The COVID-19 pandemic triggered an abrupt transition to virtual rehabilitation across physiotherapy, occupational therapy, and respiratory therapy. While telerehabilitation research has documented feasibility and patient satisfaction, less is known about how professionals navigated the destabilization and reassembly of care practices during this transformation. Existing literature frames virtual care as a technical substitution for in-person services, overlooking the deeper reconfiguration of the socio-technical networks that organize therapeutic work. Applying actor-network theory (ANT), we examined how rehabilitation professionals reconfigured their practices through technology during the first year of the pandemic. We explored how digital tools, domestic spaces, and new sensory practices reshaped therapeutic presence, professional identity, and the environments in which care was enacted. We conducted a secondary analysis of longitudinal diary-interview data collected from 16 Canadian rehabilitation professionals (occupational therapists, physiotherapists, and respiratory therapists) working in community-based primary care in Ontario and Manitoba (2020-2021). Participants recorded audio diaries over 12 weeks and completed two follow-up interviews. Analysis followed an interpretive approach informed by Science and Technology Studies, tracing how human and technological actors were enrolled, adapted, and redefined within emerging care assemblages. Three interconnected processes characterized the reconfiguration of rehabilitation: (1) technology as active participant, where digital platforms mediated rather than merely transmitted therapeutic reasoning and clinical decision-making; (2) reconfiguration of therapeutic presence, as sensory attention and embodiment were redistributed across screens, sounds, and new forms of spatial choreography; and (3) enrollment of domestic spaces as clinical environments, as clinicians' and patients' homes became sites of care shaped by new ethical, material, and relational dynamics. These processes reveal that virtual rehabilitation constituted a new form of care co-produced by humans, technologies, and spaces rather than a digitized replication of traditional practice. The pandemic exposed rehabilitation as a socio-technical practice sustained through the coordination of multiple actors rather than professional expertise alone. Virtual care redefined therapeutic presence when traditional boundaries between clinical and domestic, human and technological, were blurred. Recognizing virtual care as a distinct modality underscores the need to integrate technology-mediated competencies into rehabilitation education and practice. Future research should incorporate patient perspectives and direct observation to trace how these care networks evolve.

In the hospital, the transition from fighting for life to preparing for death involves not only a shift in medical repertoires but also a profound transformation in temporal experience. Drawing on ethnographic fieldwork in a Canadian intensive care unit, this article examines how the tempo of care, its rhythms, urgencies, and pauses shapes consciousness at the threshold of death. I follow Suzanne, a patient whose cardiac arrhythmia brought her care team to an urgent crossroads, where the frantic pace of acute care collapsed into the slower movements of palliative preparation. Building on previous work identifying the legal, curing, and care repertoires guiding end-of-life decisions, I argue that tempo functions as a fourth dimension modulating how these repertoires are deployed and experienced. When urgency drops, time becomes palpable: thickening around bodies, words, and gestures revealing dying as not merely a biological event but a choreographed, intersubjective accomplishment collectively sensed, negotiated, and enacted.

Terminal extubation, the planned withdrawal of mechanical ventilation from patients who will not recover, presents significant technical, ethical, and emotional challenges for respiratory therapists (RTs), yet their perspectives remain underexamined. Using Max Weber's concept of ideal types, this interpretive description study explored how RTs understand and enact their role at life's end. Twenty-nine RTs (20 in Canada and 9 in the United States) participated in semi-structured video interviews. Analysis revealed a continuum between two orientations: task-centered RTs emphasize technical precision, protocol adherence, and emotional detachment, often relying on informal or maladaptive coping strategies. Event-centered RTs approach extubation as a shared human experience, integrating emotional presence with clinical skill and supporting families and teams, though institutional support for such practices is limited. These orientations are fluid and context-dependent. Findings extend Weberian theory by showing how instrumental, value-rational, affective, and traditional motives converge in a single clinical act. To better support RTs, we recommend (a) inclusion in decision-making and debriefing, (b) training that blends technical and relational competencies, and (c) policies that legitimize diverse ways of "doing" terminal extubation. These shifts could reduce burnout, foster collaboration, and improve end-of-life care for patients and families.

