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Lang MJ, Bubber V. Pressure: How to meaningfully engage with patient stories. J Med Imaging Radiat Sci 2024; 55:178-180. [PMID: 38519386 DOI: 10.1016/j.jmir.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/02/2024] [Indexed: 03/24/2024]
Affiliation(s)
| | - Vikram Bubber
- Principal, Mike Lang Stories; Founder & Director, Common Language Digital Storytelling; Adjunct Assistant Professor, Faculty of Nursing, University of Calgary, Canada
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Didier A, Nathaniel A, Scott H, Look S, Benaroyo L, Zumstein-Shaha M. Protecting Personhood: A Classic Grounded Theory. QUALITATIVE HEALTH RESEARCH 2023; 33:1177-1188. [PMID: 37669352 PMCID: PMC10626982 DOI: 10.1177/10497323231190329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Abstract
The importance of perceiving and considering patients as healthcare partners has been increasingly promoted. Healthcare systems around the world are now highly interested in patient engagement, participation, collaboration, and partnership. Healthcare professionals are advised that patients, as autonomous beings, should be active in and responsible for a portion of their own care. The study presented here focused on patients' perceptions of interprofessional collaboration. It was conducted using the classic grounded theory methodology. The theory of protecting personhood emerged as the core concept of hospitalized patients, cared for by interprofessional healthcare teams. This theory encapsulates the process hospitalized patients go through to find balance in their sense of self, oscillating between personhood and patienthood in the unfamiliar hospital environment. The process consists of four stages: the stage of introspection, during which hospitalized patients become aware of their self as a person and as a patient; the stage of preservation, when patients find a balance between the sense of personhood and patienthood; the stage of rupture, wherein patients experience an imbalance between their sense of personhood and patienthood; and the stage of reconciliation, in which personhood is restored. The theory of protecting personhood offers insights into a better understanding of hospitalized patients' experiences and strategies, revealing the importance of relationships, and the driving force of empowerment. This study is about patients' perspectives of interprofessional healthcare teams. A grounded theory process allowed the emergence of patients' concerns and expectations, leading to a substantive theory grounded in the patients' data.
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Affiliation(s)
- Amélia Didier
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Alvita Nathaniel
- Department of Nursing, West Virginia University, Morgantown, WV, USA
- Grounded Theory Institute, Mill Valley, CA, USA
| | | | | | - Lazare Benaroyo
- Interdisciplinary Ethics Center, University of Lausanne (UNIL), Lausanne, Switzerland
| | - Maya Zumstein-Shaha
- Bern University of Applied Sciences Health, Bern, Switzerland
- Department of Nursing, University of Witten/Herdecke, Witten/Herdecke, Germany
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3
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Slater PJ, Herbert AR. Mentoring the Wellbeing of Specialist Pediatric Palliative Care Medical and Nursing Trainees: The Quality of Care Collaborative Australia. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:183-194. [PMID: 36895617 PMCID: PMC9990446 DOI: 10.2147/amep.s393052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The Quality of Care Collaborative Australia (QuoCCA), working across 6 tertiary centers throughout Australia, builds capability in the generalist and specialist pediatric palliative care (PPC) workforce, by providing education in metropolitan and regional areas. As part of the education and mentoring framework, Medical Fellows and Nurse Practitioner Candidates (trainees) were funded by QuoCCA at four tertiary hospitals throughout Australia. OBJECTIVE This study explores the perspectives and experiences of clinicians who had occupied the QuoCCA Medical Fellow and Nurse Practitioner trainee positions in the specialised area of PPC at Queensland Children's Hospital, Brisbane, to identify the ways in which they were supported and mentored to maintain their wellbeing and facilitate sustainable practice. METHODS Discovery Interview methodology was used to collect detailed experiences of 11 Medical Fellows and Nurse Practitioner candidates/trainees employed by QuoCCA from 2016 to 2022. RESULTS The trainees were mentored by their colleagues and team leaders to overcome challenges of learning a new service, getting to know the families and building their competence and confidence in providing care and being on call. Trainees experienced mentorship and role modelling of self-care and team care that promoted wellbeing and sustainable practice. Group supervision provided dedicated time for reflection as a team and development of individual and team wellbeing strategies. The trainees also found it rewarding to support clinicians in other hospitals and regional teams that cared for palliative patients. The trainee roles provided the opportunity to learn a new service and broaden career horizons as well as establish wellbeing practices that could be transferred to other areas. CONCLUSION Collegial interdisciplinary mentoring, with the team learning together and caring for each other along common goals, contributed immensely to the wellbeing of the trainees as they developed effective strategies to ensure their sustainability in caring for PPC patients and families.
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Affiliation(s)
- Penelope J Slater
- Oncology Services Group, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Anthony R Herbert
- Paediatric Palliative Care Service, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
- Centre for Children’s Health Research, Queensland University of Technology, Brisbane, QLD, Australia
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Slater PJ, Herbert AR. Education and Mentoring of Specialist Pediatric Palliative Care Medical and Nursing Trainees: The Quality of Care Collaborative Australia. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2023; 14:43-60. [PMID: 36726358 PMCID: PMC9885964 DOI: 10.2147/amep.s393051] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/20/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The Quality of Care Collaborative Australia (QuoCCA) builds capability in the generalist and specialist paediatric palliative care (PPC) workforce throughout Australia. It supports regional and community services to provide care close to families' homes, as well as building expertise in tertiary centers. OBJECTIVE Medical Fellows and Nurse Practitioner candidates (specialist trainees) were funded by QuoCCA at four tertiary hospitals throughout Australia supported by an education and mentoring framework. This study explored the activity and experiences of clinicians who had occupied these roles to evaluate their effectiveness to build PPC capability. METHODS Online surveys recorded the monthly activity of Medical Fellows, with a point in time check of knowledge, skills and confidence in 2019. Discovery Interview methodology was used to collect detailed experiences of 11 trainees employed between 2018 to 2022 in Queensland. RESULTS A combination of mentoring and formal and informal education, peer support and practical experience was valuable for trainees. They found the support of the whole interdisciplinary team advantageous to learning. Shadowing experienced team members gave them the opportunity to learn practical skills, especially regarding communication with families. Practicing clinical skills was beneficial, through being on call, attending home visits, supporting families, prescribing medications and developing treatment plans in collaboration with the team. The trainee experience was optimised through learning from families, personal reflection, involvement in research projects and delivering QuoCCA education. CONCLUSION The QuoCCA trainee roles for Medical Fellows and Nurse Practitioner candidates exhibit a valuable and effective education and mentorship framework that could be applied to other specialties. The service leadership and collaborative interdisciplinary team support various modes of education and mentoring. The roles not only develop the trainees' specialised PPC clinical skills, they also improve their general clinical practice, including communication, empathy and holistic care. A structured curriculum of education is recommended to protect these positive outcomes.
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Affiliation(s)
- Penelope J Slater
- Oncology Services Group, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Anthony R Herbert
- Paediatric Palliative Care Service, Queensland Children’s Hospital, Children’s Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
- Centre for Children’s Health Research, Queensland University of Technology, Brisbane, Queensland, Australia
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Donovan LA, Slater PJ, Delaney AM, Baggio SJ, Herbert AR. Building capability in paediatric palliative care and enhancing education through the voice of parents: the Quality of Care Collaborative Australia. Palliat Care Soc Pract 2022; 16:26323524221128835. [PMID: 36225949 PMCID: PMC9549082 DOI: 10.1177/26323524221128835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/06/2022] [Indexed: 11/05/2022] Open
Abstract
Background: The greater proportion of children with a life-limiting condition (LLC) and
their families want to remain at home as much as possible. Building
capability in paediatric palliative care (PPC) for generalist health and
social care professionals in nonmetropolitan regions through the Quality of
Care Collaborative Australia (QuoCCA) has improved access to palliative care
for families, regardless of where they live. Aim: To understand the experience of families whose child has received specialist
PPC, to ensure future service capability development is informed by lived
experience. Design: A retrospective, descriptive study in which parents participated in a
semi-structured telephone interview guided by Discovery Interview
methodology. Inductive thematic analysis identified the major learnings from
participants. Participants: Parents caring for a child referred to the specialist PPC service, who
received a pop-up visit and whose child is stable or who are more than 6
months bereaved. Results: Eleven parents (n = 9 mothers; n = 2
fathers) of children with an LLC (n = 5) or whose child had
died (n = 6) participated in an interview. The overarching
themes and subthemes were as follows: (1) burden of suffering, in which
parents described grieving for the life once anticipated, confronting many
life transitions and seeking quality of life for their child and (2)
umbrella of support, in which parents built partnerships with professional
support, activated a network of care around their family and sought
responses to their whole family’s needs. Conclusion: Parents caring for a child with an LLC described significant personal,
familial, social and existential adjustments. This study integrates a
relational learning approach with QuoCCA education grounded in the
relationships between children, families and professionals. Learning from
lived experience in PPC education enhances the preparedness of generalist
health and social care professionals to join a child and their family
throughout their various life transitions and facilitates the goal to remain
at home within their community for as long as possible. Education in PPC is
an imperative component of service models, enabling regional services to
gain confidence and capability in the context of a dying child and their
family, empowered and informed through the voice of the family. Plain Language Summary Enhancing palliative care for children through education informed by
the experience of families It is often the wish of many children/young people with a life-limiting
condition to stay at home with their families as much as possible. It is
important that specialist palliative care services provide training and
mentoring to the family’s local care professionals to support the delivery
of good care, particularly those in rural and remote areas. This article aims to integrate the lived experience of families with
palliative care education, so that the education reflects and addresses the
needs that they express. Parents were interviewed by telephone using a method called Discovery
Interviews. This is an open interview process, guided by a spine that
describes the main points of palliative care. Parents can openly talk about
their experience, focusing on the areas that are important to them.
