Multidisciplinary First-Line Healthcare Leaders' Roles and Experiences During the COVID-19 Pandemic in Ontario Canada.

BACKGROUND: Throughout the COVID-19 pandemic, first-line healthcare leaders across the healthcare system played crucial roles leading, motivating, and supporting staff. PURPOSE: This study aims to describe multidisciplinary first-line healthcare leaders' experiences during the COVID-19 pandemic in Ontario, Canada using transformational and crisis leadership theory. METHODS: A descriptive two-phase (quantitative & qualitative) design was conducted in the spring of 2021. Phase 1 employed an online survey sent via email to first-line leaders from various sectors who were members of healthcare professional associations in Ontario. Participants included nurse managers, professional practice leaders (e.g., occupational and physiotherapists), advanced practice nurses, and clinical educators. In Phase 2, a subset (n = 19) of the Phase 1 participants were interviewed to gain a deeper understanding of these leaders' experiences including role impact and support available. Semistructured individual interviews were conducted and recorded via Zoom©. Inductive and deductive analysis approaches identified key themes. This paper reports the qualitative findings from Phase 2. RESULTS: Leaders' behaviors were representative of the key dimensions of transformational and complexity leadership theories. Recommendations for leading during a crisis included: engaging in self-care activities to manage the personal impact of the crisis; teamwork and collaborative leadership; and support from fellow first-line leaders and senior leaders. Findings can inform healthcare leadership education programs designed to manage future crises for both academic and practice settings. CONCLUSION: Descriptions of first-line healthcare leaders' roles and experiences during multiple waves of the COVID-19 pandemic validated their important contributions within various health sectors.

Home Away from Home: How Undergraduate and Graduate Students Experience Space and Place in a new Health Sciences Building.

Buildings contribute in crucial ways to how students experience learning spaces. Four schools within a faculty (nursing, nutrition, occupational and public health, and midwifery) moved into a new Health Sciences building Fall of 2019. This new building created a unique opportunity to explore the intersection between higher education and learning space design, informed by concepts of space and place, and students' profession specific and interprofessional learning experiences in a new Health Sciences building. A qualitative descriptive design was used. All undergraduate and graduate students within the four schools were invited to participate. Focus groups were undertaken to gain a rich understanding of students' experiences and views of their space and place of learning. Data collection involved focus group data from profession specific participant users and interprofessional participant users. Inductive thematic analysis of focus group transcripts generated an initial coding scheme, key themes, and data patterns. Codes were sorted into categories and then organized into meaningful clusters. A building planning development project document relating to the vision, intentions, design, and planning for the new building provided content from which to view the study findings. The study data contributed to the conversation about space and place and its influence on higher learning within specific intraprofessional and interprofessional student groups and provided insight into the process of actualizing a vision for a new learning space and the resultant experiences and perceptions of students within that space/place.

Communication of Code Status Escalation for Nurses and Physicians in the Intensive Care Unit: A Case Study.

BACKGROUND: Interprofessional teams working in the Intensive Care Unit (ICU) care for patients requiring varying degrees of life sustaining therapy. A patient's code status can help clinicians to understand the appropriate life support measures to deliver to patients in this setting. Members of the interprofessional team, such as physicians and nurses, can experience challenges related to communication when the code status is unclear. PURPOSE: The purpose of this study was to explore how nurses and physicians in the ICU experience communication of code status escalations. METHODS: A qualitative case study approach was used. Participants were physicians and nurses, working in the medical-surgical ICU of a large, urban academic hospital. Data were collected using semi-structured interviews, observations of health care rounds and a chart review. Data were analyzed using qualitative content analysis. RESULTS: Thematic findings include: (1) engaging in an interprofessional discussion, (2) finding consistent documentation, (3) revisiting the code status, and (4) telling the patient story. The study findings also provide contextual information about participants' experiences of code status communication during the first wave (February 2020 to May 2020) of the COVID-19 pandemic. CONCLUSIONS: The results of this study could inform standard communication frameworks or practices related to dissemination of code status decisions among members of the ICU team.

Exploring work-life issues in provincial corrections settings.

Correctional nurses hold a unique position within the nursing profession as their work environment combines the demands of two systems, corrections and health care. Nurses working within these settings must be constantly aware of security issues while ensuring that quality care is provided. The primary role of nurses in correctional health care underscores the importance of understanding nurses' perceptions about their work. The purpose of this study was to examine the work environment of nurses working in provincial correctional facilities. A mixed-methods design was used. Interviews were conducted with 13 nurses and healthcare managers (HCMs) from five facilities. Surveys were distributed to 511 nurses and HCMs in all provincial facilities across the province of Ontario, Canada. The final sample consisted of 270 nurses and 27 HCMs with completed surveys. Participants identified several key issues in their work environments, including inadequate staffing and heavy workloads, limited control over practice and scope of practice, limited resources, and challenging workplace relationships. Work environment interventions are needed to address these issues and subsequently improve the recruitment and retention of correctional nurses.

Correctional nursing: a study protocol to develop an educational intervention to optimize nursing practice in a unique context.

