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Jomy J, Lin KX, Huang RS, Chen A, Malik A, Hwang M, Bhate TD, Sharfuddin N. Closing the gap on healthcare quality for equity-deserving groups: a scoping review of equity-focused quality improvement interventions in medicine. BMJ Qual Saf 2024:bmjqs-2023-017022. [PMID: 38866468 DOI: 10.1136/bmjqs-2023-017022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 05/26/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Quality improvement (QI) efforts are critical to promoting health equity and mitigating disparities in healthcare outcomes. Equity-focused QI (EF-QI) interventions address the unique needs of equity-deserving groups and the root causes of disparities. This scoping review aims to identify themes from EF-QI interventions that improve the health of equity-deserving groups, to serve as a resource for researchers embarking on QI. METHODS In adherence with Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, several healthcare and medical databases were systematically searched from inception to December 2022. Primary studies that report results from EF-QI interventions in healthcare were included. Reviewers conducted screening and data extraction using Covidence. Inductive thematic analysis using NVivo identified key barriers to inform future EF-QI interventions. RESULTS Of 5,330 titles and abstracts screened, 36 articles were eligible for inclusion. They reported on EF-QI interventions across eight medical disciplines: primary care, obstetrics, psychiatry, paediatrics, oncology, cardiology, neurology and respirology. The most common focus was racialised communities (15/36; 42%). Barriers to EF-QI interventions included those at the provider level (training and supervision, time constraints) and institution level (funding and partnerships, infrastructure). The last theme critical to EF-QI interventions is sustainability. Only six (17%) interventions actively involved patient partners. DISCUSSION EF-QI interventions can be an effective tool for promoting health equity, but face numerous barriers to success. It is unclear whether the demonstrated barriers are intrinsic to the equity focus of the projects or can be generalised to all QI work. Researchers embarking on EF-QI work should engage patients, in addition to hospital and clinic leadership in the design process to secure funding and institutional support, improving sustainability. To the best of our knowledge, no review has synthesised the results of EF-QI interventions in healthcare. Further studies of EF-QI champions are required to better understand the barriers and how to overcome them.
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Affiliation(s)
- Jane Jomy
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ke Xin Lin
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Alisia Chen
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Aleena Malik
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Tahara D Bhate
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Nazia Sharfuddin
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Trillium Health Partners, Mississauga, Ontario, Canada
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Elizalde J, Lumibao J, Lizarondo L. Barriers and facilitators to health professionals' engagement in quality improvement initiatives: a mixed-methods systematic review. Int J Qual Health Care 2024; 36:mzae041. [PMID: 38727534 DOI: 10.1093/intqhc/mzae041] [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] [Received: 12/17/2023] [Revised: 03/20/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024] Open
Abstract
Quality improvement (QI) initiatives in healthcare are crucial for enhancing service quality and healthcare outcomes. The success of these initiatives depends on the active engagement of healthcare professionals, which can be influenced by several factors within the healthcare system. This systematic review synthesized the factors influencing healthcare professionals' engagement in QI projects, focusing on identifying both barriers and facilitators. A mixed methods systematic review (MMSR) was conducted using the JBI methodology for MMSR. Databases such as MEDLINE, CINAHL, Scopus, and Embase were searched for studies that explored barriers and facilitators to QI engagement of health professionals in the clinical setting. Methodological quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). The extracted data were synthesized using the JBI convergent integrated approach to MMSR. Eighteen studies (seven qualitative, nine quantitative, and two mixed-methods) published between 2007 and 2023 were included in the review. The analysis revealed barriers and facilitators to engagement in QI initiatives at different levels of the health system. At the QI program level, the engagement of health professionals to QI was influenced by the approach to QI, evidence underpinning the QI initiative, QI knowledge and training, and access to QI specialists. At the health professional level, barriers and facilitators were related to their organizational role, motivation, perceptions about QI, and collaborations with individuals and groups. At the organizational level, factors related to culture and climate, leadership, available resources (including human resource and workload, infrastructure, and incentives), and institutional priorities influenced health professionals' participation in QI. This review highlights the complex interplay of organizational, individual, and QI program level factors that influence the engagement of healthcare professionals in QI. Overcoming these complex barriers and leveraging facilitators is crucial for enhancing participation in QI efforts. The findings underscore the need for a multi-level strategy that focuses on creating a conducive organizational culture, providing robust leadership, and ensuring adequate resources and training for healthcare professionals. Such strategies hold the potential to enhance the effectiveness and sustainability of QI initiatives in healthcare settings.
