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Suarez-Herrera JC, Diaz-Castro L, Ramirez-Rojas MG, Pelcastre-Villafuerte BE. Unpacking participation in healthcare governance: Lessons from two local health councils in Brazil and Spain. Int J Health Plann Manage 2024; 39:1097-1112. [PMID: 38373041 DOI: 10.1002/hpm.3781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 12/14/2023] [Accepted: 01/30/2024] [Indexed: 02/20/2024] Open
Abstract
This paper describes and compares the integration of cross-sector actors' participation into the governance of two local health councils, one located in Salvador de Bahia (Brazil) and the other in the Canary Islands (Spain). Based on the cross-national comparative research conducted as part of a doctoral thesis, a qualitative design based on secondary data analysis was proposed on the three stages of the organisational integration process of participation. We used information from individual semi-structured interviews (n = 70), situational observation, focus groups, literature review, and field notes to understand participatory processes of networking between multiple cross-sector actors and to show how such processes might be associated with innovative practices. For these innovations to be successfully implemented, stakeholders need to acquire adequate competencies in cross-sector collaboration, enabling them to learn about new organisational practices and to adapt the network of actors to the often unpredictable influences of contextual factors.
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Affiliation(s)
| | - Lina Diaz-Castro
- National Institute of Psychiatry Ramón de la Fuente Muñiz, Direction of Epidemiological and Psychosocial Research, Mexico City, Mexico
| | - Maria Guadalupe Ramirez-Rojas
- Department of Social and Environmental Processes and Health, National Council of Humanities, Sciences and Technologies (CONAHCYT), Center for Research and Higher Studies in Social Anthropology (CIESAS) Southeast Unit, San Cristóbal de las Casas, Chiapas, Mexico
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Peterson JW, Robles A, Underwood Carrasco VI, Zavala J, Almanzar N, Zuckerman KE, Bruce J. Educational Values of Latino Families Participating in a School Readiness Intervention: Hopes and Implications for Pediatrics. J Dev Behav Pediatr 2024:00004703-990000000-00180. [PMID: 38904654 DOI: 10.1097/dbp.0000000000001295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 05/03/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE To explore Latino parents' educational values and hopes for their preschool-aged children after a clinic school readiness (SR) intervention. METHODS Qualitative analysis of semi-structured interviews of Latino parents regarding their perceptions of a novel SR coaching intervention (2016-2017). Parents who received the intervention were approached for interview (n = 74); 59 postintervention interviews were completed in English or Spanish, audio recorded, transcribed, and translated into English. Iterative team-based coding and inductive thematic analysis of 47 interviews were conducted by 3 team members using Dedoose. RESULTS Children were on average 4.5 years old, with the majority speaking Spanish at home (57%), and having preschool experience (81%). Mothers mostly had no paid employment (53%) and limited formal education. Four domains emerged: 1) education is valued and seen as a pathway to a successful life for children, and 2) while structural and cultural barriers exist, 3) Latino families are motivated and 4) trust providers to offer SR support. Parents suggested pediatricians could provide more SR knowledge to families and offer programs within primary care. Integration of findings are summarized in a framework for clinical practice. CONCLUSION Latino parents' trust in their pediatric providers, combined with their strong educational aspirations for their children, offers the pediatric clinic an opportunity to partner with families to reduce systemic SR barriers. Pediatric providers can support Latino parents in preparing their children for school through culturally responsive, strengths-based approaches that build on their educational aspirations, value existing SR efforts, offer SR knowledge around early literacy and math, and build connections to early childhood programs.
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Affiliation(s)
- Jaime W Peterson
- Department of Pediatrics, Oregon Health and Science University, OHSU-Portland State School of Public Health, Portland, OR
| | - Alejandro Robles
- Department of Pediatrics, Oregon Health and Science University, Portland, OR
| | | | - Julia Zavala
- Center for Dermatology and Laser Surgery, Portland, OR
| | | | | | - Janine Bruce
- Division of General Pediatrics, Department of Pediatrics, Stanford School of Medicine, Stanford, CA
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Nilsen A, Eriksen S, Lichtwarck B, Hillestad AH, Julnes SG, Tretteteig S, Rokstad AMM. Treatment and Care for Nursing Home Residents with COVID-19: A Qualitative Study. J Multidiscip Healthc 2024; 17:2935-2946. [PMID: 38933696 PMCID: PMC11199164 DOI: 10.2147/jmdh.s467459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Purpose Coronavirus disease 2019 (COVID-19) placed a significant strain on nursing homes, leading to numerous outbreaks and high mortality rates. This situation created considerable stress and challenges for residents, their physicians and nurses, as well as family caregivers. By understanding these challenges, we can gain new insights and learn valuable lessons. Thus, the purpose of this study is to examine the treatment and care provided to nursing home residents with COVID-19, as experienced by physicians, nurses, and family caregivers. Participants and Methods This study is a secondary analysis of 35 interviews with physicians, nurses, and family caregivers, each with personal experience caring for nursing home residents diagnosed with COVID-19. The interviews took place from December 2020 to April 2021. We analyzed the transcriptions based on Braun and Clarke's reflexive thematic analysis model and followed a qualitative descriptive design as outlined by Sandelowski. Findings The analysis produced three themes: 1) Balancing medical treatment, 2) The need for increased systematic monitoring of vital functions, and 3) Determining the treatment level for nursing home residents. These themes were explored through the unique perspectives of the three participant groups: physicians, nurses, and family caregivers. The findings revealed several challenges related to treatment and care for nursing home residents diagnosed with COVID-19. This applied both to relief of symptoms, monitoring of vital functions, assessment of treatment level and use of advance care planning. Conclusion Drawing from the experiences of physicians, nurses, and family caregivers, there should be a unified plan at the municipal or national level for competency development in nursing homes to prepare for future crises like pandemics or epidemics. Additionally, the safe engagement of family caregivers and relatives should be given priority.
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Affiliation(s)
- Anita Nilsen
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Siren Eriksen
- Lovisenberg Diaconal University College, Oslo, Norway
| | - Bjørn Lichtwarck
- The Research Centre for Age-Related Functional Decline and Disease, Innlandet Hospital Trust, Ottestad, Norway
| | | | - Signe Gunn Julnes
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
| | - Signe Tretteteig
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
| | - Anne Marie Mork Rokstad
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway
- Norwegian National Centre for Ageing and Health, Vestfold Hospital Trust, Tønsberg, Norway
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Enriquez D. Publishing publicly available interview data: an empirical example of the experience of publishing interview data. FRONTIERS IN SOCIOLOGY 2024; 9:1157514. [PMID: 38903395 PMCID: PMC11188393 DOI: 10.3389/fsoc.2024.1157514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/19/2024] [Indexed: 06/22/2024]
Abstract
In September 2021 I made a collection of interview transcripts available for public use under a CreativeCommons license through the Princeton DataSpace. The interviews include 39 conversations I had with gig workers at AmazonFlex, Uber, and Lyft in 2019 as part of a study on automation efforts within these organizations. I made this decision because (1) I was required to contribute to a publicly available data set as a requirement of my funding and (2) I saw it as an opportunity to engage in the collaborative qualitative science experiments emerging in Science and Technology studies. This article documents my thought process and step-by-step design decisions for designing a study, gathering data, masking it, and publishing it in a public archive. Importantly, once I decided to publish these data, I determined that each choice about how the study would be designed and implemented had to be assessed for risk to the interviewee in a very deliberate way. It is not meant to be comprehensive and cover every possible condition a researcher may face while producing qualitative data. I aimed to be transparent both in my interview data and the process it took to gather and publish these data. I use this article to illustrate my thought process as I made each design decision for this study in hopes that it could be useful to a future researcher considering their own data publishing process.
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Affiliation(s)
- Diana Enriquez
- Department of Sociology, Princeton University, Princeton, NJ, United States
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Prosser AMB, Bagnall R, Higson-Sweeney N. Reflection over compliance: Critiquing mandatory data sharing policies for qualitative research. J Health Psychol 2024; 29:653-658. [PMID: 38282356 PMCID: PMC11141091 DOI: 10.1177/13591053231225903] [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] [Indexed: 01/30/2024] Open
Abstract
Many journals are moving towards a 'Mandatory Inclusion of Raw Data' (MIRD) model of data sharing, where it is expected that raw data be publicly accessible at article submission. While open data sharing is beneficial for some research topics and methodologies within health psychology, in other cases it may be ethically and epistemologically questionable. Here, we outline several questions that qualitative researchers might consider surrounding the ethics of open data sharing. Overall, we argue that universal open raw data mandates cannot adequately represent the diversity of qualitative research, and that MIRD may harm rigorous and ethical research practice within health psychology and beyond. Researchers should instead find ways to demonstrate rigour thorough engagement with questions surrounding data sharing. We propose that all researchers utilise the increasingly common 'data availability statement' to demonstrate reflexive engagement with issues of ethics, epistemology and participant protection when considering whether to open data.
