Canada has a noteworthy reputation for high quality health care. Nonetheless, street youth are one of our most vulnerable yet underserved populations. Consequently, a medical and dental clinic was created in downtown Ottawa, Ontario to respond to their needs. The purpose of this study is to describe a process evaluation of the clinic during its first year of operation with a focus on program fidelity, dose, reach, and satisfaction. A mixed methods approach was used involving interviews with providers, focus groups with street youth, analysis of Electronic Medical Record (EMR) data, and supplemental information such as document reviews. The evaluation identified areas that were working well along with challenges to program implementation. Areas of concerns and possible solutions were presented to the management team that then helped to plan and make improvements to the clinic. Our evaluation design and working relationship with clinic management promoted the integration of real-time evidence into program improvements.
The Native American Cancer Survivors' Support Network is an innovative public health program designed to improve survival from cancer and the quality of life after a cancer diagnosis for American Indians, Alaska Natives, and Canadian Aboriginal patients and their loved ones. The Network, initiated in 1999, now has more than 300 survivors enrolled as members. This article briefly describes the process that led to its formation and preliminary findings, primarily for breast cancer survivors, of ongoing qualitative and quantitative research. Network data show patterns of cancer care that are partially responsible for poor survivorship outcomes.
Atlantic Canada has some of the earliest, most comprehensive, well-established networks, and innovative applications for telehealth in the country. The region offers a range of models for telehealth, in terms of management structure, coordination, funding, equipment, utilization, and telehealth applications. Collectively, this diversity, experience, and wealth of knowledge can significantly contribute to the development of a knowledge base for excellence in telehealth services. There is no formal process in place for the sharing of information amongst the provinces. Information sharing primarily occurs informally through professional contacts and participation in telehealth organizations. A core group of organizations partnered to develop a process for knowledge exchange to occur. This type of collaborative approach is favored in Atlantic Canada, given the region's economy and available resources. The Atlantic Telehealth Knowledge Exchange (ATKE) project centred on the development of a collaborative structure, information sharing and dissemination, development of a knowledge repository and sustainability. The project is viewed as a first step in assisting telehealth stakeholders with sharing knowledge about telehealth in Atlantic Canada. Significant progress has been made throughout the project in increasing the profile of telehealth in Atlantic Canada. The research process has captured and synthesized baseline information on telehealth, and fostered collaboration amongst telehealth providers who might otherwise have never come together. It has also brought critical awareness to the discussion tables of governments and key committees regarding the value of telehealth in sustaining our health system, and has motivated decision makers to take action to integrate telehealth into e-health discussions.
In 2001, the Ontario Ministry of Health and Long-Term Care introduced the Ontario Stroke Strategy by designating regional stroke centres across the province. The primary role of these centres is to coordinate stroke care within the region and across the care continuum in keeping with best practices. Concurrently, Trillium Health Centre was identifying best practice projects to support its ongoing quest for excellence. With Trillium designated as a regional stroke centre, acute ischemic stroke care was an obvious choice for a best practice project. The aim of the project was to improve access to care and quality of care for stroke patients from emergency through acute care to in-patient rehabilitation. The team chose the rapid cycle change methodology. This approach to quality improvement advocates the testing of a series of small changes (i.e., process improvement ideas) in tandem with measurements to assess the impact of the change to drive further process improvements. The project was deemed a success, resulting in significant improvements in the timeliness and quality of care.
Previous research indicates that most vehicle occupants are unaware that a correctly adjusted, well-designed vehicular head restraint provides substantial protection against whiplash injuries. This study examined whether a brief educational intervention could improve awareness regarding whiplash injuries and prevention strategies among a cohort of vehicle fleet managers.
A brief written survey was administered prior to, and approximately 1 h after a 30-min presentation on whiplash injury and prevention measures, which was delivered at a regional fleet manager meeting held in British Columbia, Canada (n = 27 respondents).
Respondents had low baseline knowledge levels regarding the causes, consequences, and prevention of whiplash. Following the presentation, however, respondents improved awareness in all of these domains and, most important, reported an increased motivation to implement changes based on this newly acquired knowledge.
