Edward Cruz

Aim To synthesise evidence on how home care providers' readiness to care for children and youth with medical complexity (CYMC) is conceptualised, what shapes it in practice and what approaches have been used to support or enhance readiness. Methods This scoping review was conducted in accordance with PRISMA‐ScR and Joanna Briggs Institute guidelines, with the protocol registered on the Open Science Framework. MEDLINE, Scopus, CINAHL, PsycINFO, Cochrane databases and ProQuest (Nursing & Allied Health; Dissertations & Theses) were searched from 30 ^th April 2025, with an update on 29th December 2025. Quantitative, qualitative, mixed‐methods studies, reviews and relevant grey literature examining provider readiness to care for CYMC (0–18 years) at home were eligible. Two reviewers independently screened and charted data. Results A total of 19 studies were included following screening of 3530 records and 64 full‐text reviews. Providers described limited paediatric‐specific education, mentorship and supervision, variable training quality and reliance on experiential learning. Readiness was shaped by home conditions, isolation, unclear roles, family dynamics and equipment reliability. No tool measured readiness as a unified construct. Lower readiness was related to safety concerns, readmissions, family stress and provider moral distress. Conclusion Provider readiness appears to be a key safety and quality concern in paediatric home care, shaped by clinical, relational and system‐level supports. Future work should clarify the construct, develop measures and test multicomponent strategies combining paediatric‐specific education, mentorship, supported practice and service redesign.

Interpretive description is recognized as a valuable and credible qualitative approach for answering applied research questions. However, guidance for novice researchers on how to apply it remains scarce. This paper responds to that gap by presenting a reflective account of my doctoral research process, illustrating how interpretive description can be operationalized from study conceptualization through design, analysis and knowledge translation. It contributes additional methodological guidance to the literature, particularly for novice scholars whose research questions address practice-oriented problems. As a nursing researcher passionate about creating change in nursing education, I aim to create safer and more equitable learning environments in undergraduate nursing programs. When I embarked on my doctoral research, I sought a methodology that could tackle this complex and real, education and practice-driven goal. Interpretive description was an accessible and rigorous qualitative framework that respected my disciplinary knowledge and supported practical solutions for nursing education. In this paper, I share my personal journey of using interpretive description as the primary methodology for my dissertation. I offer reflections and recommendations to support other novice researchers considering interpretive description as a framework for generating credible and clinically meaningful insights that are relevant and actionable in their real-world practice contexts.

Background: Children and youth with medical complexities have chronic conditions, functional limitations, and extensive care needs requiring significant family involvement and frequent health service use. Pediatric medicine has improved their life expectancy, shifting care from acute to home settings. In Ontario, home care is publicly funded and includes nursing, therapy, personal support, and allied health services. However, families continue providing the bulk of care, often at great personal costs. As care complexity increases, so does the reliance on home care providers. Yet, many providers report feeling unprepared due to insufficient pediatric training, lack of supervision, and system-level gaps. Here we applied Weiner’s theory of organizational readiness for change, framing readiness as a shared psychological state involving commitment to and confidence in delivering change, thus helping conceptualize provider readiness as encompassing individual competence, contextual supports, and motivational factors. Despite its importance, provider readiness in pediatric home care remains poorly understood. Objective: We examine how home care providers perceive their readiness to care for children and youth with medical complexities, factors influencing readiness, and strategies proposed to enhance their capacity to deliver safe, coordinated, developmentally appropriate home care. Methods: This scoping review follows the updated Joanna Briggs Institute scoping review methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Articles focusing on (1) children and youth with medical complexities aged 0-18 years receiving home care and (2) with at least one chronic medical condition, and (3) paid home care providers will be searched on MEDLINE, CINAHL, Scopus, ProQuest Nursing & Allied Health, PsycINFO, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Gray literature will be searched on Google Scholar and ProQuest (Dissertations & Theses). A 2-stage screening process will be conducted in Covidence, involving title and abstract screening and full-text review by 2 independent reviewers. Data will be extracted using predefined charting categories and analyzed using both qualitative and quantitative approaches. Results: As of May 2025, screening is underway. The review will map key themes across provider types, care settings, and training contexts and identify factors influencing provider readiness including access to training, system navigation supports, and workplace role clarity and chart recommendations or strategies to enhance readiness. Gaps in pediatric-specific competencies and workforce preparation may also emerge. Conclusions: This review will synthesize current evidence on provider readiness in pediatric home care, identifying strengths, challenges, and development areas. Findings will inform provider training, workforce development, and policy strategies to ensure children and youth with medical complexities receive safe, coordinated, effective home care. A deeper understanding of provider readiness will support more sustainable home care systems and improve outcomes for children and youth with medical complexities and their families. Trial Registration: OSF Registries 10.17605/OSF.IO/N4FAJ; https://osf.io/n4faj International Registered Report Identifier (IRRID): PRR1-10.2196/76796

The societal stigma surrounding mental illness emerges because of dysfunctional social dynamics between patients, their families and the broader community. This phenomenon, referred to as public stigma, manifests through discriminatory actions or the exclusion of individuals within power structures. Public stigma detrimentally affects the well‐being and recovery of those grappling with mental illness, impeding their quality of life. This paper discusses public stigma, examining society's negative attitudes toward individuals diagnosed with mental illness, the systemic injustices perpetuating their marginalisation and the ramifications for nursing practice. Ultimately, the authors propose a theoretical framework to educate and inform health professionals across both mental health and general medical domains, as well as policymakers, about the impact of structural violence in perpetuating public stigma and providing recommendations for remedial action.