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Gore-Gorszewska G. "I'm telling you my story, not publishing a blog": Considerations and suggestions on data sharing in qualitative health psychology research on sensitive topics. J Health Psychol 2024; 29:665-673. [PMID: 38549221 DOI: 10.1177/13591053241239109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024] Open
Abstract
Qualitative research plays a pivotal role in health psychology, offering insights into the intricacies of health-related issues. However, the specificity of qualitative methodology presents challenges in adhering to standard open science principles, including data sharing. The guidelines to address these issues are limited. Drawing from the author's experience in conducting in-depth interviews with middle-aged and older adults regarding their sexuality, this article discusses various challenges in implementing data sharing requirements. It emphasizes factors like participants' reasonable reluctance to share in specific populations, the depth of personal information gleaned from comprehensive interviews, concerns surrounding potential data misuse both within and outside academic circles, and the complex issue of obtaining informed consent. A universal approach to data sharing in qualitative research proves impractical, emphasizing the necessity for adaptable, context-specific guidelines that acknowledge the methodology's nuances. Striking a balance between transparency and ethical responsibility requires tailored strategies and thoughtful consideration.
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Affiliation(s)
- Gabriela Gore-Gorszewska
- Institute of Psychology, Faculty of Philosophy, Jagiellonian University, Kraków, Poland
- Psychology Research Institute, Faculty of Social Studies, Masaryk University, Brno, Czechia
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Hammer NM, Bidstrup PE, Olsen M, Hansson H, Abitz M, Larsen HB. The experiences of grandparents involved in the home-based end-of-life care of their grandchild with cancer: A qualitative secondary data analysis. DEATH STUDIES 2024:1-11. [PMID: 38822452 DOI: 10.1080/07481187.2024.2355252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
While grandparents are often a valuable resource in home-based pediatric end-of-life care, they may also experience psychological consequences when faced with their grandchild's illness and death. In this qualitative study, we performed semi-structured interviews with seven bereaved grandparents of four children with cancer who received home-based end-of-life care and died at home at age <18. Through qualitative content analysis we identified the overarching theme: "Navigating complex and unclear roles to support the family" and five themes: (1) Providing comfort and support; (2) Balancing and adapting involvement; (3) Worrying silently; (4) Managing difficult emotions; and (5) Calling for support and understanding. The findings underline the often conflicting roles that grandparents undertake of providing support while respecting parents' autonomy and putting aside their own emotional reactions. Involving grandparents in pediatric end-of-life care may enhance family resources, but should also consider grandparents' perspectives and need for support.
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Affiliation(s)
- Nanna Maria Hammer
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Olsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Pediatrics and Adolescent Medicine, Section of Pediatric Hematology and Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Helena Hansson
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maja Abitz
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Hanne Bækgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Meghani SH, Mooney-Doyle K, Barnato A, Colborn K, Gillette R, Harrison KL, Hinds PS, Kirilova D, Knafl K, Schulman-Green D, Pollak KI, Ritchie CS, Kutner JS, Karcher S. Lessons Learned Establishing the Palliative Care Research Cooperative's Qualitative Data Repository. J Pain Symptom Manage 2024:S0885-3924(24)00797-8. [PMID: 38825257 DOI: 10.1016/j.jpainsymman.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/04/2024]
Abstract
Data sharing is increasingly an expectation in health research as part of a general move toward more open sciences. In the United States, in particular, the implementation of the 2023 National Institutes of Health Data Management and Sharing Policy has made it clear that qualitative studies are not exempt from this data sharing requirement. Recognizing this trend, the Palliative Care Research Cooperative Group (PCRC) realized the value of creating a de-identified qualitative data repository to complement its existing de-identified quantitative data repository. The PCRC Data Informatics and Statistics Core leadership partnered with the Qualitative Data Repository (QDR) to establish the first serious illness and palliative care qualitative data repository in the U.S. We describe the processes used to develop this repository, called the PCRC-QDR, as well as our outreach and education among the palliative care researcher community, which led to the first ten projects to share the data in the new repository. Specifically, we discuss how we co-designed the PCRC-QDR and created tailored guidelines for depositing and sharing qualitative data depending on the original research context, establishing uniform expectations for key components of relevant documentation, and the use of suitable access controls for sensitive data. We also describe how PCRC was able to leverage its existing community to recruit and guide early depositors and outline lessons learned in evaluating the experience. This work advances the establishment of best practices in qualitative data sharing.
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Affiliation(s)
- Salimah H Meghani
- Department of Biobehavioral Health Sciences NewCourtland Center for Transitions and Health (S.H.M), Leonard Davis Institute of Health Economics; University of Pennsylvania, Philadelphia, PA
| | - Kim Mooney-Doyle
- Department of Family and Community Health (K.M.D), School of Nursing, University of Maryland, Baltimore, MD
| | - Amber Barnato
- Department of Medicine, The Dartmouth Institute for Health Policy and Clinical Practice (A.B), Geisel School of Medicine, Section of Palliative Care, Dartmouth Health, Hanover, NH
| | - Kathryn Colborn
- Department of Medicine (K.C), School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Riley Gillette
- Adult and Child Center for Outcomes Research and Delivery Science (R.G), University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Krista L Harrison
- Department of Medicine, Division of Geriatrics (K.L.H), Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA
| | - Pamela S Hinds
- Department of Nursing Science, Interim Director (P.S.H), Center for Translational Research, Director, Professional Practice and Quality, Research Integrity Officer, William and Joanne Conway Chair in Nursing Research, Children's National Hospital, Professor of Pediatrics, School of Medicine and Health Sciences, George Washington University, Washington, DC
| | - Dessi Kirilova
- Qualitative Data Repository (D.K), Syracuse University, Syracuse, NY
| | - Kathleen Knafl
- FAAN. School of Nursing (K.K), University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Kathryn I Pollak
- Department of Population Health Sciences (K.I.P), Duke University School of Medicine, Cancer Prevention and Control, Duke Cancer Institute, Durham, NC
| | - Christine S Ritchie
- Harvard Medical School (C.S.R), Mongan Institute Center for Aging and Serious Illness and the Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Boston MA
| | - Jean S Kutner
- Department of Medicine (J.S.K), University of Colorado School of Medicine, Aurora, CO and
| | - Sebastian Karcher
- Department of Political Science and Qualitative Data Repository (S.K), Syracuse University, Syracuse, NY.
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Daus M, Lee M, Ujano-De Motta LL, Holstein A, Morgan B, Albright K, Ayele R, McCarthy M, Sjoberg H, Jones CD. Perspectives on supporting Veterans' social needs during hospital to home health transitions: findings from the Transitions Nurse Program. BMC Health Serv Res 2024; 24:520. [PMID: 38658937 PMCID: PMC11043030 DOI: 10.1186/s12913-024-10900-9] [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: 01/18/2024] [Accepted: 03/26/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Veterans who need post-acute home health care (HHC) are at risk for adverse outcomes and unmet social needs. Veterans' social needs could be identified and met by community-based HHC clinicians due to their unique perspective from the home environment, acuity of Veterans they serve, and access to Veterans receiving community care. To understand these needs, we explored clinician, Veteran, and care partner perspectives to understand Veterans' social needs during the transition from hospital to home with skilled HHC. METHODS Qualitative data were collected through individual interviews with Veterans Health Administration (VHA) inpatient & community HHC clinicians, Veterans, and care partners who have significant roles facilitating Veterans' hospital to home with HHC transition. To inform implementation of a care coordination quality improvement intervention, participants were asked about VHA and HHC care coordination and Veterans' social needs during these transitions. Interviews were recorded, transcribed, and analyzed inductively using thematic analysis and results were organized deductively according to relevant transitional care domains (Discharge Planning, Transition to Home, and HHC Delivery). RESULTS We conducted 35 interviews at 4 VHA Medical Centers located in Western, Midwestern, and Southern U.S. regions during March 2021 through July 2022. We organized results by the three care transition domains and related themes by VHA, HHC, or Veteran/care partner perspective. Our themes included (1) how social needs affected access to HHC, (2) the need for social needs screening during hospitalization, (3) delays in HHC for Veterans discharged from community hospitals, and (4) a need for closed-loop communication between VHA and HHC to report social needs. CONCLUSIONS HHC is an underexplored space for Veterans social needs detection. While this research is preliminary, we recommend two steps forward from this work: (1) develop closed-loop communication and education pathways with HHC and (2) develop a partnership to integrate a social risk screener into HHC pathways.
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Affiliation(s)
- Marguerite Daus
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA.
| | - Marcie Lee
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Lexus L Ujano-De Motta
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | | | - Brianne Morgan
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Karen Albright
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
- OCHIN, Inc., Portland, OR, USA
| | - Roman Ayele
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Michaela McCarthy
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Heidi Sjoberg
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
| | - Christine D Jones
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System, 1700 N Wheeling St, Aurora, CO, 80045, USA
- Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Scheer ER, Werner NE, Coller RJ, Nacht CL, Petty L, Tang M, Ehlenbach M, Kelly MM, Finesilver S, Warner G, Katz B, Keim-Malpass J, Lunsford CD, Letzkus L, Desai SS, Valdez RS. Designing for caregiving networks: a case study of primary caregivers of children with medical complexity. J Am Med Inform Assoc 2024; 31:1151-1162. [PMID: 38427845 PMCID: PMC11031225 DOI: 10.1093/jamia/ocae026] [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: 08/07/2023] [Revised: 01/21/2024] [Accepted: 02/01/2024] [Indexed: 03/03/2024] Open
Abstract
OBJECTIVE The study aimed to characterize the experiences of primary caregivers of children with medical complexity (CMC) in engaging with other members of the child's caregiving network, thereby informing the design of health information technology (IT) for the caregiving network. Caregiving networks include friends, family, community members, and other trusted individuals who provide resources, information, health, or childcare. MATERIALS AND METHODS We performed a secondary analysis of two qualitative studies. Primary studies conducted semi-structured interviews (n = 50) with family caregivers of CMC. Interviews were held in the Midwest (n = 30) and the mid-Atlantic region (n = 20). Interviews were transcribed verbatim for thematic analysis. Emergent themes were mapped to implications for the design of future health IT. RESULTS Thematic analysis identified 8 themes characterizing a wide range of primary caregivers' experiences in constructing, managing, and ensuring high-quality care delivery across the caregiving network. DISCUSSION Findings evidence a critical need to create flexible and customizable tools designed to support hiring/training processes, coordinating daily care across the caregiving network, communicating changing needs and care updates across the caregiving network, and creating contingency plans for instances where caregivers are unavailable to provide care to the CMC. Informaticists should additionally design accessible platforms that allow primary caregivers to connect with and learn from other caregivers while minimizing exposure to sensitive or emotional content as indicated by the user. CONCLUSION This article contributes to the design of health IT for CMC caregiving networks by uncovering previously underrecognized needs and experiences of CMC primary caregivers and drawing direct connections to design implications.
