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Waters L, Sohmer D, Goldman RE, Bluestein D, Burnham K, Clark PG, Slattum PW, Helm F, Marks J. Beyond knowledge and confidence: a mixed methods evaluation of a Project ECHO course on dementia for primary care. GERONTOLOGY & GERIATRICS EDUCATION 2023:1-14. [PMID: 37929922 DOI: 10.1080/02701960.2023.2278097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2023]
Abstract
Primary care clinicians have an important role in the management of dementia and have expressed interest in continuing education. The authors describe a model they used for providing dementia education in primary care, Project ECHO (Extension for Community Healthcare Outcomes), and an overview of its major features. A partnership including academic institutions and a national healthcare association is then outlined, including the unique features of the ECHO model developed through this partnership. A mixed-methods methodology was used for programmatic evaluation. This use of mixed methods adds vital new knowledge and learner perspectives that are key to planning subsequent ECHO courses related to dementia and primary care. The discussion includes an exploration of the significance of these findings for understanding the motivations of primary care providers for participation in the educational program, as well as the limitations of the current study. A final section explores the next steps in the continued development of the model and its implications for geriatrics education in dementia care, especially the supportive role that ECHO courses can play in meeting the challenges of dementia care.
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Affiliation(s)
- Leland Waters
- Virginia Center on Aging, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Dana Sohmer
- Alzheimer's Association, Chicago, Illinois, USA
| | - Roberta E Goldman
- Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel Bluestein
- Virginia Center on Aging, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Phillip G Clark
- Rhode Island Geriatric Education Center, University of Rhode Island, Kingston, USA
| | - Patricia W Slattum
- Virginia Center on Aging, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Faith Helm
- Rhode Island Geriatric Education Center, University of Rhode Island, Kingston, USA
| | - Jane Marks
- Johns Hopkins Geriatrics Workforce Enhancement Program, Division of Geriatric Medicine and Gerontology, Johns Hopkins University, Maryland, Baltimore, USA
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Kheirkhah H, Hartfeld NMS, Widdifield J, Kulhawy-Wibe S, Roberts J, Yacyshyn EA, Lee JJY, Jilkine K, Jerome D, Kwok TSH, Burt J, Barber CEH. An Overview of Reviews to Inform Organization-Level Interventions to Address Burnout in Rheumatologists. J Rheumatol 2023; 50:1488-1502. [PMID: 37527857 DOI: 10.3899/jrheum.2023-0437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE To identify organization-directed strategies that could be implemented to prevent burnout among rheumatologists. METHODS A search of English language articles published 2011 or later was conducted on Cochrane Database of Systematic Reviews, Embase, Medline, and PsycInfo on January 25, 2022. Included reviews had ≥ 1 primary studies with ≥ 10% of participants who were physicians, recorded burnout as an outcome, and described an organization-directed intervention to prevent burnout. Overlap of primary studies across reviews was assessed. The final review inclusion was determined by study quality, minimization of overlap, and maximization of intervention breadth. The A Measurement Tool to Assess Systematic Reviews (AMSTAR) 2 tool was used for quality assessment. Included studies and interventions were assessed by rheumatologists for their applicability to rheumatology. RESULTS A total of 17 reviews, including 15 systematic reviews, 1 realist review, and 1 umbrella review were included. AMSTAR 2 quality ratings classified 5 systematic reviews as low quality, 1 as moderate, and 9 as critically low. There was significant heterogeneity between and within reviews. Six conducted a metaanalysis and 11 provided a qualitative summary of findings. The following intervention types were identified as having possible applicability to rheumatology: physician workflow and organizational strategies; peer support and formal communication training; leadership support; and addressing stress, mental health, and mindfulness. Across interventions, mindfulness had the highest quality of evidence to support its effectiveness. CONCLUSION Although the quality of evidence for interventions to prevent burnout in physicians is low, promising strategies such as mindfulness have been identified.
