Self-reported oral health among a community sample of people experiencing social and health inequities: Cross-sectional findings from a study to enhance equity in primary healthcare settings

Objective: To describe the self-reported oral health issues among a community sample of primary care clients experiencing socioeconomic disadvantages. Methods: As part of a larger mixed-methods, multiple case study evaluating an equity-oriented primary healthcare intervention, we examined the oral health of a sample of 567 people receiving care at four clinics that serve marginalised populations in two Canadian provinces. Data collected included self-rated oral health and experiences accessing and receiving healthcare, standard self-report measures of health and quality of life, and sociodemographic information. Results: The prevalence of self-rated poor oral health was high, with almost half (46.3%) of the participants reporting poor or fair oral health. Significant relationships were observed between poor oral health and vulnerabilities related to mental health, trauma and housing instability. Our findings suggest that the oral health of some Canadian populations may be dramatically worse than what is reported in existing population health surveys. Conclusions: Our findings reinforce the importance of addressing oral health as part of health equity strategies. The health and oral health issues experienced by this client cohort highlight the need for interdisciplinary, team-based care that can address the intersections among people\u27s health status, oral health and social issues

Mentoring Graduate Students to Become Effective Teaching Assistants: Developing and Implementing a Student-Centred Program for Nursing

Teaching in the health professions, including nursing, requires specialized educational strategies that meet the needs of the current generation of learners. Currently there is a shortage of experienced post-secondary educators in nursing, possibly exacerbated by inadequate Teaching Assistant (TA) professional development programs. Most literature describes TA professional development programs that involve undergraduate students employed as TAs, and few consider how programs can mentor graduate students to develop their instructional skills, contribute to courses, and enhance their careers. There are limited reports in the Canadian context. In this article we outline the rationale, development, and implementation of a Graduate Teaching Assistant (GTA) mentorship program for graduate students at a school of nursing located in western Canada. Our aim is to provide mentorship and experience in educational strategies to graduate students, to help mentor and educate future nursing educators who are experienced post-secondary teachers. We discuss the rationale for offering the GTA mentorship program, followed by a description of the GTA mentorship program components. We highlight the role of the Senior TA, an experienced GTA who takes a leadership role in coordinating the program. Importantly, we discuss how knowledge related to cultural safety is presented, and how it has been adapted over time to meet GTAs’ needs. Finally, we discuss the evolution of a school of nursing GTA mentorship program, located in western Canada and we describe future changes to the program in order to remain relevant to the needs of graduate students in nursing, faculty and administration, and undergraduate nursing students. L’enseignement dans les professions de la santé, y compris les sciences infirmières, nécessite des stratégies pédagogiques répondant aux besoins de la génération actuelle d’apprenantes. Nous connaissons actuellement une pénurie d’enseignantes en sciences infirmières, possiblement aggravée par l’inadéquation des programmes de développement professionnel pour les auxiliaires d’enseignement (Teaching Assistant; TA). La littérature sur le sujet décrit surtout les programmes de développement professionnel pour les étudiantes de premier cycle qui sont embauchées comme auxiliaires d’enseignement; peu considèrent la façon dont les programmes peuvent soutenir les étudiantes des cycles supérieurs pour leur permettre de développer leurs habiletés d’enseignement, de contribuer aux cours, et d’améliorer leurs perspectives de carrière. Peu de rapports font état du contexte canadien. Dans cet article, nous justifions et exposons brièvement l’élaboration et la mise en œuvre d’un programme de mentorat pour les auxiliaires d’enseignement qui sont étudiantes aux cycles supérieurs (Graduate Teaching Assistant; GTA) dans une école de sciences infirmières de l’Ouest canadien. Notre objectif est d’offrir du mentorat ainsi qu’une expérience permettant à des étudiantes des cycles supérieurs de pratiquer des stratégies pédagogiques, afin de contribuer à la formation de nouvelles enseignantes chevronnées en sciences infirmières. Nous présentons le rationnel pour offrir un tel programme de mentorat pour les étudiants des cycles supérieurs et en décrivons les composantes. Nous soulignons le rôle de l’auxiliaire sénior, une auxiliaire expérimentée jouant un rôle de leader dans la coordination du programme. Chose importante, nous discutons de la manière de présenter les connaissances sur la sécurité culturelle, ainsi que de l’adaptation au fil du temps pour répondre aux besoins des auxiliaires d’enseignement. Enfin, nous abordons l’évolution du programme de mentorat pour les étudiantes des cycles supérieurs d’une école de sciences infirmières de l’Ouest du Canada; nous décrivons également les changements qui seront apportés au programme, afin qu’il réponde toujours aux besoins des étudiantes des cycles supérieurs en sciences infirmières, du corps professoral, de la direction et des étudiantes du premier cycle