Interviews were studied by four researchers, and emerging themes were
discussed and summarised. The study included parents whose child/young person was receiving support
from specialist palliative care and bereaved parents whose child had died
more than 6 months ago. In total, eleven parents (nine mothers and two
fathers) were interviewed, five participants had children currently
receiving palliative care and six were bereaved. The overarching themes were as follows: Burden of suffering, in which parents described grieving for the life they
had expected, confronting transitions and seeking good quality of life for
their child. Umbrella of support, in which parents built partnerships with care teams and
activated a network of care to address the needs of their whole family. This study allowed the families’ perspectives to be integrated into the
palliative care education of care professionals in the family’s local area.
The lived experience of families prepared care professionals to support
families with the care of their child/young person, allowing them to remain
at home as long as possible.
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Affiliation(s)
- Leigh A. Donovan
- Quality of Care Collaborative Australia,
Children’s Health Queensland Hospital and Health Service, Brisbane, QLD,
AustraliaCollaboraide Consultancy, Minjerribah, QLD, Australia
| | | | - Angela M. Delaney
- Quality of Care Collaborative Australia,
Children’s Health Queensland Hospital and Health Service, Brisbane, QLD,
Australia
| | - Sarah J. Baggio
- Quality of Care Collaborative Australia,
Children’s Health Queensland Hospital and Health Service, Brisbane, QLD,
Australia
| | - Anthony R. Herbert
- Quality of Care Collaborative Australia,
Children’s Health Queensland Hospital and Health Service, Brisbane,
Queensland, AustraliaCentre for Children’s Health Research, Queensland
University of Technology, Brisbane, QLD, Australia
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Gunn KM, Ross XS, Olver I. Optimizing Rural People's Access to Relevant Cancer Education and Support Using Peer-Led YouTube Films. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:973-982. [PMID: 33175333 DOI: 10.1007/s13187-020-01908-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
Rural cancer patients have inferior cancer outcomes and unique unmet information needs. This paper explores the value of rural people affected by cancer delivering cancer-related education and support to their peers via 3-5 min online YouTube films. In part 1, 14 rural Australians affected by cancer (10 survivors, 4 carers), 50% (7/14) female, 55-79 years, "storytellers", were purposively invited to be filmed sharing their cancer-related experience and advice for others facing similar challenges. They then reflected on their storytelling experience during semi-structured interviews with an independent researcher. In part 2, 11 rural South Australians affected by cancer (8 survivors, 3 carers), 82% (9/11) female, 32-75 years, "viewers", who had watched at least three of the videos, were interviewed. When data saturation was reached, thematic analysis was employed. Storytellers were found to be highly satisfied with the film-making process and product. They valued rapport building prior to filming and the opportunity to help others. They also found storytelling cathartic and the films useful in communicating their cancer experience to family and friends. Rural viewers appreciated the honesty, authenticity, relatability and believability of the storytellers, the practical advice on rural-specific psychosocial issues, acknowledgment of the impact of isolation and the opportunity to understand others' cancer experiences. The film's short duration and professional film-making added appeal. Inclusion of younger storytellers and methods of delivery other than YouTube were suggested. This study highlights the value of this approach for storytellers and viewers. It may be particularly beneficial for isolated rural cancer survivors who feel that their unique challenges are not adequately addressed by mainstream cancer education resources However, further quantitative research to test acceptability and impact in representative rural samples is required.
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Affiliation(s)
- Kate M Gunn
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia.
- Department of Rural Health, Allied Health and Human Performance, University of South Australia, North Terrace, South Australia, Adelaide, Australia.
| | - Xiomara Skrabal Ross
- Cancer Research Institute, University of South Australia, Adelaide, South Australia, Australia
| | - Ian Olver
- School of Psychology, The University of Adelaide, Adelaide, South Australia, Australia
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Sarakbi D, Graves E, King G, Webley J, Crick S, Quinn C. Gift of time: learning together to embed a palliative approach to care in long-term care. BMJ Open Qual 2022; 11:e001581. [PMID: 35790313 PMCID: PMC9258516 DOI: 10.1136/bmjoq-2021-001581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 06/12/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Embedding a Palliative Approach to Care (EPAC) is a model that helps shift the culture in long-term care (LTC) so that residents who could benefit from palliative care are identified early. Healthcare Excellence Canada supported the implementation of EPAC in seven teams from across Canada between August 2018 and September 2019. OBJECTIVE To identify effective strategies for supporting the early identification of palliative care needs to improve the quality of life of residents in LTC. INTERVENTION Training methods on the EPAC model included a combination of face-to-face education (national and regional workshops), online learning (webinars and access to an online platform) and expert coaching. Each team adapted EPAC based on their organisational context and jurisdictional requirements for advance care planning. MEASURES Teams tracked their progress by collecting monthly data on the number of residents who died, date of their most recent goals of care (GOCs) conversation, location of death and number of emergency department (ED) transfers in the last 3 months of life. Teams also shared their implementation strategies including successes, barriers and lessons. RESULTS Implementation of EPAC required leadership support and dedicated time for changing how palliative care is perceived in LTC. Based on 409 resident deaths, 89% (365) had documented GOC conversations; 78% (318) had no transfers to the ED within the last 3 months of life; and 81% (333) died at home. A monthly review of the results showed that teams were having earlier GOC conversations with residents. Teams also reported improvements in the quality of care provided to residents and their families. CONCLUSION EPAC was successfully adapted and adopted to the organisational contexts of homes participating in the collaborative.
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Affiliation(s)
- Diana Sarakbi
- Healthcare Excellence Canada, Ottawa, Ontario, Canada
- Health Quality Programs, Queen's University, Kingston, Ontario, Canada
| | - Elan Graves
- Healthcare Excellence Canada, Ottawa, Ontario, Canada
| | - Gillian King
- Healthcare Excellence Canada, Ottawa, Ontario, Canada
| | - Jane Webley
- End of Life and Palliative Care, Vancouver Coastal Health Authority, Vancouver, British Columbia, Canada
| | - Shelly Crick
- Healthcare Excellence Canada, Ottawa, Ontario, Canada
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Cercato MC, Colella E, Fabi A, Bertazzi I, Giardina BG, Di Ridolfi P, Mondati M, Petitti P, Bigiarini L, Scarinci V, Franceschini A, Servoli F, Terrenato I, Cognetti F, Sanguineti G, Cenci C. Narrative medicine: feasibility of a digital narrative diary application in oncology. J Int Med Res 2022; 50:3000605211045507. [PMID: 35107030 PMCID: PMC8859529 DOI: 10.1177/03000605211045507] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objectives We implemented narrative medicine in clinical practice using the Digital
Narrative Medicine (DNM) platform. Methods We conducted a preliminary, open, uncontrolled, real-life study in the
oncology and radiotherapy departments of Istituto di Ricovero e Cura a
Carattere Scientifico National Cancer Institute Regina Elena, Rome, Italy.
We recruited adult Italian-speaking patients who then completed the DNM
diary from the start of treatment. The primary endpoint was DNM feasibility;
secondary endpoints were health care professionals’ opinions about
communication, therapeutic alliance, and information collection and
patients’ opinions about therapeutic alliance, awareness, and coping
ability. We used open- and closed-ended questions (scores 1 to 5) and a
structured interview. Results Thirty-one patients (67%) used the diary (84% women). Health care
professionals’ mean scores for feasibility and utility were ≥4.0. Patients’
utility scores were related to health care professionals’ feedback regarding
the narratives. The main advantages for health care professionals were the
opportunity to obtain relevant patient data and to strengthen communication
and patient relationships (mean scores 4.4–5.0). Both groups strongly
encouraged introduction of the diary in clinical practice. Conclusion Use of the DNM in oncology patients assisted clinicians with understanding
their patients experience.
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Affiliation(s)
- Maria Cecilia Cercato
- Epidemiology and Tumor Registry Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Elvira Colella
- Medical Oncology 1 UOC, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessandra Fabi
- Medical Oncology 1 UOC, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Isabella Bertazzi
- Medical Oncology 1 UOC, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Paolo Di Ridolfi
- UOC Radioterapia, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Mara Mondati
- UOC Radioterapia, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Petitti
- UOC Radioterapia, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Liciano Bigiarini
- UOC Radioterapia, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Virginia Scarinci
- Digital Library «R. Maceratini», IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | | | - Francesca Servoli
- Digital Library «R. Maceratini», IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Irene Terrenato
- Biostatistics and Bioinformatics Unit - Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Francesco Cognetti
- Medical Oncology 1 UOC, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Flynn R, Mrklas K, Campbell A, Wasylak T, Scott SD. Contextual factors and mechanisms that influence sustainability: a realist evaluation of two scaled, multi-component interventions. BMC Health Serv Res 2021; 21:1194. [PMID: 34736470 PMCID: PMC8570000 DOI: 10.1186/s12913-021-07214-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Accepted: 10/21/2021] [Indexed: 12/04/2022] Open
Abstract
Background In 2012, Alberta Health Services created Strategic Clinical NetworksTM (SCNs) to develop and implement evidence-informed, clinician-led and team-delivered health system improvement in Alberta, Canada. SCNs have had several provincial successes in improving health outcomes. Little research has been done on the sustainability of these evidence-based implementation efforts. Methods We conducted a qualitative realist evaluation using a case study approach to identify and explain the contextual factors and mechanisms perceived to influence the sustainability of two provincial SCN evidence-based interventions, a delirium intervention for Critical Care and an Appropriate Use of Antipsychotics (AUA) intervention for Senior’s Health. The context (C) + mechanism (M) = outcome (O) configurations (CMOcs) heuristic guided our research. Results We conducted thirty realist interviews in two cases and found four important strategies that facilitated sustainability: Learning collaboratives, audit & feedback, the informal leadership role, and patient stories. These strategies triggered certain mechanisms such as sense-making, understanding value and impact of the intervention, empowerment, and motivation that increased the likelihood of sustainability. For example, informal leaders were often hands-on and influential to front-line staff. Learning collaboratives broke down professional and organizational silos and encouraged collective sharing and learning, motivating participants to continue with the intervention. Continual audit-feedback interventions motivated participants to want to perform and improve on a long-term basis, increasing the likelihood of sustainability of the two multi-component interventions. Patient stories demonstrated the interventions’ impact on patient outcomes, motivating staff to want to continue doing the intervention, and increasing the likelihood of its sustainability. Conclusions This research contributes to the field of implementation science, providing evidence on key strategies for sustainability and the underlying causal mechanisms of these strategies that increases the likelihood of sustainability. Identifying causal mechanisms provides evidence on the processes by which implementation strategies operate and lead to sustainability. Future work is needed to evaluate the impact of informal leadership, learning collaboratives, audit-feedback, and patient stories as strategies for sustainability, to generate better guidance on planning sustainable improvements with long term impact. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07214-5.