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Affiliation(s)
- Eleanore Rae Scheer
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
| | - Nicole E Werner
- Department of Health and Wellness Design, Indiana University School of Public Health-Bloomington, Bloomington, IN 47405, United States
| | - Ryan J Coller
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, CA 92182, United States
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA 92093, United States
| | - Lauren Petty
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
| | - Mengwei Tang
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI 53706, United States
| | - Mary Ehlenbach
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Michelle M Kelly
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Sara Finesilver
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Gemma Warner
- Department of Pediatrics, University of Wisconsin-Madison, Madison, WI 53792, United States
| | - Barbara Katz
- Family Voices of Wisconsin, Madison, WI 53705, United States
| | - Jessica Keim-Malpass
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, United States
| | - Christopher D Lunsford
- Department of Orthopedics, Duke University, Durham, NC 27710, United States
- Department of Pediatrics, Duke University, Durham, NC 27707, United States
| | - Lisa Letzkus
- Department of Pediatrics, University of Virginia, Charlottesville, VA 22903, United States
| | - Shaalini Sanjiv Desai
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
| | - Rupa S Valdez
- Department of Systems and Information Engineering, University of Virginia, Charlottesville, VA 22904, United States
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA 22903, United States
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11
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Serena TE, King E, Serena L, Breisinger K, Al-Jalodi O, Myntti MF. A Diagnostic-Driven Prospective Clinical Study Evaluating the Combination of an Antibiofilm Agent and Negative Pressure Wound Therapy. Diagnostics (Basel) 2024; 14:774. [PMID: 38611687 PMCID: PMC11012015 DOI: 10.3390/diagnostics14070774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/28/2024] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Each year, millions of Americans develop truncal pressure ulcers (PUs) which can persist for months, years, or until the end of life. Despite the negative impact on quality of life and escalating costs associated with PUs, there is sparse evidence supporting validated and efficacious treatment options. As a result, treatment is based on opinion and extrapolation from other wound etiologies. The ideal reconstructive plan maximizes the patient's nutritional status, incorporates the basic tenets of wound bed preparation (debridement, offloading, proper moisture balance, reduction of bacterial burden), and employs diagnostics to guide therapeutic intervention. The use of combination therapies can potentially overcome several of the barriers to wound healing. Negative pressure wound therapy (NPWT), a commonly used modality in the management of PUs, facilitates healing by stimulating the formation of granulation tissue and promoting wound contraction; however, NPWT alone is not always effective. Clinical studies examining microbial bioburden in PUs determined that most ulcers contain bacteria at levels that impede wound healing (>104 CFU/g). OBJECTIVE Thus, we hypothesized that adding an anti-microbial agent to decrease both planktonic and biofilm bacteria in the wound would increase the efficacy of NPWT. METHOD In this prospective study, twenty patients with recalcitrant PUs that previously failed NPWT were treated with a biofilm-disrupting agent (Blast-X, Next Science, Jacksonville, FL, USA) in combination with NPWT. Fluorescence imaging was used to follow bacterial burden and guide therapy. RESULTS In total, 45% of the PUs reduced in size over the course of the four-week study, with a resolution of bacterial fluorescence in the NPWT dressing and wound bed seen in an average of three weeks. CONCLUSION The combination of an antibiofilm agent and NPWT reduced bacterial levels and improved wound healing in recalcitrant PUs.
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Affiliation(s)
- Thomas E. Serena
- SerenaGroup Research Foundation, Cambridge, MA 02140, USA (L.S.); (K.B.); (O.A.-J.)
| | - Emily King
- SerenaGroup Research Foundation, Cambridge, MA 02140, USA (L.S.); (K.B.); (O.A.-J.)
| | - Laura Serena
- SerenaGroup Research Foundation, Cambridge, MA 02140, USA (L.S.); (K.B.); (O.A.-J.)
| | - Kristy Breisinger
- SerenaGroup Research Foundation, Cambridge, MA 02140, USA (L.S.); (K.B.); (O.A.-J.)
| | - Omar Al-Jalodi
- SerenaGroup Research Foundation, Cambridge, MA 02140, USA (L.S.); (K.B.); (O.A.-J.)
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12
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Torres-Castaño A, Perestelo-Pérez L, Koatz D, Ramos-García V, González-González AI, Toledo-Chávarri A, Bermejo-Caja CJ, Gonzalez-Pacheco H, Abt-Sack A, Pacheco-Huergo V, Orrego C. Healthcare Professionals' Perceptions about the Implementation of Shared Decision-Making in Primary Care: A Qualitative Study from a Virtual Community of Practice. Int J Integr Care 2024; 24:8. [PMID: 38638611 PMCID: PMC11025573 DOI: 10.5334/ijic.6554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/11/2024] [Indexed: 04/20/2024] Open
Abstract
Background The incorporation of shared decision making (SDM) is a central part of empowerment processes, as it facilitates greater activation on the part of patients, increasing the likelihood of them gaining control over their healthcare and developing skills to solve their health problems. Despite these benefits, there are still difficulties in the implementation of SDM among healthcare professionals due to internal and external factors related to the context and health systems. Aim To explore primary care professionals (PCPs)' perceptions of the SDM model, based on their preconceptions and experience in clinical practice. Methods A framework analysis was conducted on qualitative data derived from a virtual community practice forum, within a cluster-randomized clinical trial developed in the e-MPODERA project. Results The most important points in the opinions of the PCPs were: exploring the patients' values, preferences and expectations, providing them with and checking their understanding of up-to-date and evidence-based health information. The analysis revealed three themes: determinants of the implementation process of SDM, lack of consistency and dilemmas and benefits of PCP active listening, motivation and positive expectations of SDM. Discussion In our initial analysis, we examined the connections between the categories of the TDC model and its application in the primary care context. The categories related to the model reflect the theoretical understanding of professionals, while those related to perceptions of its application and use show certain discrepancies. These discrepancies could indicate a lack of understanding of the model and its real-world implications or insufficient commitment on the part of professionals or the organization to ensure its effective implementation. Conclusions Specific targeted training that addresses knowledge, attitudes and practice may resolve the aforementioned findings.
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Affiliation(s)
- Alezandra Torres-Castaño
- Canary Islands Health Research Institute Foundation, Tenerife, Spain
- Evaluation Unit of the Canary Island Health Service (SESCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain
| | - Lilisbeth Perestelo-Pérez
- Evaluation Unit of the Canary Island Health Service (SESCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain
| | - Débora Koatz
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Avedis Donabedian Research Institute (FAD), Spain
- Universidad Autónoma de Barcelona, Spain
| | - Vanesa Ramos-García
- Canary Islands Health Research Institute Foundation, Tenerife, Spain
- Evaluation Unit of the Canary Island Health Service (SESCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain
| | - Ana Isabel González-González
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Innovation and International Projects Unit. Vice-Directorate for Health Research and Documentation. Directorate General for Research, Education and Innovation. Madrid Health Ministry, Spain
| | - Ana Toledo-Chávarri
- Canary Islands Health Research Institute Foundation, Tenerife, Spain
- Evaluation Unit of the Canary Island Health Service (SESCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain
| | - Carlos Jesús Bermejo-Caja
- Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
- Departamento de Enfermería, Universidad Autónoma de Madrid, Madrid, Spain
| | - Himar Gonzalez-Pacheco
- Canary Islands Health Research Institute Foundation, Tenerife, Spain
- Evaluation Unit of the Canary Island Health Service (SESCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Analia Abt-Sack
- Canary Islands Health Research Institute Foundation, Tenerife, Spain
- Evaluation Unit of the Canary Island Health Service (SESCS), Tenerife, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain
| | - Valeria Pacheco-Huergo
- Avedis Donabedian Research Institute (FAD), Spain
- Centro de Atención Primaria Turó-Vilapicina, Institut Català de la Salut, Barcelona, Spain
| | - Carola Orrego
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
- Avedis Donabedian Research Institute (FAD), Spain
- Universidad Autónoma de Barcelona, Spain
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13
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Krieger B, Moser A, Morgenthaler T, Beurskens AJHM, Piškur B. Parents' Perceptions: Environments and the Contextual Strategies of Parents to Support the Participation of Children and Adolescents with Autism Spectrum Disorder-A Descriptive Population-Based Study from Switzerland. J Autism Dev Disord 2024; 54:871-893. [PMID: 36538129 PMCID: PMC9765345 DOI: 10.1007/s10803-022-05826-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2022] [Indexed: 12/24/2022]
Abstract
Environments have a modifying effect on the participation of children and adolescents with autism spectrum disorder (ASD) in all areas of life. This cross-sectional study investigated parental perspectives on supportive or hindering environments and the daily contextual strategies parents used to enhance their children's participation. Qualitative and quantitative data gathered from 115 parents from German-speaking Switzerland using the participation and environment measure-child and youth (PEM-CY) were analyzed. Results revealed 45 environmental supports and barriers at home, at school, and in the community. Contextual strategies were identified in combination with people, activities, time, objects, and places. Parental perspectives on participation and their contextual strategies should be considered in environmental-based interventions to support the participation of children and adolescents with ASD.