Framing the Issues: Moral Distress in Health Care

Moral distress in health care has been identified as a growing concern and a focus of research in nursing and health care for almost three decades. Researchers and theorists have argued that moral distress has both short and long-term consequences. Moral distress has implications for satisfaction, recruitment and retention of health care providers and implications for the delivery of safe and competent quality patient care. In over a decade of research on ethical practice, registered nurses and other health care practitioners have repeatedly identified moral distress as a concern and called for action. However, research and action on moral distress has been constrained by lack of conceptual clarity and theoretical confusion as to the meaning and underpinnings of moral distress. To further examine these issues and foster action on moral distress, three members of the University of Victoria/University of British Columbia (UVIC/UVIC) nursing ethics research team initiated the development and delivery of a multi-faceted and interdisciplinary symposium on Moral Distress with international experts, researchers, and practitioners. The goal of the symposium was to develop an agenda for action on moral distress in health care. We sought to develop a plan of action that would encompass recommendations for education, practice, research and policy. The papers in this special issue of HEC Forum arose from that symposium. In this first paper, we provide an introduction to moral distress; make explicit some of the challenges associated with theoretical and conceptual constructions of moral distress; and discuss the barriers to the development of research, education, and policy that could, if addressed, foster action on moral distress in health care practice. The following three papers were written by key international experts on moral distress, who explore in-depth the issues in three arenas: education, practice, research. In the fifth and last paper in the series, we highlight key insights from the symposium and the papers in the series, propose to redefine moral distress, and outline directions for an agenda for action on moral distress in health care

Patterns and Predictors of Service Use Among Women Who Have Separated from an Abusive Partner

# The Author(s) 2015. This article is published with open access at Springerlink.com Abstract Using baseline data from a survey of 309 Canadian women recently separated from an abusive partner, we inves-tigated patterns of access to health, social, legal, and violence-specific services and whether abuse history and social and health variables predict service use. We compared rates of service use to population rates, and used logistic regression to identify determinants of use. Service use rates were sub-stantially higher than population estimates in every category, particularly in general and mental health sectors. Although women were confident in their ability to access services, they reported substantial unmet need, difficulty accessing services, and multiple barriers. The strongest unique predictors of use varied across service type. Health variables (high disability chronic pain, symptoms of depression and PTSD), low in

A Theory-Based Primary Health Care Intervention for Women Who Have Left Abusive Partners

Although intimate partner violence is a significant global health problem, few tested interventions have been designed to improve women\u27s health and quality of life, particularly beyond the crisis of leaving. The Intervention for Health Enhancement After Leaving is a comprehensive, trauma informed, primary health care intervention, which builds on the grounded theory Strengthening Capacity to Limit Intrusion and other research findings. Delivered by a nurse and a domestic violence advocate working collaboratively with women through 6 components (safeguarding, managing basics, managing symptoms, cautious connecting, renewing self, and regenerating family), this promising intervention is in the early phases of testing

A tailored online safety and health intervention for women experiencing intimate partner violence: the iCAN Plan 4 Safety randomized controlled trial protocol

Background: Intimate partner violence (IPV) threatens the safety and health of women worldwide. Safety planning is a widely recommended, evidence-based intervention for women experiencing IPV, yet fewer than 1 in 5 Canadian women access safety planning through domestic violence services. Rural, Indigenous, racialized, and immigrant women, those who prioritize their privacy, and/or women who have partners other than men, face unique safety risks and access barriers. Online IPV interventions tailored to the unique features of women’s lives, and to maximize choice and control, have potential to reduce access barriers, and improve fit and inclusiveness, maximizing effectiveness of these interventions for diverse groups. Methods/Design In this double blind randomized controlled trial, 450 Canadian women who have experienced IPV in the previous 6 months will be randomized to either a tailored, interactive online safety and health intervention (iCAN Plan 4 Safety) or general online safety information (usual care). iCAN engages women in activities designed to increase their awareness of safety risks, reflect on their plans for their relationships and priorities, and create a personalize action plan of strategies and resources for addressing their safety and health concerns. Self-reported outcome measures will be collected at baseline and 3, 6, and 12 months post-baseline. Primary outcomes are depressive symptoms (Center for Epidemiological Studies Depression Scale, Revised) and PTSD Symptoms (PTSD Checklist, Civilian Version). Secondary outcomes include helpful safety actions, safety planning self-efficacy, mastery, and decisional conflict. In-depth qualitative interviews with approximately 60 women who have completed the trial and website utilization data will be used to explore women’s engagement with the intervention and processes of change. Discussion This trial will contribute timely evidence about the effectiveness of online safety and health interventions appropriate for diverse life contexts. If effective, iCAN could be readily adopted by health and social services and/or accessed by women to work through options independently. This study will produce contextualized knowledge about how women engage with the intervention; its strengths and weaknesses; whether specific groups benefit more than others; and the processes explaining any positive outcomes. Such information is critical for effective scale up of any complex intervention. Trial registration Clinicaltrials.gov ID NCT02258841 (Registered on Oct 2, 2014).Applied Science, Faculty ofNon UBCNursing, School ofReviewedFacult

