Partnering with patients ? a concept ready for action

[The integration of peer support in psychiatry, or how to better support patients]

Peer support plays an essential role in patient recovery by encouraging a supportive approach based on experiential knowledge. It helps to create individualised care centred on life projects and individual strengths. Within the teams, the knowledge of the peer health mediator and the carers is shared. This approach helps to improve care by drawing on the depth of people's experiences and feelings, and their resilience in the face of illness.

Nurses' perspectives on challenges and facilitators when implementing a self-management support intervention as an everyday healthcare practice: A qualitative study

AIM

To explore registered nurses' perspectives on challenges and facilitators to implementing a telephone-based self-management support (SMS) intervention (Proactive Health Support) as an everyday healthcare practice, during the early stages of implementation.

DESIGN

Data were collected using a qualitative research design involving focus-group interviews and participant observations.

METHODS

We conducted participant observation following nine nurses and four focus group interviews with 14 nurses. Data were analysed using thematic analyses.

RESULTS

Proactive Health Support was implemented in units organized independently of the existing organizational units within healthcare services. This independent organization, along with the intervention's generic (non-disease specific) design, empowered nurses to become autonomous practitioners capable of prioritizing the operationalization of SMS as an everyday healthcare practice. However, unlearning already embedded medical practices and establishing new nursing roles necessary to accommodate the intervention in practice was experienced a challenge. Education and supervision were identified as valuable tools for successful implementation.

CONCLUSION

Our study highlights the significance of organizational context and autonomy in successful SMS implementation. Balancing external factors like organizational context, priority and time is vital, but navigating the internal shift in professional practice is equally crucial. Role transition processes can constitute challenges demanding accommodation.

IMPLICATIONS FOR THE PROFESSION

From a nursing perspective, this study highlights that practising SMS requires substantial training and education. Generic SMS interventions can introduce higher levels of contingency due to their versatile nature. Thus, equipping nurses with competencies that enable them to navigate this unpredictability flexibly is crucial.

IMPACT

Policymakers and administrators should allocate resources and support implementation processes in ways that accommodate both internal and external conditions to facilitate nurses in delivering effective SMS.

REPORTING METHOD

This study adheres to the SRQR guideline.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Development and Testing of the School Healthcare Partnership Scale for Parents

BACKGROUND

Cooperation between parents and school nurses is essential for the successful completion of school courses and a healthy school life for children with long-term conditions. Therefore, this study aimed to develop and test a scale to measure parental perceptions of partnerships between school nurses and parents in the school health care (SHC) system for children with type 1 diabetes (T1D).

METHODS

The content validity, factorial structure validity, convergent validity, discriminant validity, known-group validity, internal consistency reliability, and test-retest reliability of the School Healthcare Partnership Scale for Parents (SHCPS-P) were evaluated. Data were analyzed by performing exploratory factor analysis (EFA), Pearson's correlation, Cronbach's α, and independent t-tests. The total sample included 155 parents for the EFA and 49 parents for the stability test. Seventeen items, grouped into 3 dimensions, were extracted through principal axis factoring.

RESULTS

The total variance explained by these factors was 53.57%. The scale demonstrated a high correlation with parental satisfaction regarding school nursing and a moderate correlation with diabetes-related safety, thereby showing convergent validity. A low correlation with empathy demonstrated discriminant validity. A significant difference existed in the partnership scores in known-group comparisons. Cronbach's α was 0.95, and the test-retest correlation coefficient was 0.95, which showed reliability.

CONCLUSIONS

This study suggests that the SHCPS-P is a reliable and valid tool for measuring the perception of SHC partnership among parents of children with T1D and can be used as an indicator to measure parents' perspectives about SHC.

School Health Teachers as Partners in Diabetes Caring: Maternal Perspectives

BACKGROUND

The absence of primary care providers' participation in school health care may require close collaboration between school health teachers and parents. This study explores maternal perspectives on obstacles and improvements in partnerships with school health teachers of children with type 1 diabetes.

METHODS

Participants were recruited using purposive sampling through an online type 1 diabetes self-help group in South Korea. Twenty-two mothers whose children were aged between 7 and 13 and had been diagnosed with type 1 diabetes at least 1 year ago were included. Individual interviews were conducted based on a semi-structured interview guide from February to June 2019. Qualitative data were analyzed using inductive content analysis comprising open coding, coding sheets, grouping, categorization, and abstraction.

RESULTS

Mothers recognized obstacles in eight categories and improvements in nine categories under institutional, interpersonal, and intrapersonal aspects of the partnership with school health teachers. Respondents recognized insufficient legal coverage and guidelines, and also health teacher shortage and workload as obstacles in the institutional dimension. Mothers perceived building trust, compromising to balance responsibilities, and constant and open communication as improvements in the interpersonal dimension. They recognized practical competency and tailored care for ordinary school life as school health teacher-related improvements.

CONCLUSIONS

The findings indicate that school health teachers should compromise to balance responsibilities to improve partnerships with parents in the school health care setting. Institutional improvements, such as establishing robust laws and clear guidelines and increasing the number of school health teachers, should be prioritized.

Development and validation of the school healthcare partnership scale for school nurses

PURPOSE

This study was conducted to develop the School Healthcare Partnership Scale for School Nurses (SHCPS-S) for children with type 1 diabetes and to validate its psychometric properties.

