Supporting shared decision making for older people with multiple health and social care needs: a realist synthesis

Background: Health care systems are increasingly moving towards more integrated approaches. Shared decision making (SDM) is central to these models but may be complicated by the need to negotiate and communicate decisions between multiple providers, as well as patients and their family carers; particularly for older people with complex needs. The aim of this review was to provide a context relevant understanding of how interventions to facilitate SDM might work for older people with multiple health and care needs, and how they might be applied in integrated care models. Methods: Iterative, stakeholder driven, realist synthesis following RAMESES publication standards. It involved: 1) scoping literature and stakeholder interviews (n-13) to develop initial programme theory/ies, 2) systematic searches for evidence to test and develop the theories, and 3) validation of programme theory/ies with stakeholders (n=11). We searched PubMed, The Cochrane Library, Scopus, Google, Google Scholar, and undertook lateral searches. All types of evidence were included. Results: We included 88 papers; 29 focused on older people or people with complex needs. We identified four context-mechanism-outcome configurations that together provide an account of what needs to be in place for SDM to work for older people with complex needs. This includes: understanding and assessing patient and carer values and capacity to access and use care, organising systems to support and prioritise SDM, supporting and preparing patients and family carers to engage in SDM and a person-centred culture of which SDM is a part. Programmes likely to be successful in promoting SDM are those that allow older people to feel that they are respected and understood, and that engender confidence to engage in SDM. Conclusions: To embed SDM in practice requires a radical shift from a biomedical focus to a more person-centred ethos. Service providers will need support to change their professional behaviour and to better organise and deliver services. Face to face interactions, permission and space to discuss options, and continuity of patient-professional relationships are key in supporting older people with complex needs to engage in SDM. Future research needs to focus on inter-professional approaches to SDM and how families and carers are involved

Commentary on the Past, Present, and Future of Nursing Workload Research

Maura MacPhee,1 Farinaz Havaei,1 Sue Bookey-Bassett,2 W Patrick Neumann,3 Sadeem Munawar Qureshi,3 Michael A Greig,3 David Keselman1 1School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada; 2Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada; 3Department of Mechanical and Industrial Engineering, Toronto Metropolitan University, Toronto, Ontario, CanadaCorrespondence: Maura MacPhee, School of Nursing, University of British Columbia, T201 2211 Wesbrook Mall, Vancouver, BC, V6T2B5, Canada, Tel +1 778-926-4068, Email [email protected]: The aim of this paper is to enhance readers’ understanding of research design strategies, past and present, for studying nursing workloads. Future research directions are also discussed. Nursing workloads are associated with nurse burnout and turnover. During our current global nursing shortage, researchers must identify ways to mitigate nurses’ heavy workloads. Relevant, prior nursing workload research is presented with brief descriptions of designs, methods and findings. To illustrate the current complexity of nurses’ work environments and the myriad factors that influence nurses’ workloads, this paper features the ongoing nursing workload research of two Canadian research teams with different methodological approaches. These two teams are employing current research innovations, such as human factors multi-systems frameworks, design thinking, simulation modeling and integrated knowledge translation. With respect to future research implications, the teams are melding methods and tools to promote a more sophisticated way of understanding the complex linkages between patient needs, systems design and the management of nurses’ workloads.Keywords: nursing workloads, nurses’ work environments, synergy tool, patient needs assessment, human factors, simulation modelin

The Transformative Power of Inclusion, Diversity, Equity, Accessibility, and Social Justice in Interprofessional Education and Collaborative Practice – Discussion Paper

In the ever-evolving landscape of healthcare and education, the principles of Inclusion, Diversity, Equity, Accessibility, and Social Justice have emerged as guiding beacons for Interprofessional Education and Collaborative Practice (IPECP). We recognize that these foundational elements are not mere buzzwords, they are the pillars upon which our collective impact rests. In this Discussion Paper, we unravel the significance of inclusion, diversity, equity, accessibility, and social justice in shaping a more compassionate, equitable, and effective healthcare ecosystem