Susan Sommerfeldt

HIV Testing and Care in Canadian Aboriginal Youth: A community based mixed methods study

BackgroundHIV infection is a serious concern in the Canadian Aboriginal population, particularly among youth; however, there is limited attention to this issue in research literature. The purpose of this national study was to explore HIV testing and care decisions of Canadian Aboriginal youth.MethodsA community-based mixed-method design incorporating the Aboriginal research principles of Ownership, Control, Access and Possession (OCAP) was used. Data were collected through surveys (n = 413) and qualitative interviews (n = 28). Eleven community-based organizations including urban Aboriginal AIDS service organizations and health and friendship centres in seven provinces and one territory assisted with the recruitment of youth (15 to 30 years).ResultsAverage age of survey participants was 21.5 years (median = 21.0 years) and qualitative interview participants was 24.4 years (median = 24.0). Fifty-one percent of the survey respondents (210 of 413 youth) and 25 of 28 interview participants had been tested for HIV. The most common reason to seek testing was having sex without a condom (43.6%) or pregnancy (35.4%) while common reasons for not testing were the perception of being low HIV risk (45.3%) or not having had sex with an infected person (34.5%). Among interviewees, a contributing reason for not testing was feeling invulnerable. Most surveyed youth tested in the community in which they lived (86.5%) and 34.1% visited a physician for the test. The majority of surveyed youth (60.0%) had tested once or twice in the previous 2 years, however, about one-quarter had tested more than twice. Among the 26 surveyed youth who reported that they were HIV-positive, 6 (23.1%) had AIDS at the time of diagnosis. Delays in care-seeking after diagnosis varied from a few months to seven years from time of test.ConclusionIt is encouraging that many youth who had tested for HIV did so based on a realistic self-assessment of HIV risk behaviours; however, for others, a feeling of invulnerability was a barrier to testing. For those who tested positive, there was often a delay in accessing health services.

HIV testing experiences of Aboriginal youth in Canada: service implications

Abstract The objective of this study was to explore HIV testing experiences and service views of Canadian Aboriginal youth in order to provide information for HIV testing services. An exploratory, mixed-method, community-based research design was used for this study. Findings reported here are from 210 survey participants who had experienced an HIV test. Youth were recruited through 11 Aboriginal organizations across Canada, including AIDS service organizations, health centers, community organizations, and friendship centers. Youth who had tested for HIV ranged in age from 15 to 30 years of age (20% were <20), and came from First Nations (75%), Métis (14%), and Inuit (9%) backgrounds. Participants lived in all provinces and one territory. Over half (62%) were female. While the majority of survey respondents indicated at their last HIV test they had been treated with care (80%), respect (77%), or kindness (76%), some reported being treated with hostility (19%), fear (12%), discrimination (11%), avoidance (10%), or being treated in a bored way (15%). When asked about information they had received, 28% of survey respondents could not remember; 23% said they were not given any information, and 24% said their questions were not answered. Emotional reactions to testing ranged from anxiety/apprehension (64% of survey respondents) to being “calm” (19%). When asked for suggestions to improve testing services, participants indicated emotional support, compassion, professional yet personable services, and personalized HIV information were important. Study results suggest that to facilitate HIV testing for Aboriginal youth, testing services and counseling must be respectful, compassionate, non-judgmental, and culturally responsive in order to provide emotional support and HIV information that is meaningful and memorable.

Creating interprofessional clinical learning units: developing an acute-care model.

In exploring innovative approaches to enhanced patient care, an acute care interprofessional clinical learning unit (IPCLU) was established in a medical unit of a large metropolitan hospital in Edmonton, Alberta, Canada. Part of a larger, community based, participatory mixed method research project, this acute-care model involved several post-secondary institution health science faculties, students, academics, and other post-secondary institutions partnering with the hospital to coordinate and enhance student clinical learning and improve patient care. Pre-implementation data collected from the existing acute-care unit patient-care team, students, and faculty identified areas of strength and enhancement opportunities in interprofessional education (IPE). Interested members of several professions from the patient-care units and students constituted the working group that developed the model. This paper discusses clinical IPE and its relevance in nursing education, explains the processes and mechanisms in creating the IPCLU, details the initiatives that were developed to facilitate enhanced interprofessional care, and offers considerations in advancing IPE in an acute-care setting. The work plan included initiatives that enhance interprofessional teaching and learning culture, increase awareness surrounding interprofessional teamwork and professional roles, promote interprofessional communication and decision-making strategies, and further develop clinical reflection. Insights regarding sustainability are offered.

Aboriginal Youth Experiences of Accessing HIV Care and Treatment

The purpose of this community-based research was to examine the experiences of Canadian Aboriginal youth regarding accessing HIV testing and care services. We used a mixed method exploratory research design; 413 participants completed a self-administered survey and 25 youth participated in in-depth semistructured interviews. Findings reported here are from the 26 survey participants (12.4%) and nine interview participants (28.9%) who self-reported being positive for HIV. Results of this study suggest that some Aboriginal youth do not test for HIV until late in the course of their disease, and once diagnosed, a significant number of youth delay accessing care. Support from friends, family, and others is an important motivator for youth to initiate care and treatment. Integrated, comprehensive, youth-friendly, and culturally safe services are important to keep youth in care.

Comparison of Costs and Associated Outcomes Between Women Choosing Newly Integrated Autonomous Midwifery Care and Matched Controls: A Pilot Study

OBJECTIVE In response to consumer demand and a critical shortage of Canadian maternity care providers, provinces have integrated or are in the process of integrating midwives into their health care systems. We compared the costs and outcomes of newly integrated, autonomous midwifery care with existing health care services in the province of Alberta. METHODS Alberta Health and Wellness cost data from (1) physician fee-for-service, (2) outpatient, and (3) inpatient records, as well as outcome data from vital statistics records, were compared between participants in a midwifery integration project and individually matched women who received standard perinatal care during the same time period. Records of births occurring within the same time frame were matched according to risk score, maternal age, parity, and postal code. RESULTS For women who chose midwifery care, an average saving of

Launching first-year health sciences students into collaborative practice: Highlighting institutional enablers and barriers to success

1172 per course of care was realized without adversely affecting maternal or neonatal outcomes. Cost reductions are partially realized through provision of out-of-hospital health services. Women who chose midwifery care had more prenatal visits (P < 0.01) and fewer inductions of labour (P < 0.01); their babies had greater gestational ages (P < 0.05) and higher birth weights (P < 0.05) than controls. The sample size was insufficient to compare events associated with extremely high costs, or rare or catastrophic outcomes. CONCLUSION Regulated and publicly funded midwifery care appears to be an effective intervention for low-risk women who make this choice. When compared with existing care, autonomous care by newly integrated midwives does not increase health care costs.

The Mangle of Interprofessional Health Care Teams A Performative Study Using Forum Theater

ABSTRACT Developing and sustaining a comprehensive interprofessional education (IPE) curriculum infused throughout health science programmes at large post-secondary institutions requires not only champions within each program but also collaboration across professional programmes and strong support at an institutional level. The purpose of this article is twofold. First, it reports on the development of an interprofessional learning pathway, an institutional curricular model, and the pathway launch, an introductory learning experience within the context of a large post-secondary institution. The interprofessional curricular model provides a framework to connect the IPE that was previously fragmented across faculties and professional programmes into a scaffolded coherent pathway. The launch exposes students to the principles and competencies of collaborative practice. Second, it explores the dual role of enablers and barriers to IPE within the context of one institution’s 20-year experience of developing and delivering. In examining the elements that have sustained the institution’s IPE programming, it is highlighted how the seemingly positive elements (e.g., IPE champions and strong university support from central administration) have also served as hindrances within the academy potentially threatening the sustainability and institutionalisation of IPE. We anticipate that this curricular model and learning experiences will provide mechanisms to sustain and foster IPE.

Articulating nursing in an interprofessional world

The aim of this study was to explore dimensions of relational work in interprofessional health care teams. Practitioners from a variety of disciplines came together to examine teamwork and cocreate knowledge about interprofessionalism using forum theater. Interviews held prior to the workshop to explore teamwork were foundational to structuring the workshop. The forum theater processes offered participants the opportunity to enact and challenge behaviors and attitudes they experienced in health care teams. Throughout the workshop, aspects of professional identity, power, trust, communication, system structures, and motivation were explored. The activities of the workshop were analyzed using Pickering’s theory, identifying three mangle strands found in being a team: organizational influences, accomplishing tasks, and an orientation to care. Performativity was identified as having a bearing on how teams perform and how teamwork is enacted. Practice components were seen as strands within a mangling of human and nonhuman forces that shape team performativity.