Homeless Patients Associate Clinician Bias With Suboptimal Care for Mental Illness, Addictions, and Chronic Pain.

Objective: To determine how accessible health care services are for people who are experiencing homelessness and to understand from their perspectives what impact clinician bias has on the treatment they receive. Methods: Narrative interviews were conducted with 53 homeless/vulnerably housed individuals in Ontario, Canada. Visit history records were subsequently reviewed at 2 local hospitals, for 52 of the interview participants. Results: Of the 53 participants only 28% had a primary care provider in town, an additional 40% had a provider in another town, and 32% had no access to a primary care provider at all. A subset of the individuals were frequent emergency department users, with 15% accounting for 75% of the identified hospital visits, primarily seeking treatment for mental illness, pain, and addictions. When seeking primary care for these 3 issues participants felt medication was overprescribed. Conversely, in emergency care settings participants felt prejudged by clinicians as being drug-seekers. Participants believed they received poor quality care or were denied care for mental illness, chronic pain, and addictions when clinicians were aware of their housing status. Conclusion: Mental illness, chronic pain, and addictions issues were believed by participants to be poorly treated due to clinician bias at the primary, emergency, and acute care levels. Increased access to primary care in the community could better serve this marginalized population and decrease emergency department visits but must be implemented in a way that respects the rights and dignity of this patient population.

A realist synthesis of social connectivity interventions during transition to parenthood: The value of relationships.

BACKGROUND: Social connections are important during the transition to parenthood. A wide body of literature suggests that these connections enhance health and contribute to wellbeing. In the case of parents and families, social connections can influence child development. Nurses and public health agencies are in a unique position to advocate for resources and approaches to enhance social connectivity for parents during this important life transition. OBJECTIVES: The aim of this review was to identify the universal social connectivity interventions that work, and the conditions that foster social connections for parents and enhance child development. The review was undertaken as part of a larger research project to inform the question: What are the population-level interventions that public health can implement to promote social, emotional and cognitive development from the prenatal period to the end of the first year of life? Social connectivity is one of three domains that were explored in the full study. DESIGN: Realist synthesis. DATA SOURCES: Medline, CINAHL, ERIC, SocAbs, PsychINFO, grey literature. REVIEW METHODS: A literature search was conducted using relevant key words and MeSH headings. Nearly 2000 papers were reviewed by title and sorted based on inclusion and exclusion criteria. Data extraction aided quality appraisal and analysis and informed the development of an explanatory mechanism. RESULTS: Twenty-seven papers were included in the synthesis, with findings described in four theme areas: (a) connections in the community, (b) internet connections, (c) prenatal connections, and (d) connections for fathers. The literature available to answer the research question is scant and of varying quality. Community development, family-systems intervention practices, principles of father inclusive practice and group prenatal care models have been demonstrated to foster social connectivity for parents. Online social networking provides valuable informational support. CONCLUSIONS: Changing social structures and technology have influenced the way in which new parents access support. Social connections fostered in the parenting environment have the potential to enhance wellbeing for parents and thus contribute to children's positive development. Nurses are in a position to advocate for the use of evidence-informed approaches when planning programs and services for parents.

Parent education interventions designed to support the transition to parenthood: A realist review.

BACKGROUND: Public health nurses use parent education programmes to support individuals' transition to parenthood. A wide array of these programmes exists; however, the approach must be accommodated by resources available in a publicly funded system. For example, some new-parent education approaches use 1:1 home visiting (with a nurse or trained lay-home visitor) but the costs of this intensive approach can be prohibitive. Because of this limitation there is an interest in identifying effective and efficient new parent educational approaches that can realistically be provided at a universal level. Unfortunately, there is a lack of high-quality evaluation identifying programmes or educational processes that meet these criteria. OBJECTIVES: To identify potentially effective new-parenting education interventions that could be implemented at a population level during the transition to parenthood period. DESIGN: Realist synthesis. DATA SOURCES: Medline, CINAHL, ERIC, PsycINFO, Sociological Abstracts, grey literature. REVIEW METHODS: A realist review method generated a total of 72 papers that were used to inform the results. A three-pronged approach was used incorporating an initial search (6), a database search using applicable keywords and MeSH headings (58), and review of literature identified by advisory group (8 grey literature). An 'implementation chain' was developed to outline the overall logic and process behind parent education interventions and to guide the analysis. RESULTS: Seventy-two papers informed this review: 13 systematic reviews/meta-analyses, 34 intervention studies, 9 opinion papers, 8 programme reviews, and 8 grey literature reports. There was no compelling evidence to suggest that a single educational programme or delivery format was effective at a universal level. Some inherent issues were identified. For example, adult learning principles were overlooked and theories of parent-child interaction were not in evidence. No direct links between universal new-parent education programmes and child development outcomes were established. Programme reach and attrition were key challenges. Programme evaluation criteria were inconsistent, with an over-reliance on parent satisfaction or self-reported intention to change behaviour. There was evidence that effective facilitators helped increase parents' perceived satisfaction with programmes. CONCLUSIONS: It is unlikely that a single standardized format or programme will meet all the specific learning needs of parents. Multiple approaches that will allow people to access information or education at a time and in a format that suits them may be of value. The importance of the transition to parenthood and its impact on parent and child wellbeing warrant careful consideration of current programming and careful evaluation of future initiatives.

An educational innovation to foster evidence-informed practice.

This article describes an innovation in baccalaureate nursing education that is intended to assist in the preparation of nursing students for careers in which evidence-informed practice is an imperative. The innovation involves the combination of central aspects of the internationally recognized Registered Nurses' Association of Ontario Best Practice Guidelines Program with existing curricular goals and themes in a baccalaureate nursing program at a small university in southern Ontario in Canada.