Schiller, Catharine

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.

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.