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Affiliation(s)
- Beate Krieger
- School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina Sulzer Platz 9, 8401, Winterthur, Switzerland.
- Department of Family Medicine, School Caphri, Maastricht University, Maastricht, The Netherlands.
| | - Albine Moser
- Department of Family Medicine, School Caphri, Maastricht University, Maastricht, The Netherlands
- Research Centre for Autonomy and Participation for People With Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
| | - Thomas Morgenthaler
- School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina Sulzer Platz 9, 8401, Winterthur, Switzerland
| | - Anna J H M Beurskens
- Department of Family Medicine, School Caphri, Maastricht University, Maastricht, The Netherlands
| | - Barbara Piškur
- Research Centre for Autonomy and Participation for People With Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands
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14
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Sale JEM, Frankel L, Bogoch E, Carlin-Coleman G, Hui S, Saini J, McKinlay J, Meadows L. The experience of feeling old after a fragility fracture. BMC Geriatr 2024; 24:180. [PMID: 38388900 PMCID: PMC10885483 DOI: 10.1186/s12877-024-04769-w] [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: 09/25/2023] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND There has been little exploration of the effect of fragility fractures on patient perceptions of their age. The common assumption is that fractures "happen to old people". In individuals with a fragility fracture, our objective was to explore the experience of feeling old after sustaining a fragility fracture. METHODS A secondary analysis of data from 145 community-dwelling women and men participating in six qualitative primary studies was conducted relying on a phenomenological approach. Participants were English-speaking, 45 years and older, who had sustained a recent fragility fracture or reported a history of previous fragility fractures. Data for the analysis included direct statements about feeling old as well any discussions relevant to age post-fracture. RESULTS We highlight two interpretations based on how individuals with a history of fragility fracture talked about age: (1) Participants described feeling old post-fracture. Several participants made explicit statements about being "old". However, the majority of participants discussed experiences post-fracture that implied that they felt old and had resigned themselves to being old. This appeared to entail a shift in thinking and perception of self that was permanent and had become a part of their identity; and (2) Perceptions of increasing age after sustaining a fracture were reinforced by health care providers, family, and friends. CONCLUSIONS Our findings challenge the notion that fractures "happen to old people" and suggest that fractures can make people feel old. Careful consideration of how bone health messages are communicated to patients post-fracture by health care providers is warranted. (Word Count: 248).
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Affiliation(s)
- Joanna E M Sale
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation , University of Toronto, 4th Floor- 155 College Street, M5T 3M6, Toronto, ON, Canada.
- Department of Surgery, Faculty of Medicine, University of Toronto, 5th Floor- 149 College Street, M5T 1P5, Toronto, ON, Canada.
| | - Lucy Frankel
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada
| | - Earl Bogoch
- Department of Surgery, University of Toronto, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W85, Toronto, ON, Canada
- Brookfield Chair in Fracture Prevention, University of Toronto, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada
| | - Gabriel Carlin-Coleman
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada
| | - Sean Hui
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada
| | - Jessica Saini
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada
| | - Jennifer McKinlay
- Musculoskeletal Health and Outcomes Research, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, M5B 1W8, Toronto, ON, Canada
| | - Lynn Meadows
- Department of Community Health Sciences , University of Calgary, 3D10 - 3280 Hospital Drive NW, AB, T2N 4Z6, Calgary, Canada
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15
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Simpson JE, Landers AL, White Hawk S. Longing to belong: The ambiguous loss of Indigenous fostered/adopted individuals. CHILD ABUSE & NEGLECT 2024; 148:106441. [PMID: 37833120 DOI: 10.1016/j.chiabu.2023.106441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 07/21/2023] [Accepted: 08/30/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Indigenous fostered/adopted individuals report high levels of grief because of their foster care/adoption. Little has been done, however, to explore how grief is experienced and the factors that contribute to said grief for fostered/adopted Indigenous individuals. OBJECTIVE This study examined the experiences of loss and grief of Indigenous individuals fostered/adopted during childhood. PARTICIPANTS AND SETTING Participants were 102 Indigenous fostered/adopted individuals who described the experiences of loss and grief related to adoption. METHODS This study utilized secondary data from the Fostered and Adopted Individuals Project. Inductive thematic analysis was conducted on open-ended survey data. RESULTS Two themes emerged: (1) ambiguous loss as a result of foster care and adoption and (2) the effects of the ambiguous loss that stem from foster care and adoption. Indigenous fostered/adopted persons experienced ambiguous loss in foster care and adoption. Their loss remained unresolved due to a loss of access to information about their family and tribe of origin. Although family of origin, tribal community, and culture were not physically present due to separation by foster care/adoption, they remained psychologically present. As a result of ambiguous loss, participants experienced disenfranchised grief, wondering and longing to belong, and mental health and substance abuse. CONCLUSION This study is the first of its kind to explore the loss and grief experiences of fostered/adopted Indigenous individuals using ambiguous loss theory. Ambiguous loss theory offers a framework for contextualizing the loss and grief that begins at separation and is present in adulthood.
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Affiliation(s)
- Jessica E Simpson
- Department of Family Social Science, College of Education and Human Development, University of Minnesota, St. Paul, MN, United States of America.
| | - Ashley L Landers
- Human Development and Family Science Program, Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, Columbus, OH, United States of America.
| | - Sandy White Hawk
- First Nations Repatriation Institute, Shakopee, MN, United States of America
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16
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Ziegler E, Carroll B. Primary care in Northern Ontario for transgender people in the context of the COVID-19 pandemic: A qualitative secondary analysis. J Nurs Scholarsh 2024; 56:76-86. [PMID: 37415313 DOI: 10.1111/jnu.12909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 02/23/2023] [Accepted: 04/19/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE To examine changes to primary care practice for transgender clients resulting from government mandated public health measures in response to COVID-19 in Northern Ontario. DESIGN Secondary analysis of qualitative data using interview transcripts from a dataset that included 15 interviews conducted between October 2020 and April 2021. METHODS The dataset came from a convergent mixed method study exploring the delivery of primary care services to transgender individuals in Northern Ontario. Qualitative interviews with primary care practitioners including nurse practitioners, nurses, physicians, social workers, psychotherapists, and pharmacists providing care for transgender people in Northern Ontario were included in the secondary analysis. RESULTS Fifteen primary care practitioner providing care to transgender individuals in Northern Ontario participated in the parent study. Practitioners described their understanding of the effect of the early stages of the COVID-19 pandemic changes on their practice and the care experience for their transgender patients. Two themes were identified and described by participants: (1) a change in the delivery of care; and (2) barriers and facilitators to care. CONCLUSIONS Practitioners' primary care experiences in the early waves of COVID suggest the integral use of telehealth in Northern Ontario transgender care. Nurses working in advance practice and nurse practitioners are essential in providing continuity of care for their transgender clients. CLINICAL RELEVANCE/SIGNIFICANCE Identification of initial practice changes for the primary care of trans people will illuminate avenues for further research. The urban, rural, and remote practice settings in Northern Ontario provide an opportunity for increasing access for gender diverse people in these areas and for developing increased understanding of uptake of telemedicine practice. Nurses are integral to primary care for transgender patients in Northern Ontario.
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Affiliation(s)
- Erin Ziegler
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Sigma Lambda Pi at Large Chapter, Toronto, Ontario, Canada
| | - Benjamin Carroll
- School of Nursing, Queen's University, Kingston, Ontario, Canada
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17
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Kalhovde AM, Kitzmüller G. Family Caregivers' Trajectories of Distress While Caring for a Person With Serious Mental Illness. QUALITATIVE HEALTH RESEARCH 2024; 34:154-165. [PMID: 37905732 PMCID: PMC10714708 DOI: 10.1177/10497323231203627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2023]
Abstract
Serious mental illness (SMI) can significantly impact the lives of individuals and their families. These families often experience great emotional distress over time due to the early onset of SMI, which in turn leads to long-term trajectories and only partial recovery. However, we do not fully understand the emotional distress of family caregivers. Thus, our aim was to enrich the understanding of the lived experiences of family caregivers' emotional trajectories of distress while caring for persons with SMI. We conducted a secondary analysis using a hermeneutic approach to the narratives of seven family caregivers from a study on living with voices unheard by others. Participants' trajectories of emotional distress came forth as being thrust on an unpredictable, intensely worrisome, and indefinite journey. The following themes highlighted this tumultuous journey: fumbling in the dark trying to grasp the incomprehensible, "on your toes"-enduring unpredictability, facing different forms of fear, and battling waves of sadness and regret. Caregivers face multiple threats to their well-being and sometimes even to their health. Their distress appeared to vary according to their relationship with the person with SMI, whether they lived with the ill person, illness trajectory, and amount of violent or suicidal behavior. The results underscore the need for individualized and timely information, opportunities for dialogue with healthcare providers with and without the person with SMI, and inclusion in care planning. Caregivers who have experienced trauma, threats of violence, and rejection require special attention.
