Measuring Scope of Practice Enactment among Primary Care Registered Nurses in Ontario

Background: Primary care is the sector of health care in which patients first establish contact with the health system, are provided person-focused care over time for all new or common needs, and receive coordinated integrated health services provided elsewhere by other members of the health care team. Registered Nurses (RNs) in Canada provide care within this sector in varying roles. The extent to which RNs enact their full scope of practice in primary care settings in Canada is not known. The Actual Scope of Practice questionnaire (ASCOP) is a 26 item Likert scale questionnaire developed by researchers in Canada and validated in the acute care setting to measure the extent to which RNs apply the knowledge, skills and competencies of the professional full scope of practice. Similar to the acute care setting, there is a need to measure scope of practice enactment in the primary care setting. Objectives: The overall aim of this thesis was to measure scope of practice enactment in the primary care setting. Two research objectives were addressed: (1) to revise and adapt the ASCOP questionnaire for use in the primary care setting, and (2) to determine internal consistency, construct validity, and sensitivity of the modified instrument, the ASCOP-PC. Methods: To address the first objective, a narrative literature review and synthesis and an expert panel review was conducted. To address the second objective a cross-sectional survey of 178 RNs working in primary care organizations in Ontario was conducted Results: The ASCOP, with few modifications, addressed key attributes of nursing scope of practice in the primary care setting. The ASCOP-PC yielded acceptable alpha coefficients ranging from 0.66 to 0.91 and explained variances from 44.2 to 62.6. Total mean score of 5.16 suggests that RNs within these models of care almost always engage in activities reflected in the ASCOP-PC. Interpretation: Findings from this study support the use of a the modified ASCOP questionnaire as a reliable and valid measure of scope of practice enactment among primary care nurses in the primary care setting.

Measuring Solar Energy Potentials in Residential Environments: A Comparative Study of Three Neighbourhoods in Kingston, Ontario

Photovoltaic (PV) systems offer a way to generate electricity locally in an urban setting while avoiding the environmental impacts of more widely used energy sources such as oil, coal, nuclear and natural gas. This report attempts to measure the benefits of incorporating solar technologies into urban residential land uses and identifies challenges to their widespread use by comparing implementation among three distinct residential neighbourhoods common to Canadian cities. The City of Kingston, Ontario is used as the location for this study.

Accommodating Muslim Minorities in Secular Societies: Public Education in England, Scotland, Ontario, and Quebec

Abstract This thesis examines one of the most sensitive challenges facing contemporary democracies: the accommodation of Muslim minorities in public institutions and services. It focuses on the field of education, and on two particular issues: the public funding of Islamic schools and the accommodation of Muslim needs in public secular schools. The analysis is based on an examination of outcomes in four jurisdictions that differ significantly in the level of accommodation that has emerged: England, Scotland, Ontario, and Quebec. I seek to explain why such variation in outcomes exists among these four cases. I draw on four bodies of literature to underpin the theoretical framework: historical institutionalism, political mobilization by civil society, political parties, and ideationalism. My argument can be summarized simply; historic church-state settlements, unique in each case, are the most important factor explaining the variation in outcomes in England, Scotland, Ontario, and Quebec. In some cases, the historic church-state template is incrementally adapted to accommodate Muslim minorities. In other cases, relatively little accommodation occurs and the path-dependent trajectory of church-state relations remains entrenched. While the historic church-state template is a necessary factor in the explanation, it does not fully account for the variation. For a more complete picture, I demonstrate that there are several additional key factors that also shape the outcomes: first, national identity and public attitudes towards immigration and immigrants; second, the extent of mobilization by political agents, such as civil society organizations and historic churches; and third, the response of political parties to demands by Muslims for institutional accommodation. Ultimately, I conclude that Muslims in these jurisdictions are receiving some accommodation, but the process is slow and partial. This thesis makes important theoretical and empirical contributions to the discussion of Muslim integration in liberal democratic states. First, a framework has yet to be developed that considers the theoretical implications of institutional accommodation of Muslims; I address this gap. Second, this research demonstrates the utility of historical institutionalism in explaining the adaptation of church-state templates to accommodate Muslims’ demands. Last, this study makes an original contribution by comparing the cases of England, Scotland, Ontario, and Quebec in the accommodation of Muslims in education. A comparison of Canada with the United Kingdom has not yet been done.  

