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Background Serious injuries secondary to falls are becoming more prevalent due to the worldwide ageing of societies. Several medication classes have been associated with falls and fall-related injuries. The purpose of this study was to describe medication classes and the number of medication classes prescribed to older adults prior to the fall-related injury. Methods This population-based descriptive study used secondary administrative health-care data in Ontario, Canada for 2010–2014. Descriptive statistics were reported for Anatomic Therapeutic Chemical 4th level medication classes. Frequency of medications prescribed to older adults was calculated on different sex, age groups, types of medications, and injures. Results Over five years (2010–2014), 288,251 older adults (63.2% females) were admitted to an emergency department for a fall-related injury (40.0% fractures, 12.1% brain injury). In the year before the injury, 48.5% were prescribed statins, 27.2% antidepressants, 25.0% opioids, and 16.6% anxiolytics. Females were prescribed more diuretics, antidepressants, and anxiolytics than males; and people aged 85 years and older had a higher percentage of diuretics, antidepressants, and antipsychotics. There were 36.4% of older adults prescribed 5–9 different medication classes and 41.2% were prescribed 10 or more medication classes. Discussion Older adults experiencing fall-related injuries were prescribed more opioids, benzodiazepines, and antidepressants than pre-viously reported for the general population of older adults in Ontario. Higher percentage of females and more 85+ older adults were prescribed with psychotropic drugs, and they were also found to be at higher risk of fall-related injuries. Further associations between medications and fall-related injuries need to be explored in well-defined cohort studies.

BackgroundSuicide in older adults is a significant overlooked problem worldwide. This is especially true in Canada where a national suicide prevention strategy has not been established. MethodsUsing linked health-care administrative databases, this population-level study (2011 to 2015) described the incidence of older adult suicide (aged 65+), and identified clinical and socio-demographic factors associated with suicide deaths. ResultsThe findings suggest that suicide remains a persistent cause of death in older adults, with an average annual suicide rate of about 100 per million people over the five-year study per-iod. Factors positively associated with suicide vs. non-suicide death included being male, living in rural areas, having a mental illness, having a new dementia diagnosis, and hav-ing increased emergency department visits in the year prior to death; whereas, increased age, living in long-term care, having one or more chronic health condition, and increased interactions with primary health care were negatively associ-ated with a suicide death. ConclusionFactors associated with suicide death among older adults highlighted in this study may provide better insights for the development and/or improvement of suicide prevention pro-grams and policies.

Aims /ObjectivesTo identify and synthesise theories that support the design and delivery of digital learning interventions in nursing and midwifery education.BackgroundA range of educational and other theories are used to support nursing and midwifery education, including when e-learning interventions are being designed and delivered. However, there is a limited understanding of how theory is applied across the wide range of digital learning interventions to inform pedagogical research and practice.DesignA systematic review.MethodsCINAHL, ERIC, MEDLINE and PubMed were searched using key terms. Studies were screened by independent reviewers checking the title, abstract and full text against eligibility criteria. Due to the theoretical focus of the review, critical appraisal was not undertaken. Data were extracted and synthesised using a descriptive approach.ResultsThirty-four studies were included. Twenty theories were identified from a range of scientific disciplines, with the Technology Acceptance Model and Theory of Self-Efficacy employed most often. Theoretical frameworks were used to inform and explain how the digital learning interventions were designed or implemented in nursing and midwifery education. The sample were mainly undergraduate nursing students and the digital learning interventions encompassed animation, blended approaches, general technologies, mobile, online, virtual simulation and virtual reality applications which were used mainly in university settings.ConclusionsThis systematic review found a range of theories that support the design and delivery on digital learning interventions in nursing and midwifery education. While a single theory, the Technology Acceptance Model, tended to dominate the literature, the evidence base is peppered with numerous theoretical models that need to be examined more rigorously to ascertain their utility in improving the design or implementation of digital forms of learning to improve pedagogical research and practice in nursing and midwifery.