METHODS

This was a methodological study. A total 342 school nurses in South Korea participated in the study; 171 were randomly assigned to each group for exploratory factor analysis and confirmatory factor analysis. Data was collected from December 2021 to February 2022 via online survey. The Family Nursing Practice Scale was used to evaluate criterion validity, and the school nurse's professionalism scale and empathy were used to verify concurrent validity. Content validity review, response tests, and factor analysis were conducted.

RESULTS

A 50-items pool was created based on a hybrid concept analysis. Forty items were selected following the content validity review, using content validity index. A 20-item scale with four factors (trusting relationships, balanced responsibility, providing tailored care, and transparent and open communication) was chosen following exploratory factor analysis. Confirmatory factor analysis for the four factors showed an adequate model fit. The correlation coefficient with the family nursing practice and school nurse's professionalism scale were 0.642, 0.630, and 0.376. The Cronbach's α was 0.919, and the correlation coefficient was 0.768 in test-retest.

CONCLUSIONS

The SHCPS-S is a valid and reliable scale to measure school nurses' perceived collaborative relationships with parents for children with type 1 diabetes.

PRACTICAL IMPLICATIONS

This scale can be used as a tool in interventional studies to enhance school healthcare partnerships.

Factors affecting pediatric nurses' development of partnerships with parents of hospitalized children: An evaluation based on the stress-coping adaptation model

We aimed to identify factors affecting pediatric nurses' perceptions of their development of partnerships with parents of hospitalized children based on Lazarus and Folkman's stress-coping adaptation model. This cross-sectional study included 209 pediatric nurses with over 1 year of clinical experience in South Korea. Data were collected using online-based self-report questionnaires containing items on nurses' perceived partnerships with parents, job stress, positive psychological capital, nursing professionalism, and a coping scale. Positive psychological capital, job stress, coping, hospital type, and unit type were significant factors in a hierarchical regression analysis using perceived partnership as a dependent variable. This study supports an efficient intervention program to improve pediatric nurses' partnership competency. Strategies to reduce pediatric nurses' job stress and improve their coping abilities and positive psychological capital will enhance their partnerships with parents of hospitalized children.

School Nurse-Parent Partnership in School Health Care for Children with Type 1 Diabetes: A Hybrid Method Concept Analysis

PURPOSE

To define school nurse-parent partnerships in school health care for children with type 1 diabetes (T1D) and determine its attributes using a hybrid model.

METHODS

This method involves a three-phase process: theoretical, fieldwork, and analytical. A literature review was conducted during the theoretical phase. A literature search of articles from January 1991 to February 2020 was conducted using relevant electronic databases. Eighty-three articles that met the inclusion criteria were completely read. Fieldwork data were collected through individual interviews from February to July 2019 in South Korea. In the fieldwork phase, interviews were conducted individually with 22 mothers of students with T1D and 20 school nurses recruited by purposeful sampling. Inductive content analysis was conducted. The findings from the theoretical phase were integrated with those from the fieldwork phase, and the final concept was derived.

RESULTS

School nurse-parent partnership in school health care for children with T1D has been defined as an interactive process of maintaining a balanced responsibility and providing tailored care to meet needs by establishing trusting relationships and communicating transparently and openly. This analysis yielded four attributes: trusting relationships, transparent and open communication, balanced responsibility, and providing tailored care to meet needs-this entails providing nursing actions by advocating for students and performing a negotiated role together or individually for student and family.

CONCLUSION

The findings of this study add to the importance of an attribute of balancing responsibility for partnership in school health care. The results show that this partnership could contribute to the development of a scale, theory, and nursing intervention in school health care for children with T1D.

Differences in the perceptions of partnership between nurses and mothers of children in a pediatric intensive care unit in South Korea: a qualitative study

Purpose: The purpose of this study was to investigate how pediatric intensive care unit (PICU) nurses and the mothers of hospitalized children perceived their partnership and identify the detailed differences in the common domains of partnership between them.Methods: A qualitative descriptive design with semi-structured and open-ended interviews was used. Interviews with mothers of hospitalized children and nurses in the PICU were conducted at a national university hospital in South Korea.Results: Five integrated categories were identified concerning nurses' and mothers' perceptions of partnership. Five common domains were derived by merging the partnership categories perceived by each PICU mother and nurse: expectation of trust, sharing and communication, participation in care, equality in the relationship, and coordination of opinion However, there were significant differences in the composition of the categories of these common domains.Conclusion: These results may facilitate more effective partnerships between parents and PICU nurses. Efforts should be taken to promote the formation of trust between nurses and parents and create an environment that is conductive to regular open communication in particular, steps should be taken to reduce gaps in awareness concerning this partnership and information sharing, nursing methods, and decision-making.

Validity and reliability of the Family Empowerment Scale for parents of children with cleft lip and/or palate

BACKGROUND

Empowerment is recognized as a crucial concept in strengthening the position of parents in healthcare services. This study aimed to evaluate the validity and reliability of the Turkish Family Empowerment Scale (FES).

METHODS

This methodological study was conducted between January and March 2021, with 348 family members actively caring for their children in the age group of 0-18 years with cleft lip and/or palate (CL/P). The English FES was translated into Turkish using back translation and modified so that it is generic and convenient for all families. The construct validity, internal validity, internal consistency, and split-half test reliability and responsiveness of the Turkish FES were examined.