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18
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Forstner J, Mangold J, Litke N, Weis A, Szecsenyi J, Wensing M, Ullrich C. [Between New Responsibility and Daily Routines - The Role of the VERAH in GP Care: A Qualitative Secondary Data Case Study of the Introduction of Software-Based Case Management]. DAS GESUNDHEITSWESEN 2023; 85:1124-1130. [PMID: 37852278 PMCID: PMC10713334 DOI: 10.1055/a-2144-5767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
BACKGROUND The concept of Care Assistant in General Practice (VERAH) was developed in order to integrate non-medical staff more strongly into primary care and thus to meet the increasing demand for care and the simultaneous shortage of medical staff. VERAHs are increasingly responsible for software-supported case management and are thus confronted with new tasks. The aim of this study was therefore to explore the role of the VERAH in primary care practices. METHODS The present study is a qualitative secondary data analysis; the data collection took place within the projects VESPEERA and TelePraCMan. Twenty individual interviews and two focus group meetings were conducted with a total of 30 physicians, VERAHs and medical assistants from primary care. The data were analysed qualitatively according to Emerson. Contextual and socio-demographic data were collected with an accompanying questionnaire. RESULTS The VERAHs of all primary care practices from which interview partners participated performed tasks within software-supported case management. Concerning the role of the VERAH, three themes were identified in the interviews: a) concrete tasks of the VERAH in software-supported case management within the practice team, b) relevance of software-supported case management within the activities of the VERAHS and c) relationship between VERAHs and patients. CONCLUSION Taking over tasks in software-supported case management can contribute to strengthening and expanding the role of the VERAH. In the future, more attention should be paid to a clear description of the new role, and the conditions of the VERAHs' task fulfilment should be considered.
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Affiliation(s)
- Johanna Forstner
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Jasmin Mangold
- Institut für Gesundheitswissenschaften, Abteilung
Pflegewissenschaft, Universitätsklinikum Tübingen,
Tübingen, Germany
- Zentrum für öffentliches Gesundheitswesen und
Versorgungsforschung (ZÖGV), Universitätsklinikum
Tübingen, Tübingen, Germany
| | - Nicola Litke
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Aline Weis
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Michel Wensing
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
| | - Charlotte Ullrich
- Abteilung für Allgemeinmedizin und Versorgungsforschung,
UniversitätsKlinikum Heidelberg, Heidelberg, Germany
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19
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Reif MM, Secunda KE, Clapp JT, Viglianti EM, Mylvaganam R, Peliska M, Holl JL, Kruser JM. The Duality of "Goals of Care" Language: A Qualitative Focus Group Study With Frontline Clinicians. J Pain Symptom Manage 2023; 66:e658-e665. [PMID: 37597589 PMCID: PMC10845157 DOI: 10.1016/j.jpainsymman.2023.08.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 08/07/2023] [Accepted: 08/07/2023] [Indexed: 08/21/2023]
Abstract
CONTEXT The phrase "goals of care" (GOC) is common in serious illness care, yet it lacks clarity and consistency. Understanding how GOC is used across healthcare contexts is an opportunity to identify and mitigate root causes of serious illness miscommunication. OBJECTIVES We sought to characterize frontline palliative and critical care clinicians' understanding and use of the phrase GOC in clinical practice. METHODS We conducted a secondary qualitative thematic analysis of focus group transcripts (n = 10), gathered as part of a parent study of care delivery for patients with respiratory failure. Participants (n = 59) were members of the palliative and critical care interprofessional teams at two academic medical centers. RESULTS Clinicians primarily use GOC as a shorthand signal among team members to indicate a patient is nearing the end of life. This signal can also indicate conflict with patients and families when clinicians' expectations-typically an expected "transition" toward a different type of care-are not met. Clinicians distinguish their clinical use of GOC from an "ideal" meaning of the phrase, which is broader than end of life and focused on patients' values. Palliative care specialists encourage other clinicians to shift toward the "ideal" GOC concept in clinical practice. CONCLUSION Frontline palliative and critical care clinicians understand a duality in GOC, as an idealized concept and as an expeditious signal for clinical care. Our findings suggest ambiguous phrases like GOC persist because of unmet needs for better ways to discuss and address diverse and complex priorities for patients with serious illness.
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Affiliation(s)
- Michaella M Reif
- Department of Medicine (M.M.R., M.P.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Katharine E Secunda
- Department of Medicine (K.E.S.), Division of Pulmonary, Allergy and Critical Care, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justin T Clapp
- Department of Anesthesiology & Critical Care (J.T.C.), University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Elizabeth M Viglianti
- Division of Pulmonary and Critical Care (E.M.V.), University of Michigan, Ann Arbor, Michigan, USA; Veterans Affairs Center for Clinical Management Research (E.M.V.), HSR&D Center for Innovation, Ann Arbor, Michigan, USA
| | - Ruben Mylvaganam
- Division of Pulmonary and Critical Care (R.M.), Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Michael Peliska
- Department of Medicine (M.M.R., M.P.), University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jane L Holl
- Department of Neurology, Biological Sciences Division (J.L.H.), University of Chicago, Chicago, Illinois, USA
| | - Jacqueline M Kruser
- Department of Medicine (J.M.K.), Division of Allergy, Pulmonary and Critical Care, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
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20
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Oliffe JL. Connecting Masculinities to Men's Illness Vulnerabilities and Resilience. QUALITATIVE HEALTH RESEARCH 2023; 33:1322-1332. [PMID: 37902085 PMCID: PMC10666520 DOI: 10.1177/10497323231198967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2023]
Abstract
Men's illness vulnerabilities and resilience are two predominant and regularly linked constructs in the masculinities and men's health literature. There has been a steady stream of men's strength-based vulnerabilities in the form of illness testimonials amid critiques that such disclosures are mere props for bolstering patriarchal power. The current article presents secondary analyses of case studies with four participants who took part in wide-ranging qualitative health studies to detail diverse connections between masculinities and men's illness vulnerabilities and resilience. Prostate cancer-related vulnerabilities feature in the first case study where Arthur's resilience for reclaiming his erectile function post-prostatectomy mobilizes an objection masculinity contesting his marginality. In the second case study, Chuck's vulnerabilities are conceded as permanent flowing from his severe mental illness, a positionality situating resilience as obligatory for his survival. Here, Chuck embodies a resignate masculinity that accepts but works to manage the harms of his subordinate status. In the aftermath of his young son's suicide, Jack laments that he did not model vulnerabilities. Resilience for understanding his loss influences a reimagined masculinity where Jack contemplates changes to gender norms for his and other men's lives. Lastly, Sami replaces maladaptive actions for dousing vulnerabilities incurred through a partner-initiated separation with resilience for self-growth. Aspiring progress masculinity, Sami deconstructs his emotions and behaviors to positively change how he shows up as a man, father, and partner. The case studies reveal connections between objection, resignate, reimagined, and progress masculinities and men's illness vulnerabilities and resilience to advance empirical, gender theory and methodological insights.
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Affiliation(s)
- John L. Oliffe
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
- Department of Nursing, The University of Melbourne, Parkville, VIC, Australia
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21
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Forsner M, Cyrén M, Gerdin A, Rullander A. It hurts to get forced: Children's narratives about restraint during medical procedures. PAEDIATRIC & NEONATAL PAIN 2023; 5:110-118. [PMID: 38149218 PMCID: PMC10749400 DOI: 10.1002/pne2.12093] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/08/2022] [Accepted: 01/09/2023] [Indexed: 12/28/2023]
Abstract
According to the UN Convention on the Rights of the Child (UNCRC), children have the right to be involved in decisions about medical procedures affecting them. However, research has shown that healthcare professionals sometimes find this difficult to achieve and those procedures then are performed against the will of the child. The aim was to illuminate restraint from the perspective of children's and young people's experiences of feeling forced during medical procedures. Following the phenomenological hermeneutic method, a secondary qualitative analysis of narrative data from four datasets collected between 2001 and 2020 was performed. Twelve children and young people aged 6-19 years (three male, nine female) from central and northern Sweden narrated their experiences of restraint related to medical procedures in nine narrative interviews and three short written narratives. The analysis revealed that it hurts to get forced, this being illustrated in six themes: bodily misery, emotional rebellion, feeling disregarded, physically limited, desiring escape, and leaving deep traces. From the perspective of children and young people, restraint was interpreted with inspiration from the philosopher Michel Foucault, as being overpowered - not voluntary submission but offering resistance - and according to the theory of caring and uncaring, a relationship in which the healthcare professional is perceived as indifferent to the patient as a person. In conclusion restraint hurts and means powerlessness to the child, leaving deep traces that remain for a long time. The findings call the healthcare profession to take action to support children's self-determination, participation, and integrity in healthcare. How children experience restraint in healthcare merits further investigation from the children's own perspective.
