Introduction: Despite the global shortage of nurses, there is limited literature that comprehensively maps interventions to support, stabilize, and enhance the nursing workforce. Purpose: This umbrella review aimed to identify structures, interventions, and health system arrangements that healthcare systems have put in place to stabilize, support, and sustain the nursing workforce. Methods: The review is guided by the Effective Practice and Organization of Care (EPOC) taxonomy and aimed to synthesize review-level evidence relevant to nursing workforce planning and policy development within a policy-relevant timeframe. Reviews that evaluated one or more interventions to stabilize, support, or enhance the nursing workforce within healthcare systems were considered for inclusion. We conducted academic literature searches in MEDLINE, Embase, CINAHL, and Scopus on March 11, 2024, and conducted grey literature searches in Google from April 11–16, 2024. The search strategy combined controlled vocabulary and keywords related to nurses, recruitment and retention, and review study designs. Searches were limited to sources published between January 2014 and March 11, 2024, and to English and French. Two reviewers independently screened and extracted each identified article.We used the JBI critical appraisal checklist for systematic reviews and research synthesis to appraise the included reviews, applying it pragmatically across the heterogeneous review designs in the sample. This approach was selected to provide a single, transparent review-level appraisal process across the included sample; however, it was used as a pragmatic indicator of methodological and reporting completeness. Findings: We categorized the included interventions using the EPOC taxonomy. Following screening, we selected 69 studies for inclusion, the majority of which addressed implementation strategies (n = 60) or delivery arrangements (n = 8). The findings directly addressed the primary objective of identifying interventions used to support nursing workforce sustainability and highlighted important evidence gaps related to rural and remote settings, diversity and representation, population needs, equity, and governance and financial arrangements. Discussion/Conclusion: The findings of this umbrella review suggest that there is no one-size-fits-all approach for supporting the nursing workforce; rather, a multi-level, multi-pronged approach may be more appropriate to collectively have the most impactful outcomes.Limitations of this review include the heterogeneity of the included review designs and the pragmatic use of a single appraisal approach across those designs, which limits direct cross review quality comparisons. Future studies should incorporate rigorous implementation and evaluation plans, focusing on the long-term impacts of strategies.The targeted grey literature search was designed to identify review-level synthesis.

BACKGROUND:Canada is committed to supporting internationally educated nurse (IEN) integration into the healthcare system, as a strategy to address post-pandemic nursing shortages. The province of Nova Scotia has emerged as a Canadian exemplar with the development of NICHE (Nova Scotia's International Community of Healthcare Workers Engagement) programme, which anchors intersectoral collaboration between the government, the nursing regulator and healthcare systems in service of streamlining IEN integration. METHODS:We conducted a province-wide realist evaluation of the integration of IENs into the Nova Scotia healthcare system and community. We collected data from interviews with 24 participants, comprised of IENs and stakeholders at meso- and micro-healthcare system levels. We used a theory-driven approach to data analysis which utilised elements of content analysis, reflective dialogue and the construction of CMOCs (context-mechanism-outcome configurations). RESULTS:We constructed three main CMOCs which highlight facilitators for IEN integration related to (1) the development of adaptive programme pathways for IENs, (2) the critical role of IEN allies and advocates within healthcare systems, and (3) the shift in focus from recruitment to retention. CONCLUSIONS:The study findings describe the contextual factors and key mechanisms that promote 'successful' IEN integration which may be useful for leaders and policymakers integrating IENs into their local health human workforce. The findings raise important questions about supporting IEN retention, consistent with the vision for a healthy and sustainable nursing workforce. The findings from this study underscore the need for further evaluation research in on the topic of IENs.

