There is increasing awareness that diabetes is a growing public health threat in Liberia. The high mortality and morbidity associated with diabetes have significant implications for individuals, families and communities. The current response to diabetes in Liberia is limited to the management of acute complications. Long-term strategies for the prevention and control of diabetes are almost entirely absent from national health agendas. This brief provides policy options that Liberian policymakers can adopt to prevent diabetes, improve treatment and enhance the quality of life for people living with diabetes in Liberia. Graphical Abstract

Residents of long-term care (LTC) homes have potentially painful conditions and are prescribed opioids to manage their pain, despite the risks associated with the use of these high-risk medications. Therefore, the overall aim of this study was to describe the associations between resident and facility characteristics of residents prescribed long-term opioid therapy and those who remained on opioids or had opioids deprescribed. We conducted a retrospective cohort study utilizing health administrative databases housed within ICES. Our cohort included 26,592 of 121,564 LTC residents (21.9%) of Ontario LTC homes who were prescribed long-term opioid therapy at cohort inception. Of these residents, 4,299 (16.2%) residents had opioids deprescribed during the follow-up period. Opioid deprescribing was associated with younger age, high comorbidity, and co-prescription with benzodiazepines and gabapentinoids. Our findings suggest that there is variation in the characteristics of residents who continued long-term opioid therapy and those who subsequently had opioids deprescribed, and these characteristics need to be considered as part of individualized pain management plans of care.

Background: New nurses' transition to the workforce is often described as challenging and stressful. Concerns over this transition to practice are well documented, with the hypothesis that transition experiences influence the retention of new nurses in the workforce and profession. Methods: In a cross-sectional survey (N =217) to assess new nurse transition in the province of Ontario, Canada, an open-ended item was included to solicit specific examples of the transition experience. The comments underwent thematic analysis to identify the facilitators and barriers of transition to practice for new nurses. Results: Comments were provided by 196 respondents. Three facilitator themes (supportive teams; feeling accepted, confident, and prepared; new graduate guarantee) and four barrier themes (feeling unprepared; discouraging realities and unsupportive cultures; lacking confidence/feeling unsure; false hope) to new nurse transition emerged. Conclusions: Concerns of nursing shortages are heightened in the current COVID-19 pandemic, reinforcing the priority of retaining new nurses in the workforce. The reported themes offer insight into the contribution of a supportive work environment to new nurses' transition. The recommendations focus on aspects of supportive environments and educational strategies, including final practicums, to assist nursing students' development of self-efficacy and preparation for the workplace.

BACKGROUND:Transplant rates in Ontario rose steeply in the decade prior to the COVID-19 pandemic. Reasons for that increase remain unclear, but the inter-organizational arrangement of organ donation programs may have contributed. However, there is a paucity of literature investigating these inter-organizational arrangements, with a limited understanding of how communication facilitates organ donation. Understanding these arrangements may help to re-establish rising organ donation rates post-pandemic.OBJECTIVE:To describe interprofessional interactions of Organ and Tissue Donation Coordinators (OTDCs) during organ donation cases, within organ donation programs in Ontario, from an organizational perspective (describing structure, context, process).METHODS:Mixed-method social network analysis (SNA) approach analyzing 14 organ donation cases just before the COVID-19 pandemic.RESULTS:Structure: Social network graphs depict the joint work performed by hospital staff and OTDCs, with a great part of the communication being processed through the OTDC.CONTEXT:Network density ranged from 0.05 to 0.24 across cases, and health care professionals perceived an atmosphere of shared vision and trust among team members.PROCESS:Most networks had a degree centralization <0.50 suggesting a decentralized information flow, and participants perceived decisions being jointly made. The characteristic path length of cases ranged from 1.6 to 3.2, suggesting potential for rapid information diffusion. Overall, data reinforced the OTDC role of intermediator within the communication process, and hospital staff perceived OTDCs as central players. Hospital staff and OTDCs reported frustration with some aspects of the flow of information during the organ allocation processes.CONCLUSION:Findings from this study provide a network map of communications within organ donation cases and reinforce the importance of the OTDC role. Opportunities for quality improvement within these processes are identified.