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Affiliation(s)
- Rachel Flynn
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Alberta, T6G 1C9, Edmonton, Canada.
| | - Kelly Mrklas
- Strategic Clinical Networks™, Provincial Clinical Excellence, Alberta Health Services, Calgary, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, T2N 4N1, Calgary, Canada
| | - Alyson Campbell
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Alberta, T6G 1C9, Edmonton, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks™, Provincial Clinical Excellence, Alberta Health Services, Calgary, Canada.,Faculty of Nursing, University of Calgary, T2N 4V8, Alberta, Canada
| | - Shannon D Scott
- Faculty of Nursing, Level 3, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Avenue, Alberta, T6G 1C9, Edmonton, Canada
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10
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A Systematic Review of Interventions to Improve Healthcare Experiences and Access in Autism. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00279-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractAutistic individuals report barriers to accessing and receiving healthcare, and experience increased morbidity and mortality. This systematic review synthesizes 31 research studies evaluating interventions implemented to improve the healthcare experiences and/or access of autistic persons. Interventions were most commonly patient-focused (58.1%), focused on supporting the autistic individual to engage with, tolerate, or anticipate medical procedures, care, or settings. Fewer studies were provider-focused (48.4%) or organization-focused (6.5%). Interventions were typically evaluated using measures of reactions (45.2%) or behavior (48.4%), and outcomes were predominantly positive (80.6%). Further research is imperative and should look to how providers and organizations must change. Future research must be inclusive of the autistic community, must measure what matters, and must offer complete detail on interventions implemented.
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Walsh C, Lydon S, Geoghegan R, Carey C, Creed M, O'Loughlin L, Walsh E, Byrne D, O'Connor P. Development and preliminary evaluation of a novel physician-report tool for assessing barriers to providing care to autistic patients. BMC Health Serv Res 2021; 21:873. [PMID: 34445991 PMCID: PMC8390217 DOI: 10.1186/s12913-021-06842-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 07/30/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Individuals on the autism spectrum face significant disparities in health and physicians often report difficulties in providing care to autistic patients. In order to improve the quality of care autistic individuals receive, it is important to identify the barriers that physicians experience in providing care so that these may be addressed. This paper reports the initial development and preliminary evaluation of a physician-report 'Barriers to Providing Healthcare' measurement tool. METHOD An established taxonomy of healthcare barriers for autistic individuals informed the initial draft of a 22-item measurement tool. This measurement tool was distributed to physicians working in various healthcare specialties and settings. Exploratory factor analysis (EFA) was conducted to determine the construct validity of the tool; discriminant validity between, and internal consistency of, the resultant factors were assessed. Multiple regressions were used to explore variables potentially associated with barriers endorsed by physicians. RESULTS A total of 203 physicians were included in the analyses. The EFA resulted in a 17-item tool with three distinct factors which explained 37.6% of the variance: 1) Patient-related barriers (Cronbach's α = 0.83; e.g., the patient's reactivity to the healthcare environment); 2) Healthcare provider (HCP)/family-related barriers (Cronbach's α = 0.81; e.g., a lack of providers willing to work with autistic patients); and 3) System-related barriers (Cronbach's α = 0.84; e.g., there is a lack of support for patients and families). Discriminant validity between the factors was adequate (r < .8). The barriers that were most frequently endorsed as occurring 'often' or 'very often' included a lack of support for patients and families (endorsed by 79.9% of physicians); communication difficulties (73.4%); and a lack of coordination between services (69.9%). The regression analyses identified no significant associated variables. CONCLUSION A preliminary version of a novel physician-report tool to assess barriers to providing care to autistic patients has been developed although further validation work is required. The use of this tool will help physicians to identify issues specific to different medical specialities and healthcare settings. This information may help identify the supports physicians require to recognise and implement the required accommodations. Future research which elucidates barriers to healthcare provision for autistic patients is required to support systemic change in healthcare so as to improve care experiences and health outcomes for people on the autism spectrum.
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Affiliation(s)
- Chloe Walsh
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
| | - Sinéad Lydon
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland.
- School of Medicine, National University of Ireland Galway, Galway, Ireland.
| | - Rosemary Geoghegan
- Discipline of Paediatrics, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Cornelia Carey
- Department of Liaison Psychiatry, Beaumont Hospital, Dublin 9, Ireland
| | - Michael Creed
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
- Galway University Hospital, Galway, Ireland
| | | | - Ellen Walsh
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
- Galway University Hospital, Galway, Ireland
| | - Dara Byrne
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
- School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Paul O'Connor
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Irish Centre for Applied Patient Safety and Simulation, University Hospital Galway, Galway, Ireland
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Abstract
Background: The Discovery Interview methodology was introduced to Oncology Services Group in 2012 as a service improvement strategy and was evaluated positively by staff and families. It enabled clinical staff to hear the deidentified families’ stories, understand their experience, and implement process and practice enhancements. Objective: This study collected family stories following treatment for childhood cancer at the tertiary center in Queensland, with the goal of raising awareness and improving family experience. Method: Twenty-five families were interviewed via an interview spine which covered the major stages of cancer treatment and themes were extracted. Results: Major themes were psychological support needs, adapting to the new normal, and rebuilding relationships. After treatment, the parent had time to reflect on their experience and lost the reassurance of regularly attending the tertiary hospital. There was ongoing anxiety regarding relapse. Parents reported various coping strategies and some wanted to maintain contact with other oncology families. Families strived to get back to a level of normality such as attending school and experienced some challenges in relationships with family and friends. Conclusion: Families needed support and reassurance from their local health professionals to navigate the ongoing challenges following treatment.
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Affiliation(s)
- Penelope J Slater
- Oncology Services Group, Queensland Children's Hospital, South Brisbane, Queensland, Australia
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13
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Fadlallah R, El-Jardali F, Nomier M, Hemadi N, Arif K, Langlois EV, Akl EA. Using narratives to impact health policy-making: a systematic review. Health Res Policy Syst 2019; 17:26. [PMID: 30836972 PMCID: PMC6402129 DOI: 10.1186/s12961-019-0423-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 02/06/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND There is increased interest in using narratives or storytelling to influence health policies. We aimed to systematically review the evidence on the use of narratives to impact the health policy-making process. METHODS Eligible study designs included randomised studies, non-randomised studies, process evaluation studies, economic studies, qualitative studies, stakeholder analyses, policy analyses, and case studies. The MEDLINE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), WHO Global Health Library, Communication and Mass Media Complete, and Google Scholar databases were searched. We followed standard systematic review methodology for study selection, data abstraction and risk of bias assessment. We synthesised the findings narratively and presented the results stratified according to the following stages of the policy cycle: (1) agenda-setting, (2) policy formulation, (3) policy adoption, (4) policy implementation and (5) policy evaluation. Additionally, we presented the knowledge gaps relevant to using narrative to impact health policy-making. RESULTS Eighteen studies met the eligibility criteria, and included case studies (n = 15), participatory action research (n = 1), documentary analysis (n = 1) and biographical method (n = 1). The majority were of very low methodological quality. In addition, none of the studies formally evaluated the effectiveness of the narrative-based interventions. Findings suggest that narratives may have a positive influence when used as inspiration and empowerment tools to stimulate policy inquiries, as educational and awareness tools to initiate policy discussions and gain public support, and as advocacy and lobbying tools to formulate, adopt or implement policy. There is also evidence of undesirable effects of using narratives. In one case study, narrative use led to widespread insurance reimbursement of a therapy for breast cancer that was later proven to be ineffective. Another case study described how the use of narrative inappropriately exaggerated the perceived risk of a procedure, which led to limiting its use and preventing a large number of patients from its benefits. A third case study described how optimistic 'cure' or 'hope' stories of children with cancer were selectively used to raise money for cancer research that ignored the negative realities. The majority of included studies did not provide information on the definition or content of narratives, the theoretical framework underlying the narrative intervention or the possible predictors of the success of narrative interventions. CONCLUSION The existing evidence base precludes any robust inferences about the impact of narrative interventions on health policy-making. We discuss the implications of the findings for research and policy. TRIAL REGISTRATION The review protocol is registered in PROSPERO International prospective register of systematic reviews (ID = CRD42018085011 ).