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Affiliation(s)
- Hengameh Kheirkhah
- H. Kheirkhah, MD, N.M.S. Hartfeld, MSc, MC, S. Kulhawy-Wibe, MD, MSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Nicole M S Hartfeld
- H. Kheirkhah, MD, N.M.S. Hartfeld, MSc, MC, S. Kulhawy-Wibe, MD, MSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Jessica Widdifield
- J. Widdifield, PhD, Sunnybrook Research Institute, University of Toronto, ICES, Toronto, Ontario
| | - Stephanie Kulhawy-Wibe
- H. Kheirkhah, MD, N.M.S. Hartfeld, MSc, MC, S. Kulhawy-Wibe, MD, MSc, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Janet Roberts
- J. Roberts, MD, Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia
| | - Elaine A Yacyshyn
- E.A. Yacyshyn, MD, MScHQ, Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta
| | - Jennifer J Y Lee
- J.J.Y. Lee, MD, MSc, Division of Rheumatology, Department of Pediatrics, University of Toronto, Toronto, Ontario
| | - Konstantin Jilkine
- K. Jilkine, MD, Section of Rheumatology, Department of Medicine, University of Manitoba, Winnipeg, Manitoba
| | - Dana Jerome
- D. Jerome, MD, MEd, T.S.H. Kwok, MD, MSc, Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Timothy S H Kwok
- D. Jerome, MD, MEd, T.S.H. Kwok, MD, MSc, Division of Rheumatology, Department of Medicine, University of Toronto, Toronto, Ontario
| | - Jennifer Burt
- J. Burt, PT, ACPAC-trained ERP, Rheumatology Services, Eastern Health, St. John's, Newfoundland and Labrador
| | - Claire E H Barber
- C.E.H. Barber, MD, PhD, Cumming School of Medicine, University of Calgary, Calgary, Alberta, and Arthritis Research Canada, Vancouver, British Columbia, Canada.
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Younas A, Inayat S, Masih S. Nurses' perceived barriers to the delivery of person-centred care to complex patients: A qualitative study using theoretical domains framework. J Clin Nurs 2023; 32:368-381. [PMID: 35132737 DOI: 10.1111/jocn.16245] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/21/2022] [Accepted: 01/25/2022] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES To determine nurses' perceived barriers to the delivery of person-centred care to complex patients with multiple chronic conditions in acute care settings. BACKGROUND Complex patients have multiple physical and mental health problems, and their life is also greatly affected by sociocultural and economic determinants of health. These patients require person-centred care, but nurses often find it challenging to provide effective care to these patients due to their complex health needs. DESIGN A descriptive qualitative design was used. The COREQ guidelines were followed for reporting. METHODS Semi-structured interviews were conducted with a purposive sample of 19 nurses in two hospitals. Data were analysed using deductive thematic analysis guided by the Theoretical Domains Framework, which entails 14 domains about factors affecting behaviours. RESULTS The key barriers were identified under environmental context and resources, social influences, emotions, knowledge and skills domains. Deep-rooted social issues delay patients' health-seeking and nurses' abilities to understand patients' needs and discern appropriate care. Interpersonal hostility influenced nurse-patient-families interactions, and doctor-nurses conflicts affected collaborative efforts towards optimal care. CONCLUSIONS Nurses' perceived barriers to care were intertwined with the deep-rooted social and cultural beliefs about nurses' image, patients' expectations and families' preference for home remedies over specialised nursing care. These barriers to person-centred care demonstrate an intricate interplay of personal, social and organisational issues and power struggles. Multifaceted implementation strategies targeting environmental context and resources, social influences, emotions, knowledge and skills domains may be beneficial to enable nurses to provide better person-centred care to complex patients. RELEVANCE TO CLINICAL PRACTICE Designing implementation facilitation teams, organising person-centred care grand rounds, and allocation of stress management resources to address hostility, social-cultural influences, and organisational barriers is essential. Nurses could focus on their self-awareness and collaborative skills to address emotional and interprofessional conflicts.
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Affiliation(s)
- Ahtisham Younas
- Swat College of Nursing, Swat, Pakistan.,Faculty of Nursing, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Shahzad Inayat
- Isra College of Nursing, Al-Nafees Medical College, Isra University, Islamabad, Pakistan
| | - Samuel Masih
- College of Nursing, Bashir Institute of Health Sciences, Islamabad, Pakistan
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