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Improving Well-Being and Stress Resilience Through a Primary Care Wellness Program
No full textAim: To evaluate if a skill-building program teaching evidence-based strategies in happiness, well-being and stress resilience to small groups of primary care patients will be effective in improving their mental health and decreasing their stress. Additionally, from a patient perspective, will this program be satisfying and easy to access.
Background: Good physical health is closely tied to improved mental well-being, which allows individuals to appropriately manage everyday stressors, reach their potential, perform effectively at work or school, and engage meaningfully within their communities. This aligns with research that indicates that people with better coping skills are less likely to develop mental illness.
Methods: An eight-week skill-building pilot program in well-being and stress resilience was offered to family practice patients using a mindfulness-based cognitive behaviour model for teaching evidence-based strategies. Patients voluntarily enrolled in the program and participants completed before-and-after questionnaires measuring their happiness, well-being, and stress. Participants also completed anonymous program satisfaction questionnaires.
Findings: Participants reported a reduction in stress by 40%, an increase in happiness by approximately 19% and an increase in well-being by approximately 18%. Subjectively, 90% of participants felt their mood had improved and 95% felt more confident in their skills to manage their mood. 100% of participants agreed the program was effective for learning skills to manage their mood, and 97% would recommend the program to a friend.
Conclusion: Building skills in well-being and stress resilience is an effective strategy for improving mental health in primary care patients. Offering this in the format of an 8-week program (12 hours) to small groups has shown to be an effective and accessible mental health service deemed helpful and satisfying by participants
Case Study: Counselling Older Women on Contraception Options
No full textA 37-year-old female presents to her nurse practitioner requesting a referral to gynecology for sterilization. She is divorced from the father of her two children and newly dating seeking contraception. Although a natural decline in fertility begins at age 35, effective contraception is required until natural sterility is confirmed by menopause. Therefore, nurse practitioners are in a unique position to counsel older women on contraceptive options while considering safety, efficacy and patient preference. This case highlights the importance of contraception in older women and methods for consideration
Enhancing Critical Care Transport in Northern, Rural, and Remote Ontario: The Role of Nurse Practitioners
No full textAim: To examine the challenges and potential solutions regarding delays in interfacility transport of critically ill adult patients in northern, rural, and remote regions of Ontario, focusing on integrating Nurse Practitioners (NPs) into critical care teams.
Background: Due to geographic barriers, critical care transport delays are problematic in northern, rural, and remote Ontario. Timely transfers to lead trauma centers are crucial for patient outcomes. However, delays occur due to improper triage, physician shortages, and lengthy decision-to-transfer times. NPs’ role in addressing healthcare challenges in these areas, specifically within critical care, could be significant.
Method: An integrative review analyzed NPs\u27 impact on critical care coordination in underserved regions of Ontario. A thorough search across five databases yielded 16 relevant studies meeting specified criteria that were then assessed for quality using the Mixed Methods Appraisal Tool.
Findings: Three key themes were identified, including the role of NPs in critical care teams and NP-led models of care, telehealth utilization by NPs in underserved communities, and successful NP integration models.
Conclusions: NPs effectively deliver primary and emergency care via telehealth in rural areas despite the lack of a formal funding model. Advocating for NPs ability to work within their full scope of practice with sustainable funding while exploring innovative roles like Remote Critical Care Nurse Practitioners, could optimize care delivery. Investing in NP-led initiatives promises to enhance healthcare access, quality, and equity in northern, rural, and remote Ontario
Most Responsible Providers’ Acceptance and Perceptions of Nabilone and THC/CBD Oil for Dementia Behaviours in Long-Term Care
No full textBackground: The aim of this study was to explore most responsible providers’ acceptance and perceptions of prescribing nabilone and authorizing THC/CBD oil for the management of behavioural and psychological symptoms of dementia (BPSD) in people living with dementia.
