Work precarity, employment characteristics and health among Canada's long-term care and seniors' home workers during the COVID-19 pandemic.

Background: The COVID-19 pandemic has highlighted several issues among health care workers in Canada's long-term care and seniors' (LTCS) homes, including labour shortages, staff retention difficulties, overcrowding, and precarious working conditions. There is currently a lack of information on the health, well-being and working conditions of health care workers in LTCS homes - many of them immigrants - and a limited understanding of the relationship between them. This paper examines differences between immigrant and non-immigrant workers' health outcomes and precarious working conditions during the pandemic. Data and methods: The data were from the 2021 Survey on Health Care Workers' Experiences During the Pandemic, which collected information on LTCS home health care workers' (n=2,051) health, employment or work experiences, and working environment during the COVID-19 pandemic. Summary statistics and multivariable logistic regressions were conducted to examine the association between precarious work and workers' health (life stress, mental health and general health), stratified by immigrant status. Selected working characteristics were included in the regression models as covariates, namely occupation, number of locations worked, facility ownership status and number of years worked. Results: Immigrant health care workers were more likely than non-immigrant health care workers to experience precarious work in LTCS homes. Precarious work - characterized by income loss, reduced hours of work, and unpaid leave - was associated with stress and poor general health among immigrant and non-immigrant workers in the sector. Employment precarity was also associated with poor mental health for immigrant workers, but there was no association for non-immigrant workers. Interpretation: Employment precarity and the health and well-being of health care workers warrants further attention, in particular among immigrants employed in the LTCS residential care sector.

Innovative nursing employment initiatives to strengthen and sustain the health workforce in Canada.

Health systems worldwide are at a critical juncture due to an increasing demand for health services and a diminishing pool of health human resources. While COVID-19 exacerbated nursing deficits, the need to strengthen and sustain the health workforce in Canada was evident decades prior and supported by numerous studies that warned of significant shortages. Post pandemic, building health system capacity has become paramount. This article examines innovative nursing employment initiatives in Canada. It provides a snapshot of federal, provincial and territorial approaches, with a particular focus on Internationally Educated Nurses (IENs) due to burgeoning interest in and competition for their skills and services. However, recognizing that health human resource planning is a persistent challenge, further initiatives are suggested. These include complementary policy development to improve retention and policy frameworks that support proactive long-term strategies to address the cyclical shortage of nurses.

Factors associated with pressure ulcer and dehydration in long-term care settings in Ontario, Canada.

Pressure ulcers and dehydration are common conditions among residents of long-term care facilities that result in negative health effects. They have been associated with signs of neglect and increased 30-day mortality among LTC residents. However, they are both preventable and with proper care can be effectively managed and treated. We conducted a retrospective cohort study to examine factors associated with pressure ulcers and dehydration among long-term care residents in the province of Ontario, Canada. Results indicated that close to one-fifth of residents were dehydrated (17.3%) or had a pressure ulcer (18.9%) during the study period. Advanced age was significantly associated with the presence of pressure ulcers and dehydration for both men and women. However, men were more likely to present with a pressure ulcer while women were more likely to exhibit symptoms of dehydration. Study findings also demonstrate the presence of both conditions being higher in municipal and not-for-profit homes compared to for-profit homes. The significant differences observed in relation to home ownership which require further investigation to identify the most relevant factors in explaining these differences. Overall, pressure ulcers and dehydration are preventable conditions that warrant attention from policymakers to ensure quality of care and resident safety are prioritized.

Strengthening Community Roots: Anchoring Newcomers in Wellness and Sustainability (SCORE!): A protocol for the co-design and evaluation of a healthy active living program among a newcomer community in Canada.

