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The consequences of parallel paper and electronic medical records (EMR) and their impact on informational continuity are examined. An interdisciplinary team conducted a multi-site, ethnographic field study and retrospective documentation review from January 2010 to December 2010. Three case studies from the sample of older patients with hip fractures who were transitioning across care settings were selected for examination. Analysis of data from interviews with care providers in each setting, field observation notes, and reviews of medical records yielded two themes. First, the lack of interoperability between electronic information systems has complicated, not eased providers’ ability to communicate with others. Second, rather than transforming the system, digital records have sustained health care’s ‘culture of documentation’. While some information is more accessible and communications streamlined, parallel paper and electronic systems have added to front line providers’ burden, not lessened it. Implementation of truly interoperable electronic health information systems need to be expedited to improve care continuity for patients with complex health-care needs, such as older patients with hip fractures. [ABSTRACT FROM AUTHOR]

Objective: The objective of this paper is to highlight, from within a broad study of recruitment/retention, findings that identify personal-professional boundaries as key challenges for rural child and youth mental health clinicians recruited from within the community. Design: Two mixed methods online questionnaires followed by semistructured telephone interviews with a small subset of respondents were administered to clinicians, team leaders, supervisors and managers whose practice responsibilities encompass rural settings in three regions of British Columbia, Canada. Participants: Forty-four clinicians and 27 team leaders/managers participated in the survey while eight clinicians and one team leader/manager participated in the semistructured interviews. Half the clinician respondents were recruited from within the community. Of those recruited from outside the community, half had prior experience living or working in a rural community. Main outcome measures: Levels of satisfaction with lifestyle, practice and preparation for practice were compared across categories of respondents identified earlier. Open-ended comments were coded by theme and also compared across categories of respondents. Results: While expressing their higher levels of satisfaction with rural lifestyle and professional practice, clinicians recruited from within rural communities report significant initial and ongoing stress related to personal-professional boundaries and dual relationships. They also report lower levels of satisfaction with orientation and preparation for practice relevant to dealing with these stressors. Conclusion: Prior attachment to rural communities, increasingly viewed as an effective recruitment and retention strategy, requires better preparation and ongoing supports to enable practitioners to deal with dual relationships and the personal-professional boundary issues that are a direct consequence of their attachments. [ABSTRACT FROM AUTHOR]

Objective: It is essential that the embedded process of rural case selection be highlighted and documented to provide reassurance of rigour across rural surgical services supported by generalist surgeons, general practitioners with enhanced surgical skills and general practitioner anaesthetists. This enables feedback and improves the triage and case selection process to ensure the highest quality outcomes. Therefore, this research aims to explore participants' rational criteria for decision making around rural case selection. Design: Participants participated in a series of semi‐structured in‐depth interviews which were coded and underwent thematic analysis. Setting: Six community hospitals in British Columbia, Canada. Participants: General practitioners with enhanced surgical skills, general practitioner anaesthetists, local maternity care providers, and specialists. Results: Based on participant accounts, rural surgical and obstetrical decision‐making processes for local patient selection or regional referral had five major components: (1) Clinical Factors, (2) Physician Factors, (3) Patient Factors, (4) Consensus Between Providers and (5) the Availability of Local Resources. Conclusion: Decision‐making processes around rural surgical and obstetrical patient selection are complex and require comprehensive understanding of local capacity and resources. Current policies and guidelines fail to consider the varying capacities of each rural site and should be hospital specific. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Behavioral and psychological symptoms of dementia (BPSD) influence older persons' quality of life (QoL). Non-pharmacological interventions such as individualized music (iM) is promising to mitigate BPSD. PURPOSE: To assess the impact of iM activity on affect, BPSD, QoL and antipsychotics administration of older persons with dementia living in residential care facilities and to understand residents, families and staff experiences in the use of iM activity. METHODS: We conducted a pilot study in one residential care facility in British Columbia, Canada and implemented a predetermined intervention of iM activities for older persons diagnosed with mild to moderate dementia. We collected data at baseline and follow-up via observations, surveys, and interviews. RESULTS: We observed an increase of emotions/ affect during and immediately after the iM intervention. Most participants improved QoL dimensions, while use of medications was mainly unchanged. Participants expressed lasting effects of music on residents' QoL and reduction of BPSD after the iM intervention; they suggested sustainability and continuous use of music activities. CONCLUSION: Individualized music activities may reduce BPSD and positively affect emotions, behavior and well-being of institutionalized older persons with dementia. Awareness of music effects can support continuous use and longer sessions of iM activities for sustainability of results. [ABSTRACT FROM AUTHOR]

