1
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Potter E, Lewis C, Tilbury A, Tong J, Sipanoun P. Improving healthcare transition for young people with cancer: factors fundamental to the quality improvement journey. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:622-629. [PMID: 38954441 DOI: 10.12968/bjon.2023.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
BACKGROUND Young people receiving cancer treatment in the South Thames Children's, Teenagers' and Young Adults' Cancer Operational Delivery Network usually receive care across two or more NHS trusts, meaning transition into adult services can be challenging. AIM To develop a planned, co-ordinated approach to transition across the network that meets National Institute for Health and Care Excellence guidance recommendations for transition and the cancer service specifications. METHODS A 2-year, nurse-led quality improvement (QI) project, using the principles of experience-based co-design. OUTCOMES The QI project resulted in the development of six key principles of practice; refining and testing of a benchmarking tool; initiatives to facilitate first transition conversations; and the launch of an information hub. CONCLUSION Robust QI processes, cross-network collaboration and wide stakeholder involvement required significant resource, but enabled deeper understanding of existing pathways and processes, facilitated the establishment of meaningful objectives, and enabled the testing of interventions to ensure the project outcomes met the needs of all stakeholders.
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Affiliation(s)
- Emma Potter
- Nurse Practitioner Transition and Long Term Follow Up, The Royal Marsden NHS Foundation Trust, London; South Thames Children's, Teenagers' and Young Adults' Cancer Operational Delivery Network, London
| | | | | | - Jason Tong
- Network Manager, South Thames Children's, Teenagers' and Young Adults' Cancer Operational Delivery Network, The Royal Marsden NHS Foundation Trust, RM Partners Cancer Alliance, London
| | - Pippa Sipanoun
- Research Fellow in Transition, University of Surrey, Guildford; Lead Practice Educator-Health Inequalities, Great Ormond Street Hospital for Children NHS Foundation Trust, London; and University College London Great Ormond Street Institute of Child Health, London
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2
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Jin ZA. [Reflections on integrating narrative medicine concepts into the development of pediatrics]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2024; 26:325-330. [PMID: 38660894 PMCID: PMC11057294 DOI: 10.7499/j.issn.1008-8830.2310114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 01/03/2024] [Indexed: 04/26/2024]
Abstract
Medicine is a continuously advancing science, characterized by the integration of multiple disciplines, ultimately focusing on the "human" aspect. Over the past half-century, there has been a global surge in efforts to reshape the humanistic spirit of medicine. Narrative medicine, a field that highly integrates medical professionalism with universal humanistic values, has developed rapidly in China from scratch over the past decade or so. This article introduces the development of narrative medicine both domestically and internationally, explains how to correctly understand the connotation of China's narrative medicine system and the significance of practicing narrative medicine. It analyzes current challenges in clinical practice, education and teaching, scientific research, doctor-patient consensus, and social recognition. Furthermore, it proposes directions for effort, namely, in the context of "greater health" and "new medical science", narrative medicine is empowered to help construct a harmonious medical narrative ecosystem, promote high-quality development in pediatrics, contribute to the innovation in medical education and talent training with humanistic strength and wisdom.
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Affiliation(s)
- Zhen-Ai Jin
- Perinatal/Neonatal Clinic and Children's Family Clinic, Yanbian University Affiliated Hospital, Yanji, Jilin 133000, China
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3
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Sultan N, Swinglehurst D. Living with polypharmacy: a narrative interview study with older Pakistanis in East London. BMC Geriatr 2023; 23:746. [PMID: 37968631 PMCID: PMC10652535 DOI: 10.1186/s12877-023-04392-1] [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: 03/30/2023] [Accepted: 10/06/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Polypharmacy is a growing and major public health issue. It can be burdensome and risky for patients and costly to healthcare systems. Older adults and those from ethnic minority backgrounds are disproportionately affected by polypharmacy. This study focuses on medication practices among Urdu-speaking Pakistani patients, a significant ethnic group in the UK. Most existing research on medication practices within South-Asian communities centres on adherence, leaving the social and moral dimensions of polypharmacy unpacked. Understanding how British Pakistani patients understand and manage polypharmacy in the context of their daily lives is crucial to avoiding harmful polypharmacy. METHODS In-depth narrative interviews were conducted with 15 first-generation Pakistani patients using the Biographical Narrative Interview Method. Participants were recruited from GP practices in East London. All participants were prescribed ten or more regular medications (a pragmatic marker of 'higher risk' polypharmacy) and were aged over 50. Interviews were conducted with a bilingual researcher at home and were designed to elicit narratives of patients' experiences of polypharmacy in the context of their biographies and daily lives. RESULTS Polypharmacy is enacted through networks of interpersonal and socio-material relationships. The doctor-patient relationship and the family network held particular significance to study participants. In addition, participants described emotional bonds between themselves and their medicines, identifying them as 'forces for good'-substances which allowed them to maintain their health through the intercession of God. Meanings attributed to medicines and enacted through these social, emotional, and spiritual relationships contributed to emerging and sustaining polypharmacy. CONCLUSIONS Patients make sense of and manage treatments in culturally specific ways. Developing an understanding of how medication practices in different communities are enacted is important for informing meaningful and effective conversations with patients about their medicines. Our findings contribute to enabling the integration of culturally sensitive approaches to prescribing.
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Affiliation(s)
- Najia Sultan
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
| | - Deborah Swinglehurst
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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4
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Shaw SE, Hughes G, Pearse R, Avagliano E, Day JR, Edsell ME, Edwards JA, Everest L, Stephens TJ. Opportunities for shared decision-making about major surgery with high-risk patients: a multi-method qualitative study. Br J Anaesth 2023; 131:56-66. [PMID: 37117099 PMCID: PMC10308437 DOI: 10.1016/j.bja.2023.03.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 03/27/2023] [Accepted: 03/28/2023] [Indexed: 04/30/2023] Open
Abstract
BACKGROUND Little is known about the opportunities for shared decision-making when older high-risk patients are offered major surgery. This study examines how, when, and why clinicians and patients can share decision-making about major surgery. METHODS This was a multi-method qualitative study, combining video recordings of preoperative consultations, interviews, and focus groups (33 patients, 19 relatives, 36 clinicians), with observations and documentary analysis in clinics in five hospitals in the UK undertaking major orthopaedic, colorectal, and/or cardiac surgery. RESULTS Three opportunities for shared decision-making about major surgery were identified. Resolution-focused consultations (cardiac/colorectal) resulted in a single agreed preferred option related to a potentially life-threatening problem, with limited opportunities for shared decision-making. Evaluative and deliberative consultations offered more opportunity. The former focused on assessing the likelihood of benefits of surgery for a presenting problem that was not a threat to life for the patient (e.g., orthopaedic consultations) and the latter (largely colorectal) involved discussion of a range of options while also considering significant comorbidities and patient preferences. The extent to which opportunities for shared decision-making were available, and taken up by surgeons, was influenced by the nature of the presenting problem, clinical pathway, and patient trajectory. CONCLUSIONS Decisions about major surgery were not always shared between patients and doctors. The nature of the presenting problem, comorbidities, clinical pathways, and patient trajectories all informed the type of consultation and opportunities for sharing decision-making. Our findings have implications for clinicians, with shared decision-making about major surgery most feasible when the focus is on life-enhancing treatment.
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Affiliation(s)
- Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Rupert Pearse
- Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Ester Avagliano
- Hammersmith Hospital Imperial College Healthcare NHS Trust London, London, UK
| | - James R Day
- Department of Anaesthesia, Oxford University Hospitals Foundation Trust, Oxford, UK
| | - Mark E Edsell
- Department of Anaesthesia, The Royal Brompton & Harefield Hospitals, London, UK
| | | | | | - Timothy J Stephens
- Faculty of Medicine & Dentistry, Queen Mary University of London, London, UK
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5
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Binkley JM, Gabram S, Finley J, Fowler D, VanHoose L, McCullough LE. Racial disparity in breast cancer survivorship: themes from a series of four national healthcare provider live virtual forums. J Cancer Surviv 2023:10.1007/s11764-023-01373-6. [PMID: 37040001 DOI: 10.1007/s11764-023-01373-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/25/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE Significant disparity exists in the diagnosis, treatment, and survivorship outcomes among Black breast cancer (BC) survivors. Black BC survivors have more significant survivorship issues and a greater burden of illness than White counterparts. Barriers to rehabilitation exist for all BC survivors but are magnified in Black BC survivors. The purpose of this qualitative research was to document patient, clinician, and researchers' perceptions surrounding contributing factors, lived experiences, and potential solutions to racial disparity in BC survivorship. METHODS A narrative approach was utilized to identify themes from a series of four virtual healthcare provider forums that explored lived personal and professional experiences, issues, and potential solutions surrounding racial disparity in BC survivorship. Forums included perspectives of patients, healthcare providers, researchers, and stakeholders in the BC field. An independent thematic analysis was performed by the investigators, all of whom have emic perspectives with respect to race and/or BC. RESULTS Three main themes were identified related to racial disparity in BC survivorship: (1) societal and cultural contributing factors, (2) contribution of healthcare providers and systems, and (3) models of care and research considerations. CONCLUSIONS The findings provide compelling documentation of lived personal and professional experiences of racial disparity in BC survivorship. Potential solutions exist and must be enacted immediately to ensure equitable survivorship outcomes for Black individuals following a BC diagnosis. IMPLICATIONS FOR CANCER SURVIVORS Increased awareness related to racial disparity in BC survivorship among survivors, healthcare providers, and researchers will contribute to health equity and improved outcomes for Black individuals.
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Affiliation(s)
- Jill M Binkley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA.
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA.
| | - Sheryl Gabram
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
- Georgia Center for Oncology Research and Education, Atlanta, GA, USA
| | - Janae Finley
- TurningPoint Breast Cancer Rehabilitation, Atlanta, GA, USA
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
| | | | - Lisa VanHoose
- Global Access to Breast Cancer Rehabilitation Community Partnership Initiative, Atlanta, GA, USA
- College of Saint Mary, Omaha, NE, USA
- The Ujima Center, Monroe, LA, USA
| | - Lauren E McCullough
- Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
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6
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Hughes Spence S, Khurshid Z, Flynn M, Fitzsimons J, De Brún A. A narrative inquiry into healthcare staff resilience and the sustainability of Quality Improvement implementation efforts during Covid-19. BMC Health Serv Res 2023; 23:195. [PMID: 36823599 PMCID: PMC9949907 DOI: 10.1186/s12913-023-09190-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Recent research, which explored the use of Quality Improvement (QI) methods in the Covid-19 pandemic response, found that Quality Improvement principles were utilised during the crisis management period, albeit without direct intention. Following on from this work, the aim of this paper extends that study by investigating the sustainability and resilience of not only the changes implemented by healthcare staff during Covid-19 in Ireland, but the resilience of the wellbeing of healthcare staff themselves through the various waves of Covid-19. METHODS To explore healthcare staffs experience of Quality Improvement and the sustainability and resilience of both Quality Improvement initiatives and healthcare staff, a qualitative design was implemented. Semi-structured interviews took place online over Zoom with 11 healthcare staff members from the Irish healthcare service in the Spring of 2022. An analysis of the narratives was conducted using thematic analysis supported by NVivo12. RESULTS Four key themes were evident from the data: (i) From fear to exhaustion; (ii) maintaining person-centred approaches to care; (iii) Covid-19 as a medium for change, and; (iv) staff resilience and appetite for Quality Improvement. DISCUSSION The results of this work identified three key learnings; (i) integrating learning into policies and practice: (ii) the role of collective leadership and devolving/sharing power; and (iii) key drivers/factors that promote sustainability of QI interventions. Despite the challenges in recruitment of research participants experienced during the pandemic, a narrative approach supported the collation of rich and nuanced insights into the experiences of healthcare staff during this time. CONCLUSION A growing body of literature currently exists on how healthcare staff felt during the Covid-19 pandemic. However, as the waves of Covid-19 have declined, it is vital to examine how the feelings of burnout and disillusionment will affect engagement with Quality Improvement in the future. It is also worth noting and examining the feeling of purpose and pride participants expressed from working through the Covid-19 pandemic. This study has helped to address this gap.