PROBLEM:Disruptions to sexual health after childbirth are common. While physiological changes are well documented, there is less evidence examining the psychosocial dimensions of postpartum sexuality. BACKGROUND:Sexual identity is a key psychosocial component of sexual health that may shift postpartum. New mothers' sense of sexual self may change in response to demands and expectations of motherhood. Research suggests that dominant social discourses shape how individuals navigate sexual identity in early postpartum; however, little is known about how individuals make meaning of their sexual identity and intimacy in the later postpartum period, particularly in relation to these discourses. PURPOSE:To explore how individuals make meaning of sexual identity and sexual intimacy in the later postpartum period. METHODS:Eight postpartum individuals living in the Canadian province of British Columbia completed semi-structured interviews. Data was analysed using discourse analysis informed by feminist poststructuralism. FINDINGS:Participants described difficulty prioritizing sexual identity and intimacy amidst the work of parenting. They recognised dominant discourses framing motherhood as all-consuming and desexualised, and resisted these narratives by reshaping motherhood as something that may include sexuality. Participants also intentionally reframed sexual and emotional intimacy as valuable, and redefined intimacy with partners to better align with their current realities as parents. CONCLUSION:Individuals in the later postpartum period continue to experience shifts in subjective positioning as mothers and as sexual beings, as well as with intimacy. Their experiences are shaped, in part, by dominant social discourses about motherhood and sexuality, which they may negotiate and contest as they reconstruct meaning in this stage.

Health promotion policy is an effective way to improve population health and reduce the burden of chronic disease, yet how implementation of health promotion at policy levels occurs within healthcare remains unclear. Healthcare organizations, on the one hand, aim to improve population health and 'upstream' health determinants through the Quintuple Aim, but, on the other, are complex and dynamic organizations, with a particular emphasis on downstream clinical care services. Many types of practitioners interpret health promotion policies within the healthcare setting and must implement them in their everyday work: policy implementation as an everyday occurrence. Healthy eating policies focused on creating supportive food environments (e.g., cafeterias, cafes) are being adopted by healthcare organizations as a way to improve diets and reduce the burden of chronic disease. An examination of healthy eating policy implementation is essential to better understand how health promotion is integrated into healthcare organizations. This qualitative phenomenological study uses organizational social theory on street-level bureaucrats to interpret the implementation of a healthy eating policy within healthcare food retail services and the relationships between street-level bureaucrats. We conducted 12 in-depth policy key informant interviews and analysed findings using directed content analysis. The findings showed a shift in priorities from leadership to allocate resources for health promotion tasks to make food more accessible and available to staff. Participants considered context as they implemented the policy using local knowledge arising from informal and formal networks and identified other opportunities to influence healthy eating. Studying the actions of healthcare practitioners in everyday policymaking provides essential context and insight into how policy implementation unfolds. Although standards for health promotion are lacking, practitioners can engage in quality improvement initiatives to challenge the status quo and improve food environments.

Primary care is crucial for reducing health disparities and enhancing population health. The COVID-19 pandemic exacerbated long-standing challenges for Canada in maintaining robust primary care; however, it also presented opportunities for health system transformation. One such transformation was the rapid implementation of Mobile Primary Care Clinics (MPCCs) in the Atlantic Canadian province of Nova Scotia to enhance healthcare accessibility and alleviate pressure on emergency departments (EDs). This evaluation aimed to assess the impact, implementation, and partner experiences of MPCCs as another point of primary care access for Nova Scotians. The evaluation involved a mixed-methods approach (September 2022–October 2023) guided by implementation outcomes of effectiveness, efficiency, acceptability, and feasibility. Data sources included clinic utilization and cost records, administrative data, patient and provider surveys, and a questionnaire from the implementation team. A scenario-based economic analysis with probabilistic sensitivity analysis (PSA) was performed from a third-party payer perspective. ED diversion estimates were derived by combining survey-reported counterfactual care-seeking behaviour with observed ED utilization within 72 h of an MPCC visit, identified through linkage to provincial administrative data. Across 157 clinic days, 13,019 visits were recorded. The most common presentations were respiratory or dermatological complaints and prescription renewals. Among 1,888 patient survey respondents, 23.7