Primary care physicians play a central role in pathways to care for first-episode psychosis, and their increased involvement in early detection could improve service-related outcomes. The aim of this study was to estimate the proportion of psychosis first diagnosed in primary care, and identify associated patient and physician factors. We used linked health administrative data to construct a retrospective cohort of people aged 14-35 years with a first diagnosis of non-affective psychosis in Ontario, Canada between 2005-2015. We restricted the sample to patients with help-seeking contacts for mental health reasons in primary care in the six months prior to first diagnosis of psychotic disorder. We used modified Poisson regression models to examine patient and physician factors associated with a first diagnosis of psychosis in primary care. Among people with early psychosis (n = 39,449), 63% had help-seeking contacts in primary care within six months prior to first diagnosis. Of those patients, 47% were diagnosed in primary care and 53% in secondary/tertiary care. Patients factors associated with lower likelihood of diagnosis in primary care included male sex, younger age, immigrant status, and comorbid psychosocial conditions. Physician factors associated with lower likelihood of diagnosis in primary care included solo practice model, urban practice setting, international medical education, and longer time since graduation. Our findings indicate that primary care is an important contact for help-seeking and diagnosis for a large proportion of people with early psychosis. For physicians less likely to diagnose psychosis in primary care, targeted resources and interventions could be provided to support them in caring for patients with early psychosis.

Background: Learning is a complex process involving internal cognitive processes and external stimuli from curricula, pedagogical strategies, and the learning environment. Theories are used extensively in higher education to understand the intricacies of adult learning and improve student outcomes. Nursing and midwifery education uses a range of technology enhanced learning (e-learning) approaches, some of which are underpinned by theoretical frameworks.Objective: Synthesise literature on theories that inform technology enhanced learning in nursing and midwifery education.Design: A systematic review.Data source: CINAHL, ERIC, MEDLINE and PubMed were searched for relevant studies (2000−2021). Reference lists of related literature reviews were hand searched.Review methods: Title and abstract, followed by full texts were screened by two reviewers independently using predefined eligibility criteria. Quality appraisal was not undertaken. Data were extracted and Merriam and Bierema's typology of adult learning theories used to categorise theories in each study.Results: Thirty-three studies were included, incorporating twenty-nine distinct learning theories from the behaviourist, cognitivist, constructivist, and social cognitivist domains, with constructivist being the most widely used. Kolb's Experiential Learning Theory and Driscoll's Constructivist Learning Theory were the most commonly reported theories. The population of learners were mainly undergraduate nursing students who used a range of online, mobile, blended or computerised learning, virtual reality, or digital forms of simulation, primarily in university settings. Theories were employed to inform the technology enhanced learning intervention or to help explain how these could improve student learning.Conclusion: This review highlighted a range of theories, particularly constructivist approaches, that underpin research on technology enhanced learning in nursing education, by informing or explaining how these digital interventions support learning. More rigorous research that examines the myriad of theoretical frameworks and their effectiveness in informing and explaining technology enhanced learning is needed to justify this approach to pedagogical nursing research and practice.

Providing supportive care to long-term care residents with complex medical conditions generates substantial amounts of health information. This information must be documented, shared and acted upon by the various care providers within the circle of care.The purpose of this scoping review is to describe the current digital health information exchange (HIE) processes used within Canadian long-term care facilities (LTCFs).The scoping review followed Arksey and O'Malley's approach to the methodology. Electronic databases (e.g. CINAHL, MEDLINE and SCOPUS) were searched between 2010 and 2020 using terms including 'health information exchange', 'communication' and 'health information technology'. Articles were included if they were Canadian-based and relevant to our definition of health information exchange.The search yielded 2091 citations for title and abstract screening; 78 citations were selected for independent full-text review, 42 of those met study criteria. The findings revealed gaps between the expectations of HIE for quality health care and the realities of HIE processes that impact the provision of care in long-term care.We conclude that increased provider engagement and effective use of HIE processes is recommended to improve the safety and quality of health care in the long-term care sector.HIE implementation should be preceded a review of various aspects of workflow to identify information gaps and inefficiencies that can be addressed by digitization.

BACKGROUND: Social media are a suite of popular online technologies that enable people to share and co-create digital content. Evidence suggests some nursing students utilise social media inappropriately but there is limited literature on nursing students' opinions of professionalism in online environments. This study aimed to examine the opinions of nursing students in relation to digital professionalism on social media.METHOD: A descriptive, cross-sectional study was conducted with undergraduate nursing students in the United Kingdom (n = 112). An existing self-reported questionnaire was adapted for data collection. This was distributed to adult nursing students enrolled across all four years of a Bachelor of Nursing programme. Data were analysed using descriptive statistics.FINDINGS: Many nursing students were heavy social media users (n = 49, 44%), with Facebook, Instagram, and Snapchat being the most popular applications. Nursing students were also aware of the professional nursing regulator, the Nursing and Midwifery Council, guidelines on responsible social media use (n = 48, 43%). Nursing students' responses to various digitally professional scenarios revealed agreement that posts about alcohol or sexually explicit content, along with comments about colleagues or patients were inappropriate. However, there were mixed views around taking photographs at work, with some nursing students across all four years of the degree programme perceiving this to be satisfactory behaviour.DISCUSSION: The opinions of nursing students towards digital professionalism on social media are somewhat aligned with professional standards, although students can hold varying views on the subject. More research on how nursing students employ social media is warranted to ensure their opinions match their actual practice in online environments. It is also recommended to educate nursing students about the professional values and behaviours required on social media and how best to communicate, interact, and share information on the various online platforms, to minimise personal and organisational risk.

