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Aim: To examine the level of adherence to best-practice guidelines of interprofessional teams with acute care nurse practitioners (ACNPs) compared to interprofessional teams without ACNPs., Design: A retrospective observational study was conducted in 2023., Method: A retrospective cohort was created including 280 patients who underwent a coronary artery bypass graft and/or a valve repair and hospitalised in a cardiac surgery unit of a university affiliated hospital in Québec (Canada) between 1 January 2019 to 31 January 2020. The level of adherence to best-practice guidelines was measured from a composite score in percentage. The composite score was created from a newly developed tool including 99 items across six categories (patient information, pharmacotherapy, laboratory tests, post-operative assessment, patient and interprofessional teams' characteristics). Multivariate linear and logistic regression models were computed to examine the effect of interprofessional teams with ACNPs on the level of adherence to best-practice guidelines., Results: Most of the patients of the cohort were male and underwent a coronary artery bypass graft procedure. Patients under the care of interprofessional teams with ACNP were 1.72 times more likely to reach a level of adherence higher than 80% compared to interprofessional teams without ACNPs and were 2.29 times more likely to be within the highest quartile of the scores for the level of adherence to best-practice guidelines of the cohort., Impact: This study provides empirical data supporting the benefits of ACNP practice for patients, interprofessional teams and healthcare organisations., Relevance for Practice: Our findings identify the important contributions of interprofessional teams that include ACNPs using a validated instrument, as well as their contribution to the delivery of high quality patient care., Reporting Method: This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for reporting observational studies guidelines., Patient or Public Contribution: No patient or public contribution., (© 2024 The Authors. Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: The PAROLE-Onco program was introduced in the province of Quebec, Canada in 2019. It integrates accompanying patients (APs), i.e., people who have been affected by cancer, into the clinical team as full members. These APs use their experiential knowledge with people undergoing treatment and with clinical teams. The aim of this paper is to evaluate, within the framework of two university medical centers, the perceptions of breast cancer patients who receive support from APs, particularly in terms of their active involvement in their care trajectory., Methods: A qualitative study based on semi-structured interviews with accompanied patients was performed. Fourteen individual interviews were conducted between July and September 2021 with women presenting different profiles in terms of age, education, professional status, type of treatment, family situation, and clinical background. The data were analyzed using thematic analysis, focusing on patients' perceptions of APs' contributions and suggested improvements for accessing AP support., Results: Three themes emerged from the semi-structured interviews: communication modalities used to connect patients with their APs, the characteristics of the support provided by APs, and the perceived effects of this support on the patients. Patients expressed a preference for telephone communication, highlighting its convenience and accessibility. The support provided by APs included emotional and informational support, neutrality, and adaptability. This relationship improved patient communication, reduced anxiety, helped regain control, and enhanced overall quality of life. The results emphasized the added value of APs in complementing the support offered by healthcare professionals. Patients noted the critical role of APs in helping them navigate the healthcare system, better understand their treatment processes, and manage their emotions. The ability of APs to provide practical advice and emotional reassurance was particularly valued. Overall, the findings underscored the significant impact of AP support on patients' experiences and highlighted areas for enhancing this service., Conclusion: This study highlights, during the care trajectory of people affected by breast cancer, APs' contribution to patients' emotional well-being because they improve, in particular, the management of emotions and communication with health professionals., (© 2024. The Author(s).)

Hepatic encephalopathy (HE) is defined as decline in neurological function during chronic liver disease (CLD). Alcohol is a major etiological factor in the pathogenesis of fibrosis/cirrhosis and has also been documented to directly impact the brain. However, the role of alcohol in the development of HE in CLD remains unclear. Here, we investigated the impact of excessive alcohol administration on neurological deterioration in rats with CLD. Starting day 7 post-BDL surgery, rats were administered alcohol twice daily (51% v/v ethanol, 3 g/kg, via gavage) for 4 weeks. Motor coordination was assessed weekly using rotarod and anxiety-like behavior was evaluated with open field and elevated plus maze at 5 weeks. Upon sacrifice, brains were collected for western blot and immunohistochemical analyses to investigate neuronal integrity and oxidative stress status. Alcohol worsened motor coordination performance and increased anxiety-like behavior in BDL rats. Impairments were associated with decreased neuronal markers of NeuN and SMI311, increased apoptotic markers of cleaved/pro-caspase-3 and Bax/Bcl2, increased necroptosis markers of pRIP3 and pMLKL, decreased total antioxidant capacity (TAC), and increased 4-hydroxynonenal (4-HNE)modified proteins in the cerebellum of BDL-alcohol rats when compared to respective controls. Immunofluorescence confirmed the colocalization of cleaved caspase-3 and pMLKL in the granular neurons of the cerebellum of BDL-alcohol rats. Excessive alcohol consumption exacerbates HE which leads to associated apoptotic and necroptotic neuronal loss in the cerebellum of BDL-alcohol rats. Additionally, higher levels of 4-HNE and decreased TAC in the cerebellum of BDL-alcohol rats suggest oxidative stress is the triggering factor of apoptotic and necroptotic neuronal loss/injury., (© 2024 The Authors. Journal of Neuroscience Research published by Wiley Periodicals LLC.)

Background: Development of nursing leadership is necessary to ensure that nurse leaders of the future are well-equipped to tackle the challenges of a burdened healthcare system. In this context, the Strengths-Based Nursing and Healthcare Leadership program was delivered to 121 participants from 5 organizations in Canada in 2021 and 2022. To date, no study used a qualitative approach to explore nursing leaders' perceptions of a leadership Strengths-Based Nursing and Healthcare Leadership program three months post training., Objective: To describe nursing leaders' perceptions of the impact of the Strengths-Based Nursing and Healthcare Leadership program three months post training., Methods: Qualitative descriptive design was used with individual semi-structured interviews. A convenient sample of nurse leaders ( n = 20) who had participated in the leadership program were recruited for an individual interview three months post training. The data generated by interviews were analyzed using a method of thematic content analysis., Results: Three themes emerged from the qualitative data analysis related to the leadership program that stayed with participants three months post training: 1) mentorship: a lasting relationship , 2) human connections through Story-sharing , and 3) focus on strengths . Two other themes emerged related to the changes that they have made since attending the program: 1) seeking out different perspectives to work better as a team and 2) create a positive work environment and to show appreciation for their staff., Conclusion: The present study offers evidence of the impact of the Strengths-Based Nursing and Healthcare Leadership program three months post training., Implication: This study reinforces the importance of training using a Strengths-Based Nursing and Healthcare Leadership lens when tackling leadership., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Nursing leadership teams at the point of care (POC), consisting of both formal and informal leaders, are regularly called upon to support the implementation of evidence-based practices (EBPs) in hospital units. However, current conceptualizations of effective leadership for successful implementation typically focus on the behaviors of individual leaders in managerial roles. Little is known about how multiple nursing leaders in formal and informal roles share implementation leadership (IL), representing an important knowledge gap., Objective: This study aims to explore shared IL among formal and informal nursing leaders in inpatient hospital units. The central research question is as follows: How is IL shared among members of POC nursing leadership teams on inpatient hospital units? The subquestions are as follows: (1) What IL behaviors are enacted and shared by formal and informal leaders? (2) What social processes enable shared IL by formal and informal leaders? and (3) What factors influence shared IL in nursing leadership teams?, Methods: We will use a collective case study approach to describe and generate an in-depth understanding of shared IL in nursing. We will select nursing leadership teams on 2 inpatient hospital units that have successfully implemented an EBP as instrumental cases. We will construct data through focus groups and individual interviews with key informants (leaders, unit staff, and senior nurse leaders), review of organizational documents, and researcher-generated field notes. We have developed a conceptual framework of shared IL to guide data analysis, which describes effective IL behaviors, formal and informal nursing leaders' roles at the POC, and social processes generating shared leadership and influencing contextual factors. We will use the Framework Method to systematically generate data matrices from deductive and inductive thematic analysis of each case. We will then generate assertions about shared IL following a cross-case analysis., Results: The study protocol received research ethics approval (2022-8408) on February 24, 2022. Data collection began in June 2022, and we have recruited 2 inpatient hospital units and 25 participants. Data collection was completed in December 2023, and data analysis is ongoing. We anticipate findings to be published in a peer-reviewed journal by late 2024., Conclusions: The anticipated results will shed light on how multiple and diverse members of the POC nursing leadership team enact and share IL. This study addresses calls to advance knowledge in promoting effective implementation of EBPs to ensure high-quality health care delivery by further developing the concept of shared IL in a nursing context. We will identify strategies to strengthen shared IL in nursing leadership teams at the POC, informing future intervention studies., International Registered Report Identifier (irrid): DERR1-10.2196/54681., (©Sonia Angela Castiglione, Mélanie Lavoie-Tremblay, Kelley Kilpatrick, Wendy Gifford, Sonia Elizabeth Semenic. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 19.02.2024.)

