Conectar
Home care nursing is an essential component of health care in Canada, yet little is known about the work of home care nurses.
As a part of a larger Canadian study on home care, this institutional ethnography (IE) focused on home care nurses in one health authority in Western Canada. The purpose of this research was to explore the work of home care nurses and to trace how this is organised and coordinated from the standpoint of the nurses.
IE is a methodology that focuses on day-to-day work from an established standpoint to uncover what is coordinating the work at a systems level. In this research, the standpoint of nurses was explored through interviews, observations and collected texts. Data were collected from March 2020 to December 2021.
Nurses work in home care includes the determination, coordination and provision of care, documentation, supporting care givers, communication and referrals. The role is complex and uniquely autonomous. Texts that are used to collect information about home care nursing focus on task completion resulting in a representation of nursing practice that misses significant components including the organisation, relational and ethical work. Analysis shows that nurses' work, coordinated through electronic health documentation systems and texts, is influenced by dominant safety, efficiency and measurement discourses.
Home care nurses' time is increasingly spent managing their referrals, documentation and schedules eclipsing time spent on direct client care.
Understanding the invisible but dominant forces organising, and at times disorganising, the everyday work of nurses is a vital first step in creating change for home care nursing.
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Globally there is an increasing need for home care nursing to be delivered effectively; this research provides insights relevant to home care systems across jurisdictions.
Functional seizures (FS) are events that resemble epileptic seizures, but are not attributed to brain pathology and are instead thought to be due to psychological factors. A small, multisite, open-label, single-arm, pilot trial of a breathing intervention known as breathing control training (BCT) found it to be safe and effective in reducing seizure frequency in FS. We propose a protocol for a study to confirm these results.
A 24-week, multicentre, individually-randomised, assessor-blinded, two-arm, parallel-group efficacy and acceptability trial of BCT versus control (Befriending) in 220 participants ≥16 years of age with FS. Eligible participants will be randomly allocated to receive two sessions of either BCT or Befriending over a 4-week period. Sessions will be delivered by a respiratory physiotherapist at a clinical care site or via telehealth. They will complete assessments prior to commencing treatment and at 4, 12 and 24 weeks after their initial session of BCT/Befriending. The trial will be conducted alongside treatment as usual. An economic evaluation including cost-utility and cost-effectiveness analyses will be carried out from health sector and societal perspectives.
The study has been approved by The Austin Health Human Research Ethics Committee (HREC/84335/Austin-2022) and the New Zealand Central Health and Disability Ethics Committee (2022 FULL 12324). Findings will be reported to trial participants and consumers; presented at local, national and international conferences; and disseminated by a peer-reviewed scientific journal.
by Olatundun Gafari, Ashleigh Craig, Khuthala Mabetha, Duncan Hornby, Craig Hutton, Mary Barker, Shane A. Norris
ObjectiveTo assess the associations between food insecurity, coping strategies, socio-economic status and anxiety, depression and multimorbidity in South Africa.
MethodsData from a nationally representative cross-sectional survey conducted in April 2024 (n = 3171; weighted to 20,955,234 adults aged > 18 years) were used. Food insecurity was measured using the Community Childhood Hunger Identification Project (CCHIP) tool, a validated household-level measure commonly used in South Africa. Coping strategy, anxiety and depression were measured using the coping strategies index, Generalised Anxiety Disorder–7 scale and Patient Health Questionnaire–9, respectively. Multimorbidity was self-reported as ≥2 of 14 known chronic conditions. Multivariable logistic regression was used to test associations, and a generalised structural equation model examined the roles of socio-economic status and coping strategies.
ResultsBeing from a food-insecure household more than doubled the odds of experiencing multimorbidity (OR=2.17, 95% CI 2.17, 2.19), depression (OR=2.96, 95% CI 2.95, 2.97) and anxiety (OR=2.82, 95% CI 2.81, 2.83). Food insecurity accounted for approximately 60% of the total association between socio-economic status and depression, and about 88% of the association between socio-economic status and multimorbidity.
ConclusionsFood insecurity is significantly associated with adverse physical and mental health outcomes. Interventions to improve food security, especially in low socio-economic populations, should be prioritised given their associations with multimorbidity, anxiety and depression. Potential intervention effects will require longitudinal or experimental evaluation.
Obesity disproportionately affects ethnic minority populations due to structural inequalities, such as limited access to healthy food, inadequate healthcare and systemic racism. Universal weight management programmes often fail to meet the unique needs of ethnic minority populations. These universal interventions may lead to lower engagement and poorer health outcomes compared with those observed in non-minoritised ethnic groups. This systematic review will examine the impact of culturally tailored interventions to treat and manage obesity in adult ethnic minority populations on weight- and health-related outcomes (meta-analysis) and patient experience (qualitative evidence synthesis).
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines will be followed. Interventions of interest will include standalone or multicomponent behavioural interventions with culturally tailored elements of design or delivery. These will be compared against standard weight management interventions or usual care in adults from ethnic minority populations living with obesity. The primary outcome is the mean percentage weight (kg) change between pre–post interventions. A search of databases (Ovid MEDLINE, Embase, APA PsycINFO, Scopus and Web of Science) was conducted in February 2025. Eligible studies include randomised controlled trials (RCTs), quasi-experimental (non-randomised trials, pre–post interventions) and qualitative research. Risk of bias will be assessed with the Cochrane Risk of Bias 2 tool and the Mixed Methods Appraisal Tool. Narrative synthesis will be performed according to the synthesis without meta-analysis guidelines. For eligible RCTs, a random-effects meta-analysis will calculate pooled effect sizes between pre–post intervention using standardised mean differences, with additional sensitivity and subgroup analyses. Qualitative evidence synthesis will be performed using semi-automated text analytics (unsupervised machine learning) and inductive thematic analysis.
Ethical approval is not required. Findings will be disseminated through peer-reviewed journal publications, conference presentations, professional organisations and patient and public networks.
CRD42025636750.
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