BACKGROUND:Healthy eating policies are of growing importance to the management of retail food environments in healthcare (e.g., hospital cafeterias). Several researchers have begun to analyse health promoting benchmarks within these policies. However, little is understood about the relationship between policy and continuous quality improvement (CQI) for health promotion in healthcare. Furthering our understanding of benchmarks within these policies could provide insight into how we can measure and create standards in health promotion. This policy analysis examined publicly accessible healthcare healthy eating policies in Canadian health authority jurisdictions, up until November 22, 2022. METHODS:Data was extracted using a monitoring and evaluation framework for evaluating nutrition policies in publicly funded institutions, with adaptations based on organisational CQI concepts. Policy components analysed included: policy design, nutrient profiling systems, nutrition standards, evaluation, and monitoring. A second reviewer independently extracted data and peer debriefing was completed on the extractions. RESULTS:This analysis identified five healthy eating policies meeting the inclusion criteria, from Alberta, British Columbia, Newfoundland and Labrador, Nova Scotia, and Winnipeg, Manitoba. Policies included nutrient profiling, including benchmarks for selling healthy, moderately healthy, and less healthy food and beverages. Other benchmarks were mentioned but contained fewer indicators (e.g., fundraising, catering, and advertising). Policies included benchmarks about product and placement (e.g., healthier items in visible places) but less about price. The included policies promoted collaboration amongst healthcare providers but lacked details about evaluation and monitoring. CONCLUSION:This policy analysis suggests that different healthcare settings may require different benchmarks, tailored to their contexts. Furthermore, standardisation may not be optimal if further experimentation is needed to identify benchmarks for health promotion practices, as is common in healthcare CQI. Policy implementation requires a combination of top-down and bottom-up approaches, and collaboration with multiple partners may be necessary for success. Benchmarking processes are a potential strategy for understanding improvements to other aspects of the food environment beyond nutrient standards. SO WHAT:CQI and retail food environments each focus on customer satisfaction and costs, thus sharing alignments. CQI benchmarking processes are a potential strategy for understanding improvements to other aspects of the food environment beyond nutrient standards. Further exploration is needed to implement and monitor benchmarks over time.

Background: Globally, the COVID-19 pandemic has amplified healthcare provider shortages. In Canada, multipronged strategies have been implemented to strengthen the nursing workforce; one widely implemented approach includes the expedited integration of internationally educated nurses (IENs). In 2022, the province of Nova Scotia (NS) collaborated with intersectoral partners to support the recruitment and retention of internationally educated nurses (IENs) who wish to relocate to NS. The Nova Scotia’s International Community of Healthcare Workers Engagement (NICHE) program was developed to facilitate the integration of IENs, by connecting key partners and decision-makers across the government (e.g., immigration services), nursing regulation, healthcare organizations and community supports, all with a shared vision for successful IEN integration into NS. A unique feature of the NICHE program was the intention to provide wraparound supports for the IEN workforce, by facilitating integration into the workplace (e.g., healthcare system), while connecting them with social services to support their integration into NS communities. Approach: We conducted a provincial realist evaluation (Pawson & Tilley, 1997) of the integration of IENs into Nova Scotia. We collected data via program documents and 24 interviews with: program leadership [macro-level]; organizational leaders, managers and administrators [meso-level]; and IENs from staggered cohorts [micro-level]. All interviews were audio-recorded and transcribed verbatim. Using a content analysis approach, narrative data from the interviews and documents were constructed into themes, which informed a knowledge user summary report. Results: The themes described (1) the IEN experiences of transition – inclusive of workplace integration and community integration, (2) the macro- and meso-level contextual factors and mechanisms which supported “successful” IEN integration, and (3) recommendations for desired long-term outcomes, such as IEN retention and program sustainability. This evaluation illustrates the high degree of intersectoral collaboration and commitment required by partners across healthcare, government, immigration, and community/housing support to facilitate IEN integration into the healthcare workforce and local communities. Areas for development pertain to the needs for: (1) equity-informed approaches to improve psychological safety for IENs in the workplace, and (2) enhanced community supports for IENs, particularly in relation to housing and childcare needs. Implications: Our findings will inform the provincial Nursing Workforce Strategy and provide strategies to better facilitate IEN integration into the Canadian healthcare system and communities. This research highlights that health and social care integration are necessary to support shifting workforce demographics, particularly in areas integrating internationally educated health professionals.