Background: Targeted interventions have been found effective for developing leadership practices in nurses. However, to date, no leadership training program based on the Strengths-Based Nursing and Healthcare Leadership approach exists., Objectives: Demonstrate the effectiveness of a Strengths-Based Nursing and Healthcare Leadership 6-month program designed for nurse and healthcare leaders on leadership capacity and psychological outcomes., Design: Concurrent mixed-methods with nurse and healthcare leaders from five healthcare organisations in Quebec and Ontario (Canada)., Settings: Participants were recruited from five Canadian health care organizations: two in Toronto (Ontario) and three in Montreal (Quebec)., Participants: A total of 50 nurse leaders and healthcare leaders were included in the quantitative component, and 22 (20 nurse leaders and two healthcare leaders) participated in the qualitative individual interviews., Methods: Quantitative and qualitative (interviews) methods were used. Quantitative data (pre-post surveys) were collected from the participants before their participation in the program (Time 0), as well as after the completion of the program (Time 1). Qualitative data (individual interviews) were collected from participants at the end of the program (Time 1). Analysis was conducted using descriptive statistics, paired-sample t -tests, and thematic analysis., Results: Quantitative results suggest a significant improvement in terms of leadership capabilities, work satisfaction, and reduction in perceived stress among participants. Three themes emerged from the qualitative data analysis: 1) focus on people's strengths, 2) structure and language based on Strengths-Based Nursing and Healthcare values, and 3) building support networks., Conclusions: The Strengths-Based Nursing and Healthcare Leadership program developed to build the leadership capabilities of nurse and healthcare leaders was found to be effective. The positive impact of the 6-month program was demonstrated. It was also shown that the leadership program can help improve the leadership competencies, well-being, and work satisfaction of participating nurses and healthcare leaders., Implication: This study reinforces the importance of working with educational, research, and healthcare organizations to establish leadership development programs and mentorship opportunities. Future leadership training should use a Strengths-Based Nursing and Healthcare Leadership lens when tackling leadership and stress in the workplace., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors. Published by Elsevier Ltd.)

Objectives: Since 2018, four establishments in Quebec have been instrumental in implementing the PAROLE-Onco program, which introduced accompanying patients (APs) into healthcare teams to improve cancer patients' experience. APs are patient advisors who have acquired specific experiential knowledge related to living with cancer, using services, and interacting with healthcare professionals. They are therefore in a unique and reliable position to be able to provide emotional, informational, cognitive and navigational support to patients who are dealing with cancer. We aimed to explore APs' perspectives regarding the limiting and facilitating factors in terms of how they are integrated into the clinical oncology teams., Methods: A qualitative study based on semi-structured interviews and focus groups was conducted with 20 APs at the beginning of their intervention (T1) and, two years later, during a second data collection (T2). Limiting and facilitating factors of APs' integration into clinical teams were analyzed in terms of governance, culture, resources and tools., Results: The limited factors raised by APs to be integrated into clinical teams include the following: confusion about the specific roles played by APs, lifting the egos of certain professionals who feel they are already doing what APs typically do, lack of identification of patient needs, absence of APs in project governance organizational boundaries, and team members' availability. Various communication challenges were also raised, resulting in the program being inadequately promoted among patients. Also mentioned as limiting factors were the lack of time, space and compensation. Creating opportunities for team members to meet with APs, building trust and teaching team members how APs' activities complement theirs were enhancing factors. Other facilitators include APs being involved in decision-making committees, being leaders in promoting the PAROLE-Onco program to patients and clinical team members and creating opportunities to communicate with team members to help enhance their work and provide feedback to improve patient services. Awareness of APs' added value for the team and patients is also a key facilitator. Regarding tools, offering accompanying services by telephone allows both patients and APs to benefit from the flexibility they need., Conclusion: Over time, APs were able to identify optimal factors for successful implementation. Recommendations include APs and professionals working in co-construction on organization, leadership, resources and status factors. This could help catalyze a change in culture within health establishments and allow people dealing with cancer to benefit from the experiential knowledge of other patients within their clinical team., (© 2024. The Author(s).)

Background: As we experience a shortage of healthcare providers in Canada, it has become increasingly challenging for healthcare educators to secure quality clinical placements. We evaluated the impact of virtual simulations created for the virtual work-integrated learning (Virtu-WIL) program, a pan-Canadian project designed to develop, test, and offer virtual simulations to enrich healthcare clinical education in Canada. Evaluation was important since the virtual simulations are freely available through creative commons licensing, to the global healthcare community., Methods: Students self-reported their experiences with the virtual simulations and the impact on their readiness for practice using a survey that included validated subscales. Open-ended items were included to provide insight into the students' experiences., Results: The evaluation included 1715 Nursing, Paramedicine and Medical Laboratory students enrolled in the Virtu-WIL program from 18 post-secondary universities, colleges, and institutions. Results showed most students found the virtual simulations engaging helped them learn and prepare for clinical practice. A key finding was that it is not sufficient to simply add virtual simulations to curriculum, careful planning and applying simulation pedagogy are essential., Conclusion: Virtual simulation experiences are increasingly being used in healthcare education. Results from this rigorous, large-scale evaluation identified ways to enhance the quality of these experiences to increase learning and to potentially decrease the number of hours healthcare students need in clinical practice to meet professional competencies. Further research is needed regarding many aspects of virtual simulations and, in particular, curriculum integration and the timing or sequencing of virtual simulations to best prepare students for practice., (© 2024. The Author(s).)

Background & Aims: Hepatic encephalopathy (HE) is defined as a reversible syndrome and therefore should resolve following liver transplantation (LT). However, neurological complications have been reported in up to 47% of LT recipients, which have been documented to be associated with a history of overt HE pre-LT. We hypothesise that multiple episodes of HE lead to permanent cell injury and exacerbate neurological dysfunction. Our goal was to evaluate the impact of cumulative HE episodes on neurological status and brain integrity in rats with chronic liver disease., Methods: Episodes of overt HE (loss of righting reflex) were induced following injection of ammonium acetate in bile duct ligation (BDL) rats (BDL-Ammonia) every 4 days starting at week 3 post-BDL. Neurobehaviour was evaluated after the last episode. Upon sacrifice, plasma ammonia, systemic oxidative stress, and inflammation markers were assessed. Neuronal markers including neuron-specific nuclear antigen and SMI311 (anti-neurofilament marker) and apoptotic markers (cleaved caspase-3, Bax, and Bcl2) were measured. Total antioxidant capacity, oxidative stress marker (4-hydroxynonenal), and proinflammatory cytokines (tumour necrosis factor-alpha and interleukin-1β) were measured in brain (hippocampus, frontal cortex, and cerebellum). Proteomic analysis was conducted in the hippocampus., Results: In hippocampus of BDL-Ammonia rats, cleaved caspase-3 and Bax/Bcl2 ratio were significantly increased, whereas NeuN and SMI311 were significantly decreased compared with BDL-Vehicle rats. Higher levels of oxidative stress-induced post-translational modified proteins were found in hippocampus of BDL-Ammonia group which were associated with a lower total antioxidant capacity., Conclusions: Ammonia-induced episodes of overt HE caused neuronal cell injury/death in BDL rats. These results suggest that multiple bouts of HE can be detrimental on the integrity of the brain, translating to irreversibility and hence neurological complications post-LT., Impact and Implications: Hepatic encephalopathy (HE) is defined as a reversible neuropsychiatric syndrome resolving following liver transplantation (LT); however, ∼47% of patients demonstrate neurological impairments after LT, which are associated with a previous history of overt HE pre-LT. Our study indicates that multiple episodes of overt HE can cause permanent neuronal damage which may lead to neurological complications after LT. Nevertheless, preventing the occurrence of overt HE episodes is critical for reducing the risk of irreversible neuronal injury in patients with cirrhosis., Competing Interests: The authors declare no conflicts of interest that pertain to this issue. Please refer to the accompanying ICMJE disclosure forms for further details., (© 2023 The Authors.)

Background: Virtual simulations (VS) are educational tools that can help overcome the limitations of in-person learning highlighted during the COVID-19 pandemic. Research has illustrated that VS can support learning, but little is known about the usability of VS as a distance learning tool. Research on students' emotions about VS is also scarce, despite the influence of emotions on learning., Methods: A quantitative longitudinal study was conducted with undergraduate nursing students. 18 students participated in a hybrid learning experience involving a virtual simulation (VS) followed by an in-person simulation. Students completed questionnaires about their emotions, perceived success, and usability and received a performance score from the VS., Results: Nursing students reported statistically significant improvements in their emotions about completing their program after completing both VS and in-person simulations compared to their emotions before the pair of simulations. Emotions directed toward the VS were weak-to-moderate in strength, but predominantly positive. Positive emotions were positively associated with nursing students' performance. Findings replicated "okay" approaching "good" usability ratings from a recent study with key methodological differences that used the same software., Conclusions: VS can be an emotionally positive, effective, efficient, and satisfying distance learning supplement to traditional simulations., (© 2023 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.)