RESULTS

The original FES structure with three factors (family, health services provided to the child and community participation) and 34 items was verified in Turkish culture. This obtained structure can explain 66% of the variance of the relevant concept. Scores of parents ranged between 34 and 170 points. Increasing scores indicated a positive significance regarding family empowerment. The Cronbach's α reliability coefficient of the scale was calculated as 0.976.

CONCLUSION

The study findings and the goodness-of-fit values indicated that the FES and its Turkish version are a valid and reliable measurement instrument to be used in Turkish culture.

Defining an enabling environment for those with chronic disease: an integrative review

BACKGROUND

Health policies are currently being implemented to cope with the 37% of those affected by chronic disease and 63% of deaths worldwide. Among the proposals, there is accelerating support for greater autonomy for patients, which incorporates several concepts, including empowerment. To achieve this, develop an environment to increase an individual's capacity for action seems to be a fundamental step. The aim of this study is to characterize an enabling environment for patients in the context of chronic disease management.

METHODS

An integrative review design was applied. Medline, CINAHL, and Web of Science databases were searched to identify relevant literature published between 2009 and 2019. Overall, the review process was guided by the PRISMA 2020 checklist. The Mixed Methods Appraisal Tool for quality evaluation was used.

RESULTS

A total of 40 articles were analyzed, divided into 18 quantitative studies, 11 qualitative studies, two mixed studies, seven expert opinions, one theory and one conference report. The following characteristics defining an enabling environment were taken from the literature relating to those with a chronic condition: Needs assessment-adaptation of responses, supporting "take care", involvement in support, knowledge improvement, engagement with professionals, use of information and communication technologies, and organization of care. Beyond that, the interactions highlighted between these seven categories characterize an enabling environment.

CONCLUSION

This review specifies the essential elements of an enabling environment for patients with chronic conditions. It encompasses the partnership between the healthcare professional, such as the advanced practice nurse, and the individual for whom interventions and care strategies must be devised.

Development and validation of the Scale for Staff-Family Partnership in Long-term Care (SSFPLC)

Background

A partnership between staff and families is crucial to maintain nursing home residents' health and promote quality of care, and currently, there is a need for a measurement tool to assess the partnership.

Objectives

This study aimed to develop a tool for assessing the partnership between staff and the families of older adult nursing home residents from the perspective of staff members and to verify its reliability and validity.

Methods

The instrument was developed in the following four stages: (1) generation of an item pool via literature review and focus group interview, (2) experts' content validity analysis of 32 items, (3) a preliminary survey on 30 staff members and (4) validity and reliability tests of the instrument on 346 staff members in nursing homes between July and October 2018.

Results

The final instrument consists of 17‐items in four categories (family's trust and support, collaborative relationship and communication, encouragement to participate in care and professional care). Each item was rated on a 4‐point Likert scale, and the higher scores indicating better partnership between staff and families of nursing home residents. The reliability of the instrument was 0.90, and the test–retest intra‐class correlation coefficient was 0.96.

Conclusion

The Scale for Staff–Family Partnership in Long‐term Care (SSFPLC) showed acceptable reliability and validity as an instrument to assess the partnership between nursing home staff and families.

Implications for practice

This tool can be used for evaluating staff and family partnerships within nursing homes.

Stabilizing life: A grounded theory of surviving critical illness

OBJECTIVES

The experience of critical illness among patients is both complex and multifaceted. It can make patients vulnerable to long-term consequences such as impairment in cognition, mental health and physical functional ability which affects health related quality of life. This study aims to explore patients' patterns of behaviour during the process from becoming critical ill to recovery at home.

DESIGN

We used a classic grounded theory methodology to explore the main concern for intensive care patients. Thirteen participants were interviewed and seven different participants were observed.

SETTING

Three general intensive care units in Sweden, consisting of a university hospital, a county hospital and a district hospital.

FINDINGS

The theory Stabilizing life explains how patients' main concern, being out of control, can be resolved. This theory involves two processes, recapturing life and recoding life, and one underlying strategy, emotional balancing that is used during the whole process.

CONCLUSION

The process from becoming critically ill until recovery home is perceived as a constant fight in actions and mind to achieve control and stabilize life. This theory can form the basis for further qualitative and quantitative research about interventions that promotes wellbeing during the whole process.

Patients and Professionals as Partners in Hypertension Care: Qualitative Substudy of a Randomized Controlled Trial Using an Interactive Web-Based System Via Mobile Phone

BACKGROUND

The use of technology has the potential to support the patient´s active participation regarding treatment of hypertension. This might lead to changes in the roles of the patient and health care professional and affect the partnership between them.

OBJECTIVE

The aim of this qualitative study was to explore the partnership between patients and health care professionals and the roles of patients and professionals in hypertension management when using an interactive web-based system for self-management of hypertension via the patient's own mobile phone.

METHODS

Focus group interviews were conducted with 22 patients and 15 professionals participating in a randomized controlled trial in Sweden aimed at lowering blood pressure (BP) using an interactive web-based system via mobile phones. The interviews were audiorecorded and transcribed and analyzed using thematic analysis.

