Helping the helpers: Understanding information and support needs of caregivers in underserved communities.

Informal caregivers caring for patients at the end of life in rural geographic areas may have inadequate support due to insufficient community-based palliative care services. We conducted a parallel mixed-methods study to understand informal caregivers' unmet supportive, educational, and informational needs living in rural areas with limited community-based palliative care services. Forty-four caregivers of loved ones that died at home between December 2017 and September 2020 completed the Carer Support Needs Assessment Tool (CSNAT) and 14 caregivers were interviewed. Using a parallel mixed analysis, results showed that caregiver distress was associated with unmet information needs about how to accurately assess and manage pain levels and identify signs and symptoms of end-of-life. Caregivers needed more support related to available, knowledgeable, and well-trained home health care providers, accessible equipment, 24-hour respite care, accessible grief counseling, and a central triage contact number for community support.

Northeastern Ontario nurses' perceptions of e-learning: An interpretive description.

BACKGROUND: E-learning is a common method of continuing education for nurses that supports professional competencies and learning needs. However, variations in setting, information technology, and quality of the e-learning may impact these experiences. OBJECTIVE: To explore registered nurses' perceptions of e-learning in a hospital setting. DESIGN: A qualitative study using an Interpretive Description methodology. SETTING: A small urban Northeastern Ontario hospital. PARTICIPANTS: Ten registered nursing staff from acute medical and surgical inpatient departments. METHOD: Face-to-face semi-structured interviews were conducted to explore nurses' e-learning perceptions. Interview transcripts were analyzed for themes. RESULTS: Three key themes were found that described the participants' perceptions of e-learning and how it related to their continuing education: Unsatisfactory, Meaningful, and Enhancing learning experiences. CONCLUSION: E-learning can be a useful method of continuing education for registered nurses; however, there are challenges in the delivery of e-learning and an ongoing need for quality development.

Maternity and postpartum care: perspectives.

EBN Perspectives brings together key issues from the commentaries in one of our nursing topic themes.

Development of Nurse Practitioner Competencies for Advance Care Planning.

This article describes the development of nurse practitioner (NP) competencies for advance care planning. Nurse practitioners are well positioned to implement advance care planning with their patients; however, very few patients have an advance care plan. A modified Delphi method was used to engage NPs in achieving consensus for advance care planning competencies. In round 1, draft competencies were developed from the findings of a survey of NP beliefs, knowledge, and level of implementation of advance care planning. In round 2, 29 NPs participated in the evaluation of the draft competencies and their components. Revisions were made, and a final round was conducted where 15 of the original NP participants confirmed their consensus with the final document. The final document includes 4 competencies, each with several elements: (1) Clinical Practice, (2) Consultation and Communication, (3) Advocacy, and (4) Therapeutic Management. Advance care planning competencies will provide NPs with a guide that can be used to ensure that they are able to clearly identify their distinct role in advance care planning. These competencies may inform the integration of advance care planning in a variety of health care settings and with other health care providers.

Identifying the Factors Associated With Canadian Registered Nurses' Engagement in Advance Care Planning.

Advance care planning (ACP) is a series of discussions in which patient values and wishes for end-of-life care are made known. The purpose of this study was to determine the extent to which registered nurses (RNs) engaged in ACP with their patients and understand the factors associated with this practice decision in Canada. One hundred twenty-five RNs participated in this cross-sectional descriptive survey. Registered nurse participants agreed that end-of-life decision making is an important part of their work; however, the majority of respondents did not participate in ACP, especially those RNs who were employed in community settings. Study respondents cited barriers to implementing ACP into their practice such as limited organizational policy, limited expectations of others to engage in ACP, inadequate educational opportunities to learn about or practice ACP, and a lack of patient and family readiness for the conversation. Study conclusions support recommendations for continuing education topics and the importance of organizational support in ACP.

Characteristics of Nurse Practitioner Practice in Family Health Teams in Ontario, Canada.

Nurse practitioners (NPs) in Ontario work in a number of settings, including physician-led, interprofessional Family Health Teams (FHTs). However, many aspects of NP practice within the FHTs are unknown. Our study aimed to describe the characteristics of NP practice in FHTs and the relationships between NPs and physicians within this model. This cross-sectional descriptive study analyzed NP service and diagnostic code data collected for every NP patient encounter from 2012 to 2015. Encounter data were linked to health administrative data housed at the Institute for Clinical Evaluative Sciences to allow for comparison with physician service and diagnostic codes. Findings demonstrated that NPs saw patients across all age groups for one to more than five problems per encounter and that NPs handled both acute and episodic care and chronic disease management issues. Patients with chronic conditions had more encounters with physicians than with NPs. In addition, compared to physicians, NPs saw more female than male patients. Our findings provide a snapshot of NP practice in FHTs and may be useful in informing other practice models in Ontario, elsewhere in Canada, and internationally. More evidence is needed, however, to clarify the responsibilities of the NPs in collaborative relationships with physicians and to embed policies that will ensure that NPs work to their full potential. In addition, applying service coding to all health care providers in FHTs could enhance data on interprofessional teams and the individual clinicians that comprise them.

Exploring Self-Perceptions of Anxiety among Nursing Students in the Clinical Setting and Select Demographics.

Clinical learning experiences are essential in nursing education but they are often anxiety provoking for learners. Understanding the factors associated with the anxiety levels of nursing students in clinical placements has become more complex over the years with increasing heterogeneity within the nursing population. A correlational study was conducted to examine the relationships between nursing students' self-perceived anxiety levels, as measured by the State-Trait Anxiety Inventory (STAI), and the students' age, gender, previous employment, and previous education. The findings revealed that nursing students have a higher than average level of anxiety and that male nursing students reported higher levels of anxiety compared to female nursing students. No significant correlations were found between age, previous education, previous employment, and self-perceived anxiety levels. Findings from this study provide an opportunity for discussion by nursing educators and identify a need for future research and practice.

Communication technology and healthcare.

EBN Perspectives bring together key issues from the commentaries in one of our nursing topic themes.

Nurse practitioner's perceptions of the impact of the nurse practitioner-led clinic model on the quality of care of complex patients.

AimTo evaluate the organizational processes that influence the quality of care for patients with multimorbidity at nurse practitioner-led clinics (NPLCs). BACKGROUND: People are living longer, most with one or more chronic diseases (mulitmorbidity) and primary healthcare for these patients has become increasingly complex. One response was the establishment of new models of primary healthcare. NPLCs are an example of a model developed in Ontario, Canada, which feature nurse practitioners as the primary care providers practicing within an interprofessional team. Evaluation of the extent to which the processes within NPLC model addressed the needs of patients with multimorbidity is warranted. METHODS: Eight nurse practitioners were interviewed to determine their perception of the quality of care provided to patients with multimorbidity at NPLCs. Interpretive description guided the analysis and themes were identified.FindingsThree themes arose from the analysis, each of which has an impact on the quality of care. The level of patient vulnerability at the NPLCs was high resulting in the need to address social and financial issues before the care of chronic conditions. Dynamics within the interprofessional team impacted the quality of patient care, including NP recruitment and retention, leaves of absence and turnover in staff at the NPLCs had an effect on interprofessional team functioning and patient care. Finally, coordination of care at the NPLCs, such as length of appointments, determined the extent to which attention was given to individual clinical issues was a factor. Strategies to address social determinants of health and for recruitment and retention of NPs is essential for improved quality of care. Comprehensive orientation to the interprofessional team as well as flexibility in care processes may also have positive effects on the quality of care of patients with complex clinical issues.