Interprofessional collaborative practice (IPC) occurs when health professions work collaboratively to improve quality of care and enhance patient outcomes. Yet myriad challenges to enacting collaborative practice exist. Interprofessional education for collaborative practice (IPECP) is foundational for promoting collaboration among health professions, yet there is a gap in understanding how students perceive their readiness for IPC and how early socialization experiences may contribute to developing a dual—uni-professional and interprofessional—identity. This study seeks to understand how new practitioners perceive and experience IPC upon entry to practice, and identify individual and systemic factors that facilitate and impede dual identity development. An interpretive, narrative methodology was used to understand the IPC and early professional practice experiences of 24 individuals from a longitudinal study of five health professions. Facilitators to interprofessional identity development included exposure to/working with interprofessional teams, settings, role models, and directly experiencing benefits of collaborative practice during patient care. Impediments include settings and situations where professional stereotyping and hierarchies were reinforced by the dominant uni-professional culture of work environments. Interprofessional socialization and identity development are contingent on exposure to interprofessional role models and settings. Healthcare professionals’ dual identity development begins in pre-licensure IPECP but is shaped by socialization experiences within practice. Healthcare institutions need to provide nourishing collaborative environments (time, settings, and contexts) that foster interprofessional collaboration and behaviors and empower dual identity formation. Post-licensure IPECP for healthcare professionals to continue to learn with, from, and about one another in practice is essential for collaborative interprofessional healthcare teams/systems.

Continuous quality improvement (CQI) has become a widely accepted approach to optimize health services while lowering healthcare costs (Quintuple Aim) and has expanded from clinical interventions to health promotion. Retail food environments (e.g. hospital cafeterias, cafes) are of interest given the increased adoption of healthy eating policies and interventions to influence diet (e.g. price, promotion, placement and product). However, there is a lack of understanding of what organizational and policy processes are necessary to implement CQI for health promotion in healthcare. This research uses a qualitative multiple exploratory case study design to explore the barriers and facilitators of CQI for health promotion in healthcare retail food environments. This research occurred in a healthcare setting with an organizational Healthy Eating Policy applicable to staff, patients and visitors. We collected semi-structured interview data with 12 healthcare staff working in Nutrition & Food Services in a Canadian provincial health authority from January to June 2023. We used directed content analysis to analyze the data. We used the Inside out model to interpret cross-cutting organizational barriers and facilitators. Four cases of quality improvement interventions (Plan-Do-Study-Act (PDSA) cycles) were identified. Barriers included expertise to interpret nutrient criteria, lack of data, conflicting benchmarks (e.g. finance and health), third-party vendors, past negative experiences, and a lack of time to monitor and evaluate. Facilitators included an organizational Healthy Eating Policy, understanding community context, local knowledge, partnerships with researchers and leadership. This study revealed how overarching policies, accompanied by organizational support, facilitated quality improvement and engagement in CQI but also created barriers to routine practice and sustainability of health-promoting interventions.

Introduction The COVID-19 pandemic has made long-standing nursing workforce challenges apparent on an international scale. Decision-makers must develop multi-pronged approaches to foster the development and maintenance of a strong nursing workforce to support health systems. These approaches require attendance to recruitment and retention initiatives that show promise for stabilising the nursing workforce now and into the future.Methods and analysis Searches were conducted across MEDLINE, Embase, CINAHL and Scopus from January 2014 up to 11 March 2024. This rapid umbrella review protocol is guided by the Joanna Briggs Institute scoping review methodology and adheres to Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines. The research question guiding this review is: what structures have healthcare systems put in place to stabilise, support and sustain the nursing workforce? This review will include existing reviews of nursing workforce initiatives with outcomes that impact nursing recruitment and retention. Results will support local health transformation including the development of a jurisdictional nursing workforce stabilisation strategy. Findings from this review will be relevant for the design, refinement and implementation of nursing workforce sustainability strategies in countries around the globe and may apply to strategies for other healthcare workers.Ethics and dissemination Institutional research ethics board exemption was received. The research team is supported by an advisory group that includes provider and patient partners. The results from this study will inform the Nursing Workforce Strategy for the province of Nova Scotia as part of a larger Canadian Institutes of Health Research-funded project. They will also inform broader planning and strategy in Canada through integration with other evidence-generation activities such as comparative policy analyses and workforce planning exercises. Finally, the results will be published in a peer-reviewed journal.Review registration number Registered through Open Science Framework: https://doi.org/10.17605/OSF.IO/CUJYK

