Navigation programs to support community-dwelling individuals with life-limiting illness: determinants of implementation.

BACKGROUND: As the Canadian population ages and the prevalence of chronic illnesses increases, delivering high-quality care to individuals with advanced life limiting illnesses becomes more challenging. Community-based navigation programs are a promising approach to address these challenges, but little is known about how these programs are successfully implemented to meet the needs of this population. This study sought to identify the key determinants that contribute to the successful implementation of these programs within Canada. METHODS: A qualitative study was undertaken to understand the implementation of eleven innovative, community-based navigation programs that aim to address the needs of individuals with life-limiting illnesses as they approach the end of life. The Consolidated Framework for Implementation Research (CFIR) guided the study design. Key informants (n = 23) within these programs took part in semi-structured interviews where they were asked to discuss how these programs are implemented. Data were analyzed using techniques employed in qualitative description. RESULTS: We identified key determinants of successful implementation within each CFIR domain. In the outer setting domain, participants emphasized the importance of filling gaps in care to meet client needs, developing strong relationships with clients and community-based organizations, and navigating relationships with healthcare providers. At the inner setting level, leadership support, staff compatibility, and available resources were identified as important factors. In terms of intervention characteristics, the ability to adapt was cited as a facilitator, whereas costs were identified as a barrier. For the characteristics of individuals, participants described the importance of having staff whose values align with the program, and who have the experience and skills necessary to work with complex clients. Finally, having strong champions and evaluation processes were highlighted as important process-oriented determinants of successful implementation. CONCLUSION: This study provides valuable insights into the determinants of successful implementation of community-based navigation programs in Canada. Understanding these determinants can guide the future development and integration of navigation programs to successfully meet the needs of those with life-limiting illnesses.

How do navigation programs address the needs of those living in the community with advanced, life-limiting Illness? A realist evaluation of programs in Canada.

BACKGROUND: We sought to identify innovative navigation programs across Canadian jurisdictions that target their services to individuals affected by life-limiting illness and their families, and articulate the principal components of these programs that enable them to address the needs of their clients who are living in the community. METHODS: This realist evaluation used a two-phased approach. First, we conducted a horizon scan of innovative community-based navigation programs across Canadian jurisdictions to identify innovative community-based navigation programs that aim to address the needs of community-dwelling individuals affected by life-limiting illness. Second, we conducted semi-structured interviews with key informants from each of the selected programs. Informants included individuals responsible for managing and delivering the program and decision-makers with responsibility and/or oversight of the program. Analyses proceeded in an iterative manner, consistent with realist evaluation methods. This included iteratively developing and refining Context-Mechanism-Outcome (CMO) configurations, and developing the final program theory. RESULTS: Twenty-seven navigation programs were identified from the horizon scan. Using specific eligibility criteria, 11 programs were selected for subsequent interviews and in-depth examination. Twenty-three participants were interviewed from these programs, which operated in five Canadian provinces. The programs represented a mixture of community (non-profit or volunteer), research-initiated, and health system programs. The final program theory was articulated as: navigation programs can improve client outcomes if they have supported and empowered staff who have the time and flexibility to personalize care to the needs of their clients. CONCLUSIONS: The findings highlight key principles (contexts and mechanisms) that enable navigation programs to develop client relationships, personalize care to client needs, and improve client outcomes. These principles include staff (or volunteer) knowledge and experience to coordinate health and social services, having a point of contact after hours, and providing staff (and volunteers) time and flexibility to develop relationships and respond to individualized client needs. These findings may be used by healthcare organizations - outside of navigation programs - to work towards more person-centred care.

Nurse leaders' experiences of upwards violence in the workplace: a qualitative systematic review.