Medical technologies like mechanical ventilators have introduced complexities to end-of-life decision-making by placing patients in a liminal 'zone of indistinction', where their status as living or dying is uncertain. This paper examines a week in the life of Margarite, a 68-year-old woman intubated and ventilated due to pneumonia, to explore how her identity as a living or dying person was negotiated by healthcare professionals and family members. Drawing on the concept of situated identity, this study reveals how perceptions of Margarite's status shifted over time and across contexts, influenced by medical information, cultural beliefs, and emotional dynamics. Initially viewed as a fighter, legitimising continued life support, Margarite's status transitioned for some to that of a dying person, prompting calls for withdrawal of care to ensure a dignified death. Others remained uncertain, perceiving her as caught between these states. This case study highlights the fluid and situated nature of identity in end-of-life care and the challenges posed by indecision in the 'zone of indistinction'. By centring on Margarite's journey, this paper sheds light on how identity construction influences the decision to continue or withdraw life support.

BACKGROUND:Intensive care units house critically acute patients requiring extensive treatments and specialised care. Highly trained healthcare providers work tirelessly to perform life-sustaining measures, but when all possible treatment options have been exhausted, it sometimes becomes necessary to withdraw treatment. This process places critical care nurses and the interprofessional teams at the centre of emotionally and ethically challenging end-of-life care. OBJECTIVES:The objective of this review was to synthesise what is known about the types of moral, emotional, and psychological distress experienced by healthcare providers during treatment withdrawal in adult intensive care units and to summarise the support strategies described in the literature to mitigate these experiences. RESULTS:Nine studies met inclusion criteria, representing 883 healthcare professionals across eight countries. Emotional distress was linked to repeated exposure to death, patient-family relationships, and the act of extubation. Moral distress arose from perceived prolongation of suffering, contradictions with patient wishes, and exclusion from decision-making. None of the studies directly measured psychological distress, representing a critical gap. Nurses consistently reported the greatest burden, often coordinating care and supporting families while being excluded from withdrawal planning. Across all studies, institutionalised support strategies were absent, with providers relying on individual coping mechanisms. CONCLUSION:Withdrawing treatment is a task that can lead to emotional and moral distress of healthcare professionals. This review highlights the disconnect between predictable distress and the absence of systematic institutional support. Collaborative planning, standardised withdrawal protocols, mandatory breaks, and structured debriefing could help transform withdrawal experiences into opportunities for meaningful end-of-life care. IMPLICATION FOR PRACTICE:The findings suggest that institutionalising interprofessional collaboration, communication training, and postextubation debriefing could reduce moral distress and improve team resilience during terminal extubation procedures.

Registered Respiratory Therapists (RRTs) have unique skills in managing chronic obstructive pulmonary disease (COPD) in primary care settings. With an 82% increase in COPD diagnoses between 2000 and 2010 in Canada, the fact that over 10% of Canadians aged 35 and older are living with COPD, and primary care reform in Ontario and Manitoba, we would expect an increasing number of RRTs working in this setting. However, this is not happening. Through the concept of job satisfaction, we want to investigate the barriers of integrating this allied healthcare professional into primary care settings. Using a pragmatic approach, we examined RRT job satisfaction in primary care via semi-structured interviews of 19 RRTs in Manitoba and Ontario in 2018 and 2019. A combined inductive and deductive (Mottaz framework) analysis approach allowed us to cross reference work context with job satisfaction. The context in which primary care is operationalized impacts RRT job satisfaction. In Ontario, retention of RRTs in primary care was the main issue due to lower salaries and benefits. In Manitoba, recruitment of RRTs in primary care was the main issue due to lack of human resources and funding. Efforts should be made to address gaps in job satisfaction of RRTs in primary care. To improve retention in Ontario, RRTs should be compensated similarly to their counterparts in acute care. In Manitoba, there should be increased positions for RRTs in primary care. Developing strategies for enhancing job satisfaction will ensure the delivery of high-quality, patient-centered care. This study provides both theoretical and practical contributions to primary care workforce research. Theoretically, our findings demonstrate how contextual factors moderate job satisfaction, showing that the primary care context produces various work situations and heavily impacts work satisfaction. Practically, our results offer specific guidance for healthcare policymakers and administrators, including standardizing compensation across care settings, converting part-time positions to full-time roles, and developing targeted educational initiatives to improve workforce recruitment and retention in underserved areas.

