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Drutchas A, Rusch R, Leiter R. The Palliative Story Exchange: An innovative storytelling intervention to build community, foster shared meaning, and improve sustainability. Palliat Support Care 2024:1-8. [PMID: 39344265 DOI: 10.1017/s1478951524001226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/01/2024]
Abstract
OBJECTIVE Palliative care (PC) faces a workforce crisis. Seriously ill patients surpass the supply of PC cliniciansin their work clinicians face repeated loss and extreme suffering which can have deleterious consequences, such as burnout and attrition. We urgently need interventions that foster thriving communities in this emotionally complex environment. Storytelling represents a promising path forward. In response to widespread loneliness and moral distress among PC clinicians before, during, and after the early months of the COVID-19 pandemic, we created the Palliative Story Exchange (PSE), a storytelling intervention to build community, decrease isolation, and help clinicians rediscover the shared meaning in their work. This paper discusses this novel intervention and initial program evaluation data demonstrating the PSE's impact thus far. METHODS Participants voluntarily complete a post-then-pre wellness survey reflecting on their experience. RESULTS Thus far, over 1,000 participants have attended a PSE. In the fall of 2022, we began distributing a post-then-pre-evaluation survey. To date, 130 interprofessional participants from practice locations across 10 different countries completed the survey. Responses demonstrate an increase in the connection that participants felt toward their work and the larger palliative care community after attending a PSE. Further, more than half of all free-text responses include terms such as, "meaningful," "healing," "powerful," and "universal," to describe their participation. SIGNIFICANCE OF RESULTS Training programs and healthcare organizations use the humanities to support clinician wellness and improve patient care. The PSE builds upon this work through a novel combination of storytelling, community co-creation using reflection, and shared meaning making. Initial survey data demonstrates that after attending a PSE, participants feel increased meaning in their work, in the significance of their own stories, and connection with the PC community. Moving forward, we seek to expand our community of practice, host a facilitator leadership course, and rigorously study the PSE's impact on clinician wellness outcomes.
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Affiliation(s)
- Alexis Drutchas
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Rachel Rusch
- Division of Comfort and Palliative Care, Children's Hospital Los Angeles, Boston, MA, USA
| | - Richard Leiter
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
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2
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Arturén H, Zetherström J, Sjöström N, Abrams D, Johansson L. Handling conflict situations in psychosis inpatient care: Nursing staff experiences of the Interactive Approach model. J Psychiatr Ment Health Nurs 2024. [PMID: 38796785 DOI: 10.1111/jpm.13066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 04/15/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: In inpatient wards, there is a risk that conflicts occur when nursing staff interact with psychotic patients. The Interactive Approach (IA) model is an action-based model, used in psychiatric settings, to manage conflict situations. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: The IA model can be used to improve communication between nursing staff and patients in numerous critical situations. Using a structured risk scale to evaluate a conflict can be an effective way to guide action and sort out the different aspects of communication between nursing staff and psychotic patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The clarity of an action-based model will help sort out which interventions are most likely to succeed in each conflict situation. The IA model highlights the importance of understanding and strengthening the patient's perspective, being flexible for each individual patient, and providing the patient with clear information about the situation. ABSTRACT: Introduction The Interactive Approach (IA) model is a structured management tool used to improve communication between caregivers and patients in psychiatric care settings. Aim/Question To examine the nursing staff's experiences of the IA model. How do they use the interventions in conflict situations with psychotic patients? Method A sample of nursing staff (n = 11) was recruited from three psychosis inpatient care units. Semi-structured questions covered staff experiences of working with the problem-solving interventions in the IA model. Transcribed data were analysed by qualitative content analysis. Results Three categories were defined: (1) 'To apply a flexible approach' describes how staff tried to adapt to each patient and situation; (2) 'Try to understand the person's inner world' describes the importance of active listening and exploring the patient's concerns; and (3) 'To communicate clearly' relates to experiences of clear communication and the setting up of boundaries. Discussion The risk scale and training in communication skills helped the interaction between staff and patients in conflict situations. Different interventions were used with a focus on maintaining patient alliance. Implications for Practice The findings highlight the importance of educational efforts and practical training, to prevent violence and the use of coercive measures.