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Affiliation(s)
- Racha Fadlallah
- Center for Systematic Review for Health Policy and Systems Research, American University of Beirut, Beirut, Lebanon.,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Fadi El-Jardali
- Center for Systematic Review for Health Policy and Systems Research, American University of Beirut, Beirut, Lebanon.,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Mohamed Nomier
- Center for Systematic Review for Health Policy and Systems Research, American University of Beirut, Beirut, Lebanon
| | - Nour Hemadi
- Center for Systematic Review for Health Policy and Systems Research, American University of Beirut, Beirut, Lebanon
| | - Khurram Arif
- Center for Systematic Review for Health Policy and Systems Research, American University of Beirut, Beirut, Lebanon
| | - Etienne V Langlois
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Elie A Akl
- Center for Systematic Review for Health Policy and Systems Research, American University of Beirut, Beirut, Lebanon. .,Department of Internal Medicine, American University of Beirut, Beirut, Lebanon.
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Slater PJ, Edwards RM. Needs analysis and development of a staff well-being program in a pediatric oncology, hematology, and palliative care services group. J Healthc Leadersh 2018; 10:55-65. [PMID: 30532608 PMCID: PMC6241859 DOI: 10.2147/jhl.s172665] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Around 170 multidisciplinary staff of the Oncology Services Group at Queensland Children's Hospital, Brisbane, care for children with oncology, hematology, and palliative care needs from throughout Queensland and northern New South Wales. A series of challenges impacted staff resilience and retention, and strategies were needed to improve staff well-being and enable them to flourish despite the inherent work stressors. METHODS A needs analysis was conducted using themes from Discovery Interviews with 51 staff, surveys related to "The Work Stressors Scale - Pediatric Oncology" and "The Work Rewards Scale - Pediatric Oncology" completed by 59 staff, and an organizational staff survey responded to by 51 staff. RESULTS The needs analysis informed the development of a customized Oncology Staff Well-being Program with a range of strategies aligned to a PERMA framework for flourishing (positive emotion, engagement, relationships, meaning, and accomplishment). Positive emotion areas included education on topics such as well-being, resilience, responding to escalating behaviors, grief and loss, and self-care. Staff attended the available mindfulness sessions, debriefing and counselors on site, developed self-care plans, and followed a well-being Facebook Group. Engagement was supported through exploring character strengths, improving communication, supporting innovation, and addressing frustrations and safety concerns. Relationships within the team were addressed through team building and social events. Meaning of the work was emphasized through sharing family updates and end of treatment celebrations. Accomplishments of staff were acknowledged in newsletters and meetings. CONCLUSION The needs analysis drove a multifaceted approach to staff well-being with the development of strategies which aligned to a framework that would empower staff to flourish at work. Implementation and evaluation are ongoing and will be reported in a subsequent paper.
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Affiliation(s)
- Penelope J Slater
- Oncology Services Group, Queensland Children's Hospital, South Brisbane, QLD, Australia,
| | - Rachel M Edwards
- Nursing Learning and Workforce Development, Queensland Children's Hospital, South Brisbane, QLD, Australia
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Black A, McGlinchey T, Gambles M, Ellershaw J, Mayland CR. The 'lived experience' of palliative care patients in one acute hospital setting - a qualitative study. BMC Palliat Care 2018; 17:91. [PMID: 29980197 PMCID: PMC6034290 DOI: 10.1186/s12904-018-0345-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 06/25/2018] [Indexed: 11/24/2022] Open
Abstract
Background There is limited understanding of the ‘lived experience’ of palliative care patient within the acute care setting. Failing to engage with and understand the views of patients and those close to them, has fundamental consequences for future health delivery. Understanding ‘patient experience’ can enable care providers to ensure services are responsive and adaptive to individual patient need. Methods The aim of this study was to explore the ‘lived experience’ of a group of patients with palliative care needs who had recently been in-patients in one acute hospital trust in the north-west of England. Qualitative research using narrative interviews was undertaken, and data was analysed using thematic analysis. A sample of 20 consecutive patients complying with the inclusion/exclusion criteria were recruited and interviewed. Results Patient Sample: Of the 20 patients recruited, there was a fairly equal gender split; all had a cancer diagnosis and the majority were white British, with an age range of 43–87 years. Findings from Interviews: Overall inpatient experience was viewed positively. Individual narratives illustrated compassionate and responsive care, with the patient at the centre. Acts of compassion appeared to be expressed through the ‘little things’ staff could do for patients, i.e., time to talk, time to care, humanity and comfort measures. AHSPCT involvement resulted in perceived improvements in pain control and holistic wellbeing. However, challenges were evident, particularly regarding over-stretched staff and resources, and modes of communication, which seemed to impact on patient experience. Conclusions Listening to patients’ experiences of care across the organisation provided a unique opportunity to impact upon delivery of care. Further research should focus on exploring issues such as: why some patients within the same organisation have a positive experience of care, while others may not; how do staff attitudes and behaviours impact on the experience of care; transitions of care from hospital to home, and the role of social networks.
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Affiliation(s)
- Anne Black
- Palliative Care Institute Liverpool, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK.
| | - Tamsin McGlinchey
- Palliative Care Institute Liverpool, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK
| | - Maureen Gambles
- Palliative Care Institute Liverpool, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK
| | - John Ellershaw
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK
| | - Catriona Rachel Mayland
- Palliative Care Institute Liverpool, Cancer Research Centre, University of Liverpool, 200 London Road, Liverpool, L3 9TA, UK
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16
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Roebotham T, Hawthornthwaite L, Lee L, Lingard LA. Beyond catharsis: the nuanced emotion of patient storytellers in an educational role. MEDICAL EDUCATION 2018; 52:526-535. [PMID: 29430729 DOI: 10.1111/medu.13510] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/07/2017] [Accepted: 11/16/2017] [Indexed: 06/08/2023]
Abstract
CONTEXT As health care organisations seek to cultivate patient and family-centred care, patient storytelling has emerged as a valued educational resource. However, repeatedly harnessing patient perspectives to educate health care professionals may have consequences. We need robust insight into what it means to be a patient storyteller in order to ensure ethical and appropriate engagement with patients as an educational resource. METHODS Constructivist grounded theory was used to explore the experience of patients involved in a storytelling curriculum as part of hospital staff continuing education. All 33 storytellers were invited by e-mail to participate in the study. Twenty-six storytellers responded to the invitation, and 25 could be scheduled to participate. Using theoretical sampling, semi-structured interviews were conducted and analysed in a process that was inductive, iterative and comparative. RESULTS Participants described the central role of emotions in their storytelling experience, which varied from 1 to 25 tellings over a period of 1 month to 2 years. These emotions were shaped by the passage of time, repetition of storytelling and audience acknowledgement. However, emotion remained unpredictable and had lingering implications for storytellers' vulnerability. CONCLUSION The multiple storytelling experiences of our participants and ongoing educational nature of their role provides unique insight into how emotions ebb and flow across tellings, how emotions can be both a surprise and a rhetorical strategy, and how emotions are influenced by audience acknowledgement. These findings contribute to an emerging conversation regarding the power and politics of selecting and using storytellers for organisational purpose. Implications include how we support patient storytellers in educational roles and how we can sustainably integrate patient storytelling into health professional education.
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Affiliation(s)
- Taylor Roebotham
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | - Lauren Lee
- Patient Experience, London Health Sciences Centre, London, Ontario, Canada
| | - Lorelei A Lingard
- Centre for Education Research and Innovation, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- Department of Medicine, Western University, London, Ontario, Canada
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17
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Hawthornthwaite L, Roebotham T, Lee L, O'dowda M, Lingard L. Three Sides to Every Story: Preparing Patient and Family Storytellers, Facilitators, and Audiences. Perm J 2018; 22:17-119. [PMID: 29702058 DOI: 10.7812/tpp/17-119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There is a growing recognition that patient engagement is necessary for the cultivation of patient- and family-centered care (PFCC) in the hospital setting. Acting on the emerging understanding that hearing stories from our patients gives valuable insight about our ability to provide compassionate PFCC, we developed an educational patient experience curriculum at our acute care teaching hospital. OBJECTIVES To understand the benefits and consequences of patient storytelling and to explore the impact of our curriculum on participants. METHODS The curriculum was codesigned with patients to illustrate the value and meaning of PFCC to health professional audiences. We surveyed audience members at nursing orientation events and interviewed the patient storytellers who shared their stories. RESULTS Participants indicated that patient stories could serve as lessons or reminders about the dimensions of PFCC and could inspire changes to practice. Storytellers reported an immensely rewarding experience and highlighted the value of educating and connecting with participants. However, they reported that the experience could also pose emotional challenges. CONCLUSION Careful and considerate facilitation of storytelling sessions is crucial to the delivery of a curriculum that is beneficial to both patients and participants. Our storytelling framework offers a novel approach to engaging patients in education, and it contributes to our existing understanding of how patient engagement efforts resonate within organizations.
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Affiliation(s)
- Lisa Hawthornthwaite
- Senior Patient Experience Specialist at the London Health Science Centre in London, Ontario, Canada.
| | - Taylor Roebotham
- Medical Student at the Schulich School of Medicine and Dentistry at Western University in London, Ontario, Canada.
| | - Lauren Lee
- Patient Advisor at the London Health Science Centre in London, Ontario, Canada.
| | - Mim O'dowda
- Patient Advisor at the London Health Science Centre in London, Ontario, Canada.
| | - Lorelei Lingard
- Founding Director and Senior Scientist for the Centre for Education Research and Innovation at Western University in London, Ontario, Canada.