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Affiliation(s)
- Shannon Hughes Spence
- grid.7886.10000 0001 0768 2743Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin (UCD) Centre for Interdisciplinary Research UCD School of Nursing, Midwifery and Health Systems University College Dublin, Dublin, Ireland
| | - Zuneera Khurshid
- grid.418449.40000 0004 0379 5398Improvement Academy, Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Duckworth Lane, Bradford, UK
| | - Maureen Flynn
- grid.424617.20000 0004 0467 3528Office of the Nursing and Midwifery Services Director, National Quality and Patient Safety Directorate, Health Service Executive (HSE), Dublin, Ireland
| | - John Fitzsimons
- grid.424617.20000 0004 0467 3528Temple Street and Clinical Director for Quality Improvement, Health Service Executive (HSE), Children’s Health Ireland, National Quality and Patient Safety Directorate, Dublin, Ireland
| | - Aoife De Brún
- Education and Innovation in Health Systems (UCD IRIS Centre), University College Dublin (UCD) Centre for Interdisciplinary Research UCD School of Nursing, Midwifery and Health Systems University College Dublin, Dublin, Ireland.
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7
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Faux‐Nightingale A, Kelemen M, Lilley S, Stewart C. Sensemaking in the early stages of the COVID-19 pandemic: A narrative exploration of polarised morality in an NHS Trust. SOCIOLOGY OF HEALTH & ILLNESS 2023; 45:386-404. [PMID: 36369855 PMCID: PMC9878263 DOI: 10.1111/1467-9566.13586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 10/28/2022] [Indexed: 06/16/2023]
Abstract
This article presents an analysis of personal diaries kept by health-care staff within a specialist NHS Trust in England during the initial 3 months of the COVID-19 pandemic. It adopts a moral sensemaking perspective to explore how NHS employees mobilised and reframed ideas of right and wrong in order to make sense of unprecedented uncertainty and displacement. By focussing on how the macro and micro politics of the pandemic were played out in the organisation, the study finds that polarised moral judgements were invoked in order to justify and rationalise a broad array of associated emergent emotions, intuitions, behaviours and practices. This polarisation of moral responses could be seen as a desire to bring order out of chaos and put matters back into place following displacement. This is inevitably an ongoing, complex and variegated enterprise whose results can be as often discomforting as they can be reassuring. Indeed, while moral sensemaking was partly beneficial for staff in that it promoted a greater sense of camaraderie and support for others, it also appeared to have darker consequences in terms of staff wellbeing and the development of more impermeable social boundaries across the organisation through processes of moral 'othering'.
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Affiliation(s)
| | | | | | - Caroline Stewart
- Keele UniversityKeeleUK
- Robert Jones and Agnes Hunt Orthopaedic Hospital (RJAH) Foundation TrustGobowenUK
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8
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Avoiding God’s Waiting Room: Lessons from the Lived Experiences of Older People who Use Digital Technology to Support Physical Activity. PHYSICAL ACTIVITY AND HEALTH 2023. [DOI: 10.5334/paah.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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9
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Abrams R, Conolly A, Rowland E, Harris R, Kent B, Kelly D, Couper K, Maben J. Speaking up during the COVID-19 pandemic: Nurses' experiences of organizational disregard and silence. J Adv Nurs 2023; 79:2189-2199. [PMID: 36645162 DOI: 10.1111/jan.15526] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 11/11/2022] [Accepted: 11/24/2022] [Indexed: 01/17/2023]
Abstract
AIM To critically examine nurses' experiences of speaking up during COVID-19 and the consequences of doing so. DESIGN Longitudinal qualitative study. METHODS Participants were purposively sampled to represent differing geographical locations, specialities, settings and redeployment experiences. They were interviewed (remotely) between July 2020 and April 2022 using a semi-structured interview topic guide. RESULTS Three key themes were identified inductively from our analysis including: (1) Under threat: The ability to speak up or not; (2) Risk tolerance and avoidance: Consequences of speaking up; and (3) Deafness and hostility: Responses to speaking up. Nurses reported that their attempts to speak up typically focused on PPE, patient safety and redeployment. Findings indicate that when NHS Trusts and community services initiated their pandemic response policies, nurses' opportunities to speak up were frequently thwarted. CONCLUSION Accounts presented in this article include nurses' feeling a sense of futility or of suffering in silence in relation to speaking up. Nurses also fear the consequences of speaking up. Those who did speak up encountered a 'deaf' or hostile response, leaving nurses feeling disregarded by their organization. This points to missed opportunities to learn from those on the front line. IMPACT Speaking up interventions need to focus on enhancing the skills to both speak up, and respond appropriately, particularly when power, hierarchy, fear and threat might be concerned. PATIENT OR PUBLIC CONTRIBUTION Nurses working clinically during COVID-19 were involved in the development of this study. Participants were also involved in the development of our interview topic guide and comments obtained from the initial survey helped to shape the study design.
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Affiliation(s)
| | | | | | | | | | | | - Keith Couper
- University of Warwick and University Hospitals Birmingham NHS Foundation Trust, Coventry, UK
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10
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Sutton E, Booth L, Ibrahim M, McCulloch P, Sujan M, Willars J, Mackintosh N. Am I safe? An Interpretative Phenomenological Analysis of Vulnerability as Experienced by Patients With Complications Following Surgery. QUALITATIVE HEALTH RESEARCH 2022; 32:2078-2089. [PMID: 36321384 PMCID: PMC9709529 DOI: 10.1177/10497323221136956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Abdominal surgery carries with it risks of complications. Little is known about patients' experiences of post-surgical deterioration. There is a real need to understand the psychosocial as well as the biological aspects of deterioration in order to improve care and outcomes for patients. Drawing on in-depth interviews with seven abdominal surgery survivors, we present an idiographic account of participants' experiences, situating their contribution to safety within their personal lived experiences and meaning-making of these episodes of deterioration. Our analysis reveals an overarching group experiential theme of vulnerability in relation to participants' experiences of complications after abdominal surgery. This encapsulates the uncertainty of the situation all the participants found themselves in, and the nature and seriousness of their health conditions. The extent of participants' vulnerability is revealed by detailing how they made sense of their experience, how they negotiated feelings of (un)safety drawing on their relationships with family and staff and the legacy of feelings they were left with when their expectations of care (care as imagined) did not meet the reality of their experiences (care as received). The participants' experiences highlight the power imbalance between patients and professionals in terms of whose knowledge counts within the hospital context. The study reveals the potential for epistemic injustice to arise when patients' concerns are ignored or dismissed. Our data has implications for designing strategies to enable escalation of care, both in terms of supporting staff to deliver compassionate care, and in strengthening patient and family involvement in rescue processes.
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Affiliation(s)
- Elizabeth Sutton
- Department of Health Sciences,
University
of Leicester, Leicester, UK
| | | | - Mudathir Ibrahim
- Nuffield Department of Surgical
Sciences, University of Oxford, Oxford, UK
- Department of General Surgery,
Maimonides
Medical Center, Brooklyn, NY, USA
| | - Peter McCulloch
- Nuffield Department of Surgical
Sciences, University of Oxford, Oxford, UK
| | - Mark Sujan
- Nuffield Department of Surgical
Sciences, University of Oxford, Oxford, UK
- Human Factors Everywhere
Ltd., UK
| | - Janet Willars
- Department of Health Sciences,
University
of Leicester, Leicester, UK
| | - Nicola Mackintosh
- Department of Health Sciences,
University
of Leicester, Leicester, UK
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11
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Maben J, Conolly A, Abrams R, Rowland E, Harris R, Kelly D, Kent B, Couper K. 'You can't walk through water without getting wet' UK nurses' distress and psychological health needs during the Covid-19 pandemic: A longitudinal interview study. Int J Nurs Stud 2022; 131:104242. [PMID: 35525086 PMCID: PMC8976696 DOI: 10.1016/j.ijnurstu.2022.104242] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 03/29/2022] [Accepted: 03/29/2022] [Indexed: 02/09/2023]
Abstract
BACKGROUND Pre-COVID-19 research highlighted the nursing profession worldwide as being at high risk from symptoms of burnout, post-traumatic stress disorder (PTSD) and suicide. The World Health Organization declared a pandemic on 11th March 2020 due to the sustained risk of further global spread of COVID-19. The high healthcare burden associated with COVID-19 has increased nurses' trauma and workload, thereby exacerbating pressure on an already strained workforce and causing additional psychological distress for staff. OBJECTIVES The Impact of COVID-19 on Nurses (ICON) interview study examined the impacts of the pandemic on frontline nursing staff's psychosocial and emotional wellbeing. DESIGN Longitudinal qualitative interview study. SETTINGS Nurses who had completed time 1 and 2 of the ICON survey were sampled to include a range of UK work settings including acute, primary and community care and care homes. Interviewees were purposively sampled for maximum variation to cover a broad range of personal and professional factors, and experiences during the COVID-19 pandemic, including redeployment. METHODS Nurses participated in qualitative in-depth narrative interviews after the first wave of COVID-19 in July 2020 (n = 27) and again at the beginning of the second wave in December 2020 (n = 25) via video and audio platform software. Rigorous qualitative narrative analysis was undertaken both cross-sectionally (within wave) and longitudinally (cross wave) to explore issues of consistency and change. RESULTS The terms moral distress, compassion fatigue, burnout and PTSD describe the emotional states reported by the majority of interviewees leading many to consider leaving the profession. Causes of this identified included care delivery challenges; insufficient staff and training; PPE challenges and frustrations. Four themes were identified: (1) 'Deathscapes' and impoverished care (2) Systemic challenges and self-preservation (3) Emotional exhaustion and (4) (Un)helpful support. CONCLUSIONS Nurses have been deeply affected by what they have experienced and report being forever altered with the impacts of COVID-19 persisting and deeply felt. There is an urgent need to tackle stigma to create a psychologically safe working environment and for a national COVID-19 nursing workforce recovery strategy to help restore nurse's well-being and demonstrate a valuing of the nursing workforce and therefore support retention.