Introduction:Black nurses are under-represented in the Canadian nursing workforce. A legacy of discrimination and systemic barriers reinforce the under-representation of Black nurses in the nursing workforce throughout the health system. Objective:The objective of this study was to identify and describe organizational initiatives for the recruitment, retention and advancement of Black nurses in the healthcare system. Methods:We conducted a rapid review of peer-reviewed and grey literature regarding the recruitment, retention and advancement initiatives for Black nurses, in North America and the UK. Results:Thirty-eight sources were included in this review. Majority of the included sources focused on leadership initiatives that described a multi-pronged approach for recruitment, retention or advancement. Examples of useful initiatives included mentorship, dedicated leadership and advancement programs, as well as supportive institutional policies. In addition, several Black nurse-led organizations/initiatives were identified. Conclusion:These findings highlight the importance of multi-pronged approaches to enhance and support the Black nurse workforce. In addition, implementing and evaluating initiatives is critical to understanding how workforce representation and inclusion is strengthened.

BACKGROUND:The ongoing impacts of the COVID-19 pandemic on Canada's healthcare workforce and service delivery necessitate focused health system planning and delivery that prioritizes coordination, collaboration, and evidence-based strategies. A rapid evidence synthesis was commissioned by Health Canada to determine the impacts of the pandemic on the healthcare workforce and to identify promising strategies and innovations that mitigate these challenges. METHODS:Two, sequential rapid evidence syntheses were conducted between October 2022 and March 2023 using methodologies aligned with Preferred Reporting Items for Systematic reviews and Meta-Analyses literature search extension (PRISMA-S) guidelines. The first review (October-November 2022) focused on the impacts of COVID-19 on Canadian healthcare workers and mitigation strategies, while the second (November 2022-March 2023) broadened the scope to international interventions. Findings were organized by impact level (individual, organizational, system). Quality assessment of sources was not performed. RESULTS:We included 176 and 31 sources, respectively in the analysis. Sources identifying impacts of the COVID-19 pandemic described significant mental health impacts on healthcare workers, alongside changes in demand and supply of services, physical health challenges, and shifts in scopes of practice or care models. Interventions were primarily targeted at the individual or organizational level and included mental health support, training and upskilling, enhanced organizational communication and workforce planning initiatives. System-level interventions were less common, and most interventions lacked robust evaluation or evidence-informed design. CONCLUSIONS:This review highlights a significant gap in literature regarding evaluated interventions to address healthcare workforce challenges during the pandemic. While numerous sources document the adverse impacts on healthcare workers, detailed reports on specific interventions are scarce. Most interventions focus on workforce planning, education, practice scopes, recruitment and technology integration. The research underscores the need for comprehensive recommendations addressing social and mental health support, workplace safety, organizational communication and pandemic preparedness. These recommendations are vital for developing future workforce strategies, thus enabling policymakers and healthcare leaders to effectively respond to current and future healthcare challenges. This strategic approach will enhance system resilience and improve healthcare delivery across Canada.

The coronavirus disease 2019 (COVID-19) pandemic highlighted the crucial role of robust health research systems (HRSs) in supporting effective public health responses. Understanding the responses and lessons learned from HRS during the pandemic is vital for future preparedness. This environmental scan examined high income Countries with a HRS that responded to the COVID-19 pandemic using both academic and grey literature sources to gather comprehensive insights into these areas. The analysis was structured using an organizing framework to facilitate systematic extraction and synthesis of relevant information. A total of 5336 sources were identified of which 3609 were screened following duplicate removal. A total of 117 full-text sources were reviewed leading to 65 being included. Effective interdisciplinary and cross-sector collaborations significantly enhanced the capacity to respond to the pandemic. Clear and streamlined governance structures were essential for coordinated efforts across various entities, facilitating swift decision-making and resource allocation. The robustness of pre-existing research infrastructures played a crucial role in the rapid mobilization of resources and execution of large-scale research projects. Knowledge mobilization efforts were vital in disseminating research findings promptly to inform public health responses. Continuous tracking and evaluation of health research activities enabled real-time adjustments and informed decision-making. Rapid identification and funding of research priorities, including vaccine and therapeutic development, were critical in addressing urgent public health needs. Effective resource allocation and capacity-building efforts ensured focused and accelerated research responses. Comprehensive strategic planning, involving stakeholder engagement and robust monitoring tools, was essential for aligning research efforts with health system needs. The findings underscore the necessity of flexible funding mechanisms, enhanced data-sharing practices and robust strategic planning to prepare for future health emergencies. Policy implications emphasize the need for sustained investments in health policy and systems research (HPSR) and the development of comprehensive governance frameworks. Research implications highlight the importance of community engagement and interdisciplinary partnerships. For decision-makers, the study stresses the importance of rapid response mechanisms and evidence-based policy making. Health research systems must prioritize maintaining adaptable infrastructures and strategic planning to ensure effective crisis response. Despite potential biases and the rapidly evolving context, this comprehensive analysis provides valuable lessons for strengthening HRSs to address future public health challenges.