Background: Centre hospitalier de l'Université de Montréal in Canada introduced accompanying patients (APs) into the breast cancer care trajectory. APs are patients who have been treated for breast cancer and have been integrated into the clinical team to expand the services offered to people affected by cancer. This study describes the profiles of the people who received the support and explores whether one-offs vs ongoing encounters with APs influence their experience of care, on self-efficacy in coping with cancer, and on their level of psychological distress., Methods: An exploratory cross-sectional study was carried out among patients to compare patients who had one encounter with an AP (G1) with those who had had several encounters (G2). Five questionnaires were administered on socio-demographic characteristics, care pathway, evaluation of the support experience, self-efficacy in coping with cancer, and level of psychological distress. Logbooks, completed by the APs, determined the number of encounters. Linear regression models were used to evaluate the associations between the number of encounters, patient characteristics, care pathway, number of topics discussed, self-efficacy measures in coping with cancer, and level of psychological distress., Results: Between April 2020 and December 2021, 60% of 535 patients who were offered support from an AP accepted. Of these, one hundred and twenty-four patients participated in the study. The study aimed to recruit a minimum of 70 patients with the expectation of obtaining at least 50 participants, assuming a response rate of 70%. There were no differences between G1 and G2 in terms of sociodemographic data and care pathways. Statistical differences were found between G1 and G2 for impacts on and the return to daily life (p = 0.000), the return to the work and impacts on professional life (p = 0.044), announcement of a diagnosis to family and friends (p = 0.033), and strategies for living with treatment under the best conditions (p = 0.000). Significant differences were found on the topics of cancer (p = 0.000), genetic testing (p = 0.023), therapeutic options (p = 0.000), fatigue following treatment (p = 0.005), pain and discomfort after treatment or surgery (p = 0.000), potential emotions and their management (p = 0.000) and the decision-making processes (p = 0.011). A significant relationship was found between the two groups for patients' ability to cope with cancer (p = 0.038), and their level of psychological distress at different stages of the care pathway (p = 0.024)., Conclusions: This study shows differences between one-time and ongoing support for cancer patients. It highlights the potential for APs to help patients develop self-efficacy and cope with the challenges of cancer treatment., (© 2023. The Author(s).)

Introduction: Since 2018, four establishments in Quebec, Canada, have decided to implement the PAROLE-Onco programme, which introduced accompanying patients (APs) in healthcare teams to improve the experience of cancer patients. APs are patient advisors who have had a cancer treatment experience and who conduct consultations to complement the service offered by providing emotional, informational and educational support to patients undergoing treatments (e.g., radiotherapy, chemotherapy, surgery), mostly for breast cancer. We aimed to explore the evolution of APs' perspectives regarding their activities within the clinical oncology teams as well as the perceived effects of their intervention with patients, the clinical team and themselves., Methods: A qualitative study based on semistructured interviews and focus groups was conducted with APs at the beginning of their intervention (T1) and 2 years afterwards (T2). The themes discussed were APs' activities and the perceived effects of their interventions on themselves, on the patients and on the clinical team., Results: In total, 20 APs were interviewed. In T2, APs' activities shifted from listening and sharing experiences to empowering patients by helping them become partners in their care and felt generally more integrated into the clinical team. APs help patients feel understood and supported, alleviate stress and become partners in the care they receive. They also alleviate the clinical team's workload by offering a complementary service through emotional support, which, according to them, helps patients feel calmer and more prepared for their appointments with healthcare professionals. They communicate additional information about their patients' health journey, which makes the appointment more efficient for healthcare professionals. When APs accompany patients, they feel as if they can make a difference in patients' lives. Their activities are perceived by some as an opportunity to give back but also as a way of giving meaning to their own experience, in turn serving as a learning experience., Conclusion: By mobilizing their experiential knowledge, APs provide emotional, informational, cognitive and navigational support, which allows patients to be more empowered in their care and which complements professionals' scientific knowledge, thereby helping to refine their sensitivity to the patients' experiences., Patient or Public Contribution: Two patient-researchers have contributed to the study design, the conduct of the study, the data analysis and interpretation, as well as in the preparation and writing of this manuscript., (© 2023 The Authors. Health Expectations published by John Wiley & Sons Ltd.)

Rationale: Nurses are responsible for engaging in continuing professional development throughout their careers. This implies that they use tools such as competency frameworks to assess their level of development, identify their learning needs, and plan actions to achieve their learning goals. Although multiple competency frameworks and guidelines for their development have been proposed, the literature on their implementation in clinical settings is sparser. If the complexity of practice creates a need for context-sensitive competency frameworks, their implementation may also be subject to various facilitators and barriers., Aims and Objectives: To document the facilitators and barriers to implementing a nursing competency framework on a provincial scale., Methods: This multicentre study was part of a provincial project to implement a nursing competency framework in Quebec, Canada, using a three-step process based on evidence from implementation science. Nurses' participation consisted in the self-assessment of their competencies using the framework. For this qualitative descriptive study, 58 stakeholders from 12 organizations involved in the first wave of implementation participated in group interviews to discuss their experience with the implementation process and their perceptions of facilitators and barriers. Data were subjected to thematic analysis., Results: Analysis of the data yielded five themes: finding the 'right unit' despite an unfavourable context; taking and protecting time for self-assessment; creating value around competency assessment; bringing the project as close to the nurses as possible; making the framework accessible., Conclusion: This study was one of the first to document the large-scale, multi-site implementation of a nursing competency framework in clinical settings. This project represented a unique challenge because it involved two crucial changes: adopting a competency-based approach focused on educational outcomes and accountability to the public and valorizing a learning culture where nurses become active stakeholders in their continuing professional development., (© 2022 John Wiley & Sons Ltd.)

Background: Acute care nurse practitioners (ACNPs) in postoperative cardiac surgery settings provide significant benefits to patients and organizations. Recent studies have suggested that ACNPs increase the level of adherence to best-practice guidelines by interprofessional teams. It is however, unknown whether interprofessional teams with ACNP are associated with higher levels of adherence to best-practice guidelines compared to interprofessional teams without ACNPs. Furthermore, no extraction tool is available to measure the level of adherence to best-practice guidelines by interprofessional teams in postoperative cardiac surgery settings. This project aims to measure and examine the level of adherence to best-practice guidelines of interprofessional teams with and without ACNPs in a postoperative cardiac surgery setting in Québec, Canada., Methods: A retrospective observational study will be conducted of 300 patients hospitalized between January 1, 2019 and January 31, 2020 in a postoperative cardiac surgery unit in Québec, Canada. Data will be collected from patient health records and electronic databases. An extraction tool will be developed based on systematic review of the literature, and will include best-practice guidelines and confounding variables related to patient and interprofessional teams' characteristics. Content and criterion validation, and a pilot-test will be conducted for the development of the tool. A multivariate linear regression model will be developed and adjusted for confounding variables to examine the association between interprofessional teams with and without ACNPs, and level of adherence to best-practice guidelines by those teams., Discussion: This project represents the first study to measure and examine the level of adherence to best-practice guidelines by interprofessional teams with and without ACNPs in a postoperative cardiac surgery setting. The findings of this project will generate empirical data focusing on the contribution of ACNPs within interprofessional teams, and ultimately enhance the delivery of high quality and evidence-based care for patients and families., Competing Interests: The authors have declared that non competing interests exist., (Copyright: © 2023 Audet et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Issue: Prior to the COVID-19 pandemic, there was evidence of challenges surrounding the psychological well-being of health care professionals (HCPs). HCPs already frayed psychological ability to cope risks being further compromised by COVID-19-related stresses., Critical Theoretical Analysis: Most research on stress, psychological distress, and coping among HCPs is done in a piecemeal manner without a theoretical model connecting these different but related phenomena. This critical advancement article aims to apply and extend Wheaton and Montazer's model of stressors, stress, and distress to the literature on HCPs, generally, and COVID-19, specifically, to summarize past and guide future research on HCPs' mental health, resilience, and coping. Our model describes how different sources of support buffer the effect of stressors on stress and how coping strategies moderate the effect of stress on psychological distress., Advance: We extended the model by (a) distinguishing context from the support in HCPs' environment; (b) distinguishing adaptive from maladaptive coping strategies and their relationships with antecedents and outcomes; (c) describing the adverse impacts that psychological distress has on patients, HCPs, and health services; and (d) describing how such outcomes can become stressors, in turn, further contributing to HCPs' stress in a vicious cycle., Practice Implications: Our model provides a broader perspective of HCPs' work-related mental health and helps guide the creation, implementation, and evaluation of different sources of support and promote adaptive coping strategies. This model helps HCPs, researchers, and health services managers better understand and respond to the well-being crisis HCPs are facing, especially during the pandemic., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Undergraduate nursing students experience high levels of stress during their programs. The literature on their stress is extensive, however, what is less well-known are the specific sources of stresses for students in different years of study., Purpose: The aim of this study is to understand nursing students' sources of stress and coping strategies in each year of study., Method: A transversal descriptive qualitative study was used. A sample of 26 undergraduate students attending a university in Montreal, Canada were recruited and participated in a semi-structured interview. Data were analysed using inductive thematic analysis., Results: The sources of stress differed according to year of study and related significantly to the specific novelty of that year. For first-year students, their stress was related to their academic courses. High clinical performance expectations and a lack of time for their personal lives was a main source of stress for second-year students. The prospect of graduating and transitioning into the work environment caused stress for students in their final year. Students across all years of study utilized similar coping strategies., Conclusion: The findings suggest that interventions can be developed to address the sources of stress experienced by nursing students in each year of study.

