University of Northern British Columbia. Nursing-Family Nurse Practitioner

Individuals who practice consensual non-monogamy (CNM) face a variety of challenges in the healthcare system, from administrative barriers to negative comments to overt discrimination to refusal of care. It is estimated that up to 20% of adults in Canada and the United States have engaged in CNM during their lifetime, and public awareness of CNM is increasing (Haupert et al., 2017). However, the provision of pertinent education for healthcare providers (HCPs), as well as research into this type of relationship, remains rudimentary at best and this has resulted in a lack of knowledge, understanding, and general sensitivity to the healthcare needs of these individuals. This lack of awareness, in combination with a general dearth of sexual health training for HCPs, and a societal privileging of monogamy, most often results in negative healthcare experiences for those individuals who practice CNM. This review explores existing research into the healthcare experiences of adults who practice CNM, and it offers suggestions for enabling a better understanding of CNM by HCPs.

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.

People in custody in Canadian provincial prisons experience disproportionately high rates of hepatitis C virus infection. Despite national and international calls for hepatitis C elimination, treatment access remains inconsistent within correctional settings. This integrative review examines the barriers primary care providers face in delivering hepatitis C care to people in custody in Canada. Following Whittemore and Knafl’s (2005) five-step framework, nine peerreviewed studies published between 2015 and 2024 were analyzed using thematic synthesis. Studies included qualitative, quantitative, and mixed method designs, and were drawn from Canada, Australia Austria, the United States, and international contexts. Five global themes emerged: (1) inconsistencies in screening, treatment access, and healthcare systems across institutions; (2) variable access to opioid agonist therapy and harm-reduction services; (3) challenges in implementing opt-out hepatitis C screening; (4) poor linkage to care post-release; and (5) education gaps among both providers and people in custody. Barriers were found to be compounded by the coercive nature of correctional environments, institutional fragmentation, and limited continuity of care. The review supports recommendations for transferring healthcare oversight to public health authorities, expanding nurse practitioner-led care, implementing harm reduction practices, and strengthening intersectoral collaboration to improve system level coordination. Addressing these systemic issues is essential to meeting hepatitis C elimination targets and improving health equity for incarcerated populations.

This integrative review, “From Compliance to Connection: How Primary Care Providers Can Support Diabetes Care in a Good Way,” explores how primary care providers (PCPs) can more effectively support diabetes self-management among Indigenous adults in Canada. Type 2 Diabetes Mellitus (T2DM) disproportionately affects Indigenous communities, a disparity rooted in colonialism, intergenerational trauma, and systemic inequities. Historically, Western medicine has pathologized Indigenous bodies and dismissed Indigenous knowledge, reinforcing narratives of “non-compliance” and undermining trust in care relationships. Using an integrative literature review methodology, 11 studies were identified through CINAHL, Google Scholar, and hand searching. These were appraised using the Critical Appraisal Skills Programme (CASP) and an adapted Aboriginal and Torres Strait Islander Quality Appraisal Tool. Findings were analyzed through a culturally grounded qualitative synthesis. The review revealed that diabetes is often experienced not only as a physiological condition, but also as a relational and psychological disruption. Barriers to effective management included biomedical dominance, lack of cultural safety, ineffective diabetes education, and the framing of resistance as non-compliance. However, promising practices emerged: the integration of traditional medicine, use of culturally resonant strategies like peer support and talking circles, and the alignment of biomedical concepts with Indigenous worldviews. This review urges PCPs to move from authority-driven models toward relational, culturally-grounded care. It concludes with implications for practice, education, and research, centring Indigenous-led approaches in all aspects of diabetes care.

Shared decision-making (SDM) is central component of patient-centered care and is of particular interest in contraceptive counselling, where a range of potentially suitable options are available, and personal preferences and values must guide clinical decisions. A systematic search was conducted in MEDLINE (via Ovid) and CINAHL to identify qualitative, quantitative, and mixed-methods studies published between 2019 and 2024. Inclusion criteria focused on studies evaluating SDM tools or strategies in clinic-based settings with women of reproductive age. Among the seven articles included in this review, a variety of SDM tools and strategies were used: decision aids, interview guides, provider prompts, and physical models. Key outcomes included improved patient satisfaction, decisional certainty, interpersonal quality of contraceptive counselling, perceived self-efficacy in decision-making and increased contraceptive knowledge. However, there was variability in how SDM was measured and whether outcomes were explicitly linked to SDM processes. Findings suggest that effective implementation of SDM tools or strategies in primary care practice may require a multifaceted approach involving both pre-visit patient tools and provider and patient supports during contraceptive counselling. Future research should seek to more clearly establish causal links between SDM strategies and outcomes, and to evaluate SDM tools or strategies in the Canadian context.

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.