BACKGROUND: The burden of childhood obesity and cardiometabolic risk factors affecting newcomer Canadians living in lower socioeconomic circumstances is a concerning public health issue. This paper describes Strengthening Community Roots: Anchoring Newcomers in Wellness and Sustainability (SCORE!), an academic-community research partnership to co-design interventions that nurture and optimize healthy activity living (HAL) among a community of children and families new to Canada in Hamilton, Ontario, Canada. METHODS/DESIGN: Our overarching program is informed by a socio-ecological model, and will co-create HAL interventions for children and families new to Canada rooted in outdoor, nature-based physical activity. We will proceed in three phases: Phase 1) synthesis of existing evidence regarding nature based HAL interventions among children and families; Phase 2) program development through four data collection activities including: i) community engagement activities to build trustful relationships and understand barriers and facilitators, including establishing a community advisory and action board, qualitative studies including a photovoice study, and co-design workshops to develop programs; ii) characterizing the demographics of the community through a household survey; iii) characterizing the built environment and HAL programs/services available in the community by developing an accessible real-time systems map; and iv) reviewing municipal policies relevant to HAL and sustainability; leading to Phase 3) implementation and evaluation of the feasibility of co-designed HAL programs. CONCLUSION: The etiology of childhood obesity and related chronic diseases is complex and multifactorial, as are intervention strategies. The SCORE! program of research brings together partners including community members, service providers, academic researchers, and organizational leaders to build a multi-component intervention that promotes the health and wellness of newcomer children and families.

Response and innovations of advanced practice nurses during the COVID-19 pandemic: A scoping review.

AIM: Identify and map international evidence regarding innovations led by or involving advanced practice nurses in response to COVID-19. BACKGROUND: COVID-19 necessitated unprecedented innovation in the organization and delivery of healthcare. Although advanced practice nurses have played a pivotal role during the pandemic, evidence of their contributions to innovations has not been synthesized. Evidence is needed to inform policies, practices, and research about the optimal use of advanced practice nurses. METHODS: A scoping review was conducted and reported using the PRISMA-ScR checklist. Electronic databases were searched for peer-reviewed articles published between January 2020 and December 2021. Papers were included that focused on innovations emerging in response to COVID-19 and involved advanced practice nurses. RESULTS: Fifty-one articles were included. Four themes were identified including telehealth, supporting and transforming care, multifaceted approaches, and provider education. Half of the articles used brief and mostly noncomparative approaches to evaluate innovations. CONCLUSION: This is the first synthesis of international evidence examining the contributions of advanced practice nurses during the pandemic. Advanced practice nurses provided leadership for the innovation needed to rapidly respond to healthcare needs resulting from COVID-19. Innovations challenged legislative restrictions on practice, enabled implementation of telehealth and new models of care, and promoted evidence-informed and patient-centered care. IMPLICATIONS FOR PRACTICE: Advanced practice nurses led, designed, implemented, and evaluated innovations in response to COVID-19. They facilitated the use of telehealth, supported or transformed models of care, and enabled health providers through education, mentorship, and mental health support. IMPLICATION FOR POLICY: Advanced practice nurses are a critical resource for innovation and health system improvement. Permanent removal of legislative and regulatory barriers to their full scope of practice is needed.

The changing profile of the internationally educated nurse workforce: Post-pandemic implications for health human resource planning.

As part of its post COVID-19 recovery plan, the Canadian government is increasing the number of skilled immigrants, including Internationally Educated Nurses (IENs). However, pre-pandemic data show that IENs are underutilized and underemployed despite their education and experience. Focusing on the province of Ontario, this article explores trends in the IEN workforce and policies to address the nursing shortage. Barriers to IEN integration are reviewed and changes in the demographic and employment characteristics of IENs are analyzed. The disproportionate number of IENs employed in the Ontario long-term care sector, which has low wages and poor working conditions, emphasizes the need for policies that support the integration of IENs into the broader Canadian health system and increase their earning potential. To engage in strategic workforce planning and policy development, health leaders require access to nurse demographic and employment data that is timely and reflects the international and domestic labour supply.

The Crisis in the Nursing Labour Market: Canadian Policy Perspectives.

The labour market for care professionals has experienced significant changes, resulting in critical shortages globally. Nurses represent the largest share of health workers worldwide; nonetheless, an estimated 13 million more nurses will be needed over the next 10 years. Prior to the pandemic, the domestic supply of nurses in Canada had not kept pace with the ever-increasing demand for services. Pre-pandemic age- and needs-based forecasting models have estimated shortages in an excess of 100,000 nurses nationwide by 2030. While COVID-19 has accelerated the demand for and complexity of service requirements, it has also resulted in losses of healthcare professionals due to an increased sick leave, unprecedented burnout and retirements. This paper examines key factors that have contributed to nursing supply issues in Canada over time and provides examples of policy responses to the present shortage facing the healthcare system. To provide adequate care, the nursing workforce must be stabilized and-more importantly-recognized as critical to the health of the population.