When someone is very ill in Canada, the individual is taken under charge of the medical system and put on one of two distinct paths for handling the situation: either acute or palliative care. In the acute path, all available medical technology is deployed to save lives and avoid death, while the main objective of the palliative path is comfort, as death becomes inevitable and expected. The two paths are ordinarily seen as part of a linear process, wherein acute care is initially deployed and palliative care only after acute care is determined ineffective. In practice, however, the two paths are intermittent, as the reasoning repertoires that guide care practices along both paths are constantly renegotiated by care teams. This article follows the decision-making process regarding the use of the ventilator for two individuals at the end of their lives as their care teams alternate between legal, curing, and care repertoires. The entanglement of these repertoires leads to unexpected care practices as patients are shifted from one path to another. In both cases, the transition from acute to palliative care was nonlinear, and the purposes of the possible medical actions that could be taken along the two paths kept changing as events unfolded.

Background/Objectives: Aerosolized medications are common practice for mechanically ventilated pediatric patients. Infants often receive nebulized medications via hand ventilation using an anesthesia bag, but evidence on optimal aerosol delivery with this method is limited. For this study, various configurations of the Mapleson breathing circuit were tested to optimize albuterol delivery to a simulated pediatric model. Methods: Using a simulated pediatric lung model (ASL 5000) with the semi-open Mapleson anesthesia circuit, 2.5 mg/3 mL of albuterol sulfate solution was nebulized to a viral/bacterial filter (Respiguard 202). Four models were compared with varying fresh gas flows (FGFs), small-volume nebulizer (SVN) placements, and adjusting dead space. Five Registered Respiratory Therapists (RRTs) bagged the aerosol into a collection filter following defined ventilation parameters. Each model was tested in random order to avoid fatigue bias. Albuterol concentrations eluted from in-line filters were measured by spectrophotometry (absorbance at 276 nm). Results: No inter-user variability was observed among the RRTs. Significant differences in albuterol recovered were noted between models (One Way ANOVA, Tukey’s post hoc, n = 5). Model 4, with the nebulizer closest to the collecting filter, recovered 21.77 ± 1.89% of albuterol. The standard clinical model was the least effective, with only 0.10 ± 0.17% albuterol recovery. Conclusions: Modifying the anesthesia breathing circuit significantly improved aerosol drug delivery efficiency. Our findings suggest that current clinical practices for nebulized drug delivery are inefficient and can be markedly improved with simple adjustments in nebulizer positioning and gas flow within the circuit.

Introduction The COVID-19 pandemic required substantial changes in delivery of team-based primary care, impacting both how and which patients accessed the more comprehensive services teams provide. We sought to explore changes in access to primary care rehabilitation services during the first year of the COVID-19 pandemic to identify potential new problems and improvements. Methods In this longitudinal study, sixteen rehabilitation professionals working on primary care teams in Manitoba and Ontario recorded audio-diaries and later participated in interviews throughout the first year of the pandemic. Qualitative analysis included data immersion, coding to identify the practice changes and associated access impacts, then applying Levesque and colleagues’ Patient-Centred Access to Healthcare framework to interpret findings. Findings Participants described service changes that both enhanced and reduced access, including redeployment, outreach, virtual care, discontinuation of some services and start of new ones, and new risk management strategies. Some implied equity-specific impacts. Virtual care and outreach activities created access for patient populations who previously may have been underserved, while virtual care, redeployment, and new risk management activities created new access barriers and inequities, leaving some patients completely unable to reach care. Changes to team collaboration activities could help or hinder access. Conclusion Continuing outreach activities, strengthening team collaboration, and thoughtfully integrating virtual care can improve access to comprehensive primary care. As the primary care sector works to recover from pandemic impacts and address population health needs, applying a patient-centred access framework during practice redesign offers a meaningful way to strengthen services.

