Examining adaptive models of care implemented in hospital ICUs during the COVID-19 pandemic: a qualitative study.

BACKGROUND: The emergence of the COVID-19 pandemic led to an increased demand for hospital beds, which in turn led to unique changes to both the organisation and delivery of patient care, including the adoption of adaptive models of care. Our objective was to understand staff perspectives on adaptive models of care employed in intensive care units (ICUs) during the pandemic. METHODS: We interviewed 77 participants representing direct care staff (registered nurses) and members of the nursing management team (nurse managers, clinical educators and nurse practitioners) from 12 different ICUs. Thematic analysis was used to code and analyse the data. RESULTS: Our findings highlight effective elements of adaptive models of care, including appreciation for redeployed staff, organising aspects of team-based models and ICU culture. Challenges experienced with the pandemic models of care were heightened workload, the influence of experience, the disparity between model and practice and missed care. Finally, debriefing, advanced planning and preparation, the redeployment process and management support and communication were important areas to consider in implementing future adaptive care models. CONCLUSION: The implementation of adaptive models of care in ICUs during the COVID-19 pandemic provided a rapid solution for staffing during the surge in critical care patients. Findings from this study highlight some of the challenges of implementing redeployment as a staffing strategy, including how role clarity and accountability can influence the adoption of care delivery models, lead to workarounds and contribute to adverse patient and nurse outcomes.

Creating a relational arts-based academy for persons living with dementia.

A hospital-university collaboration has created an innovative learning Academy for persons living with dementia. Authors propose essential foundations for creating a different culture of dementia care: a home-like, judgement free place; a relational space focused on artistic expression and discovery; and, the marriage of learning with a deep respect for difference and growth. An array of challenges and insights highlight the commitments required to create and sustain real change. Partnerships with community organizations and schools merged relational philosophy-based research, teaching-learning, and art to generate new patterns of innovative practices. The commitment of the Academy is to relational arts-based inquiry focused on relationships, life enrichment, and engagement in a space where everyone thrives.

Overcoming Challenges to Support Clinician-Scientist Roles in Canadian Academic Health Sciences Centres.

Clinician-scientists (CSs) make significant contributions to the healthcare system, yet their roles are not fully understood, supported or recognized by healthcare leaders or policy makers. CSs are healthcare professionals with advanced research training who continue to pursue clinical work and are considered an essential component of the research infrastructure in academic health sciences centres. The current literature supports the role of CSs but is also clear that there are multiple challenges in attracting and retaining clinicians to the role. To gain a comprehensive understanding of the current status of the CS role, two literature reviews were conducted. The findings reported here include an overview of: the education and training preparation for CS roles; the importance of the CS role; barriers and challenges to developing and implementing the CS role; and strategies for supporting and sustaining CS roles in practice. The paper further describes one Canadian academic health sciences centre's approach to supporting and increasing the number of CSs from nursing and allied health professions to support academic practice. Non-physician CSs may conduct research using multiple research designs across the research continuum from randomized controlled trials to grounded theory or qualitative descriptive approaches. Their research generally focuses on practice-based issues such as best practices for managing pain or frailty or evaluating the effectiveness of new approaches to care. Researchers and healthcare leaders in other organizations may find this work helpful for establishing their own structures to enhance research capacity and practice-based research, especially for non-physician CSs.

Attributes and Actions Required to Advance Quality and Safety in Hospitals: Insights from Nurse Executives.

To lead effectively within their organizations, nurse executives must possess quality and safety literacy and be able to engage and motivate clinicians to participate in safety and quality initiatives. Given the paucity of research in Canada, a study was undertaken to explore nurse executives' understanding of the key concepts and strategies associated with patient safety and quality improvement, and their engagement with patient safety and quality improvement in their hospitals and healthcare systems. This study used an exploratory qualitative design with a content analysis approach on 20 nurse executives working in hospitals in Ontario. Three key themes emerged from the narrative data set including: (1) being a strategic and system thinker while possessing the emotional intelligence to influence staff; (2) building credibility and relationships with point-of-care staff, board of directors, and leadership team and (3) creating a culture of safety and high reliability. Study findings can be useful in informing future learning opportunities for nurse executives and nurses leaders at all levels to enhance their quality and safety literacy.

Building A High Quality Oncology Nursing Workforce Through Lifelong Learning: The De Souza Model.