In Canada, nurses have known about the chronic shortage of nurses for years; the pandemic has just opened the floodgates. For the authors, the current nursing crisis and the accompanying response have led to flashbacks of the early 2000s, when extensive advocacy work took place to prevent a looming nursing crisis. In the key reports reviewed in this paper, the statement "lack of respect for nursing" has echoed over and over and over again and continues to be heard today throughout social media. Based on nurses' voices, meaningful respect starts with nurse leaders and administrators recognizing nurses' education, knowledge, values and experience; seeking and listening to nurses' voices and input on decisions affecting nursing; and striving for quality practice environments with reasonable workloads, adequate supplies and resources. While long-term planning must take place to correct this, there is no easy fix and no single strategy to turn the situation around quickly. Short-term strategies to relieve nurses' feelings of disrespect are a good place to start to retain nurses and stop the bleeding. It is time to work with all the nurses to find ground-level strategies to assure a sustainable and healthy nursing workforce for today and tomorrow. In this paper, the authors provide an overview of the meaning of respect both generally and from the nurses' perspective using the literature from the past 20 years. The authors then outline several implications for nurse leaders and administrators that are relevant today.

While nursing is a profession built on collaborative relationships, a lack of unity and historically disparate power structures have become entrenched within the profession during our long history. We are still having many of the same conversations today about the state of the profession as we were 30 years ago. If we want nurses graduating today to enjoy vibrant careers that will see them holding different sorts of conversations about the profession in 2040, then a blueprint for action to optimize intraprofessional practice is required. This paper provides an overview of a recent pan-Canadian report, paints a picture of the current landscape of nursing in Canada and outlines several key strategies to begin transforming intraprofessional practice.

Purpose Interprofessional collaboration (IPC) among health professionals is well-recognised to enhance care delivery and patient outcomes. Emerging evidence suggests that the early socialisation of students in health professional programmes to teamwork may have a positive impact on their future as collaborative practitioners. With a purpose of contributing to growing evidence on the processes of professional identity construction, and to explore how early expectations and perceptions of IPC develop during professional socialisation and pre-licensure education, our study examined the early professional socialisation experiences among five groups of health professional students. Method A qualitative, narrative approach was used to examine early professional socialisation among five programmes of health professional students (dentistry, medicine, nursing, pharmacy, physiotherapy) at an Atlantic Canadian University. In March and October 2016, students participated in interviews after first term (n = 44) and first year of study (n = 39). Interviews focused on participants' professional identify formation, as well as their perceptions and experiences of IPC. The authors analysed interview transcripts using narrative analysis. Results Findings identify that despite the espoused importance of IPC within health professional training, students have a limited understanding of their professional roles and are largely focused on developing a uniprofessional, vs. interprofessional identity. Clinical experiences, role models and exposure to teamwork are critical to contextualise collaborative practice and enhance the development of an interprofessional identity. Conclusions Findings can be used to guide the development of curricula that promote interprofessional identity development and IPC during early professional socialisation.

It is time to acknowledge what has been hidden inside Canada's healthcare system for decades but has become more visible during the COVID-19 pandemic: widespread stress, mental health problems and burnout in the nursing workforce. For the past 20+ years, repeated concerns about the mental health of nurses in Canada have been raised within many national reports, yet the rates have continued to rise.

Background Scope of practice enactment is poorly understood in the primary care setting. Purpose The following research objectives were addressed: (1) to revise and adapt the Actual Scope of Practice (ASCOP) questionnaire for use in the primary care setting, and (2) to determine internal consistency, construct validity, and sensitivity of the modified instrument. Methods To address the first objective, a narrative literature review and synthesis and an expert panel review was conducted. To address the second objective, a cross-sectional survey of 178 registered nurses who worked in primary care was conducted. Results The ASCOP, with few modifications, addressed key attributes of nursing scope of practice in the primary care setting. The modified instrument yielded acceptable alpha coefficients ranging from 0.66 to 0.91. Total mean score of 4.8 (SD = .67) suggests that registered nurses within interprofessional primary care teams almost always engage in activities reflected in the modified instrument. Conclusions The modified instrument is the first instrument validated to measure nursing scope of practice enactment in the primary care setting. Findings from this study support the use of the modified ASCOP questionnaire as a reliable and valid measure of scope of practice enactment among primary care registered nurses.