RESULTS

Three themes were identified: the technology, the patient, and the professional. The technology enabled documentation of BP treatment, mainly for sharing knowledge between the patient and the professional. The patients gained increased knowledge of BP values and their relation to daily activities and treatment. They were able to narrate about their BP treatment and take a greater responsibility, inspired by new insights and motivation for lifestyle changes. Based on the patient's understanding of hypertension, professionals could use the system as an educational tool and some found new ways of communicating BP treatment with patients. Some reservations were raised about using the system, that it might be too time-consuming to function in clinical practice and that too much measuring could result in stress for the patient and an increased workload for the professionals. In addition, not all professionals and patients had adopted the instructions regarding the use of the system, resulting in less realization of its potential.

CONCLUSIONS

The use of the system led to the patients taking on a more active role in their BP treatment, becoming more of an expert of their BP. When using the system as intended, the professionals experienced it as a useful resource for communication regarding BP and lifestyle. Patients and professionals described a consultation on more equal grounds. The use of technology in hypertension management can promote a constructive and person-centered partnership between patient and professional. However, implementation of a new way of working should bring benefits and not be considered a burden for the professionals. To establish a successful partnership, both the patient and the professional need to be motivated toward a new way of working.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03554382; https://clinicaltrials.gov/ct2/show/NCT03554382.

Exploring the theory, barriers and enablers for patient and public involvement across health, social care and patient safety: a systematic review of reviews

BACKGROUND

The emergence of patient and public involvement (PPI) in healthcare in the UK can be traced as far back as the 1970s. More recently, campaigns by harmed patients have led to a renewed focus on strengthening PPI. There is a growing awareness of the benefits of PPI in research as well as a need to address power inequities and a lack of diversity and inclusion. This review was undertaken to look at evidence for theories, barriers and enablers in PPI across health, social care and patient safety that could be used to strengthen PPI and address a perceived knowledge and theory gap with PPI in patient safety.

METHODS

We searched MEDLINE, EMBASE and PsycINFO from inception to August 2018, using both MeSH and free-text terms to identify published empirical literature. Protocols in PROSPERO were also searched to identify any systematic reviews in progress. The extracted information was analysed using a narrative approach, which synthesises data using a descriptive method.

RESULTS

Forty-two reviews were identified and grouped by key outcomes. Twenty-two papers mentioned theory in some form, 31 mentioned equality and diversity (although with no theory mentioned in this area), and only 19 cited equality and diversity as a barrier or enabler. Thirty-four reviews identified barriers and enablers at different organisational levels: personal/individual; attitudes; health professional; roles and expectations; knowledge, information and communication; financing and resourcing; training; general support; recruitment and representation, PPI methods and working with communities and addressing power dynamics.

CONCLUSIONS

The review findings suggest that a commitment to PPI and partnership working is dependent on taking a whole system approach. This needs to consider the complex individual and organisational enablers and constraints to this process and address imbalances of power experienced by different groups. Addressing equality and diversity and use of a theory-driven approach to guide PPI are neglected areas. The long tradition of involvement across health and social care can provide considerable expertise in thinking about ways to strengthen approaches to PPI. This is especially important in patient safety, with a much newer tradition of developing PPI than other areas of healthcare.

Meaningful Text: Total Hip Replacement Patients’ Lived Experience of a Nursing Care Plan Written in Lay Language

Background:

Person-centred care involves respecting patients’ experiences, preferences, and needs, as well as sharing information with them and involving them in care planning. Scant research has been conducted on how it influences patients to have direct access to their care planning when it has been established through the use of standardised care plans or pathways. In the orthopaedic ward in which this study was conducted, a standardised nursing care plan for total hip replacement patients (THR), which was originally written in professional language, was rewritten in lay language and used as peri-operative teaching material for this patient group.

Study Aim:

To explore the meaning THR patients ascribe to the lived experience of reading and retaining their standardised nursing care plan in lay language during their hospital stay.

Methods:

The data collection and analysis followed a method adapted by the Vancouver School of Doing Phenomenology. Data were collected through 12 in-depth interviews with six THR patients.

Results:

The main finding was that the participants acquired knowledge from the text of the care plan that was understandable and meaningful, as evidenced by the empowering impact it had on them. This impact included improved psychological wellbeing, more open communication, and the provision of a tool to keep track of care. Some revisions of the care plan were recommended.

Conclusion:

The study suggests that a patient version of standardised care plans can act as an important educational tool for THR patients that can empower them to manage their health situations.

Partnership between staff and family in long-term care facility: a hybrid concept analysis

Purpose

The purpose of this study was to examine the attributes and verify the definition of the partnership concept using the hybrid model.

Methods

A hybrid model was used to develop the concept of partnership. The hybrid model consists of three phases: theoretical, fieldwork and final analytical. In the theoretical phase, a working definition of partnership was developed by an extensive review with 35 studies. The fieldwork phase comprised seven focused-group interviews with 35 participants consisted of 25 facility staff and 10 family caregivers in long-term care facilities. The final analytical phase compared and interpreted the findings from the first and second phases in order to clarify the concept of partnership.

Results

The concept of partnership was found to have two dimensions: interpersonal and environmental dimensions. The seven attributes emerged from this study. They included relationship, information sharing, shared decision-making, professional competence, negotiation, involvement in care, shared responsibility.