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Affiliation(s)
- Hanna Arturén
- Department of Psychosis, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jenny Zetherström
- Department of Psychosis, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Nils Sjöström
- Department of Psychosis, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel Abrams
- Department of Psychosis, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lena Johansson
- Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, Centre for Ageing and Health (AgeCap), University of Gothenburg, Gothenburg, Sweden
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3
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Hodge G, Lang I, Byng R, Pearce S. Older peoples' lived experiences of personalised care in care homes: A meta-ethnography. Int J Older People Nurs 2024; 19:e12585. [PMID: 37899684 DOI: 10.1111/opn.12585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Revised: 09/06/2023] [Accepted: 10/19/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Guidance and policy on personalised (or person-centred) care of older people living in care homes advocates that all residents must have their preferences considered, and that all care provided must be reasonably adjusted to meet the person's specific needs. Despite this, research that considers what matters to residents in terms of the care they receive is limited. OBJECTIVES Our review aims to explore care home residents' lived experiences of personalised care and understand what really matters to them. METHODS Six electronic databases (CINHAL, Medline (Ovid), Embase, PubMed, Web of Science & PsychInfo) and Google Scholar (grey literature) were searched to identify qualitative studies relating to personalised care in care home settings, which also included resident (voices) quotes. The literature review and synthesis are reported using eMERGe guidance. RESULTS Fifteen studies met the inclusion criteria for our meta-ethnography. Four conceptual categories (the challenge of fitting into institutional care, the passing of time, holding onto a sense of self and a desire to feel at home) and two key concepts (creating a culture of purposeful living and caring and forming and maintaining meaningful & empowering relationships) were identified. Finally, a conceptual framework of understanding represents what personally matters to residents in terms of their care. CONCLUSION Our meta-ethnography, guided by residents' lived experiences of personalised care, offers a new perspective of what personally matters to residents in terms of the care they receive. The conceptual framework of understanding highlights the importance of moving from an institutional position of doing for residents to a person-centred position of doing with residents. IMPLICATIONS FOR PRACTICE Our findings highlight the importance of understanding the differences between personalised and person-centred care for policy and practice. Further considerations are required on how this might be applied through nurse and care home professionals' education and work practices.
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Affiliation(s)
- Gary Hodge
- School of Nursing & Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Iain Lang
- Medical School, University of Exeter, Exeter, UK
| | - Richard Byng
- Peninsula Schools of Medicine and Dentistry, Primary Care, University of Plymouth, Plymouth, UK
| | - Susie Pearce
- School of Nursing & Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
- Torbay and South Devon NHS Foundation Trust, Torquay, UK
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4
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Herulf Scholander L, Boström AM, Josephsson S, Vikström S. Engaging in narrative relations in everyday work on a geriatric ward: A qualitative study with healthcare professionals. J Clin Nurs 2022. [PMID: 36734355 DOI: 10.1111/jocn.16480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/11/2022] [Accepted: 07/15/2022] [Indexed: 02/04/2023]
Abstract
AIMS AND OBJECTIVES To explore healthcare professionals' experiences and reflections about narration in their everyday work. BACKGROUND The need for integrated and people-centred healthcare for older adults has highlighted the relevance of narration in healthcare practice. Although theoretical foundations vary, different frameworks building on narration have been proposed for translating person-centredness philosophies into practice. However, to understand how theoretical knowledge on narration can be adopted into clinical work, we need to learn how healthcare staff understand narration from their experiential knowledge and practice. DESIGN The research process followed guidelines from Constructivist Grounded Theory as described by Charmaz. The study adheres to the COREQ guidelines. METHODS Data collection entailed interprofessional focus groups discussions with healthcare staff (n = 31). Vignettes depicting realistic scenarios were used to encourage participants to reflect on clinical practice. Data were analysed via a constant comparative method. RESULTS One core theme arose from the analysis. The core theme showed how narration was a relational process that people engaged in to pursue and uphold several foundational qualities in healthcare practice presented in the following subthemes: preventing simplistic understandings of people and situations; supporting trustful relations; supporting continuity and coherence; and learning from coworkers. However, a minor theme raised awareness of narrative relations as a double-edged sword. CONCLUSIONS By acknowledging the mutual and multifacetted nature of narration in everyday practice, this study shows how healthcare professionals' engagement in narrative relations may contribute to upholding several foundational qualities which resonate with philosophies of person-centredness in everyday healthcare practice. RELEVANCE TO CLINICAL PRACTICE Recognition of both the advantages and possible risks embedded in narrative relations in healthcare practice emphasises the obligation to collectively reflect on the repercussions of narrative relations in any local context. PATIENT OR PUBLIC CONTRIBUTION Healthcare professionals contributed by sharing their experiential knowledge and reflections on narration in practice.