People living in long-term care frequently have inadequate access to properly fitted wheelchairs. This can lead to potential problems with mobility, positioning, comfort, and skin integrity. A provincial programme to provide individually fitted lightweight wheelchairs to residents started in January 2016; however, no research has evaluated programme outcomes. To identify seating needs of residents before and after implementation of a provincial wheelchair programme at two long term care facilities in Vancouver and to explore stakeholders experiences with this programme. A pre/post study design was used which involved chart reviews to collect Seating Identification Tool (SIT), and interviews with stakeholders having experience with the provincial programme to gather information on their experiences. SIT data were analysed using a Wilcoxon Signed-Rank test and interviews were analysed thematically. SIT scores improved by 2 (median) which was statistically significant for the 22 residents with pre/post data available. Prevalence of seating needs decreased on average by 18%. Among the six stakeholders interviewed, themes identified included: wheelchairs/cushions provided addressed many residents' needs; and saved residents and their families money and stress; and there is still ongoing need for more specialised equipment for frail residents (not covered by this programme). This study provides some evidence regarding the benefits of the introduction of this programme in two care homes and identifies potential changes that might improve wheelchair seating among residents with more severe seating needs. Further research is required on how these equipment changes might affect their mobility or participation in activities. These findings appear to support the provision of lightweight individually fitted wheelchairs and moderate pressure redistribution cushions by occupational therapists in long-term care through this programme. Regular use of the SIT (i.e., on admission, condition change, annual care conference, and as needed) may be beneficial to ensure residents are properly screened for seating needs. Collaboration with the resident appears to be important to ensure equipment on provision and follow-up are meeting residents' needs. Recommend future research on the use of tilt in space wheelchairs for residents' in long-term care. [ABSTRACT FROM AUTHOR]

Objective: To identify key school-level contexts and mechanisms associated with implementing a provincial school food and beverage policy.Design: Realist evaluation. Data collection included semi-structured interviews (n 23), structured questionnaires (n 62), participant observation at public events (n 3) and scans of school, school district and health authority websites (n 67). The realist heuristic, context + mechanism → outcome configuration was used to conduct the analysis.Setting: Public schools in five British Columbia (BC), Canada school districts.Participants: Provincial and regional health and education staff, private food vendors and school-level stakeholders.Results: We identified four mechanisms influencing the implementation of BC's school food and beverage sales policy. First, the mandatory nature of the policy triggered some actors' implementation efforts, influenced by their normative acceptance of the educational governance system. Second, some expected implementers had an opposite response to the mandate where they ignored or 'skirted' the policy, influenced by values and beliefs about the role of government and school food. A third mechanism related to economics demonstrated ways vendors' responses to school demand for compliance with nutritional Guidelines were mediated by beliefs about food preferences of children, health and food. The last mechanism demonstrated how resource constraints and lack of capacity led otherwise motivated stakeholders to not implement the mandatory policy.Conclusion: Implementation of the food and beverage sales policy at the school level is shaped by interactions between administrators, staff, parent volunteers and vendors with contextual factors such as varied motivations, responsibilities and capacities. [ABSTRACT FROM AUTHOR]

Social work research and literature in the area of supervision tends to focus on the supervision of field education students. Less attention is given to the supervision of social work practitioners and there is almost no information that examines how social workers become supervisors. This exploratory study interviewed 27 practicing social work supervisors across different fields of social work practice in Western Canada. The participants included 15 supervisors with a graduate degree and 12 supervisors with an undergraduate degree. The supervisors completed a brief questionnaire that was followed by a structured interview. Supervisors were asked how they came to be social work supervisors. Thematic analysis of the supervisors' responses revealed three pathways to supervision: task exposure, supervision by happen chance, and deliberate decision. The responses suggested that additional focus on supervision might be included in undergraduate education and that universities, professional associations, and employers pay more attention to succession planning. [ABSTRACT FROM AUTHOR]

Purpose of the Study: To examine the dynamics of caring relations in older families that include an adult with Intellectual Disabilities (ID). To date, there has been very little research exploring the experiences of aging families of community-dwelling adults with ID. Design and Methods: An exploratory, qualitative study was conducted in British Columbia, Canada. Eight participants were recruited through purposive sampling. In-depth, semistructured interviews were conducted to explore the experience of aging concurrently with a community-dwelling relative with ID. Data were analyzed using a thematic approach. Results: Three main themes emerged: (a) Recognizing the Changes of Aging, (b) Strengthening Connections, and (c) Planning for the Future. Implications: Aging concurrently with a community-dwelling relative with ID is a unique experience for older adults and challenges traditional views of familial caring relations. These relationships are characterized by evolving patterns of care and exchange. There is also a sense of urgency to securing future care arrangements for the adult relative with ID. Advanced care-planning is complicated by the adult with ID' understanding of death and dying. Family caregiving policies and practices that take into account the complexities of these relationships are needed. [ABSTRACT FROM AUTHOR]