Conclusions

The partnership between family and staff in long-term care facilities was defined as an ongoing and dynamic process associated with interpersonal and environmental factors. Based on the results, it can be suggested that the development of a tool for measuring partnership and an effective program for enhancing to establish a collaborative relationship.

Teaching About Partnerships Between Patients and the Team: Exploring Student Perceptions

Health profession educators are responding to shifting approaches where patients are increasingly recognized as partners in an interprofessional care process. To foster competencies related to partnerships between patients and the team, educators have advanced the role of patient partners; however, an appreciation of resulting student learning is in its early stages. First-year students from 9 programs interacted with patient partners and participated in a Reader’s Theater that explored partnerships with patients in an interprofessional team. Students completed reflective assignments; an inductive thematic analysis explored student learning. The following 4 overarching themes were recognized: developing insights through patient perspective, promoting partnerships with patients, recognizing attitudes that promote therapeutic relationships, and advocating for the patient to be a team member. Accompanying subthemes provide enhancement of each of the identified themes. Students discussed the effect of poor collaboration, identified attitudes that promote collaboration, and expressed the value of advocacy for patient partnership. An enriched appreciation of student learning will guide educator engagement of patient partners in both health professional and interprofessional curricula.

Questionnaire measuring patient participation in health care: Scale development and psychometric evaluation

BACKGROUND

Patient participation in treatment and care is often encouraged and is desirable because of its proven positive impact on treatment, quality of care and patient safety.

AIMS

To develop an instrument to measure patient participation in health care and to investigate the measurement properties of the Patient Participation Questionnaire (PPQ).

METHODS

A literature review was conducted to develop a model of patient participation. The PPQ was constructed consisting of 17 items organized into four subscales. Psychometric evaluation of factor structure, convergent construct validity by hypothesis testing and analyses of internal consistency using Cronbach's alpha were performed on data from a hospitalised mixed group of patients with cardiac disease, pulmonary disease and cancer (N=378 patients).

RESULTS

Confirmatory factor analysis did not show a clear model fit, which is why an exploratory factor analysis was performed, suggesting a different four subscale structure consisting of a total of 16 items. The four subscales were labelled Shared decision power, Adapted and individualized knowledge, Collaboration and Human approach. There were strong ceiling effects on all items. Analysis of convergent construct validity showed a moderate correlation (0.59) between the PPQ and another instrument measuring patient participation. Internal consistency for the total PPQ score was high: 0.89.

CONCLUSION

In a mixed group of patients with cardiac disease, pulmonary disease and cancer, the PPQ showed promising psychometric properties in terms of factor structure, convergent construct validity and internal consistency. The PPQ may be used to shed light on the experience of patient participation and guide quality improvements.

Empowering LGBTQ parents: How to improve maternity services and child healthcare settings for this community – ‘She told us that we are good as a family’

Parental empowerment plays an essential role in maternity and child healthcare. Professionals delivering these services are ideally placed to improve parents' empowerment and well-being. This study aims to describe the supporting factors of parental empowerment from the perspective of self-identified lesbian, gay, bisexual, trans, or queer (LGBTQ) parents in Finland. The study was conducted using a qualitative inductive design, and 22 parents participated. Interviews were conducted between July and September of 2016 and analysed using inductive content analysis. Four categories emerged: 1) Parents' willingness to create socially recognized families, 2) Parenthood support, 3) Respectful partnership with all parents, and 4) Accessible services. Services were more empowering when parents were treated with dignity. This focus requires gender-neutral communication and a clear sense of security for parents. The findings indicate more education on LGBTQ-related issues is still needed.

Family Group Conferencing in Coercive Psychiatry: On Forming Partnership Between the Client, Social Networks and Professionals

Family Group Conferencing is a new decision model to assign caring responsibilities among various actors in society, including the client, social networks, and professionals. The process of Family Group Conferencing in coercive psychiatry is delicate; nevertheless, it paves the way for courageous conversation, and it facilitates ownership over the problematic situation and the formation of a partnership. Different actors co-construct an open and new actuality by taking initiative during and after the Family Group Conference, by confronting each other; by sharing information about the situation and so forming a partnership. Family Group Conferencing requires a change in thinking and doing of mental health professionals that is close to nursing; instead of focusing on the treatment of individual clients, they support primary groups to deal with the situation at hand.

The transition from patient to mental health peer worker: A grounded theory approach

Peer workers are increasingly being engaged in contemporary mental healthcare. To become a peer worker, patients must evolve from having a patient identity to a peer worker identity. This study aims to understand how mental health peer workers experience their transition and how it affects their view of themselves and their direct working context. A grounded theory approach was used. Seventeen mental health peer workers in Belgium were recruited through theoretical sampling. Semi-structured interviews were conducted and analysed according to the constant comparative method. The results indicate that novice peer workers experience peer work as an opportunity to liberate themselves from the process of mental suffering and realise an acceptable form of personal self-maintenance. As peer workers become more experienced, they are confronted with external factors that influence their self-maintenance and personal development. Experiencing clarity in their duties and responsibilities, equality, and transparency in the workplace reinforce their experience of self-maintenance and positively influence their self-development. Experiencing a lack of clarity in their duties and responsibilities, inequality, and lack of openness discourage peer workers' self-development process. These experiences challenge their personal motivations to become peer workers, which are usually linked to building a meaningful life for themselves. The insights can encourage organisations to build up a supportive environment collaboratively with peer workers and ensure that peer workers can exert their authentically unique role in mental healthcare.

