While public health leadership is identified as essential to advance health equity, there is limited evidence to guide it. A scoping review of the literature was guided by the research question "What aspects of public health leadership to advance health equity have been considered by research?” A subsequent metasummary synthesis was conducted to answer two further questions: How is leadership (and leaders) described in the literature set at an individual, organizational, community, and system level? and What is the relationship between leadership and the outcomes?

The scoping review methodology was based on Arksey and O’Malley’s (2005) six-phase framework to facilitate a broad review of the research literature. Systematic and rigorous selection processes were used to identify the evidence base (~8,000 articles) and review 27 included research studies. Data extraction and analysis iteratively revealed factors that contribute to public health leadership at multiple system levels. The metasummary method extracted 510 data elements from the 27 studies. Statements describing public health leadership to advance health equity were derived from the words most often used in the data elements, illuminating aspects unique to public health leadership for health equity.

Research evidence to guide public health leadership is in its infancy, difficult to locate and diverse in its use of research methods and designs. Key findings include: attributes of public health leaders matter, relationships are central, and multiple types of knowledge are required. Results also reveled that public health leadership to advance health equity occurs at multiple systems levels simultaneously, includes a bridging role between levels, and is grounded in values of social justice, equity, and solidarity. Nurses can use the description of leadership as well as the tools, strategies, and mechanisms identified for policy development, practice, education, research, and to support public health leadership competence at individual, organizational, community, and system levels.

Learning Objectives:

  

  

May Tao, RN, BScN, MSN, CCHN(C), Toronto Public Health, Toronto, ON

Excellence in community health nursing requires consistent application of evidence to improve outcomes. This large urban public health unit, designated as a Best Practice Spotlight Organization (BPSO®), demonstrated innovative nursing leadership to support evidence-informed practice. An initial evaluation demonstrated inadequate use of evidence in practice. Systematic changes were necessary to improve the use of evidence throughout the organization to advance practice.

Nursing leaders used novel strategies to build organizational capacity. A network of Champions was developed to implement and evaluate evidence. These Champions were supported to become leaders in their field. Innovative strategies were also used to build evaluation capacity and leverage resources for sustainability. A performance management framework was utilized to evaluate and identify areas for improvement including a logic model; key performance measures; data dictionaries and data collection tools. An online survey was conducted and results were compared with a previous evaluation.

 

Amongst the many findings was: a marked increase in the use of evidence; increased collaboration among interdisciplinary staff from different programs; and an increase in sustainability of the evidence-informed approaches. Champions, seen as opinion leaders and experts in their field, are available on-site to support their colleagues in a 'just in time' basis; providing personalized approach to professional learning.

The results demonstrate a very encouraging trend, and illustrate the value of systematic integration of evidence to enhance excellence in quality care. Community health nurses in any settings, can adapt and apply this innovative approach. Nursing leadership has been pivotal in transforming the culture in the organization to one that is rich in evidence-based practice, and ultimately improves the health of Canadians.

Learning Objectives:

Learn about how an innovative leadership approach achieved excellence in nursing practice.

• Describe the successes and challenges of evaluation of the BPSO® initiative.
• Gain insights in using the performance management framework to integrate continuous improvement into practice.

 

Rhonda Croft, BSN, MSN, BC Nurses’ Union, Burnaby, BC,   Sharon Sponton, RN, MBA, BC Nurses’ Union, Burnaby, BC,   Maura MacPhee, RN, PhD, BC Nurses’ Union, Burnaby, BC,   Christine Sorensen, RN, BC Nurses’ Union, Burnaby, BC,  Tarya Laviolette, MPH, BC Nurses’ Union, Burnaby, BC,   Andrea Wardrop, MA, BC Nurse

Violence is on the rise within BC health care facilities, adversely affecting patients and front line providers. This presentation will focus on violence statistics and violence prevention strategies with respect to nurses on the frontline in community care.

Nurses are now more likely than law enforcement and security workers to suffer violent injuries on the job. Furthermore, research shows that violence in the health care industry is underreported by as much as 70%. In response to the growing risk faced by nurses at work, the BC Nurses’ Union has launched a violence prevention campaign. To inform this campaign, academic researchers and provincial nurses’ union data analysts used mixed methods to examine direct care nurses’ perspectives on current policy. Two survey approaches were used: a) a convenience sample of 3000 nurses, and b) a stratified random sample of 500 nurses from acute, community, and long-term care sectors. Focus groups were conducted with a purposeful sample of 100 nurses.

The survey results are striking. The public survey revealed general awareness of violence issues in health care, but respondents had no idea of the extent of the violence. The majority of direct care nurses in all sectors reported verbal (80%) and physical abuse (68%), yet 28% said that violent incidents are never reviewed with staff, even though policy requires employers to assess hazard risks with them. This presentation will review survey and focus group data from nurses in community care and the public and describe how these data will inform evidence-based strategies for violence prevention including risk assessment, incident reporting, data sharing, collaborative decision-making, particularly at local levels (i.e., direct care staff and management), and ongoing monitoring and evaluation.