Background: Liver transplantation (LT) is the only curative treatment for cirrhosis. However, the presence of complications can impact outcomes following LT. Sarcopenia, or muscle mass loss, is highly prevalent in patients with cirrhosis and is associated with longer hospitalization stays and a higher infection rate post-surgery. We aimed to identify patients at higher risk of early sarcopenia post-LT., Methods: This retrospective study included 79 cirrhotic patients who underwent LT. Muscle mass was evaluated using the third lumbar spine vertebra skeletal muscle index (SMI) and sarcopenia was defined using established cut-off values. Computerized tomography (CT) scans performed within a six-month peri-operative period (three months pre- and post-LT) were included in the study. Complications and comorbidities were collected and correlated to SMI post-LT and predictive models for SMI post-LT were constructed., Results: The overall prevalence of sarcopenia was 46% and 62% before and after LT, respectively. Newly developed sarcopenia was found in 42% of patients. Post-LT sarcopenia was associated with longer hospital stays (54±37 versus 29±10 days, p = 0.002), higher number of infection (3±1 versus 1±2, p = 0.027), and greater number of complications (5±2 versus 3±2, p < 0.001) compared to absence of sarcopenia. Multivariate analyses showed that the SMI post-LT was independently associated with pre-LT renal function markers, the glomerular filtration rate (GFR) and creatinine (Model 1, GFR: β = 0.33; 95% CI 0.04-0.17; p = 0.003; Model 2, Creatinine: β = -0.29; 95% CI -0.10 to -0.02; p = 0.009)., Conclusions: The present study highlights the potential role of renal dysfunction in the development and persistence of sarcopenia after LT., Competing Interests: A Tang has received speaking honoraria from Eli Lilly and Siemens Healthcare on topics unrelated to this manuscript, and has received equipment from Siemens Healthcare for the conduct of two research studies unrelated to this manuscript and received a research scholarship from the Fonds de recherche du Québec en Santé and Fondation de l’association des radiologistes du Quebec (#298509). G Huard has received payments from AbbVie and Gilead for presentations; and CF Rose has received payment or honoraria from Horizon Therapeutics for lectures, presentations, speakers bureaus, manuscript writing, or educational events, and has received payment for expert testimony from the law office of JC Orr. The other authors have nothing to disclose., (Copyright © 2022 Canadian Association for the Study of the Liver.)

Hepatic encephalopathy (HE) is a debilitating neurological complication of chronic liver disease (CLD). Hyperammonemia plays an important role in HE's pathogenesis, acting synergistically with systemic oxidative stress. During CLD, muscle plays a compensatory role in detoxifying ammonia, and therefore muscle loss leads to an increase in the risk of developing HE. With most animal studies involving males, sex's impact on the development of CLD and associated complications such as HE and muscle loss remains unknown. Therefore, we aimed to identify the impact of sex on CLD, HE, and muscle mass loss in a rodent model of CLD. Liver injury markers, hyperammonemia, oxidative stress, muscle mass, and ammonia clearance were measured in female and male bile-duct ligated (BDL) rats. In addition, covert HE was assessed in females while ammonia-precipitated severe HE was assessed in female and male BDL rats, and male BDL rats treated with allopurinol (100 mg/kg), an antioxidant (xanthine oxidase inhibitor). Female BDL developed CLD and HE (impaired motor coordination and night activity) compared to respective SHAM. Hyperammonemia and muscle ammonia clearance were similar between female and male BDL. However, only female BDL rats did not develop muscle loss, brain edema, and short-term memory impairment (vs. female SHAM) and systemic oxidative stress and decreased albumin levels (vs. male BDL). Furthermore, both female BDL and allopurinol-treated male BDL rats were protected against ammonia-induced overt HE. In conclusion, female and male BDL rats develop distinct features of CLD and HE, with systemic oxidative stress playing a pivotal role in the susceptibility to ammonia-precipitated overt HE., (© 2022 International Society for Neurochemistry.)

Introduction: Healthcare-associated infections are an important patient safety concern, especially in the context of the COVID-19 pandemic. Infection prevention and control implemented in healthcare settings are largely focused on the practices of healthcare professionals. Patient and family engagement is also recognised as an important patient safety strategy. The extent to which patients and families can be engaged, their specific roles and the strategies that support their engagement in infection prevention remain unclear. The overarching objective of the proposed study is to explore how patients and families can effectively be engaged in infection prevention by developing a consensus framework with key stakeholders., Design and Methods: The proposed study is based on a cross-sectional exploratory study at one of the largest university hospitals in North America (Montreal, Canada). The targeted population is all healthcare professionals, managers and other non-clinical staff members who work on clinical units, and the in-patients and their families. The study is based on Q methodology that takes advantage of both quantitative and qualitative methods to identify the consensus among the various stakeholders. This exploratory Q research approach will provide a structured way to elicit the stakeholders' perspectives on patient and family engagement in infection prevention., Ethics and Dissemination: The research ethics board approved this study. The research team plans to disseminate the findings through different channels of communication targeting healthcare professionals, managers in healthcare settings, and patients and family caregivers. The findings will also be disseminated through peer-reviewed journals in healthcare management and in quality and safety improvement., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

Background: The COVID-19 crisis in long-term care (LTC) homes was devastating for residents and front-line workers. Recent reports have detailed what went wrong in LTC facilities, including equipment shortages, lack of preparedness, underestimation of COVID-19's virulence and bans on caregiver visits. Less is known about what went well in some facilities., Purpose: To describe nurses' and other staff members' experiences and lessons learned in two LTC facilities in Quebec that reported no COVID-19 outbreaks during the first wave of the pandemic., Methods: Methods: A case study design guided by appreciative inquiry was conducted, in which a case was defined as a LTC facility without COVID-19 outbreaks; two cases were included. Twenty-three healthcare team members from the two sites were recruited and interviewed between October and November, 2020., Results: Several common themes were identified: being informed and respecting outbreak protocols; the presence of key outbreak protocols, which allowed for stable teams; a clear action plan; and access to materials and resources. Key management themes included team support and reward, ongoing communication and providing compassionate care to residents., Conclusion: This study highlights several lessons learned that have the potential to strengthen the LTC health system., (Copyright © 2022 Longwoods Publishing.)

Early in the pandemic, many long-term care (LTC) homes struggled to manage resources and care for vulnerable residents. Using an appreciative inquiry approach, we analyzed exemplar homes in Ontario that remained free of COVID-19 in wave one and interviewed executive directors, directors of care and staff. Findings demonstrate the importance of leadership styles; clear, consistent communication; focusing on staff and resident safety; using a team-based approach; and adapting staff roles to meet care needs. The exemplar homes showed what works in practice. The decisions and approaches that they implemented could be used to develop standards to improve LTC and strengthen the sector., (Copyright © 2022 Longwoods Publishing.)

The COVID-19 pandemic has led to thousands of deaths; of these, a disproportionate number has occurred in long-term care settings. The papers presented here deal with a number of issues highlighted by this crisis in several jurisdictions, including Ontario, Quebec and the Netherlands. Analyzing these may give us some insight into what is necessary to prevent this disaster from happening again., (Copyright © 2022 Longwoods Publishing.)

Aim: To describe the state of health of Quebec nursing staff during the pandemic according to their exposure to COVID-19, work-related characteristics and sociodemographic factors (gender, generational age group). State of health was captured essentially by assessing psychological distress, depression symptoms and fatigue., Design and Methods: A large-scale cross-sectional study was conducted with 1,708 nurses and licenced practical nurses in Quebec (87% women, mean age of 41 ± 11 years). The survey included several questionnaires and validated health-related scales (psychological distress, depression symptoms and fatigue). The STROBE guidelines were followed in reporting the study's findings., Results: Results showed that the prevalence of psychological distress and depression symptoms was moderate to severe. Women, generation Xers and Yers, nurses who cared for COVID-19 patients and those with a colleague who was infected with COVID-19 at work scored higher for fatigue, psychological distress and depression., (© 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

