Examining the Contemporary Use of Hospitals in Canada for Palliative Care Purposes: A Population-Based Study to Enable Policy and Program Developments.

Background: It is commonly thought that most deaths in developed countries take place in hospital. Death place is a palliative care quality indicator. Objectives: To determine the use of Canadian hospitals by patients who died in hospital during the 2019-2020 year and any additional hospital utilization occurring over their last 365 days of life. Design: An investigation of population-based (2018-2020) Canadian hospital data using SAS. Settings/Subjects: All patients admitted to hospital and discharged alive or deceased. Measurements: Describe patients who died in hospital, and any additional use of hospitals by these patients over their last year of life. Results: Ninety-one thousand six hundred forty inpatients died during 2019-2020; 4.85% of all 1.88 million hospitalized individuals and 41.82% of all deaths in Canada that year. Decedents were primarily 65+ years of age (81.16%), male (53.44%), admitted through an emergency department (80.16%), and arrived by ambulance (72.15%). The most common diagnosis was the nonspecific ICD-10 defined "factors influencing health status and contact with health services" (23.75%), followed by "circulatory diseases" (18.22%), "respiratory diseases" (15.58%), and many other less common diagnoses. The average length of final hospital stay was 16.54 days, with 89.97% having some Alternative Level of Care (ALC) or ALC days recorded, indicating another care setting was preferable. Only 5.78% had cardiopulmonary resuscitation performed during their final hospitalization. Of all 91,640 decedents, 74.33% had only one admission to hospital in their last 365 days of life, while 25.67% (more often younger than older decedents) had two to five admissions. Conclusions: This study confirms a continuing shift of death and dying out of hospital in Canada. Most deaths and end-of-life care preceding death take place outside of hospitals now. Enhanced community-based services are recommended to support optimal dying processes outside of hospitals and also help more dying people avoid hospital deaths.

Burden of depression among Canadian adults with cancer; results from a national survey.

OBJECTIVE: To assess the prevalence and association of depression among Canadian adults with cancer in a population-based context. METHODS: The Canadian Community Health Survey (CCHS) (2015-2016) was accessed and adult participants with cancer who completed the Personal Health Questionnaire (PHQ9) were included in the current analysis. Multivariable logistic regression was conducted to elucidate the factors associated with the development of depression. An additional multivariable logistic regression analysis was conducted to evaluate the association of depression with ever contemplating suicide (suicidal ideation). RESULTS: A total of 867 participants with cancer have completed PHQ9 were included in the current analysis (including 603 participants (69.6%) without depression (PHQ9 ≤ 4) and 264 participants (30.4%) with depression (PHQ9 > 4)). Moreover, 92 participants (10.6%) fulfill the criteria for moderate/severe depression (PHQ9 > 9). The following factors were associated with the presence of depression (PHQ9 > 4), female sex (OR for males versus females: 0.56; 95% CI: 0.34-0.93; P = 0.02); poor self-perceived health (OR for excellent health versus poor health: 0.12; 95% CI: 0.02-0.62; P = 0.01) and poor self-perceived mental health (OR for excellent mental health versus poor mental health: 0.02; 95% CI: <0.01-0.24; P < 0.01). Additional multivariable logistic regression analysis showed that depression (PHQ9 > 4) was associated with a higher probability of suicidal ideation (OR for no depression versus depression: 0.43; 95% CI: 0.21-0.91; P = 0.02). CONCLUSIONS: Depression seems to be an underdiagnosed and possibly undertreated comorbid condition among Canadian adults with cancer.