Background: Well-established performance measures for organ donation programs do not fully address the complexity and multifactorial nature of organ donation programs such as the influence of relationships and organizational attributes. Objective: To synthesize the current evidence on key organizational attributes and processes of international organ donation programs associated with successful outcomes and to generate a framework to categorize those attributes. Design: Scoping Review using a mixed methods approach for data extraction. Setting: Databases included PubMed, CINAHL, Embase, LILACS, ABI Business ProQuest, Business Source Premier, and gray literature (organ donation association websites, Google Scholar—first 8 pages), and searches for gray literature were performed, and relevant websites were perused. Sample: Organ donation programs or processes. Methods: We systematically searched the literature to identify any research design, including text and opinion papers and unpublished material (research data, reports, institutional protocols, government documents, etc). Searches were completed on January 2018, updated it in May 2019, and lastly in March 2020. Title, abstracts, and full texts were screened independently by 2 reviewers with disagreements resolved by a third. Data extraction followed a mixed method approach in which we extracted specific details about study characteristics such as type of research, year of publication, origin/country of study, type of journal published, and key findings. Studies included considered definitions and descriptions of success in organ donation programs in any country by considering studies that described (1) attributes associated with success or effectiveness, (2) organ donation processes, (3) quality improvement initiatives, (4) definitions of organ donation program effectiveness, (5) evidence-based practices in organ donation, and (6) improvements or success in such programs. We tabulated the type and frequency of the presence or absence of reported improvement quality indicators and used a qualitative thematic analysis approach to synthesize results. Results: A total of 84 articles were included. Quantitative analysis identified that most of the included articles originated from the United States (n = 32, 38%), used quantitative approaches (n = 46, 55%), and were published in transplant journals (n = 34, 40.5%). Qualitative analysis revealed 16 categories that were described as positively influencing success/effectiveness of organ donation programs. Our thematic analysis identified 16 attributes across the 84 articles, which were grouped into 3 categories influencing organ donation programs’ success: context (n = 39, 46%), process (n = 48, 57%), and structural (n = 59, 70%). Limitations: Consistent with scoping review methodology, the methodological quality of included studies was not assessed. Conclusions: This scoping review identified a number of factors that led to successful outcomes. However, those factors were rarely studied in combination representing a gap in the literature. Therefore, we suggest the development and reporting of primary research investigating and measuring those attributes associated with the performance of organ donation programs holistically. Trial Registration: Not applicable.

BACKGROUND:The COVID-19 pandemic is placing unprecedented pressure on a nursing workforce that is already under considerable mental strain due to an overloaded system. Convergent evidence from the current and previous pandemics indicates that nurses experience the highest levels of psychological distress compared with other health professionals. Nurse leaders face particular challenges in mitigating risk and supporting nursing staff to negotiate moral distress and fatigue during large-scale, sustained crises. Synthesizing the burgeoning literature on COVID-19-related burnout and moral distress faced by nurses and identifying effective interventions to reduce poor mental health outcomes will enable nurse leaders to support the resilience of their teams. AIM:This paper aims to (1) synthesize existing literature on COVID-19-related burnout and moral distress among nurses and (2) identify recommendations for nurse leaders to support the psychological needs of nursing staff. METHODS:Comprehensive searches were conducted in Medline, Embase and PsycINFO (via Ovid); CINAHL (via EBSCOHost); and ERIC (via ProQUEST). The rapid review was completed in accordance with the World Health Organization Rapid Review Guide. KEY FINDINGS:Thematic analysis of selected studies suggests that nurses are at an increased risk for stress, burnout and depression during the ongoing COVID-19 pandemic. Younger female nurses with less clinical experience are more vulnerable to adverse mental health outcomes.

