It is well-established that Two-Spirit, lesbian, gay, bisexual, trans, queer, intersex, and asexual (2SLGBTQIA+) people are subject to discrimination within healthcare settings, leading to poor health outcomes. In fact, these instances of discrimination are growing in context of rising hate toward the 2SLGBTQIA+ community. In response, the Island Health Authority has recently launched a revolutionary role: the 2SLGBTQIA+ Liaison Nurse. This Liaison Nurse works directly with 2SLGBTQIA+ patients in the healthcare system to support: navigating the system, advocating for services, ensuring a safe and respectful healthcare encounter, and accessing gender-affirming care. Our larger project will involve scaling up and implementing this role across additional healthcare sites in BC, and evaluating the role to ensure safe, quality, and equitable care for 2SLGBTQIA+ people across the province. Funding through a C2 grant will support bringing together health authority, community, and researcher representatives to develop a comprehensive research plan for implementing and evaluating this role. In particular, funds will support a 2-Day Intensive in Vancouver to support necessary conversations in support of the project’s next steps.
Research Location: Island Health
Embedding research knowledge to prevent seclusion in a young adult inpatient mental health setting in British Columbia
Young people living with mental health challenges are often hospitalized as a part of their journey in engaging with supports and services to improve their mental health. These experiences of hospitalization can be traumatizing, however, especially if young people experience seclusion: confinement of a person in an isolated, locked room to minimize harm and promote safety. There is a growing need to prevent the use of seclusion among young people in inpatient mental health settings. Our project will build on knowledge gained from a previous research study exploring the perspectives of healthcare providers and young people with mental health challenges to better integrate seclusion prevention strategies in inpatient mental health settings. To achieve this, we will host a one-day session that will bring together healthcare providers, young people, and researchers to identify seclusion prevention strategies. These strategies will then be directly embedded within a new Young Adult Mental Health Inpatient Unit within Island Health, in Victoria. They will also be shared with healthcare providers and students nationally and globally through a webinar, educational module, and an academic publication and conference presentation.
Walking Together: Strengthening Peer Leadership in Island Health towards a reduction in stigma and improvements in health services for people at the heart of the toxic drug crisis
Using as a focus-point one of the Walk With Me team’s recommendations identified in multiple of its research reports — to strengthen Peer Leadership within Island Health — the Project Team will:
a) Co-create a knowledge translation workshop for Island Health managers focused on Peer Leadership (ie: why Peer Leadership is an essential ingredient in the pursuit of an equity-conscious health system; how Peer Leadership might be incorporated and supported by Island Health; strategies to ensure success of Peer Leaders, etc.)
b) Co-deliver this presentation to at least 5 teams of Island Health managers, and
c) Work with managers to strategize the implementation of Peer Leadership plans.
Convening Health and Community Service Providers and Patients to Support the Co-design of A Digital Social Prescribing Platform
This project aims to support meaningful collaboration with Island Health and the Nanaimo Division of Family Practice in order to co-develop a social prescribing program. Social prescribing is a model of patient-centered, team-based care that aims to link individuals with community services to address their non-clinical health needs.[1] By leveraging social prescribing, Island Health and the Nanaimo Division of Family Practice aim to address social and material determinants of health by building low-barrier referral pathways for “social prescriptions” within the Nanaimo region. Examples of social prescriptions include Parks and Recreation passes, referrals to job programs, and other types of social and material support. In order to implement social prescribing in the Nanaimo region, we propose the co-design of Connect Rx, an online platform that will facilitate social prescribing (See prototype at www.casch.org/connect-rx). To accomplish this, we will (1) identify community assets and social prescriptions in Nanaimo, (2) convene health and community service providers to participate in the co-design of Connect Rx, and (3) co-develop an evaluation that can be used to assess the acceptability, feasibility, and efficacy of Connect Rx.
Co-Developing a Research Plan to identify roles, optimal resource allocation, and educational preparation for Nurse Practitioners (NPs) in acute care settings in Island Health
Nurse Practitioners (NPs) have practiced in BC since 2005, predominantly in primary care settings. Our completed C2 grant addressed the facilitators and challenges for integration of NPs into primary care in Island Health from the perspective of Island Health NPs, family practitioners, the MOH Nursing Policy Secretariat and Nurse and Nurse Practitioners Association of BC (NNPBC). During that grant, the health care environment in BC became more resource depleted in both primary and acute care settings. Demand for NPs in acute care are driven by shortages of hospitalist physicians, gaps in integrated care models, patients utilizing emergency departments for primary care, and unresolved challenges related to alternative level of care (ALC) patients occupying acute care beds. This environment has created unprecedented demand for NPs and CNSs within acute care settings. A MOH strategy for optimal NP utilization in acute care settings does not currently exist, and NP education programs in BC have curriculum gaps preparing NPs for acute care roles. We aim to leverage established relationships between NPs, Island Health, UVic, MOH & NNPBC to map the model of care, resource supports and educational preparation for NPs in acute settings.