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Affiliation(s)
- J. Maben
- University of Surrey, United Kingdom,Corresponding author
| | | | - R. Abrams
- University of Surrey, United Kingdom
| | | | - R. Harris
- King's College London, United Kingdom
| | - D. Kelly
- Cardiff University, United Kingdom
| | - B. Kent
- University of Plymouth, United Kingdom
| | - K. Couper
- University of Warwick and University Hospitals Birmingham NHS Foundation Trust, United Kingdom
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12
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Roest B, Leget C. A multidisciplinary perspective on physician-assisted dying in primary care in The Netherlands: A narrative interview study. DEATH STUDIES 2022; 47:315-327. [PMID: 35521997 DOI: 10.1080/07481187.2022.2065554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Most research on physician-assisted dying (PAD) in the Netherlands focuses on general practitioners (GPs). Less is known about the perspectives of other professionals. We performed narrative interviews with 10 professionals other than GPs to explore their perspectives on PAD in primary care. The results provide insight into PAD as an enacted practice involving many different actors, considerations, and expectations and into the intertwinement between PAD and palliative sedation. The study shows how a multidisciplinary perspective to PAD provides new avenues for practice, research, and ethics. It poses the question whether PAD can and should be considered merely a physicians' concern.
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Affiliation(s)
- B Roest
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
| | - C Leget
- Department of Care Ethics, University of Humanistic Studies, Utrecht, The Netherlands
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13
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Iedema R. The problem with … using stories as a source of evidence and learning. BMJ Qual Saf 2022; 31:234-237. [PMID: 35177434 DOI: 10.1136/bmjqs-2021-014221] [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: 09/15/2021] [Accepted: 10/25/2021] [Indexed: 11/04/2022]
Abstract
This commentary is a response to the growing trend in health care to use stories as evidence for amending care practices and behaviours. It points to a pervasive misunderstanding of the role of stories in the patient safety and quality improvement literature; namely, that stories can be treated as 'information'. Doing so misses the significance of the socio-cultural dynamics that are the foundation of story-telling and story-sharing. The Commentary points out that story dynamics are unique for negotiating complexity and situations that do not afford simple, categorical, elegant answers. It reminds us that the story's cardinal value is moving us rather than informing us. Reducing the story to suit the transactional, technical and informational demands of 'past-conforming systems' means sacrificing its potential for behavioural-psychological novelty and lived transformation.
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Affiliation(s)
- Rick Iedema
- School of Life Sciences and Medicine, King's College London, London, London, UK
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14
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Abstract
In this paper, I set out the challenges of care for refugees and suggest approaches to assessment and intervention. I discuss clinical interventions that can address the immediate concern of the clinician in a bio-psycho-social framework, and the value of considering eco-social and structural influences that can hinder recovery and perpetuate inequalities. Refugees face multiple adversities before, during and after escaping from life-threatening situations, political violence, torture and persecution. They present with complex health needs and encounter hostility from host countries and public services, which see their needs as an additional demand on the public purse. Regrettably, existing care practice and training of professionals do not often include skills for working across cultures, including cultural formulations and fair assessment, cultural adaptation of interventions, cultural competence and cultural consultation methods, including clinical ethnography and exploration of cultural identity and explanatory models. There are little data on effective and kind models of interpretation and translation. Care systems are rarely designed to fully address the needs of refugees. Health practitioners are not trained to address structural and institutional racism and discrimination, which leads to exclusion of the most marginalised, with little attention to social justice and fair processes as part of appropriate healthcare.
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Affiliation(s)
- Kamaldeep Bhui
- Department of Psychiatry and Nuffield Department of Primary Care Health Sciences, University of Oxford, UK; East London NHS Foundation Trust, UK; Oxford Health NHS Foundation Trust, UK; and World Psychiatric Association Collaborating Centre in Research, Training, Policy and Practice, UK
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15
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Conolly A, Abrams R, Rowland E, Harris R, Couper K, Kelly D, Kent B, Maben J. "What Is the Matter With Me?" or a "Badge of Honor": Nurses' Constructions of Resilience During Covid-19. Glob Qual Nurs Res 2022; 9:23333936221094862. [PMID: 35528859 PMCID: PMC9073120 DOI: 10.1177/23333936221094862] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 12/23/2022] Open
Abstract
It has long been known that nursing work is challenging and has the potential for negative impacts. During the COVID-19 pandemic most nurses' working landscapes altered dramatically and many faced unprecedented challenges. Resilience is a contested term that has been used with increasing prevalence in healthcare with health professionals encouraging a "tool-box" of stress management techniques and resilience-building skills. Drawing on narrative interview data (n = 27) from the Impact of Covid on Nurses (ICON) qualitative study we examine how nurses conceptualized resilience during COVID-19 and the impacts this had on their mental wellbeing. We argue here that it is paramount that nurses are not blamed for experiencing workplace stress when perceived not to be resilient "enough," particularly when expressing what may be deemed to be normal and appropriate reactions given the extreme circumstances and context of the COVID-19 pandemic.
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Affiliation(s)
| | - Ruth Abrams
- University of Surrey, Guildford, United Kingdom
| | | | - Ruth Harris
- King’s College London, London, United Kingdom
| | - Keith Couper
- University of Warwick and University Hospitals Birmingham NHS Foundation Trust, United Kingdom
| | | | - Bridie Kent
- University of Plymouth, Plymouth, United Kingdom
| | - Jill Maben
- University of Surrey, Guildford, United Kingdom
- Jill Maben, School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Kate Granger Building, 30 Priestley Road, Surrey Research Park, Guildford, Surrey GU2 7YH, UK.
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Chauhan A, Leefe J, Shé ÉN, Harrison R. Optimising co-design with ethnic minority consumers. Int J Equity Health 2021; 20:240. [PMID: 34736455 PMCID: PMC8567634 DOI: 10.1186/s12939-021-01579-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/25/2021] [Indexed: 12/19/2022] Open
Abstract
Co-design as a participatory method aims to improve health service design and implementation. It is being used more frequently by researchers and practitioners in various health and social care settings. Co-design has the potential for achieving positive outcomes for the end users involved in the process; however, involvement of diverse ethnic minority population in the process remains limited. While the need to engage with diverse voices is identified, there is less information available on how to achieve meaningful engagement with these groups. Ethnic minorities are super-diverse population and the diversity between and within these groups need consideration for optimising their participation in co-design. Based on our experience of working with diverse ethnic minority groups towards the co-design of consumer engagement strategies to improve patient safety in cancer services as part of the two nationally-funded research projects in Australia, we outline reflections and practical techniques to optimise co-design with people from diverse ethnic backgrounds. We identify three key aspects of the co-design process pertinent to the involvement of this population; 1) starting at the pre-commencement stage to ensure diverse, seldom heard consumers are invited to and included in co-design work, 2) considering logistics and adequate resources to provide appropriate support to address needs before, during and beyond the co-design process, and 3) supporting and enabling a diversity of contributions via the co-design process.
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Affiliation(s)
- Ashfaq Chauhan
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation (AIHI), Macquarie University, North Ryde, NSW, 2109, Australia.
| | - Jessica Leefe
- System Transformation Evaluation and Patient Experience, Agency for Clinical Innovation (ACI), NSW Health, St Leonards, NSW, 2065, Australia
| | - Éidín Ní Shé
- School of Population Health, University of New South Wales (UNSW), Sydney, NSW, 2052, Australia
| | - Reema Harrison
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation (AIHI), Macquarie University, North Ryde, NSW, 2109, Australia
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Aminoff H, Meijer S. Context and Complexity in Telemedicine Evaluation: Work Domain Analysis in a Surgical Setting. JMIR Perioper Med 2021; 4:e26580. [PMID: 34528894 PMCID: PMC8485199 DOI: 10.2196/26580] [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: 12/17/2020] [Revised: 04/19/2021] [Accepted: 08/01/2021] [Indexed: 11/13/2022] Open
Abstract
Many promising telemedicine innovations fail to be accepted and used over time, and there are longstanding questions about how to best evaluate telemedicine services and other health information technologies. In response to these challenges, there is a growing interest in how to take the sociotechnical complexity of health care into account during design, implementation, and evaluation. This paper discusses the methodological implications of this complexity and how the sociotechnical context holds the key to understanding the effects and outcomes of telemedicine. Examples from a work domain analysis of a surgical setting, where a telemedicine service for remote surgical consultation was to be introduced, are used to show how abstracted functional modeling can provide a structured and rigorous means to analyze and represent the implementation context in complex health care settings.
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Affiliation(s)
- Hedvig Aminoff
- Division of Health Informatics and Logistics, Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
| | - Sebastiaan Meijer
- Division of Health Informatics and Logistics, Department of Biomedical Engineering and Health Systems, KTH Royal Institute of Technology, Stockholm, Sweden
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18
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McGranahan R, Jakaite Z, Edwards A, Rennick-Egglestone S, Slade M, Priebe S. Living with Psychosis without Mental Health Services: A Narrative Interview Study. BMJ Open 2021; 11:e045661. [PMID: 34281919 PMCID: PMC8291296 DOI: 10.1136/bmjopen-2020-045661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Little research has looked at how people who do not use mental health services experience psychosis. Thus, the present study aimed to explore the experiences and views of people with psychosis who have neither sought nor received support from mental health services for at least 5 years. DESIGN A narrative interview study. Thematic analysis was used to analyse the data. SETTING England. PARTICIPANTS Twenty-eight participants with self-defined psychotic experiences were asked to provide a free narrative about their experiences. RESULTS Five themes were identified: (1) Perceiving psychosis as positive; (2) Making sense of psychotic experiences as a more active psychological process to find explanations and meaning; (3) Finding sources of strength, mainly in relationships and the environment, but outside of services; (4) Negative past experiences of mental health services, leading to disengagement and (5) Positive past experiences with individual clinicians, as an appreciation of individuals despite negative views of services as a whole. CONCLUSIONS Perceiving psychosis as something positive, a process of making sense of psychotic experiences and the ability to find external sources of strength all underpin-in addition to negative experiences with services-a choice to live with psychosis outside of services. Future research may explore to what extent these perceptions, psychological processes and abilities can be facilitated and strengthened, in order to support those people with psychosis who do not seek treatment and possibly also some of those who are in treatment.