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Affiliation(s)
- Lisa Herulf Scholander
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,R&D Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Anne-Marie Boström
- R&D Unit, Stockholms Sjukhem Foundation, Stockholm, Sweden.,Division of Nursing, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
| | - Staffan Josephsson
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
| | - Sofia Vikström
- Division of Occupational Therapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Bradshaw J, Siddiqui N, Greenfield D, Sharma A. Kindness, Listening, and Connection: Patient and Clinician Key Requirements for Emotional Support in Chronic and Complex Care. J Patient Exp 2022; 9:23743735221092627. [PMID: 35434291 PMCID: PMC9008851 DOI: 10.1177/23743735221092627] [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] [Indexed: 11/16/2022] Open
Abstract
Emotional support for patients is critical for achieving person-centered care. However, the literature evidences an ongoing challenge in embedding emotional support within current health services. This study aimed to investigate the strategies to embed emotional support from the perspectives of patients and clinicians. This is an exploratory qualitative study that collected data through focus group discussions (FGDs) and interviews from 11 patients, 2 carers, and 7 clinicians in the multi-disciplinary care teams in an outpatient complex and chronic care setting in New South Wales, Australia. The FGDs and interviews were recorded, transcribed, and thematically analyzed. Three main themes emerged from the experience of both the patients and clinicians: (1) warmth and kindness, (2) deep listening, and (3) social connection in the process of treatment. Clinicians' and patients' shared experience of these themes was key to embed emotional support in care. Practical strategies including promoting shared understanding of emotional support, enhancing provider's capability to deliver emotional support, and building patient's networking opportunities in treatment processes were discussed to facilitate emotional support in patient care and health services.
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Affiliation(s)
- Jane Bradshaw
- University of Tasmania, Health Service Management School of Business & Economics, Sydney,
Australia
- Be Pain Smart Service, Royal Rehab, Ryde, Australia
| | - Nazlee Siddiqui
- University of Tasmania, Health Service Management School of Business & Economics, Sydney,
Australia
| | - David Greenfield
- UNSW Simpson Centre for Health Services
Research, Sydney, Australia
- University of New South Wales Southwestern Sydney
Clinical School, Liverpool, Australia
| | - Anita Sharma
- Nepean Blue Mountains Local Health
District, Western Sydney, Australia
- Nepean Clinical School, University of Sydney, Sydney, Australia
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Buckley C, Hartigan I, Coffey A, Cornally N, O'Connell S, O'Loughlin C, Timmons S, Lehane E. Evaluating the use of participatory action research to implement evidence-based guidance on dementia palliative care in long-term care settings: A creative hermeneutic analysis. Int J Older People Nurs 2022; 17:e12460. [PMID: 35362252 PMCID: PMC9539682 DOI: 10.1111/opn.12460] [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: 05/28/2021] [Revised: 01/21/2022] [Accepted: 03/08/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Dementia affects a large proportion of society and places a significant burden on older people and healthcare systems internationally. Managing symptoms at the end of life for people with dementia is complex. Participatory action research can offer an approach that helps to encourage implementation of evidence-based practices in long-term care settings. METHODS Three evidence-based guidance documents (pain assessment and management, medication management, nutrition and hydration management) were introduced in three long-term care settings for older people. Data generated from work-based learning groups were analysed using a critical hermeneutic approach to explore the use of participatory action research to support the implementation of guidance documents in these settings. RESULTS Engagement and Facilitation emerged as key factors which both enabled and hindered the PAR processes at each study site. CONCLUSIONS This study adds to the body of knowledge that emphasises the value of participatory action research in enabling practice change. It further identifies key practice development approaches that are necessary to enable a PAR approach to occur in care settings for older people with dementia. The study highlights the need to ensure that dedicated attention is paid to strategies that facilitate key transformations in clinical practice.
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Affiliation(s)
- Catherine Buckley
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.,Northridge House Education and Research Centre, St Luke's Nursing Home, Cork, Ireland
| | - Irene Hartigan
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Alice Coffey
- Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, Ireland.,Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Selena O'Connell
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.,Health Implementation Science and Technology Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
| | | | - Suzanne Timmons
- Centre for Gerontology and Rehabilitation, School of Medicine, University College Cork, Cork, Ireland
| | - Elaine Lehane
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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7
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Ryan T. Facilitators of person and relationship-centred care in nursing. Nurs Open 2022; 9:892-899. [PMID: 34590790 PMCID: PMC8859070 DOI: 10.1002/nop2.1083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/26/2021] [Accepted: 09/14/2021] [Indexed: 11/27/2022] Open
Abstract
AIMS To provide an expert overview on the current state of evidence as it relates to person and relationship-centred care. DESIGN Review and commentary. METHODS The paper was prepared in order to contribute to a Consensus Development Project. It is based upon a scoping review with additional theoretical material used to supplement the narrative. The content is limited to that person and relationship-centred literature as it relates to nursing practice and policy. RESULTS There is compelling evidence in favour of nurses pursuing person and relationship-centred policies and practices. Organizational and individual factors contribute to the successful implementation of person and relationship-centred care. These include conditions that enable nurses to provide high-quality care (resources, clinical supervision and security) and include training and development, a biographical approach to care and those care environments centred on innovation and person-centred care processes.