BACKGROUND Artificial intelligence (AI) is set to transform the health system, yet little research to date has explored its influence on nurses—the largest group of health professionals. Furthermore, there has been little discussion on how AI will influence the experience of person-centered compassionate care for patients, families, and caregivers. OBJECTIVE This review aims to summarize the extant literature on the emerging trends in health technologies powered by AI and their implications on the following domains of nursing: administration, clinical practice, policy, and research. This review summarizes the findings from 3 research questions, examining how these emerging trends might influence the roles and functions of nurses and compassionate nursing care over the next 10 years and beyond. METHODS Using an established scoping review methodology, MEDLINE, CINAHL, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central, Education Resources Information Center, Scopus, Web of Science, and ProQuest databases were searched. In addition to the electronic database searches, a targeted website search was performed to access relevant gray literature. Abstracts and full-text studies were independently screened by 2 reviewers using prespecified inclusion and exclusion criteria. Included articles focused on nursing and digital health technologies that incorporate AI. Data were charted using structured forms and narratively summarized. RESULTS A total of 131 articles were retrieved from the scoping review for the 3 research questions that were the focus of this manuscript (118 from database sources and 13 from targeted websites). Emerging AI technologies discussed in the review included predictive analytics, smart homes, virtual health care assistants, and robots. The results indicated that AI has already begun to influence nursing roles, workflows, and the nurse-patient relationship. In general, robots are not viewed as replacements for nurses. There is a consensus that health technologies powered by AI may have the potential to enhance nursing practice. Consequently, nurses must proactively define how person-centered compassionate care will be preserved in the age of AI. CONCLUSIONS Nurses have a shared responsibility to influence decisions related to the integration of AI into the health system and to ensure that this change is introduced in a way that is ethical and aligns with core nursing values such as compassionate care. Furthermore, nurses must advocate for patient and nursing involvement in all aspects of the design, implementation, and evaluation of these technologies. INTERNATIONAL REGISTERED REPORT RR2-10.2196/17490

BACKGROUND It is predicted that artificial intelligence (AI) will transform nursing across all domains of nursing practice, including administration, clinical care, education, policy, and research. Increasingly, researchers are exploring the potential influences of AI health technologies (AIHTs) on nursing in general and on nursing education more specifically. However, little emphasis has been placed on synthesizing this body of literature. OBJECTIVE A scoping review was conducted to summarize the current and predicted influences of AIHTs on nursing education over the next 10 years and beyond. METHODS This scoping review followed a previously published protocol from April 2020. Using an established scoping review methodology, the databases of MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, Cochrane Database of Systematic Reviews, Cochrane Central, Education Resources Information Centre, Scopus, Web of Science, and Proquest were searched. In addition to the use of these electronic databases, a targeted website search was performed to access relevant grey literature. Abstracts and full-text studies were independently screened by two reviewers using prespecified inclusion and exclusion criteria. Included literature focused on nursing education and digital health technologies that incorporate AI. Data were charted using a structured form and narratively summarized into categories. RESULTS A total of 27 articles were identified (20 expository papers, six studies with quantitative or prototyping methods, and one qualitative study). The population included nurses, nurse educators, and nursing students at the entry-to-practice, undergraduate, graduate, and doctoral levels. A variety of AIHTs were discussed, including virtual avatar apps, smart homes, predictive analytics, virtual or augmented reality, and robots. The two key categories derived from the literature were (1) influences of AI on nursing education in academic institutions and (2) influences of AI on nursing education in clinical practice. CONCLUSIONS Curricular reform is urgently needed within nursing education programs in academic institutions and clinical practice settings to prepare nurses and nursing students to practice safely and efficiently in the age of AI. Additionally, nurse educators need to adopt new and evolving pedagogies that incorporate AI to better support students at all levels of education. Finally, nursing students and practicing nurses must be equipped with the requisite knowledge and skills to effectively assess AIHTs and safely integrate those deemed appropriate to support person-centered compassionate nursing care in practice settings. INTERNATIONAL REGISTERED REPORT RR2-10.2196/17490