Introduction: Health care providers (HCPs) have experienced more stress and burnout during COVID-19 than before. We compared sources and levels of stress, distress, and approaches to coping between nurses and physicians, and examined whether coping strategies helped mitigate the negative impact of stress and intentions to quit., Methods: Using a cross-sectional study design, burnout was measured with the Maslach Burnout Inventory. Psychological distress was measured using the Depression, Anxiety, and Stress Scale. A self-reported survey was used to evaluate stressors, impact on perceived performance, and intentions to quit. The data were analyzed using t-tests and linear regression models., Results: Responses of 119 HCPs were analyzed. Findings suggest that (1) compared to physicians, nurses experienced a higher level of distress and burnout, and used more maladaptive coping strategies. (2) Both nurses and physicians experienced more distress and burnout during COVID-19 than before. (3) Adaptive coping strategies moderated the negative impact of stress on work performance (4) Adaptive coping strategies moderated the negative effect of stress on burnout, which in turn reduced intentions to quit. Stress negatively impacted work performance and burnout only for those with low, but not high, levels of adaptive coping strategies., Discussion: The current findings of HCPs' challenges, risks, and protective factors provide valuable information (1) on COVID-19's impact on HCPs, (2) to guide the distribution of institutional supportive efforts and recommend adaptive coping strategies, and (3) to inform medical education, such as resilience training, focusing on adaptive coping approaches., Competing Interests: Disclosures: This research was funded by The McGill Interdisciplinary Initiative in Infection and Immunity (MI4). MI4 adjudicates funds from the McGill University Health Centre (MUHC) Foundation. This study surveyed MUHC healthcare workers. N.M. Lou reports payment from MI4. T.M. Montreuil reports grant from MI4 (PA). L.F. Feldman reports grant from MI4 and TheatOR, and is on the advisory board for Abbott and Merck. G.M. Fried reports grant from MI4 and Theator, Inc. Dr. Lavoie-Tremblay reports grant from MI4. M.L.-T. Bhanji reports grant from MI4. H. Kennedy reports payment from MI4. J.M. Harley reports grant from MI4 (NPA) and having received a speaking honorarium from Bayer Canada outside the submitted work. P. Kaneva declare no conflict of interest., (Copyright © 2021 The Alliance for Continuing Education in the Health Professions, the Association for Hospital Medical Education, and the Society for Academic Continuing Medical Education.)

Aim: This study aims to examine, through the lens of the Job Demands-Resources model, the influence of caring for COVID-19 patients on nurse's perception of chronic fatigue, quality of care, satisfaction at work and intention to leave their organisation and the profession., Background: Studies have examined how fear of COVID-19 contributes to the mental, physical and work adjustment among nurses. To date, few studies have been conducted examining how caring for patients with COVID-19 contributes to work outcomes among nurses., Methods: This is a cross-sectional survey involving 1705 frontline nurses and licensed practical nurses in Quebec, Canada. From these, 782 reported caring for COVID-19 patients., Results: High chronic fatigue, poor quality of care, lower work satisfaction and higher intention to leave their organisation were found for nurses caring for COVID-19 patients. Poorly prepared and overwhelmed nurses showed higher turnover intention than those well prepared and in control., Conclusions: There is an urgent need to provide support to nurses during the pandemic, with a long-term strategy to increase their retention., Implications for Nursing Management: Nurse administrators play an important role in supporting their nurses during a pandemic in the form of education, training and policy development to positively impact quality of care and retention., (© 2021 John Wiley & Sons Ltd.)

Aim: This study aims at better understanding the relationships between nurses' enacted scope of practice, work environment and work satisfaction, missed care, and organizational indicators of performance., Background: The enacted scope of practice model describes the determinants and consequences of the actual enactment of the nursing scope of practice., Method: A correlational design was used to investigate nurses' enacted scope of practice in five Canadian healthcare centres., Results: Suboptimal enacted scope of practice were found in the current sample. Significant positive correlations were found between the total enacted scope of practice score, use of qualification, control over tasks, decisional latitude and psychological demand as well as role ambiguity. Moreover, a higher enacted scope of practice was correlated with lower organizational indicators of short-term absenteeism., Conclusion: Results suggest an insufficient deployment of nurses' enacted scope of practice, likely caused by some job characteristics, leading to lower work satisfaction and negative patients and organizational outcomes., Implications for Nursing Management: Optimizing nurses' enacted scope of practice would be a significant integrated strategy for improving organizational performance, patient care and nurses' satisfaction and well-being. Nurses and frontline managers must be involved in the decision-making process necessary to improve nurses' enacted scope of practice., (© 2021 John Wiley & Sons Ltd.)

Objectives: The COVID-19 pandemic represents a major crisis for governments and populations. The public's risk perceptions, knowledge, and behaviors are key factors that play a vital role in the transmission of infectious diseases. Our scoping review aims to map the early evidence on risk perceptions, knowledge, and behaviors of general and high-risk adult populations towards COVID-19. Methods: A systematic scoping review was conducted of peer-reviewed articles in five databases on studies conducted during the early stages of COVID-19. Thirty-one studies meeting the inclusion criteria were appraised and analyzed. Results: The levels of risk perceptions, knowledge, and behaviors towards COVID-19 were moderate to high in both general and high-risk adult populations. Adults were knowledgeable about preventive behaviors. Our review identified hand-washing and avoiding crowded places as dominant preventive behaviors. Being a female, older, more educated, and living in urban areas was associated with better knowledge of COVID-19 and appropriate preventive behaviors. Conclusion: This review offers a first understanding of risk perceptions, knowledge and behaviors of adult populations during the early stages of the COVID-19 pandemic., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Clavel, Badr, Gautier, Lavoie-Tremblay and Paquette.)

Objectives: Due to the importance of developing leadership competencies during nursing education, it is critical to make evidence-based decisions regarding the transformation from face-to-face to online delivery of leadership and policy courses for nursing students in the wake of the COVID-19 pandemic. This rapid review aims to identify effective learning strategies for creating online leadership and policy courses for undergraduate nursing students., Data Sources and Review Methods: A rapid review methodology was used. Searches in CINAHL and ERIC yielded 4112 records. After screening, seven articles were included. The Criteria for Describing and Evaluating Training Interventions in Healthcare Professions (CRe-DEPTH) tool was used for quality appraisal and data extraction. A narrative synthesis approach was used to summarize the data., Results: The learning activities were heterogeneous in terms of content and format. Articles described the use of discussion forums, case studies, virtual clinical learning experiences, microblogging, and video clips. The methods of evaluation for these learning activities also varied greatly., Conclusion: The findings will act as a steppingstone to help develop an online undergraduate leadership and policy nursing course. This review also demonstrated the need for rigorous evaluation of learning activities. The use of a tool such as the CRe-DEPTH can help instructors plan and report on their learning interventions or courses., (Crown Copyright © 2021. Published by Elsevier Inc. All rights reserved.)

Background: Empirical findings have shown significant and non-significant effects of advanced practice nursing roles within postoperative cardiac settings. The inconsistencies of the current literature preclude the identification of a significant effect of advanced practice nursing roles on patient and organizational outcomes., Objective: 1) identify patient and organizational outcomes of advanced practice nursing roles in postoperative cardiac surgery and 2) synthesize the evidence of current roles of advanced practice nurses in postoperative cardiac surgery to provide the best quality of care for patients., Method: A systematic review of randomized controlled trials was conducted in six electronic databases, including Medline, CINHAL, Embase, Cochrane Database, Joanna Briggs Database and Web of Science, and the grey literature. Randomized controlled trials published after 1999 were included if they examined advanced practice nursing roles and recruited patients who underwent cardiac surgery. The study selection was performed by two independent reviewers, and consensus was achieved with a third reviewer. Data extraction was conducted by one reviewer and revised by a second reviewer. The methodological quality of the included studies was assessed with the Evidence Project risk of bias tool by two independent reviewers and revised by a third reviewer. A narrative synthesis of the available evidence was completed. No meta-analysis technique was attempted because of the high heterogeneity of the included studies., Results: Among 4,448 retrieved papers, ten randomized controlled trials and three secondary analyses were included in this review. The methodological quality of the included studies was moderate. All studies included a comparison group and the majority of the studies collected data using a blinded researcher. However, all studies were based on small sample sizes and failed to randomly recruit participants. Five studies implemented nurse practitioner roles and five studies implemented clinical nurse specialist roles. The advanced practice nursing care included health condition management, lifestyle promotion and coping strategies with patients. A total of 22 outcomes were identified, including 13 patient outcomes (e.g., depressive symptoms) and nine organizational outcomes (e.g., rehospitalization after discharge). Each outcome was examined in one to five studies. All of the included outcomes were associated with inconsistent findings., Conclusion: The findings from existing literature remain inconsistent. The high risk of bias and the small sample sizes could potentially explain the non-significant findings. Avenues for future research should focus on the development of methodologically high-quality studies with larger sample sizes to enhance our understanding of the effectiveness of advanced practice nursing roles., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Although mental health difficulties are common among healthcare professionals (HCP), little research exists exploring the decision to disclose these difficulties in the healthcare context., Aims: This rapid scoping review aims to explore HCP disclosure of mental health difficulties in the workplace., Methods: The methodological framework was based on rapid and scoping review guidelines. A thematic synthesis approach was used for data analysis., Results: Seventeen articles were included. Disclosure was found to be a process that starts with weighing its pros ("personal benefits", "personal beliefs", and "professional responsibility") and cons ("fears related to professional identity", "fears related to employment", "risk of stigmatization", and "personal experiences with mental health difficulties"). A decision-making process then occurs to help HCPs figure out how to disclose. Situations of nonconsensual disclosure can transpire through "third party disclosure" or "inadvertent disclosure". Disclosure results in outcomes including "positive experiences", "negative personal consequences" and "negative consequences related to others"., Conclusion: Disclosure in healthcare and other workplaces is a complex process with few benefits and many potential repercussions. However, there is an opportunity to improve. Recognizing the value of and educating the workforce about HCPs with mental health difficulties will help work environments become safer for disclosure.