Longitudinal effectiveness of a woman-led, nurse delivered health promotion intervention for women who have experienced intimate partner violence: iHEAL randomized controlled trial

Abstract Background Intimate partner violence (IPV) threatens the safety, health and quality of life of women worldwide. Comprehensive IPV interventions that are tailored, take a long-term view of women’s needs, including health concerns, and maximize choice and control, have the potential to effectively address heath and safety concerns. Few such interventions have been tested, including in the Canadian context. Methods A parallel randomized controlled trial of adult (age 19 + years), English-speaking, Canadian women with histories of IPV randomized either to iHEAL, a tailored health promotion intervention delivered by Registered Nurses over 6–7 months, or to community service information (usual care control). Primary (Quality of Life, PTSD symptoms) and secondary outcomes (Depression, Confidence in Managing Daily Life, Chronic Pain, IPV Severity) were measured at baseline and 6, 12 and 18 months post-intervention via an online survey. Generalized estimating equations were used to test for differences by study arm in intention-to-treat (full sample) and per protocol (1 + iHEAL visit) analyses focussing on short-term (immediately post-intervention) and longer-term (1 year post-intervention) effects. Selected process evaluation data were summarized using descriptive statistics. Results Of 331 women enrolled, 175 were randomized to iHEAL (135 who engaged in 1 + visits) and 156 to control. Women who received iHEAL showed significantly greater short-term improvement in Quality of Life compared to the control group, with these effects maintained 1 year later. Changes in PTSD Symptoms also differed significantly by group, with weaker initial effects that were stronger 1 year post-intervention. Significant moderate, short- and longer-term group effects were also observed for Depression and Confidence in Managing Daily Life. IPV Severity decreased for both groups, with significant immediate effects in favour of the intervention group that grew stronger 1 year post-intervention. There were no changes in Chronic Pain. Conclusion iHEAL is an effective, acceptable and safe intervention for diverse groups of women with histories of IPV. Trial results provide a foundation for implementation and ongoing evaluation in health care settings and systems. Delayed effects noted for PTSD Symptoms and IPV Severity suggest that longer-term assessment of these outcomes may be needed in trials of IPV interventions. Trial registration Clinicaltrials.gov ID NCT03573778 (Registered on June 29, 2018)

The British Columbia Healthy Connections Project: findings on socioeconomic disadvantage in early pregnancy

Background: Maternal exposure to socioeconomic disadvantage increases the risk of child injuries and subsequent child developmental and mental health problems — particularly for young mothers. To inform early intervention planning, this research therefore aimed to describe the health and social adversities experienced by a cohort of girls and young women in early pregnancy in British Columbia (BC), Canada. Methods: Participants were recruited for the BC Healthy Connections Project (BCHCP), a randomized controlled trial examining the effectiveness of Nurse-Family Partnership, a home visitation program, in improving child and maternal outcomes. Baseline data were collected from 739 participants on trial entry. Participants were selected on the basis of preparing to parent for the first time and experiencing socioeconomic disadvantage. Analyses involved descriptive statistics and age-group comparisons. Results: Most participants reported having low income (84%), having limited education (52%) and being single (91%) at trial entry. Beyond these eligibility criteria, other health and social adversities included: housing instability (52%); severe anxiety or depression (47%); other diagnosed mental disorders (22%); prenatal nicotine and cannabis use (27 and 21%); physical health problems (20%); child maltreatment when younger (56%); and intimate partner violence recently (50%). As well, few (29%) had received income assistance entitlements. More than two thirds (70%) were experiencing four or more forms of adversity. Age-group differences were observed for cognitive functioning, being single, low income, limited education, psychological distress and service use (p-value ≤0.05). Conclusions: This cohort was selected on the basis of socioeconomic disadvantage. Yet all participants were experiencing substantial added adversities — at higher rates than other Canadians. Furthermore, despite Canada’s public programs, these pregnant girls and young women were not being adequately reached by social services. Our study adds new data to inform early intervention planning, suggesting that unacceptably high levels of socioeconomic disadvantage exist for some young British Columbians. Therefore greater health and social supports and services are warranted for these young mothers and their children. Trial registration: Registered August 24, 2012 with ClinicalTrials.gov Identifier: NCT01672060 . Active not recruiting.Applied Science, Faculty ofNon UBCNursing, School ofReviewedFacult