AbstractCancer is one of the leading causes of death in the world. Along with increased new cases, cancer care has become increasingly complex due to advances in diagnostics and treatments, greater survival, and new models of palliative care. Nurses are a critical resource for cancer patients and their families. Their roles and responsibilities are expanding across the cancer care continuum, calling for specialized training and support. Formal education prepares nurses for entry level of practice, however, it does not provide the specialized competencies required for quality care of cancer patients. There is urgent need to align the educational system to the demands of the health care system, ease transition from formal academic systems to care settings, and to instill a philosophy of lifelong learning. We describe a model of education developed by de Souza Institute in Canada, based on the Novice to Expert specialty training framework, and its success in offering structured oncology continuing education training to nurses, from undergraduate levels to continued career development in the clinical setting. This model may have global relevance, given the challenge in managing the demand for high quality care in all disease areas and in keeping pace with the emerging advances in technologies.

What is "the patient perspective" in patient engagement programs? Implicit logics and parallels to feminist theories.

Public and patient involvement (PPI) in health care may refer to many different processes, ranging from participating in decision-making about one's own care to participating in health services research, health policy development, or organizational reforms. Across these many forms of public and patient involvement, the conceptual and theoretical underpinnings remain poorly articulated. Instead, most public and patient involvement programs rely on policy initiatives as their conceptual frameworks. This lack of conceptual clarity participates in dilemmas of program design, implementation, and evaluation. This study contributes to the development of theoretical understandings of public and patient involvement. In particular, we focus on the deployment of patient engagement programs within health service organizations. To develop a deeper understanding of the conceptual underpinnings of these programs, we examined the concept of "the patient perspective" as used by patient engagement practitioners and participants. Specifically, we focused on the way this phrase was used in the singular: "the" patient perspective or "the" patient voice. From qualitative analysis of interviews with 20 patient advisers and 6 staff members within a large urban health network in Canada, we argue that "the patient perspective" is referred to as a particular kind of situated knowledge, specifically an embodied knowledge of vulnerability. We draw parallels between this logic of patient perspective and the logic of early feminist theory, including the concepts of standpoint theory and strong objectivity. We suggest that champions of patient engagement may learn much from the way feminist theorists have constructed their arguments and addressed critique.

Times of crisis, times of action.

At the recent Academy of Canadian Executive Nurses (ACEN) Annual Meeting in November 2008 in Ottawa, I had the privilege and honour of becoming president of this dynamic organization. Founded more than 30 years ago, ACEN represents the voice of senior academic nursing leadership in Canada, helping to set directions for healthcare policy and contributing to the alignment and advancement of the national agendas for nursing practice, education, research and leadership.

Reconnecting to care: a nursing initiative at the Baycrest Geriatric Health System.

This paper describes and examines a change program for nursing services in Complex: Continuing/Long Term Care (CC/LTC) at the Baycrest Centre for Geriatric Care in Toronto. It presents a brief history of the rise of CC/LTC services and the difficulties associated with them. In particular it claims that demographic, professional and insti tutional changes have produced a differentiated specialization of supports which tend to disregard some necessary aspects of daily support for patients, and devalue the role of direct care workers in these settings. The "Reconnecting to Care" (RTC) initiative is a response the to these changes by nurses at Baycrest. In detailing why Baycrest has decided to get back to basics and reconnect to care and how it has begun to do this, this paper provides an overview of the reasons for this initiative, a little of how it has been implemented so far, and some initial lessons for nursing leaders and others.

Exploring an alternative metaphor for nursing: relinquishing military images and language.

The language used to describe nursing practice and nursing leadership has a profound influence on how nurses think about themselves, their work relationships, and indeed the very essence of their reason for being. Language often includes metaphor in order to help capture the complexities and layers of meaning that establish contexts for action. Nurses and others have relied on various metaphors to describe nursing work. However, there is one metaphor that, more than any other, has shaped the context of nursing work and formed the images and the meanings that nurses have of themselves and their purposes in practice. The privileged one is the military metaphor. This article explores the notion of metaphor, and its usefulness and potential to help nurses change their work patterns. The traditions and history of the military metaphor are examined and an alternative notion of the "frontier" is proposed in order to enhance understanding of the potential for change.

Oral hygiene in the elderly: a quality improvement initiative.

This paper describes a unit-based quality improvement initiative to ameliorate mouth care of elderly residents in a long-term care facility. Using the Nursing Role Effectiveness Model developed by Irvine et at. (1998) as the organizing framework, this project highlights the importance of the nurse's role in quality improvement initiatives.