Dana Edge

Canadian Home Care Policy and Practice in Rural and Remote Settings: Challenges and Solutions

ABSTRACT With the aging of the population, especially in Canadian rural areas, providing home care services will be particularly challenging as care is needed by increasingly vulnerable rural older adults in increasingly vulnerable rural settings with fewer services, supports, and caregivers. The purpose of this paper is to present examples of the federal (e.g., First Nations and Inuit Home and Community Care) and provincial (e.g., Ontarios Community Care Access Centres) home care policy context in which Canadian home care is provided, to identify the challenges faced by home care providers in meeting the needs of rural residents, and to offer solutions to these challenges. The most pressing challenges in aging rural settings are to ensure effective access to quality health care services and to address the shortage of home care providers, especially registered nurses. Provincial and federal home care models would be enhanced by an integrative model of continuing care and a national home care framework that would address the broader funding and human resource issues. Other uniquely rural recruitment and retention strategies are suggested such as maximizing the “fit” between the home care providers attributes and the needs and expectations of the rural community. Sufficient public funding and resources for rural and remote home care programs are needed to develop and implement (1) the expanded role of case managers; (2) health care teams that include both professionals and paraprofessionals; (3) standardized assessment tools and reporting systems; (4) innovative use and training in the use of technology; and (5) partnerships that optimize resources and build support networks for rural home care providers, clients, and family and friend caregivers.

Self-reported patient safety competence among Canadian medical students and postgraduate trainees: a cross-sectional survey

Background Quality and patient safety (PS) are critical components of medical education. This study reports on the self-reported PS competence of medical students and postgraduate trainees. Methods The Health Professional Education in Patient Safety Survey was administered to medical students and postgraduate trainees in January 2012. PS dimension scores were compared across learning settings (classroom and clinical) and year in programme. Results Sixty-three percent (255/406) of medical students and 32% (141/436) of postgraduate trainees responded. In general, both groups were most confident in their learning of clinical safety skills (eg, hand hygiene) and least confident in learning about sociocultural aspects of safety (eg, understanding human factors). Medical students’ confidence in most aspects of safety improved with years of training. For some of the more intangible dimensions (teamwork and culture), medical students in their final year had lower scores than students in earlier years. Thirty-eight percent of medical students felt they could approach someone engaging in unsafe practice, and the majority of medical students (85%) and postgraduate trainees (78%) agreed it was difficult to question authority. Conclusions Our results suggest the need to improve the overall content, structure and integration of PS concepts in both classroom and clinical learning environments. Decreased confidence in sociocultural aspects of PS among medical students in the final year of training may indicate that culture in clinical settings negatively affects students’ perceived PS competence. Alternatively, as medical students spend more time in the clinical setting, they may develop a clearer sense of what they do not know.

Nursing contributions to chronic disease management in primary care.

BACKGROUND: As the prevalence of chronic diseases continues to increase, emphasis is being placed on the development of primary care strategies that enhance healthcare delivery. Innovations include interprofessional healthcare teams and chronic disease management strategies. OBJECTIVE: To determine the roles of nurses working in primary care settings in Ontario and the extent to which chronic disease management strategies have been implemented. METHODS: We conducted a cross-sectional survey of a random sample of primary care nurses, including registered practical nurses, registered nurses, and nurse practitioners, in Ontario between May and July 2011. RESULTS: Nurses in primary care reported engaging in chronic disease management activities but to different extents depending on their regulatory designation (licensure category). Chronic disease management strategy implementation was not uniform across primary care practices where the nurses worked. CONCLUSIONS: There is the potential to optimize and standardize the nursing role within primary care and improve the implementation of chronic disease management strategies.

The Lost Creek Fire: managing social relations under disaster conditions.

