Improving the response of primary care providers to rural First Nation women who experience intimate partner violence: a qualitative study.

BACKGROUND: Some legacies of colonialism are that Indigenous women living in Canada experience higher rates of intimate partner violence (IPV) and that violence is often more severe relative to non-Indigenous women. This results in avoidable physical, psychological, emotional, financial, sexual and spiritual harm in the lives of Indigenous women, families, and communities. Trusted primary care providers are well positioned to provide brief interventions and referrals to treatment and services, but little is known about the providers' preparedness to support Indigenous women. Information on what enables or prevents providers to respond to Indigenous patients who experience IPV is needed in order to ensure this potential lifeline for support is realized. METHODS: The purpose of this community-based participatory study was to elucidate the barriers and facilitators to care for rural Indigenous women who experience IPV from the perspectives of primary care providers and to recommend strategies to improve their preparedness. Using a Grounded Theory approach, we conducted qualitative research with 31 providers to discuss their experiences with patients affected by IPV. RESULTS: The results showed providers often feel a degree of unpreparedness to deal with IPV in a clinical setting. Underlying the feelings of unpreparedness were: Recognition of patients' under disclosure of IPV due to stigma, shame and fear Lack of formal provider training on appropriate approaches to IPV Lack of referral network due to fragmented, scarce services for IPV Lack of understanding of jurisdictional complexity of First Nations and non-First Nations specific services for IPV Uncertainty how to negotiate cultural safety around IPV Multiple-role relationship & confidentiality dilemmas characteristic of small communities Risk of jeopardizing patient-provider relationship CONCLUSIONS: Our recommendations to improve provider preparedness to address IPV include reducing the stigma of IPV; creating effective referral pathways; improving cultural safety within the referral network; developing services for perpetrators; engaging natural helpers in the community, and; developing policies, procedures and continuing education related to patients who experience IPV in the clinical and community setting. We suggest that increasing providers' comfort to respond to IPV for rural and Indigenous women will ultimately lead to improved safety and health outcomes.

The meaning of home for ageing women living alone: An evolutionary concept analysis.

The concept of home to women ageing should be visited in the light of ongoing cultural, political, temporal and disciplinary evolutions. In part, to compliment policies increasing focus on supporting older adults to age in place and a growing attention on the home as a place where healthcare is designed and provided. The following concept analysis utilises Rodgers' evolutionary method to inductively analyse literature in order to elicit the meaning and experience of home among older women who are ageing at home. Literature was collected over an 18-month period during 2014-2015 and the sample was made up of 49 articles. The analysis led to the concept of home among women ageing in communities to be defined by four attributes. These attributes are home as (i) a resource, (ii) an attachment, (iii) the precariousness of maintaining and sustaining home and (iv) a cultural expectation. This analysis of the meaning and experience of home among women ageing at home has shed light on the needs for this group of women, while highlighting the need to continue to further clarify and define the concept through research.

[Overlapping, interdependence or complementarity, interprofessional collaboration between nurse practitioners and other health professionals in Ontario]. / Chevauchement, interdépendance ou complémentarité?, la collaboration interprofessionnelle entre l?infirmière praticienne et d?autres professionnels de santé en Ontario.

OBJECTIVE: The Naylor Report (2015) states that nurse practitioners (NP) are still underutilized in Canada despite positive evidence of their work and the benefits they provide to health systems and, more generally, the health of the population. METHODS: Why are nurse practitioners not more actively involved in the Canadian health care system? A socio-historical literature review showed that there is overlap, interdependence or complementarity between the role of NPs and that of other health professionals and that this concerns their status, training as well as the scope of their practice. The development of an interprofessional collaborative approach, although supported by most professional nursing associations in Canada, is difficult to establish in NP practice and training. RESULTS: This article describes the emergence of the role of NPs in Canada and provides an update on the current status of their integration in the health system with reference to the Ontario example. It provides insight into the overlap and zones of complementarity or interdependence between NPs and other health professionals. CONCLUSION: In conclusion, the authors call for improved governance by the contribution of a new collaborative contract with other health professionals. This contract should be based on the interdependence of practices and the complementarity of roles between all health professionals including NPs.

[Nursing training in Canada]. / La formation infirmière au Canada.

Job prospects for nurses in Canada are excellent. By bringing nursing studies up to degree level, new opportunities have been created. Before undertaking a bachelor's, master's or doctoral degree, it is important that students understand the content of the lessons, the desired level of studies and how the programme works. Canadian students can choose whether to start work or to continue their studies at a higher level.

An exploration of patient satisfaction in a nurse practitioner-led clinic.

A unique and innovative model of primary healthcare (PHC) delivery began at the Sudbury District Nurse Practitioner Clinics (SDNPC) in 2007. Significant growth and development has taken place since the opening of this new model of PHC delivery. Now that SDNPC is operating at full capacity, an evaluation was warranted of patient experiences with clinic services and the level of overall patient satisfaction. A survey of clinic patients was conducted in the spring of 2011. Results demonstrated high satisfaction with clinic services. Some areas were identified for review, including the level of accessibility to same-day appointments and rationale for patient use of walk-in clinics and emergency department care. One of the strengths and benefits of this model of NP care was demonstrated in this evaluation, whereby a majority of patients identified that they had received counselling about a lifestyle issue and, of those patients, most reported a resulting positive health-related behavioural change. Ongoing comprehensive evaluation is important to ensure that services are efficient and directed to optimal patient health outcomes.