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Affiliation(s)
- Rose McGranahan
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - Zivile Jakaite
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
| | - Alice Edwards
- Newham Centre for Mental Health, East London NHS Foundation Trust, London, UK
| | | | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Stefan Priebe
- Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, UK
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McKenzie R, Miller S, Cope V, Brand G. Transition experiences of newly qualified registered graduate nurses employed in a Neonatal Intensive Care Unit. Intensive Crit Care Nurs 2021; 67:103112. [PMID: 34247938 DOI: 10.1016/j.iccn.2021.103112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To explore the experiences of newly qualified registered graduate nurses' clinical and professional learning experiences, during their first six-months of post registration employment within a graduate nurse transition program in a Neonatal Intensive Care Unit (NICU). METHOD Narrative inquiry with thematic analysis was used to explore the newly qualified registered graduate nurses' accounts via semi-structured interviews, conducted between January 2018 - January 2019, of their clinical and professional learning during their employment in the Neonatal Intensive Care Unit. SETTING In total, eight newly qualified registered graduate nurses employed at two Western Australian Hospitals sites were recruited. FINDINGS Themes identified included: feeling unprepared; experiences of horizontal violence; the need for a supportive structural environment and seeking feedback. Participants reported overwhelming feelings of stress, emotional exhaustion, concerns for patient safety and for some, fear of early career burnout. CONCLUSION In this study, newly qualified registered graduate nurses were clinically underprepared for entering a Neonatal Intensive Care Unit with all participants reporting high levels of psychosocial distress. This was further compounded by a lack of structured support, horizontal violence, and inadequate or no regular feedback from preceptors, resulting from a negative workplace culture and poor educator behaviours. Recommendations for improving the experiences of newly qualified registered graduate nurses employed in the Neonatal Intensive Care are discussed.
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Affiliation(s)
- Renee McKenzie
- Discipline of Nursing, College of Science, Health, Engineering and Education, Murdoch University, Western Australia, Australia.
| | - Susan Miller
- Division of Health Professions Education, School of Allied Health, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, Western Australia, Australia
| | - Vicki Cope
- Discipline of Nursing, College of Science, Health, Engineering and Education, Murdoch University, Western Australia, Australia. https://twitter.com/VickiCCope
| | - Gabrielle Brand
- Nursing and Midwifery, Monash University, Frankston, Victoria, Australia. https://twitter.com/GabbyBrand6
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20
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Ceccarelli F, Covelli V, Olivieri G, Natalucci F, Conti F. Systemic Lupus Erythematosus before and after COVID-19 Lockdown: How the Perception of Disease Changes through the Lenses of Narrative Medicine. Healthcare (Basel) 2021; 9:healthcare9060726. [PMID: 34204733 PMCID: PMC8231514 DOI: 10.3390/healthcare9060726] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic contributes to the burden of living with different diseases, including Systemic Lupus Erythematosus (SLE). We described, from a narrative point of view, the experiences and perspectives of Italian SLE adults during the COVID-19 emergency, by distinguishing the illness experience before and after the lockdown. METHODS Fifteen patients were invited to participate. Illness narratives were collected between 22 and 29 March 2020 using a written modality to capture patients' perspectives before and after the COVID-19 lockdown. We performed a two-fold analysis of collected data by distinguishing three narrative types and a qualitative analysis of content to identify the relevant themes and sub-themes reported. RESULTS Eight narratives included in the final analysis (mean length 436.9 words) have been written by eight females (mean age 43.3 ± 9.9 years, mean disease duration 13.1 ± 7.4 years). Six patients provided a quest narrative, one a chaos and the remaining one a restitution narrative. By text content analysis, we identified specific themes, temporally distinct before and after the lockdown. Before COVID-19, all the patients referred to a good control of disease, however the unexpected arrival of the COVID-19 emergency broke a balance, and patients perceived the loss of health status control, with anxiety and stress. CONCLUSIONS We provided unique insight into the experiences of people with SLE at the time of COVID-19, underlining the perspective of patients in relation to the pandemic.
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Affiliation(s)
- Fulvia Ceccarelli
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, 00161 Roma, Italy; (G.O.); (F.N.); (F.C.)
- Correspondence: ; Tel.: +39-06-4997-4631
| | - Venusia Covelli
- Faculty of Psychology, eCampus University, Novedrate, 22060 Como, Italy;
| | - Giulio Olivieri
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, 00161 Roma, Italy; (G.O.); (F.N.); (F.C.)
| | - Francesco Natalucci
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, 00161 Roma, Italy; (G.O.); (F.N.); (F.C.)
| | - Fabrizio Conti
- Lupus Clinic, Reumatologia, Dipartimento di Scienze Cliniche, Internistiche, Anestesiologiche e Cardiovascolari, Sapienza Università di Roma, 00161 Roma, Italy; (G.O.); (F.N.); (F.C.)
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21
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Scheffelaar A, Janssen M, Luijkx K. The Story as a Quality Instrument: Developing an Instrument for Quality Improvement Based on Narratives of Older Adults Receiving Long-Term Care. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052773. [PMID: 33803372 PMCID: PMC7967278 DOI: 10.3390/ijerph18052773] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 02/26/2021] [Accepted: 03/04/2021] [Indexed: 11/25/2022]
Abstract
The individual experiences of older adults in long-term care are broadly recognized as an important source of information for measuring wellbeing and quality of care. Narrative research is a special type of qualitative research to elicit people’s individual, diverse experiences in the context of their lifeworld. Narratives are potentially useful for long-term care improvement as they can provide a rich description of an older adult’s life from their own point of view, including the provided care. Little is known about how narratives can best be collected and used to stimulate learning and quality improvement in long-term care for older adults. The current study takes a theoretical approach to developing a narrative quality instrument for care practice in order to discover the experiences of older adults receiving long-term care. The new narrative quality instrument is based on the available literature describing narrative research methodology. The instrument is deemed promising for practice, as it allows care professionals to collect narratives among older adults in a thorough manner for team reflection in order to improve the quality of care. In the future, the feasibility and usability of the instrument will have to be empirically tested.
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22
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Vaughan C, Gill‐Atkinson L, Devine A, Zayas J, Ignacio R, Garcia J, Bisda K, Salgado J, Marco MJ. Enabling Action: Reflections upon Inclusive Participatory Research on Health with Women with Disabilities in the Philippines. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:370-380. [PMID: 33078846 PMCID: PMC7821201 DOI: 10.1002/ajcp.12468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
People with disabilities experience health disparities arising from social, environmental, and system-level factors. Evidence from a range of settings suggests women with disabilities have reduced access to health information and experience barriers to screening, prevention, and care services. This results in greater unmet health needs, particularly in relation to sexual and reproductive health. Women with disabilities are also more likely to experience physical and sexual violence than women without disabilities, further undermining their health. Community-based participatory research (CBPR) can generate knowledge and underpin action to address such health disparities and promote health equity. However, the potential and challenges of disability inclusion in CBPR, particularly in contexts of poverty and structural inequality such as those found in low- and middle-income countries, are not well documented. In this paper, we reflect on our experience of implementing and evaluating W-DARE, a three-year program of disability-inclusive CBPR aiming to increase access to sexual and reproductive health and violence-response services for women with disabilities in the Philippines. We discuss strategies for increasing disability inclusion in research and use a framework of reflexive solidarity to consider the uneven distribution of the benefits, costs, and responsibilities for action arising from the W-DARE program.
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Affiliation(s)
- Cathy Vaughan
- Centre for Health EquityThe University of MelbourneMelbourneVic.Australia
| | - Liz Gill‐Atkinson
- Centre for Health EquityThe University of MelbourneMelbourneVic.Australia
| | - Alexandra Devine
- Nossal Institute for Global HealthThe University of MelbourneMelbourneVic.Australia
| | - Jerome Zayas
- Social Development Research CenterDe La Salle UniversityManilaPhilippines
| | - Raquel Ignacio
- Center for Women’s Studies FoundationUniversity of the PhilippinesQuezon CityPhilippines
| | | | | | - Joy Salgado
- Likhaan Center for Women’s HealthQuezon CityPhilippines
| | - M. Jesusa Marco
- Social Development Research CenterDe La Salle UniversityManilaPhilippines
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23
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Moll S, Wyndham-West M, Mulvale G, Park S, Buettgen A, Phoenix M, Fleisig R, Bruce E. Are you really doing 'codesign'? Critical reflections when working with vulnerable populations. BMJ Open 2020; 10:e038339. [PMID: 33148733 PMCID: PMC7640510 DOI: 10.1136/bmjopen-2020-038339] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
'Codesign' and associated terms such as 'coproduction' or 'patient engagement', are increasingly common in the health research literature, due to an increased emphasis on the importance of ensuring that research related to service/systems development is meaningful to end-users. However, there continues to be a lack of clarity regarding the key principles and practices of codesign, and wide variation in the extent to which service users are meaningfully engaged in the process. These issues are particularly acute when end-users include populations who have significant health and healthcare disparities that are linked to a range of intersecting vulnerabilities (eg, poverty, language barriers, age, disability, minority status, stigmatised conditions). The purpose of this paper is to prompt critical reflection on the nature of codesign research with vulnerable populations, including key issues to consider in the initial planning phases, the implementation process, and final outputs. Risks and tensions will be identified in each phase of the process, followed by a tool to foster reflexivity in codesign processes to address these issues.
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Affiliation(s)
- Sandra Moll
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | - Gillian Mulvale
- DeGroote School of Business, McMaster University, Hamilton, Ontario, Canada
| | - Sean Park
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Alexis Buettgen
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
- Canadian Centre on Disability Studies, Inc. o/a Eviance, Winnipeg, Manitoba, Canada
| | - Michelle Phoenix
- School of Rehabilitation Science and CanChild, McMaster University Faculty of Health Sciences, Hamilton, Ontario, Canada
| | - Robert Fleisig
- Walter G. Booth School of Engineering Practice and Technology, McMaster University Faculty of Engineering, Hamilton, Ontario, Canada
| | - Emma Bruce
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
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Marcus TS, Heese J, Scheibe A, Shelly S, Lalla SX, Hugo JF. Harm reduction in an emergency response to homelessness during South Africa's COVID-19 lockdown. Harm Reduct J 2020; 17:60. [PMID: 32831083 PMCID: PMC7443613 DOI: 10.1186/s12954-020-00404-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 08/11/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Caledonian Stadium, the main mass temporary shelter for homeless people in the City of Tshwane, was created as a local response to the imperatives of the novel coronavirus disease (COVID-19) National State of Disaster lockdown in South Africa. This is a case study of the coordinated emergency healthcare response provided by the University of Pretoria's Department of Family Medicine between 24 March and 6 April 2020. METHODS This study uses a narrative approach to restory situated, transient, partial and provisional knowledge. Analysis is based on documented data and iteratively triangulated interviews on the operational experiences of selected healthcare first responders directly involved in the shelter. RESULTS The impending lockdown generated intense interactions by UP-DFM to prepare for the provision of COVID-19 and essential generalist primary with partners involved in the Community Oriented Substance Use Programme (COSUP). With approximately 2000 people at the shelter at its peak, the numbers exceeded expectations. Throughout, while government officials tried to secure bedding, food and toilets, the shelter was poorly equipped and without onsite management. The COSUP clinical team prioritised opioid substitution therapy using methadone and COVID-19 screening over generalist healthcare to manage withdrawal and contain tension and anxiety. COSUP and its partners helped the city plan and implement the safe re-sheltering of all Caledonian residents. CONCLUSION The Caledonian shelter is an account of organisational resilience in the face of homelessness and substance use emergencies triggered by lockdown. Through community-oriented, bottom-up self-organisation, a clinically led team navigated a response to the immediate needs of people who are homeless and/or use drugs that evolved into a more sustainable intervention. Key lessons learnt were the importance of communicating with people directly affected by emergencies, the value of using methadone to reduce harms during emergencies and the imperative of including OST in essential primary healthcare.