OBJECTIVE: The objective of this review was to synthesize the qualitative literature on the experience of upwards violence in nursing workplaces directed towards nurse leaders who have authority over those who direct the violence towards them. INTRODUCTION: Workplace violence has impacted nursing work life for decades. It has been studied mostly from a downwards and lateral perspective and less often from an upwards direction towards individuals in leadership positions. Little is known about the experiences of nurse leaders or the potential consequences of workplace violence, including what impact upwards violence has on leadership ability and sustainability. INCLUSION CRITERIA: This review considered qualitative studies that included nurse leaders who experienced upwards violence in nursing workplaces from nurses they supervise. Nurse leaders were registered nurses or advanced practice nurses employed in a position where they supervised other nursing personnel (eg, registered nurses, licensed practical nurses, nurse practitioners, student nurses). The positions held by nurse leaders included all roles (eg, nurse manager, clinical nurse specialist, nurse practitioner, nursing professor) where the position included supervising other nursing personnel. METHODS: The search strategy aimed to find both published and unpublished studies in English from 2000. The search was first conducted in January 2019 and rerun in June 2020. The databases searched included CINAHL, MEDLINE, PsycINFO, and Embase. To ensure full coverage, databases not specific to the nursing profession, but with potential content on upwards violence, were also searched for examples of upwards violence against nurse leaders. These databases were ABI/INFORM, Sociological Abstracts, LexisNexis Academic, Scopus, and Web of Science. The search for unpublished studies included ProQuest Dissertations and Theses, Google Scholar, OpenGrey Repository, Health Business Elite, and Factiva. Papers meeting the inclusion criteria were appraised by two independent reviewers for methodological quality using the JBI critical appraisal checklist for qualitative research. Data extraction was conducted according to the standardized data extraction tool from JBI. The qualitative research findings were pooled using the JBI method of meta-aggregation. RESULTS: Six papers were included in the review yielding a total of 50 findings and nine categories. The categories were aggregated to form three synthesized findings: i) Physical, psychological, financial, and quality-of-work toll of upwards bullying: paying a high price; ii) Coping with violence alone; and iii) What happened to me? My take on the violence. The ConQual scores were low to moderate. CONCLUSION: The synthesized findings reveal that nurse leaders' experiences of upwards workplace violence is a troublesome problem that leads to a negative impact on physical and psychological health, and creates a cost in terms of time, money, and efficacy of the workplace.

Nurse leaders' experiences of upwards violence in the workplace: a systematic review protocol.

REVIEW QUESTION: What are nurse leaders' experiences of upwards violence in nursing workplaces?

Association between quality of sleep and health-related quality of life in persons with diabetes mellitus type 2.

AIM AND OBJECTIVES: To estimate the relationship of sleep quality with health-related quality of life (HRQOL) in persons with diabetes mellitus type 2 (DMT2) living in the United Arab Emirates (UAE). BACKGROUND: DMT2 is an epidemic health condition in the UAE that has enormous impacts on heath, and consequent effects on HRQOL. However, because of an absence of screening for quality of sleep, people with DMT2 who experience poor sleep are likely to go untreated, which may compound the distressing impacts of DMT2 on their HRQOL. DESIGN: This is a cross-sectional quantitative research design. METHODS: A sample of 268 participants with DMT2 were recruited from community healthcare settings in the UAE using cluster sampling. Participants completed questionnaires, including the Pittsburgh Sleep Quality Index (PSQI) and the World Health Organization HRQOL. Data analysis used descriptive and correlational statistics. RESULTS: Of the 268 participants, 34% identified as "poor sleepers" and 55% had poor HRQOL. Poor sleepers showed significantly lower scores for HRQOL than good sleepers. The global PSQI scores were found to be independently predictive of global HRQOL. Subjective perceptions of sleep quality, the use of sleep medications and impaired daytime functioning were the variables found to have the highest correlations with global HRQOL and its four domains. CONCLUSIONS: This study found that people with DMT2 who indicate experiencing poor quality sleep are more likely to show a negative correlation with HRQOL. Additional research is needed to investigate how poor sleep may impact the health of people with DMT2. RELEVANCE TO CLINICAL PRACTICE: Findings suggest that assessment of sleep quality should be an essential component of diabetes care. Understanding sleep practices may aid public health practitioners and other healthcare providers in the design of culturally appropriate interventions to improve sleep quality in persons with DMT2.