These results indicate that improved education practices and social marketing tools are potentially valuable to increase awareness among relevant stakeholders.
The study investigated how a group intervention programme (13 sessions over 16 weeks), designed for men with cancer (n = 17), affected their sense of well-being and had a positive impact on their ability to cope with the physical, psychological and social consequences of living with cancer. The close-knit relationships fostered between participants stimulated a sense of solidarity and commitment amongst them. New thinking in relation to gender, group dynamics and social processes is presented, as are the implications for clinical nursing practice in cancer care. The experience from male orientated group intervention programmes shows that men with cancer have undiscovered strengths, whilst some wish to die 'with their boots on'.
Restructuring nursing services following a hospital merger has an impact on retention. A career development program for nurses can be an effective retention strategy. Data were gathered from three focus groups of practicing nurses and an e-mail survey of students in the graduating nursing class. Based on their responses, a new career development structure was proposed. The structure involves three levels of development that provide an opportunity for registered nurses to grow in and expand their careers. The General Internship Program is geared toward new graduates and establishing a career. The Specialty Internship Program provides knowledge and skills in specialized nursing, and the Service Focused Cross Training Program allows nurses to expand their skills and focus their practice on one patients population.
Despite many attempts to support stroke patients, there is still room for improvement. The aim of this study is to gain insight into care professionals' perceived usefulness of an online care and rehabilitation planning tool. A functional prototype was developed and presented to a neurology team in a primary care centre in Stockholm. Three focus group meetings were conducted. The data were analysed based on the unified theory of acceptance and use of technology. The results indicate that the care professionals were positive towards the tool and described potential usefulness such as ease of understanding the rehabilitation process and support for collaboration among care providers and also cooperation between the patient and the team. They also identified challenges such as time limitation in daily care.
The aims of this study were to describe: (1) how the Homelessness Intervention Programme addressed the needs of elderly people who were homeless or at risk of homelessness; and (2) the factors that influenced the ability of the programme to address client needs. The programme was offered by a multi-service non-profit agency serving low-income families and individuals in an urban neighbourhood in Ontario, Canada. Using a case study approach, we conducted 10 individual interviews and three focus groups with programme clients, programme providers, other service providers and programme funders. Programme providers completed intake forms, monthly follow-up forms and exit/housing change forms for each of the 129 clients served by the programme over a 28-month period. Approximately equal proportions of clients were between 54 years old and 65 years old (47%) and over 65 years (53%). There were equal proportions of women and men. In addition to being homeless or marginally housed, clients lived with multiple and complex issues including chronic illness, mental illness and substance abuse. Through the facilitation of continuity of care, the programme was able to meet the needs of this vulnerable group of elderly people. Three types of continuity of care were facilitated: relational, informational and management continuity. The study confirmed the value of a continuous caring relationship with an identified provider and the delivery of a seamless service through coordination, integration and information sharing between different providers. Study findings also highlighted the broader systemic factors that acted as barriers to the programme and its ability to meet the needs of elderly people. These factors included limited housing options available; limited income supports; and lack of coordinated, accessible community health and support services. The central findings stress the importance of continuity of care as a guiding concept for intervention programmes for homeless and marginally housed elderly people.
The Greater Involvement of People Living with HIV/AIDS Principle (GIPA) has been a core commitment for many people involved in the community-based HIV/AIDS movement. GIPA refers to the inclusion of people living with HIV/AIDS in service delivery and decision-making processes that affect their lives. Despite its central importance to the movement, it has received little attention in the academic literature. Drawing on focus group discussions among staff members and volunteers of AIDS service organizations, activists, and community members, we explore challenges to the implementation of the GIPA principle in community-based HIV/AIDS organizations in Ontario, Canada. Our findings reveal ways in which implementing GIPA has become more complicated over recent years. Challenges relating to health, stigma and disclosure, evolving HIV/AIDS organizations, and GIPA-related tensions are identified. This paper considers our findings in light of previous research, and suggests some implications for practice.