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Affiliation(s)
- Tessa S Marcus
- COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia, City of Tshwane, 0007, South Africa.
| | - Jan Heese
- COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia, City of Tshwane, 0007, South Africa
| | - Andrew Scheibe
- COPC Research Unit, Community Oriented Substance Use Programme, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia, City of Tshwane, 0007, South Africa
| | - Shaun Shelly
- COPC Research Unit, Community Oriented Substance Use Programme, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia, City of Tshwane, 0007, South Africa
| | - Sasha X Lalla
- COPC Research Unit, Community Oriented Substance Use Programme, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia, City of Tshwane, 0007, South Africa
| | - Jannie F Hugo
- COPC Research Unit, Department of Family Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, P/Bag x323, Arcadia, City of Tshwane, 0007, South Africa
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Shaw S, Hughes G, Stephens T, Pearse R, Prowle J, Ashcroft RE, Avagliano E, Day J, Edsell M, Edwards J, Everest L. Understanding decision making about major surgery: protocol for a qualitative study of shared decision making by high-risk patients and their clinical teams. BMJ Open 2020; 10:e033703. [PMID: 32376751 PMCID: PMC7223149 DOI: 10.1136/bmjopen-2019-033703] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Surgical treatments are being offered to more patients than ever before, and increasingly to high-risk patients (typically multimorbid and over 75). Shared decision making is seen as essential practice. However, little is currently known about what 'good' shared decision making involves nor how it applies in the context of surgery for high-risk patients. This new study aims to identify how high-risk patients, their families and clinical teams negotiate decision making for major surgery. METHODS AND ANALYSIS Focusing on major joint replacement, colorectal and cardiac surgery, we use qualitative methods to explore how patients, their families and clinicians negotiate decision making (including interactional, communicative and informational aspects and the extent to which these are perceived as shared) and reflect back on the decisions they made. Phase 1 involves video recording 15 decision making encounters about major surgery between patients, their carers/families and clinicians; followed by up to 90 interviews (with the same patient, carer and clinician participants) immediately after a decision has been made and again 3-6 months later. Phase 2 involves focus groups with a wider group of (up to 90) patients and (up to 30) clinicians to test out emerging findings and inform development of shared decision making scenarios (3-5 summary descriptions of how decisions are made). ETHICS AND DISSEMINATION The study forms the first part in a 6-year programme of research, Optimising Shared decision-makIng for high-RIsk major Surgery (OSIRIS). Ethical challenges around involving patients at a challenging time in their lives will be overseen by the programme steering committee, which includes strong patient representation and a lay chair. In addition to academic outputs, we will produce a typology of decision making scenarios for major surgery to feed back to patients, professionals and service providers and inform subsequent work in the OSIRIS programme.
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Affiliation(s)
- Sara Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gemma Hughes
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Tim Stephens
- School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - Rupert Pearse
- Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | - John Prowle
- Barts and the London School of Medicine & Dentistry, Queen Mary University of London, London, UK
| | | | - Ester Avagliano
- Department of Anaesthesia, St. George's University Hospitals Foundation Trust, London, UK
| | - James Day
- Department of Anaesthesia, John Radcliffe Hospital, Oxford, UK
| | - Mark Edsell
- Department of Anaesthesia, St. George's University Hospitals Foundation Trust, London, UK
| | - Jennifer Edwards
- Department of Anaesthesia, Royal Alexandra Hospital, Paisley, UK
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Multiple Stakeholder Perspectives on School-Based Responses to Student Suicide Risk in a Diverse Public School District. SCHOOL MENTAL HEALTH 2019. [DOI: 10.1007/s12310-019-09354-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stories of Patient Involvement Impact in Health Technology Assessments: A Discussion Paper. Int J Technol Assess Health Care 2019; 35:266-272. [DOI: 10.1017/s0266462319000552] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectivesAs more health technology assessment (HTA) bodies seek to implement patient involvement, there is a desire to learn from other HTA bodies about their experiences and understand what approaches can be used and which ones make a real difference to HTA. This is difficult, as the impact of patient involvement in HTA is not well documented. This study aims to promote further discussion about the ways in which patient involvement can impact HTAs by studying stories of impact.MethodsIn a multi-stakeholder workshop, experts leading patient involvement in four HTA bodies shared examples of HTAs where they believed patient involvement made a difference, then they reflected on these impact stories within the wider context of impact evaluation.ResultsThe HTA bodies drew on patient input and patient-based evidence to inform their HTAs. The patient involvement was observed to elucidate patients’ experiences, needs and preferences which, in turn, was observed to influence the HTA recommendations about optimal use of technologies, including taking account of issues for sub-groups, outcomes that matter to patients and educational needs.ConclusionsPersonal stories of patient involvement may enable a wider understanding of different approaches to and impact of patient involvement. The examples relate to both patient input and patient-based evidence and highlight the role that patient involvement can play in reducing uncertainties and complementing the clinical and economic evidence in HTA. They suggest that impact can be seen in recommendations about how and when a technology is used.
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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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Thompson C, Ponsford R, Lewis D, Cummins S. Fast-food, everyday life and health: A qualitative study of 'chicken shops' in East London. Appetite 2018; 128:7-13. [PMID: 29807123 DOI: 10.1016/j.appet.2018.05.136] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/04/2018] [Accepted: 05/22/2018] [Indexed: 11/26/2022]
Abstract
The higher prevalence of fast food outlets in deprived areas has been associated with the production and maintenance of geographical inequalities in diet. In the UK one type of fast food outlet - the 'chicken shop' - has been the focus of intense public health and media interest. Despite ongoing concerns and initiatives around regulating these establishments, the 'chicken shop' is both a commercially successful and ubiquitous feature of disadvantaged urban neighbourhoods. However, little is known about how they are perceived by local residents. We report data from a qualitative study of neighbourhood perceptions in a low SES urban setting. Narrative family interviews, go-along interviews and school video focus group workshops with 66 residents of East London were conducted over two waves. The topic of chicken shops was a prolific theme and a narrative analysis of these accounts revealed that local perceptions of chicken shops are complex and contradictory. Chicken shops were depicted as both potentially damaging for the health of local residents and, at the same time, as valued community spaces. This contradiction was discursively addressed in narrative via a series of rhetorical rebuttals that negated their potential to damage health on the grounds of concepts such as trust, choice, balance, food hygiene and compensatory physical activity. In some instances, chicken shops were described as 'healthy' and patronising them constructed as part of a healthy lifestyle. Chicken shops are embedded in the social fabric of neighbourhoods. Successful strategies to improve diet therefore requires context-sensitive environmental interventions.
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Affiliation(s)
- Claire Thompson
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
| | - Ruth Ponsford
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
| | - Daniel Lewis
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
| | - Steven Cummins
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, WC1H 9SH, London, UK.
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Thomas C, Turner M, Payne S, Milligan C, Brearley S, Seamark D, Wang X, Blake S. Family carers' experiences of coping with the deaths of adults in home settings: A narrative analysis of carers' relevant background worries. Palliat Med 2018; 32:950-959. [PMID: 29400619 DOI: 10.1177/0269216318757134] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Internationally, evidence on the support needs of family carers who look after a terminally ill adult in home settings is incomplete. AIM To illustrate the relevance of 'relevant background worries' in family carers' accounts of caring at home for a dying adult. DESIGN A qualitative cross-sectional observational study was conducted in England, United Kingdom, in 2011-2013 on the experiences of adult family carers ( n = 59) of older dying adults (aged 50+ years) with malignant and/or non-malignant conditions. Interviews occurred post-bereavement. This article reports on a subset of participants' interview transcripts ( n = 30) where narrative analysis was undertaken. SETTING/PARTICIPANTS Carers were interviewed in their home setting, having been purposively recruited via general practitioner practices in two study sites in England. The subset of participants ( n = 30) was purposively selected from the parent sample with reference to carers' age, relationship to the patient, family circumstances and study sites. RESULTS Evidence is provided on the importance of what we conceptualise as carers' 'relevant background worries'; these varied in nature, significance and impact. Four case studies are presented where these worries constituted psychosocial factors that impacted on caregivers' actions and emotional well-being. Two themes are discussed: (1) whether relevant background worries are important enough to be identified and responded to and (2) how such worries could be picked up and managed by professionals. CONCLUSION It is argued that the quality of clinical practice could be improved if specialist palliative care teams in community contexts both identified and responded to significant support needs associated with family carers' relevant background worries.
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Affiliation(s)
- Carol Thomas
- 1 Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Mary Turner
- 1 Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sheila Payne
- 1 Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Christine Milligan
- 1 Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Sarah Brearley
- 1 Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | | | - Xu Wang
- 3 Psychology Department, Leeds Metropolitan University, Leeds, UK
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Witham G, Haigh C. Narrative intelligence in nursing: Storying patient lives in dementia care. Nurs Inq 2018; 25:e12244. [DOI: 10.1111/nin.12244] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Gary Witham
- Department of Nursing; Manchester Metropolitan University; Manchester UK
| | - Carol Haigh
- Department of Nursing; Manchester Metropolitan University; Manchester UK
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Goff SL, Kleppel R, Makari-Judson G. 'No Pink Ribbons': How Women's Lived Experiences With Breast Atypia Inform Decisions Involving Risk-Reducing Medications. J Patient Cent Res Rev 2018; 5:158-166. [PMID: 31414000 DOI: 10.17294/2330-0698.1594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Purpose Atypical hyperplasia (AH) is associated with a nearly 4-fold elevation of lifetime risk for breast cancer, and lobular carcinoma in situ (LCIS) is associated with a 7- to 8-fold risk. Women with AH/LCIS make numerous decisions in the course of treatment, including whether to take a risk-reducing medication, an option relatively few women pursue. We explored women's decision-making processes through patient narratives in an effort to inform decision supports for AH/LCIS. Methods We conducted in-depth interviews with 20 English-speaking women with AH/LCIS and no subsequent diagnosis of invasive breast cancer who had enrolled in the Rays of Hope Center for Breast Cancer Research patient registry between April 5, 2012, and March 31, 2016. Interviews were audiotaped, professionally transcribed, and qualitatively analyzed using thematic qualitative content analysis. Results We identified three major narrative themes: 1) experiences with medical care; 2) decision-making; and 3) making sense of AH/LCIS. Each major theme had several subthemes, many of which map onto existing decisional theories and heuristics. Subthemes included the impact of life context on diagnosis meaning, emotional responses, changes in self-concept and body image, and understanding of the risk-benefit of risk-reducing medications. Conclusions This narrative analysis offers important insights into how lived experience may influence decision-making for women with AH/LCIS. Decision supports that focus not only on analytic decisional processes, but also patients' subjectivities and decisional heuristics, could prove useful for women and their health care providers.