BACKGROUND:In Canada, disparities between Indigenous and non-Indigenous Peoples continue to exist in health and education because of the past and current harms of racism and colonization. One step towards closing health gaps is clinicians who can provide health and social care services that are free of racism and mistrust. Indigenous health providers are in the best position to provide this culturally relevant and safe care to their own communities. Therefore, more Indigenous students graduating from health professional programs are required to meet these needs. Indigenous identity support can be a facilitator for Indigenous student academic success but developing one's Indigenous identity can be challenging in post-secondary education environments. We explored how Indigenous rehabilitation students expressed, and wanted to be supported in their identity and academic success.METHODS:Using a narrative inquiry approach, we conducted interviews with seven students from the occupational, physical, and respiratory therapy programs of a Canadian university. Students were asked to tell their story of learning about, applying to, and being in their rehabilitation program and how their Indigenous identity impacted these experiences. Data analysis was conducted by Indigenous and non-Indigenous team members, analyzing the stories on interaction of the participant with (1) themselves and others, (2) time, and (3) situation or place.RESULTS:The researchers developed seven mini-stories, one for each participant, to illustrate the variation between participant experiences in the development of their Indigenous and professional identity, before and during their rehabilitation program. The students appreciated the opportunities afforded to them by being admitted to their programs in a Indigenous Peoples category, including identity affirmation. However, for most students, being in this category came with feared and/or experienced stigma. The work to develop a health professional identity brought even more complexity to the already complex work of developing and maintaining an Indigenous identity in the colonized university environment.CONCLUSION:This study highlights the complexity of developing a rehabilitation professional identity as an Indigenous student. The participant stories call for universities to transform into an environment where Indigenous students can be fully accepted for their unique gifts and the identities given to them at birth.

BACKGROUND:Occupational, physical and respiratory therapists are relatively new to primary care settings, and thus their roles are still emerging. The COVID-19 pandemic was a time of abrupt changes in professional roles. Professional role adaptations are integral to the ability of health care teams to respond to day-to-day care delivery challenges, such as the current physician and nurse shortage, as well as disaster situations. This study explored the role adaptation of occupational, physical, and respiratory therapists in Canadian primary care settings throughout the first year of the COVID-19 pandemic, as well as barriers and facilitators to adaptation.METHODS:This longitudinal interpretative descriptive study purposively sampled primary care occupational, physical, and respiratory therapists from two Canadian provinces (Manitoba and Ontario). We asked participants to prepare at least 10 semi-structured audio-diary entries during a 12-week period (April - Oct 2020), followed by two semi-structured interviews (Dec 2020, Apr 2021). Questions focused on changes happening in their practice over time. Analysis was iterative, including developing a individual summaries and coding data using both inductive and pre-determined codes. We then entered an immersion/crystallization process to develop key themes related to role adaptation.RESULTS:We represent our findings with the metaphor of the game of Role Adaptation Snakes and Ladders (aka Chutes and Ladders). The pandemic was certainly not a game, but this metaphor represents the tension of being a pawn to circumstance while also being expected to take control of one's professional and personal life during a disaster. The object of the game is to move through three phases of role adaptation, from Disorienting, through Coping and Waiting, to Adapting. In the Adapting phase, the therapists creatively found ways to provide vital services for the pandemic response. The therapists were influenced both negatively and positively (snakes and ladders) by their personal circumstances, and professional meso and macro contexts. Each therapist moved across the board in a unique trajectory and timeline based on these contexts.CONCLUSIONS:Rehabilitation professionals, with adequate meso and macro system supports, can maximize their role on primary care teams by adapting their services to work to their full scope of practice.