Increased stressful experiences are pervasive among healthcare providers (HCPs) during the COVID-19 pandemic. Identifying resources that help mitigate stress is critical to maintaining HCPs' well-being. However, to our knowledge, no instrument has systematically examined how different levels of resources help HCPs cope with stress during COVID-19. This cross-sectional study involved 119 HCPs (64 nurses and 55 physicians) and evaluated the perceived availability, utilization, and helpfulness of a list of personal, hospital, and healthcare system resources. Participants also reported on their level of burnout, psychological distress, and intentions to quit. Results revealed that HCPs perceived the most useful personal resource to be family support; the most useful hospital resources were a safe environment, personal protective equipment, and support from colleagues; the most useful system resources were job protection, and clear communication and information about COVID. Moreover, HCPs who perceived having more available hospital resources also reported lower levels of psychological distress symptoms, burnout, and intentions to quit. Finally, although training and counseling services were perceived as useful to reduce stress, training was not perceived as widely available, and counseling services, though reported as being available, were underutilized. This instrument helps identify resources that support HCPs, providing implications for healthcare management.

Purpose: For the student nurse, peripheral venous cannulation is one of the most stressful skills to be learned. Although some healthcare employers/establishments offer courses on vascular access and infusion nursing as part of their onboarding programs, ultimately educational institutions should share the responsibility to ensure that graduating nurses can provide safe infusion therapies., Methods: An innovative vascular access and infusion nursing (VAIN) curriculum was created and mapped onto the entry to practice undergraduate nursing program at McGill University in Montréal, Québec, Canada. This presented an opportunity to implement new teaching approaches., Results: Students experienced multiple new teaching approaches including multimedia and experiential learning and live simulation to ensure acquisition of knowledge and psychomotor skills. The teaching approaches had to be rapidly modified with the advent of the COVID-19 pandemic., Conclusions: The VAIN curriculum emphasizes simulation and directed practice, seeking to increase competence, confidence, and knowledge. The pandemic underscored the need for flexibility and creativity in content delivery.

Hepatic encephalopathy (HE) is a debilitating neurological complication of cirrhosis. By definition, HE is considered a reversible disorder, and therefore HE should resolve following liver transplantation (LT). However, persisting neurological complications are observed in as many as 47% of LT recipients. LT is an invasive surgical procedure accompanied by various perioperative factors such as blood loss and hypotension which could influence outcomes post-LT. We hypothesize that minimal HE (MHE) renders the brain frail and susceptible to hypotension-induced neuronal cell death. Six-week bile duct-ligated (BDL) rats with MHE and respective SHAM-controls were used. Several degrees of hypotension (mean arterial pressure of 30, 60 and 90 mm Hg) were induced via blood withdrawal from the femoral artery and maintained for 120 min. Brains were collected for neuronal cell count and apoptotic analysis. In a separate group, BDL rats were treated for MHE with the ammonia-lowering strategy ornithine phenylacetate (OP; MNK-6105), administered orally (1 g/kg) for 3 weeks before induction of hypotension. Hypotension 30 and 60 mm Hg (not 90 mm Hg) significantly decreased neuronal marker expression (NeuN) and cresyl violet staining in the frontal cortex compared to respective hypotensive SHAM-operated controls as well as non-hypotensive BDL rats. Neuronal degeneration was associated with an increase in cleaved caspase-3, suggesting the mechanism of cell death was apoptotic. OP treatment attenuated hyperammonaemia, improved anxiety and activity, and protected the brain against hypotension-induced neuronal cell death. Our findings demonstrate that rats with chronic liver disease and MHE are more susceptible to hypotension-induced neuronal cell degeneration. This highlights MHE at the time of LT is a risk factor for poor neurological outcome post-transplant and that treating for MHE pre-LT might reduce this risk., (© 2020 International Society for Neurochemistry.)

Hyperammonemia associated with chronic liver disease (CLD) is implicated in the pathogenesis of hepatic encephalopathy (HE). The gut is a major source of ammonia production that contributes to hyperammonemia in CLD and HE and remains the primary therapeutic target for lowering hyperammonemia. As an ammonia-lowering strategy, Escherichia coli Nissle 1917 bacterium was genetically modified to consume and convert ammonia to arginine (S-ARG). S-ARG was further modified to additionally synthesize butyrate (S-ARG + BUT). Both strains were evaluated in bile-duct ligated (BDL) rats; experimental model of CLD and HE., Methods: One-week post-surgery, BDLs received non-modified EcN (EcN), S-ARG, S-ARG + BUT (3x10 11 CFU/day) or vehicle until sacrifice at 3 or 5 weeks. Plasma (ammonia/pro-inflammatory/liver function), liver fibrosis (hydroxyproline), liver mRNA (pro-inflammatory/fibrogenic/anti-apoptotic) and colon mRNA (pro-inflammatory) biomarkers were measured post-sacrifice. Memory, motor-coordination, muscle-strength and locomotion were assessed at 5 weeks., Results: In BDL-Veh rats, hyperammonemia developed at 3 and further increased at 5 weeks. This rise was prevented by S-ARG and S-ARG + BUT, whereas EcN was ineffective. Memory impairment was prevented only in S-ARG + BUT vs BDL-Veh. Systemic inflammation (IL-10/MCP-1/endotoxin) increased at 3 and 5 weeks in BDL-Veh. S-ARG + BUT attenuated inflammation at both timepoints (except 5-week endotoxin) vs BDL-Veh, whereas S-ARG only attenuated IP-10 and MCP-1 at 3 weeks. Circulating ALT/AST/ALP/GGT/albumin/bilirubin and gene expression of liver function markers (IL-10/IL-6/IL-1β/TGF-β/α-SMA/collagen-1α1/Bcl-2) were not normalized by either strain. Colonic mRNA (TNF-α/IL-1β/occludin) markers were attenuated by synthetic strains at both timepoints vs BDL-Veh., Conclusion: S-ARG and S-ARG + BUT attenuated hyperammonemia, with S-ARG + BUT additional memory protection likely due to greater anti-inflammatory effect. These innovative strategies, particularly S-ARG + BUT, have potential to prevent HE., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: Liver-type fatty acid binding protein (FABP1) has previously been demonstrated to improve prognostic discrimination in acetaminophen (APAP)-induced ALF but has not been investigated in other etiologies of ALF., Aim: To determine whether FABP1 levels (early: admission or late: days 3-5) are associated with 21-day transplant-free survival in non-APAP ALF., Methods: FABP1 was measured in serum samples from 384 ALF patients (n = 88 transplant-free survivors (TFS), n = 296 died/LT-NTFS) using solid-phase enzyme-linked immunosorbent assay and analyzed with US ALFSG registry data., Results: Of 384 ALF patients (autoimmune hepatitis n = 125, drug-induced liver injury n = 141, Hepatitis B n = 118), 177 (46%) patients received LT. Early FABP1 levels were significantly higher in ALF patients requiring vasopressor support (203.4 vs. 76.3 ng/mL) and renal replacement therapy (203.4 vs. 78.8 ng/mL; p < 0.001 for both). Late FABP1 levels were significantly higher in patients requiring mechanical ventilation (77.5 vs. 53.3 ng/mL), vasopressor support (116.4 vs. 53.3 ng/mL) and in patients with grade 3/4 hepatic encephalopathy (71.4 vs. 51.4 ng/mL; p = 0.03 for all). Late FABP1 levels were significantly lower in TFS patients (TFS 54 vs. NTFS 66 ng/mL; p = 0.049) but not admission (TFS 96 vs. NTFS 87 ng/mL; p = 0.67). After adjusting for significant covariates, serum FABP1 did not discriminate significantly between TFS and patients who died/received LT at day 21 either on admission (p = 0.29) or late (days 3-5, p = 0.087) time points., Conclusion: In this first report of FABP1 in non-APAP ALF, FABP1 levels at late time points (days 3-5) were significantly lower in ALF patients who were alive without transplant at day 21 but not after adjusting for covariates reflecting severity of illness. Higher FABP1 levels were associated with the presence of increased organ failure.