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Affiliation(s)
- Sarah L Goff
- Division of General Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA.,Institute for Healthcare Delivery and Population Science, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Reva Kleppel
- Division of General Medicine, University of Massachusetts Medical School-Baystate, Springfield, MA
| | - Grace Makari-Judson
- Division of Hematology-Oncology, University of Massachusetts Medical School-Baystate, Springfield, MA
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Weggelaar-Jansen AM, van Wijngaarden J. Transferring skills in quality collaboratives focused on improving patient logistics. BMC Health Serv Res 2018; 18:224. [PMID: 29606124 PMCID: PMC5879809 DOI: 10.1186/s12913-018-3051-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/21/2018] [Indexed: 12/24/2022] Open
Abstract
Background A quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. However, no prior research has been done on the knowledge and skills healthcare professionals need to achieve improvements or the extent to which quality improvement collaboratives help enhance both knowledge and skills. Our research focused on quality improvement collaboratives aiming to improve patient logistics and tried to identify which knowledge and skills are required and to what extent these were enhanced during the QIC. Methods We defined skills important for logistic improvements in a three-phase Delphi study. Based on the Delphi results we made a questionnaire. We surveyed participants in a national quality improvement collaborative to assess the skills rated as 1) important, 2) available and 3) improved during the collaborative. At two sense-making meetings, experts reflected on our findings and hypothesized on how to improve (logistics) collaboratives. Results The Delphi study found 18 skills relevant for reducing patient access time and 21 for reducing throughput time. All skills retrieved from the Delphi study were scored as ‘important’ in the survey. Teams especially lacked soft skills connected to project and change management. Analytical skills increased the most, while more reflexive skills needed for the primary goal of the collaborative (reduce access and throughput times) increased modestly. At two sense-making meetings, attendees suggested four improvements for a quality improvement collaborative: 1) shift the focus to project- and change management skills; 2) focus more on knowledge transfer to colleagues; 3) teach participants to adapt the taught principles to their own situations; and 4) foster intra-project reflexive learning to translate gained insights to other projects (inter-project learning). Conclusions Our findings seem to suggest that Quality collaboratives could benefit if more attention is paid to the transfer of ‘soft skills’ (e.g. change, project management and communication skills) and reflexive skills (e.g. adjusting logistics principles to specific situations and inter-project translation of experiences). Electronic supplementary material The online version of this article (10.1186/s12913-018-3051-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Marie Weggelaar-Jansen
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Campus Woudestein, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
| | - Jeroen van Wijngaarden
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Campus Woudestein, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
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Roush K, Tesoro M. An examination of the rigor and value of final scholarly projects completed by DNP nursing students. J Prof Nurs 2018; 34:437-443. [PMID: 30527690 DOI: 10.1016/j.profnurs.2018.03.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 02/25/2018] [Accepted: 03/28/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Final scholarly projects are the culmination of the DNP educational process and as such reflect the achievement of doctoral level scholarship that prepares graduates to be leaders in providing high quality, accessible health care and creating health care systems that are effective and responsive to the needs of a diverse population. PURPOSE The purpose of this study was to determine the rigor and value of final scholarly projects being produced by DNP graduates in the United States. METHODS Using the DNP Project Critical Appraisal Tool (DNP-PCAT) we appraised 65 DNP practice projects consecutively selected from online repositories and the ProQuest dissertation/theses database. FINDINGS The mean total score for all projects was 78.27 out of a possible 141. Substantive problems were identified in all 16 components of the DNP-PCAT. Particularly concerning was a lack of critical evaluation of implementation and outcomes in many projects, including invalid data analysis. CONCLUSIONS The mean total score of 78.28, which is only 56% of the possible maximum score, and substantive problems identified, indicates that continued work is needed to ensure that DNP programs are universally graduating students prepared for rigorous practice-scholarship.
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Affiliation(s)
- Karen Roush
- Lehman College, City University of New York, 250 Bedford Park Blvd., Bronx, NY 10468, United States.
| | - Mary Tesoro
- Lehman College, City University of New York, 250 Bedford Park Blvd., Bronx, NY 10468, United States.
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Mackintosh N, Rance S, Carter W, Sandall J. Working for patient safety: a qualitative study of women's help-seeking during acute perinatal events. BMC Pregnancy Childbirth 2017; 17:232. [PMID: 28716050 PMCID: PMC5513134 DOI: 10.1186/s12884-017-1401-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 07/03/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Women and their relatives can play an important role in early detection and help seeking for acute perinatal events. Recent UK reports indicate that patient-professional partnership in 'working for safety' can be difficult to achieve in practice, sometimes with catastrophic consequences. This research explored the experiences of women and relatives who had experienced early warning signs about their condition and sought help in escalating care. METHODS Secondary analysis of case study data which included qualitative interviews with 22 women purposively sampled on account of experiencing a step up in care and 4 of their relatives from two NHS Trusts in England during 2010. Analysis focused on the type of safety work participants engaged in, and the opportunities and challenges reported by women and family members when negotiating safety at home and in hospital. RESULTS Women and relatives took on a dual responsibility for self-diagnosis, self-care and seeking triage, whilst trying to avoid overburdening stretched services. Being informed, however, did not necessarily enable engagement from staff and services. The women's narratives highlighted the work that they engaged in to build a case for clinical attention, the negotiations that took place with health care professionals and the strategies women and partners drew on (such as objective signs and symptoms, use of verbal insistence and repetition) to secure clinical help. For some women, the events left them with a lasting feeling that their concerns had been disregarded. Some described a sense of betrayal and loss of trust in an institution they believed had failed to care for them. CONCLUSION The notion of 'safety partnerships' which suggests a sense of equality and reciprocity was not borne out by our data, especially with regards to the experiences of teenage women. To enable women and families to secure a rapid response in clinical emergencies, strategies need to move beyond the provision of patient information about warning signs. Effective partnerships for safety may be supported by system level change such as improved triage, continuity of care, self-referral pathways and staff training to address asymmetries of power that persist within the health system.
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Affiliation(s)
- Nicola Mackintosh
- SAPPHIRE Group, Department of Health Sciences, University of Leicester, Centre for Medicine, University Road, Leicester, LE1 7RH UK
| | - Susanna Rance
- Institute for Health and Human Development, University of East London, London, UK
| | - Wendy Carter
- Division of Women’s Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Jane Sandall
- Division of Women’s Health, Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Naß J, Banerjee M, Efferth T, Wohlmann A. Pharmaceutical care as narrative practice? Rethinking patient-centered care through a pharmacist's perspective. Int J Clin Pharm 2017; 38:1346-1349. [PMID: 27766501 DOI: 10.1007/s11096-016-0391-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Illness is a disruptive experience that requires high-quality care. The best evidence-based medical treatment risks losing some of its efficacy, however, when patients feel misunderstood when faced with the complexity of their experiences. They might stop treatment, refuse to disclose relevant information or seek unsound alternatives. A narrative-based approach to health care understands the patient's case history as a narrative that can be read or analyzed like a story. In other words, this approach honors individual illness experiences through the stories that patients tell. While programs that train 'narrative competence' have been successfully implemented in medical education, an application to pharmaceutical training is missing so far. We argue for the necessity to complement evidence-based pharmaceutical practice with narrative-based approaches to ensure high-quality care. Using the perspective of a pharmacist in a case scenario, we exemplify the centrality of "narrative pharmacy" for improving the quality and safety of pharmaceutical health care.
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Affiliation(s)
- Janine Naß
- Institute of Pharmacy and Biochemistry, Department of Pharmaceutical Biology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Mita Banerjee
- Department of English and Linguistics/Transnational American Studies Institute, Johannes Gutenberg University Mainz, Colonel-Kleinmann-Weg 2, SB II, # 04-451, 55099, Mainz, Germany
| | - Thomas Efferth
- Institute of Pharmacy and Biochemistry, Department of Pharmaceutical Biology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Anita Wohlmann
- Department of English and Linguistics/Transnational American Studies Institute, Johannes Gutenberg University Mainz, Colonel-Kleinmann-Weg 2, SB II, # 04-451, 55099, Mainz, Germany.
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Thematic analysis of barriers and facilitators to implementation of neonatal resuscitation guideline changes. J Perinatol 2017; 37:249-253. [PMID: 27906192 PMCID: PMC5334207 DOI: 10.1038/jp.2016.217] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 10/20/2016] [Accepted: 10/10/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To evaluate experiences regarding implementation of Neonatal Resuscitation Program (NRP) guideline changes in the context of a collaborative quality improvement (QI) project. STUDY DESIGN Focus groups were conducted with local QI leaders and providers from nine sites that participated in a QI collaborative. Thematic analysis identified facilitators and barriers to implementation of NRP guideline changes and QI in general. RESULTS Facilitators for QI included comparative process measurement and data tracking. Barriers to QI were shifting priorities and aspects of the project that seemed inefficient. Specific to NRP, implementation strategies that worked involved rapid feedback, and education on rationale for change. Changes that interrupted traditional workflow proved challenging to implement. Limited resources and perceptions of increased workload were also barriers to implementation. CONCLUSION Collaborative QI methods are generally well accepted, particularly data tracking, sharing experience and education. Strategies to increase efficiency and manage workload may facilitate improved staff attitudes toward change.
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Thompson C, Lewis DJ, Greenhalgh T, Smith NR, Fahy AE, Cummins S. "I don't know how I'm still standing" a Bakhtinian analysis of social housing and health narratives in East London. Soc Sci Med 2017; 177:27-34. [PMID: 28157566 DOI: 10.1016/j.socscimed.2017.01.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 11/01/2016] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
Housing is a significant determinant of health and substandard housing is a public health issue. East London has long had a shortage of social and affordable housing, worsened in recent years by a combination of stressors. In one of East London's most deprived boroughs, Newham, changes brought about by the 2011 Localism Act and the unique demands of being the host Olympic borough in 2012 have brought considerable pressures to bear on social infrastructure. This paper examines how these pressures were experienced by local residents via their narratives of social housing and health. The data reported here are from a qualitative study comprising two waves of data collection. Narrative family interviews and go-along interviews were conducted with 40 Newham residents at wave one and 28 at wave two. A narrative analysis with a Bakhtinian interpretation was undertaken. This revealed that residents framed experiences of social housing in terms of an inherent system-level ideology based on notions of need and waiting. A particularly striking feature of this ideology was the extent to which descriptions of ill health and impairment were implicated in constructions of housing need; participants directly attributed a range of health complaints to their housing predicaments, including stress, depression, cancer scares, panic attacks and loss of sleep. Understanding the contested ideology of social housing can illuminate both the dynamic processes of social exclusion and the ways in which its subjects seek to resist it.