Walking together in the same direction: Co-developing a culturally rooted model for diabetes prevention for Coast Salish and Nuu-Chah-Nulth communities of southern Vancouver Island
The nine Coast Salish and Nuu-Chah-Nulth nations of southern Vancouver Island have supported diabetes prevention and management with a variety of programs; however, the rate of diabetes continues to rise. Our goal is to engage with the nine First Nations communities through one-day gatherings to identify the assets, experiences, barriers, and gaps within each community, and integrate culture and language into a community-led model for diabetes prevention, treatment and management. We aim to co-create a framework for a diabetes prevention and care model that is community-driven, improves diabetes services at the local level, and supports nation-based self-determined approaches to diabetes prevention and management. It is imperative that we prioritize this work and align our efforts to explore a collaborative, decolonized approach to diabetes care. Our model will enhance the culture and resilience that is already present within our communities and bridge gaps in care to develop a diabetes strategy that can support our question of “How can we be who we are as First Nations people while integrating our Traditional knowledge with the best of Western approaches to diabetes care?”.
Team members: Valerie Bob (Simon Fraser University); Gwen Underwood (Saanich First Nations Adult Care Society); Marie Va’a (Tsartlip First Nation); Emily Doehnel (Tsartlip First Nation); Lois Williams (Tsawout First Nation); Kelli Telford (Tseycum First Nation); Kinsey Goertz (Tseycum First Nation); MaryAnn Daniels (Pauquachin First Nation); Jessie Jim (Songhees Nation); Hayley Moreau (Songhees Nation); Chris McElroy (Songhees Nation); Jeneen Hunt (Esquimalt Nation); Stephanie McMahon (Esquimalt Nation); Krista Johnny (Scia’new First Nation); Angie Gibson (Scia’new First Nation); Rose Dumont (T’sou’ke Nation); Jennifer Routhier (T’sou’ke Nation); Grant Robinson (Island Health); Penny Cooper (Island Health); Ashley Simpson (University of Victoria); Jennifer Murray (UBC); Brenda Bartleman (Tsartlip First Nation); Judith Atkin (Island Health); Amanda Henry (Island Health); Carol Hill (Pacheedaht Nation); Tara Claxton (Pacheedaht Nation); Rachel Dickens (Nuu-Chah-Nulth Tribal Council); Mathew Dueck (First Nations Health Authority)
Co-developing a research plan to investigate inter-disciplinary experiences, enablers, challenges and unintended outcomes of nurse practitioner integration into primary care in Island Health
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Nurse Practitioners (NPs) have practiced in BC since 2005, and are qualified to provide holistic primary care across the life span, similar to primary care physicians. Until 2018, NPs were health authority employees in salaried positions; in 2018 the MOH announced 200 new community NP positions and a contract payment structure option. Numerous contracted NP positions have since been introduced in Island Health. Integrating contracted NPs into an established primary care model traditionally provided by doctors has exposed unique challenges, opportunities and unintended outcomes. Although all stakeholders have generally worked well together, unanticipated conflicts and inefficient work flow impacts have arisen. Integrating inter-professional scopes of practice into an efficient and seamless system of innovative primary care in context of mixed expectations has been challenging. Published evidence suggests that full NP role optimization is affected by practice environments. We aim to develop a research plan to identify the enablers, challenges and unexpected outcomes, and determine how innovative processes enabling focused collaboration, clear scope of practice and improved teamwork can improve flow and access in primary care.
Digital storytelling: Bringing evidence-based treatment for C. difficile infection closer to home
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Dr. Christine Lee and her research co-lead Dr. Katharine McKeen, a primary care physician (PCP) with the Victoria Division of Family Practice (DFP), are employing a patient-oriented research (POR) approach to raise awareness and disseminate evidence of fecal microbiota transplant (FMT) to treat recurrent Clostridium difficile infection (rCDI). FMT, the administration of feces from a healthy screened donor, is demonstrated to be both safe and more effective than the usual ways to treat rCDI. Estimates from three recent Canadian studies indicate that only 1,000 rCDI patients have received FMT, yet approximately 10,000 Canadians each year are diagnosed with rCDI.
The team is proposing a distributed knowledge translation approach, one that will enable them to reach diverse stakeholders: patients, families, PCPs, and healthcare decision makers (HCMs). Using a POR approach, they will co-develop a digital story that will enable their patient partner to share her lived experience of rCDI and FMT, and then the research team will relay the evidence for FMT. This video will be used for public outreach and as an education tool. They will also engage PCPs and HCDMs through presentations at their respective networks. During this outreach, the digital story will be displayed.
The overall goal is to increase FMT access for patients diagnosed with rCDI. The objectives are to:
- Raise awareness of rCDI and FMT.
- Inform stakeholders of FMT’s safety and effectiveness.
- Engage PCPs and HCDMs in a constructive dialogue to discuss the benefits of and evidence for FMT for rCDI.
The expected outcomes and outputs are to:
- Raise stakeholder awareness of FMT and its benefits as a treatment for rCDI. Output: Production and launch of a digital story telling video on rCDI and FMT as an education and public awareness tool.
- Foster communications with PCPs and increase their awareness of regional FMT resources. Output: Share the digital story and engage PCPs in a constructive dialogue via a café scientifique style discussion at the DFP “Dine and Learn” session.
- Increase HCDMs awareness of regional FMT resources and FMTs positive contributions to the healthcare system overall. Output: Share the digital story and engage HCMs through presentations to Island Health's Medical Advisory and Clinical Practice Councils.
The team will evaluate the impact of their work by using the domains of the Canadian Academy of Health Science “Making and Impact” framework: advancing knowledge; research capacity building; informed decision making; health impact; and broad social and economic impact.