BACKGROUND: Nurses are the primary healthcare providers in correctional facilities. A solid knowledge and expertise that includes the use of research evidence in clinical decision making is needed to optimize nursing practice and promote positive health outcomes within these settings. The institutional emphasis on custodial care within a heavily secured, regulated, and punitive environment presents unique contextual challenges for nursing practice. Subsequently, correctional nurses are not always able to obtain training or ongoing education that is required for broad scopes of practice. The purpose of the proposed study is to develop an educational intervention for correctional nurses to support the provision of evidence-informed care. METHODS: A two-phase mixed methods research design will be used. The setting will be three provincial correctional facilities. Phase one will focus on identifying nurses' scope of practice and practice needs, describing work environment characteristics that support evidence-informed practice and developing the intervention. Semi-structured interviews will be completed with nurses and nurse managers. To facilitate priorities for the intervention, a Delphi process will be used to rank the learning needs identified by participants. Based on findings, an online intervention will be developed. Phase two will involve evaluating the acceptability and feasibility of the intervention to inform a future experimental design. DISCUSSION: The context of provincial correctional facilities presents unique challenges for nurses' provision of care. This study will generate information to address practice and learning needs specific to correctional nurses. Interventions tailored to barriers and supports within specific contexts are important to enable nurses to provide evidence-informed care.

Comparing self-guided learning and educator-guided learning formats for simulation-based clinical training.

AIM: In this paper, we tested the over-arching hypothesis that progressive self-guided learning offers equivalent learning benefit vs. proficiency-based training while limiting the need to set proficiency standards. BACKGROUND: We have shown that self-guided learning is enhanced when students learn on simulators that progressively increase in fidelity during practice. Proficiency-based training, a current gold-standard training approach, requires achievement of a criterion score before students advance to the next learning level. METHODS: Baccalaureate nursing students (n = 15/group) practised intravenous catheterization using simulators that differed in fidelity (i.e. students' perceived realism). Data were collected in 2008. Proficiency-based students advanced from low- to mid- to high-fidelity after achieving a proficiency criterion at each level. Progressive students self-guided their progression from low- to mid- to high-fidelity. Yoked control students followed an experimenter-defined progressive practice schedule. Open-ended students moved freely between the simulators. One week after practice, blinded experts evaluated students' skill transfer on a standardized patient simulation. Group differences were examined using analyses of variance. RESULTS: Proficiency-based students scored highest on the high-fidelity post-test (effect size = 1.22). An interaction effect showed that the Progressive and Open-ended groups maintained their performance from post-test to transfer test, whereas the Proficiency-based and Yoked control groups experienced a significant decrease (P < 0.05). Surprisingly, most Open-ended students (73%) chose the progressive practice schedule. CONCLUSION: Progressive training and proficiency-based training resulted in equivalent transfer test performance, suggesting that progressive students effectively self-guided when to transition between simulators. Students' preference for the progressive practice schedule indicates that educators should consider this sequence for simulation-based training.

Coordinating progressive levels of simulation fidelity to maximize educational benefit.

PURPOSE: To evaluate the effectiveness of a novel, simulation-based educational model rooted in scaffolding theory that capitalizes on a systematic progressive sequence of simulators that increase in realism (i.e., fidelity) and information content. METHOD: Forty-five medical students were randomly assigned to practice intravenous catheterization using high-fidelity training, low-fidelity training, or progressive training from low to mid to high fidelity. One week later, participants completed a transfer test on a standardized patient simulation. Blinded expert raters assessed participants' global clinical performance, communication, procedure documentation, and technical skills on the transfer test. Participants' management of the resources available during practice was also recorded. Data were analyzed using multivariate analysis of variance. The study was conducted in fall 2008 at the University of Toronto. RESULTS: The high-fidelity group scored higher (P < .05) than the low-fidelity group on all measures except procedure documentation. The progressive group scored higher (P < .05) than other groups for documentation and global clinical performance and was equivalent to the high-fidelity group for communication and technical skills. Total practice time was greatest for the progressive group; however, this group required little practice time on the resource-intensive high-fidelity simulator. CONCLUSIONS: Allowing students to progress in their practice on simulators of increasing fidelity led to superior transfer of a broad range of clinical skills. Further, this progressive group was resource-efficient, as participants concentrated on lower fidelity and lower resource-intensive simulators. It is suggested that clinical training curricula incorporate exposure to multiple simulators to maximize educational benefit and potentially save educator time.

Supported housing programs for persons with serious mental illness in rural northern communities: a mixed method evaluation.

BACKGROUND: During the past two decades, consumers, providers and policy makers have recognized the role of supported housing intervention for persons diagnosed with serious mental illness (SMI) to be able to live independently in the community. Much of supported housing research to date, however, has been conducted in large urban centers rather than northern and rural communities. Northern conditional and contextual issues such as rural poverty, lack of accessible mental health services, small or non-existing housing markets, lack of a continuum of support or housing services, and in some communities, a poor quality of housing challenge the viability of effective supported housing services. The current research proposal aims to describe and evaluate the processes and outcomes of supported housing programs for persons living with SMI in northern and rural communities from the perspective of clients, their families, and community providers. METHODS: This research will use a mixed method design guided by participatory action research. The study will be conducted over two years, in four stages. Stage I will involve setting up the research in each of the four northern sites. In Stage II a descriptive cross-sectional survey will be used to obtain information about the three client outcomes: housing history, quality of life and housing preference. In Stage III two participatory action strategies, focus groups and photo-voice, will be used to explore perceptions of supported housing services. In the last stage findings from the study will be re-presented to the participants, as well as other key community individuals in order to translate them into policy. CONCLUSION: Supported housing intervention is a core feature of mental health care, and it requires evaluation. The lack of research in northern and rural SMI populations heightens the relevance of research findings for health service planning. The inclusion of multiple stakeholder groups, using a variety of data collection approaches, contributes to a comprehensive, systems-level examination of supported housing in smaller communities. It is anticipated that the study's findings will not only have utility across Ontario, but also Canada.