BACKGROUND:Effective handover communication by nurses is essential to ensuring care continuity, care quality and patient safety and minimizing the risk of adverse events. Notably, the increasing globalization of the nursing profession and the resulting rise of multicultural workplaces in health care can affect handover communication. However, no tools have yet been developed to evaluate the current practices and factors contributing to effective handover in multicultural care settings, even though such instruments are deemed necessary to identify communication challenges and opportunities for improvement. AIMS:This paper describes the protocol that will be used in a proposed study that aims to adapt and validate an existing instrument for measuring handover quality-namely the Handover Evaluation Scale. The proposed study will also examine the factors contributing to effective handovers in a multicultural critical care context using a sequential exploratory mixed-method and will involve a qualitative and a quantitative phase. STUDY DESIGN:The first phase will explore Saudi Arabian ICU nurses' perceptions of effective shift handovers and the factors influencing handover quality. Data will be collected by recruiting 20 nurses through purposive sampling for semi-structured interviews. Interpretive description will be used to analyse the data to identify items useful for modifying the tool. Next, the tool will be modified based on the qualitative findings. Lastly, a quantitative study will be conducted based on the results of the first phase to assess the instrument's reliability and content validity and determine its internal dimensional structure. RESULTS:This paper describes the study protocol that will be applied to adapt and validate an existing tool to measure the quality of handover in multicultural ICUs, using an exploratory sequential mixed-methods design. RELEVANCE TO CLINICAL PRACTICE:The protocol described in this paper provides a framework for an adaptation of the Handover Evaluation Scale to measure handover effectiveness and to identify current challenges and factors affecting handover effectiveness in the multicultural critical care context. This version of the scale can be applied in clinical practice to determine best practices for improving handover.

Human trafficking is increasingly recognized as a significant global public health issue. Human trafficking (HT) exists in all nations, including Canada, and is estimated to impact 25 million people globally. HT is a crime that is not always visible. It is associated with a myriad of deleterious health outcomes arising from adverse living and working conditions, and the physical, sexual, and/or psychological violence often accompanying it. Human trafficking also disproportionately affects people living under vulnerable circumstances, particularly those with intersecting vulnerabilities. Public health can advance health equity for trafficked persons and add value to existing anti-trafficking (AT) efforts. Among its many contributions, public health can bring its expertise in health promotion and surveillance. While efforts to incorporate a public health perspective are already underway in at least the United States and the United Kingdom, the nexus of public health and AT is still nascent and requires further development. A public health approach to trafficking focused on intervening on the upstream drivers of well-being can add value to the extant counter-trafficking paradigm. This commentary is intended to catalyze discussion in Canada and elsewhere as to what public health can contribute to this emergent field.

The present study assessed the effects of an intervention that was designed to provide on-site, predischarge housing assistance for psychiatric clients. Participants included clients from acute (n = 219) and tertiary (n = 32) care hospital sites. Data were collected from hospital and shelter databases. Results revealed that in the majority of cases, the intervention reduced the number of individuals discharged to homelessness or no fixed address. In addition, the costs of implementing and maintaining the intervention were less than the increased medical costs associated with homelessness and housing individuals in shelters.

After spending time in the hospital, psychiatric clients are often discharged to homeless shelters or the streets, which can place a burden on health care systems. This study examined the effects of an intervention in which psychiatric clients from acute ( n = 219) and tertiary ( n = 32) sites were provided with predischarge assistance in securing housing. A program evaluation design was used to examine the effectiveness of the intervention. Qualitative data were available through interviews, focus groups, and monthly meetings. The results highlight several benefits of the intervention and show that homelessness can be reduced by connecting housing support, income support, and psychiatric care.

this edited volume by cheryl Forchuk, rick csiernik, and elsabeth Jensen provides a powerful example of the possibilities of a program of research dealing with the complexities of real-world research with persons with severe mental illness. the population of interest was individuals currently living in the community but diagnosed with a mental illness at some point in their lives. the overall program goal was to understand the complex issues related to housing and mental health at individual, community, and societal levels. the editors, also leaders in the program of research, note that the research was conducted in ontario and so is of primary relevance to that context.

BACKGROUND:The challenge of facilitating knowledge translation in clinical practice includes enabling practitioners and agencies to implement a common set of best practices, such as the Transitional Relationship Model (TRM). In 1992, a participatory action project implemented the TRM on a long-term psychiatric hospital ward in Ontario, Canada. All participants were successfully "bridged" to the community. Despite positive outcomes associated with the TRM, implementation of any best practice is difficult because it involves changing processes. OBJECTIVE:It was hypothesized that using multiple implementation strategies developed by wards that had already implemented the model would result in improved TRM implementation. METHOD:This study compared three groups of hospital wards; Group A wards had already adopted the TRM, Group B wards implemented the TRM in Year 1, and Group C wards implemented the TRM in Year 2. An iterative process was used in which strategies suggested by the A wards were used to enhance implementation on the B and C wards, respectively. These included enhancing staff participation, creating/maintaining supportive ward milieus, meeting specific educational needs, and supporting managers throughout the implementation process. The degree of actual implementation on each ward served as the primary outcome measure. RESULTS:Group C implemented the TRM model significantly quicker than the other groups. Sustainability in the initial A wards required the implementation of additional strategies used by the later wards.