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18
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Ward V, Pinkney L, Fry G. Developing a framework for gathering and using service user experiences to improve integrated health and social care: the SUFFICE framework. BMC Res Notes 2016; 9:437. [PMID: 27609366 PMCID: PMC5017127 DOI: 10.1186/s13104-016-2230-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 08/18/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND More people than ever receive care and support from health and social care services. Initiatives to integrate the work of health and social care staff have increased rapidly across the UK but relatively little has been done to chart and improve their impact on service users. Our aim was to develop a framework for gathering and using service user feedback to improve integrated health and social care in one locality in the North of England. METHODS We used published literature and interviews with health and social care managers to determine the expected service user experiences of local community-based integrated teams and the ways in which team members were expected to work together. We used the results to devise qualitative data collection and analysis tools for gathering and analyzing service user feedback. We used developmental evaluation and service improvement methodologies to devise a procedure for developing service improvement plans. FINDINGS We identified six expected service user experiences of integrated care and 15 activities that health and social care teams were expected to undertake. We used these to develop logic models and tools for collecting and analysing service user experiences. These include a narrative interview schedule, a plan for analyzing data, and a method for synthesizing the results into a composite 'story'. We devised a structured service improvement procedure which involves teams of health and social care staff listening to a composite service user story, identifying how their actions as a team may have contributed to the story and developing a service improvement plan. CONCLUSIONS This framework aims to put service user experiences at the heart of efforts to improve integration. It has been developed in collaboration with National Health Service (NHS) and Social Care managers. We expect it to be useful for evaluating and improving integrated care initiatives elsewhere.
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Affiliation(s)
- Vicky Ward
- Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ UK
| | - Lisa Pinkney
- Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ UK
| | - Gary Fry
- Leeds Institute of Health Sciences, University of Leeds, 101 Clarendon Road, Leeds, LS2 9LJ UK
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Cenci C. Narrative medicine and the personalisation of treatment for elderly patients. Eur J Intern Med 2016; 32:22-5. [PMID: 27210901 DOI: 10.1016/j.ejim.2016.05.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/05/2016] [Indexed: 11/26/2022]
Abstract
Healthcare organisations, medical knowledge and clinical practice are among the contexts that have most strongly felt the impact of the over 75 population. This is a population of multimorbidity and polypharmacy patients. They are often seen as a conglomeration of juxtaposed guidelines resulting in the intake of more than 10 drugs a day, with absolutely no certainty of their efficacy. The scientific community is increasingly calling into question the current disease-focused approach. Narrative medicine can provide the tools for a treatment plan which is instead more patient-centred. Narrative medicine can promote the development of a systemic, integrated and multi-disciplinary approach to elderly patients. The stories of patients and caregivers, their representations, perceptions, experiences and preferences can reduce the risk of inappropriate tests and treatments. They can promote deprescribing procedures based on a careful analysis of a specific patient's needs. Narration time is treatment time which does not necessarily create a burden on organisations and caregivers. Quite the contrary since by facilitating adherence and team work, it can significantly reduce time and costs. Given their training and the importance of their relationship with elderly patients, internists, together with geriatricians, can play a key role in promoting and coordinating a narrative medicine approach.
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Affiliation(s)
- C Cenci
- Center for Digital Health Humanities, OMNI-Osservatorio Medicina Narrativa Italia, Rome, Italy.
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20
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Adams M, Robert G, Maben J. Exploring the Legacies of Filmed Patient Narratives: The Interpretation and Appropriation of Patient Films by Health Care Staff. QUALITATIVE HEALTH RESEARCH 2015; 25:1241-50. [PMID: 25576480 PMCID: PMC4535314 DOI: 10.1177/1049732314566329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We trace the legacies of filmed patient narratives that were edited and screened to encourage engagement with a participatory quality improvement project in an acute hospital setting in England. Using Gabriel's theory of "narrative contract," we examine the initial success of the films in establishing common grounds for participatory project and later, and more varied, interpretations of the films. Over time, the films were interpreted by staff as either useful sources of learning by critical reflection, dubious (invalid or unreliable) representations of patient experience, or as "closed" items available as auditable evidence of completed quality improvement work. We find these interpretations of the films to be shaped by the effect of social distance, the differential outcomes of project work, and changing organizational agendas. We consider the wider conditions of patient narrative as a form of quality improvement knowledge with immediate potency and fragile or fluid legitimacy over time.
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Affiliation(s)
- Mary Adams
- King's College London, London, United Kingdom
| | | | - Jill Maben
- King's College London, London, United Kingdom
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21
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Garrino L, Picco E, Finiguerra I, Rossi D, Simone P, Roccatello D. Living with and treating rare diseases: experiences of patients and professional health care providers. QUALITATIVE HEALTH RESEARCH 2015; 25:636-51. [PMID: 25667160 DOI: 10.1177/1049732315570116] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
We explored the experiences of illness of patients suffering from rare diseases and of the health professionals who care for them at the Center for the Interregional Coordination of Rare Diseases of Piedmont and Valle d'Aosta in Italy. The research was carried out between 2010 and 2011. We collected qualitative data from 22 patients and 12 health professional health care providers. The interviews were analyzed using the Colaizzi phenomenological approach. We identified five themes from the narratives of the patient participants--dealing with disease development, living with the disease, everyday living, relating to others, and relations with health care providers--and four themes from the professional health care participants--dealing with the disease, dealing with expectations, building relationships, and being operators in the context. The study has raised awareness about the issue of rare diseases and it provides some useful considerations for improving services.
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Affiliation(s)
| | | | | | - Daniela Rossi
- University of Turin, Italy San Giovanni Bosco Hospital, Turin, Italy
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22
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Cotugno JD, Ferguson M, Harden H, Colquist S, Stack AA, Zimmerman JI, Russell AW, Ball LE, Hickman IJ. "I wish they could be in my shoes": patients' insights into tertiary health care for type 2 diabetes mellitus. Patient Prefer Adherence 2015; 9:1647-55. [PMID: 26604714 PMCID: PMC4655948 DOI: 10.2147/ppa.s91214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Insightful accounts of patient experience within a health care system can be valuable for facilitating improvements in service delivery. OBJECTIVE The aim of this study was to explore patients' perceptions and experiences regarding a tertiary hospital Diabetes and Endocrinology outpatient service for the management of type 2 diabetes mellitus (T2DM). METHOD Nine patients participated in discovery interviews with an independent trained facilitator. Patients' stories were synthesized thematically using a constant comparative approach. RESULTS Three major themes were identified from the patients' stories: 1) understanding T2DM and diabetes management with subthemes highlighting that specialist care is highly valued by patients who experience a significant burden of diabetes on daily life and who may have low health literacy and low self confidence; 2) relationships with practitioners were viewed critical and perceived lack of empathy impacted the effectiveness of care; and 3) impact of health care systems on service delivery with lack of continuity of care relating to the tertiary hospital model and limitations with appointment bookings negatively impacting on patient experience. DISCUSSION The patients' stories suggest that the expectation of establishing a productive, ongoing relationship with practitioners is highly valued. Tertiary clinics for T2DM are well placed to incorporate novel technological approaches for monitoring and follow-up, which may overcome many of the perceived barriers of traditional service delivery. CONCLUSION Investing in strategies that promote patient-practitioner relationships may enhance effectiveness of treatment for T2DM by meeting patient expectations of personalized care. Future changes in service delivery would benefit from incorporating patients as key stakeholders in service evaluation.
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Affiliation(s)
- Jacqueline D Cotugno
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Maree Ferguson
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | | | | | - Annabelle A Stack
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
| | - Jane I Zimmerman
- Department of Diabetes & Endocrinology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
| | - Anthony W Russell
- Department of Diabetes & Endocrinology, Princess Alexandra Hospital, University of Queensland, Brisbane, QLD, Australia
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Lauren E Ball
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
| | - Ingrid J Hickman
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, The University of Queensland, Brisbane, QLD, Australia
- The Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Correspondence: Ingrid J Hickman, Department of Nutrition and Dietetics, Ground Floor, Building 15, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, QLD 4102, Australia, Tel +61 7 3176 5588, Fax +61 7 3176 5619, Email
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Jakimowicz S, Stirling C, Duddle M. An investigation of factors that impact patients’ subjective experience of nurse-led clinics: a qualitative systematic review. J Clin Nurs 2014; 24:19-33. [DOI: 10.1111/jocn.12676] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2014] [Indexed: 11/27/2022]
Affiliation(s)
| | - Christine Stirling
- School of Health Sciences; University of Tasmania; Hobart Tas. Australia
| | - Maree Duddle
- School of Nursing & Midwifery; University of Tasmania; Sydney Australia
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McGrath P, Holewa H. Patient stories: an innovative direction for nurses providing support to hematology patients in rural areas. Nurs Forum 2014; 49:182-188. [PMID: 24404922 DOI: 10.1111/nuf.12079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIMS This study set out to explore the attitudes toward a "Patient Stories" DVD as a psychosocial support initiative for patients diagnosed with a hematological malignancy. DESIGN A qualitative research design was employed through a series of open-ended interviews and one focus group. PARTICIPANTS Participants were purposively sampled from a database of patients maintained by the Leukaemia Foundation of Queensland. In total, there were 50 participants (n=26 male, n=24 female), which represented the following major hematological diagnostic groups: multiple myeloma (n=15), lymphoma (n=14), leukemia (n=17), and other (n=4). Of the overall cohort, 11 participants had undergone a bone marrow transplant, and 15 had undergone a stem cell transplant (allogeneic and autologous transplants). RESULTS AND CONCLUSION Most participants believed that a "Patient Stories" DVD would be a beneficial and effective way for nurses delivering psychosocial support to hematology patients. Such benefits included a sense of normalization from hearing similar stories and providing convenient support that did not require travel or potentially uncomfortable social situations. However, some participants did not show interest in the idea for reasons such as already having a local support system and not wanting to watch potentially frightening stories.