Background The transition of new nurses into practice has been identified as challenging, and new nurses report having intentions to leave (ITL) jobs. Concerns of ITL are worrisome for the nursing profession, especially when faced with the need to replace an aging nursing workforce and to maintain quality patient care. Purpose Guided by components of Meleis et al.’s mid-range transition theory, the purpose of this study was to test a theoretical model linking transition and ITL, as well as the personal, community and societal conditions of transition. Methods A predictive, non-experimental design using cross-sectional data was employed. Ontario registered nurses, who had graduated within two years, were randomly selected to complete a mailed questionnaire in 2015 ( N = 217). Structural equation modeling was undertaken to test the model. Results The new nurses reported a relatively positive transition; yet, 44% of the respondents indicated leaving their first job, and 1% departed the nursing profession. A revised model of the constructs showed a more adequate fit with the data, but overall, the hypothesized model was not supported and methodological validity of tools questioned. From the modeling, lower role stress led to a positive transition. Conclusions Given organizational and governmental investments in orientation and transition programs, challenges in measuring transition and ITL requires additional research. Our findings highlight the value of organizations supporting new nurses by reducing role stress through reasonable workloads and expectations, which in turn contributes to a positive transition.

Unprecedented is one of the words that has been most frequently heard during the COVID-19 pandemic. We read daily about the ongoing challenges nurses and nurse leaders face in ways that one could not have imagined 15 months ago. With each wave of rising COVID-19 cases, we are reminded of the toll that this pandemic is having on nurses. Nurse leaders have described being scared of failing and not being able to guide or support their staff through the pandemic while recognizing the need to be a strong leader, resilient and adaptable to change every single day (Lapum et al. 2021). The uncertainty and complexity have been overwhelming, and throughout this crisis, nurse leaders have been continually asked to reach into their leadership toolboxes to find ways to support nurses within contexts that have rapidly changed over and over again.

Objectives To collate and synthesise available literature on burnout and compassion fatigue (CF) among organ and tissue donation coordinators (OTDCs) and to respond to the research question: what is known about burnout and CF among OTDCs worldwide? Design Scoping review using Joanna Briggs Institute methodology for scoping reviews. Data sources Medline, EMBASE, PsycINFO, CINAHL, LILACS, PTSpubs and grey literature (ResearchGate, OpenGrey, Organ Donation Organization (ODO) websites, open access theses and dissertations) up to April 2020. Study selection Studies reporting aspects of burnout and CF among OTDCs, including risk and protective factors. Data extraction Two reviewers independently screened the studies for eligibility and extracted data from chosen sources using a data extraction tool developed for this study; NVIVO was used to perform a qualitative directed content analysis. Results The searches yielded 741 potentially relevant records, of which 29 met the inclusion criteria. The majority of articles were from the USA (n=7, 24%), Canada (n=6, 21%) and Brazil (n=6, 21%), published between 2013 and 2020 (n=13, 45%) in transplant journals (n=11, 38%) and used a qualitative design approach (n=12, 41%). In the thematic analysis, we classified the articles into five categories: (1) burnout characteristics, (2) CF characteristics, (3) coping strategies, (4) protective factors and (5) ambivalence. Conclusion We identified aspects of burnout and CF among OTDCs, including defining characteristics, demographic predispositions, protective factors, coping strategies, precursors, consequences and personal ambivalences. Researchers described burnout and CF characteristics but did not use consistent terms when referring to CF and burnout, which may have hindered the identification of all relevant sources. This gap should be addressed by the application of consistent terminology, systematic approaches and appropriate research methods that combine quantitative and qualitative investigation to examine the underlying reasons for the development of burnout and CF among OTDCs.

Canadian Donation and Transplantation Research Program. Background: Research has shown that organ and tissue donation coordinators (OTDC) face challenging and stressful scenarios daily, leading often to burnout, attrition, and compassion fatigue1-3. Unfortunately, coping with those scenarios is overwhelming and OTDCs may resign in less than 3 years2, 3. Increased turnover rates of OTDCs would likely have significant negative impact Organ Donation Organizations’ optimization of donation. Therefore, as part of a national three-phase study, this scoping review aims to understand the nature of burnout problem worldwide and inform the development of following studies to identify and intervene in the causes to avoid losing experienced and exceptional OTDCs. Research question: What experiences of burnout, compassion fatigue, and/or attrition among Organ and Tissue Donor Coordinators worldwide have been reported? Methods: Systematic scoping following the Joanna Briggs Institute (JBI) methodology: Title/protocol registration followed by a three-step search strategy (figure 1) on PUBMED, CINAHL, EMBASE, LILACS) and grey literature (Organ donation association websites, Google Scholar (first ten pages), Research Gate, and consultation of international researchers and associations in organ donation field). Inclusion criteria: Documents reporting burnout syndrome, moral distress, attrition, or compassion fatigue, grief, trauma, vicarious trauma, secondary trauma, conflict, anxiety, psychological distress, PTSD, depression, resilience processes, and consequences of stress among OTDCs, full text in Spanish, Portuguese, French or English, no year limit. Data synthesis: quantitative analysis (e.g., frequency analysis) of general data on the type of study, country of study, etc.; and qualitative analysis (e.g. thematic analysis). Results: A total of 610 articles were identified and 149 duplicates were removed. During the title and abstract screening phase 362 articles were excluded. We reviewed 99 full texts and 21 articles were included for data analysis. A word cloud represents the 1000 most frequent words identified (figure 1).Fig. 1. The characteristics of the articles are summarized on table 1.Some authors clearly mentioned burnout (n=5,23.8%) or compassion fatigue (n=1, 4.8%), but the great majority only presented defining characteristics for both (n=15, 71.4%). The strategies used to manage burnout and compassion fatigue summarized on table 2.Qualitative analysis revealed 9 themes summarized on table 3.Conclusion: We identified articles mentioning burnout and compassion fatigue worldwide. Even though not all authors used the terms burnout or compassion fatigue, they mentioned defining characteristics. This review results will inform the development of a research question, and the best methodology for the next phase of a national study that will investigate and intervene in burnout and compassion fatigue among organ donation coordinators in Canada. We thank Katie O’Hearn, MSc, (Children’s Hospital of Eastern Ontario Research Institute) for methodological assistance, Amanda Ross-White, MLIS, AHIP (Bracken Health Sciences Library, Queen’s University) for developing the phase 1 search and peer review of the main MEDLINE search strategy and Margaret Sampson, MLIS, PhD, AHIP (Children’s Hospital of Eastern Ontario) for developing the main electronic search strategies. References: 1. Jesse MT, Abouljoud MS, Hogan K, Eshelman A. Burnout in Transplant Nurses. Progress in Transplantation. 2015;25(3):196-202. 2. Mao P, Cai P, Luo A, Huang P, Xie W. Burnout and Related Factors in Organ Donation Coordinators: A Cross-Sectional Study in China. Annals of transplantation. 2018;23:647. 3. Taylor G, McGaw J, Mayes G, Cossé TJ, Weisenberger T. The coordinator attrition problem in the United States: myth or reality? Journal of transplant coordination: official publication of the North American Transplant Coordinators Organization (NATCO). 1998;8(2):88.

In a high-speed pivot never seen before in post-secondary education in Canada, the COVID-19 pandemic upended every facet of academia. Almost overnight the system transitioned to remote teaching, empty campuses and research stoppages. Nursing school administrators were asked to make hundreds of decisions daily to ensure the safety of students, faculty and staff while maintaining education standards. Several months into the pandemic, circumstances are still far from normal as we continue to expect the unexpected and prepare to be nimble agents of change in the months ahead. This commentary outlines my observations as a faculty member during the past few months.

Background Building research capacity in nursing academic units continues to be a challenge. There are a number of external contextual factors and internal factors that influence individual faculty as well as the collective to engage successfully in research. Purpose The overall aim of this opinion article is to provide an overview of the current external and internal, processes and structures, relevant to capacity of nursing faculty to engage in research. Methods To inform the external context, we reviewed national research funding trends for nursing. To inform the internal context, we provided an exemplar of the internal processes and structures designed to support research capacity building within our academic unit. Results Canadian Institutes of Health Research funding trends for research grants led by nurse principal applicants increased between 2010 and 2013, followed by a steady decline. In 2017 to 2018, there were only 24 research grants led by nurse principal applicants. These external challenges coupled with the traditional internal barriers, such as the imbalance between teaching and research time, threaten research capacity for nursing academics. Conclusion Organizational strategies to promote research capacity within academic nursing units are a necessary requirement to move forward.