteria. Results showed that on one hand, administrative and financial management and governance were among those domains with lower ratings. On the other hand, assessment/orientation and follow-up/support had high levels of fidelity of implementation. This research helps to better understand which factors are contributing to varying levels of fidelity of implementation. To reach an increased level of fidelity of implementation, it is recommended that adequate resources be in place.

Factors Related to the Intention to Get Vaccinated Against COVID-19 in the Province of New Brunswick, Canada.

Vaccine refusal by even a small subset of the population can undermine the success of the vaccination campaigns which are currently underway worldwide. The goal of this study was to identify determinants of intention to receive COVID-19 vaccine. More precisely, it aimed at examining whether socioeconomic factors, levels of mistrust toward authorities, perceived scientific consensus, and perceived severity of COVID-19 can predict vaccination intentions against COVID-19. Vaccination intentions included being ready to get vaccinated, contemplating vaccination, and not considering vaccination. A sample of 399 individuals from New Brunswick, Canada, completed an online survey in March and April 2021. Results revealed that participants who declared they would probably get vaccinated were more likely to report lower levels of mistrust toward authorities, as well as higher perceived scientific consensus and perceived severity of COVID-19, compared to those who did not intend to get vaccinated or remained unsure. Strategies to guide healthcare professionals in assisting their patients in making the best healthcare decision for their family and themselves are discussed.

Observation and Institutional Ethnography: Helping Us to See Better.

Observation is a staple data collection method, which is used in many qualitative approaches, including both traditional and institutional ethnographies. While observation is one of the most used data collection methods in traditional ethnography, less is written about its use by institutional ethnographers. Institutional ethnography is an approach to social research where the aim is to explicate how peoples' every activities are coordinated or ruled by different institutions. In this article we explore uses of observation as a data collection method, focusing on its use in institutional ethnography. We use examples from the health care literature to show how observation can be beneficial and help institutional ethnographers see better.

Transforming child and youth mental health care: ACCESS Open Minds New Brunswick in the rural Francophone region of the Acadian Peninsula.

AIM: This paper describes how the transformation of youth mental health services in the rural Francophone region of the Acadian Peninsula in New Brunswick, Canada, is meeting the five objectives of ACCESS Open Minds. METHODS: Implementation of the ACCESS Open Minds framework of care in the Acadian Peninsula of New Brunswick began in 2016 at a well-established volunteer centre and community-based mental health organization. Through focus groups with youth aged 14 to 22 (n = 13), community mapping was used to describe the youth-related mental health service transformation, followed by thematic analysis, validation by member checking and triangulation. RESULTS: Preliminary results show a generally successful implementation of the ACCESS Open Minds model, as evidenced by the transformation of mental health service provision, the enhancement of capacity in human resources and the participation of youth. Transformation was evidenced across the five objectives of mental healthcare of ACCESS Open Minds, albeit to variable extents. Several facilitating factors and challenges are identified based on youths' accounts. CONCLUSIONS: It is possible to successfully implement the ACCESS Open Minds model among francophones living in a minority setting and despite the constraints of a rural area. Most key components of the framework were implemented with high program fidelity. The rural context presents unique challenges that require creative and effective use of resources, while offering opportunities that arise from a culture of resourcefulness and collaboration.

Bridging the silos in HIV and Hepatitis C prevention: a cross-provincial qualitative study.

OBJECTIVES: The Our Youth Our Response (OYOR) study explored the scope and accessibility of existing youth-oriented human immunodeficiency virus (HIV) and Hepatitis C (HCV) prevention in Atlantic Canada. METHODS: A cross-provincial, qualitative population health and gender-based analytic approach was used in this study. Four hundred and twenty-five documents were part of the initial scoping review, while 47 in-depth interviews across youth-relevant sectors were undertaken to explore the perceptions related to current approaches to youth-oriented HIV/HCV prevention policies and programs. The study also conducted focus group discussions with 21 key informants aimed at identifying strategies to address the challenges identified from the interview data. RESULTS: Five overarching themes emerged from our triangulated data in relation to the present state of youth-related HIV/HCV prevention. These included: inter-organizational and intersectoral collaboration; youth engagement; access to testing; harm reduction; and education. CONCLUSIONS: Our findings will assist in informing the next generation for HIV/HCV prevention aimed at youth. Specifically, the results indicate that future prevention initiatives should support the use of intersectoral collaboration, gender-based approaches, and HIV/HCV testing innovation to help de-stigmatize prevention efforts.

Quality of life in end stage renal disease: a concept analysis.

AIM: This concept analysis examines quality of life (QOL) in the context of end stage renal disease (ESRD). BACKGROUND: Quality of life is a multidimensional concept historically used by governmental bodies to measure society's satisfaction of economic and social outcomes. However, health care researchers have demonstrated that the concept of QOL relates to a deeper meaning of an individual's experience of life and health. DESIGN: Walker and Avant's (2010) framework of concept analysis was chosen to provide conceptual clarity for nephrology nurses and allied health care professionals. DATA SOURCES: The CINHAL, EBSCO, ERIC, Medline, PsycINFO, and PubMed databases were searched for the period of 1998-2013 for literature published in English and French with a focus of peer-reviewed journals from disciplines of health sciences and psychology. RESULTS: Consequent to this concept analysis, QOL has been defined by three defining attributes, such as the ability to engage in vigorous activities, the ability to perform activities of daily living (ADL), and the ability to engage in family, social, and occupational roles. CONCLUSION: These findings enable a clear and functional definition of the concept of QOL in the context of ESRD, therefore facilitating the ability of nephrology nurses and allied health care professionals to assess clients' needs and improve their health care outcomes through their lived experience.