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Affiliation(s)
- C Thompson
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom.
| | - D J Lewis
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
| | - T Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, New Radcliffe House, Radcliffe Observatory Quarter, Woodstock Road, Oxford OX2 6GG, United Kingdom
| | - N R Smith
- NatCen Social Research, 35 Northampton Square, London EC1V 0AX, United Kingdom
| | - A E Fahy
- Centre for Psychiatry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, Old Anatomy Building, Charterhouse Square, London EC1M 6BQ, United Kingdom
| | - S Cummins
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, United Kingdom
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Wong C, Hogan DB. Care Transitions: Using Narratives to Assess Continuity of Care Provided to Older Patients after Hospital Discharge. Can Geriatr J 2016; 19:97-102. [PMID: 27729948 PMCID: PMC5038931 DOI: 10.5770/cgj.19.229] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A common scenario that may pose challenges to primary care providers is when an older patient has been discharged from hospital. The aim of this pilot project is to examine the experiences of patients' admission to hospital through to discharge back home, using analysis of patient narratives to inform the strengths and weaknesses of the process. METHODS For this qualitative study, we interviewed eight subjects from the Sheldon M. Chumir Central Teaching Clinic (CTC). Interviews were analyzed for recurring themes and phenomena. Two physicians and two resident learners employed at the CTC were recruited as a focus group to review the narrative transcripts. RESULTS Narratives generally demonstrated moderate satisfaction among interviewees with respect to their hospitalization and follow-up care in the community. However, the residual effects of their hospitalization surprised five patients, and five were uncertain about their post-discharge management plan. CONCLUSION Both secondary and primary care providers can improve on communicating the likely course of recovery and follow-up plans to patients at the time of hospital discharge. Our findings add to the growing body of research advocating for the implementation of quality improvement measures to standardize the discharge process.
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Affiliation(s)
- Carolyn Wong
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary
| | - David B Hogan
- Division of Geriatric Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB
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Abstract
This article argues for a major shift in focus from the strong management orientation of organization development (OD) to a more “user-centric” OD, one that seeks to mobilize and privilege change on behalf of the consumers or users of an organization’s product or service, involving them at every stage of the design process, from problem diagnosis to solution generation and implementation. This reconceptualization of OD draws its inspiration from the rapidly expanding field of experience-based design (EBD), a subfield of the design sciences whose distinctive features are direct user participation in the design process and a focus on designing experiences as opposed to systems or processes. The article reports on an original EBD intervention methodology designed and tested by the authors and colleagues in a cancer clinic within the National Health Service, which following successful “proof of concept,” offers OD some promising new directions for the future.
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Littlejohns P, Knight A, Littlejohns A, Poole TL, Kieslich K. Setting standards and monitoring quality in the NHS 1999-2013: a classic case of goal conflict. Int J Health Plann Manage 2016; 32:e185-e205. [PMID: 27435020 PMCID: PMC5484322 DOI: 10.1002/hpm.2365] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 05/09/2016] [Accepted: 05/16/2016] [Indexed: 11/08/2022] Open
Abstract
2013 saw the National Health Service (NHS) in England severely criticized for providing poor quality despite successive governments in the previous 15 years, establishing a range of new institutions to improve NHS quality. This study seeks to understand the contributions of political and organizational influences in enabling the NHS to deliver high‐quality care through exploring the experiences of two of the major new organizations established to set standards and monitor NHS quality. We used a mixed method approach: first a cross‐sectional, in‐depth qualitative interview study and then the application of principal agent modeling (Waterman and Meier broader framework). Ten themes were identified as influencing the functioning of the NHS regulatory institutions: socio‐political environment; governance and accountability; external relationships; clarity of purpose; organizational reputation; leadership and management; organizational stability; resources; organizational methods; and organizational performance. The organizations could be easily mapped onto the framework, and their transience between the different states could be monitored. We concluded that differing policy objectives for NHS quality monitoring resulted in central involvement and organizational change. This had a disruptive effect on the ability of the NHS to monitor quality. Constant professional leadership, both clinical and managerial, and basing decisions on best evidence, both technical and organizational, helped one institution to deliver on its remit, even within a changing political/policy environment. Application of the Waterman–Meier framework enabled an understanding and description of the dynamic relationship between central government and organizations in the NHS and may predict when tensions will arise in the future. © 2016 The Authors. The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Peter Littlejohns
- King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Alec Knight
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Anna Littlejohns
- University of Leeds School of Medicine, Faculty of Medicine and Health, Leeds, United Kingdom
| | - Tara-Lynn Poole
- School of Life and Medical Sciences, University College London, UCL Medical School, London, United Kingdom
| | - Katharina Kieslich
- King's College London, Faculty of Life Sciences and Medicine, London, United Kingdom
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Thompson C, Lewis D, Greenhalgh T, Smith N, Fahy A, Cummins S. “Everyone was looking at you smiling”: East London residents' experiences of the 2012 Olympics and its legacy on the social determinants of health. Health Place 2015; 36:18-24. [DOI: 10.1016/j.healthplace.2015.08.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 06/19/2015] [Accepted: 08/20/2015] [Indexed: 11/27/2022]
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Adams M, Robert G, Maben J. Exploring the Legacies of Filmed Patient Narratives: The Interpretation and Appropriation of Patient Films by Health Care Staff. QUALITATIVE HEALTH RESEARCH 2015; 25:1241-50. [PMID: 25576480 PMCID: PMC4535314 DOI: 10.1177/1049732314566329] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
We trace the legacies of filmed patient narratives that were edited and screened to encourage engagement with a participatory quality improvement project in an acute hospital setting in England. Using Gabriel's theory of "narrative contract," we examine the initial success of the films in establishing common grounds for participatory project and later, and more varied, interpretations of the films. Over time, the films were interpreted by staff as either useful sources of learning by critical reflection, dubious (invalid or unreliable) representations of patient experience, or as "closed" items available as auditable evidence of completed quality improvement work. We find these interpretations of the films to be shaped by the effect of social distance, the differential outcomes of project work, and changing organizational agendas. We consider the wider conditions of patient narrative as a form of quality improvement knowledge with immediate potency and fragile or fluid legitimacy over time.
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Affiliation(s)
- Mary Adams
- King's College London, London, United Kingdom
| | | | - Jill Maben
- King's College London, London, United Kingdom
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Ponsignon F, Smart A, Williams M, Hall J. Healthcare experience quality: an empirical exploration using content analysis techniques. JOURNAL OF SERVICE MANAGEMENT 2015. [DOI: 10.1108/josm-10-2014-0265] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to set out to explore how cancer patients and their carers perceive and evaluate the healthcare experience in order to develop and validate a classification framework for experience quality in healthcare.
Design/methodology/approach
– The empirical work is centred on the systematic analysis of 200 cancer patient stories published on an independent healthcare feedback web site. Using the critical incident method, the authors captured 1,351 experience quality data items. Three judges independently sorted and classified these data items.
Findings
– The authors identify and describe 22 main categories and 51 sub-categories that underlie the experience quality concept in healthcare and present them in a classification framework. The framework is informed through the categorisation of direct, indirect, and independent interactions. It also suggests a relationship between experience quality and satisfaction and loyalty behaviours.
Research limitations/implications
– This study provides researchers with a foundation for the further development and validation of a measurement scale for experience quality in healthcare.
Practical implications
– The framework assists managers and healthcare professionals with the definition, evaluation, and improvement of the quality of the experience of patients and their carers.
Originality/value
– The main contributions of this study lie in: first, a comprehensive classification framework for experience quality in healthcare; second, dimensions that extend existing health service quality models; third, dimensions that contextualise the generic concept of customer experience quality to healthcare.
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Van Cleave J, Boudreau AA, McAllister J, Cooley WC, Maxwell A, Kuhlthau K. Care coordination over time in medical homes for children with special health care needs. Pediatrics 2015; 135:1018-26. [PMID: 25963012 PMCID: PMC8194473 DOI: 10.1542/peds.2014-1067] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To explore how care coordination changes conceptually and practically in primary care practices when implementing the medical home and to identify reasons for different types of changes. METHODS Six years after a 2003-2004 national learning collaborative to implement the medical home model for children with special health care needs, we examined care coordination in 12 pediatric practices with the highest postintervention Medical Home Index scores, indicating high level of adoption of the model. Data included interviews of 48 clinicians, care coordinators, and parents and medical record reviews of 60 patients with special health care needs receiving care in these practices. RESULTS Initially, care coordination activities were prompted by patients' acute problems, and over time activities, tools, and policies were implemented to avert many such problems and expand the scope of services offered to patients. Example activities were making previsit calls with families, writing care plans, developing relationships with community agencies, and tracking referrals. Although some activities were common across practices, the persons involved and efforts toward different activities varied with practice context. Drivers included motivation and creativity of medical home teams, organizational changes, funding to expand care coordinator positions, protected time for such activities, and adoption of electronic record systems. CONCLUSIONS In high-performing medical homes, care coordination activities changed from being mostly reactive to patients' episodic needs to being more systematically proactive and comprehensive. This shift was promoted by factors external and internal to the practice. Ensuring these factors in medical home implementation may accelerate adoption of proactive care coordination activities.
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Affiliation(s)
- Jeanne Van Cleave
- Division of General Pediatrics/MGH Center for Child and Adolescent Health Research & Policy, MassGeneral Hospital for Children, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts;
| | - Alexy Arauz Boudreau
- Division of General Pediatrics/MGH Center for Child and Adolescent Health Research & Policy, MassGeneral Hospital for Children, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jeanne McAllister
- Children’s Health Services Research, Indiana University Medical School, Indianapolis, Indiana;,Center for Medical Home Improvement, Crotched Mountain Foundation, Greenfield, New Hampshire; and
| | - W. Carl Cooley
- Center for Medical Home Improvement, Crotched Mountain Foundation, Greenfield, New Hampshire; and
| | - Andrea Maxwell
- Internal Medicine/Pediatrics Residency Program, University of Pennsylvania/Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Karen Kuhlthau
- Division of General Pediatrics/MGH Center for Child and Adolescent Health Research & Policy, MassGeneral Hospital for Children, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Smith B, Parsons M, Hand J. War leaves an enduring legacy in combatants' lives. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2014; 57:790-809. [PMID: 24873865 DOI: 10.1080/01634372.2014.898006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The memory of combat experience endures in World War II veterans. As veterans age, traumatic memory that previously may have been suppressed in the busyness of family and everyday life can re-emerge. Combat stress may affect not only the veterans, but also those people closely associated with them. Interviews were conducted with World War II veteran aircrew, wives, children, grandchildren, siblings, and friends to examine the impact of combat experience on the veterans and the family across the life course from the perspectives of the various participants. The combat experience significantly affected the life course of most.