Workplace Violence Against Nurses in Canada: A Legal Analysis.

Workplace violence against nurses is a significant global occupational health problem, with incidents of violence increasing in frequency since the COVID-19 pandemic began. In this article, we provide a review of recent legislative amendments meant to bolster workplace safety in health care in Canada, analyze legal cases where nurses were the victims of violence, and discuss what these legal reforms and decisions reveal about how nurses' work is treated within the Canadian legal system. Under criminal law, the limited number of cases we could find with oral or written sentencing decisions show that, historically, the fact a victim was a nurse was not always considered an aggravating factor on sentencing. Recent legislative amendments make this a specified aggravating factor and it is important to track the impact of these amendments when judges exercise their discretion in sentencing. Under employment law, it appears that, despite the government's efforts to increase the deterrence factor under legislation with significantly increased fines for employers who fail to protect their employees from injury, courts remain reluctant to impose such sanctions. In these cases, it is also important to track the impact of harsher penalties. We conclude that combating the widespread normalization of workplace violence in health care, and specifically against nurses, is acutely needed to help ensure that these ongoing legal reforms aimed at improving the safety of health workers are effective.

Perceptions of sulphadoxine-pyrimethamine use among pregnant women in sub-Saharan Africa: a scoping review.

Background: Malaria is a major global public health issue that disproportionately affects pregnant women in sub-Saharan Africa. The World Health Organization recommends intermittent preventive treatment with sulfadoxine-pyrimethamine (IPTp-SP) for its control. Despite its proven efficacy, drug uptake remains low. Sulphadoxine-pyrimethamine (SP) safety concerns have been cited as one of several reasons for this low uptake. Methods: We conducted a scoping review using the Arksey and O'Malley framework and the health belief model to investigate perceptions of SP use among pregnant women in sub-Saharan Africa. We looked for peer-reviewed publications in five international databases. Results: The review included 19 articles out of a total of 246. It showed that pregnant women in sub-Saharan Africa have a good understanding of malaria and its consequences, but this does not necessarily translate into increased IPTp-SP uptake. It is worrisome to know that some pregnant women (from 2 studies) did not believe that SP use is beneficial, and several participants (from 4 studies) were unsure or did not see the drug as an effective intervention. Many pregnant women believe SP harms them, their partners, or their unborn children. Conclusions: Healthcare professionals should continue prescribing and encouraging pregnant women to use SP for malaria prevention until a better substitute becomes available.

A commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres.

This article provides a commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres (PANMCC). The objectives are to present an overview of the formation and evolution of the network, its impact on education, research, policy and communication and the benefits of membership. The advantages of international networks as a mechanism to strengthen nursing and midwifery workforces and improve health systems are also highlighted. The Pan American Health Organization (PAHO), the World Health Organization (WHO) Office in the Americas, oversees collaborating centres in the Region. Established in 1999, PANMCC consists of 17 centres situated in universities and schools of nursing. These centres provide crucial nursing and midwifery input to PAHO/WHO. The network supports global engagement and capacity building via collaboration, resource sharing and research colloquia. The linkages within the network enhance professional development, increase capacity building and heighten visibility of PANMCC and the work of its members.

En este artículo se presenta un comentario sobre la Red Panamericana de Centros Colaboradores de Enfermería y Partería (PANMCC, por su sigla en inglés). Los objetivos son presentar una visión general de la formación y evolución de la red, sus repercusiones en los ámbitos de la educación, la investigación, la política y las comunicaciones, así como los beneficios de pertenecer a la red. También se destacan las ventajas de las redes internacionales como mecanismo para fortalecer al personal de enfermería y partería y mejorar los sistemas de salud. La Organización Panamericana de la Salud (OPS), Oficina Regional de la Organización Mundial de la Salud (OMS) para las Américas, supervisa los centros colaboradores en la Región. Fundada en 1999, la PANMCC consta de 17 centros ubicados en universidades y facultades de enfermería, los cuales proporcionan información crucial sobre enfermería y partería a la OPS/OMS. Esta red respalda el compromiso general y el desarrollo de capacidades mediante la colaboración, el intercambio de recursos y los coloquios de investigación. Los vínculos en la red mejoran el desarrollo profesional, aumentan el desarrollo de capacidades y aumentan la visibilidad de la PANMCC y el trabajo de sus miembros.