Perspectives of parents and nurses on the content validity of the Family Empowerment Scale for parents of children with a chronic condition: A mixed-methods study

BACKGROUND

Insight into parental empowerment is important to understanding the impact of health care policy and to supporting and strengthening parents in the care of their child. The Family Empowerment Scale (FES) is a valid 24-item instrument that measures parental empowerment. It was originally developed for parents of children with emotional disabilities. It has been translated from English into Dutch. Before using the translated FES in another context, the aim of this study was to assess the content validity of the Dutch FES in the context of children with a chronic condition in a children's hospital, according to parents and nurses.

METHOD

This content validity study has a convergent, mixed-methods design. The content validity index was used to examine the relevance, according to 22 parents and 12 nurses quantitatively, on a scale and item level. The qualitative part assessed the comprehensiveness and comprehension of the FES through cognitive interviewing with eight parents and four nurses. The results of both analyses were converged to determine content validity.

RESULTS

The scale-content validity index was 0.88; three items scored < 0.78 on the item level. For 10 (of 24) items, issues were noticed about the tone and clarity of wording. Participants considered the FES to be not only an instrument of research but also an instrument that could be used to give insight into the personal degree of parental empowerment.

CONCLUSION

The content validity of the Dutch FES for parents of children with a chronic condition can be considered sufficient. Resolving some minor translation issues in some of the items is advised. The FES can be used in further research to examine the value of the FES in health care services, aiming to support the needs of parents and to increase their empowerment.

Teaching self-management support in Dutch Bachelor of Nursing education: A mixed methods study of the curriculum

BACKGROUND

Nurses are expected to support people to self-manage. Student nurses therefore need to master competencies that include the assessment of peoples' needs and preferences, and shared decision-making, whilst respecting and enhancing peoples' autonomy. Adapting nurse education programmes to meet this goal requires insight into the practice of teaching self-management support. In order to reveal this practice, one can distinguish between the intended, the taught, and the received curriculum.

OBJECTIVES

This study aimed to explore how Dutch Bachelor of Nursing students are educated to support peoples' self-management in clinical practice.

DESIGN

Mixed methods.

METHODS AND PARTICIPANTS

Focus group meetings with 30 lecturers, and qualitative semi-structured interviews with four coordinators and four (associate) professors of four Dutch schools for Bachelor of Nursing. Syllabuses were screened for learning objectives related to self-management. A survey measuring self-efficacy and behaviour regarding self-management support was distributed among 444 final-year students of these schools, resulting in 238 valid responses (response rate 53.6%).

RESULTS

Much attention is paid in the curriculum to assessment of people's preferences and healthcare education but less attention is given to teaching the arrangement of follow-up care. The study further reveals that students have problems transferring theory into practice, and that they experience conflicting values between their nurse education and internships.

CONCLUSIONS

Currently, students are taught to provide people with self-management support by learning about theoretical models, developing communication skills, and reflecting on their internships. This approach seems inadequate to prepare students for this task in daily practice. A shared view on self-management support based on authentic situations, having role models at university and on internships and empowering students may enable them to better support people to self-manage.

The Management of Chronic Back Pain in Primary Care Settings: Exploring Perceived Facilitators and Barriers to the Development of Patient-Professional Partnerships

Supporting patients in forming partnerships with health professionals is the key of effective self-management. This study aimed to explore the nature of patient-professional partnerships and its related factors that create facilitators and barriers to patients' self-management ability. A constructivist grounded theory approach was undertaken. Three main themes emerged: interaction and communication, integrated care, and service and system. A theoretical model was generated that posits effective communication, individualized integrated care, and high-quality service as key influences on the successful development of patient-professional partnerships and patients' ability to self-manage. Giving attention to these factors helps understand the development, implementation, mechanisms, and evaluation of building a patient-professional partnership and maximizes the opportunities for patient self-management of chronic pain. Future research and practice are needed to move beyond a simplistic focus on health outcomes to address the complex links between partnerships and treatment delivery processes, and interventions, effects, and patients' context.

A pedagogical framework for facilitating parents' learning in nurse-parent partnership

Nursing work increasingly demands forms of expertise that complement specialist knowledge. In child and family nursing, this need arises when nurses work in partnership with parents of young children at risk. Partnership means working with parents in respectful, negotiated and empowering ways. Existing partnership literature emphasises communicative and relational skills, but this paper focuses on nurses' capacities to facilitate parents' learning. Referring to data from home visiting, day-stay and specialist toddler clinic services in Sydney, a pedagogical framework is presented. Analysis shows how nurses notice aspects of children, parents and parent-child interactions as a catalyst for building on parents' strengths, enhancing guided chance or challenging unhelpful constructs. Prior research shows the latter can be a sticking point in partnership, but this paper reveals diverse ways in which challenges are folded into learning process that position parents as agents of positive change. Noticing is dependent on embodied and communicative expertise, conceptualised in terms of sensory and reported channels. The framework offers a new view of partnership as mind-expanding for the parent and specifies the nurse's role in facilitating this process.

Readiness for hospital discharge: A concept analysis

AIM

To report on an analysis on the concept of 'readiness for hospital discharge'.

