Canadian nurse practitioner's quest for identity: A philosophical perspective.

The role of nurse practitioners in primary healthcare has been validated over the years and is now being considered as a key solution in various primary healthcare settings to the provision of comprehensive care. The context in which the role has been established positions nurse practitioners' practice within medical and nursing paradigms. As the healthcare system evolves, nurse practitioners must define their identity to advocate for roles that reflect their professional values. A historical overview highlighting the context in which the NP role expanded will guide a philosophical discussion regarding role identity. After exposing tensions between the nursing and medicine disciplines, Abbots' theory of profession will be utilized to understand the foundations leading to initial research on nurse practitioner integration within the healthcare system. Feminist philosopher bell hooks' discourse on marginality will serve as a platform to reflect on the nurse practitioner identity within the current social context. Foucault's notions of governmentality, parrhesia and care of the self will then guide reflections regarding ways for nurse practitioners to locate themselves as a profession.

Estimated impact of aggressive empirical antiviral treatment in containing an outbreak of pandemic influenza H1N1 in an isolated First Nations community.

BACKGROUND: The 2009 influenza A (H1N1) pandemic was mild by historical standards, but was more severe in isolated Canadian Indigenous communities. Oseltamivir was used aggressively for outbreak control in an isolated northern Ontario First Nations community. We used mathematical modeling to quantify the impact of antiviral therapy on the course of this outbreak. METHODS: We used both a Richards growth model and a compartmental model to evaluate the characteristics of the outbreak based on both respiratory visits and influenza-like illness counts. Estimates of best-fit model parameters, including basic reproductive number (R0 ) and antiviral efficacy, and simulations, were used to estimate the impact of antiviral drugs compared to social distancing interventions alone. RESULTS: Using both approaches, we found that a rapidly growing outbreak slowed markedly with aggressive antiviral therapy. Richards model turning points occurred within 24 hours of antiviral implementation. Compartmental models estimated antiviral efficacy at 70-95%. Plausible estimates of R from both modeling approaches ranged from 4·0 to 15·8, higher than published estimates for southern Canada; utilization of aggressive antiviral therapy in this community prevented 962-1757 cases of symptomatic influenza and as many as 114 medical evacuations in this community. CONCLUSION: Although not advocated in other settings in Canada, aggressive antiviral therapy markedly reduced the impact of a pandemic-related influenza A (H1N1) outbreak in an isolated Canadian First Nations community in northern Ontario, Canada. The differential risk experienced by such communities makes tailored interventions that consider risk and lack of access to medical services, appropriate.