BACKGROUND Many health care organizations around the world have implemented health information technologies (ITs) to enhance health service efficiency, effectiveness, and safety. Studies have demonstrated that promising outcomes of health IT initiatives can be obtained when patients and family members participate and engage in the adoption, use, and evaluation of these technologies. Despite knowing this, there is a lack of health care organizations using patient and family engagement strategies to enhance the use and adoption of health ITs, specifically. OBJECTIVE This study aimed to answer the following three research questions (RQs): (1) what current frameworks or theories have been used to guide patient and family engagement in health IT adoption, use, implementation, selection, and evaluation?, (2) what studies have been done on patient and family engagement strategies in health IT adoption, use, implementation, selection, and evaluation?, and (3) what patient and family engagement frameworks, studies, or resources identified in the literature can be applied to health IT adoption, use, implementation, selection, and evaluation? METHODS This scoping review used a five-step framework developed by Arksey and O’Malley and adapted by Levac et al. These steps include the following: (1) identifying the RQ, (2) identifying relevant studies, (3) selecting studies, (4) charting relevant data, and (5) summarizing and reporting the result. Retrieved academic and grey literature records were evaluated using a literature review software based on inclusion and exclusion criteria by two independent reviewers. If consensus was not achieved, two reviewers would resolve conflicts by discussion. Research findings and strategies were extracted from the studies and summarized in data tables. RESULTS A total of 35 academic articles and 23 gray literature documents met the inclusion criteria. In total, 20 of the 35 included studies have been published since 2017. Frameworks found include the patient engagement framework developed by Healthcare Information and Management Systems Society and the patient and family engagement framework proposed by Carman et al. Effective strategies include providing patients with clear expectations and responsibilities and providing reimbursement for time and travel. The gray literature sources outlined key considerations for planning and supporting engagement initiatives such as providing patients with professional development opportunities, and embedding patients in existing governance structures. CONCLUSIONS Several studies have reported their findings regarding successful strategies to engage patients and family members in health IT initiatives and the positive impact that can emerge when patients and family members are engaged in such initiatives in an effective manner. Currently, no framework has consolidated all of the key strategies and considerations that were found in this review to guide health care organizations when engaging patients and family members in a health IT–specific project or initiative. Further research to evaluate and validate the existing strategies would be of value.

Knowledge and skills related to medication administration are a fundamental element of nursing education. With the increased use of electronic medication administration technology in practice settings where nurses work, nursing educators need to consider how best to implement these forms of technology into clinical simulation. This article describes the development of a simulated electronic medication administration system, including the use of sociotechnical systems theory to inform elements of the design, implementation, and testing of the system. Given the differences in the medication administration process and workflow generated by electronic medication administration technology, nursing educators should explore sociotechnical theory as a potentially informative lens from which to plan and build curricula related to simulation activities involving clinical technology.

Background Despite the uptake of mass media campaigns, their overall impact remains unclear. Since 2011, a Canadian telecommunications company has operated an annual, large-scale mental health advocacy campaign (Bell Let’s Talk) focused on mental health awareness and stigma reduction. In February 2012, the campaign began to explicitly leverage the social media platform Twitter and incented participation from the public by promising donations of Can $0.05 for each interaction with a campaign-specific username (@Bell_LetsTalk). Objective The intent of the study was to examine the impact of this 2012 campaign on youth outpatient mental health services in the province of Ontario, Canada. Methods Monthly outpatient mental health visits (primary health care and psychiatric services) were obtained for the Ontario youth aged 10 to 24 years (approximately 5.66 million visits) from January 1, 2006 to December 31, 2015. Interrupted time series, autoregressive integrated moving average modeling was implemented to evaluate the impact of the campaign on rates of monthly outpatient mental health visits. A lagged intervention date of April 1, 2012 was selected to account for the delay required for a patient to schedule and attend a mental health–related physician visit. Results The inclusion of Twitter into the 2012 Bell Let’s Talk campaign was temporally associated with an increase in outpatient mental health utilization for both males and females. Within primary health care environments, female adolescents aged 10 to 17 years experienced a monthly increase in the mental health visit rate from 10.2/1000 in April 2006 to 14.1/1000 in April 2015 (slope change of 0.094 following campaign, P Conclusions The 2012 Bell Let’s Talk campaign was temporally associated with an increase in the rate of mental health visits among Ontarian youth. Furthermore, there appears to be an upward trend of youth mental health utilization in the province of Ontario, especially noticeable in females who accessed primary health care services.