Context: In Canada, physical, occupational, and respiratory therapists (PORTs) have joined primary care teams to improve the comprehensiveness of primary care, especially for chronic condition management. We have little research on the roles of PORTs in primary care, and minimal guidance on possible adapted roles for PORTs in disasters, such as pandemics. Objective: Explore clinical adaptations made, and micro/meso/macro challenges primary care PORTs experienced, in the first year of the COVID-19 pandemic. Study design/instruments and analysis: A longitudinal semi-structured diary-interview study, involving 12 weeks of audiodiaries (Apr-Oct 2020), and two interviews (Dec 2020/Jan 2021; Apr/May 2021). Analysis focused on change over time within each case, and cross-case comparisons. Setting: Primary care clinics in Ontario and Manitoba Population studied: PORTs Instrument: Semi-structured diary prompts; semi-structured interview guide. Outcome measures: N/A Results: Initial weeks were marked by confusion, including about how to adapt care, with much emotional strain and uncertainty. At a micro level, each profession suffered a disorienting loss of central role early in the pandemic. Over time, they created new methods to meet patients’ needs, including strengthening education and support for health behavior change and chronic condition management. The move to virtual care was mostly unplanned, with limited or untimely supports. Over time, they perceived benefits of virtual care, and hope to continue offering this option for some patients. At the meso level, team functioning was much like it was pre-pandemic; those with strong teams found new ways to maintain relationships, while others remained isolated. Participants described multiple disconnects with the macro-level decision-makers, and redeployment assignments made it evident that health administrators did not understand their role, and the important work that they were leaving behind. Conclusions: Despite challenges and barriers, the participants showed creativity and adaptability in the pandemic. In the face of negative impacts on some aspects of practice, therapists tested and embraced practices, some of which may continue post-pandemic, including a broader use of technologies and a broadened scope of practice that can positively contribute to patient outcomes in primary care. Moving forward, better understanding of PORTs’ contributions, and involvement in pandemic could improve future response.

Disciplines anchor themselves using a particular kind of epistemology and ontology to produced it’s knowledge. In healthcare, quantitative research has been dominant were in social sciences, qualitative research was. However, in the last two decades, we have seen a mixing (better said in French with the word métissage) of strategies within those two disciplines. Despite the newfound acceptance of qualitative research within the healthcare field, some criticism about those strategies still exists and still impact the feasibility of conducting qualitative research, especially in hospital setting. More particularly, when it comes to the systematisation of the method, when conducting ethnography. In this paper, I argue that ethnography does remain scientifically rigorous, especially when it is informed by theory and used consistently. This article presents the ways in which I negotiated the uncertainties of doing a hospital ethnography on the use of the ventilator by using concepts from Latour’s (2005) Actor’s Network Theory, of ‘mediators’ and ‘intermediaries’. Staying attuned to various actors in the healthcare setting and taking care to ensure that whatever my research brought into the field maintained an intermediary status enabled me to alter my methods in the field while still respecting the necessity to gather data systematically.

