Waters, Nicola

The number of menopausal women the world over is increasing. Many women will experience debilitating, severe menopausal symptoms and increased incidence of chronic disease. Despite substantive evidence that Menopause Hormone Therapy (MHT) offers safe, effective relief from menopausal symptoms, reducing the long term sequalae from progressive hormone loss, access to treatment remains limited. All women will experience the menopausal transition; however, management of menopausal symptoms is still viewed as a specialty area of practice. Primary care providers, inclusive of Nurse Practitioners (NP)s play a crucial role in the assessment, diagnosis, and treatment of menopause, yet their involvement and prescribing patterns are not fully understood. Exploring the prescribing patterns of Healthcare Providers (HCP)s can help identify barriers and opportunities to improve access to this valuable therapy, ensuring more women can benefit from appropriate menopausal care.

Purpose. To identify the factors that influence primary care providers in their decision to provide medical abortions. Background. Medical abortion has been commercially available in Canada since 2017, with reduced restrictions on prescribing since 2019. It is a safe and effective option for induced abortion and provides autonomy to pregnant people. Understanding the barriers that exist for primary care providers can help to identify ways to further incorporate medical abortion into practice and increase accessibility for patients. Design. Integrative review. Data sources. Studies were obtained through a search of the electronic databases CINAHL (EBSCO), Medline (OVID), and Google Scholar. Review Methods. The Critical Skills Appraisal Programme (CASP, 2023) checklist was modified to appraise all studies. Themes and study characteristics were elicited for data synthesis. Results. Eight studies were selected for review using inclusion and exclusion criteria. The themes identified were the availability of a community of practice, health equity, educational exposure, stigma, regulatory and funding issues, and interprofessional collaboration. Conclusions. Addressing the themes identified through careful consideration of policy implementation, exposure to medical abortion practice in training, ensuring a community of practice and interprofessional collaboration are important factors in increasing access to medical abortion.

Breaking bad news (BBN) is a necessary component of communication in health care. When health care practitioners (HCPs) communicate illnesses of a serious nature with Indigenous people, they often do not do so in a culturally safe way, and this can perpetuate health inequities and catalyze poor health outcomes, which are often linked to Indigenous historical trauma. In this integrative review I sought to analyze and synthesize the published experiences of Indigenous adults from Canada, the United States, New Zealand, and Australia with BBN conversations. I included twelve qualitative studies ranging from 1999 to 2022. I obtained the studies through CINAHL (EBSCO), MEDLINE (OVID), manual reference list screening, and citation tracking on Google Scholar. Themes identified were (a) Indigenous identity, (b) HCP misinterpretation, (c) the meaning of words, (d) truth-telling and the prophetic power of words, (e) indirect communication, and (f) the role of family. The review findings can inform HCPs’ understanding of potential communication errors and offer recommendations to improve culturally safe BBN conversations. However, it is important to recognize that although commonalities in experience exist, further research is needed to understand and address the unique experiences of BBN in culturally diverse Indigenous tribes and nations.

Human papillomaviruses (HPV) and their associated complications are major public health issues in Canada and across the globe. There is significant data to support immunization against HPV in youth as an effective method to prevent the spread of HPV. However, despite a well-established school-based and gender-neutral program, HPV immunization rates remain largely below targeted goals across Canada. This integrative review sought to examine the factors influencing and inhibiting uptake amongst Canadian youth eligible for the vaccine. These factors included parental influence, cultural and personal beliefs, societal attitudes, and structural factors (e.g. access to healthcare services, geographic location, and socioeconomic status). Understanding these factors is critical for developing effective interventions aimed at improving vaccine coverage and protecting youth from HPV-related diseases.

In August 2024, the number of people impacted by Long COVID (LC) was estimated to be about 400 million globally (Al-Aly et al., 2024). Currently, there are no FDA–approved treatments for LC. Many of the centres treating LC have noticed the similarity to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in some patients. Low–dose naltrexone (LDN) is a drug that has recently shown potential in treating ME/CFS. In this integrative review, ten articles were selected for analysis to investigate whether LDN could be a viable treatment for LC. Although the studies conducted on LDN and LC are small, non–randomized, and unblinded, a few interesting themes emerged from this analysis that could guide future studies and treatment decisions. LDN seems to be most effective for individuals with a LC phenotype that mimics ME/CFS, as, of all the symptoms of LC, it was found to be most effective for fatigue and pain. In the future, pre–screening tools will likely be developed to identify patients most likely to respond to LDN. Two double–blind randomized controlled trials (RCTs) are currently underway that will be published next year, yielding a higher degree of evidence and certainty around LDN for LC. In the meantime, initial findings support consideration of LDN for patients with LC whose primary complaints are fatigue or pain.