Reducing the "cost of caring" in cancer care: Evaluation of a pilot interprofessional compassion fatigue resiliency programme.

Compassion fatigue (CF) is a combination of secondary traumatic stress and burnout. Empathy becomes depleted among professional caregivers due to repeated exposure to emotional pain. Negative effects include decreased general wellbeing, impaired caregiver health and diminished team functioning. Intervention is needed to support caregiver quality of life and team relationships in high-stress work environments. This pilot study evaluated the impact of a pilot CF resiliency (CFR) programme on interprofessional staff at a regional cancer centre. An embedded experimental mixed-methods design was employed to evaluate a 6-week formalised CFR intervention. We measured CF satisfaction, burnout, clinical stress and silencing responses pre- and post-intervention. Focus group and individual interviews were conducted mid-programme and at end-programme completion to understand participants' views about how the programme affected their experiences of CF. Qualitative and quantitative data were analysed separately and merged to produce the overall findings. Participants reported reduced clinical stress at programme completion (t = 3.5; p = .005). This finding may be explained by participants' ability to identify signs and symptoms of CF and engage in self-care and mindfulness activities. Further larger studies are needed to evaluate the long-term effects of CFR programmes on caregiver and organisational wellbeing.

Scoping review of complexity theory in health services research.

BACKGROUND: There are calls for better application of theory in health services research. Research exploring knowledge translation and interprofessional collaboration are two examples, and in both areas, complexity theory has been identified as potentially useful. However, how best to conceptualize and operationalize complexity theory in health services research is uncertain. The purpose of this scoping review was to explore how complexity theory has been incorporated in health services research focused on allied health, medicine, and nursing in order to offer guidance for future application. Given the extensiveness of how complexity theory could be conceptualized and ultimately operationalized within health services research, a scoping review of complexity theory in health services research is warranted. METHODS: A scoping review of published research in English was conducted using CINAHL, EMBASE, Medline, Cochrane, and Web of Science databases. We searched terms synonymous with complexity theory. RESULTS: We included 44 studies in this review: 27 were qualitative, 14 were quantitative, and 3 were mixed methods. Case study was the most common method. Long-term care was the most studied setting. The majority of research was exploratory and focused on relationships between health care workers. Authors most commonly used complexity theory as a conceptual framework for their study. Authors described complexity theory in their research in a variety of ways. The most common attributes of complexity theory used in health services research included relationships, self-organization, and diversity. A common theme across descriptions of complexity theory is that authors incorporate aspects of the theory related to how diverse relationships and communication between individuals in a system can influence change. CONCLUSION: Complexity theory is incorporated in many ways across a variety of research designs to explore a multitude of phenomena.. Although complexity theory shows promise in health services research, particularly related to relationships and interactions, conceptual confusion and inconsistent application hinders the operationalization of this potentially important perspective. Generalizability from studies that incorporate complexity theory is, therefore, difficult. Heterogeneous conceptualization and operationalization of complexity theory in health services research suggests there is no universally agreed upon approach of how to use this theory in health services research. Future research should include clear definitions and descriptions of complexity and how it was used in studies. Clear reporting will aid in determining how best to use complexity theory in health services research.

Empowerment and mentoring in nursing academia.

In 2011, there was an expected shortage of 200 full-time faculty. While there are an estimated 322 graduate students in Nurse Practitioner and Masters/PhD programs in Canada today, the supply of potential new faculty falls short of the anticipated demand in the years ahead (Canadian Association of Schools of Nursing). This mixed method study explored how organizational culture and the perceived level of psychological and structural empowerment are associated with one's work environment among Canadian nursing faculty and to explore the state of mentorship in schools of nursing.

The effectiveness of a multimedia intervention on parents' knowledge and use of vehicle safety systems for children.