This paper examines some of the social processes associated with disaster conditions. Utilising an asset-based perspective of community capacity, it focuses on four types of normative systems to interpret the ability of communities to manage disasters through market-, bureaucratic-, associative-, and communal-based norms. Drawing on experience of a wildfire in the Crowsnest Pass region of southwest Alberta, Canada, in 2003, the tensions and compatibilities among these normative systems are evaluated through interviews with 30 community leaders. The results confirm the contributions of all types of social capital to resiliency, the necessity for rapid use of place-based knowledge, and the importance of communication among all types and levels of agents. In addition, they point to the value of identifying and managing potential conflicts among the normative systems as a means to maximising their contributions. The integration of local networks and groups into the more general disaster response minimised the impacts on health and property.

Identification, summary and comparison of tools used to measure organizational attributes associated with chronic disease management within primary care settings

Rationale, aims and objectives Given the increasing emphasis being placed on managing patients with chronic diseases within primary care, there is a need to better understand which primary care organizational attributes affect the quality of care that patients with chronic diseases receive. This study aimed to identify, summarize and compare data collection tools that describe and measure organizational attributes used within the primary care setting worldwide. Methods Systematic search and review methodology consisting of a comprehensive and exhaustive search that is based on a broad question to identify the best available evidence was employed. Results A total of 30 organizational attribute data collection tools that have been used within the primary care setting were identified. The tools varied with respect to overall focus and level of organizational detail captured, theoretical foundations, administration and completion methods, types of questions asked, and the extent to which psychometric property testing had been performed. The tools utilized within the Quality and Costs of Primary Care in Europe study and the Canadian Primary Health Care Practice-Based Surveys were the most recently developed tools. Furthermore, of the 30 tools reviewed, the Canadian Primary Health Care Practice-Based Surveys collected the most information on organizational attributes. Conclusions There is a need to collect primary care organizational attribute information at a national level to better understand factors affecting the quality of chronic disease prevention and management across a given country. The data collection tools identified in this review can be used to establish data collection strategies to collect this important information.

Trends in nurse practitioners' prescribing to older adults in Ontario, 2000-2010: a retrospective cohort study.

BACKGROUND Nurse prescribing is a practice that has evolved and will continue to evolve in response to emerging trends, particularly in primary care. The goal of this study was to describe the trends and patterns in medication prescription to adults 65 years of age or older in Ontario by nurse practitioners over a 10-year period. METHODS We conducted a population-based descriptive retrospective cohort study. All nurse practitioners registered in the Corporate Provider Database between Jan. 1, 2000, and Dec. 31, 2010, were identified. We identified actively prescribing nurse practitioners through linkage of dispensed medications to people aged 65 years or older from the Ontario Drug Benefit database. For comparison, all prescription medications dispensed by family physicians to a similar group were identified. Geographic location was determined based on site of nurse practitioner practice. RESULTS The number and proportion of actively prescribing nurse practitioners prescribing to older adults increased during the study period, from 44/340 (12.9%) to 888/1423 (62.4%). The number and proportion of medications dispensed for chronic conditions by nurse practitioners increased: in 2010, 9 of the 10 top medications dispensed were for chronic conditions. There was substantial variation in the proportion of nurse practitioners dispensing medication to older adults across provincial Local Health Integration Networks. INTERPRETATION Prescribing by nurse practitioners to older adults, particularly of medications related to chronic conditions, increased between 2000 and 2010. The integration of nurse practitioners into primary care has not been consistent across the province and has not occurred in relation to population changes and perhaps population needs.

Social support needs of families: the context of rheumatoid arthritis

AIM The present study aimed to describe the experience of family members who provide social support to their relative with rheumatoid arthritis (RA), and explore the forms of support that they require. BACKGROUND The psychosocial effects and changes that family members experience with their relatives illness can pose considerable challenge for the family unit. METHODS The study used a descriptive qualitative design. A semi-structured interview guide was used to interview seven participants. Qualitative direct content analysis was used to analyze the data. RESULTS Five themes emerged from the data analysis: effect of the disease; reshaping the relationship; provider of support; social support needs of family members; and, finding balance and coping. CONCLUSIONS Family members of people with RA require social support to achieve balance and cope with the chronicity and disability of RA. Nurses should tailor nursing interventions to provide emotional support, informational support, and guidance to families.