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Farhana N, Peckham A, Marani H, Roerig M, Marchildon G. The Social Construction of Dementia: Implications for Healthcare Experiences of Caregivers and People Living with Dementia. J Patient Exp 2023; 10:23743735231211066. [PMID: 38026064 PMCID: PMC10663651 DOI: 10.1177/23743735231211066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Globally, systems have invested in a variety of dementia care programs in response to the aging population and those who have been diagnosed with dementia. This study is a qualitative secondary analysis of interview data from a larger study investigating stakeholder perceptions of programs that support caregivers and people living with an Alzheimer's Disease or Alzheimer's Disease-related dementia (AD/ADRD) in five North American jurisdictions. This study analyzed interviews with individuals living with an AD/ADRD and caregivers of individuals living with an AD/ADRD (n = 11). Thematic analysis was conducted to understand how the perception of dementia may have shaped their engagement and experience with healthcare systems. Our analysis resulted in three main themes of care users' experience: (i) undesirable experience owing to the overarching negative shared understanding and stereotyping of dementia; (ii) dismissal throughout disease progression when seeking health and social care support; and (iii) dehumanization during care interactions. The findings carry critical social and clinical implications, for example, in informing person-centered approaches to care, and communication tools clinicians can use to enhance provider, patient, and caregiver well-being.
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Affiliation(s)
- Nusrat Farhana
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
| | - Allie Peckham
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona, USA
- Center for Innovation in Healthy and Resilient Aging, Arizona State University, Phoenix, Arizona, USA
| | - Husayn Marani
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Monika Roerig
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Greg Marchildon
- North American Observatory on Health Systems and Policies, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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23
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Stone NI, Downe S. Women's experience of early labour in a free-standing birth centre: Midwifing embodied labour. Women Birth 2023; 36:538-545. [PMID: 36906450 DOI: 10.1016/j.wombi.2023.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
ISSUE Women who present at hospital labour wards in early labour must often meet measurable diagnostic criteria before admission. BACKGROUND Early labour is a phase of neurohormonal, emotional, and physical changes that are often not measurable. When admission to birthplace is based on results of diagnostic procedures, women's embodied knowledge may be disregarded. AIM To describe the early labour experience of women with spontaneous onset of labour in a free-standing birth centre, as well as midwifery care when women arrived in labour. METHODOLOGY An ethnographic study was conducted in 2015 in a free-standing birth centre after receiving ethics approval. The findings for this article were drawn from a secondary analysis of the data, which included interview data with women and detailed field notes of midwives' activities related to early labour. FINDINGS The women in this study were instrumental in the decision-making process to stay at the birth centre. Observational data showed that vaginal exams were rarely conducted when women arrived at the birth centre and were not a deciding factor in admission. DISCUSSION The women and midwives co-constructed early labour based on the lived experience of women and the meaning that this experience held for both. CONCLUSION Given the growing concern about the need for respectful maternity care, this study provides examples of good practice in listening to women, as well as an illustration of the consequences of not doing so.
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Affiliation(s)
- Nancy Iris Stone
- Evangelische Hochschule Berlin, Department of Midwifery Sciences, Teltower Damm 118-122, 14167 Berlin, Germany.
| | - Soo Downe
- School of Community Health & Midwifery, University of Central Lancashire, Preston PR1 2HE, UK
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Lin CP, Chiang CH, Sheu SJ. Using the Kipling method to explore the contextual factors of decision-making during advance care planning for older cancer patients, their family, and health-care professionals: A qualitative secondary analysis. Palliat Support Care 2023:1-7. [PMID: 37859416 DOI: 10.1017/s1478951523001256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
OBJECTIVES Advance care planning (ACP) interventions are supposed to affect patients' autonomy and family health-care outcomes positively. However, the clinical benefits of ACP actualization and associated contextual factors merit questioning. Therefore, this study explores the critical contextual and procedural factors related to ACP decision-making based on the actual situation of older patients with cancer encountering end-of-life care in Taiwan. METHODS This retrospective qualitative secondary analysis used the Kipling method (5W1H) to explore further the critical contextual and procedural factors related to ACP decision-making processes. We applied thematic analysis and dual coding for 35 narratives, including 10 patients with cancer, 10 family caregivers, and 15 health-care staff, derived from a preliminary qualitative study regarding palliative care decision-making among patients with advanced cancer, their families, and health-care staff. RESULTS We identified 6 domains detailing the contextual factors for ACP decision-making: (1) WHO (decision makers); (2) WHAT (discussion content); (3) WHEN (care plan for which disease stage); (4) WHERE (patient's situational location); (5) WHY (reasons underpinning the decisions); and (6) HOW (the way to form the decisions). SIGNIFICANCE OF RESULTS Using the Kipling method to elaborate the contextual factors for ACP decision-making among older patients with cancer strengthens the understanding of complicated end-of-life care decision-making procedure. This study also demonstrates the dynamic and cultural complexity and the various factors considered during end-of-life care and future ACP discussion.
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Affiliation(s)
- Cheng-Pei Lin
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery, and Palliative Care, King's College London, London, UK
| | - Chia-Hsuan Chiang
- Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuh-Jen Sheu
- Institute of Community Health Care, College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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25
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Bourgeois I, Maltais S. Translating Evaluation Policy Into Practice in Government Organizations. THE AMERICAN JOURNAL OF EVALUATION 2023; 44:353-373. [PMID: 37719780 PMCID: PMC10499548 DOI: 10.1177/10982140221079837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 09/19/2023]
Abstract
Organizational evaluation policies describe how evaluation practices should be structured and implemented. As such, they provide key insights into organizational priorities and values regarding evaluation. However, the link between evaluation policies and how evaluation policies translate into concrete practices has seldom been explored until now. Our study examines the implementation of two Canadian federal government evaluation policies over a 10-year timespan, through the secondary analysis of reports produced on behalf of governmental evaluation functions. Our findings show that some policy elements have been fully implemented, but the way in which these have been implemented varies between organizations. Further, we observed that the level of control of various organizational members responsible for implementing policy elements, as well as time, can influence implementation of certain policy requirements. We conclude by proposing further directions for research to examine the policy-practice link.
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26
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Michl G, Paterson C, Bail K. 'It's all about ticks': A secondary qualitative analysis of nurse perspectives about documentation audit. J Adv Nurs 2023; 79:3440-3455. [PMID: 37106563 DOI: 10.1111/jan.15685] [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: 06/06/2022] [Revised: 03/02/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023]
Abstract
AIM To understand how nurses talk about documentation audit in relation to their professional role. BACKGROUND Nursing documentation in health services is often audited as an indicator of nursing care and patient outcomes. There are few studies exploring the nurses' perspectives on this common process. DESIGN Secondary qualitative thematic analysis. METHODS Qualitative focus groups (n = 94 nurses) were conducted in nine diverse clinical areas of an Australian metropolitan health service for a service evaluation focussed on comprehensive care planning in 2020. Secondary qualitative analysis of the large data set using reflexive thematic analysis focussed specifically on the nurse experience of audit, as there was the significant emphasis by participants and was outside the scope of the primary study. RESULTS Nurses': (1) value quality improvement but need to feel involved in the cycle of change, (2) highlight that 'failed audit' does not equal failed care, (3) describe the tension between audited documentation being just bureaucratic and building constructive nursing workflows, (4) value building rapport (with nurses, patients) but this often contrasted with requirements (organizational, legal and audit) and additionally, (5) describe that the focus on completion of documentation for audit creates unintended and undesirable consequences. CONCLUSION Documentation audit, while well-intended and historically useful, has unintended negative consequences on patients, nurses and workflows. IMPACT Accreditation systems rely on care being auditable, but when individual legal, organizational and professional standards are implemented via documentation forms and systems, the nursing burden is impacted at the point of care for patients, and risks both incomplete cares for patients and incomplete documentation. NO PATIENT OR PUBLIC CONTRIBUTION Patients participated in the primary study on comprehensive care assessment by nurses but did not make any comments about documentation audit.
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Affiliation(s)
- Gabriella Michl
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
| | - Catherine Paterson
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra, Australian Capital Territory, Australia
- Robert Gordon University, Aberdeen, UK
| | - Kasia Bail
- School of Nursing, Midwifery and Public Health, University of Canberra, Bruce, Australian Capital Territory, Australia
- Canberra Health Services & ACT Health, SYNERGY Nursing & Midwifery Research Centre, Canberra, Australian Capital Territory, Australia
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Simpson R, Szigeti Z, Sheppard CL, Minezes J, Hitzig SL, Mayo AL, Robinson L, Lung M, Wasilewski MB. The experiences of patients, family caregivers, healthcare providers, and health service leaders with compassionate care following hospitalization with COVID-19: a qualitative study. Disabil Rehabil 2023; 45:2896-2905. [PMID: 36354063 DOI: 10.1080/09638288.2022.2113564] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/04/2022] [Accepted: 08/07/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE This study explored the experiences of patients, caregivers, healthcare providers, and health service leaders of compassion in the care of people hospitalized with COVID-19. MATERIALS AND METHODS This study is a secondary analysis of qualitative data deriving from primary research data on recommendations for healthcare organizations providing care to people hospitalized with COVID-19. Participants comprised patients with COVID-19 (n = 10), family caregivers (n = 5) and HCPs in COVID-19 units (n = 12). Primary research data were analyzed deductively under the "lens" of compassion, as defined by Goetz. RESULTS Four interacting themes were found: (1) COVID-19 - to care or not to care? The importance of feeling safe, (2) A lonely illness - suffering in isolation with COVID-19, (3) Compassionate care for people with COVID-19 across the hospital continuum, and (4) Sustaining compassionate care for people hospitalized with COVID-19 - healthcare provider compassion fatigue and burnout. CONCLUSIONS Compassionate care is not a given for people hospitalized with COVID-19. Healthcare providers must feel safe to provide care before responding compassionately. People hospitalized with COVID-19 experience additional suffering through isolation. Compassionate care for people hospitalized with COVID-19 is more readily identifiable in the rehabilitation setting. However, compassion fatigue and burnout in this context threaten healthcare sustainability.IMPLICATIONS FOR REHABILITATIONHealthcare providers need to feel physically and psychologically safe to provide compassionate care for people hospitalized with COVID-19.People hospitalized with COVID-19 infection experience added suffering through the socially isolating effects of physical distancing.Compassion and virtuous behaviours displayed by healthcare providers are expected and valued by patients and caregivers, including during the COVID-19 pandemic.High levels of compassion fatigue and burnout threaten the sustainability of hospital-based care for people with COVID-19.