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Affiliation(s)
- Pam McGrath
- Centre for Community Science, Population and Social Health Program, Griffith Health Institute, Logan Campus, Griffith University, Brisbane, Qld, Australia
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Stirling C, Campbell B, Bentley M, Bucher H, Morrissey M. A qualitative study of patients' experiences of a nurse-led memory clinic. DEMENTIA 2013; 15:22-33. [PMID: 24381213 DOI: 10.1177/1471301213512841] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Little is known about patients' decision-making to attend a nurse-led memory clinic (NLMC) or of their experiences in the months following attendance. This paper reports qualitative follow-up data from 13 participants who attended a NLMC run by a Nurse Practitioner, and who were interviewed later in their own homes. Participants attended the NLMC seeking 'benchmarking' against the broader population or confirmation of diagnosis, with the Nurse Practitioner perceived as having more time to talk. Although we anticipated that participants would have changed some behaviours to incorporate 'brain health material', we found that the focus was on maintaining current capacity and lifestyle with most participants delaying planning and decisions about future lifestyle changes until 'necessary'. Understanding why people contact a NLMC and how their participation influences future planning can help us better target health care messages with the aim of improving health literacy.
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Affiliation(s)
| | - Briony Campbell
- School of Nursing and Midwifery, University of Tasmania, Australia
| | - Michael Bentley
- Wicking Dementia Research & Education Centre, University of Tasmania, Tasmania, Australia
| | - Hazel Bucher
- Older Persons Mental Health Service, Department of Health and Human Services, Australia
| | - Martin Morrissey
- Older Persons Mental Health Service, Department of Health and Human Services, Australia
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27
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Kirk M, Tonkin E, Skirton H, McDonald K, Cope B, Morgan R. Storytellers as partners in developing a genetics education resource for health professionals. NURSE EDUCATION TODAY 2013; 33:518-524. [PMID: 22197414 PMCID: PMC3661988 DOI: 10.1016/j.nedt.2011.11.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2011] [Accepted: 11/18/2011] [Indexed: 05/31/2023]
Abstract
Advances in genetics are bringing unprecedented opportunities for understanding health and disease, developing new therapies and changes in healthcare practice. Many nurses and midwives lack competence and confidence in integrating genetics into professional practice. One approach to enhance understanding of genetics is to simulate clinical exposure through storytelling. Stories are acknowledged as a powerful learning tool, being understandable and memorable, stimulating critical thinking, and linking theory to practice. Telling Stories, Understanding Real Life Genetics is a freely accessible website that sets people's stories within an education framework. The links between the stories and professional practice are made explicit and additional features support learning and teaching. Care of the storytellers within an ethical framework is of paramount importance. Storytellers are viewed as partners in the project. The challenges encountered include preserving the authentic voice and dignity of the storyteller. Project team members have also experienced 'professional shame' when negative experiences have been recounted, and the stories have had an impact on the team. The experience of working with storytellers has been positive. The storytellers want to be heard so that others will benefit from their stories. They serve as a reminder of why this work is important.
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Affiliation(s)
- Maggie Kirk
- NHS National Genetics Education and Development Centre, University of Glamorgan, Pontypridd, Wales, United Kingdom.
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Fear WJ. What is the story? The uniqueness paradox and the Patient Story in the minutes of the boardroom. MANAGEMENT LEARNING 2013. [DOI: 10.1177/1350507613478891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Stories are ubiquitous in organizations and play an important role in all aspects of organizing. Patient Stories have come to prominence in health care in a number of different forms. In Wales, they have been used as one element of a large-scale organizational development program, the 1000 Lives Campaign. The purpose of the Patient Stories was to bring about learning and organizational change at the board level. Using Lakoff and Johnson’s theory of metaphor, I deconstructed the Patient Stories being presented to the board. I found that the stories were being used as a vehicle to present the Uniqueness Story to the board. The Uniqueness Story highlighted the value and worth of nursing and was a means of attracting and maintaining resources. This led to the understanding that there was a story behind the stories that can be explained using the original theory of metaphor. The implication is that if the Uniqueness Story is presented through the vehicle of the Patient Story, it assumes the validity of an accepted truth claim.
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Tanna N, Buijs H, Pitkin J, Reichert R. Breast cancer patient stories project. MENOPAUSE INTERNATIONAL 2012; 18:128-133. [PMID: 23081974 DOI: 10.1258/mi.2012.012028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE It is estimated that there are almost half a million women living with or beyond a breast cancer diagnosis in the UK, often referred to as the breast cancer survivor population. We report on the setting up of a dedicated breast cancer and menopause symptoms service (BCMS), and present results from research undertaken with breast cancer survivors with the aim of obtaining their perspectives on the BCMS service. METHOD An action-oriented approach incorporating improvement science methodology has been used to help develop and drive changes to support a high standard of NHS patient care delivery for women with breast cancer within the BCMS setting. Evaluation was undertaken of this innovative service using qualitative methodology, and included discussion within a focus group setting, patient consent to record discussion, followed by thematic analysis of transcription. RESULTS Women who have survived breast cancer identified a need for specialist support to help improve their quality of life, which is also affected by menopause type symptomology. This support can be provided within the BCMS service setting. Our recommendations are that the BCMS service model is incorporated into any regional or national breast cancer patient pathway and service redesign work in place. CONCLUSIONS Breast cancer survivors would support the setting up of a BCMS service, and would actively help raise awareness and market this service.
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Affiliation(s)
- Nuttan Tanna
- Womens Services, N W London Hospitals NHS Trust, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
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Mytton OT, Oliver D, Mirza N, Lippett J, Chatterjee A, Ramcharitar K, Maxwell J. Avoidable acute hospital admissions in older people. ACTA ACUST UNITED AC 2012. [DOI: 10.12968/bjhc.2012.18.11.597] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | - David Oliver
- Medicine and Elderly Care, Royal Berkshire NHS Foundation Trust
| | | | - Janet Lippett
- Medicine and Elderly Care, Royal Berkshire NHS Foundation Trust
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Rafman H, Lim SN, Quek SC, Mahadevan M, Lim C, Lim A. Using systematic change management to improve emergency patients' access to specialist care: the Big Squeeze. Emerg Med J 2012; 30:447-53. [PMID: 22753640 DOI: 10.1136/emermed-2012-201096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Heidi Rafman
- NUHS Way Department, National University Hospital, National University Health System, Singapore.
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Tsianakas V, Robert G, Maben J, Richardson A, Dale C, Griffin M, Wiseman T. Implementing patient-centred cancer care: using experience-based co-design to improve patient experience in breast and lung cancer services. Support Care Cancer 2012; 20:2639-47. [PMID: 22544223 PMCID: PMC3461206 DOI: 10.1007/s00520-012-1470-3] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 04/09/2012] [Indexed: 11/28/2022]
Abstract
Purpose The aim of this paper was to briefly describe how the experience-based co-design (EBCD) approach was used to identify and implement improvements in the experiences of breast and lung cancer patients before (1) comparing the issues identified as shaping patient experiences in the different tumour groups and (2) exploring participants' reflections on the value and key characteristics of this approach to improving patient experiences. Methods Fieldwork involved 36 filmed narrative patient interviews, 219 h of ethnographic observation, 63 staff interviews and a facilitated co-design change process involving patient and staff interviewees over a 12-month period. Four of the staff and five patients were interviewed about their views on the value of the approach and its key characteristics. The project setting was a large, inner-city cancer centre in England. Results Patients from both tumour groups generally identified similar issues (or 'touchpoints') that shaped their experience of care, although breast cancer patients identified a need for better information about side effects of treatment and end of treatment whereas lung cancer patients expressed a need for more information post-surgery. Although the issues were broadly similar, the particular improvement priorities patients and staff chose to work on together were tumour specific. Interviewees highlighted four characteristics of the EBCD approach as being key to its successful implementation: patient involvement, patient responsibility and empowerment, a sense of community, and a close connection between their experiences and the subsequent improvement priorities. Conclusion EBCD positions patients as active partners with staff in quality improvement. Breast and lung cancer patients identified similar touchpoints in their experiences, but these were translated into different improvement priorities for each tumour type. This is an important consideration when developing patient-centred cancer services across different tumour types.
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Affiliation(s)
- Vicki Tsianakas
- Florence Nightingale School of Nursing and Midwifery, King's College London, 57 Waterloo Road, London, SE1 8WA, UK.
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Iredale R, Mundy L, Hilgart J. An online resource of digital stories about cancer genetics: qualitative study of patient preferences and information needs. J Med Internet Res 2011; 13:e78. [PMID: 22057223 PMCID: PMC3222166 DOI: 10.2196/jmir.1735] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Revised: 06/16/2011] [Accepted: 06/16/2011] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Cancer Genetics Service for Wales (CGSW) was established in 1998 as an all-Wales service for individuals with concerns about their family history of cancer. CGSW offers a range of services such as risk assessment, genetic counseling, and genetic testing. Individuals referred to cancer genetics services often have unmet information and support needs, and they value access to practical and experiential information from other patients and health professionals. As a result of the lifelong nature of genetic conditions, a fundamental challenge is to meet the ongoing needs of these patients by providing easily accessible and reliable information. OBJECTIVES Our aims were to explore how the long-term information and support needs of CGSW patients could be met and to assess whether an online bank of digital stories about cancer genetics would be acceptable to patients. METHODS In 2009, CGSW organized patient panels across Wales. During these events, 169 patients were asked for their feedback about a potential online resource of digital stories from CGSW patients and staff. A total of 75 patients registered to take part in the project and 23 people from across Wales agreed to share their story. All participants took part in a follow-up interview. RESULTS Patient preferences for an online collection of cancer genetics stories were collected at the patient panels. Key topics to be covered by the stories were identified, and this feedback informed the development of the website to ensure that patients' needs would be met. The 23 patient storytellers were aged between 28 and 75 years, and 19 were female. The digital stories reflect patients' experiences within CGSW and the implications of living with or at risk of cancer. Follow-up interviews with patient storytellers showed that they shared their experiences as a means of helping other patients and to increase understanding of the cancer genetics service. Digital stories were also collected from 12 members of staff working at CGSW. The digital stories provide reliable and easily accessible information about cancer genetics and are hosted on the StoryBank website (www.cancergeneticsstorybank.co.uk). CONCLUSIONS The Internet is one mechanism through which the long-term information and support needs of cancer genetics patients can be met. The StoryBank is one of the first places where patient and staff stories have been allied to every aspect of a patient pathway through a service and provides patients with an experiential perspective of the cancer genetics "journey." The StoryBank was developed in direct response to patient feedback and is an innovative example of patient involvement in service development. The stories are a useful resource for newly referred patients, current patients, the general public, and health care professionals.