Methods: A cross-sectional survey was sent to 9 most responsible providers (MRP) of residents with dementia residing in long-term care settings. The participant sample included 8 nurse practitioners and 1 physician.
Results: Data were analysed using survey outcome categories: MRP acceptance of nabilone for BPSD; MRP perception of nabilone; MRP acceptance of THC/CBD oil for BPSD; and MRP perceptions of THC/CBD oil. Participants considered BPSD to be managed somewhat well (77.8%) or very well (22.2%) in their resident population. More than half (66.7%) of participants have previously prescribed nabilone to manage BPSD, and 55.6% have trialed THC/CBD oil. Only 12.5% reported they were prepared to answer a resident or family member’s questions regarding nabilone “a great deal” (0% for THC/CBD oil), and 37.5% reported “quite a bit”. However, participants indicated they were less prepared to answer questions regarding THC/CBD oil. The participants felt that nabilone prescription for BPSD could “somewhat improve” quality-of-life indicators including physical functioning (71.4%); energy levels (57.1%); mood (100%); enjoyment of life (100%); social engagement (85.7%); ability to perform activities of daily living (57.1%); and sense of hope (83.3%).
Conclusion: Participants believed that nabilone and THC/CBD could improve quality-of-life outcomes in their residents living with dementia, including physical functioning and mood outcomes. Most participants believed that nabilone and THC/CBD oil could effectively treat BPSD, however, some participants reported a lack of confidence in answering resident or family questions about cannabinoid treatments. Further research is required to understand MRP acceptance and perceptions of specific cannabinoid products for BPSD in long-term care settings
Online Workload Measurement Index for NPs: Study of Acceptability
No full textAim: To examine the acceptability of using a workload measurement tool for nurse practitioners (NPs).
Background: There are important pressures in healthcare systems in Canada and internationally to increase the number of patients seen by healthcare providers in primary care, including NPs, as a strategy to increase care access. NPs work in various primary care settings, and with diverse patient populations. Previous research has found that patient, NP and organizational factors influence NP workload, with NPs utilizing both clinical and non-clinical activities to address patient care needs. However, we have a limited understanding of the factors that influence the acceptability and adequacy of measuring NP workload. Implementing an online NP workload measure in community-based primary care is complex.
Methods: Qualitative descriptive approach with individual semi-structured interviews (n = 13) with NPs and decision-makers. Data were collected from May–July 2024 in Québec, Canada. After a deductive coding strategy based on the Theoretical Framework of Acceptability, an inductive approach was used, to enable themes to emerge from the data. Interviews were coded individually by two researchers, and a third researcher reviewed the coding for consistency.
Findings: NPs and decision-makers (n = 13) reported that the workload measure was easy to use and comprehend. Participants believed the measure represented NPs’ work, emphasizing that the recorded data enabled them to observe how their workload was spread among various activities. The tool\u27s content and the brief data input time (five minutes per day) were perceived as facilitators of acceptability. A few minor obstacles were identified, including software issues, and recommendations were made for enhancements.
Conclusion: The study provides an in-depth understanding of the acceptability of using a workload measurement tool for NPs. Additional research is needed to explore the acceptability of implementing the tool of NP workload in other clinical areas, including mental health
Understanding the Healthcare Teams’ Experiences of Working with Nurse Practitioners: A Mixed-Method’s Survey Study
No full textAim: This study aimed to explore the experiences and perceptions of healthcare team members working with NPs across multiple practice areas within the Fraser Health Authority, a large health authority in British Columbia, Canada.
Background: Nurse Practitioners (NPs) are increasingly integrated into healthcare teams, providing advanced clinical expertise, enhancing patient-centered care, and fostering collaboration. However, little is known about how the integration of NPs impacts the team experience.
Methods: A mixed-methods study using an online cross-sectional survey with integration of closed and opened ended survey data was employed, involving primarily quantitative questions with optional open-ended qualitative responses from 115 participants. The quantitative data assessed various attributes of satisfaction across multiple units and clinics, while thematic analysis was used to identify major themes from qualitative data.