Trauma due to road crashes is the leading cause of death and injury in Canadian children younger than 14 years, despite mandatory use of vehicle restraints since 1977. A multisite intervention study using a pretest-posttest design was conducted in four Ontario cities to test the effectiveness of an educational program on parents' knowledge of safety system use for children (0-12 years) 6 weeks following the educational intervention. The sample consisted of 418 families who reported on 732 children. Results indicated that knowledge increased significantly following the intervention. Use of professional sources of information was an important factor that is linked with increased parents' knowledge.

Patient perceptions of satisfaction following diabetes education: use of the mastery of stress instrument.

PURPOSE: The purpose of this study was to test the conceptual congruency of scores from the Mastery of Stress Instrument (MSI) with qualitative data in an effort to identify patients for whom a specific educational intervention was sufficient. METHODS: A convenience sample of patients with diverse age and educational backgrounds was recruited from those who registered for a 4-session diabetes educational experience as new or refresher patients. All 57 patients completed the MSI before and after diabetes educational experiences, and half participated in before and after audiotaped interviews. All patients responded to a query about their perceptions of the educational experience. MSI scores were analyzed by demographic variables as well as compared to qualitative interviews for greater insights and explanation. RESULTS: Consistency was noted between the MSI scores and the information revealed in the interviews. Additional support for the use of the MSI to identify patients at risk and in need of additional educational interventions was realized. CONCLUSIONS: Further research to explore the use of the MSI with persons with different educational experiences and to standardize the MSI scores for adult persons taking diabetes or other patient education classes is needed before generalization can be achieved.

Parents' knowledge about and use of child safety systems.

Road crashes are the leading cause of death and injury in children under 14 years of age in Canada, despite mandatory use of vehicle restraints. A survey design was used to examine parental knowledge and perceptions of the use of safety systems for children in 2 communities in the province of Ontario. Parents of children aged newborn to 9 years were recruited from 3 urban/rural school boards and from daycare centres and hospitals. A total of 1,263 parents reported on 2,199 children's use of safety systems. Data analysis revealed that only 68% of children used correct seats for their weight and that as the child advanced in age the rate of misuse increased significantly due to high rates of premature transitioning into safety seats inappropriate for the child's height and weight. The results also revealed that parents had limited knowledge concerning the correct use of safety seats and frequently used non-professional sources of information for vehicle safety information. The authors recommend that nurses develop a comprehensive and systematic strategy to ensure that families understand how to secure children in vehicles using the correct safety seat for the child's height, weight, and age.

Perceptual evaluation of voice quality and its correlation with acoustic measurements.

To determine whether a correlation exists between the Grade, Roughness, Breathiness, Aesthenia, Strain (GRBAS) scale (a subjective measure of voice) and the Multi-Dimensional Voice Program (MDVP) scale (an objective measure of voice). A retrospective review of 37 voice patients (12 male/25 female) was conducted. Each voice was perceptually evaluated using the GRBAS scale by an experienced speech pathologist and acoustically analyzed using the MDVP scale. Statistical analysis using a multivariate regression model identified a significant correlation between the noise-related parameters of MDVP and the components of the GRBAS scale. Grade correlated with voice turbulence index (VTI), noise harmonic ratio (NHR), and soft phonation index (SPI). Roughness correlated with NHR only. Breathiness correlated with SPI only. Aesthenia also correlated with SPI only. Of the 19 acoustic variables measured by the MDVP system, only three noise parameters significantly correlated with the GRBAS perceptual voice analysis. Perhaps "noise" is the perceived acoustical quality of the dysphonic voice. A voice quantifying measure such as a "voice index score" could be proposed using the GRBAS scoring and the three clinically relevant MDVP values following further studies.

The literature review: demystifying the literature search.

This article provided an overview of the strategies, tools, and techniques for searching the literature. Also discussed was how to retrieve, manage, and report relevant information that has been found. There are many books and computer tutorials about each of these topics available in libraries and bookstores. It may be worth-while to investigate the availability of courses in your workplace and community for fine-tuning your search skills. A hands-on opportunity to search relevant databases under the guidance of a librarian or experienced researcher would be worth the investment. One key message is to be organized when approaching the literature. Careful planning and organization can help ensure that your research trip is a productive one.