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Affiliation(s)
- Tony Ryan
- Division of Nursing & Midwifery, Health Sciences SchollFaculty of Medicine Dentistry & HealthUniversity of SheffieldSheffieldUK
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8
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Cowdell F, Dyson J, Sykes M, Dam R, Pendleton R. How and how well have older people been engaged in healthcare intervention design, development or delivery using co-methodologies: A scoping review with narrative summary. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:776-798. [PMID: 33103313 DOI: 10.1111/hsc.13199] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/17/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
Co-methodological working is gaining increasing traction in healthcare, but studies with older people have been slower to develop. Our aim was to investigate how and how well older people have been engaged in healthcare intervention design, development or delivery using co-methodologies. We conducted a systematic search of four electronic databases to identify international literature published between 2009 and November 2019. We included peer-reviewed empirical research of any design. Three authors screened papers. Our review is reported in accordance with the Joanna Briggs Institute manual for scoping reviews, we have referred to the preferred reporting items for systematic reviews and meta-analyses statement. We data extracted to a bespoke spreadsheet and used the Co:Create Co-production Matrix to guide quality appraisal. Included studies (n = 48) were diverse in nature of interventions, co-methodologies and reporting. We offer a narrative summary of included papers. Establishing how older people were engaged in co-methodological work was largely straightforward. How well this was done was more challenging, however we have identified gems of good practice and offered directions for future practice. The Co:Create Co-Production Matrix was the best fit for evaluating papers, however it is not intended as a measure per se. In essence we argue that notions of 'best' and 'scores' are an oxymoron in co-methodological working, what is important that: (a) researchers embrace these methods, (b) incremental change is the way forward, (c) researchers need to do what is right for people and purpose and (d) have time to consider and articulate why they are choosing this approach and how best this can be achieved for their particular situation. Future evaluation of participant's experience of the process would enable others to learn about what works for who and in what circumstances.
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Affiliation(s)
- Fiona Cowdell
- Faculty of Health, Education and Life Sciences, Birmingham City University, Birmingham, UK
| | - Judith Dyson
- School of Health Sciences, City University, London, UK
| | - Michael Sykes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Rinita Dam
- Department of Zoology, University of Oxford, Oxford, UK
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9
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Olson AW, Stratton TP, Isetts BJ, Vaidyanathan R, C Van Hooser J, Schommer JC. Seeing the Elephant: A Systematic Scoping Review and Comparison of Patient-Centeredness Conceptualizations from Three Seminal Perspectives. J Multidiscip Healthc 2021; 14:973-986. [PMID: 33953566 PMCID: PMC8092624 DOI: 10.2147/jmdh.s299765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 03/19/2021] [Indexed: 12/30/2022] Open
Abstract
“Patient-Centeredness” (PC) is a theoretical construct made up of a diverse constellation of distinct concepts, processes, practices, and outcomes that have been developed, arranged, and prioritized heterogeneously by different communities of professional healthcare practice, research, and policy. It is bound together by a common ethos that puts the holistic individual at the functional and symbolic center of their care, a quality deemed essential for chronic disease management and health promotion. Several important contributions to the PC research space have adeptly integrated seminal PC conceptualizations to improve conceptual clarity, measurement, implementation, and evaluation in research and practice. This systematic scoping review builds on that work, but with a purpose to explicitly identify, compare, and contrast the seminal PC conceptualizations arising from the different healthcare professional groups. The rationale for this work is that a deeper examination of the underlying development and corresponding assumptions from each respective conceptualization will lead to a more informed understanding of and meaningful contributions to PC research and practice, especially for healthcare professional groups newer to the topic area like pharmacy. The literature search identified four seminal conceptualizations from the healthcare professions of Medicine, Nursing, and Health Policy. A compositional comparison across the seminal conceptualizations revealed a shared ethos but also six distinguishing features: (1) organizational structure; (2) predominant level of care; (3) methodological approach; (4) care setting origin; (5) outcomes of interest; and (6) language. The findings illuminate PC’s stable theoretical foundations and distinctive nuances needed to appropriately understand, apply, and evaluate the construct’s operationalization in contemporary healthcare research and practice. These considerations hold important implications for future research into the fundamental aims of healthcare, how it should look when practiced, and what should reasonably be required of it.