Aims and objectives To gain a better understanding of nurses' perspectives on factors that influence their readiness to provide appropriate care for hospitalised older people. Background Hospitals have consistently been criticised for failing to address the unique, complex needs of older people. Research suggests that multiple issues have led to this situation, including a lack of educational preparation for nurses, limited attention to environmental factors, and an absence of organisational preparedness that ensures hospitals are adapted to meet the needs of older people. Design An exploratory, qualitative approach was used. Methods Forty-one Registered Nurses participated (24 point-of-care nurses; 17 organisational leaders). Six focus groups and one individual interview were conducted. Thematic data analysis was employed to generate the main study findings. Results An overarching theme of 'Poor Fit' emerged. While participants identified the shifting needs of patients towards more complex and relational care, the broader organisational and societal contexts were, largely, unchanging. This resulted in nurses recognising the factors needed to be ready to care for older patients and their families, but working in hospitals that were not suited to these needs. Conclusions The findings identify factors at the point-of-care, the organisational level, and in broader societal attitudes that shape nurses' readiness to care for hospitalised older people. However, many of these factors are modifiable and care for older people could be improved through quality improvement initiatives and nursing leadership. This study offers insight into ways to re-imagine nursing care that can be responsive to older people's complex needs in hospitals. Implications for practice With a growing contingent of hospitalised older people, it is imperative that nurses, who comprise the largest workforce in this setting, be included in the planning and delivery of healthcare services to ensure readiness to meet the needs of this population. [ABSTRACT FROM AUTHOR]

Aims and objectives To offer an explanation of how registered nurses' are providing care to hospitalised older adults in nursing teams comprised of a variety of roles and educational levels. Background Around the globe economic pressures, nursing shortages and increased patient acuity have resulted in tasks being shifted to healthcare workers with less education and fewer qualifications than registered nurses. In acute care hospitals, this often means reducing the number of registered nurses and adding licensed practical nurses and care aides (also referred to as unregulated healthcare workers) to the nursing care team. The implications of these changes are not well understood especially in the context of hospitalised older adults, who are complex and the most common care recipients. Design Thematic analysis of data that were collected in a previous grounded theory study to provide an opportunity in-depth analysis of how nurses provided care to hospitalised older adults within nursing teams. Methods Data collected in western Canada on two hospital units in two different health authorities were analysed in relation to how nursing teams provide care. Hand coding and thematic analysis were employed. Results The themes of scrutinised skill mix and working together highlighted how the established nursing value of reciprocity is challenging to enact in teams with a variety of scopes of practice. The value of reciprocity both aided and hindered the nursing team in engaging in team behaviours to effectively manage patient care. Conclusion Educators and leaders could assist the nursing care team in re-thinking how they engage in teamwork by providing education about roles and communication techniques to support teams and ultimately improve nursing care. Relevance to clinical practice The value of reciprocity within nursing teams needs to be re-examined within the context of team members with varying abilities to reciprocate in kind. [ABSTRACT FROM AUTHOR]

Background: Some patients receiving treatment in conventional health care systems access therapeutic yoga outside their mainstream care to improve cancer symptoms. Given the current knowledge gap around patient preferences and documented experiences of yoga in adult cancer, this study aimed to describe patient-reported benefits, barriers and characteristics of programming for yoga practice during conventional treatment. Methods: In depth semi-structured interviews (n = 10) were conducted in men and women recruited from cancer care clinics in Vancouver, Canada using a purposive sampling technique. The exploratory interviews were audio-recorded, transcribed and analyzed using Interpretive Description methodology and constant comparative analysis methods. Results: Four themes emerged from the data to address our research objectives: patient-perceived benefits of yoga, reasons and motivations for practising yoga, hurdles and barriers to practising yoga, and advice for effective yoga program delivery in adult cancer. Several patients reported yoga reduced stress and other symptoms associated with cancer treatment. Thematic analysis found the social dimension of group yoga was important, as well as yoga's ability to encourage personal empowerment and awareness of physical body and self. Barriers to yoga adherence from the patient perspective included lack of time, scheduling conflicts and worries about financial burden. Conclusion: This small, diverse sample of patients reported positive experiences and no adverse effects following yoga practice for management of cancer and its symptoms. Results of this qualitative study identified patient-reported preferences, barriers and characteristics of yoga intervention optimal during adult cancer treatment. [ABSTRACT FROM AUTHOR]