BACKGROUND Children and youth with medical complexities have chronic conditions, functional limitations, and extensive care needs requiring significant family involvement and frequent health service use. Pediatric medicine has improved their life expectancy, shifting care from acute to home settings. In Ontario, home care is publicly funded and includes nursing, therapy, personal support, and allied health services. However, families continue providing the bulk of care, often at great personal costs. As care complexity increases, so does the reliance on home care providers. Yet, many providers report feeling unprepared due to insufficient pediatric training, lack of supervision, and system-level gaps. Here we applied Weiner’s theory of organizational readiness for change, framing readiness as a shared psychological state involving commitment to and confidence in delivering change, thus helping conceptualize provider readiness as encompassing individual competence, contextual supports, and motivational factors. Despite its importance, provider readiness in pediatric home care remains poorly understood. OBJECTIVE We examine how home care providers perceive their readiness to care for children and youth with medical complexities, factors influencing readiness, and strategies proposed to enhance their capacity to deliver safe, coordinated, developmentally appropriate home care. METHODS This scoping review follows the updated Joanna Briggs Institute scoping review methodology and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Articles focusing on (1) children and youth with medical complexities aged 0-18 years receiving home care and (2) with at least one chronic medical condition, and (3) paid home care providers will be searched on MEDLINE, CINAHL, Scopus, ProQuest Nursing & Allied Health, PsycINFO, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. Gray literature will be searched on Google Scholar and ProQuest (Dissertations & Theses). A 2-stage screening process will be conducted in Covidence, involving title and abstract screening and full-text review by 2 independent reviewers. Data will be extracted using predefined charting categories and analyzed using both qualitative and quantitative approaches. RESULTS As of May 2025, screening is underway. The review will map key themes across provider types, care settings, and training contexts and identify factors influencing provider readiness including access to training, system navigation supports, and workplace role clarity and chart recommendations or strategies to enhance readiness. Gaps in pediatric-specific competencies and workforce preparation may also emerge. CONCLUSIONS This review will synthesize current evidence on provider readiness in pediatric home care, identifying strengths, challenges, and development areas. Findings will inform provider training, workforce development, and policy strategies to ensure children and youth with medical complexities receive safe, coordinated, effective home care. A deeper understanding of provider readiness will support more sustainable home care systems and improve outcomes for children and youth with medical complexities and their families. CLINICALTRIAL OSF Registries 10.17605/OSF.IO/N4FAJ; https://osf.io/n4faj INTERNATIONAL REGISTERED REPORT PRR1-10.2196/76796

Internationally educated nurses’ (IENs) transition to practice in a new country is facilitated by education programs, commonly known as “bridging programs.” IENs experiences and understanding of interprofessional collaboration, essential in today’s health care environment, is often overlooked in education and research. Therefore, this mixed methods study sought to understand the experiences of IENs enrolled in a practical nursing bridging program at an urban community college in Canada. Findings indicate a need to address IENs’ understanding of interprofessional collaboration in their entry-to-practice education to optimize their role in the receiving country’s health care system.

The purpose of this study is to explore a practical nursing bridging program's education environment and the role transition of internationally educated nurses (IENs) who were enrolled full-time at a community college in Toronto, Canada, during the winter semester of school year 2018-2019. A survey questionnaire consisting of three parts was used to gather data from 68 IEN students who volunteered to participate in this study. Descriptive statistics and multiple regression analysis were used to analyze data. Participants' responses to the open-ended question "Could you please list any problems/issues you have encountered in the bridging program?" were thematically analyzed. Results indicate that all bridging program education environment components, as well as role transition subscales, were described as "agree." There is a significant relationship between the respondents' perception of learning within their bridging program's education environment and role transition. However, views on teachers and atmosphere, as well as academic and social self-perception, seemed insignificant predictors of role transition. Participants' responses to the open-ended question were analyzed and grouped into four themes: concern with teachers, program content issues, program pace, and financial issues.

This meta-synthesis explored the effect of bridging programs on internationally educated nurses (IENs). Eight papers that met the inclusion criteria were selected for this review. There were 437 participants from eight studies who come from different parts of the globe and who settled in either Australia, Canada, New Zealand, or the United Kingdom. Using a grounded theory approach for data analysis, four effects of bridging programs on IENs were identified. These are: (a) the concepts from the regulatory body, the client-centred care; (b) do something better for us, for our future; (c) we have to learn English; and, (d) faculty, program coordinator and preceptors that were willing to work with them. These effects were defined and explored in light of the study samples selected for this study.

Aim To provide an overview of the relevance and strengths of focused ethnography in nursing research. The paper provides descriptions of focused ethnography and discusses using exemplars to show how focused ethnographies can enhance and understand nursing practice. Background Orthodox ethnographic approaches may not always be suitable or desirable for research in diverse nursing contexts. Focused ethnography has emerged as a promising method for applying ethnography to a distinct issue or shared experience in cultures or sub-cultures and in specific settings, rather than throughout entire communities. Unfortunately, there is limited guidance on using focused ethnography, particularly as applied to nursing research. Data sources Research studies performed by nurses using focused ethnography are summarised to show how they fulfilled three main purposes of the genre in nursing research. Additional citations are provided to help demonstrate the versatility of focused ethnography in exploring distinct problems in a specific context in different populations and groups of people. Discussion The unique role that nurses play in health care, coupled with their skills in enquiry, can contribute to the further development of the discipline. Focused ethnography offers an opportunity to gain a better understanding and appreciation of nursing as a profession, and the role it plays in society. Conclusion Focused ethnography has emerged as a relevant research methodology that can be used by nurse researchers to understand specific societal issues that affect different facets of nursing practice. Implications for practice/research As nurse researchers endeavour to understand experiences in light of their health and life situations, focused ethnography enables them to understand the interrelationship between people and their environments in the society in which they live.