Findings: High satisfaction was noted in urgent care and surgical units, while lower satisfaction emerged in patient assessment transition to home units where NPs served as MRPs. Three key themes were identified: enhanced patient-centered care, collaborative and integrated team dynamics, and advanced clinical expertise and accessibility. Some participants expressed concerns about delays in patient flow due to thorough NP assessments and diagnostics.
Conclusion: NPs significantly contribute to patient-centered care, team collaboration, and overall healthcare quality. However, satisfaction with NP integration varies across settings, particularly in units where NPs assume greater responsibility as MRPs. Tailoring NP roles to fit the unique needs of specific healthcare settings, fostering role clarity, and promoting interprofessional collaboration are key to optimizing NP integration and satisfaction. Future research should explore unit-specific dynamics and strategies for improving NP effectiveness, as well as examining the perception of impact on access and flow related to NP assessments and diagnostics
Silent Invader: The Battle Against Gas Gangrene in Diabetic Foot Infections: A case presentation in the emergency department
No full textIntroduction: Necrotizing soft tissue infections (NSTIs) are rapidly progressive and potentially life-threatening infections requiring early recognition and urgent intervention. Individuals with comorbidities such as type 2 diabetes mellitus (T2DM) are at increased risk due to impaired immune response and delayed wound healing.
Case Presentation: Mr. X is a 66-year-old male with T2DM who presented to the emergency department with a worsening left foot infection. He had recently completed a three-day course of cefazolin for a diabetic wound. On reassessment, the nurse practitioner noted red-flag features including increasing erythema, edema, purulent drainage, and new gas emanating from the wound bed. Laboratory testing revealed leukocytosis and hyperglycemia. Plain film radiographs demonstrated gas in the dorsal soft tissue extending from the metatarsophalangeal joints to the distal shin.
Management and Outcome: Using a diagnostic algorithm, the nurse practitioner suspected a type 1 polymicrobial or type 3 NSTI. Immediate management included the addition of intravenous clindamycin to reduce bacterial exotoxin production, administration of Ringer’s lactate to address potential capillary leak syndrome, and urgent consultation with vascular surgery for source control and tissue biopsy. The patient was transferred for ongoing surgical management and definitive diagnosis.
Discussion: This case highlights the importance of early recognition of NSTI in high-risk patients, particularly those with diabetes. The nurse practitioner played a critical role in identifying the progression of cellulitis to a necrotizing infection and initiating timely, evidence-informed management. Prompt escalation to multidisciplinary surgical care was essential to reduce morbidity and guide further treatment. This case underscores the importance of vigilance, clinical reasoning, and interprofessional collaboration when managing complex soft tissue infections
Nurse Practitioners and COVID-19: Early Challenges and Future Strategies
No full textAim: To discuss the challenges experienced by nurse practitioners (NPs) caring for individuals with chronic diseases during the early years of COVID-19 pandemic in Newfoundland and Labrador (NL) and to recommend potential strategies that can be utilized in the current practice environment and when planning for future pandemics.
Background: Chronic diseases may not have been adequately managed during the early years of the COVID-19 pandemic, even with the increased use of virtual care services. Most literature has focused on identifying the challenges faced by healthcare providers, rather than options for strategies to improve collaboration with individuals and enhance team management of chronic conditions.
Methods: In this sequential exploratory mixed methods study, 14 NPs were interviewed in the qualitative phase to identify challenges. Results informed the development of a contextually- relevant survey questionnaire (first integration step). In the quantitative phase, 32 NPs completed the questionnaire. Data collected during the quantitative survey were compared with the qualitative data, the second integration step, to assess how widespread challenges were and to gain further insights for potential strategies to implement in the current practice environment.