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Affiliation(s)
- Robert Simpson
- Sunnybrook Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | - Christine L Sheppard
- Sunnybrook Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | | | - Sander L Hitzig
- Sunnybrook Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Amanda L Mayo
- Sunnybrook Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Lawrence Robinson
- Sunnybrook Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
| | - Maria Lung
- Sunnybrook Research Institute, Toronto, Canada
| | - Marina B Wasilewski
- Sunnybrook Research Institute, Toronto, Canada
- University of Toronto, Toronto, Canada
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28
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Kokorelias KM, Singh H, Nelson MLA, Hitzig SL. "Why Do We Always Have to Focus on the Bad": A Strengths-Based Approach to Identify the Positive Aspects of Care From the Perspective of Older Adults Using a Secondary Qualitative Analysis. J Patient Exp 2023; 10:23743735231188841. [PMID: 37547702 PMCID: PMC10399251 DOI: 10.1177/23743735231188841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
Hospitalization is often viewed as a burdensome and stressful period for older adults and their family caregivers; however, little attention has been given to the positive aspects of the care continuum journey. The purpose of this article is to highlight the positive aspects of healthcare from the perspective of Canadian older adults with complex needs and their family caregivers. This study utilized a strengths-based theoretical perspective to conduct a secondary qualitative analysis of interviews with 12 older adults and seven family caregivers. Four themes relating to positive aspects of care were identified, including: (1) looking beyond illness, (2) emotional support from healthcare providers, (3) timely discharge, and (4) upholding independence. Focusing on the positive aspects can help determine areas of care practice that currently work well. These insights will be valuable for current and future initiatives seeking to restructure and optimize healthcare services for older adults.
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Affiliation(s)
- Kristina M Kokorelias
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- KITE, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
- Temerty Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Michelle LA Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Sander L Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Temerty Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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29
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Mason HRC, Pérez M, Colson ER, Jeffe DB, Aagaard EM, Teherani A, Hanson JL. Student and Teacher Perspectives on Equity in Clinical Feedback: A Qualitative Study Using a Critical Race Theory Lens. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2023; 98:S68-S74. [PMID: 37071697 DOI: 10.1097/acm.0000000000005248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
PURPOSE The authors aimed to gain a better understanding of students' and teachers' perspectives about whether clinical clerkship feedback is provided equitably irrespective of a student's race/ethnicity. METHOD A secondary analysis of existing interview data was conducted, focusing on racial/ethnic disparities in clinical grading. Data had been acquired from 29 students and 30 teachers at 3 U.S. medical schools. The authors performed secondary coding on all 59 transcripts, writing memos focused on statements related to aspects of feedback equity and developing a template for coding students' and teachers' observations and descriptions specific to clinical feedback. Using the template, memos were coded, and thematic categories emerged describing perspectives on clinical feedback. RESULTS Forty-eight (22 teachers and 26 students) participants' transcripts provided narratives about feedback. Both student and teacher narratives described how students who are racially/ethnically underrepresented in medicine may receive less helpful formative clinical feedback needed for professional development. Thematic analysis of narratives yielded 3 themes related to feedback inequities: 1) teachers' racial/ethnic biases influence the feedback they provide students, 2) teachers have limited skill sets to provide equitable feedback, and 3) racial/ethnic inequities in the clinical learning environment shape clinical and feedback experiences. CONCLUSIONS Narratives indicated that both students and teachers perceived racial/ethnic inequities in clinical feedback. Teacher- and learning environment-related factors influenced these racial/ethnic inequities. These results can inform medical education's efforts to mitigate biases in the learning environment and provide equitable feedback to ensure every student has what they need to develop into the competent physician they aspire to be.
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Affiliation(s)
- Hyacinth R C Mason
- H.R.C. Mason is assistant dean of students and associate professor of public health and community medicine, Tufts University School of Medicine, Boston, Massachusetts; ORCID: https://orcid.org/0000-001-6443-4244
| | - Maria Pérez
- M. Pérez is clinical research specialist, Washington University School of Medicine in St. Louis, St. Louis, Missouri; ORCID: https://orcid.org/0000-0002-2809-2504
| | - Eve R Colson
- E.R. Colson is professor of pediatrics and associate dean for program evaluation and continuous quality improvement, Washington University School of Medicine in St. Louis, St. Louis, Missouri; ORCID: https://orcid.org/0000-0003-3505-5071
| | - Donna B Jeffe
- D.B. Jeffe is professor of medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri; ORCID: https://orcid.org/0000-0002-7642-3777
| | - Eva M Aagaard
- E.M. Aagaard is professor of medicine, Carol B and Jerome T Loeb Professor of Medical Education, and senior associate dean for education, Washington University School of Medicine in St. Louis, St. Louis, Missouri; ORCID: https://orcid.org/0000-0002-5773-0923
| | - Arianne Teherani
- A. Teherani is professor of medicine, education scientist, Center for Faculty Educators, and director of program evaluation, University of California, San Francisco, School of Medicine, San Francisco, California; ORCID: https://orcid.org/0000-0003-2936-9832
| | - Janice L Hanson
- J.L. Hanson is professor of medicine, Washington University School of Medicine in St. Louis, St. Louis, Missouri; ORCID: https://orcid.org/0000-0001-7051-8225
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30
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Cowell I, McGregor A, O'Sullivan P, O'Sullivan K, Poyton R, Murtagh G. Physiotherapists' perceptions on using a multidimensional clinical reasoning form during psychologically informed training for low back pain. Musculoskelet Sci Pract 2023; 66:102797. [PMID: 37343402 DOI: 10.1016/j.msksp.2023.102797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 05/27/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Abstract
PURPOSE Building clinical reasoning skills is important to effectively implement psychologically informed practice. We developed a multidimensional clinical reasoning form (CRF) to be used by physiotherapists in a psychologically informed practice training programme for low back pain. In this paper we describe the development of the CRF, how the CRF was used in the training, and present an evaluation of physiotherapists' perceptions of the CRF. METHODS Qualitative semi-structured interviews were conducted with ten physiotherapists purposively sampled in primary care. Data were gathered through pre, and post training focus group interviews and a secondary analysis of individual physiotherapist interviews conducted after the training. Thematic analysis was used to analyse the data and capture the emergent themes. RESULTS Two main themes emerged before the training: (1) the CRF 'needs formal training' and (2) 'lacked instruction'. Three main themes emerged after the training (1) it provided 'a helpful framework for multidimensional clinical reasoning' (2) the CRF, and accompanying operational definitions, helped physiotherapists 'elicit information, with 'question prompts' helpful in facilitating patient disclosure (3) 'Utility' - although the CRF was not formally used by the physiotherapists it provided a conceptual reasoning framework to work from with more challenging patients. CONCLUSION The CRF was not designed to be used in isolation by clinicians without training. However, when used as a training adjunct it appears to be valued by physiotherapists to help develop their critical thinking and better characterise patients' presentations in order to personalise care from a bio-psychosocial perspective.