Background: Providing care to cancer patients is associated with a substantial psychological and emotional load on oncology workers. The purpose of this project is to co-construct, implement and assess multidimensional intervention continuums that contribute to developing the resilience of interdisciplinary cancer care teams and thereby reduce the burden associated with mental health problems. The project is based on resources theories and theories of empowerment., Methods: The study will involve cancer care teams at four institutions and will use a mixed-model design. It will be organized into three components: (1) Intervention development. Rather than impose a single way of doing things, the project will take a participatory approach involving a variety of mechanisms (workshops, discussion forums, surveys, observations) to develop interventions that take into account the specific contexts of each of the four participating institutions. (2) Intervention implementation and assessment. The purpose of this component is to implement the four interventions developed in the preceding component, assess their effects and whether they are cost effective. A longitudinal quasi-experimental design will be used. Intervention monitoring will extend over 12 months. The effects will be assessed by means of generalized estimating equation regressions. A cost-benefit analysis will be performed to assess the cost-effectiveness of the interventions, taking an institutional perspective (costs and benefits associated with the intervention). (3) Analysis of co-construction and implementation process. The purpose of this component is to (1) describe and assess the approaches used to engage stakeholders in the co-construction and implementation process; (2) identify the factors that have fostered or impeded the co-construction, implementation and long-term sustainability of the interventions. The proposed design is a longitudinal multiple case study., Discussion: In the four participating institutions, the project will provide an opportunity to develop new abilities that will strengthen team resilience and create more suitable work environments. Beyond these institutions, the project will generate a variety of resources (e.g.: work situation analysis tools; method of operationalizing the intervention co-development process; communications tools; assessment tools) that other oncology teams will be able to adapt and deploy elsewhere.

Background: Family-centred care is the dominant model for providing nursing care in paediatrics. Unit layout has been shown to impact nurses' ability to provide family-centred care. Little is known about the meanings and experiences of paediatric intensive care unit nurses concerning the care they provide to families within their unique physical setting., Aim: This study examined paediatric intensive care unit nurses' lived experience of caring for families following a major hospital transformation project, which included the construction of a new unit and quality improvement changes., Study Design: A hermeneutic-phenomenological design was selected to study a paediatric intensive care unit in a large Canadian paediatric teaching hospital., Methods: Data were collected over a 6-month period through individual interviews, photographs, participant observation, and document review. The sample consisted of 15 paediatric intensive care unit nurses who experienced the unit both pre- and post-transformation. Data were analysed in an ongoing fashion using the method described by Benner to identify common and divergent meanings., Results: Despite pride in offering a family-friendly environment, nurses' practice prejudiced a family focus in favour of patient-centred care. Nurses in this study negotiated physical and practice spaces with families by interpreting that nurses do not belong in the home-like patient room and exhibiting gatekeeping comportments., Conclusion: Although similar nurse comportments have been identified in prior works, no previous studies have identified these as forming a pattern of negotiating spaces with families., Relevance to Clinical Practice: This study provides insights into the lived experience of paediatric intensive care unit nurses in relation to family care, which can stimulate reflections at an organizational level about creating environments where nurses and families can both feel at home., (© 2019 British Association of Critical Care Nurses.)

Aim: To provide insights for health care managers by exploring paediatric intensive care unit nurses' lived experience of professional identity in the context of organisational change., Background: While professional identity improves retention of nurses and provision of quality care, outcomes of importance for managers, organisational change perturbs this identity., Method: The study used a hermeneutic-phenomenological design. Data were collected via individual interviews, photographs, participant observation and document review. A purposive sampling strategy was used to recruit paediatric intensive care unit nurses (n = 15) in a large Canadian paediatric hospital., Results: Nurses' critical care identity eroded in this organisation due to the interplay between hospital redesign and new eligibility criteria for patient admissions., Conclusion: Interactions between multiple projects and the unit context, as well as nursing professional identity, need to be considered early on during project planning. This study fills an important gap in research concerning the management challenges brought about by the intersection of multiple changes., Implications for Nursing Management: The results from this study bring to light three important lessons for nurse managers: 1) the specific unit context should be evaluated before a project is initiated; 2) the physical environment needs to be considered when determining staffing requirements; and 3) identity transitions need to be managed., (© 2020 John Wiley & Sons Ltd.)

Aim: This study describes the impact of a university-based mentorship programme that is designed to prepare nursing students for the transition to practice during their last year of classes., Background: Research shows that mentorship is an effective strategy for facilitating the transition to clinical practice. However, there is a lack of programmes that provide mentorship prior to the students' graduation from nursing school., Methods: A mixed qualitative and quantitative approach was chosen to describe nursing students' perceptions. Mentees and mentors were invited to complete a survey or participate in an interview (September-November 2018)., Results: Nine participants were interviewed and 22 completed the survey. Four themes were found. Students were as follows: Feeling unsure and looking for answers from clinicians and wanted to Learn about practical real-life situations. Their experiences allowed them to Normalize the entry to practice and become more prepared and capable to address pragmatic issues., Conclusions: By bridging the academic and clinical environments, this mentorship programme helped mentees address their concerns and facilitated an easier transition to the workplace after graduation., Implications for Nursing Management: Nurse managers can advocate for mentorship programmes by partnering with educational institutions. This support can also be continued as new graduates transition into their careers., (© 2020 John Wiley & Sons Ltd.)

Aim: This longitudinal study examines the motivational factors that explain why and how fatigue acts on new nurses' affective (work engagement), attitudinal (intention to leave the occupation) and behavioural (sickness absence) work outcomes., Background: Growing nurse shortage makes it crucial to understand how and why fatigue can cut short the career of nurses., Methods: This two-wave longitudinal study (baseline, 12-month follow-up) was conducted among 630 French-speaking new registered nurses from Canada. The proposed cross-lagged model was analysed using the EQS statistical software package for structural equation modelling (SEM)., Results: Time 1 fatigue was positively related to time 2 controlled motivation (working under internal or external pressure). Taking into account the cross-lagged effects of T1 fatigue on T2 outcomes, T1 controlled motivation was positively associated with T2 sickness absence, whereas T1 autonomous motivation (working because the activity is valued or inherently interesting) was related to all T2 outcomes., Conclusion: These findings provide insights into the motivational processes that affect nurses' early career functioning, revealing that distinct forms of motivation explain how fatigue relates to work outcomes., Implications for Nursing Management: Organisational efforts to strengthen autonomous over controlled motivation constitute a promising strategy to improve new nurses' well-being and retention in the occupation., (© 2020 John Wiley & Sons Ltd.)

Mental health problems in the workplace represent an important issue for public organizations, particularly for people working in the health sector who have been confronted to multiple changes following the recent health system reform in Quebec. Managers need to take into consideration employee mental health within their organization in order to ensure productive and healthy employees. Managers are thus called upon to take on a role that includes prevention (e.g., detection of early warning signs), team management (e.g., working on recognition at work) and coaching employees in their tasks when returning to work following a sick leave due to a common mental disorder (e.g., depression). Although there is an abundant literature on the manager's role in the prevention of mental health problems in the workplace and the work rehabilitation of employees on sick leave due to a common mental disorder, to our knowledge, little research has been conducted on these issues regarding managers' perceptions working in large health organizations. Furthermore, potential solutions have not been explored in this context. Objective The purpose of the study is to document, from the managers' perspective within a large health organization in Quebec, the issues pertaining to mental health and work (from prevention to work rehabilitation), and the solutions to deal with them. Method As part of a participatory research project, researchers and collaborators of a large health organization conducted focus groups with managers on the theme of mental health and work: issues and solutions. A total of 83 managers spread out in 10 focus groups participated in this study. Results From these focus groups, 6 broad categories of issues related to mental health in the workplace emerged: 1) the management framework, 2) human, financial, material and information resource management, 3) management of mental health and tools, 4), stakeholders' collaboration, roles and actions, 5) employees' sense of belonging to the organization and, 6) work-life balance. From these broad conceptual categories, 23 specific issues and associated solutions emerged. Conclusions From this study, the general consensus was the need to have access to a series of tools (e.g., toolbox) in order to assist managers across the different steps, from sick-leave prevention, to rehabilitation and return to work. The results also highlighted the need to better define the roles of each stakeholder in this process. These results bring a new light to the issues and potential solutions perceived by managers dealing with mental health and work issues in a large health organization. These results could eventually be replicated in other settings or large organizations.

The decision on patients' competency to manage their affairs and take care of themselves requires a rigorous evaluation process and consistency among practice settings. Research indicates there is a lack of resources to guide healthcare and social service professionals in the interprofessional decision-making process that such an evaluation requires. A web-based tool, the Competency Assessment Tool (CAT), was designed to assist professionals in that process. The authors conducted a usability study with a beta version of the CAT. The objectives of this study were to: (1) explore what is needed to support its use in community-based and specialized settings; and (2) identify barriers to and facilitators of implementation. A major concern was the perceived onerous nature of the tool. Participants indicated a need for different versions of the tool, depending on the complexity of the evaluation. They want to be directed to areas in the tool based on their field of expertise and want adjustments to functionalities related to collaborative work. This study highlights the importance of the awareness of User Experience (UX) considerations at the outset of the design process, to limit the impact of required modifications and facilitate implementation in the workplace.