Karst hazard analysis towards the development of predictive karst models for southern Ontario

An investigation into karst hazard in southern Ontario has been undertaken with the intention of leading to the development of predictive karst models for this region. The reason these are not currently feasible is a lack of sufficient karst data, though this is not entirely due to the lack of karst features. Geophysical data was collected at Lake on the Mountain, Ontario as part of this karst investigation. This data was collected in order to validate the long-standing hypothesis that Lake on the Mountain was formed from a sinkhole collapse. Sub-bottom acoustic profiling data was collected in order to image the lake bottom sediments and bedrock. Vertical bedrock features interpreted as solutionally enlarged fractures were taken as evidence for karst processes on the lake bottom. Additionally, the bedrock topography shows a narrower and more elongated basin than was previously identified, and this also lies parallel to a mapped fault system in the area. This suggests that Lake on the Mountain was formed over a fault zone which also supports the sinkhole hypothesis as it would provide groundwater pathways for karst dissolution to occur. Previous sediment cores suggest that Lake on the Mountain would have formed at some point during the Wisconsinan glaciation with glacial meltwater and glacial loading as potential contributing factors to sinkhole development. A probabilistic karst model for the state of Kentucky, USA, has been generated using the Weights of Evidence method. This model is presented as an example of the predictive capabilities of these kind of data-driven modelling techniques and to show how such models could be applied to karst in Ontario. The model was able to classify 70% of the validation dataset correctly while minimizing false positive identifications. This is moderately successful and could stand to be improved. Finally, suggestions to improving the current karst model of southern Ontario are suggested with the goal of increasing investigation into karst in Ontario and streamlining the reporting system for sinkholes, caves, and other karst features so as to improve the current Ontario karst database.

Changes in the Ecology and Abundance of Smallmouth Bass in Lake Ontario: 1958-2014

Understanding the reasons for long-term population change in a species requires an evaluation of ecological variables that may account for the observed dynamics. In this study, long-term changes in indices of Smallmouth Bass condition and population levels were examined for eastern Lake Ontario and the Bay of Quinte. Smallmouth Bass are an extremely important recreational fish species native to Lake Ontario. They have experienced numerous changes in their environment through direct human impacts, climate change, predation, and habitat sharing with non-native species. Smallmouth Bass have experienced an increase in body length and weight likely due to a diet shift from crayfish to predominantly Round Gobies which has allowed them to increase their growth rate. According to existing assessment data however, this increase in body size has not been associated with an increase in abundance. Long-term data from gill net sampling shows that Smallmouth Bass populations have been declining since the late 1980s with no indication of recovery. This could be due to a variety of factors, but it is most likely due to a change in the selectivity of gill nets because of the change in body size as well as a habitat shift away from gill net sampling sites. Adjusting for gill net selectivity has revealed that sub-adult bass abundance is currently greater than it was historically, and that very large bass are likely not being retained within the gill nets that are currently used. The use of a long-term data set in this study has led to a much better understanding of Smallmouth Bass abundance and ecology.

Predictors of caregiver burden across the home-based palliative care trajectory in Ontario, Canada

Family caregivers of patients enrolled in home-based palliative care programmes provide unpaid care and assistance with daily activities to terminally ill family members. Caregivers often experience caregiver burden, which is an important predictor of anxiety and depression that can extend into bereavement. We conducted a longitudinal, prospective cohort study to comprehensively assess modifiable and non-modifiable patient and caregiver factors that account for caregiver burden over the palliative care trajectory. Caregivers (n = 327) of patients with malignant neoplasm were recruited from two dedicated home-based palliative care programmes in Southern Ontario, Canada from 1 July 2010 to 31 August 2012. Data were obtained from bi-weekly telephone interviews with caregivers from study admission until death, and from palliative care programme and home-care agency databases. Information collected comprised patient and caregiver demographics, utilisation of privately and publicly financed resources, patient clinical status and caregiver burden. The average age of the caregivers was 59.0 years (SD: 13.2), and almost 70% were female. Caregiver burden increased over time in a non-linear fashion from study admission to patient death. Increased monthly unpaid care-giving time costs, monthly public personal support worker costs, emergency department visits and low patient functional status were associated with higher caregiver burden. Greater use of hospice care was associated with lower burden. Female caregivers tended to report more burden compared to men as death approached, and burden was higher when patients were male. Low patient functional status was the strongest predictor of burden. Understanding the influence of modifiable and non-modifiable factors on the experience of burden over the palliative trajectory is essential for the development and targeting of programmes and policies to support family caregivers and reduce burden. Supporting caregivers can have benefits such as improved caregiver health outcomes, and enhancing their ability to meet care-giving demands, thereby potentially allowing for longer patient care in the home setting.