Desafios da enfermagem na promoção de práticas de equidade em saúde: um diálogo entre a enfermagem no Brasil e no Canadá / Nursing challenges to enact health equity in practice: a Brazilian-Canadian nursing dialogue / Retos de enfermería en la promoción de prácticas de equidad en salud: diálogo entre enfermería de Brasil y Canadá

No presente artigo desenvolvemos um diálogo reflexivo acerca da equidade na saúde, traçando um paralelo entre os desafios próprios da prática de Enfermagem com equidade no Brasil e no Canadá. O conceito de equidade em saúde implica o reconhecimento das injustiças sofridas por alguns grupos populacionais, considerando-se que a distribuição de bens e serviços aos indivíduos abarca o reconhecimento de suas diferenças e necessidades distintas. O princípio da equidade em saúde se estabelece no âmbito das próprias condições de saúde e do acesso e utilização dos serviços com base em um parâmetro de distribuição heterogênea desses serviços. Os principais responsáveis pelas diferenças nas condições de saúde de distintos grupos populacionais são fatores sociais que podem ser alterados ou controlados por políticas públicas, ou seja, as iniquidades em saúde devem ser compreendidas como as diferenças desnecessárias e evitáveis. No que se refere às práticas de Enfermagem, em uma perspectiva sociológica, elas devem ser entendidas como práticas sociais que devem possibilitar a autonomia e o exercício da cidadania das pessoas, cabendo questionar sé é possível atuar como profissionais de saúde na perspectiva da equidade. Nesse contexto, entendemos que a proposição de práticas de equidade em saúde, na perspectiva da Enfermagem, pressupõe a superação de complexos desafios que podem ser analisados a partir de cinco dimensões: assistência, gestão, formação/educação permanente, engajamento político e pesquisa.(AU)

In this paper we develop a reflective dialogue about health equity, drawing a parallel between selected challenges to enact equity in nursing practice in Brazil and Canada. The concept of health equity implies the recognition of injustices suffered by some population groups, considering that a distribution of goods and services to individuals requires recognition of their differences and distinct needs. The principle of health equity emerges in light of inequalities in health and access to health care services. Living and social conditions are critical factors in the development of health inequities that affect population groups. These factors are modifiable and controllable by public policies. Health inequities are considered unnecessary, unjust, and avoidable differences in the health status of populations. Nursing practices can be understood as social practices that seek to enable people to enact their autonomy and citizenship. A proposal for health equity practices, from the perspective of nursing, requires that we tackle complex challenges that can be analyzed from the perspective of five domains: clinical practice, nursing education, research, administration and political engagement.(AU)

En este artículo llevamos a cabo un diálogo reflexivo sobre la equidad en salud, trazando un paralelo entre los retos propios de la práctica de enfermería con equidad en Brasil y Canadá. El concepto de equidad en salud implica el reconocimiento de las injusticias sufridas por algunos grupos de población, considerando que la distribución de bienes y servicios a individuos incluye el reconocimiento de sus diferencias y necesidades distintas. El principio de equidad en salud se establece dentro del alcance de las condiciones de salud y del acceso y uso de los servicios en función de un parámetro de distribución heterogénea de estos servicios. Los principales responsables de las diferencias en las condiciones de salud de los diferentes grupos de población son los factores sociales que pueden ser alterados o controlados por las políticas públicas, es decir, las inequidades en salud deben entenderse como diferencias innecesarias y evitables. Con respecto a las prácticas de enfermería, desde una perspectiva sociológica, deben entenderse como prácticas sociales que deberían permitir la autonomía de las personas y el ejercicio de la ciudadanía, y vale la pena preguntarse si es posible actuar como profesionales de la salud desde la perspectiva de la equidad. En este contexto, entendemos que la propuesta de prácticas de equidad en salud, desde la perspectiva de la enfermería, presupone superar retos complejos que se pueden analizar desde cinco dimensiones: asistencia, gestión, capacitación / educación permanente, compromiso político e investigación. (AU)

Quality of Life among Female Cancer Survivors in Africa: An Integrative Literature Review.