The study examined rural housing and homelessness issues and looked at similarities and differences between rural and urban areas. It involved a secondary analysis of focus group data collected in a 2001-06 Community University Research Alliance study of mental health and housing. The findings highlight concerns regarding the lack of services, which can precipitate a move from a rural to an urban community. Inadequate transportation services often posed a challenge to rural residents attempting to access services. Many participants preferred rural living but felt they had to choose between residing where they wanted to and having access to essential services. In some cases entire families were uprooted in pursuit of services. Once in an urban environment, rural participants had ongoing difficulty obtaining employment, housing, and services, which in turn led to disappointment in their new environment. The primary reason given for entering the shelter system was lack of alternatives and supports. Increased services need to be allocated to rural communities so that a health promotion and illness-prevention model of care can replace the current emphasis on crisis management.

This study assessed the effectiveness of a discharge planning service that was remodelled and relocated from a hospital to community-based setting. The study used a single group program evaluation strategy. In this “in-reach” model, the discharge planner is based with the community service, and visits the hospital daily to meet with all admitted clients to offer discharge services. Through analyses of administrative data and interviews with clients, the study found that readmission rates were 40% lower in the year following the change in service delivery model. This change was statistically significant. Agency partners used the findings to modify their program during the course of the evaluation. Findings will be helpful for other acute care mental health services.

This study compared communities with three models of crisis service: (a) police as part of a specialized mental health team, (b) mental health worker as part of a specialized police team, and (c) informal relationship between police and mental health crisis service. Rural and urban areas were examined and compared. Data included focus groups and participant observation. Analysis revealed that while all communities valued their crisis services, all identified limitations in responsiveness, access, and systems-related issues. Quick access to psychiatric beds was important to services. Rural communities had no public transportation, and an important police role was safe transportation. In rural communities, mental health workers were generalists because they had to be able to address situations on their own. In urban areas, transportation was more readily available, and more specialization developed among mental health team members.

Relatively little is understood concerning the role of gender in persons with a history of mental illness residing in the community. This paper aims to explore gender's effect using data from the Community Research University Alliance project entitled, Mental Health and Housing. The primary five-year longitudinal study examined housing situations for psychiatric consumer/survivors in a mid-size, central Canadian region in an effort to improve the number and quality of appropriate housing situations. Data from 887 subjects in the original research underwent secondary analysis with particular relevance to differences between gender and indicators of health status including psychiatric history, levels of functioning, personal strengths and resources, and illness severity. Results of the secondary analysis found male and female differences that corroborated previous research. More women are housed than men, more women with mental illness were coupled than men, men have fewer social supports, and men have more substance abuse issues than women. These findings suggest health services within the community must consider these sex differences if they wish to properly assist Canadian individuals diagnosed with mental illnesses.

Objective We demonstrate the combination of several source measures into a comprehensive pooled index (PI) that measures functioning at a single point in time as well as improvement or worsening in functioning over time, and illustrate how this measure can be used to compare functioning in psychiatric clients living in three different housing types. Methods One hundred and forty-eight clients (55% women, mean age 45 yr.) were administered comprehensive interviews at two times one year apart. Four variables measured at both times were combined into a PI: three subscale scores from the Colorado Client Assessment Record, and the Quality of Life score from the Lehman interview. The PI was calculated for the initial interview, and between the two interviews to measure change in functioning over time (ΔPI). Results The greatest improvements in ΔPI scores occurred in those living independently, very slight worsening was seen among those in subsidized housing, and considerable worsening occurred among those in shelters. Regression results showed that living in a shelter, being older, PI at Year 1, being non-compliant with medications, duration of symptoms, and having more than 1 undesirable move in the past 2 years were independently associated with worsening in overall functioning over one year. Conclusion A pooled index change score, calculated from existing scale scores, provides a single dependent variable that quantifies the improvement or worsening of the overall functioning of psychiatric clients living in different housing types over time. A pooled index is one method of reducing multiple outcomes for analysis.

Effective discharge planning is needed to facilitate clients' transition from psychiatric hospital wards to community care. Previous studies have shown that client outcomes can be improved by using a Transitional Discharge Model (TDM) that includes peer support and an extension of inpatient-practitioner relationships that are introduced prior to discharge. However, countries vary in many ways that may affect implementation of the model. This article describes some of the similarities and differences related to introducing transitional discharge in two countries: Canada and Scotland. It is important to elucidate facilitators and challenges in implementing the TDM to identify and disseminate strategies to aid implementation. Implications for future implementation of the model are also discussed.