Suchergebnisse

Critically examines the notion of military & civilian organizations as readily collaborative instruments of state power, looking at organizational culture as a key impediment to greater civilian-military cooperation in the context of complex interventions. Adapted from the source document.

The demand for higher education has increased worldwide and the response has been an impressive expansion of educational offerings both within and across countries. The purpose of this manuscript is to emphasize the necessity of common educational standards for nurses in a globalized world. Common standards are crucial in regulated professions, such as nursing, in which lives depend on the possession of specific competencies. This article defines and describes globalization and the internationalization of education, including nursing education, discusses the exporting of nursing education, identifies the challenges and current solutions related to nurse migration, and presents current standards and future trends in harmonizing nursing education internationally.

Ontario has an immediate need for 70,000 long-term-care (LTC) beds—38,000 to address current waitlists and a further 32,000 in need of replacement, which together will cost more than $20 billion. This study examines funding sources and requirements and ownership structures in the LTC homes sector in Ontario. Semi-structured interviews were used to understand the ability, challenges, and willingness of LTC home owners to undertake the needed construction. Respondents identified poor access to capital funding, inadequate returns on private capital, differences in funding by ownership model, differing costs by region, and regulatory obstacles. Policy options are identified to overcome constraints and spur construction and redevelopment of LTC homes.

Due to economic instability, employment status has been shifting over time. Organizations have been moving toward a flexible contingent workforce. An early study of employment patterns demonstrated a significant rise in part-time and casual employment in the Ontario nursing workforce ( Baumann et al. 2006 ). The Nursing Graduate Guarantee, a public policy initiative, represents a substantial investment by the provincial government to stimulate full-time employment. This article presents the results of a trend analysis of nurse employment. Results indicated that stimulus funding attached to the public policy influenced employment of new graduate nurses.

Historically, economic changes have negatively affected the nursing workforce in Ontario. The trend towards part-time and casual employment emerged from healthcare restructuring in the 1990s. The severe acute respiratory syndrome (SARS) outbreak in 2003 alerted the Ontario government to the issue of part-time and casual nursing. In 2007, the Nursing Graduate Guarantee (NGG), a health human resources employment policy, was developed as a financial incentive for employers to hire and mentor new graduate nurses for a six-month period. The purpose of this study was to examine facilitators and barriers to policy implementation and assess the impact of the NGG on full-time employment and workforce integration of new graduate nurses in Ontario. A mixed-methods approach was used and included surveys, interviews and focus groups. Results indicated that full-time employment of new graduate nurses increased during the study period and that mentorship facilitated workforce integration of new graduate nurses.

In Ontario, the unpredictable funding climate of the 1990s led health care organizations to look for ways to reduce costs. Adopting a just-in-time staffing policy, they employed fewer full-time workers, scheduled part-time workers to work regular shifts, took on more casual staff, and became increasingly reliant on agency nurses and overtime to cover shifts. These policies resulted in higher costs and reduced surge capacity, and placed the health of nurses and patients in jeopardy. Fewer staff meant more overtime. Stress-related absenteeism increased. Some nurses reacted to casualization by working for multiple employers. During the SARS (severe acute respiratory syndrome) epidemic in Toronto, nursing resources were stretched to their limits. An exploratory investigation, based on relevant literature and interviews with 13 nurse administrators who held key positions during the epidemic, confirmed the lack of spare capacity in the health care system and indicated that community and long-term care sectors had less capacity than acute care. Low surge capacity in these sectors increased the vulnerability of the entire health care system. Capacity issues should be addressed as part of a larger human resources initiative to create a more flexible workforce. Since SARS, a number of government and organizational initiatives have been developed to increase nursing capacity.

The development of refugee health policies is significant, given the increased volume of displaced persons seeking refuge in Canada and around the world. Changes to the Canadian refugee health policy, known as the Interim Federal Health Program (IFHP), limited healthcare access for refugees and refugee claimants from 2012 to 2016. In this article, we present a policy analysis using the case of the IFHP retrenchments to examine how political actors on opposing sides of the issue defined the problem using different causal story mechanisms. This analysis reveals that organized interests dramatically changed the problem definition of the IFHP reforms. Following their use of causal stories in redefining the problem, the courts declared that the reforms to refugee healthcare were a form of cruel and unusual treatment. Understanding policy strategies used by proponents of refugee healthcare coverage expansion is important for countries responding to the current, enduring refugee crisis.

BACKGROUND: Changes to the Interim Federal Health Program (IFHP) in 2012 reduced health care access for refugees and refugee claimants, generating concerns among key stakeholders. In 2014, a new IFHP temporarily reinstated access to some health services; however, little is known about these changes, and more information is needed to map the IFHP's impact. OBJECTIVE: This study explores barriers occurring during the time period of the IFHP reforms to health care access and provision for refugees. METHODS: A stakeholder analysis, using 23 semi-structured interviews, was conducted to obtain insight into stakeholder perceptions of the 2014 reforms, as well as stakeholders' position and their influence to assess the acceptability of the IFHP changes. RESULTS: The majority of stakeholders expressed concerns about the 2014 IFHP changes as a result of the continuing barriers posed by the 2012 retrenchments and the emergence of new barriers to health care access and provision for refugees. Key barriers identified included lack of communication and awareness, lack of continuity and comprehensive care, negative political discourse and increased costs. Afew stakeholders supported the reforms as they represented some, but limited, access to health care. CONCLUSION: Overall, the reforms to the IFHP in 2014 generated barriers to health care access and provision that contributed to confusion among stakeholders, the transfer of refugee health responsibility to provincial authorities and the likelihood of increased health outcome disparities, as refugees and refugee claimants chose to delay seeking health care. The study recommends that policy-makers engage with refugee health stakeholders to formulate a policy that improves health care provision and access for refugee populations.

Little has been written about how regulatory bodies define and demonstrate accountability. This paper describes a substudy of a research project on accountability in healthcare. The aim was to increase understanding of how regulatory bodies perceive and demonstrate accountability to their stakeholders. Twenty-two semi-structured interviews were conducted with provincial/territorial CEOs from the two largest health professional regulatory bodies in Canada: medicine and nursing. The regulators indicated that accountability was essential to their mandates and provided the foundation for regulatory frameworks. However, they did not offer a common definition of accountability. They agreed that they were accountable to three constituencies: the public, government and their members. Regulators noted that protecting the public and meeting the demands of the government and their members creates tension. They were also concerned about maintaining independence in the regulatory role.