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Affiliation(s)
- Barbara Smith
- a School of Nursing , The University of Auckland , Auckland , New Zealand
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Cohen DJ, Keller SR, Hayes GR, Dorr DA, Ash JS, Sittig DF. Developing a model for understanding patient collection of observations of daily living: A qualitative meta-synthesis of the Project HealthDesign Program. PERSONAL AND UBIQUITOUS COMPUTING 2014; 19:91-102. [PMID: 26949381 DOI: 10.1007/s00779-014-0804-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We conducted a meta-synthesis of five different studies that developed, tested, and implemented new technologies for the purpose of collecting Observations of Daily Living (ODL). From this synthesis, we developed a model to explain user motivation as it relates to ODL collection. We describe this model that includes six factors that motivate patients' collection of ODL data: usability, illness experience, relevance of ODLs, information technology infrastructure, degree of burden, and emotional activation. We show how these factors can act as barriers or facilitators to the collection of ODL data and how interacting with care professionals and sharing ODL data may also influence ODL collection, health-related awareness, and behavior change. The model we developed and used to explain ODL collection can be helpful to researchers and designers who study and develop new, personal health technologies to empower people to improve their health.
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Affiliation(s)
- Deborah J Cohen
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, FM, Portland, Oregon 97239
| | - Sara R Keller
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, FM, Portland, Oregon 97239
| | - Gillian R Hayes
- Department of Informatics, Donald Bren School of Information and Computer Sciences, University of California, Irvine, Irvine, California 92697
| | - David A Dorr
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, FM, Portland, Oregon 97239
| | - Joan S Ash
- Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, FM, Portland, Oregon 97239
| | - Dean F Sittig
- University of Texas School of Biomedical Informatics at Houston, UT - Memorial Hermann Center for Healthcare Quality & Safety, 6410 Fannin St., UTPB 1100.43, Houston, TX 77030
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Locock L, Robert G, Boaz A, Vougioukalou S, Shuldham C, Fielden J, Ziebland S, Gager M, Tollyfield R, Pearcey J. Using a national archive of patient experience narratives to promote local patient-centered quality improvement: an ethnographic process evaluation of 'accelerated' experience-based co-design. J Health Serv Res Policy 2014; 19:200-7. [PMID: 24840387 DOI: 10.1177/1355819614531565] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate an accelerated form of experience-based co-design (EBCD), a type of participatory action research in which patients and staff work together to improve quality; to observe how acceleration affected the process and outcomes of the intervention. METHODS An ethnographic process evaluation of an adapted form of EBCD was conducted, including observations, interviews, questionnaires and documentary analysis. Whilst retaining all components of EBCD, the adapted approach replaced local patient interviews with secondary analysis of a national archive of patient experience narratives to create national trigger films; shortened the timeframe; and employed local improvement facilitators. It was tested in intensive care and lung cancer in two English National Health Service (NHS) hospitals. A total of 96 clinical staff (primarily nursing and medical), and 63 patients and family members participated in co-design activities. RESULTS The accelerated approach proved acceptable to staff and patients; using films of national rather than local narratives did not adversely affect local NHS staff engagement, and may have made the process less threatening or challenging. Local patients felt the national films generally reflected important themes although a minority felt they were more negative than their own experience. However, they served their purpose of 'triggering' discussion between patients and staff, and the resulting 48 co-design (improvement) activities across the four pathways were similar to those in EBCD, but achieved more quickly and at lower cost. CONCLUSIONS Accelerated EBCD offers a rigorous and relatively cost-effective patient-centered quality improvement approach.
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Affiliation(s)
- Louise Locock
- Director of Applied Research, Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK, and Health Experiences Fellow, NIHR Oxford Biomedical Research Centre, UK
| | - Glenn Robert
- Professor of Healthcare Quality and Innovation, National Nursing Research Unit, King's College London, UK
| | - Annette Boaz
- Reader in Healthcare Research, Faculty of Health, Social Care and Education, St George's Medical School, University of London and Kingston University, UK
| | - Sonia Vougioukalou
- Research Associate, School of Healthcare Sciences, Cardiff University, UK
| | - Caroline Shuldham
- Director of Nursing and Clinical Governance, Royal Brompton and Harefield NHS Foundation Trust, UK
| | - Jonathan Fielden
- Medical Director, University College London Hospitals NHS Foundation Trust, UK
| | - Sue Ziebland
- Director, Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Melanie Gager
- Senior Sister, Intensive Care, Royal Berkshire NHS Foundation Trust, UK
| | - Ruth Tollyfield
- Senior Sister, Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, UK
| | - John Pearcey
- Cancer and Thoracic Surgery Manager, Royal Brompton and Harefield NHS Foundation Trust, UK
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Hartley S, McArthur M, Coenen M, Cabello M, Covelli V, Roszczynska-Michta J, Pitkänen T, Bickenbach J, Cieza A. Narratives reflecting the lived experiences of people with brain disorders: common psychosocial difficulties and determinants. PLoS One 2014; 9:e96890. [PMID: 24805128 PMCID: PMC4013080 DOI: 10.1371/journal.pone.0096890] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Accepted: 04/13/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND People with brain disorders - defined as both, mental disorders and neurological disorders experience a wide range of psychosocial difficulties (PSDs) (e.g., concentrating, maintaining energy levels, and maintaining relationships). Research evidence is required to show that these PSDs are common across brain disorders. OBJECTIVES To explore and gain deeper understanding of the experiences of people with seven brain disorders (alcohol dependency, depression, epilepsy, multiple sclerosis, Parkinson's disease, schizophrenia, stroke). It examines the common PSDs and their influencing factors. METHODS Seventy seven qualitative studies identified in a systematic literature review and qualitative data derived from six focus groups are used to generate first-person narratives representing seven brain disorders. A theory-driven thematic analysis of these narratives identifies the PSDs and their influencing factors for comparison between the seven disorders. RESULTS First-person narratives illustrate realities for people with brain disorders facilitating a deeper understanding of their every-day life experiences. Thematic analysis serves to highlight the commonalities, both of PSDs, such as loneliness, anger, uncertainty about the future and problems with work activities, and their determinants, such as work opportunities, trusting relationships and access to self-help groups. CONCLUSIONS The strength of the methodology and the narratives is that they provide the opportunity for the reader to empathise with people with brain disorders and facilitate deeper levels of understanding of the complexity of the relationship of PSDs, determinants and facilitators. The latter reflect positive aspects of the lives of people with brain disorders. The result that many PSDs and their influencing factors are common to people with different brain disorders opens up the door to the possibility of using cross-cutting interventions involving different sectors. This strengthens the message that 'a great deal can be done' to improve the lived experience of persons with brain disorders when medical interventions are exhausted.
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Affiliation(s)
- Sally Hartley
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
- Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
- The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Maggie McArthur
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
| | - Michaela Coenen
- Department of Medical Informatics, Biometry and Epidemiology – IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Maria Cabello
- Instituto de Salud Carlos lll CIBERSAM, Faculty of Medicine, Universidad Autonoma de Madrid, Instituto de investigacion de la Princesa (IIS-IP), Madrid, Spain
| | - Venusia Covelli
- Neurology, Public Health and Disability Unit, Scientific Directorate, Neurological Institute Carlo Besta IRCCS Foundation, Milan, Italy
| | | | - Tuuli Pitkänen
- A-Clinic Foundation (A-klinikkasäätiö), Helsinki, Finland
| | | | - Alarcos Cieza
- Department of Medical Informatics, Biometry and Epidemiology – IBE, Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Ludwig-Maximilians-University (LMU), Munich, Germany
- Swiss Paraplegic Research (SPR), Nottwil, Switzerland
- Faculty of Social and Human Sciences, University of Southampton, Southampton, United Kingdom
- * E-mail:
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Kyratsis Y, Ahmad R, Hatzaras K, Iwami M, Holmes A. Making sense of evidence in management decisions: the role of research-based knowledge on innovation adoption and implementation in health care. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02060] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAlthough innovation can improve patient care, implementing new ideas is often challenging. Previous research found that professional attitudes, shaped in part by health policies and organisational cultures, contribute to differing perceptions of innovation ‘evidence’. However, we still know little about how evidence is empirically accessed and used by organisational decision-makers when innovations are introduced.Aims and objectivesWe aimed to investigate the use of different sources and types of evidence in innovation decisions to answer the following questions: how do managers make sense of evidence? What role does evidence play in management decision-making when adopting and implementing innovations in health care? How do wider contextual conditions and intraorganisational capacity influence research use and application by health-care managers?MethodsOur research design comprised multiple case studies with mixed methods. We investigated technology adoption and implementation in nine acute-care organisations across England. We employed structured survey questionnaires, in-depth interviews and documentary analysis. The empirical setting was infection prevention and control. Phase 1 focused on the espoused use of evidence by 126 non-clinical and clinical hybrid managers. Phase 2 explored the use of evidence by managers in specific technology examples: (1) considered for adoption; (2) successfully adopted and implemented; and (3) rejected or discontinued.Findings(1) Access to, and use of, evidence types and sources varied greatly by profession. Clinicians reported a strong preference for science-based, peer-reviewed, published evidence. All groups called upon experiential knowledge and expert opinion. Nurses overall drew upon a wider range of evidence sources and types. Non-clinical managers tended to sequentially prioritise evidence on cost from national-level sources, and local implementation trials. (2) A sizeable proportion of professionals from all groups, including experienced staff, reported difficulty in making sense of evidence. Lack of awareness of existing implementation literature, lack of knowledge on how to translate information into current practice, and lack of time and relevant skills were reported as key reasons for this. (3) Infection outbreaks, financial pressures, performance targets and trusted relationships with suppliers seemed to emphasise a pragmatic and less rigorous approach in sourcing for evidence. Trust infrastructure redevelopment projects, and a strong emphasis on patient safety and collaboration, appeared to widen scope for evidence use. (4) Evidence was continuously interpreted and (re)constructed by professional identity, organisational role, team membership, audience and organisational goals. (5) Doctors and non-clinical managers sourced evidence plausible to self. Nursing staff also sought acceptance of evidence from other groups. (6) We found diverse ‘evidence templates’ in use: ‘biomedical-scientific’, ‘practice-based’, ‘rational-policy’. These represented shared cognitive models which defined what constituted acceptable and credible evidence in decisions. Nurses drew on all diverse ‘templates’ to make sense of evidence and problems; non-clinical managers drew mainly on the practice-based and rational-policy templates; and doctors drew primarily on the biomedical-scientific template.ConclusionsAn evidence-based management approach that inflexibly applies the principles of evidence-based medicine, our findings suggest, neglects how evidence is actioned in practice and how codified research knowledge inter-relates with other ‘evidence’ also valued by decision-makers. Local processes and professional and microsystem considerations played a significant role in adoption and implementation. This has substantial implications for the effectiveness of large-scale projects and systems-wide policy.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Yiannis Kyratsis
- National Centre for Infection Prevention and Management, Imperial College London, London, UK
- School of Health Sciences, City University London, London, UK
| | - Raheelah Ahmad
- National Centre for Infection Prevention and Management, Imperial College London, London, UK
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Kyriakos Hatzaras
- National Centre for Infection Prevention and Management, Imperial College London, London, UK
- Information Technology Services Directorate, King’s College London, London, UK
| | - Michiyo Iwami
- National Centre for Infection Prevention and Management, Imperial College London, London, UK
| | - Alison Holmes
- National Centre for Infection Prevention and Management, Imperial College London, London, UK
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