Experiences of Inuit in Canada who travel from remote settings for cancer care and impacts on decision making.

BACKGROUND: Inuit experience the highest cancer mortality rates from lung cancer in the world with increasing rates of other cancers in addition to other significant health burdens. Inuit who live in remote areas must often travel thousands of kilometers to large urban centres in southern Canada and negotiate complex and sometimes unwelcoming health care systems. There is an urgent need to improve Inuit access to and use of health care. Our study objective was to understand the experiences of Inuit in Canada who travel from a remote to an urban setting for cancer care, and the impacts on their opportunities to participate in decisions during their journey to receive cancer care. METHODS: We are an interdisciplinary team of Steering Committee and researcher partners ("the team") from Inuit-led and/or -specific organizations that span Nunavut and the Ontario cancer health systems. Guided by Inuit societal values, we used an integrated knowledge translation (KT) approach with qualitative methods. We conducted semi-structured interviews with Inuit participants and used process mapping and thematic analysis. RESULTS: We mapped the journey to receive cancer care and related the findings of client (n = 8) and medical escort (n = 6) ("participant") interviews in four themes: 1) It is hard to take part in decisions about getting health care; 2) No one explains the decisions you will need to make; 3) There is a duty to make decisions that support family and community; 4) The lack of knowledge impacts opportunities to engage in decision making. Participants described themselves as directed, with little or no support, and seeking opportunities to collaborate with others on the journey to receive cancer care. CONCLUSIONS: We describe the journey to receive cancer care as a "decision chain" which can be described as a series of events that lead to receiving cancer care. We identify points in the decision chain that could better prepare Inuit to participate in decisions related to their cancer care. We propose that there are opportunities to build further health care system capacity to support Inuit and enable their participation in decisions related to their cancer care while upholding and incorporating Inuit knowledge.

Above and beyond: A qualitative study of the work of nurses and care assistants in long term care.

BACKGROUND: As the Canadian population ages, there is a need to improve long-term care (LTC) services. An increased understanding of the positive work experiences of LTC staff may help attract more human health resources to LTC. OBJECTIVE: To describe the perceptions of the roles and work of nurses and care assistants in LTC from interprofessional perspectives. METHODS: This study used qualitative data collected from a larger mixed-methods study, Care by Design. The qualitative phase explored the lived experience of LTC staff from the perspectives of key stakeholders via focus groups and individual interviews. RESULTS: One central theme that emerged from the study was that of LTC staff going "above and beyond" their clinical duties to care for residents. This above and beyond theme was categorized into subthemes including: 1. familial bonds between residents and staff; 2. staff spending additional time with residents; 3. the ability to provide comfort to family members; and 4. staff dedication during end-of-life care. CONCLUSIONS: The findings show that staff develop a kinship with residents, demonstrate respect towards residents' families and provide comfort at the end-of-life. In emphasizing these themes of positive and fulfilling work, the present study provides insight into why staff work in LTC.

A new long-term care facilities model in nova scotia, Canada: protocol for a mixed methods study of care by design.

BACKGROUND: Prior to the implementation of a new model of care in long-term care facilities in the Capital District Health Authority, Halifax, Nova Scotia, residents entering long-term care were responsible for finding their own family physician. As a result, care was provided by many family physicians responsible for a few residents leading to care coordination and continuity challenges. In 2009, Capital District Health Authority (CDHA) implemented a new model of long-term care called "Care by Design" which includes: a dedicated family physician per floor, 24/7 on-call physician coverage, implementation of a standardized geriatric assessment tool, and an interdisciplinary team approach to care. In addition, a new Emergency Health Services program was implemented shortly after, in which specially trained paramedics dedicated to long-term care responses are able to address urgent care needs. These changes were implemented to improve primary and emergency care for vulnerable residents. Here we describe a comprehensive mixed methods research study designed to assess the impact of these programs on care delivery and resident outcomes. The results of this research will be important to guide primary care policy for long-term care. OBJECTIVE: We aim to evaluate the impact of introducing a new model of a dedicated primary care physician and team approach to long-term care facilities in the CDHA using a mixed methods approach. As a mixed methods study, the quantitative and qualitative data findings will inform each other. Quantitatively we will measure a number of indicators of care in CDHA long-term care facilities pre and post-implementation of the new model. In the qualitative phase of the study we will explore the experience under the new model from the perspectives of stakeholders including family doctors, nurses, administration and staff as well as residents and family members. The proposed mixed method study seeks to evaluate and make policy recommendations related to primary care in long-term care facilities with a focus on end-of-life care and dementia. METHODS: This is a mixed methods study with concurrent quantitative and qualitative phases. In the quantitative phase, a retrospective time series study is being conducted. Planned analyses will measure indicators of clinical, system, and health outcomes across three time periods and assess the effect of Care by Design as a whole and its component parts. The qualitative methods explore the experiences of stakeholders (ie, physicians, nurses, paramedics, care assistants, administrators, residents, and family members) through focus groups and in depth individual interviews. RESULTS: Data collection will be completed in fall 2013. CONCLUSIONS: This study will generate a considerable amount of outcome data with applications for care providers, health care systems, and applications for program evaluation and quality improvement. Using the mixed methods design, this study will provide important results for stakeholders, as well as other health systems considering similar programs. In addition, this study will advance methods used to research new multifaceted interdisciplinary health delivery models using multiple and varied data sources and contribute to the discussion on evidence based health policy and program development.

Evaluating the integration of cultural competence skills into health and physical assessment tools: a survey of Canadian schools of nursing.

Currently used audiovisual (AV) teaching tools to teach health and physical assessment reflect a Eurocentric bias using the biomedical model. The purpose of our study was to (a) identify commonly used AV teaching tools of Canadian schools of nursing and (b) evaluate the identified tools. A two-part descriptive quantitative method design was used. First, we surveyed schools of nursing across Canada. Second, the identified AV teaching tools were evaluated for content and modeling of cultural competence. The majority of the schools (67%) used publisher-produced videos associated with a physical assessment textbook. Major findings included minimal demonstration of negotiation with a client around cultural aspects of the interview including the need for an interpreter, modesty, and inclusion of support persons. Identification of culturally specific examples given during the videos was superficial and did not provide students with a comprehensive understanding of necessary culturally competent skills.

Using an interactive journal club to enhance nursing research knowledge acquisition, appraisal, and application.

Nursing practice is intricate and multifaceted. It requires the application of current, health-related research. Nurses are expected to employ evidence-informed practice in making decisions about the clinical care of their clients. A journal club is one method that can help promote an increased awareness of research, educating students to critique and use research findings. In this descriptive pilot study, the use of a journal club was evaluated. University undergraduate nursing students (N=35) across three sites in eastern Canada participated. Although the results are limited, participants found the journal club sessions enjoyable and beneficial for helping them interpret research findings and apply research to clinical practice. More research directed at helping nursing students critique and apply research to nursing practice is warranted.

The notion of evidence in evidence-based practice by the Nursing Philosophy Working Group.

Questions concerning the nature of evidence in evidence-based practice have kindled debate within nursing and other health care disciplines. Such questions include the ends for which evidence is sought, the form(s) of evidence, and the values underlying evidence-based practice. In this article, some of the issues, contradictions, and tensions implicit in these questions are highlighted. It is imperative that the nursing profession continue to explore the philosophic perspectives that underscore evidence-based practice and their implications for decision making in nursing practice.