Quality of life (QOL) has been studied extensively among cancer populations in high income countries where cancer care resources are available to many. Little is known concerning the QOL of cancer groups residing in Africa where resources can be scarce. The integrative review of the literature explored and critically examined studies that had addressed QOL in female cancer survivors in Africa. The extent to which QOL studies incorporated a cultural perspective was also examined. Research studies published between 2005 and 2015 were retrieved from five databases: CINAHL, MEDLINE, SCOPUS, ProQuest dissertations and Theses full text, and GlobalHealth. Primary qualitative or quantitative studies regardless of sample size or setting were included. A total of 300 studies were identified and 28 full text studies were retrieved and assessed for eligibility. Eight studies met inclusion criteria. Factors that affected the QOL were socio-demographic especially age, education, employment, income and residence; illness-related factors such as having advanced cancer and multiple symptoms; treatment-related factors associated with surgery and radiotherapy; psychosocial factors such as support and anxiety; and cultural factors including fatalism and bewitching. Practice implications entail increasing awareness among nurses and allied healthcare providers of the potential effects on QOL of a cancer diagnosis and treatment of female cancers such as pain, fatigue, sexual dysfunction, hormonal and body image changes, anxiety, depression and cultural practices. Failure to identify and deal with these may result in poor treatment adherence, low self-esteem, and ultimately poor QOL.

Nurses' experiences of providing care to bereaved families who experience unexpected death in intensive care units: A narrative overview.

BACKGROUND: Death is a common occurrence in intensive care units (IC Us) and the complexity of care makes it difficult for nurses to find a balance between the patient's physical needs and the family's emotional needs, especially in circumstances of unexpected death. Cumulative or unresolved grief for families can have lasting negative repercussions. Nurses, therefore, need access to bereavement education in order to provide optimal- bereavement support. PURPOSE: The purpose of this review is to identify challenges and facilitators that nurses experience in delivering bereavement support during and after sudden or unexpected death in ICUs. METHODS: A narrative overview was conducted based on a literature search using GINA HL, Medline, Psyclnfo, Scopus, and Pro quest databases, as well as grey literature, revealing 241 articles, 15 of which met inclusion criteria. FINDINGS: Four themes surrounding bereavement support in the ICUs emerged: influence of hospital policies and organizational constraints; sign ~tl cance of time and trust; level of knowledge and support of staff and nurses' inner conflict, moral distress, and personal ways of coping. CONCLUSION: The availability of up-to-date literature in this area is limited. Further research could inform organizational poli- cies, nursing education, and nursing staff development to address existing barriers. With adequate resources, practical strate- gies could be implemented to provide bereavement support that ensures optimal bereavement outcomes for families experiencing sudden or unexpected death in ICUs.

Understanding inequalities in access to health care services for aboriginal people: a call for nursing action.

We present findings from an Access Research Initiative to reduce health disparities and promote equitable access with Aboriginal peoples in Canada. We employed Indigenous, interpretive, and participatory research methodologies in partnership with Aboriginal people. Participants reported stories of bullying, fear, intimidation, and lack of cultural understanding. This research reveals the urgent need to enhance the delivery of culturally appropriate practices in emergency. As nurses, if we wish to affect equity of access, then attention is required to structural injustices that act as barriers to access such as addressing the stigma, stereotyping, and discrimination experienced by Aboriginal people in this study.

Participatory knowledge exchange to support palliative care in Chile: lessons learned through global health research.

The authors designed a participatory qualitative research study to develop a collaborative partnership between palliative care practitioners in Canada and in Chile. The research goal was to support the provision of palliative care in vulnerable settings through a participatory knowledge exchange process using qualitative and participatory methodologies. The study involved an interprofessional palliative care team from a primary health care centre in Chile and 5 adults receiving palliative care and their relatives. It also involved the participation of registered nurses and allied health professionals from a palliative home care team in Canada. Participatory knowledge exchange activities included teamwork with the primary health care team in Chile and a process of participatory knowledge exchange with palliative care clinicians in Chile and Canada. The study produced qualitative evidence on the efficacy of a process of participatory knowledge exchange with palliative care practitioners from 2 diverse settings.