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Affiliation(s)
- Rachel Iredale
- Institute of Medical Genetics, Cardiff University, United Kingdom.
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Vaismoradi M, Salsali M, Turunen H, Bondas T. Patients' understandings and feelings of safety during hospitalization in Iran: A qualitative study. Nurs Health Sci 2011; 13:404-11. [DOI: 10.1111/j.1442-2018.2011.00632.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Haigh C, Hardy P. Tell me a story--a conceptual exploration of storytelling in healthcare education. NURSE EDUCATION TODAY 2011; 31:408-11. [PMID: 20810195 DOI: 10.1016/j.nedt.2010.08.001] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2009] [Revised: 08/03/2010] [Accepted: 08/05/2010] [Indexed: 05/23/2023]
Abstract
The importance of storytelling as the foundation of human experiences cannot be overestimated. The oral traditions focus upon educating and transmitting knowledge and skills and also evolved into one of the earliest methods of communicating scientific discoveries and developments. A wide ranging search of the storytelling, education and health-related literature encompassing the years 1975-2007 was performed. Evidence from disparate elements of education and healthcare were used to inform an exploration of storytelling. This conceptual paper explores the principles of storytelling, evaluates the use of storytelling techniques in education in general, acknowledges the role of storytelling in healthcare delivery, identifies some of the skills learned and benefits derived from storytelling, and speculates upon the use of storytelling strategies in nurse education. Such stories have, until recently been harvested from the experiences of students and of educators, however, there is a growing realization that patients and service users are a rich source of healthcare-related stories that can affect, change and benefit clinical practice. The use of technology such as the Internet discussion boards or digitally-facilitated storytelling has an evolving role in ensuring that patient-generated and experiential stories have a future within nurse education.
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Affiliation(s)
- Carol Haigh
- School of Nursing, Manchester Metropolitan University, UK.
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Taylor AM, Hutchings M. Using video narratives of women's lived experience of breastfeeding in midwifery education: exploring its impact on midwives' attitudes to breastfeeding. MATERNAL AND CHILD NUTRITION 2010; 8:88-102. [PMID: 22136222 DOI: 10.1111/j.1740-8709.2010.00258.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Strong evidence supports the health benefits of breastfeeding contributing to the public health campaign to improve initiation and duration of breastfeeding globally, yet breastfeeding continuation rates are persistently low in the UK. Inadequate support from health professionals appears to be an underlying feature, aggravated by a dearth of professional education that uses a biopsychosocial approach. This paper describes how using women's video narratives of their lived experience of breastfeeding within higher education impacted positively on the attitudes of a group of midwives in relation to supporting breastfeeding women. It reports on the qualitative element of a two-phase sequential mixed methods study where focus group methods generated rich data about how and why the educational intervention altered attitudes. Analysis was thematic. Six major themes emerged, 'listening and learning from real women's experiences'; 'generation of emotions'; 'acquisition of new knowledge and learning'; 'reflection on practice'; 'promotion of independent learning' and 'sharing learning and ideas with peers'. 'Listening and learning from real women's experiences' was central to learning, and was pivotal to attitudinal change, motivating an intense need to improve practice. Findings support the value of using women's video narratives within midwifery education, through their power to integrate affective and cognitive learning, and to promote a transformative learning process. This novel approach brings value-added learning benefits by enhancing the potential to improve attitudes towards supporting breastfeeding women and improving clinical practice.
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Affiliation(s)
- Alison M Taylor
- Centre for Midwifery Maternal and Perinatal Health, School of Health and Social Care, Bournemouth University, Bournemouth, Dorset, UK.
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Wrigley M, Lathlean J. Family history of premature coronary heart disease: Exploring the experience. ACTA ACUST UNITED AC 2010. [DOI: 10.12968/bjca.2010.5.1.46032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Martha Wrigley
- Surrey & Sussex CLRN, based at Ashford & St Peter’s Hospitals NHS Trust, Cardiology Research Department, St Peter’s Hospital, Chertsey, Surrey, KT16 0PZ
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Doherty D, Benbow SM, Craig J, Smith C. Patients’ and carers’ journeys through older people’s mental health services. DEMENTIA 2009. [DOI: 10.1177/1471301209350286] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mapping the patient journey is a way of investigating the experiences of people using older people’s mental health services, particularly those with a dementia. It is a useful concept for patients and their families and enables them to tell their stories in a way which carries the potential for improving and developing the service. Similarly it is a useful concept for health and social care professionals in giving them the opportunity to understand, and reflect on, how their services work in practice for users and carers and how they might be improved. The collaboration between patients, carers and professionals may itself bring about broader benefits and changes in culture for the individuals and services involved. The West Midlands Older People’s Mental Health Collaborative has encouraged the use of mapping by Collaborative teams in order to identify areas for improvement work.
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Affiliation(s)
- Donna Doherty
- Staffordshire University and West Midlands Older People's
Mental Health Collaborative, UK,
| | - Susan Mary Benbow
- Staffordshire University and West Midlands Older People's
Mental Health Collaborative, UK, ,
| | - Julie Craig
- Wolverhampton City Council Adults & Community, UK
| | - Carol Smith
- Wolverhampton City Council Adults & Community, UK,
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Goodman H, Davison J, Preedy M, Peters E, Waters P, Persaud-Rai B, Shuldham C, Pepper J, Cowie MR. Patient and Staff Perspective of a Nurse-Led Support Programme for Patients Waiting for Cardiac Surgery: Participant Perspective of a Cardiac Support Programme. Eur J Cardiovasc Nurs 2009; 8:67-73. [DOI: 10.1016/j.ejcnurse.2008.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2007] [Revised: 01/07/2008] [Accepted: 03/26/2008] [Indexed: 11/30/2022]
Affiliation(s)
- Helen Goodman
- Royal Brompton and Harefield NHS Trust, London, UK
- Health Services Research Unit, Clinical Cardiology, Imperial College, London, UK
| | - June Davison
- Health Services Research Unit, Clinical Cardiology, Imperial College, London, UK
| | - Michael Preedy
- Health Services Research Unit, Clinical Cardiology, Imperial College, London, UK
| | - Emma Peters
- Royal Brompton and Harefield NHS Trust, London, UK
| | | | | | - Caroline Shuldham
- Royal Brompton and Harefield NHS Trust, London, UK
- Health Services Research Unit, Clinical Cardiology, Imperial College, London, UK
| | - John Pepper
- Royal Brompton and Harefield NHS Trust, London, UK
- Health Services Research Unit, Clinical Cardiology, Imperial College, London, UK
| | - Martin R. Cowie
- Royal Brompton and Harefield NHS Trust, London, UK
- Health Services Research Unit, Clinical Cardiology, Imperial College, London, UK
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Greenhalgh T, Wengraf T. Collecting stories: is it research? Is it good research? Preliminary guidance based on a Delphi study. MEDICAL EDUCATION 2008; 42:242-247. [PMID: 18275411 DOI: 10.1111/j.1365-2923.2007.02956.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
CONTEXT The use of narratives (stories) in research, education, audit and evaluation is increasingly common, but there is no consensus on when research ethics committee approval is necessary for such studies or what counts as 'good narrative research'. OBJECTIVE This study aimed to produce preliminary guidance for researchers, reviewers and ethics committees on what to classify as narrative research in health care and how to evaluate it. METHODS We carried out a 3-round Delphi study on a volunteer sample of 20 academic researchers, practitioners and service users who were active in narrative health research and its application. After reading academic papers on narrative theory and method, and via extensive online discussion, participants generated a set of preliminary statements. Each participant ranked these on a 9-point Likert scale for relevance and validity (round 1), and then received feedback on his or her scorings compared with the group median and range for each item. This cycle of group discussion, revision of statements, individual rankings and aggregation of scores was repeated twice. RESULTS The study produced a definition of narrative research which allows such work to be distinguished from the non-research use of stories in health care, and preliminary quality standards for evaluating narrative research. Most participants on this heterogeneous panel felt able to sign up to the final guidance. Residual disagreements were generally attributable to incommensurabilities in philosophical positions. CONCLUSIONS Research ethics committees and scientific reviewers may find the guiding principles in this paper a useful starting point for further reflection and discussion about narrative research studies.
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Affiliation(s)
- Trisha Greenhalgh
- Department of Primary Care and Population Sciences, University College London, London, UK.
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Todres L, Galvin K, Dahlberg K. Lifeworld-led healthcare: revisiting a humanising philosophy that integrates emerging trends. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2007; 10:53-63. [PMID: 16847724 DOI: 10.1007/s11019-006-9012-8] [Citation(s) in RCA: 154] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2005] [Accepted: 05/17/2006] [Indexed: 05/10/2023]
Abstract
In this paper, we describe the value and philosophy of lifeworld-led care. Our purpose is to give a philosophically coherent foundation for lifeworld-led care and its core value as a humanising force that moderates technological progress. We begin by indicating the timeliness of these concerns within the current context of citizen-oriented, participative approaches to healthcare. We believe that this context is in need of a deepening philosophy if it is not to succumb to the discourses of mere consumerism. We thus revisit the potential of Husserl's notion of the lifeworld and how lifeworld-led care could provide important ideas and values that are central to the humanisation of healthcare practice. This framework provides a synthesis of the main arguments of the paper and is finally expressed in a model of lifeworld-led care that includes its core value, core perspectives, relevant indicative methodologies and main benefits. The model is offered as a potentially broad-based approach for integrating many existing practices and trends. In the spirit of Husserl's interest in both commonality and variation, we highlight the central, less contestable foundations of lifeworld-led care, without constraining the possible varieties of confluent practices.
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Affiliation(s)
- Les Todres
- Institute of Health and Community Studies, Bournemouth University, First Floor, Royal London House, Christchurch Road, Bournemouth, Dorset, BH1 3LT, UK.
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Crofts L. Learning from critical case reviews: emergent themes and their impact on practice. Intensive Crit Care Nurs 2006; 22:362-9. [PMID: 16899367 DOI: 10.1016/j.iccn.2006.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 03/28/2006] [Accepted: 03/29/2006] [Indexed: 12/26/2022]
Abstract
This paper describes the process of conducting critical case reviews as part of a leadership programme for critical care. Forty-five cases were reviewed over 2 years in five different hospitals and permission was sought from local research ethics committees and research and development committees for the discussions to be treated as research data. Typically the cases presented were patients with complex needs whose trajectory of care had not gone smoothly. Key themes to emerge from the case reviews were: The case reviews themselves were: Communication failures between professional groups, between professional themselves, between staff and families, between wards and departments and between different hospitals. Documentation was also often less than satisfactory. Teams often had problems in working together as a team and different professionals often had different expectations of other members of the team. Individual action may compensate for weaknesses in formal clinical risk system. The case reviews themselves were showcases of the difficulties the health service faces every day and the challenges of communicating effectively. The case reviews provided an effective medium to both resolve those difficulties and model a means through which teams could effectively manage and communicate patient care issues. Furthermore their strength as a learning tool was attributed to team learning as a powerful catalyst for change.
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Affiliation(s)
- Linda Crofts
- Department of Health and Human Sciences, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, United Kingdom.
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Dodds S, Chamberlain C, Williamson GR. Modernising chronic obstructive pulmonary disease admissions to improve patient care: Local outcomes from implementing the Ideal Design of Emergency Access project. ACTA ACUST UNITED AC 2006; 14:141-7. [PMID: 16762552 DOI: 10.1016/j.aaen.2006.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2005] [Revised: 03/10/2006] [Accepted: 03/30/2006] [Indexed: 11/25/2022]
Abstract
This project illustrates how benefits to patients, carers, staff and NHS trusts can result from service redesign that is targeted at improving services for patients with chronic obstructive pulmonary disease. Using a Continuous Quality Improvement methodology and 'plan-do-study-act' cycles, this project established key local measures for service redesign based on the national Ideal Design of Emergency Care project. These were to improve patients' experiences of care, by: decreasing patient journey time, improving patient, carer and staff experiences and reducing process variability. The result was a reduction in the average length of stay for patients and an increase in the numbers of patients admitted directly to the emergency medical unit and transferred to the respiratory department. Service users were actively involved in developing the changes. Although not generalizable, this project provides useful insights for consideration by others facing similar issues in their own organisations: we conclude that the methodology used in this study has been instrumental in improving key aspects of patient care, and that a similar methodological approach could be effective for other organisations.
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Affiliation(s)
- Sarah Dodds
- Respiratory Department, Royal Devon and Exeter Health Care NHS Foundation Trust (Wonford), Barrack Rd, Exeter, Devon EX2 5DW, United Kingdom
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Segaran E. Returning to normal: The role of eating in recovery from a critical illness. ACTA ACUST UNITED AC 2006. [DOI: 10.12968/bjnn.2006.2.3.21103] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ella Segaran
- The National Hospital for Neurology and Neurosurgery, Queens Square, London WC1N 3BG
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Crofts L. Learning from experience: constructing critical case reviews for a leadership programme. Intensive Crit Care Nurs 2006; 22:294-300. [PMID: 16617019 DOI: 10.1016/j.iccn.2006.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2005] [Revised: 02/10/2006] [Accepted: 02/14/2006] [Indexed: 10/24/2022]
Abstract
A previous paper described the development of a leadership programme for critical care and highlighted that one of the strengths of the programme was the critical case review. This paper sets out in some depth the major theoretical influences in the construction of the case review. Case reviews have been used in education for some time but often have predetermined outcomes. The education approach favoured here was based on action learning, which in itself belongs to the broad church of reflective practice. While reflective practice has been advocated in nursing since 1986 together with the introduction of clinical supervision neither have met with unqualified success in their own right. This paper concludes that while the concept and construction of the critical case review may be new it is in essence no more than a jigsaw of already well-established practices of reflection, clinical supervision and action learning woven into the foundations of clinical risk management and whole systems working.
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Affiliation(s)
- Linda Crofts
- Department of Health and Human Sciences, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, United Kingdom.
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Green A, Ross D, Mirzoev T. Primary health care and England: the coming of age of Alma Ata? Health Policy 2006; 80:11-31. [PMID: 16545486 DOI: 10.1016/j.healthpol.2006.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2005] [Accepted: 02/09/2006] [Indexed: 11/30/2022]
Abstract
The Alma Ata Declaration is now 28 years old. This article uses its framework to assess the changes that have occurred in recent years in the English health system. It summarises the health reform changes that have occurred internationally and those in the English health system in two eras, pre- and post-1997 - when the Labour Party came to power. It concludes that linked forces of managerialism and consumerism have had an impact on the health system which has undergone a number of structural changes in recent years. It suggests that the original Alma Ata focus on equity is being modified by the concept of choice. The tensions between central priorities, often reflected in targets, and local accountability and needs are explored. There appears to be a greater interest in seeking genuine health (rather than solely health care) change, with attendant public health and partnership policies, however the gap between policy and practice still needs to be bridged, and questions as to the appropriate locus and leadership for health promotion activities addressed. However there have been numerous institutional changes which carry the danger of distracting from the purpose of achieving health change, and which continue to raise questions as to the appropriateness of a market model for health. Finally the paper argues that the PHC framework of Alma Ata remains a useful framework for assessing health systems, but needs to be tailored to, and prioritised within, a political dynamic.
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Affiliation(s)
- Andrew Green
- International Health Planning, Nuffield Centre for International Health and Development, University of Leeds, UK.
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Davis D, McIntosh C. Partnership in education: The involvement of service users in one midwifery programme in New Zealand. Nurse Educ Pract 2005; 5:274-80. [DOI: 10.1016/j.nepr.2005.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2004] [Accepted: 02/24/2005] [Indexed: 10/25/2022]
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Abstract
This research arose out of a collaboration between a service user (M) and two researchers. Following M's invitation to us to explore issues surrounding a carer's experience of Alzheimer's, we jointly agreed a research strategy in which we would engage in a series of interviews with M, with the aim of developing insight into how the intimate carer's complex journey can support and benefit other family caregivers faced with similar challenges. Using a broadly hermeneutic-phenomenological method, three essential themes emerged to describe the carer's journey: (i) something is wrong; (ii) the challenging shared journey: being the carer; (iii) coping through meaning-making: advocacy. We arrive at a position which considers the unique role of an intimate carer as a 'liminal' figure between the private world of an Alzheimer's sufferer and the public world of health and social care systems. The paper concludes with a consideration of how the unique role of the intimate carer as mediator could be more respectfully involved as an ongoing knowledge source for care planning and treatment decisions. Specific areas of consideration in this regard include mechanisms for such user involvement in policy making, day-to-day care delivery, and developments in the support of other carers. We hope to highlight the 'intimacy' of this position and the distinctive benefits and challenges of such intimacy in providing a crucial level of user knowledge and 'evidence' for ongoing treatment decisions. We also hope to highlight the value and power of single-case study in generating useful insights for practice.
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Affiliation(s)
- Kathleen Galvin
- Institute of Health and Community Studies, Bournemouth University, Bournemouth, UK.
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Rycroft-Malone J, Harvey G, Seers K, Kitson A, McCormack B, Titchen A. An exploration of the factors that influence the implementation of evidence into practice. J Clin Nurs 2005; 13:913-24. [PMID: 15533097 DOI: 10.1111/j.1365-2702.2004.01007.x] [Citation(s) in RCA: 370] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The challenges of implementing evidence-based practice are complex and varied. Against this background a framework has been developed to represent the multiple factors that may influence the implementation of evidence into practice. It is proposed that successful implementation is dependent upon the nature of the evidence being used, the quality of context, and, the type of facilitation required to enable the change process. This study sets out to scrutinize the elements of the framework through empirical enquiry. AIMS AND OBJECTIVES The aim of the study was to address the following questions: * What factors do practitioners identify as the most important in enabling implementation of evidence into practice? * What are the factors practitioners identify that mediate the implementation of evidence into practice? * Do the concepts of evidence, context and facilitation constitute the key elements of a framework for getting evidence into practice? DESIGN AND METHODS The study was conducted in two phases. Phase 1: Exploratory focus groups (n = 2) were conducted to inform the development of an interview guide. This was used with individual key informants in case study sites. Phase 2: Two sites with on-going or recent implementation projects were studied. Within sites semi-structured interviews were conducted (n = 17). RESULTS A number of key issues in relation to the implementation of evidence into practice emerged including: the nature and role of evidence, relevance and fit with organizational and practice issues, multi-professional relationships and collaboration, role of the project lead and resources. CONCLUSIONS The results are discussed with reference to the wider literature and in relation to the on-going development of the framework. Crucially the growing body of evidence reveals that a focus on individual approaches to implementing evidence-based practice, such as skilling-up practitioners to appraise research evidence, will be ineffective by themselves. RELEVANCE TO CLINICAL PRACTICE Key elements that require attention in implementing evidence into practice are presented and may provide a useful checklist for future implementation and evaluation projects.
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