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Affiliation(s)
- Anthony W Olson
- Research Division, Essentia Institute of Rural Health, Duluth, MN, USA.,Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota - College of Pharmacy, Duluth, MN, USA
| | - Timothy P Stratton
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota - College of Pharmacy, Duluth, MN, USA
| | - Brian J Isetts
- Department of Pharmaceutical Care and Health Systems, University of Minnesota - College of Pharmacy, Minneapolis, MN, USA
| | - Rajiv Vaidyanathan
- Department of Marketing, University of Minnesota Duluth - Labovitz School of Business and Economics, Duluth, MN, USA
| | - Jared C Van Hooser
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota - College of Pharmacy, Duluth, MN, USA
| | - Jon C Schommer
- Department of Pharmaceutical Care and Health Systems, University of Minnesota - College of Pharmacy, Minneapolis, MN, USA
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10
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Glover L, Dyson J, Cowdell F, Kinsey D. Healthy ageing in a deprived northern UK city: A co-creation study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:2233-2242. [PMID: 32445280 DOI: 10.1111/hsc.13036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 04/18/2020] [Accepted: 04/29/2020] [Indexed: 06/11/2023]
Abstract
With ageing comes an increased risk of poor health and social isolation, particularly in poorer populations. Older people are under-represented in research and as a result interventions may not take account of their context or barriers to participation. In co-creative work, future service users work with professionals on an equal basis to design, develop and produce a service or intervention. Our objectives were to (a) undertake a co-creation study with older people living in a northern city in the United Kingdom, (b) explore maintenance of health and well-being in older age, (c) explore the application of co-creation with an older community population and (d) evaluate the process and inform future work. The study was conducted during 2017 by a project team of 10 lay community dwelling older people and four university researchers. Findings demonstrate that state of mind and of health were key to well-being in older age. Feeling safe, comfortable and pain free were important along with being able to adapt to change, have choice and a sense of personal freedom. Social connectedness was seen as the keystone to support healthy behaviours. Rather than developing new interventions, there was a perceived need to connect people with existing resources and provide a human 'bridge' to address barriers to accessing these. In conclusion, the co-creation process proved productive, even when undertaken on a small scale. The scope of the project needs to be realistic, to use diverse methods of recruitment and skilled facilitators, and to prepare well in terms of accessibility, simple systems and appropriate information provision.
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Affiliation(s)
- Lesley Glover
- Faculty of Health Sciences, University of Hull, Hull, UK
| | - Judith Dyson
- School of Health Sciences, City, University of London, London, UK
| | - Fiona Cowdell
- School of Nursing and Midwifery, Birmingham City University, Birmingham, UK
| | - Debbie Kinsey
- College of Medicine and Health, University of Exeter, Exeter, UK
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11
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Vikström S, Johansson K. Professional pride: A qualitative descriptive study of nursing home staff's experiences of how a quality development project influenced their work. J Clin Nurs 2019; 28:2760-2768. [PMID: 31001864 DOI: 10.1111/jocn.14884] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/05/2019] [Accepted: 04/07/2019] [Indexed: 12/27/2022]
Abstract
AIMS AND OBJECTIVES To explore and describe how daily work at a nursing home had been influenced by a quality improvement project, from the perspective of direct care staff. BACKGROUND Deficiencies in nursing home care are widely reported, often with a focus on lack of competence among direct care staff. The present trend in quality development in nursing homes brings direct care staff's perspectives into focus through participatory action research approaches. Still, little is known about how staff experience the impact of such projects on their everyday work. DESIGN The study was designed as an interpretive descriptive study, based on interviews with nursing home staff. The methods were conducted in accordance with the SRQR guidelines. RESULTS The analysis revealed that the participants reasoned on whether the improvement project contributed to their possibilities perform their work at the unit for the benefit of the residents. This was strongly connected to their professional pride. The participants reflected on this through three changes generated by the project: (a) participating in project activities-supporting or threatening daily work at the unit, (b) from performing individual duties towards a shared responsibility and (c) confirming and strengthening competence that brings the everyday situation of residents into focus. CONCLUSION The importance of professional pride identified in this study points towards a need for reducing barriers for direct care staff to express and develop competences they regard as part of their professional identity. The findings also shed some light on competence that brings the everyday situation of residents into focus as a driving force behind lack of compliance and resistance to change. RELEVANCE TO CLINICAL PRACTICE The findings indicate a call for quality development designs to reduce barriers for care staff to express and develop knowledge that they regard as part of their professional identity.
