Background and PurposePatients admitted to intensive care units (ICUs) are critically ill and suffer from life-threatening sickness of injury. To work in ICU, registered nurses require additional knowledge and skills. While practices regarding the hire of new graduate nurses (NGNs) into settings such as the ICU vary, it is common that NGNs are being hired. However, NGNs in general, are at a higher risk for turnover within the profession as compared to their more experienced colleagues. NGNs in ICU settings may be at higher risk of turnover due to the complexity of the care context. It is of particular importance that the experiences of NGNs in ICU be explored with the intent of identifying what these nurses experience but also to consider how they can be best supported during a period of transition. This manuscript reports the findings from a mixed design study that sought to understand the transition of a cohort of NGNs over a period of 2 years.MethodsThis study used both a purposive and convenience sample of NGNs. The qualitative component incorporated Thorne's (2016) interpretive description. Face-to-faceinterviews were completed.ResultsFive themes were identified: an emotional transition, a social transition, a transitioning mindset, transitioning through firsts, and transitioning with confidence. Within each theme, there is a distinct difference and elements of transition were evident. Findings demonstrate that the NGNs appeared to be more confident in their skills and in their nursing practice over time. Findings from this study provide important insight into the experiences of NGNs in ICUs.

One reviewer conducted a thematic synthesis of 16 studies focused on the perspectives, expectations, and experiences of people living with knee osteoarthritis (OA) regarding accessing and engaging with presurgical interventions for managing knee OA incorporating individual and/or group-based exercise. People with knee OA held various beliefs regarding the safety and usefulness of presurgical exercise-based interventions for the condition, often informed by interactions with health care providers early in their knee OA journey. Negative beliefs about exercise could make people apprehensive about engaging in it, while positive beliefs motivated initial access and engagement. Intrinsic, personal, and extrinsic contexts could influence people’s beliefs about presurgical exercise-based interventions and their ability and motivation to access, use, and ultimately benefit from them. People experiencing intrinsic motivation, self-efficacy, and a natural tendency toward physical activity, and those who did not experience symptoms or comorbidities interfering with exercise, described accessing and engaging in these interventions as easier. Initial access also depended largely on the nature of interactions with health care providers early in their knee OA journey. Some people reported difficulty accessing or engaging in these interventions when they had competing commitments or lacked sufficient funds, insurance coverage, equipment, and appropriate physical environments. People with knee OA generally reported feeling motivated by and benefiting from interventions that were structured, had an educational component, contained appropriately challenging but easily mastered exercises tailored to their contexts and needs, and included either in-person or virtual guidance from an exercise expert. They tended to find encouragement and motivation through group-based exercises. Some also reported feeling externally motivated by technologies sending automated reminders, motivations, and feedback regarding their physical activity. Many experienced positive outcomes after engaging in these interventions, which improved their quality of life, encouraged positive beliefs about exercise, and promoted continued use. Decision-makers interested in promoting equity in access, use, and benefit may consider publicly funding exercise-based interventions that can be tailored to individuals’ needs; may be delivered either in-person or virtually; can be offered outside of working hours; include exercises that are easy to execute while tending to other commitments; and use affordable equipment suitable for a range of body types.

Background and PurposeTo address the nursing shortage, it is increasingly common for hospitals to hire new graduate nurses into intensive care units (ICU). New graduates in intensive care likely experience needs beyond those of their peers outside of critical care contexts. Yet, relatively little is known about the experiences of this unique population. The purpose of this study was to explore the transition experience of a cohort of new graduate nurses in the ICU over a 2-year period.MethodsA longitudinal mixed-methods convergent design using a purposive and convenience sample of new graduate nurses working in an ICU. Surveys were administered and in-depth qualitative interviews were conducted at four points in time over a 2-year period.ResultsParticipants identified a number of skills that remained difficult, as well as less comfort in performing a number of nursing interventions, over the four time points. In addition, they highlighted a decline in their perception of receiving encouragement and feedback from their manager. Participants identified that a lack of confidence was a barrier to transition and that improved orientation and work environment could further support them in their journey. Certain aspects of their work environment, such as peer support, were identified as most satisfying, whereas the environment and system were least satisfying.Implications for PracticeThe results provide a greater understanding of the transition experienced by new graduate nurses in the ICU. In addition, the results may provide the ICU leadership team with potential areas to further support the transition of new graduates within this critical care environment.

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We conducted a custom technology review to narratively describe treatment outcomes and considerations important to people living with type 2 diabetes mellitus (T2DM) in Canada, as detailed in patient input provided to CADTH in the past. Patient groups submitted the input described in this review to inform CADTH Reimbursement Reviews, which advise reimbursement decisions made by public drug programs in Canada. CADTH staff produced this report through close engagement with representatives from patient groups that had contributed these inputs, including Diabetes Canada, Type 2 Diabetes Experience Exchange (T2DXX), and Patient Commando. This learning project provided an opportunity for CADTH to explore patient input in a new but rigorous way outside of the time constraints of Reimbursement Reviews for specific drugs. In past patient input, people living with T2DM emphasized that the condition demands intensive, perpetual self-management and has a profound and usually negative impact on their physical, psychosocial, and economic well-being. People living with T2DM want a cure for the condition. In the meantime, to improve their quality of life, they desire treatments that reduce the risk of hyperglycemia and its short- and long-term complications; facilitate weight loss; and improve their mental state, focus, and energy levels. They also desire treatments that can lessen the burden of medication administration, specifically by decreasing polypharmacy and dose frequency and allowing for easy storage, preparation, and administration. They would like medications to reduce the need for blood glucose checks, injections, and insulin, and they hope that new treatments can promote a return to normalcy by providing the freedom to eat and do what they want, when they want. In addition to these desired treatment outcomes, people living with T2DM want medications that cause few or no adverse effects, especially hypoglycemia, weight gain, and gastrointestinal and urogenital side effects. All patient input emphasized the need to increase access to and affordability of T2DM treatments in Canada. When discussing the contexts in which people living with T2DM access and use medications, patient groups also stressed the importance of respect and effective communication in therapeutic and interprofessional relationships; the need to provide and enhance knowledge to support informed decisions about and safe use of medications; and the importance of offering people with T2DM individualized treatment plans and a variety of choices. Patient groups reported limited demographic information on the people they surveyed and interviewed to inform their inputs. Inputs providing demographic information, however, showed that the voices of those belonging to equity-deserving groups in Canada were missing or underrepresented. The treatment outcomes and considerations emphasized in past patient input may differ from those important to members of these groups or may carry additional meaning or significance to them. Future avenues of inquiry and active engagement could focus on gaining insight into the perspectives and preferences of equity-deserving groups that include but are not limited to Black people, Indigenous people, and other people of colour; people living in poverty or with low income; people living in rural and remote communities; adolescents and adults aged 25 years or younger; and members of the LGBTQ2S+ community.