Effect of mode of healthcare delivery on job satisfaction and intention to quit among nurses in Canada during the COVID-19 pandemic.

The COVID-19 pandemic resulted in a major shift in the delivery of healthcare services with the adoption of care modalities to address the diverse needs of patients. Besides, nurses, the largest profession in the healthcare sector, were imposed with challenges caused by the pandemic that influenced their intention to leave their profession. The aim of the study was to examine the influence of mode of healthcare delivery on nurses' intention to quit job due to lack of satisfaction during the pandemic in Canada. This cross-sectional study utilized data from the Health Care Workers' Experiences During the Pandemic (SHCWEP) survey, conducted by Statistics Canada, that targeted healthcare workers aged 18 and over who resided in the ten provinces of Canada during the COVID-19 pandemic. The main outcome of the study was nurses' intention to quit within two years due to lack of job satisfaction. The mode of healthcare delivery was categorized into; in-person, online, or blended. Multivariable logistic regression was performed to examine the association between mode of healthcare delivery and intention to quit job after adjusting for sociodemographic, job-, and health-related factors. Analysis for the present study was restricted to 3,430 nurses, weighted to represent 353,980 Canadian nurses. Intention to quit job, within the next two years, due to lack of satisfaction was reported by 16.4% of the nurses. Results showed that when compared to participants who provided in-person healthcare services, those who delivered online or blended healthcare services were at decreased odds of intention to quit their job due to lack of job satisfaction (OR = 0.47, 95% CI: 0.43-0.50 and OR = 0.64, 95% CI: 0.61-0.67, respectively). Findings from this study can inform interventions and policy reforms to address nurses' needs and provide organizational support to enhance their retention and improve patient care during times of crisis.

Internet non-use among Canadian indigenous older adults: Aboriginal Peoples Survey (APS).

BACKGROUND: Older adults benefit considerably from Internet use, as it can improve their overall health and quality of life, for example through accessing healthcare services and reducing social isolation. The aim of this study is to assess the prevalence and characteristics of Indigenous older adults in Canada who do not use the Internet. METHODS: The Aboriginal Peoples Survey (APS) 2017 was used and analysis was restricted to those above 65 years of age. The main outcome variable was non-use of the internet in a typical month. Multivariable logistic regression was conducted to assess the relationship between each of the sociodemographic, socioeconomic, lifestyle and health factors and internet non-use. RESULTS: The prevalence of Indigenous older adults who reported never using the Internet in a typical month was 33.6% with the highest prevalence reported by residents of the Canadian territories while the lowest prevalence was reported in British Columbia. After adjustment, results indicated that older age (OR = 4.02, 95% CI 3.54-4.57 comparing 80+ to 65-69 years of age), being a male (OR = 1.52, 95% CI 1.41-1.63), married (OR = 1.34, 95% CI 1.25-1.44), and living in rural areas (OR = 1.95, 95% CI 1.79-2.13) increased the odds of not using the Internet. First Nation individuals and those who have a strong sense of belonging to the Indigenous identity were more likely to not use the Internet compared to their counterparts. In addition, those who were less educated (OR = 8.74, 95% CI 7.03-1 0.87 comparing less than secondary education to Bachelor's Degree and above), unemployed (OR = 1.41, 95% CI 1.26-1.57), smoked cigarettes, used marijuana and those with lower self-perceived mental health and unmet health needs were at increased odds of Internet non-use compared to their counterparts. CONCLUSIONS: Findings from this study show that a large proportion of the Indigenous older adults in Canada do not use the internet. It is necessary to address Indigenous communities' lack of internet access and to create interventions that are consistent with Indigenous values, traditions, and goals.

Comparison between two different selective spinal anesthesia techniques in ambulatory knee arthroscopy as fast-track anesthesia.

BACKGROUND: There were several studies using either low dose Bupivacaine as unilateral selective spinal anesthesia (SSA) or low dose lidocaine SSA for ambulatory knee arthroscopy. There were many concerns about high failure rate, complications, and different times to home readiness discharges. AIM OF THE STUDY: The study aimed to: (1) Compare the clinical efficacy and side effects of two different techniques of SSA in subarachnoid block for ambulatory knee arthroscopy (2) evaluate the possibility of a shorter stay in post-anesthesia care unit (PACU) or eligibility for fast tracking anesthesia (bypassing PACU) after SSA and numbers of patient bypassed PACU (3) compare the time to ambulate and time to home readiness. PATIENTS AND METHODS: Prospective, randomized and open study was conducted, including 50 outpatients undergoing knee arthroscopy. Patients allocated into two groups: Bupivacaine group (group B); was injected with 3 mg bupivacaine and 10 ug fentanyl intrathecally in lateral decubitus position and remained for 20 min then supine position. Lidocaine group (group L) was injected with 20 mg lidocaine, plus 25 ug fentanyl intrathecally and immediately keeps in the supine position after injection. The quality and durations of motor and sensory block were compared between groups. Sensory block assessed by pin brick method and motor block assessed by Bromage scale. Time spent in PACU, the time to ambulate, and times to home-readiness were compared. Number of patients bypassed PACU was recorded. Side effects as pain, nausea, vomiting, postdural puncture headache, transient neurological symptoms, retention of urine and pruritus were evaluated and compared after SSA. RESULTS: Bupivacaine group provided unilateral spinal anesthesia with significantly longer duration of both motor and sensory blocks than bilateral spinal of lidocaine group P < 0.001 and P < 0.01 respectively. The upper dermatomal height of sensory block reached was T9 and T8 in groups B and L respectively. Group B showed more intense motor block than group L. There was no significant difference between both groups as regards postoperative side effects P > 0.05. Group L patients did not stay in PACU, and all patients bypassed it P < 0.001. Bupivacaine group patients showed significantly longer time to ambulate and time to home-readiness than lidocaine group P < 0.001 and P < 0.01 respectively. CONCLUSION: Both techniques of SSA were clinically efficient as subarachnoid block, and they had less postoperative side effects. Lidocaine spinal was more eligible for fast-tracking anesthesia than bupivacaine spinal with shorter time to ambulate and home-readiness time.