BACKGROUND

No uniform operational definition of 'readiness for hospital discharge' exists in the literature; therefore, a concept analysis is required to clarify the concept and identify an up-to-date understanding of readiness for hospital discharge. Clarity of the concept will identify all uses of the concept; provide conceptual clarity, an operational definition and direction for further research.

DESIGN

Literature review and concept analysis.

METHOD

A review of literature was conducted in 2016. Databases searched were: Academic Search Complete, CINAHL Plus with Full Text, PsycARTICLES, Psychology and Behavioural Sciences Collection, PsycINFO, Social Sciences Full Text (H.W. Wilson) and SocINDEX with Full Text. No date limits were applied.

RESULTS

Identification of the attributes, antecedents and consequences of readiness for hospital discharge led to an operational definition of the concept. The following attributes belonging to 'readiness for hospital discharge' were extracted from the literature: physical stability, adequate support, psychological ability, and adequate information and knowledge.

CONCLUSION

This analysis contributes to the advancement of knowledge in the area of hospital discharge, by proposing an operational definition of readiness for hospital discharge, derived from the literature. A better understanding of the phenomenon will assist healthcare professionals to recognize, measure and implement interventions where necessary, to ensure patients are ready for hospital discharge and assist in the advancement of knowledge for all professionals involved in patient discharge from hospital.

The Patient Experience With Shared Decision Making: A Qualitative Descriptive Study

Shared decision making is a process characterized by a partnership between a nurse and a patient. The existence of a relationship does not ensure shared decision making. Little is known about what nurses need to know and do for this experience to take place. A qualitative descriptive study was implemented using Coalizzi's method. Semistructured interviews were held with patients, and 3 themes were uncovered. The findings suggest that a nurse's conduct aimed at drawing patients in and inviting them to participate in a conversation leads toward shared decisions. Infusion nurses may find this information useful as they engage their patients in shared decisions.

Contract theories and partnership in health care. A philosophical inquiry to the philosophy of John Rawls and Seyla Benhabib

Over the last 20 years, a paternalistic view in health care has been losing ground. The question about less asymmetrical positions in the healthcare professional-patient relationship is, for example, being addressed by the increased emphasis on person-centred care, promoted in disciplines such as medicine and nursing. Partnership is considered as a key component in person-centred care. Although the previous studies have addressed the attributes inherent in partnership, there is still potential for further discussion on how the various interpretations of partnership influence their use in healthcare literature. A vague understanding might also affect education and evaluation. As we see it, the philosophical underpinnings of the idea of partnership have not been sufficiently explored and discussed. The study reveals that partnership originates in the term "partener" defined as a relationship between individuals or groups characterized by cooperation and responsibility. Etymologically speaking, partnership is hence bound by a contract, which in this study is discussed in the frame of Rawls' contract theory, which in turn intersects with Benhabib and her distinction between "the abstract" and "the concrete Other." Further, the expression "equal partnership," which often appears in the context of person-centredness, is explored in relation to the philosophies of Rawls and Benhabib. The opportunity for partnership, as well as the risk of partnership becoming a tempting magnet with a vague and imprecise meaning, is discussed. Without exploration, reflection and discussion of the philosophical underpinnings, partnership carries a substantial risk of becoming an indistinct idea used in health care.

Power and resistance within the hospital's hierarchical system: the experiences of chronically ill patients

AIMS AND OBJECTIVES

To explore experiences of chronically ill patients and registered nurses when they negotiate patient care in hospital settings. Specifically, we explored how social and institutional discourses shape power relations during the negotiation process.

BACKGROUND

The hospital system is embedded in a hierarchical structure where the voice of the healthcare provider as expert is often given more importance than the patient. This system has been criticised as being oppressive to patients who are perceived to be lower in the hierarchy. In this study, we illustrate how the hospital's hierarchical system is not always oppressing but can also create moments of empowerment for patients.

DESIGN

A feminist poststructuralist approach informed by the teaching of Foucault was used to explore power relations between nurses and patients when negotiating patient care in hospital settings.

METHODS

Eight individuals who suffered from chronic illness shared their stories about how they negotiated their care with nurses in hospital settings. The interviews were tape-recorded. Discourse analysis was used to analyse the data.

RESULTS AND CONCLUSIONS

Patients recounted various experiences when their voices were not heard because the current hospital system privileged the healthcare provider experts' advice over the patients' voice. The hierarchical structure of hospital supported these dynamics by privileging nurses as gatekeepers of service, by excluding the patients' input in the nursing notes and through a process of self-regulation. However, patients in this study were not passive recipients of care and used their agency creatively to resist these discourses.

RELEVANCE TO CLINICAL PRACTICE

Nurses need to be mindful of how the hospital's hierarchical system tends to place nurses in a position of power, and how their authoritative position may positively or adversely affect the negotiation of patient care.

What's in a name? Concordance is better than adherence for promoting partnership and self-management of chronic disease

The choice of language health professionals use to discuss self-management of chronic disease is important and influences patients' self-management. The words compliance, adherence and concordance are used to discuss patients' agreement with prescribed treatment plans, but have different tone and meanings. Models of care linked to the words compliance and adherence are underpinned by interactions between patients and healthcare providers that merely reinforce instructions about treatments. The 'patient-professional partnership' is introduced as a model by Bodenheimer et al. (2002, p. 2469) whereby true partnership working should be an opportunity to pool the expertise of both parties to arrive at mutually agreed goals in concordance. The impact these words might have on partnership working is important in defining the patient-health professional relationship, and for the patients' healthcare outcomes and the potential effect on healthcare utilisation.