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Affiliation(s)
- Joanna Elizalde
- College of Medicine, De La Salle University, Dasmariñas, Cavite 4114, Philippines
| | - Jommel Lumibao
- Quality Department, Qatar Red Crescent, Doha 202449, Qatar
| | - Lucylynn Lizarondo
- JBI, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5005, Australia
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Singh A. Nurse Faculty Perceptions of External Factors Affecting Psychological Capital and Leadership Development. Nurs Educ Perspect 2024; 45:82-86. [PMID: 38147016 DOI: 10.1097/01.nep.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
BACKGROUND Psychological capital (PsyCap) is a higher order construct that includes four psychological capacities: hope, efficacy, resiliency, and optimism (known as HERO). PsyCap can be instrumental in navigating workplace challenges; it can be impeded by factors within the environment that may also impact intention to seek leadership development. METHOD A descriptive, qualitative study guided by Husserl's descriptive phenomenology sought to explore faculty perceptions of the external factors of workload, organizational support, organizational resources, and incentive on PsyCap and intent to seek leadership development. RESULTS Analysis uncovered three themes: reset button, driving factors for seeking leadership development, and faculty as leaders. CONCLUSION External factors can either hinder or promote PsyCap and intent to seek leadership development. Constructs within PsyCap are critical for nursing faculty to achieve a "reset." Organizations should offer resources or support to further foster PsyCap.
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Affiliation(s)
- Ashley Singh
- About the Author Ashley Singh, PhD, DNP, RN, EBP-C, is an assistant professor, Chatham University, Pittsburgh, Pennsylvania. This article was part of her doctoral dissertation. She acknowledges the support of her dissertation committee members at Indiana University of Pennsylvania: Dr. Riah Hoffman, Dr. Kristy Chunta, and Dr. David Piper. Statistical support was provided by Dr. David Phillippi. For more information, contact Dr. Singh at
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Radbron E, McCance T, Middleton R, Wilson V. Using data from mHealth apps to inform person-centred practice: A discussion paper. Contemp Nurse 2024; 60:96-105. [PMID: 38368623 DOI: 10.1080/10376178.2024.2316604] [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] [Received: 08/15/2023] [Accepted: 02/04/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND mHealth applications (apps) are tools that can enhance research by efficiently collecting and storing large amounts of data. However, data collection alone does not lead to change. Innovation and practice change occur through utilisation of evidence. The volume of data collected raises questions regarding utilisation of data by nurses and midwives, and how data from mHealth apps can be used to improve person-centred practice. There is limited empirical evidence and a lack of direction from global health authorities to guide nurses and midwives in this area. AIM To describe strategies for nurses and midwives that could enhance the effective use of data generated by mHealth apps to inform person-centred practice. The purpose of this paper is to stimulate reflection and generate actions for data utilisation when using mHealth apps in nursing research and practice. METHODS This discussion paper has been informed by current evidence, the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, and research experience as part of doctoral study. FINDINGS Before engaging in data collection using mHealth apps, nurses and midwives would benefit from considering the nature of the evidence collected, available technological infrastructure, and staff skill levels. When collecting data and interpreting results, use of a team approach supported by engaged leadership and external facilitation is invaluable. This provides support to operate apps, and more importantly use the data collected to inform person-centred practice. CONCLUSIONS This paper addresses the limited available evidence to guide nurses and midwives when using mHealth apps to collect and use data to inform practice change. It highlights the need for appropriate technology, external facilitative support, engaged leadership, and a team approach to collect meaningful evidence using mHealth apps. Clinicians, leaders, and researchers can apply the strategies provided to enhance the use of mHealth apps and ensure translation of evidence into practice.