Healthy eating is influenced by a myriad factors ranging from individual to societal. Healthcare organizations have recently adopted healthy eating policies to improve food environments; however, how such policies shape practice is still unknown. This qualitative study explores perspectives on continuous quality improvement (CQI) among healthcare staff and managers working in hospital foodservices post-implementation of a healthy eating policy aimed at improving food environments. We conducted semi-structured interviews with 12 foodservices staff at Nova Scotia Health. Participants varied in role (administrative, point-of-sale) and location (rural/urban). We analyzed findings using directed content analysis. Participants' approach to quality revealed a range of definitions of healthy eating, from health promotion efforts directed towards individual behavior change management to a broader emphasis on supportive food environments. This research also highlighted the complexity of the healthcare food environment in which health promotion was being implemented, a 'setting' as per the 'settings approach' to health promotion, but also revealing a 'setting within a setting': food environments within healthcare environments. These nested environments are alternatively more business or healthcare service-centric, within the larger healthcare environment. Healthcare practitioners' views on effective implementation of the policy also spanned many scales of healthy eating, informed by concepts within their core healthcare practice (dietetics: nutrients), the organization (historical nutrition contexts) and broader food culture (food trends and choice). This study has demonstrated that CQI for a healthier food environment within healthcare needs a broader focus to advance benchmarks for health promotion.

Objective The COVID-19 pandemic accelerated the use of virtual health care in Canada. Nova Scotia launched VirtualCareNS—a hybrid model integrating virtual and in-person primary care—to address access gaps. This rapid evaluation assesses its feasibility, preliminary economic outcomes, and stakeholder experiences. Methods A mixed-methods rapid evaluation design was employed, incorporating utilization and economic analyses. Surveys were completed by key informants, including users (N = 74,159), non-users (N = 3130), and implementation team members (N = 31). Interviews were conducted with providers (N = 8), implementation team members (N = 11), and platform users (N = 28). Results Over 101,000 virtual primary care visits were completed, with 76,054 unique profiles created. The cost per consultation was $123 (95% CI: $99–$149), and the net cost-savings per consultation was $85 (95% CI: $62–$111), primarily driven by reduced travel time and avoidance of emergency department and walk-in clinic visits. Patient satisfaction was high (91%), and providers reported improved access, especially for patients without a regular primary care provider. Conclusion Our rapid evaluation suggests that a hybrid model of virtual and in-person care can effectively address non-urgent care needs, generate cost savings, and improve access for both unattached and attached patients. VirtualCareNS benefits from dedicated leadership structures and integration with Nova Scotia's broader primary care services, positioning it as a scalable and sustainable approach to primary care delivery. Ongoing refinement—guided by user, provider, and implementation feedback—will be critical to realizing its full potential within the publicly funded health system.