Este artigo traz um comentário sobre a Rede Pan-Americana de Centros Colaboradores de Enfermagem e Obstetrícia (PANMCC). Os objetivos são apresentar uma visão geral da formação e evolução da Rede, seu impacto em educação, pesquisa, políticas e comunicação e os benefícios da filiação. Também são destacadas as vantagens das redes internacionais como mecanismo para valorizar as forças de trabalho em enfermagem e obstetrícia e melhorar os sistemas de saúde. A Organização Pan-Americana da Saúde (OPAS) ­ o Escritório da Organização Mundial da Saúde (OMS) nas Américas ­ supervisiona os Centros Colaboradores na região. Criada em 1999, a PANMCC é composta por 17 centros situados em universidades e escolas de enfermagem. Esses centros fornecem informações essenciais sobre enfermagem e obstetrícia para a OPAS/OMS. A rede apoia o envolvimento global e o fortalecimento institucional por meio de colaboração, compartilhamento de recursos e colóquios de pesquisa. Os elos dentro da rede aprimoram o desenvolvimento profissional, estimulam o fortalecimento institucional e aumentam a visibilidade da PANMCC e do trabalho dos seus membros.

A commentary on the Pan American Network of nursing and midwifery collaborating centres

[ABSTRACT]. This article provides a commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres (PANMCC). The objectives are to present an overview of the formation and evolution of the network, its impact on education, research, policy and communication and the benefits of membership. The advantages of international networks as a mechanism to strengthen nursing and midwifery workforces and improve health systems are also highlighted. The Pan American Health Organization (PAHO), the World Health Organization (WHO) Office in the Americas, oversees collaborating centres in the Region. Established in 1999, PANMCC consists of 17 centres situated in universities and schools of nursing. These centres provide crucial nursing and midwifery input to PAHO/WHO. The network supports global engagement and capacity building via col- laboration, resource sharing and research colloquia. The linkages within the network enhance professional development, increase capacity building and heighten visibility of PANMCC and the work of its members.

[RESUMEN]. En este artículo se presenta un comentario sobre la Red Panamericana de Centros Colaboradores de Enfer- mería y Partería (PANMCC, por su sigla en inglés). Los objetivos son presentar una visión general de la formación y evolución de la red, sus repercusiones en los ámbitos de la educación, la investigación, la política y las comunicaciones, así como los beneficios de pertenecer a la red. También se destacan las ventajas de las redes internacionales como mecanismo para fortalecer al personal de enfermería y partería y mejorar los sistemas de salud. La Organización Panamericana de la Salud (OPS), Oficina Regional de la Organización Mundial de la Salud (OMS) para las Américas, supervisa los centros colaboradores en la Región. Fundada en 1999, la PANMCC consta de 17 centros ubicados en universidades y facultades de enfermería, los cuales proporcionan información crucial sobre enfermería y partería a la OPS/OMS. Esta red respalda el compromiso general y el desarrollo de capacidades mediante la colaboración, el intercambio de recursos y los coloquios de investigación. Los vínculos en la red mejoran el desarrollo profesional, aumentan el desarrollo de capaci- dades y aumentan la visibilidad de la PANMCC y el trabajo de sus miembros.

[RESUMO]. Este artigo traz um comentário sobre a Rede Pan-Americana de Centros Colaboradores de Enfermagem e Obstetrícia (PANMCC). Os objetivos são apresentar uma visão geral da formação e evolução da Rede, seu impacto em educação, pesquisa, políticas e comunicação e os benefícios da filiação. Também são destacadas as vantagens das redes internacionais como mecanismo para valorizar as forças de trabalho em enfermagem e obstetrícia e melhorar os sistemas de saúde. A Organização Pan-Americana da Saúde (OPAS) – o Escritório da Organização Mundial da Saúde (OMS) nas Américas – supervisiona os Centros Colaboradores na região. Criada em 1999, a PANMCC é composta por 17 centros situados em universi- dades e escolas de enfermagem. Esses centros fornecem informações essenciais sobre enfermagem e obstetrícia para a OPAS/OMS. A rede apoia o envolvimento global e o fortalecimento institucional por meio de colaboração, compartilhamento de recursos e colóquios de pesquisa. Os elos dentro da rede aprimoram o desenvolvimento profissional, estimulam o fortalecimento institucional e aumentam a visibilidade da PANMCC e do trabalho dos seus membros.

A commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres / Comentario sobre la Red Panamericana de Centros Colaboradores de Enfermería y Partería / Comentário sobre a Rede Pan-Americana de Centros Colaboradores de Enfermagem e Obstetrícia

ABSTRACT This article provides a commentary on the Pan American Network of Nursing and Midwifery Collaborating Centres (PANMCC). The objectives are to present an overview of the formation and evolution of the network, its impact on education, research, policy and communication and the benefits of membership. The advantages of international networks as a mechanism to strengthen nursing and midwifery workforces and improve health systems are also highlighted. The Pan American Health Organization (PAHO), the World Health Organization (WHO) Office in the Americas, oversees collaborating centres in the Region. Established in 1999, PANMCC consists of 17 centres situated in universities and schools of nursing. These centres provide crucial nursing and midwifery input to PAHO/WHO. The network supports global engagement and capacity building via collaboration, resource sharing and research colloquia. The linkages within the network enhance professional development, increase capacity building and heighten visibility of PANMCC and the work of its members.

RESUMEN En este artículo se presenta un comentario sobre la Red Panamericana de Centros Colaboradores de Enfermería y Partería (PANMCC, por su sigla en inglés). Los objetivos son presentar una visión general de la formación y evolución de la red, sus repercusiones en los ámbitos de la educación, la investigación, la política y las comunicaciones, así como los beneficios de pertenecer a la red. También se destacan las ventajas de las redes internacionales como mecanismo para fortalecer al personal de enfermería y partería y mejorar los sistemas de salud. La Organización Panamericana de la Salud (OPS), Oficina Regional de la Organización Mundial de la Salud (OMS) para las Américas, supervisa los centros colaboradores en la Región. Fundada en 1999, la PANMCC consta de 17 centros ubicados en universidades y facultades de enfermería, los cuales proporcionan información crucial sobre enfermería y partería a la OPS/OMS. Esta red respalda el compromiso general y el desarrollo de capacidades mediante la colaboración, el intercambio de recursos y los coloquios de investigación. Los vínculos en la red mejoran el desarrollo profesional, aumentan el desarrollo de capacidades y aumentan la visibilidad de la PANMCC y el trabajo de sus miembros.

RESUMO Este artigo traz um comentário sobre a Rede Pan-Americana de Centros Colaboradores de Enfermagem e Obstetrícia (PANMCC). Os objetivos são apresentar uma visão geral da formação e evolução da Rede, seu impacto em educação, pesquisa, políticas e comunicação e os benefícios da filiação. Também são destacadas as vantagens das redes internacionais como mecanismo para valorizar as forças de trabalho em enfermagem e obstetrícia e melhorar os sistemas de saúde. A Organização Pan-Americana da Saúde (OPAS) - o Escritório da Organização Mundial da Saúde (OMS) nas Américas - supervisiona os Centros Colaboradores na região. Criada em 1999, a PANMCC é composta por 17 centros situados em universidades e escolas de enfermagem. Esses centros fornecem informações essenciais sobre enfermagem e obstetrícia para a OPAS/OMS. A rede apoia o envolvimento global e o fortalecimento institucional por meio de colaboração, compartilhamento de recursos e colóquios de pesquisa. Os elos dentro da rede aprimoram o desenvolvimento profissional, estimulam o fortalecimento institucional e aumentam a visibilidade da PANMCC e do trabalho dos seus membros.

Publication activities relating to digital teaching and learning in the GMS Journal for Medical Education - a descriptive analysis (1984-2020).