Background: Hypertension affects 1.28 billion individuals globally and is one of the key public health issues in Canada impacting nearly one in four adults. Non-adherence to antihypertensive medications is a major contributor to uncontrolled hypertension and related complications. Objective: To examine the strategies that can be used by primary care providers to improve medication adherence in adult patients with hypertension. Methods: An integrative literature review approach (Toronto & Remington, 2020) was used along with the PRISMA guidelines (2021). A systematic search of CINAHL and Ovid MEDLINE was undertaken. A critical appraisal was conducted using two tools. Results: Six studies met the inclusion criteria. Study designs included randomized controlled trials, observational cohorts, and mixed-methods studies from developed countries. Three key strategies were identified to improve medication adherence in adults with hypertension within primary care settings: patient-centered interventions (e.g., education tools, reminders, self-monitoring); collaborative care strategies involving pharmacists and nurses; and fixed-dose combination therapies. Conclusion: Findings indicate that while several single strategies can support medication adherence in adults with hypertension, primary care providers should use a combination of strategies to achieve the most effective improvements in medication adherence and clinical outcomes.

The aim of this integrative review is to explore how mindfulness training affects postpartum anxiety (PPA) and/or postpartum depression (PPD). PPA and PPD can have negative effects on the postpartum (PP) person and child’s health, and which can result in intrauterine growth restrictions multigenerational repercussions or even perinatal suicide. Mindfulness is defined as the ability to maintain purposeful and intentional attention to the present moment. An emerging theme in the literature is the impact of mindfulness-based interventions on reducing anxiety and/or depression during PP. This integrative review included twelve studies examining the effects of mindfulness training on PPA and/or PPD. All studies reported that mindfulness training was associated with some reduction in PPA and/or PPD. However, findings were inconsistent as three out of the twelve studies found that anxiety and/or depression scores increased between six weeks to four months PP with mindfulness training. These findings highlight the need for further longitudinal, randomized control trials to explore the sustained effects of mindfulness training in this population.

Heart Failure (HF) is a life-limiting condition which causes symptoms beyond the physical manifestations of cardiac dysfunction. HF can significantly impact patients' quality of life (QOL), which is often not addressed in standard regimes of HF care. QOL encompasses the individual's physical, functional, psychological, and social aspects of life. The specialty of palliative care (PC) addresses all these aspects and can significantly improve a patient’s QOL. PC is underutilized for patients with HF due to the non-linear progression of the disease and the general uncertainty of the prognosis. The aim of this integrative review was to explore the impacts of early integration of outpatient PC on the QOL of patients with HF. Findings demonstrate that outpatient PC can positively impact the QOL of HF patients and can be introduced early in the disease process, even when patients are receiving life-prolonging treatment. PC can improve measures of overall QOL, palliative symptom burden, HF symptom burden, and depression in this populations. Primary care providers can implement the early introduction of PC for their HF patients to preserve their QOL despite their current prognosis.

Ovarian torsion is a rare gynecological emergency that occurs when the ovary spontaneously becomes twisted on itself. If not recognized and treated, it can result in tissue necrosis and loss of the ovary. Ovarian torsion most frequently affects women and people with ovaries in their childbearing years, and if oophorectomy is required from missed diagnosis, this can result in decreased fertility of the individual. Due to the broad differential diagnoses present with abdominal pain, ovarian torsion diagnosis is challenging for clinicians. An integrative review of available data was completed to determine factors that impact the diagnosis of ovarian torsion in adult non-pregnant women who present to the emergency department. A literature search was conducted using databases MEDLINE and CINAHL for articles in English and studies published from 2000-2025. A total of 12 papers were reviewed and data extraction completed to ascertain common factors impacting the diagnosis of ovarian torsion. Methods of diagnosis for ovarian torsion include patient history and clinical exam, bloodwork and urinalysis, and imaging via ultrasound and/or computed tomography. There has been improvement in ovarian salvage rate in the last 20 years, possibly due to increased preference for attempting ovarian salvage versus oophorectomy even if ovaries appear dusky on initial exam. No single physical exam or diagnostic can rule out torsion definitively, and care should not be delayed obtaining an ultrasound if high suspicion for ovarian torsion. The gold standard for diagnosis and treatment of ovarian torsion remains operative exploration, and clinicians should not hesitate to involve obstetrics and gynecology promptly when they suspect a patient has ovarian torsion.