Learning Objectives:

 

Supporting the themes of practice innovation and client centred care, the Maternal Wellness Program (MWP) provided by HealthLine811 is an innovative, outbound call program in Saskatchewan that provides timely interim support to women at risk for postpartum depression and/or anxiety. The MWP provides client-centred, accessible and cost-effective support integrated within the larger health system. This program began as a pilot in two regional health authorities in 2013 and has since expanded province-wide. The MWP is a Ministry of Health funded initiative that supports the Working Together for Change: A 10-Year Mental Health and Addictions Action Plan for Saskatchewan.

Public Health Nurses (PHNs) utilize the Edinburgh Postnatal Depression Scale to identify at-risk women at postpartum encounters and the infant’s two and six month Child Health Clinic appointment. Prior to the MWP, a woman determined to be at risk of post-partum depression and/or anxiety was offered referrals to her primary care provider and/or a mental health clinician. With the MWP, the PHN now offers clients an additional/alternative referral option. With client consent, a HealthLine 811 mental health clinician (Registered Psychiatric Nurses or Social Workers) calls the woman at her preferred time within 24 – 72 hours of receiving her referral. HealthLine 811 staff conduct assessments, provide information, offer support and coping strategies. Ongoing communication to the referring PHN from intake to discharge is provided as needed. Discharge usually occurs when permanent supports are in place with the woman’s primary health care provider and/or mental health clinician. Some women served by the MWP are geographically and/or socially isolated. Client satisfaction results and women’s narratives have demonstrated positive health outcomes from the MWP. 

The current MWP evaluation and surveillance results will be discussed. Attendees will meet conference objectives by acquiring practical processes and innovative ideas for meeting the mental health needs of postpartum women.

Learning Objectives:

 

The roles and responsibilities of community mental health nurses are complex and broad. Community mental health nurses are nurse leaders and play a crucial role in promoting, protecting, and restoring the health of Canadians. As a sub sect of community health nurses, community mental health nurses need to be recognized and esteemed for their unique role in community health care.

Community mental health nurses face a considerable amount of pressure to provide exceptional care for their clients, but face numerous internal and external barriers that obscure their duties. With case management caseloads of up to 60 clients with chronic mental health needs, addiction struggles and health inequity hardships, CMHN’s continue to be stretched to the limits. CMHN’s are guided by the SRNA and RPNA standards of practice and recovery oriented practice guidelines, but their nursing practice is dichotomized by the rules and regulations of the provincial mental health acts resulting in cautious and conservative clinical decisions. With the overall goal of promoting client autonomy and empowerment, CMHNs must balance governing laws but also ensure their clients are empowered and dignified. In order to promote client centered care, CMHNs must have 1) the ability to be ‘a jack of all trades’ 2) the power to control and organize their work, particularity the content of their work, and 3) the ability to successfully self regulate their practice. Community mental health nurses need to be recognized and esteemed for their unique role and responsibilities in community health care.

Learning Objectives:

  

Wherever people interact, there is a potential for violence. From gossip, intimidation, and/or physical attacks, workplace violence is a serious issue that affects every occupation, which could cause high risk to an organization and to those involved. With Violence-related legislation and compliance regulations changing, workplaces need to prepare their policies, procedures, and practices to align accordingly. With or without specific workplace violence legislation, employers need to take all reasonable precautions to protect the health, safety, and well-being of their employees.

This interactive session, Taking Action: Violence Prevention at Work, will guide participants through the exercise of defining the scope of what workplace violence is. Subjects such as harassment, what their legal obligations are as employers, what goes into a workplace violence prevention policy, how to assess the workplace for violence, and how to develop preventative measures will also be explored. This session's facilitators will interact with participants via group exercises to help encourage them to test their knowledge and explore the tools provided. By the end of the session, participants will leave feeling prepared to take action on eliminating or minimizing the potential for workplace violence within their workplaces.

Learning Objectives:

 

Josephine Etowa, PhD RN University of Ottawa School of Nursing, Ottawa ON,  Megan Aston, PhD RN, Dalhousie University School of Nursing, Halifax, NS,  Sheri Price, PhD RN, Dalhousie University School of Nursing, Halifax, NS,  Andrea Hunter, PhD Concordia

It is imperative that health care professionals understand how postpartum health outcomes for mothers, newborns and their families have been socially and institutionally constructed. This type of understanding will make evident how dominant discourses focused only on physical health is detrimental to the overall well-being of mothers, newborns and their families. Understanding how health outcomes are socially and institutionally constructed will not only guide effective postpartum programs, services and support, it will also help guide research and evaluation. Although postpartum assessments conducted by public health nurses include physical, mental and emotional well-being, the range of health outcomes has not been equitably reflected in research or health outcomes posted by the Public Health Agency of Canada. The dominant health discourse regarding postpartum health outcomes continues to primarily focus on physical aspects of health such as breastfeeding, smoking and return visits to health care practitioners. In our ongoing research conducted in Nova Scotia through public health and in the community (2010-2017), the most cited health outcomes by mothers and PHNs were the need for confidence, self-efficacy and feeling normal. These every day mental and emotional health outcomes are foundational to moving forward and experiencing overall good postpartum health for mothers, newborns and their families. It is imperative that health care professionals and mothers critique and challenge hegemonic ways of presenting postpartum health outcomes. Focusing primarily on physical health outcomes creates a gap in services and research. Public health nurses and mothers need to work together and act as political change agent to ensure mothers, babies and families are the healthiest they can be.

Learning Objectives: