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Introduction: Total joint arthroplasty (TJA) for osteoarthritis is one of several treatment options with benefits and harms that patients value differently. However, the process for determining TJA appropriateness does not sufficiently acknowledge patient perspectives. The aim of this paper is to propose an evidence‐informed patient‐centred conceptual model for elective TJA appropriateness for hip and knee osteoarthritis. Methods: Our interprofessional team developed a conceptual model for determining the appropriateness of adults considering elective TJA. The model was informed by a review of the evidence, a qualitative study we conducted with adults who underwent TJA for osteoarthritis to determine barriers and facilitators to the use of appropriateness criteria, and the research and clinical experience of team members. Results: Appropriateness is providing health services (e.g., TJA) with net benefits to the right patient at the right time. The proposed Patient‐centred Elective TJA Appropriateness Conceptual Model involves three key steps. First, assess adults with osteoarthritis to determine eligibility for TJA. Second, acknowledge the patient's informed preferences including their expectations and goals. Third, explore and support their mental and physical readiness for TJA. Given that osteoarthritis is a chronic condition, these steps can be revisited over time with patients. Discussion and Conclusion: Our proposed conceptual model reconceptualises the appropriateness of TJA to be more patient‐centred. Hence, this approach has the potential to be a more inclusive approach and ensure patients undergoing TJA are eligible, ready to proceed, and achieve what matters most to them. Future research is needed to test and validate the model. [ABSTRACT FROM AUTHOR]

Purpose: Employment participation offers benefits including income, sense of accomplishment, social engagement, and meaningful contribution to society. Rates of competitive employment of youth with disabilities are amongst the lowest in society, despite having capacity and motivation to participate in the workplace. The marginalization of young workers with disability presents a lost opportunity for youth, potential employers, and social care systems. In order to engage young people with disabilities in employment, we present an integrated, community-based model for employment participation preparation. Materials and methods: The employment participation pathway model is based on best available evidence and 15 years of program delivery for youth with disabilities preparing to transition out of school and into employment in the Canadian context. It was conceptualized using the Knowledge to Action framework and presented for consideration in the current paper. Results: Starting early, taking a person-directed approach to planning, and considering the individual and our systems contribute to effective and comprehensive transition to employment. Conclusions: The employment participation model provides evidence and examples for service providers to consider integrating into their repertoire and begin to construct similar pathways to equip their clients and families with skills, capacities, and knowledge as they journey towards workplace participation. [ABSTRACT FROM AUTHOR]

Globally, mental health systems have failed to adequately respond to the growing demands of mental health services resulting in a disparity between the need and provision of treatment. Paucity of mental health care providers contributes to the aforementioned disparity. This can be addressed by engaging Nurse Practitioners (NPs) in an integrated model within healthcare teams. This paper describes the implementation of NPs as Most Responsible Provider (MRP) care of model in a specialised mental health hospital in Ontario, Canada. Guided by the participatory, evidence‐based, patient‐focused process for advanced practise nursing (APN) role development, implementation, and evaluation (PEPPA) framework, authors developed a model of care and implemented the first seven steps of the PEPPA framework – (a) define the population and describe the current model of care, (b) identify stakeholders, (c) determine the need for a new model of care (d) identify priority areas and goals of improvement, (e) define the new model of care, and (f) plan and implement the NP as MRP model of care. Within these steps, different strategies were implemented: (a) revising policies and procedures (b) harmonising reporting structures, (c) developing and implementing a collaborative practise structure for NPs, (d) standardised and transparent compensation (e) performance standards and monitoring (f) Self‐Assessment Competency frameworks, education, and development opportunities. This paper contributes to the state of the knowledge by implementing NPs as MRP model of care in a specialised mental health care setting in Ontario, Canada; and advocates the need for incorporating mental health programmes within the Ontario nursing curriculum. [ABSTRACT FROM AUTHOR]

The purpose of this discussion paper is to explore how nurses can be strategically poised to advocate for needed policy change in support of greater income equality and other social determinants of health. We adapted Bronfenbrenner's social‐ecological model to highlight how four broad pervasive subsystems shape the opportunities that nurses have to engage in advocacy at the policy level. These subsystems include organizations (the microsystem), professional bodies (the mesosystem), public policies (the exosystem), and societal values (the macrosystem). On the basis of this adapted model, we recommend changes among modifiable elements of the microsystem and mesosystem that can help position nurses (ecologically and collectively) to advocate for public policy change and use examples from a Canadian context to illustrate these points. We believe that the ideas arising from this model can be widely used where policy action on the social determinants of health is needed to inform, guide, and frame change efforts and advocacy work. [ABSTRACT FROM AUTHOR]

Indigenous Peoples across Turtle Island (North America) experience ongoing health disparities tied to the effects of colonization and persistent racism toward Indigenous Peoples. Educating future clinicians to develop a critical consciousness is an important way to work toward cultural safety and improve the health care experiences of Indigenous patients. The present study evaluated the ability of the KAIROS Blanket Exercise (KBE) to foster critical consciousness. Two hundred thirteen medical students at the University of Toronto participated in the KBE. Subsequently, 174 students completed a paper evaluation, designed to capture concepts of cultural safety and critical consciousness. Data were analyzed using quantitative and qualitative methods to identify shifts in perspectives. The majority of students reported the exercise altered the way they viewed those from backgrounds different from their own, and comments regarding bias, power and privilege were highlighted throughout the responses. Engaging in critical reflection through dialogue and revealing the complex sociopolitical context of Indigenous Peoples' history were emphasized as central to this transformation. Following participation in the KBE, medical students demonstrated a shift in their perspectives. This suggests that creating curricular space for critical pedagogy may be effective in fostering critical consciousness, ultimately encouraging reflexive practice and social action. [ABSTRACT FROM AUTHOR]

Hospitals remain the most common location of death in a significant number of countries, and specialist palliative care is positioned as a crucial resource for improving hospital care for those nearing end of life. Little is known, however, about a substantive aspect of this work: how hospital palliative clinicians anticipate and organize a patient's dying trajectory. In this paper I draw from a larger original ethnographic research study of palliative specialists in two Canadian hospitals. Abductive analysis resulted in framing their work as affective labour, both reflecting and re-creating a larger affective economy shaping the affective states of everyone involved in the provision and uptake of care. I articulate six analytically ideal outcomes of clinicians' affective labour that organize end of life, including: 1) proactive co-authorship of disease trajectory; 2) mutual acknowledgement of a dying trajectory; 3) naturalizing direction and outcome of care, 4) ensuring a minimum of social disruption, 5) identification as compassionate and efficient care providers, and 6) increased specialist knowledge and interventions. In so doing, clinicians' practices become understandable as labour to meet a diversity of – at times conflicting – individual, organizational, and societal mandates that necessarily include, but extend well beyond, the patient and her immediate social network. This is the first study to consider hospital palliative care as an affective economy, and presents a theoretically innovative and empirically grounded model to advance new ways of conceptualizing hospital palliative care. I conclude by considering how this model, and the unique insights it affords, can inform the future development of end of life care in hospital settings. • Hospital palliative care is shaped by diverse health system priorities. • Clinicians use affective labour to meet patient, family member, and system needs. • Hospital palliative care can be understood and modeled as an "affective economy". • Negotiation and ambivalence are constitutive features of hospital palliative care. [ABSTRACT FROM AUTHOR]