Background: Industrialized countries are facing pressure to address the complexity of populations who experience high needs with significant costs to the health system. Interprofessional team-based care (TBC) is an essential component of integrated care strategies to respond to these complex needs. However, TBC models operate within complex policy environments that can facilitate or constrain their activities. The main goal of this project is to develop deeper insights on the manner in which system-level policies contributed in shaping TBC in three Canadian provinces - Ontario (ON), British Columbia (BC) and Nova Scotia (NS). Approach: This research consisted of an analysis of provincial policy documents (3 ON, 7 BC and 4 NS). Data was extracted using an innovative framework, based on a concept mapping exercise completed by the research team. Qualitative description and matrix comparative analysis for similarities and differences were used for data analysis. Results: Across the provinces, government investments encouraged the development of various models of TBC models (physician clinics, interprofessional team clinics, nurse practitioner led clinics, Community Health Centers). Government support was often tied to changes in the operations of TBC models such as increasing the number of services or extending opening hours. To enhance TBC, some policies expanded the roles and competencies of allied health professionals or shifted services from hospital to community settings. Patient engagement and participation in policy development and implementation was more salient in BC policies than ON. Implications: Provincial policymakers play a key role in creating the conditions in which TBC models are created and operate. This policy analysis highlights successful strategies that can contribute to improving the development and operations of TBC. These findings can inform the development of public polices and avenues for adopting practices so as to foster TBC in Canada.

Fostering Experiential Learning and Evidence-Informed Impact in Health Systems: Reflections From a Canadian Health System Impact Fellow

Interprofessional education for collaborative practice (IPECP) within pre-licensure health education supports development of collaborative healthcare teams. However, challenges to enacting collaboration exist within contemporary healthcare practice. This study explores the professional socialization experiences of recent medical graduates during early residency/practice to understand contributions of undergraduate IPECP for new medical professionals’ development of an interprofessional identity and readiness for collaborative healthcare practice. Interpretive, narrative methodology was used to explore the early residency/practice experiences of recent medical graduates (n = 8). Participants were recruited from a longitudinal study of the IPECP experiences of students from five health programs. Interviews centred on personal, social and systemic factors that enable and challenge new graduates’ interprofessional identity development. Narratives reveal that developing an interprofessional identity evolves through exposure to interprofessional settings and collaboration in practice. Mentorship from experienced professionals and exposure to collaborative teamwork were facilitators for interprofessional socialization. However, prevailing healthcare culture and settings dictate the level to which meaningful connection and collaboration can occur. The attitudes and behaviours of practicing healthcare professionals were found to reinforce professional hierarchies, stereotypes and a profession-specific identity for new graduates. IPECP experiences which address and deconstruct professional hierarchies and stereotypes are needed in education and practice settings to promote collaboration. Preparing new medical professionals to assume their role within interprofessional teams is contingent on the provision of ‘real’ collaborative experiences and interprofessional exposure. Findings support the development of IPECP programming in health education/practice that address barriers to collaborative practice and promotes interprofessional identity development.

Background Respiratory viral illness (RVI)—e.g., influenza, COVID-19—is a serious threat in long-term care (LTC) facilities. Standard infection control measures are suboptimal in LTC facilities because of residents’ cognitive impairments, care needs, and susceptibility to loneliness and mental illness. Further, LTC residents living with high degrees of frailty who contract RVIs often develop the so-called atypical symptoms (e.g., delirium, worse mobility) instead of typical cough and fever, delaying infection diagnosis and treatment. Although far-UVC (222 nm) light devices have shown potent antiviral activity in vitro, clinical efficacy remains unproven. Methods Following a study to assay acceptability at each site, this multicenter, double-blinded, cluster-randomized, placebo-controlled trial aims to assess whether far-UVC light devices impact the incidence of RVIs in LTC facilities. Neighborhoods within LTC facilities are randomized to receive far-UVC light devices (222 nm) or identical placebo light devices that emit only visible spectrum light (400–700 nm) in common areas. All residents are monitored for RVIs using both a standard screening protocol and a novel screening protocol that target atypical symptoms. The 3-year incidence of RVIs will be compared using intention-to-treat analysis. A cost-consequence analysis will follow. Discussion This trial aims to inform decisions about whether to implement far-UVC light in LTC facilities for RVI prevention. The trial design features align with this pragmatic intent. Appropriate additional ethical protections have been implemented to mitigate participant vulnerabilities that arise from conducting this study. Knowledge dissemination will be supported through media engagement, peer-reviewed presentations, and publications. Trial registration ClinicalTrials.gov NCT05084898. October 20, 2021.