Objectives:Delivering aerosolized medication to patients during mechanical ventilation is a common practice in respiratory therapy for adult, pediatric, and neonatal populations. However, aerosol delivery in pediatric populations is inconsistent and challenging, impacting how the drug is delivered. Some factors that influence drug delivery efficiency are directly under the purview of the clinician or therapist administering the drugs. However, excessive variability exists amongst clinicians and therapists working at the same site and between different sites. This review aims to systematically summarize the literature to identify current practice variations, identify common practices, and provide suggestions to guide future research in this area. In addition, this scoping review aims to identify the available evidence and knowledge gaps in the literature regarding the delivery of aerosolized medication to pediatric populations during mechanical ventilation. More specifically, the question that guided our research was: What are the best strategies for optimizing aerosol delivery of medication to pediatric patients, including neonates, while on mechanical ventilation? Methods:A scoping review, using the Joanna Briggs Institute methodology, was conducted until September 2022 in the CINAHL, EMBASE (Ovid), and Medline (Ovid) databases. Our initial search yielded 248 articles. After screening the titles, abstracts, and full text of the articles according to inclusion and exclusion criteria, five articles were analyzed. Results:We identified three main topics for discussion: the type of device used for administering aerosolized medication, appropriate mechanical ventilation settings, and optimal placement of the nebulizer delivery system. Conclusion:Of the three topics we intended to discuss, we only found enough evidence to suggest using mesh nebulizers to increase aerosol deposition. We found conflicting or outdated results for the other two topics. This demonstrates a significant gap in the literature since aerosol medications are routinely administered to mechanically ventilated neonatal and other pediatric patients.

In this article, we examine primetime television as a source of entertainment-education on death. Using directed (deductive) and conventional (inductive) approaches to content analysis, we describe how death and dying are being depicted on two primetime medical television series, Grey's Anatomy and Saving Hope. We then discuss what kinds of information viewers may be taking from these series. Our deductive content analysis suggests that much of the messages obtained are fairly representative of what occurs in real hospital settings, with the exception of emotional display. From the inductive analysis, we identified four thematic categories: 'the person dies, but life goes on', 'the tragic death', 'the purposeful death', and 'the well-timed death'. Regardless of category, no rituals are conducted at the moment of death and little space is made for grieving on primetime medical television shows. While death is often present, displays of grief are avoided.

Diary-interview studies are a longitudinal qualitative approach that allows both participants and researchers to explore participants’ experiences and sense-making in relation to life situations. The purpose of this Methods Brief is to introduce readers to the diary-interview method and highlight methodological decisions researchers need to make when using this type of qualitative approach to generating data. We will introduce each of these decisions in turn, then detail the methodological options. To further exemplify, we describe our 2020–2021 diary-interview study of Canadian primary care clinicians navigating the first year of the pandemic.

While treatment is often withdrawn from patients in intensive care units (ICUs), few people outside the healthcare profession have witnessed a death under such circumstances. Family members who have made the decision to withdraw treatment may have expectations about the dying process, what constitutes a good death and how they should behave in an ICU based on popular prime-time television series. An inductive comparative thematic coding strategy is therefore used to examine how death following treatment withdrawal as depicted in a US medical drama (Grey's Anatomy) differs from realities observed for 6 months fieldwork at an ICU in Canada. Three common frames (privacy, emotional control and memorialising) help patients' intimates normalise the unfamiliar experience and guide their behaviour during the event. However, discrepancies between media representations and experiences in the ICU, especially around the frames of timing of death and the physicality of the unbounded body (incontinence and agonal breathing), can traumatise them. The bereaved may be left viewing ventilator withdrawal and dying as chaotic processes and believing their loved one suffered through a bad death. Understanding these normative and discrepant frames should help healthcare professionals better prepare the public to witness death.

The 1996 Health Care Consent Act of Ontario (Canada) is a law that regulates medical decision making. Therefore, it also gives indications on how end of life decisions should be made. The goal of the law was to ensure and protect patient’s autonomy and avoid medical paternalism, especially at the end of life. Throughout this article, I would like to argue that one of the consequences of the 1996 Health Care Consent Act of Ontario is to promote individualism. Therefore, this law makes it improbable to attain a shared decision model. More specifically, the way the 1996 Health Care Consent Act is currently written, a proxy is assigned as a decision-maker for someone who is deemed incompetent. However, it also ensures that the proxy will be the only one with the burden of that decision. This argument will be supported by providing a qualitative description of three cases that I have encountered during my six-month fieldwork in the Intensive Care Unit (ICU) of a hospital located in Ontario. This paper offers a reflection upon the consequences of using an alternative decision maker (proxy) to withdraw life support.