Background and Purpose: The Relational Care Scale (RCS) is a Canadian evaluative instrument designed to measure nursing home residents' perceptions of care aides' relational abilities. Care aides' abilities to be reliable and empathetic with nursing home residents are very important determinants of quality of care, but few instruments are designed specifically for residents or focus exclusively on these determinants. Initially developed and tested in metropolitan teaching-affiliated nursing homes in Ontario, we expanded testing by reevaluating the psychometric properties of the RCS in 5 rural nursing homes in British Columbia. Method: There were 62 residents living in 5 rural nursing homes who completed 3 instruments: the RCS under investigation, the Experiences in Close Relationships-Relationship Structures (ECR-RS) questionnaire to test for convergent validity, and the Lubben Social Network Scale-6 (LSNS-6) to test for discriminant validity. Results: The reliability of the RCS was strongly supported (Cronbach's alpha = .90, item-total correlation > .77). Consistent with previous testing, a unidimensional internal structure was extracted. A moderate to strong correlation between the RCS and the Anxiety and Avoidance subscales of the ECR-RS supported convergent validity of the instrument. Last, partial support was obtained for the discriminant validity of the RCS. Conclusions: The RCS was easy to use for both residents and researchers. Expanded testing demonstrated its recurring reliability and validity. [ABSTRACT FROM AUTHOR]

This qualitative study explores narrative interviews of street-involved individuals with mental health issues and reflects on how they speak to experiences of both helpful and unhelpful social and mental health service provisions, and the disconnections between what they articulate as needing, and what services and supports they are able to receive. The article draws on and contributes to the field of peer research as the authors use lived experience of homelessness and/or mental health issues to inform both the approach to and analysis of the narratives. This study confirms that participants find the emerging, recovery-oriented structures of service provision more helpful than the dominant, biomedical structures, but that there is a continued disconnect in accessing emerging structure service deliveries. [ABSTRACT FROM PUBLISHER]

This article summarizes the findings of a project investigating women’s experiences with the Canadian child protection (CPS) and family law (FLS) systems. We examine both service systems together here because although both privilege children’s best interests as their primary consideration and define the concept similarly, the two systems diverge in their expectations of women relative to child custody. While FLS requires women to accept custody arrangements that provide close and continued contact between themselves and their former abusive partners, CPS expects women to leave these same abusive partners or risk removal of their children. The results of thirty-five qualitative interviews with women demonstrate their struggles, firstly, in having their experiences of intimate partner violence (IPV) recognized by professionals in the FLS, and, secondly, in becoming caught between the opposing expectations of CPS and FLS while not receiving help from either. Recommendations for change to improve these services are included in this article. [ABSTRACT FROM PUBLISHER]

This study undertook a qualitative exploration of an operational definition of health literacy and an examination of quantitative measures of health literacy skills. We interviewed 229 older Canadian adults. First we engaged them in open-ended discussions about their search for information on a self-selected health topic. Next we administered nine self-report items on health literacy skills, and then task-performance items. Task-performance questions were based on two published reading passages on five levels of difficulty to measure ‘understanding’ of health-related material. The Rapid Estimate of Adult Literacy in Medicine (REALM) was also administered as the comparison for criterion-related validity. Our open-ended questions elicited responses about the processes that people undergo when they attempt to access, understand, appraise and communicate health information. Qualitative findings revealed complexities in participants’ interpretation of the meaning of all four health literacy skills. These descriptive findings add new knowledge about health literacy as a construct. Participants agreed with most of the self-report statements, thus indicating high belief in their own health literacy. REALM scores ranged from 45 to 66 with an average of 65 and standard deviation of 2.5. Quantitative scores on the reading passages were modestly correlated with scores on the REALM. The sum scale of self-report items, however, did not correlate with task-performance items, suggesting that the different types of items may not be measuring the same construct. We suggest that self-report items need more development and validation. Our study makes a contribution in exploring the complexities of measuring health literacy skills for general health contexts. [ABSTRACT FROM AUTHOR]

This study explored the body-mind experiences of eight midlife women who had integrated the movement of NIA (Neuromuscular Integrative Action) into their lives. NIA is a holistic fitness programme that combines the physicality of movement with an inner focus of awareness that is ever-present, self-monitoring, and nonjudgmental. A hermeneutic phenomenological methodology guided the research and conversational interviews were used to retrieve a narrative view of experience. The findings focus on the women's descriptions and explanations of the reflexive nature of NIA, which support interpretations of its possible uses within psychotherapy. Due to a reflexive cycle present in the practice itself and a feedback process that occurred during the study, understanding of NIA's overall effects on the participants’ lives were revealed as discovering the wisdom of the body and becoming aware of the body's movement. The practice of NIA offers midlife women an opportunity to reconstruct notions of the self and to give voice to reflective interpretations that could result in deeper self-discovery and healing. [ABSTRACT FROM AUTHOR]