Aims and objectives: Digital teaching, learning and assessment have been part of medical education and continuing education for decades. The objective of this review paper is to highlight developments and perspectives in these areas in the GMS Journal for Medical Education (GMS JME). Methodology: In the spring of 2020, we conducted a systematic literature search of the Journal for Medical Education (JME) and analysed the articles with regard to different categories such as article type, digital tools used or mode of data collection. Results: Of the 132 articles analysed, 78 were digital interventions (53 of which were exploratory-descriptive), 28 were project descriptions, 16 were surveys of needs or equipment and 10 were concept papers. About one-third of the studies and project reports each dealt with virtual patients or case-based learning, whereas no articles were published on trends such as serious games or virtual reality. Overall, our analysis shows that in many respects, the studies on digital teaching were more broadly based, especially between 2006 and 2010, after which this trend tended to decline again. Conclusions: Our analysis shows that publications in the JME consider some key aspects of digital teaching in medical education and continuing education, such as educational videos or virtual patients. The variability of information and methods of presentation advocate the use of guidelines to optimise the quality of scientific papers. Furthermore, clues for future research topics and experimental study designs are identified.

COVID-19 and Long-Term Care: What Have We Learned?

The COVID-19 pandemic has led to thousands of deaths; of these, a disproportionate number has occurred in long-term care settings. The papers presented here deal with a number of issues highlighted by this crisis in several jurisdictions, including Ontario, Quebec and the Netherlands. Analyzing these may give us some insight into what is necessary to prevent this disaster from happening again.

Exemplars in Long-Term Care during COVID-19: The Importance of Leadership.

Early in the pandemic, many long-term care (LTC) homes struggled to manage resources and care for vulnerable residents. Using an appreciative inquiry approach, we analyzed exemplar homes in Ontario that remained free of COVID-19 in wave one and interviewed executive directors, directors of care and staff. Findings demonstrate the importance of leadership styles; clear, consistent communication; focusing on staff and resident safety; using a team-based approach; and adapting staff roles to meet care needs. The exemplar homes showed what works in practice. The decisions and approaches that they implemented could be used to develop standards to improve LTC and strengthen the sector.

COVID-19 Issues in Long-Term Care in Ontario: A Document Analysis.

The COVID-19 crisis in long-term care in Canada has been characterized as a crisis upon a crisis. This study examines recent documents on the crisis in long-term care in Ontario, using document and thematic analysis to synthesize issues and recommendations from the perspectives of different groups and organizations. Thirty-three documents from 20 organizations were analysed and six thematic areas were identified: resident care; human resources; governance, leadership and management; financing; physical infrastructure and supplies; and training and preparation. The six common themes, as perceived by different perspectives, can inform policy makers on long-term care issues.

Frequency of Neglect and Its Effect on Mortality in Long-Term Care before and during the COVID-19 Pandemic.

Neglect of vulnerable adults living in long-term care (LTC) homes has been well documented. It often presents first in the physical symptoms of decubitus ulcers, dehydration and urinary tract infections (UTIs). A retrospective cohort study was conducted to examine the relationship between neglect and 90-day mortality among LTC residents in Ontario. An index of neglect was created. Of 106,765 residents, more than one-quarter were found to have at least one indicator of neglect: 13.1% had decubitus ulcers, 13.5% had dehydration, 6.2% had a UTI. Residents who exhibited clinical signs of neglect had higher risks of death within 90 days, both before and during the COVID-19 pandemic.

What Is Old Is New Again: Global Issues Influencing Workers and Their Work in Long-Term Care.

We offer a broad understanding of contemporary issues relevant to the long-term care (LTC) sector and its workers, globally, and the concurrent evolution and involution of these workers' roles, their work and policy environments. While contemporary, most issues are also longstanding and fall into two broad categories: issues relating to the work environments in LTC, including resource availability and worker support, and issues relating to the changing nature of LTC work. We identify five key challenges that relate to the system structures of the LTC sector.

Inspection Reports: The Canary in the Coal Mine.

Neglect in the Ontario long-term care (LTC) sector is defined under section 5 of O. Reg. 79/10 of the Long-Term Care Homes Act, 2007. Allegations are monitored and investigated via inspections. Using an exploratory descriptive design, we analyzed reports of neglect in LTC homes from 2019 to 2020. The majority were in response to critical incidents, followed by complaints from family members or staff. Thematic analysis revealed four areas of neglect: (1) failure to provide treatment; (2) failure to provide care; (3) failure to attend to or assist residents; and (4) failure to investigate allegations. Study findings demonstrate that an accountability framework that includes consequences for institutions is needed.