Cancer is a disease of increasing global prevalence, resulting in a rising need for cancer survivorship care (CSC; World Health Organization [WHO], 2024). While definitions of CSC vary, primary care providers (PCPs) are increasingly required to care for cancer survivors (Nekhlyudov et al., 2017). The purpose of this integrative review is to appraise existing literature to gain an understanding of the experiences of cancer survivors who receive CSC from a PCP. This review was guided by the research question: for adult cancer survivors, what is the experience of cancer survivorship care provided by a PCP? A systematic literature search was conducted, followed by an appraisal of the selected eight studies. The findings reveal the complexity and potential scope of CSC, revealing inconsistency and wide variability in patient experiences of receiving CSC from a PCP. While some study participants reported positive experiences of accessing CSC and the overall quality of their CSC from a PCP, others expressed dissatisfaction in these areas. Some consistency in cancer survivor experience was found in the areas of PCP knowledge levels and organization of CSC, with the overall perception being one of inadequacy. Given the numerous benefits of improving the care of cancer survivors, and the need to increase the role of PCPs in CSC provision, researchers, policymakers, and educators need to take note of these patient experiences to make positive improvements to CSC.

Depression during the perimenopausal transition is a significant concern for women’s mental health and quality of life. Hormone Replacement Therapy (HRT), traditionally used to manage vasomotor and genitourinary symptoms of menopause, has also been investigated for its potential to alleviate depressive symptoms associated with hormonal fluctuations. This integrative literature review examined the impact of HRT on depression in perimenopausal women by analyzing articles published between 2014 and 2025, reflecting the most recent evidence following shifts in clinical practice post-Women’s Health Initiative. A comprehensive search strategy using Medline (Ovid), CINAHL (EBSCO), PsycINFO (EBSCO), and Google Scholar was employed, utilizing Medical Subject Headings (MeSH) and keywords. Six primary studies met inclusion criteria and were critically appraised and synthesized. Key themes arising out of the studies were the timing of HRT initiation, individual variability in depressive symptom response, and methodological heterogeneity across studies. Findings suggest that HRT, particularly transdermal estradiol, may be effective in reducing depressive symptoms when initiated during early perimenopause. However, inconsistencies in study design, outcome measures, and population definitions highlight the need for more standardized, high-quality research. These findings have implications for nurse practitioners and other primary care providers who play a critical role in screening, education, and patient-centered decision-making in the management of menopausal mental health.

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.

Modifiable risk factors for cardiovascular health are often associated with healthy diet, physical activity, and smoking cessation. Rarely is psychological stress mentioned or attributed to cardiovascular disease (CVD). However, the literature is beginning to recognize psychological stress as contributing to an increased risk of CVD (Aggarwal et al., 2021; Rippe, 2018; Walton et al., 2002). Acute stress may impact the autonomic nervous system, increasing heart rate and blood pressure, while chronic stress is associated with inflammation and the development of atherosclerosis (Aggarwal et al., 2021; Ware, 2008). Healthcare guidelines remark on the need to address modifiable risk factors in preventing and treating CVD (British Columbia [BC] Guidelines, 2023; Jain et al., 2022; Pearson et al., 2021). However, the guidelines provide poor directives regarding what intervention a practitioner should use, and how they should use it, to reduce or manage patient stress. Furthermore, implementation of lifestyle interventions can be challenging, and practitioners often face several barriers. Therefore, an integrative literature review was conducted to identify stress-reducing interventions that primary care nurse practitioners (NP) can implement when treating CVD. Nine articles were reviewed utilizing Cooper’s (1982) systematic approach for integrative literature reviews, a method first published in 1982 and frequently cited and used throughout the literature. Randomized controlled trials, cohort studies, and qualitative research were included in this analysis. Unfortunately, this review did not yield conclusive evidence that psychosocial interventions can achieve statistically significant results in the treatment of CVD compared to standard CVD treatment. Nevertheless, the practice recommendations are that psychosocial stress should be assessed and monitored for those with CVD, and that lifestyle interventions should continue to be promoted as adjuncts to traditional treatment regimes.

Cervical cancer incidence continues to rise across Canada. Unlike some other cancers, cervical cancer is largely preventable through a combination of vaccination and routine screening. Cervical cancer screening was introduced in British Columbia in 1955 using the Papanicoulau smear which requires a cervical specimen be obtained during a pelvic exam. However, the pelvic exam has been identified by patients as a barrier to participation in cervical cancer screening. Today, vaginal human papillomavirus testing provides a safe, validated alternative to the Papanicoulau smear. Importantly, the human papillomavirus specimen can be collected by patients themselves using a vaginal swab, thereby removing pelvic exam-related barriers to cervical cancer screening. Specimen self-collection tends to be preferred by patients, however primary care providers' perspectives on its use are not known. Primary care providers, including nurse practitioners, have the potential to impact their patients' health behaviours, and as such, understanding providers' perspectives on the use of self-collection is an important consideration in order to reduce the burden of cervical cancer.

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.