It is just not fair: the Endangered Species Act in the United States and Ontario

The United States and the Canadian province of Ontario have enacted endangered species laws that regulate private land. The rationale for this is that the vast majority of endangered species in the two countries rely on private lands for survival. However, from a landowner perspective the law is deemed unfair. This paper presents analysis from 141 interviews with landowners in three U.S. states and Ontario. In recognition of distributive justice claims, both the U.S. government and the Ontario government have enacted programs aimed at increasing financial incentives for participation and compliance with the law. However, the law is still perceived as unfair. The central argument of this paper is that future amendments and new policies for endangered species should confront two other forms of environmental justice: procedural justice and justice-as-recognition. Landowners in both countries expressed not only concerns about compensation, but also a deep desire to be included in the protection and recovery process, as well as to be recognized by government and society as good stewards of the land. The paper concludes by stating that future policy amendments need to address justice-as-recognition if endangered species conservation on private lands is to be considered fair by landowners.

Physiotherapy practices and third party payers: issues in professional ethics in Ontario

[À l'origine dans / Was originally part of : ESPUM - Dép. médecine sociale et préventive - Travaux et publications]

Changes in the Ecology and Abundance of Smallmouth Bass in Lake Ontario: 1958-2014

Thesis (Master, Biology) -- Queen's University, 2016-10-04 08:39:25.778

“Come and live in my Shoes”: Food Access and social isolation for People living in poverty IN GANANOQUE, Ontario

This community-based research project, in collaboration with the Gananoque and Area Food Access Network (GAFAN), gathered data from self-reported food insecure residents of Gananoque and area to determine how to improve their access to healthy, personally acceptable food. In March 2016, I recruited 14 participants for three focus groups and one personal interview with those struggling to put food on the table for themselves and others in the household. Participants were single parents, adults over the age of 50, and adults who could benefit from improved access to healthy food but do not currently use existing services. Health issues, social isolation, scraping by, and lack of income were four themes that underscored the impact of poverty on the lives of participants. Lack of income, transportation, cost of food, lack of affordable or accessible childcare, and inadequate access to support services proved to be major barriers to food security: strongly influenced by the impact of rurality. The results of this research have the potential to help GAFAN improve food access for those living in this community. It may also have implications for enhancing food security in other rural Canadian communities.

The science of assessment : identifying and predicting environmental impacts

The historical challenge of environmental impact assessment (EIA) has been to predict project-based impacts accurately. Both EIA legislation and the practice of EIA have evolved over the last three decades in Canada, and the development of the discipline and science of environmental assessment has improved how we apply environmental assessment to complex projects. The practice of environmental assessment integrates the social and natural sciences and relies on an eclectic knowledge base from a wide range of sources. EIA methods and tools provide a means to structure and integrate knowledge in order to evaluate and predict environmental impacts.----- This Chapter will provide a brief overview of how impacts are identified and predicted. How do we determine what aspect of the natural and social environment will be affected when a mine is excavated? How does the practitioner determine the range of potential impacts, assess whether they are significant, and predict the consequences? There are no standard answers to these questions, but there are established methods to provide a foundation for scoping and predicting the potential impacts of a project.----- Of course, the community and publics play an important role in this process, and this will be discussed in subsequent chapters. In the first part of this chapter, we will deal with impact identification, which involves appplying scoping to critical issues and determining impact significance, baseline ecosystem evaluation techniques, and how to communicate environmental impacts. In the second part of the chapter, we discuss the prediction of impacts in relation to the complexity of the environment, ecological risk assessment, and modelling.