Twitter® is a popular microblogging site that allows users to disseminate information in 140 characters of text or less. A review of literature indicated that, to date, there has been little inquiry into the health based discussions conceptualized and enacted within and among Twitter users. Methods for this qualitative study included a directed content analysis, guided by the Public Health Agency of Canada's Determinant of Health (DOH) framework was completed to explore health based discussions on Twitter. A 24-hour cross-section of tweets (N=2400) containing the word or hashtag 'health' were collected for analysis. Findings revealed predominant themes of health services, personal health practices, and education. Many of the tweeted messages reflected existing political and social issues publicized within the global mass media. This study also considered the evolving dynamic behind the conceptualization of health and how it is co-constructed through news media, advertising, and social network technologies. Discussion of the emerging themes and implications for practice are presented.

As technological advances continue to expand connectivity and communication, the number of patients and nurses engaging in social media increases. Nurses play a significant role in identification, interpretation, and transmission of knowledge and information within healthcare. Social media is a platform that can assist nursing faculty in helping students to gain greater understanding of and/or skills in professional communication; health policy; patient privacy and ethics; and writing competencies. Although there are barriers to integration of social media within nursing education, there are quality resources available to assist faculty to integrate social media as a viable pedagogical method. This article discusses the background and significance of social media tools as pedagogy, and provides a brief review of literature. To assist nurse educators who may be using or considering social media tools, the article offers selected examples of sound and pedagogically functional use in course and program applications; consideration of privacy concerns and advantages and disadvantages; and tips for success.

ABSTRACT New pulse-compression techniques have made feasible the design and construction of solid state transmitters emitting Loran-C signals. When coupled with new receivers, there are tangible benefits for every user and operator of position-fixing services:ranges that are at least double what is presently obtainable with shore-based CW phase-comparison survey networks;portable transmitters can be erected and operated where needed;unambiguous, yet continuous, position-fixing for multiple users; andacceptable accuracies. Initial operation of two networks were in the Gulf of Mexico where offshore operations are now extending to the continental slope; and in the Java Sea where a survey chain was erected specifically for geophysical exploration. INTRODUCTION As resource exploration and production has spread to the edge of the continental shelves, the need for accurate electronic positioning to cover these areas of activity has arisen. Land-based positioning networks for survey work are presently utilized out to the limit of their range. However, new technical advances have made possible the design and fabrication of solid-state transmitters for Loran-C signals. In addition, new receiver designs are available. Combining these two components, it is now possible and practical to set up Loran-C chains in any part of the world where accurate, medium range survey fixing is demanded. (By medium range is meant 100 to 300 miles from the network baselines, and up to 500 miles from any one transmitter station.) The positioning operator is not required to track and maintain lane count, thus the system is non-ambiguous. There is no signal deterioration due to sky wave effect within the medium range area. Initialization is not required when entering the system. EQUIPMENT Since this paper deals with the survey application of this new Loran-C equipment, the theory of operation will not be discussed. Similarly I rather than offer an explanation of Loran-C transmissions, the authors refer to the many excellent summaries available. One such summary is Coast Guard Publication CG-462, "Loran-C User Handbook." Of course, new solid-state transmitters do not emit the same peak power as do the Government transmitters, and hence do not have the same ranges. However, the Coast Guard Loran-C chains are designed for long-range navigation by ships and aircraft. The new Loran-C system is intended to provide the same potential accuracy within the survey area, easier mobilization of chains I and economy of operation. Each chain comprises a master transmitter, and two or more secondary transmitters, all emitting properly timed signals on their ' assigned Group Repitition Interval (GRI.) GRI's are now selectable in ten microsecond increments and are chosen so as to minimize adjacent chain interference. The transmitters are normally controlled by a cesium standard to provide the most stable transmissions possible. However, each station has a timing receiver to provide back-up for the cesium standard as an alternate transmitter control. The transmitting stations, in addition to the cesium standard, consists of the transmitting equipment, the antenna system, and a prime power source. The transmitter is made up of eight compact units with interconnecting cables that will fit on a standard office desk.