Partnership-based practice with young people: relational dimensions of partnership in a therapeutic setting

The recent literature concerning partnership between professionals and young people reveals important developments regarding the nature of partnership: from short-term partnerships with young people's parents intended to improve decision-making in the context of critical life decisions, to a growing interest in direct partnership between professionals and young people as a core principle of long-term relationships. Although it is widely acknowledged among health and social service professionals that partnerships can have positive outcomes for young people, the concept and implementation of partnership remain vague. This article examines the meanings of partnership for people involved in a community youth centre for marginalised youth. Data were collected during the year 2011 using multiple-methods including focus groups (with eight youth workers), participant observations (in assembly meetings and 'partnership meetings') and semi-structured interviews (with 10 principal stakeholders, including youth, youth workers and the Center's founders). Data were analysed using principles of grounded theory to articulate partnership as an ongoing experience, combining both structural-technical and content-experiential components. Our findings present partnership as existing simultaneously in the practice of decision-making and in the realm of self-experience and interpersonal relationships, and explore the relationship between both spheres. The findings also shed light on the importance of the specific characteristics of shared decision-making (atmosphere, content and duration) in the creation of partnership. We discuss our findings in the light of possibilities for partnership-based practice with marginalised youth.

Seeking connections, creating movement: the power of altruistic action

Participation of older people in designing and improving the care and services provided in residential care settings is limited. Traditional forms of democratic representation, such as client councils, and consumer models are management-driven. An alternative way of involving older people in the decisions over their lives, grounded in notions of care ethics and deliberative democracy, was explored by action research. In line with this tradition older people engage in collective action to enhance the control over their lives and those of others. In this article the theoretical background of altruistic action is presented and illustrated by a case example of a group of older women who changed the food policies within their residential home. Altruistic action is the joint and coordinated action by a group of clients based on their agenda. Such action is given in by a shared dissatisfaction and search for connections. Altruistic action may enhance the sense of self, belonging and ownership, and create a transformative movement enhancing the wellbeing and community life in residential settings.

Partnership With Parents of Technology-Dependent Children: Clarification of the Concept

A strategy based on the Hybrid Model of Concept Development was used to integrate previous concept analyses and research with data from interviews with parents and nurses caring for children dependent on technology to clarify the concept. Partnership was generally described positively in the literature, but some cautions were noted. Six characteristics of partnering were identified from the fieldwork data: respect, flexibility, caring professionalism, communication, acknowledgment of parental control, and support for parents. The concept of participation is clarified and extended to a unique area of nursing practice, the care of children dependent on technology in the home.

Using appreciative inquiry to bring neonatal nurses and parents together to enhance family-centred care: A collaborative workshop

Family-centred care (FCC) has been well recognised, accepted and reported in the literature as an optimised way of caring for hospitalised children. While neonatal units strive to adopt this philosophy, published research suggests there are difficulties implementing FCC principles in daily practice. Appreciative inquiry (AI) is a philosophy and methodology that offers a unique, strength-based approach to promoting organisational learning and positive organisational change. As a participatory approach, AI facilitates change from the ground up and lends itself to building effective partnerships or collaborations. This article reports the findings of a one-day workshop using an AI methodology to bring neonatal nurses and parents together to enhance the FCC within a neonatal intensive care unit in Sydney, Australia. Participants (n = 15) developed collaborative insights of optimal FCC that can be built upon to support neonates and their families in the future. Shared visions were formed, strategies identified and a development plan made for ongoing collaborations and partnerships. AI provides a flexible framework that enables the mandatory collaboration needed to develop action plans that can form the catalyst for organizational change in health-care research and practice.

Perceived influence, decision-making and access to information in family services as factors of parental empowerment: a cross-sectional study of parents with young children

BACKGROUND

Parental empowerment is known to increase parents' resources and to reduce stress, and therefore to improve family well-being. Professionals working in family services (child health clinics, school health care, day care, preschool and primary school) encounter families in various everyday settings and can significantly support parental empowerment.

AIM

This study aimed (i) to identify associations between parental empowerment and demographic and family service characteristics (i.e. parents' participation and perceived influence, decision-making and access to information) and (ii) to identify predictors of maternal and paternal empowerment.

METHOD

Study design was cross-sectional. Participants were mothers (n = 571) and fathers (n = 384) of children aged 0-9 who were selected by stratified random sampling in 2009. Associations were analysed by t-test, one-way analysis of variance and multiple linear regression analysis.

RESULTS

Sufficient perceived influence and joint decision-making by family and professionals on family service appointments emerged as significant variables of increased parental empowerment. Access to adequate information about municipal services was also associated with high empowerment. These family service characteristics were associated with parents' sense that they were able to manage in everyday life and had influence on specific service situations and family services in general. Mothers with a child aged under 3 or a child in home care or primary school, and fathers with a lower education feel less empowered in family services than other parents.

CONCLUSION

Knowledge about the factors associated with parental empowerment can contribute to further reinforce parental empowerment, help identify parents who need special attention and contribute to the development of family services.