Findings: In addition to identifying stress and changes to the NP practice environment, key themes related to chronic disease management were identified by the interviewed NPs (qualitative phase) and supported by the surveyed NPs (quantitative phase). These related to reduced access to care (e.g. due to closures or lack of cell service), difficulty diagnosing and managing patients even with virtual care availability (e.g. due to inability to conduct a physical assessments), and inadequacies in patient self-management of their chronic diseases. The NPs agreed with the recommended strategies, at the individual, team, and organizational levels, to address the identified challenges.
Conclusion: Numerous strategies, relevant to the identified challenges and the local practice context, are recommended to be used by NPs and other HCPs in caring for individuals with chronic diseases, in the current practice environment and when planning for future pandemics
A Workload Measurement Instrument for Nurse Practitioners: Finding Consensus with the TRIAGE Method
No full textAim: To determine consensus on the elements to include in a nurse practitioner (NP) workload measurement instrument in community-based primary care.
Background: Optimal use of NP roles can facilitate equitable access to healthcare. Administrative databases capture limited information about NPs.
Methods: A qualitative descriptive study was conducted using the 4-step TRIAGE method (i.e., preparation, production, compilation, collective production). Participants (n = 29) were identified across four stakeholder groups (i.e., NPs, patients, decision-makers, other healthcare professionals). Data were collected online from November 2021–February 2022. Content analysis, with inductive and deductive approaches, was used. Descriptive statistics were generated. Study reported using COREQ guidelines.
Findings: Consensus within and between stakeholder groups was reached on consultation times for different types of appointments (e.g., walk-in, pregnancy follow-up) and different types of clienteles (e.g., patients requiring a translator). There was consensus that NP level of experience and level of expertise (e.g., novice, expert) influence the time needed to care for patients. Participants were unable to reach consensus on 1) an acceptable amount of time to fill out the workload instrument; 2) whether they lacked expertise with a specific clientele; and 3) the use of the term elderly or senior to describe older patients.
Conclusion: The project provides benchmarks to describe NP workload based on appointment types and clientele. The innovative use of the TRIAGE method incorporated online technology to build stakeholder consensus. Several areas of consensus and some areas of divergence were identified among stakeholders on what to include in an NP workload measurement instrument.
This study provides NPs and decision-makers with insight into the factors that influence NP workload, allowing them to manage NPs’ workload more effectively. This, in turn, will enhance NPs’ ability to provide optimal patient care
Nurse Practitioners Documentation Approach: A Scoping Review
No full textAim: To identify barriers and facilitators to nurse practitioner (NP) documentation and highlight opportunities for improvement in practice and research.
Background: Documentation is central to safe and effective NP practice. It ensures continuity of care, supports communication, and meets regulatory standards. Yet persistent challenges remain, shaped by organizational and educational factors. These issues can create inefficiencies, contribute to provider burden, and ultimately affect the quality of patient care. Understanding these influences is key to strengthening NP practice and outcomes.
Methods: A scoping review was conducted using Arksey and O’Malley’s framework. Literature from 2014–2024 was systematically searched for studies on NP documentation. Of 153 articles screened, six met inclusion criteria. Data were charted and synthesized thematically to identify common patterns across studies.
Findings: Two themes stood out: organizational culture and educational interventions. Facilitators included structured training, standardized tools, and streamlined processes. Barriers were linked to workflow inefficiencies, inconsistent templates, and limited support for electronic health record (EHR) systems. Although only a small number of studies met inclusion criteria, findings consistently emphasized the importance of system-level supports in strengthening documentation practices.
Conclusion: Research on NP documentation is limited but growing. System-level changes—such as better EHR training, consistent templates, and supportive workplace cultures—can enhance accuracy and efficiency. Emerging technologies, including artificial intelligence (AI), also show promise in easing documentation burden, improving accuracy, and freeing NPs to focus more on patient care. Further research is needed to explore NP documentation reasoning and to evaluate targeted interventions that enhance practice and accountability