Health care management

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

Current literature on concussion management focuses primarily on the return to physical activity, while the return to learn process is less clearly understood. This knowledge gap is particularly problematic for adolescents, whose primary responsibility is academics. The present study sought to develop a more in-depth understanding of the return to learn process through the perspectives of adolescents who had sustained a concussion and their parents in in-person, semi-structured interviews. A substantive grounded theory of the return to learn process for adolescents that emerged from the data is provided. The basic model is consistent with many speculative, non-empirically based concussion management protocols, but extends these models by emphasizing the central role of parents in managing their child's recovery process, highlighting the importance of role fulfillment within the concussion management network, and identifying the impact of the adolescent's capacity and readiness for help-seeking. The results also highlight the vulnerability of concussed adolescents to losing their support structure as they move through key school transitions. Implications for educators, medical professionals, parents, and adolescents in the return to learn process are also discussed.

Author Keywords: Adolescent, Concussion, Concussion Management, Multidisciplinary Management, Return to Learn, Return to School

Cardiovascular disease (CVD) prevention, treatment and outcomes in women remain largely inequitable globally. Unique sex-specific stages of life, including pregnancy conditions, and their influence on cardiac risk is a growing area of research (Norris et al., 2020). For example, preeclampsia is strongly associated with CVD risk. This connection has led to prevention interventions such as postpartum risk clinics. Research to date on pregnancy and chronic disease is rooted in the medical paradigm of risk and lacks women's lived experience. The present study qualitatively explored illness and risk perceptions of women with risky pregnancy conditions. Some participants felt self-blame for their conditions. Consequences and severity were focused on "baby first", while maternal risk was viewed in the distant future. Aspects of the pregnancy experience, including prompt access to mental health support, was viewed as a "blessing in disguise". Risks, such as lack of agency, and benefits of healthcare risk communication and intervention and implications for practice were also explored.

Author Keywords: communication, critical, health care, phenomenology, pregnancy, risk

Background: Ontario's Ministry of Health and Long Term Care (MOHLTC) claims people with mental illnesses/addictions need improved care/overuse emergency departments. MOHLTC expects Coordinated Care Planning (CCP, teams of mental/physical health professionals, social workers and informal caregivers) to improve care and lower emergency department returns/healthcare costs. CCPs are directed by policies, Smith's "problematics," or Deleuze's "expressions," supposedly reflecting "contents"/"everyday worlds."

Research Question: How do Ontario health/allied professionals come together with a person with mental illness/addictions and informal caregiver(s) to address health needs through a CCP?

Method: 1) Analyzed CCP policies; generated questions about creation/implementation. 2) Interviewed eight professionals about interpreting/enacting policies. 3) Connected interview data to policies.

Findings: Opportunities for fragmentation exist in gaining consent; determining eligibility; persons in care, informal caregivers and professionals' participation; person-centeredness; "shame-free" environments; health literacy; records of medications.

Conclusion: CCP participants need to minimize fragmentations which takes time, space, money; creates contradictions in lowering costs/improving care.

Author Keywords: Addiction, Dual Diagnosis, Health Care Policy, Institutional Ethnography, Integrated Health Care, Mental Illness

My research explores potential motivators for social and health service providers to be more holistic and compassionate with those they serve. From previous research focused on spirituality, I identified seven additional concepts: faith, religion, community, culture, compassion, wellness, and wholeness. Using elements of Appreciative Inquiry, data was collected through a focus group and an in-depth, online survey. The participants work with Indigenous, religious, other spiritually motivated, or non-spiritual social or health service organizations in Peterborough, Ontario, Canada. Prototype concept analysis allowed participants to personally define each concept, and then indicate how much each motivated them. Results indicate, regardless of individual demographics, the definitions and motivations are very personal. The concepts with the most to least motivational impact were community, compassion, spirituality, wellness, wholeness, culture, faith and religion. Participants' voices speak directly through this research. I use their suggestions to make recommendations for improving the systems within which they provide service.

Author Keywords: community, compassion, health services, indigenous knowledge, social services, spirituality