Zimmer, Lela

The goal of this project was to outline best practices regarding the organization of diabetes care and services in the community in relation to the local context of services in Squamish, BC, Canada to create a foundation for future quality improvement work. The theoretical framework of personcentered care is essential to chronic disease management and underpins this work. The methods include: 1) A narrative literature review consisting of a database search, and 2) A gap analysis consisting of local data and an environmental scan. The Chronic Care Model is an evidence-based integrated care framework used to organize the findings of the narrative literature review and the gap analysis and to frame the recommendations (Clement et al., 2018). Based on the findings, evidence-based recommendations were created specific to the context of diabetes care in Squamish, BC creating the opportunity for meaningful future quality improvement work.

Due to earlier recognition and advances in cancer treatment, increasing numbers of women are surviving breast cancer. In Canada, these women are transitioned back to their Primary Care Providers (PCPs), including Nurse Practitioners (NPs) and physicians, soon after their cancer treatment is complete. However, the research suggests that there are numerous barriers that hinder PCPs from delivering evidence-based care to breast cancer survivors. The purpose of this project was to answer the following research question: what are the barriers that PCPs encounter in providing breast cancer survivorship care in the primary health care setting to women who have completed active cancer treatment in Canada? To answer this question a comprehensive review of the literature was conducted. The findings of this integrative review demonstrated provider-related barriers and system-related barriers linked to knowledge deficits, attitudes, workload demands, and perceived suboptimal oncologist support. Key strategies and recommendations to overcome these barriers were examined and discussed in order to improve the care of breast cancer survivors in the primary health care setting.

A medication error committed by a student nurse during a clinical placement often results in the student fearing its potential impact on the patient, unit staff, and the student’s educational journey. Student nurses must navigate two parallel systems during a clinical placement – the educational system and the healthcare system – and there can be confusion about what each requires of the student. Neither of these systems contain clear direction for managing student-committed medication errors and for allocating associated responsibility and accountability. This exploratory mixed methods study examines the process by which responsibility and accountability for a student-committed medication error is allocated and the factors that influence that allocation decision. It describes key features of an ideal allocation process and suggests reasons why the current allocation process often does not meet those requirements. Qualitative data were analyzed through interpretive description and quantitative data were analyzed using descriptive statistics. The results were situated, interpreted, and triangulated within a critical realism philosophical framework. An ideal post-error environment must incorporate a just culture. Since students must navigate both the educational institution and the healthcare facility environments during a clinical placement, a just culture must permeate both. However, students are instead colliding with a post-error environment that they perceive as not meeting key ideals of a just culture: fairness, transparency, minimization of fear, and dedication to learning. Findings of this study can be used to drive change that will better support those who are involved in a post-error process, and decrease the significant inconsistencies that are currently of particular concern.