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Affiliation(s)
- Sofia Vikström
- Division of Occupational Therapy, Department NVS, Karolinska Institutet, Stockholm, Sweden
| | - Karin Johansson
- Division of Occupational Therapy, Department NVS, Karolinska Institutet, Stockholm, Sweden
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12
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Kelly F, Reidy M, Denieffe S, Madden C. Older adults' views on their person-centred care needs in a long-term care setting in Ireland. ACTA ACUST UNITED AC 2019; 28:552-557. [DOI: 10.12968/bjon.2019.28.9.552] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: person-centred care should be responsive to the needs of older adults in long-term care. It is central to collaborative and high-quality healthcare delivery. Aim: to explore the perceptions of older Irish adults aged 65 years of age or more regarding the person-centred climate of the long-term care setting in which they live. Method: a cross-sectional study design using the Person-centered Climate Questionnaire–Patient (PCQ-P) was used to survey 56 older adults in a long-term care setting. Results: overall, residents considered the setting to be hospitable, welcoming, clean and safe; the mean (SD) scale score was 5.39 (0.520). Psychosocial concerns about adapting to living in long-term care environments need to be addressed, particularly among the younger male residents when compared with older male residents (53.8% v 86.7%, P=0.018). Conclusion: older people in long-term care may prioritise different facets of person-centredness to staff. Further research of approaches used in Irish older adult long-term person-centred care delivery is warranted.
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Affiliation(s)
- Fiona Kelly
- Practice Nurse, Keogh Practice, Waterford, Ireland
| | - Mary Reidy
- Lecturer, Department of Nursing and Health Care, Waterford Institute of Technology, Waterford, Ireland
| | - Suzanne Denieffe
- Dean, School of Humanities, Waterford Institute of Technology, Waterford Ireland
| | - Catherine Madden
- Lecturer, Department of Nursing and Health Care, Waterford Institute of Technology, Waterford, Ireland
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Griffith L, Board M. Influences on clinical decision-making during a community placement: reflections of a student nurse. Br J Community Nurs 2018; 23:606-609. [PMID: 30521395 DOI: 10.12968/bjcn.2018.23.12.606] [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] [Indexed: 06/09/2023]
Abstract
High quality care is dependent on good clinical judgement and often-complex decision making. Nurses need to be able to justify and defend their clinical decisions. In this article, a third-year nursing student reflects on an incident from a community placement involving a collaborative clinical decision. Carper's (1978) four fundamental patterns of knowing are used to analyse the decision-making process. It is shown that influences on decision-making include prior knowledge and expertise, law and accountability, and ethical principles such as respect for autonomy and beneficence. Good communication, interpersonal skills and a person-centred approach have a bearing on decision-making. It is argued that intuition also has a place and may be increasingly used with experience.
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Affiliation(s)
- Lynne Griffith
- Final year adult nursing student, Bournemouth University
| | - Michele Board
- Principal academic nursing - older people, Bournemouth University
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Jefferies D, Hatcher D. Developing Person-Centered Care Through the Biographies of the Older Adult. J Nurs Educ 2018; 57:742-746. [PMID: 30512111 DOI: 10.3928/01484834-20181119-07] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/17/2018] [Indexed: 12/30/2022]
Abstract
BACKGROUND A lack of specialized knowledge about providing health care to older people decreases their health outcomes and quality of life. This article presents an innovative learning strategy for preregistration nursing students to raise awareness of person-centered care of the older adult. METHOD This report is based on the authors' own experience and includes comments from students to the authors who taught the unit of study from 2010 to 2015, supported by current literature and theory discussing contemporary educational strategies. RESULTS Students came to value the older adult as a person to whom they could relate and the learning promoted person-centered care delivery. Although many students found this approach to learning to be challenging, student feedback demonstrated that the overall reception of the strategy was very positive. CONCLUSION This strategy facilitated learning to improve person-centered care and addressed negative attitudes toward older adults, which improved health outcomes and their quality of life. [J Nurs Educ. 2018;57(12):742-746.].
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