Effective diversity, equity, and inclusion practices.

Demographics in Canada, and the workplace, are changing. These include population changes due to race, ethnicity, religion/faith, immigration status, gender, sexual identity and orientation, disability, income, educational background, socioeconomic status, and literacy. While this rich diversity can present challenges for patient experiences/outcomes and working environments, it can also present opportunities for positive transformation. For successful transformation to take place, strategies should focus on "Diversity, Equity, and Inclusion" (DEI) versus "diversity" alone and on creating inclusive team environments for positive staff experiences/engagement. There is a growing understanding of the relationship between the providers' work environments, patient outcomes, and organizational performance. This article leverages the principle of improving the healthcare provider's experience based on Health Quality Ontario's Quadruple Aim ("people caring for people"). Based on learnings/experiences, the top three successful practices from the organization's DEI strategy have been outlined in this article.

Bringing back the house call: how an emergency mobile nursing service is reducing avoidable emergency department visits for residents in long-term care homes.

Avoidable emergency department (ED) visits are a source of clinical risk, stress and anxiety for older, more vulnerable patients. The complexity of health conditions and the unique challenges associated with the care of older patients can also contribute to overcrowding and longer wait times in EDs--issues of significant concern for both healthcare providers and patients. Generally, older patients are more likely than younger patients to visit EDs and be admitted to hospital. In addition, older adults living in long-term care (LTC) homes are more likely to be transferred to EDs for preventable issues than those living in other settings. This paper describes how mobilizing a team of registered nurses working at full scope of practice might reduce the number of avoidable transfers of older patients to the ED. Utilizing nurses in this capacity demonstrates how the nursing profession can drive systemwide change to improve care between healthcare sectors for older adults.

Immigrant women's experiences of receiving care in a mobile health clinic.

AIM: This paper is a report of a study of the experiences of Portuguese-speaking immigrant women who used a mobile health clinic for their reproductive health care. BACKGROUND: Upon arrival in Canada, immigrant women often are in better health than their Canadian-born counterparts; however, this health status tends to deteriorate over time. One reason for this change is limited access to services. METHOD: Data collection during 2004 and 2005 involved individual interviews with seven Portuguese-speaking women who received care in a mobile health clinic in Toronto, Canada, and with four clinic care providers. Non-participant observation of the interaction between clients and care providers was also conducted. Interviews conducted in Portuguese were translated into English and transcribed, along with those conducted in English. Interview transcripts were read and re-read in the context of observational notes to develop codes. Emerging codes were grouped together to develop subcategories and categories. FINDINGS: Participants' experiences of accessing and receiving care in the mobile health clinic were shaped by their perceptions of health, which included physical, mental, social and spiritual aspects, and their pre- and postmigration care experiences. As an alternative model of care delivery, the mobile health clinic was perceived by participants to address their care needs and to help overcome postmigration barriers by providing accessible, holistic, and linguistically and culturally appropriate care. CONCLUSION: Mobile health clinics should be considered as an alternative care delivery model for immigrant women who may be at a disadvantage because of their socio-economic, cultural, and racialized statuses.

"Why doesn't she seek help for partner abuse?" An exploratory study with South Asian immigrant women.

This study explores why South Asian immigrant women with experiences of partner abuse delay seeking help from professionals. Three focus groups were conducted in Hindi language with South Asian immigrant women in Toronto. Twenty-two women participated with a mean age of 46 years (range 29-68 years). Thematic analysis was conducted on the transcribed data using constant comparison techniques within and across the groups. We found that three major themes emerged from the discussions: reasons for delayed help-seeking, turning points and talking to professionals. Women expressed delaying help-seeking to the point when "Pani sar se guzar jata he" (water crosses over your head). Their dominant reasons for delayed help-seeking were social stigma, rigid gender roles, marriage obligations, expected silence, loss of social support after migration and limited knowledge about available resources and myths about partner abuse. Women usually turned for help only after experiencing pronounced mental and physical health problems. The findings are interpreted in light of participants' immigration context and the socio-cultural norms of patriarchy, collectivism and familism. Prevention approaches to address partner abuse and delayed help-seeking among South Asian immigrant women should include tailored community education, social services to reduce vulnerability, and cultural competency of professionals. Further research and program evaluation is needed to advance the field.

Portuguese immigrant women's perspectives on wife abuse: a cross-generational comparison.

This descriptive study seeks to understand what first and second generation Portuguese women believe about wife abuse and what actions they believe are appropriate for an abused wife. Eighty first generation and 54 second generation women participated. The researcher read the questionnaire items aloud in one-on-one meetings. Overall, participants defined wife abuse broadly, did not approve of wife abuse, were most likely to believe that women should seek external help, and did not hold strong patriarchal beliefs. However, a number of generational differences were found. Second generation women were more likely to label an abusive behavior as abuse, and first generation women were more likely to approve of abuse, endorse indirect or traditional options to deal with wife abuse, and hold stronger patriarchal beliefs. The study's implications for research and practice within Portuguese communities are discussed.

Portuguese-speaking women voice their opinions: using their words to teach about wife abuse.

BACKGROUND: This study examined Portuguese-speaking women's definitions of wife abuse and beliefs about appropriate responses to abuse. The goals were to determine the breadth of definitions and to examine cultural stereotyping. This information was sought in an effort to design education strategies in the Portuguese-speaking community. METHODS: One-on-one semistructured interviews were conducted with 163 Portuguese-speaking women living in Toronto, Canada. The participants' open-ended answers were first coded using Qualitative Software Research NUDIST and then narrowed and grouped. Responses were then tagged by group label to generate descriptive statistics using Statistical Package for Social Sciences. RESULTS: Participants defined wife abuse broadly with respect to kind, prevalence, and severity. Six themes for abuse emerged: physical, psychological, sexual, financial, patriarchal, and infidelity. Participants provided various responses to what women should do and actually do in response to abuse. Most participants believed that Portuguese-speaking women should leave their husbands and/or seek help for the abuse, but that they actually remain quiet about the abuse and take very little action. Their responses and explanations demonstrate that they hold stereotypes about their culture. CONCLUSIONS: The range of definitions reported by participants suggests that a continuum of wife abuse, using Portuguese-speaking women's own words, can be created to educate them about how abusive acts are linked and used to maintain control over women. The differences that emerged with respect to appropriate responses to abuse suggest that it may be important to challenge Portuguese-speaking women about the cultural stereotypes that they hold to help them see patriarchy as widespread rather than particular to their culture.

Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model.

The aim of this study was to review published studies that examined factors influencing breast and cervical cancer screening behavior in Hispanic women, using the Health Belief Model (HBM). MEDLINE and PsycINFO databases and manual search were used to identify articles. Cancer screening barriers common among Hispanic women include fear of cancer, fatalistic views on cancer, linguistic barriers, and culturally based embarrassment. In addition, Hispanic women commonly feel less susceptible to cancer, which is an important reason for their lack of screening. Positive cues to undergo screening include physician recommendation, community outreach programs with the use of Hispanic lay health leaders, Spanish print material, and use of culturally specific media. Critical review of the literature using the theoretical framework of the Health Belief Model identified several culturally specific factors influencing cancer screening uptake and compliance among Hispanic women. Future interventions need to be culturally sensitive and competent.