The Canadian healthcare system is experiencing significant strain due to a growing and increasingly complex patient population, coupled with provider shortages. Consequently, patients are increasingly seeking emergency room care to address their healthcare needs, further exacerbating the burden on already overwhelmed emergency services. In response, communities in Ontario and Alberta have begun integrating nurse practitioners (NPs) into their emergency settings. This review aims to explore the patient experience of adults receiving NP-led care within the emergency department. Peer-reviewed literature from 2000 to the present were explored using Academic Search Complete, Web of Science, Google Scholar, and Medline OVID. Findings highlighted that NPs enhance the patient experience by fostering patient empowerment and promoting open communication, leading to increased patient satisfaction. Furthermore, NPs improve access to care by reducing wait times, decreasing length of stay, and minimizing instances of patients leaving without treatment. The established public trust in nurses extends to NPs, exhibiting positive patient perceptions of NPs. Despite increasing NP integration, confusion regarding the NP role continues to exist within both patient and healthcare communities, indicating a need for future research to address this ambiguity.

Background Primary care providers face challenges when caring for palliative care patients and their informal caregivers. Many primary care providers have limited understanding and comfort in providing palliative care. The situation is even more complex in rural areas, where access to resources is often challenging. A primary care providers lack of experience can result in inconsistent and inefficient approaches to care. Method This integrative review examines research from CINAHL on palliative care as it affects informal caregivers and their experiences. It focuses on the actions of Primary Care Providers (PCPs) and how their interventions impact informal caregivers. CASP checklists and thematic analysis were used to critically analyze and organize the results. Results The reviewed studies revealed four themes: support, communication and coordination, post-discharge transition, and holistic, person-centred care. The findings suggested that palliative care does not always need to be interventional but can serve as essential supportive care. Conclusion The findings of this review highlight the need for a collaborative team approach in palliative care, which goes beyond the provider-patient dyad. Integrating this approach into palliative care plans can improve care for individuals during palliative care.

This integrative review examines the growing prevalence of depression, a leading cause of primary care visits in Canada, and the need for accessible treatment options such as telemedicine. Despite substantial evidence supporting the widespread adoption of telemedicine in primary care, including for treating depression, research on patient experiences with telemedicine for depression remains limited. This integrative review aims to explore patients' experiences of using telemedicine for the treatment of depression in primary care to identify areas for enhancing the quality of care. The key findings reveal several themes influencing patient experience: the therapeutic relationship, the environment of care delivery, individualization of treatment approaches, accessibility of telemedicine, and the level of knowledge patients possess regarding telemental health. The findings have implications for primary care providers, including nurse practitioners (NPs), in optimizing the delivery of telemedicine for depression. Limitations of this review include a restricted number of studies that specifically focused on depression. Further investigation is needed to gain a deeper understanding of patient experiences with telemedicine for depression treatment.

The opioid crisis remains a significant public health concern, with fentanyl contributing to 79% of accidental opioid-related deaths in Canada between January and June 2024, nearly a 40% increase since the national surveillance in 2016. Opioid agonist therapy (OAT), using medications such as methadone and buprenorphine, is an evidence-based treatment for opioid use disorder (OUD) that aims to reduce harm and mortality. While OAT is increasingly delivered in primary care to improve accessibility, patient retention in these programs remains a significant challenge. Retention is a commonly used outcome in OUD treatment studies; however, there is no universal definition. This integrative review explores the factors influencing OAT retention among individuals with opioid use disorder in primary care settings. A systematic search of peerreviewed literature published from 2016 to 2024 identified nine U.S.-based studies, including three qualitative and six cohort studies. Findings indicate that comorbid mental health and substance use disorders, along with limited access to psychosocial supports, negatively affect retention. Conversely, low-barrier, trauma-informed, and multidisciplinary care models are associated with improved outcomes. These findings highlight the need for OAT programs to adapt to the complex needs of patients with OUD by providing individualized, flexible, and accessible treatment options. Integrating mental health and addiction care within primary care settings may improve patient engagement and decrease opioid-related harm and mortality.