Synthesizing the findings from diverse methodologies, this integrative review aimed to guide nurse practitioners (NPs) in supporting the mental health and wellbeing of Syrian adults with refugee experiences in Canada (Syrian Adults). A comprehensive search strategy was conducted in three databases (APA PsycInfo, MEDLINE with Full Text (EBSCO) and Web of Science), Google Scholar and Google Search Engine to identify relevant literature. Twelve publications met the inclusion criteria and were critically appraised. The analysis of these publications led to the identification of four key themes: (1) Correlates and Social Determinants of Mental Health, (2) Cultural and Linguistic Considerations (including the subthemes of Stigma and Perceptions of Mental Distress; and Screening and Self-Report Tools), (3) Non-Clinical Facilitators of Mental Wellbeing, and (4) Trauma and Provision of Trauma-Informed Care. The findings of this integrative review highlight the importance for NPs to build their foundational knowledge to provide comprehensive, culturally appropriate, and trauma-informed care. Key strategies include the use of validated mental health screening tools tailored for Arabic-speaking and/or refugee populations, fostering trust and safety through an awareness of the role of stigma and trauma in mental health care, utilizing interpreters and cultural brokers where appropriate, and assessing social determinants of health during routine assessments. This review also emphasizes the importance of interagency collaboration and ongoing professional development in cross-cultural mental health to support access to care and mental wellbeing for Syrian Adults.

Background: The increasing complexity of trauma care and provider shortages have led to the expanded role of nurse practitioners (NPs). While NPs are integrated into various healthcare settings, their influence on length of stay (LOS) for adult trauma patients remains an area of interest, particularly from a qualitative perspective. Objective: This integrative review explores qualitative findings on how NPs can influence LOS in adult trauma patients, identifying potential contributions such as care coordination, efficiency, and provider workload. Methods: A systematic search of CINAHL, MEDLINE, and Google Scholar was conducted to identify qualitative studies that examined the impact of NPs on LOS in adult trauma care. Using an integrative review approach, data were analyzed to assess how NPs influence LOS. Key themes were synthesized, LOS outcomes were reported, and the generalizability and applicability of the integrative review findings were discussed. Results: Findings suggest NPs contribute to reduced LOS by improving care coordination, enhancing multidisciplinary communication, and facilitating discharge planning. However, the extent of their impact remains unclear due to limited evidence. Conclusion: While NPs are described as valuable members of trauma teams, their specific impact on LOS in adult trauma patients is not well established in the qualitative literature. Further research is needed to explore this relationship and determine whether NP-led interventions can effectively reduce LOS. Keywords: trauma service, trauma center, trauma centre, trauma unit, nurse practitioner, advance practice nurse, trauma nurse practitioner, length of stay, LOS, impact on length of stay, hospital length of stay.

Cervical cancer (CC) remains a major public health concern, disproportionately affecting low-income populations due to barriers in screening and follow-up care. Inadequate follow-up after a positive HPV self-sample result puts individuals at higher risk of disease progression, yet there is limited research on effective follow-up strategies for this group. This integrative review explores interventions aimed at improving adherence to follow-up care in low-income women. A systematic search identified eight studies examining follow-up interventions in lowincome populations. Follow-up rates varied widely (5.6%–92%), with higher adherence observed when multiple follow-up methods were used, such as phone calls, text messages, postal mail, and home visits. Patient education, patient navigation, and the provision of a second self-sampling kit also showed promise in increasing follow-up rates. However, inconsistencies in study methodologies and healthcare settings make direct comparisons challenging. These findings highlight the need for standardized, evidence-based follow-up strategies to address disparities in CC care. Future research should focus on scalable, cost-effective interventions, including mobile health (mHealth) approaches and patient navigation models. Policy efforts should prioritize integrating multi-modal follow-up strategies into national screening programs to improve outcomes for vulnerable populations.

Aim: To explore whether Nurse Practitioner-led outpatient interventions targeting heart failure patients can reduce hospital readmissions or emergency department visits, thereby improving healthcare efficiency and demands on hospitals. Background: Heart failure is a leading cause of hospital readmissions, contributing significantly to healthcare system strain. Despite advancements in HF care, readmission rates remain high, posing substantial clinical and financial burdens. Nurse Practitioners, with their expertise in chronic disease management and holistic care, are well-positioned to address these challenges through proactive, personalized post-discharge care. Method: An integrative review synthesizing most recent evidence on Nurse Practitioner-led outpatient care models for heart failure patients, focusing on their impact on readmissions and emergency department visits. Results: Evidence suggests that Nurse Practitioner-led interventions improve post-discharge continuity of care, reducing preventable readmissions and emergency department visits. These models effectively target key factors contributing to readmissions, including medication adherence, dietary management, patient education, and timely patient follow-ups. Although no ethical concerns were identified, additional rigorous research across diverse populations and settings is necessary to solidify the evidence base and guide widespread implementation. Conclusion: Nurse Practitioner-led care presents a viable and scalable strategy to improve outcomes in heart failure management and alleviate healthcare system pressures. Further research and policy support are crucial to expand and standardize these programs.

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.