Ammonia-scavenging transmembrane pH-gradient poly(styrene)-b-poly(ethylene oxide) polymersomes are investigated for the oral treatment and diagnosis of hyperammonemia, a condition associated with serious neurologic complications in patients with liver disease as well as in infants with urea cycle disorders. While these polymersomes are highly stable in simulated intestinal fluids at extreme bile salt and osmolality conditions, they unexpectedly do not reduce plasmatic ammonia levels in cirrhotic rats after oral dosing. Incubation in dietary fiber hydrogels mimicking the colonic environment suggests that the vesicles are probably destabilized during the dehydration of the intestinal chyme. The findings question the relevance of commonly used simulated intestinal fluids for studying vesicular stability. With the encapsulation of a pH-sensitive dye in the polymersome core, the local pH increase upon ammonia influx could be exploited to assess the ammonia concentration in the plasma of healthy and cirrhotic rats as well as in other fluids. Due to its high sensitivity and selectivity, this polymersome-based assay could prove useful in the monitoring of hyperammonemic patients and in other applications such as drug screening tests., (© 2019 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Objective: This scoping review aims to identify the known impact of unit design on intensive care unit clinicians, and more specifically, to explore similarities and differences across critical care settings., Introduction: Construction and infrastructure renewal represent great opportunities for designing units that enhance patient care, as well as support the work of clinicians. A growing body of evidence is showing how unit design can impact clinical staff, but no reviews have been found that focus exclusively on clinicians within intensive care units., Inclusion Criteria: The review will consider studies that include healthcare staff who offer direct patient care in adult or pediatric intensive care units. Studies that focus on the impact of design (related to physical environment features) on clinicians will be included., Methods: The proposed systematic review will be conducted in accordance with JBI methodology for scoping reviews. The search strategy aims to find published and unpublished studies. The databases to be searched will include Embase MEDLINE, PsycINFO, Healthstar and CINAHL. Retrieved studies will be assessed against the inclusion criteria by two independent reviewers. For the papers included in the scoping review, data will be extracted and quality assessed by two independent reviewers. The extracted data will be presented in tabular form, and a narrative summary will describe how the results relate to the review objective.

Background: The architectural design of a neonatal intensive care unit may affect the quality of the work environment for nurses, yet few studies have been conducted using reliable and valid measures. Recent studies have suggested some drawbacks of single-family rooms (SFRs) for both infants and parents. Research is needed to explore nurses' work environment in units combining pods and SFRs., Purpose: To compare neonatal intensive care unit nurses' work stress, satisfaction, obstacles, support, team effectiveness, ability to provide family-centered care, and satisfaction with noise, light, and sightlines in an open ward with a new unit of pods and SFRs., Methods: A pre-post occupancy study was conducted in a level 3 unit before and after transitioning to a new unit of 6-bed pods and SFRs., Results: There were no significant differences in nurse stress, satisfaction, support from colleagues, perceptions of team effectiveness, and ability to provide family-centered care between the open ward and the pod/SFR unit. Organizational obstacles, such as difficulties obtaining information from colleagues, were significantly lower in the pod/SFR. In contrast, environmental and technology obstacles were greater in the new pod/SFR unit., Implications for Practice: Some specific aspects of the pod/SFR unit are optimal for neonatal intensive care unit nurses, while other aspects of the open ward are perceived more favorably., Implications for Research: Studies are needed to examine the isolation the nurses may experience in SFR units, as well as strategies to reduce isolation.

The purpose of this article is to describe interprofessional relations in order to better understand their impact on nurse retention, while considering the operating room culture and its specific context. A focused ethnography was performed between September and October 2017 at a university hospital in an urban center in the province of Quebec, Canada. This was a secondary analysis of 11 nurses' semistructured one-on-one interviews. Additional data were collected through 6 days of observations, informal conversations, field notes, and a journal. A thematic analysis followed. Interprofessional relations and the need for recognition are important for nurse retention. In addition, a nurse's personality appears to be an important aspect in the complex and specific context of the operating room. Nurse retention in the operating room is multifactoral, and like the need for recognition, interprofessional relations are important issues. Interventions to improve working relationships, recognition of nurses, and consideration of a nurse's personality during hiring appear to be promising avenues for improving retention in the operating room.

Background: The importance of supporting caregivers is recognized in home care for older persons, and facilitating their help-seeking process is a way to meet that need. The use of electronic health (eHealth) is a potentially promising solution to facilitate caregivers' help-seeking process., Objective: The aim of this research was to develop, in partnership with community organizations, health and social service professionals and caregivers, an eHealth tool promoting the earlier identification of needs of older persons and an optimal use of available resources., Methods: To design the tool, 8 co-design sessions (CoDs) were conducted and 3 advisory committees were created (in 11 regions) in Quebec between May 2017 and May 2018. A variety of methods were used, including the sorting method, the use of personas, eHealth tool analysis, brainstorming, sketching, prototyping, and pretesting., Results: A total of 74 co-designers (women n=64 and men n=10) were recruited to participate in the CoDs or the advisory committees. This number allowed for the identification of needs to which the tool must respond and for the identification of its requirements (functionalities and content), as well as for the development of the information architecture. Throughout the study, adjustments were made to the planning of CoD, notably because certain steps required more sessions than expected. Among others, this was true for the identification of functionalities., Conclusions: This study led to the development of an eHealth tool for caregivers of functionally dependent older persons to help them identify their needs and the resources available to meet them., International Registered Report Identifier (irrid): RR2-10.2196/11634., (©Dominique Giroux, Mélanie Tremblay, Karine Latulippe, Véronique Provencher, Valérie Poulin, Anik Giguere, Véronique Dubé, Andrée Sévigny, Manon Guay, Sophie Ethier, Maude Carignan. Originally published in JMIR Aging (http://aging.jmir.org), 22.08.2019.)

Background: In Quebec, Canada, many public, community, and private organizations provide resources to caregivers of functionally impaired older adults. Nevertheless, these resources may be difficult for caregivers to find. A co-design study was conducted to address the gap between caregivers and access to resources. The purpose of this study was to support the process of help seeking by caregivers of functionally impaired older adults through electronic health (eHealth)., Objective: The purpose of this study was to focus on the identification of functional and content requirements for an eHealth tool to support the help-seeking process of caregivers of functionally impaired older adults., Methods: This study uses a co-design process based on qualitative action research approach to develop an eHealth tool with health and social service professionals (HSSPs), community workers, and caregivers. The participants acted as co-designers in identifying requirements for the tool. A total of 4 design workshops and 1 advisory committee session were held in different locations in Quebec, Canada. Activities were videotaped and analyzed with a conceptual framework of user experience., Results: A total of 11 caregivers, 16 community workers, and 11 HSSPs participated in identifying the requirements for the eHealth tool. Several functional and content requirements were identified for each user need (19). Content requirements differed depending on the category of participant, corresponding to the concept of user segmentation in the design of information and communication technology. Nevertheless, there were disagreements among co-designers about specific functionalities, which included (1) functionalities related to the social Web, (2) functionalities related to the evaluation of resources for caregivers, and (3) functionalities related to the emerging technologies. Several co-design sessions were required to resolve disagreements., Conclusions: Co-designers (participants) were able to identify functional and content requirements for each of the previously identified needs; however, several discussions were required to achieve consensus. Decision making was influenced by identity, social context, and participants' knowledge, and it is a challenge to reconcile the different perspectives. The findings stressed the importance of allowing more time to deal with the iterative aspect of the design activity, especially during the identification of requirements of an eHealth tool., International Registered Report Identifier (irrid): RR2-10.2196/11634., (©Mélanie Tremblay, Karine Latulippe, Anik MC Giguere, Véronique Provencher, Valérie Poulin, Véronique Dubé, Manon Guay, Sophie Ethier, Andrée Sévigny, Maude Carignan, Dominique Giroux. Originally published in JMIR Aging (http://aging.jmir.org), 07.06.2019.)

Background: Caregivers of functionally dependent older persons sometimes seek formal services to support their relatives. However, this process of help-seeking is complex., Objective: The overall aim of the study was to use a co-design approach to develop an electronic health (eHealth) tool to support caregivers in their process of help-seeking. This study presents the first step of the design phase, which aimed to prioritize the user needs to be considered during the development of an eHealth tool., Methods: A total of 3 groups of caregivers, community workers, and health and social service professionals participated in either a co-design session (1 or 2) or an advisory committee in 2 rural areas and 1 urban area. The needs identified in the academic literature and during a previous study were sorted (Technique for Research of Information by Animation of a Group of Experts [TRIAGE] method) by the participants (referred to in this study as co-designers) to obtain a consensus on those to be prioritized. Needs identified, grouped, and removed were ranked and compared., Results: Of the initial list of 32 needs, 12 were modified or merged, 3 added, and 7 deleted as the co-designers felt that the needs were poorly formulated, redundant, irrelevant, or impossible to meet. In the end, 19 needs were identified for the design of the eHealth tool., Conclusions: Many of the identified needs are informational (eg, having access to up-to-date information) and are probably met by existing tools. However, many others are emotional (eg, being encouraged to use the services) and offer an interesting challenge to eHealth tool development., International Registered Report Identifier (irrid): RR2-10.2196/11634., (©Karine Latulippe, Mélanie Tremblay, Valérie Poulin, Véronique Provencher, Anik MC Giguere, Andrée Sévigny, Véronique Dubé, Sophie Éthier, Manon Guay, Maude Carignan, Dominique Giroux. Originally published in JMIR Aging (http://aging.jmir.org), 23.05.2019.)