Woodend, Kirsten

The transition from student to newly graduated nurse (NGN) can be a period filled with significant stress and uncertainty as NGNs are required to develop and refine practical skills, learn to work with interdisciplinary team members, and adjust to their new professional identity. Clinical externships provide students an opportunity to work alongside nurses as unregulated healthcare workers in hospitals. This study explored how NGNs felt their participation in a clinical extern program influenced their transition from student to nurse. Interpretive description (ID) guided the research of this study and produced a qualitative description of the experiences from a sample of eight NGNs working in Ontario.Three main themes emerged from the data collection: developing self-efficacy, developing a professional identity, and being on the inside. Implications from this study address the need for research on how clinical externships influence transition to practice and the continuation and development of such programs.

Author Keywords: clinical extern, externships, newly graduated nurse, novice nurse, transition, transition to practice

Aligning health services with aging populations is the fundamental issue of modern Canadian health policy, yet rural older populations still experience compromised patient safety and poor-quality care as they transfer between care settings. As such, contemporary scholars acknowledge that more contextually sensitive studies are needed to better understand the unique health and care experiences of this vulnerable population across the care continuum. Informed by inquiry in critical gerontology, health services and human geography, my dissertation attends to this gap in research by revealing the interplay between older adult health construction and the influence of multidimensional contexts on rural older adult transitions in care. Using a community-based approach, I conduct a case study on Haliburton County that encompasses three phases (e.g., a rural community inventory, go-alongs and semi-structured interviews) and focuses on two types of transitions in care (when an older adult is transferred from a hospital to a long-term care home and when an older adult is transferred from a hospital to a home in the community). In total, 19 patients, 24 informal supports, 51 front-line staff and five administrators/managers participated in my dissertation, resulting in 99 total participants being included in 19 go-alongs and 85 semi-structured interviews. My results indicate that multi-leveled facets of the rural care context continually attend to and hinder rural older adult health during transitions in care. In particular, sectored divisions, urban centrism, biomedicine and ageism inhibit rural care providers from leveraging their strengths to attend to the heterogeneity of rural older adult health and the nuances of rural care contexts. I then argue the need for macro health systems reform to embrace the relationality of rural older adult transitions in care and to capitalize on the strengths inherent in rural communities. To foster knowledge mobilization of my findings, I provide a foundation of information and recommendations for the community partners (Haliburton Highlands Health Services and Seniors Care Network) as well as questions to inform research, policy and practice. Establishing the first study of rural older adult transitions in care where a researcher accompanies older adults and their informal supports across care settings, my dissertation will help prepare Canada for the impact of the aging population and transform transitional care provision to meet the needs of all Canadians in the 21st century.

Author Keywords: Canada, Geriatric Care, Health Care, Older Adult Health, Rural Health Care, Transitions in care

A consistent provincial approach to capacity planning for rehabilitative care had been

identified as a critical gap in the field of health care in Ontario (Rehabilitative Care

Alliance, 2015a). In response, the rehabilitative care alliance (RCA) developed a needs

based hip fracture capacity planning canvas together with persons and families. This

research utilized computer assisted participation (CAP) to gather additional perspectives

from Virtual Voices via an on-line survey. The results of the Virtual Voices survey were

compared to Ontario's RCA hip fracture patient focus group findings. CAP facilitated

more voices and more ideas through virtual engagement. The survey method required

97% (10.6 hours) less time than the focus group. The Virtual Voices respondents

provided validation of the focus groups' confirmation of the rehabilitative care needs,

locations and most core team members as well as identified new ideas. The results

support the implementation of a needs-based capacity plan that enables individualized

care planning. This research provides a blueprint for the ongoing engagement of

persons and families in the co-creation of a sustainable rehabilitative care system. A

dashboard and e-health app would enable ongoing co-design, monitoring and

evaluation.

Author Keywords: Computer Assisted Participation (CAP), Computer Assisted Survey, Hip Fracture, Rehabilitative Care Needs, Virtual Collaboration, Virtual Engagement