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Affiliation(s)
- Emma Radbron
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Tanya McCance
- Institute of Nursing and Health Research, Ulster University, Belfast, UK
| | - Rebekkah Middleton
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | - Valerie Wilson
- School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
- South Western Sydney Local Health District (SWSLHD), Ingham Institute for Applied Medical Research, Liverpool, Australia
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Arkin L, Schuermann AA, Loerzel V, Penoyer D. Original Research: Exploring Medication Safety Practices from the Nurse's Perspective. Am J Nurs 2023; 123:18-28. [PMID: 37934872 DOI: 10.1097/01.naj.0000996552.02491.7d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
BACKGROUND Medication preparation and administration are complex tasks that nurses must perform daily within today's complicated health care environment. Despite more than two decades of efforts to reduce medication errors, it's well known that such errors remain prevalent. Obtaining insight from direct care nurses may clarify where opportunities for improvement exist and guide future efforts to do so. PURPOSE The study purpose was to explore direct care nurses' perspectives on and experiences with medication safety practices and errors. METHODS A qualitative descriptive study was conducted among direct care nurses employed across a large health care system. Data were collected using semistructured interview questions with participants in focus groups and one-on-one meetings and were analyzed using qualitative direct content analysis. RESULTS A total of 21 direct care nurses participated. Four major themes emerged that impact the medication safety practices of and errors by nurses: the care environment, nurse competency, system influences, and the error paradigm. These themes were often interrelated. Most participants depicted chaotic environments, heavy nursing workloads, and distractions and interruptions as increasing the risk of medication errors. Many seemed unsure about what an error was or could be. CONCLUSIONS The complexity of medication safety practices makes it difficult to implement improvement strategies. Understanding the perspectives and experiences of direct care nurses is imperative to implementing such strategies effectively. Based on the study findings, potential solutions should include actively addressing environmental barriers to safe medication practices, ensuring more robust medication management education and training (including guidance regarding the definition of medication errors and the importance of reporting), and revising policies and procedures with input from direct care nurses.
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Affiliation(s)
- Laura Arkin
- Laura Arkin is the director of quality services at the Orlando Health Jewett Orthopedic Institute, Orlando, FL. Daleen Penoyer is the director of the Center for Nursing Research at Orlando Health, Orlando, FL. Andrea A. Schuermann is the manager of quality process improvement and patient safety at Orlando Health South Seminole Hospital, Longwood, FL. Victoria Loerzel is a professor and the Beat M. and Jill L. Kahli Endowed Professor in Oncology Nursing in the College of Nursing at the University of Central Florida, Orlando. The authors receive ongoing support through a research grant from Sigma Theta Tau International Nursing Honor Society, Theta Epsilon chapter. Contact author: Laura Arkin, . The authors have disclosed no potential conflicts of interest, financial or otherwise
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McDermott J. Using Project-Based Learning to Teach Advanced Practice Nurses About Quality Improvement. AACN Adv Crit Care 2022; 33:376-381. [PMID: 36477838 DOI: 10.4037/aacnacc2022419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jaime McDermott
- Jaime McDermott is an Advanced Practice Provider, Division of Cardiology, Duke University Hospital, 2301 Erwin Rd, Box 3677, Durham, NC 27710
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von Gerich H, Moen H, Peltonen L. Identifying nursing sensitive indicators from electronic health records in acute cardiac care-Towards intelligent automated assessment of care quality. J Nurs Manag 2022; 30:3726-3735. [PMID: 36124426 PMCID: PMC10086830 DOI: 10.1111/jonm.13802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/24/2022] [Accepted: 09/14/2022] [Indexed: 12/30/2022]
Abstract
AIM The aim of this study is to explore the potential of using electronic health records for assessment of nursing care quality through nursing-sensitive indicators in acute cardiac care. BACKGROUND Nursing care quality is a multifaceted phenomenon, making a holistic assessment of it difficult. Quality assessment systems in acute cardiac care units could benefit from big data-based solutions that automatically extract and help interpret data from electronic health records. METHODS This is a deductive descriptive study that followed the theory of value-added analysis. A random sample from electronic health records of 230 patients was analysed for selected indicators. The data included documentation in structured and free-text format. RESULTS One thousand six hundred seventy-six expressions were extracted and divided into (1) established and (2) unestablished expressions, providing positive, neutral and negative descriptions related to care quality. CONCLUSIONS Electronic health records provide a potential source of information for information systems to support assessment of care quality. More research is warranted to develop, test and evaluate the effectiveness of such tools in practice. IMPLICATIONS FOR NURSING MANAGEMENT Knowledge-based health care management would benefit from the development and implementation of advanced information systems, which use continuously generated already available real-time big data for improved data access and interpretation to better support nursing management in quality assessment.
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Affiliation(s)
- Hanna von Gerich
- Turku University Hospital, Department of Nursing ScienceUniversity of TurkuTurkuFinland
| | - Hans Moen
- Department of Computer ScienceAalto UniversityEspooFinland
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