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Affiliation(s)
- Ian Cowell
- Department of Surgery and Cancer, Imperial College, London, UK; Brook Physiotherapy Ltd, Woodford Green, Essex, UK.
| | - Alison McGregor
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Peter O'Sullivan
- School of Physiotherapy and Exercise Science, Curtin University, WA,Australia; Bodylogic Physiotherapy, Perth, WA,Australia
| | - Kieran O'Sullivan
- School of Allied Health, University of Limerick, Ireland; Sports Spine Centre, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Ross Poyton
- Department of Surgery and Cancer, Imperial College, London, UK
| | - Ged Murtagh
- Department of Surgery and Cancer, Imperial College, London, UK
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Stenman T, Näppä U, Rönngren Y, Melin-Johansson C. "Daring to deal with the difficult and unexpected" registered nurses' confidential conversations with patients with palliative care needs: a qualitative interview study. BMC Palliat Care 2023; 22:108. [PMID: 37518580 PMCID: PMC10388485 DOI: 10.1186/s12904-023-01228-y] [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: 02/09/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND In palliative care, registered nurses provide advanced nursing care to relieve patients' symptoms and increase their quality of life based on physical, mental, social and existential dimensions. Conversations, often about existential issues, are an important part of nursing and can affect quality of life positively. Confidential conversations between patients and nurses occur naturally while other nursing activities are being performed. Despite their great importance for palliative care these are rarely described. AIM To gain a deeper understanding of how nurses in palliative care experience and describe confidential conversations with patients. METHOD Secondary analysis of data from 17 open-ended face-to-face interviews with registered nurses in palliative care was conducted. Qualitative content analysis using an inductive approach was used to gain a deeper understanding and analyse the latent content. RESULTS The confidential conversation was considered an important part of palliative care and is the nurse's responsibility. This responsibility was described as complex and placed various demands on the nurses, both personal and professional. A prerequisite for the conversation was the interpersonal relationship. The conversation allowed the patient to process important matters not previously addressed or put into words. It had no predetermined content, was unplanned and entirely on the patient's terms. For nurses the conversation could be experienced both as draining and a source of power and strength. The nurses also described safeguarding the patient through the conversation. CONCLUSION Nurses' confidential conversations with patients are essential in palliative care and must be highlighted more to increase the quality of palliative care. The confidential conversations often have an existential content and are challenging for the nurses. Therefore, nurses need time, knowledge, and supervision to increase their conversation skills.
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Affiliation(s)
- Tove Stenman
- Department of Health Sciences Nursing Science, Mid Sweden University, Östersund, Sweden.
| | - Ulla Näppä
- Department of Health Sciences Nursing Science, Mid Sweden University, Östersund, Sweden
| | - Ylva Rönngren
- Department of Health Sciences Nursing Science, Mid Sweden University, Östersund, Sweden
| | - Christina Melin-Johansson
- Department of Health Sciences Nursing Science, Mid Sweden University, Östersund, Sweden
- Department of Nursing, Mid Sweden University, Östersund, S-831 25, Sweden
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32
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Kafczyk T, Hämel K. Primary mental healthcare for older people in India: between stigmatization and community orientation. DISCOVER MENTAL HEALTH 2023; 3:14. [PMID: 37861873 PMCID: PMC10501019 DOI: 10.1007/s44192-023-00040-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/20/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Questions of equitable access to primary mental healthcare (PMHC) for older persons in India have been examined mostly in terms of the coverage of services, although perceptions of mental health and old age and social norms at the community level should be considered in the shaping of PMHC approaches. The present qualitative study, therefore, examined how social perceptions and norms of mental health in old age are and should be considered in the design and implementation of primary healthcare approaches in India. METHODS A secondary thematic analysis of semi-structured interviews with key stakeholders (n = 14) of PMHC in India was conducted. RESULTS Four key themes emerged from the analysis, in which social perceptions and norms were discussed: (1) family participation and low threshold access to mental healthcare, (2) the position of community health workers as an important pillar of old age and mental health-sensitive community-based care, (3) the role of social cohesion and traditional values in fostering a positive and supportive community environment for old age mental health, and (4) the empowerment of communities, families and older persons through mental health education. CONCLUSIONS PMHC, with its focus on mental health promotion, could be an important anchor for combatting negative attitudes about mental health and old age. The findings presented in this study can inform age-sensitive policies and programmes for mental health in India and could inform future research on the subject.
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Affiliation(s)
- Tom Kafczyk
- School of Public Health, Department of Health Services Research and Nursing Science, Bielefeld University, Universitaetsstrasse 25, 33651, Bielefeld, Germany.
| | - Kerstin Hämel
- School of Public Health, Department of Health Services Research and Nursing Science, Bielefeld University, Universitaetsstrasse 25, 33651, Bielefeld, Germany
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Laberge M, Brundisini FK, Zomahoun HTV, Sawadogo J, Massougbodji J, Gogovor A, David G, Légaré F. Knowledge exchange sessions on primary health care research findings in public libraries: A qualitative study with citizens in Quebec. PLoS One 2023; 18:e0289153. [PMID: 37490456 PMCID: PMC10368291 DOI: 10.1371/journal.pone.0289153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 07/12/2023] [Indexed: 07/27/2023] Open
Abstract
Little is known about knowledge transfer with the public. We explored how citizens, physicians, and communication specialists understand knowledge transfer in public spaces such as libraries. The initial study aimed at evaluating the scaling up of a program on disseminating research findings on potentially inappropriate medication. Twenty-two citizen workshops were offered by 16 physicians and facilitated by 6 communication specialists to 322 citizens in libraries during spring 2019. We did secondary analysis using the recorded workshop discussions to explore the type of knowledge participants used. Participants described four kinds of knowledge: biomedical, sociocultural beliefs, value-based reasoning, and institutional knowledge. Biomedical knowledge included scientific evidence, research methods, clinical guidelines, and access to research outcomes. Participants discussed beliefs in scientific progress, innovative clinical practices, and doctors' behaviours. Participants discussed values related to reliability, transparency, respect for patient autonomy and participation in decision-making. All categories of participants used these four kinds of knowledge. However, their descriptions varied particularly for biomedical knowledge which was described by physician-speakers and communication specialists-facilitators as scientific evidence, epidemiological and clinical practice guidelines, and pathophysiological theories. Communication specialists-facilitators also described scientific journalistic sources and scientific journalistic reports as proxies of scientific evidence. Citizens described biomedical knowledge in terms of knowledge to make informed decisions. These findings offer insights for future scientific knowledge exchange interventions with the public.
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Affiliation(s)
- Maude Laberge
- Faculty of Medicine, Department of Social and Preventive Medicine, Université Laval, Quebec, Canada
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Université Laval, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
| | - Francesca Katherine Brundisini
- Faculty of Medicine, Department of Social and Preventive Medicine, Université Laval, Quebec, Canada
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada
| | - Hervé Tchala Vignon Zomahoun
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Jasmine Sawadogo
- First Nations of Quebec and Labrador Health and Social Services Commission, Quebec, Canada
| | - José Massougbodji
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
| | - Amédé Gogovor
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada
| | - Geneviève David
- Centre d'excellence sur le Partenariat avec les Patients et le Public, Centre de Recherche du CHUM, Québec, Canada
- École Nationale d'administration Publique, Québec, Canada
| | - France Légaré
- VITAM Centre de Recherche sur la Santé Durable, CIUSSS de la Capitale Nationale, Québec, Canada
- Centre de Recherche du CHU de Québec-Université Laval, Université Laval, Québec, Canada
- Quebec SPOR-SUPPORT Unit, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Quebec, Canada
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Canada
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Zhong Y, McKenna L, Copnell B, Zhao W, Moss C. Professional Adaptation Experiences of Chinese Migrant Nurses in Australia: A Qualitative Study. West J Nurs Res 2023; 45:626-633. [PMID: 37021833 PMCID: PMC10278380 DOI: 10.1177/01939459231167711] [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] [Indexed: 04/07/2023]
Abstract
Chinese-educated nurses are increasingly important to the international labor market. This study aimed to examine how Chinese migrant nurses adapt and evolve professionally while pursuing nursing careers in Australia, using a qualitative descriptive approach. A total of 17 Chinese-educated nurses were recruited by purposive and snowball sampling in Australia during 2017. Data were collected by individual semi-structured interviews and analyzed using thematic analysis. Three central themes and eight subthemes were generated. Perceived differences in nursing involved: work options and flexibility, professional autonomy and independence, and freedom of expressing professional opinions. Elements comprising challenges to adaptation included communication barriers, nursing workload and responsibilities, and collegial relationships. Participants' professional transition journeys were accompanied by two key areas of self-evolution: Embracing the authentic self and embracing individual differences. Our findings have important implications for migrant-host nursing workforce integration in Australia and internationally.
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Affiliation(s)
- Yaping Zhong
- School of Nursing and Midwifery, Monash University, Victoria, Australia
- Peter MacCallum Cancer Centre, Victoria, Australia
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Victoria, Australia
| | - Beverley Copnell
- School of Nursing and Midwifery, La Trobe University, Victoria, Australia
| | - Wenjuan Zhao
- Department of Nursing Administration, Shanghai Cancer Center, Shanghai, China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Cheryle Moss
- School of Nursing and Midwifery, Monash University, Victoria, Australia
- School of Nursing and Midwifery, La Trobe University, Victoria, Australia
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Thompson HG, Askelson NM, Bucklin R, Gauthreaux N, Faber E, Ball C, Yang S, Steere E. Organization-Level Factors Associated With Burnout: Guided Discussions With Micropolitan Public Health Workers During COVID-19. J Occup Environ Med 2023; 65:580-583. [PMID: 36893056 PMCID: PMC10329979 DOI: 10.1097/jom.0000000000002837] [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] [Indexed: 03/10/2023]
Abstract
OBJECTIVE To understand how micropolitan public health workers (PHWs) experienced burnout antecedents during the COVID-19 pandemic. METHODS We conducted in-depth guided discussions with 34 representatives from 16 micropolitan public health departments using semistructured, open-ended questions about departments' experiences during the COVID-19 pandemic. We coded discussion transcripts to develop themes according to the Six Areas of Worklife model. RESULTS PHWs described antecedents of burnout that stemmed from organizational and external forces, most notably within the workload, control, reward, and values dimensions of the Six Areas of Worklife model, as well as instances of workplace violence. CONCLUSIONS Our findings support organization-level approaches to reducing and preventing burnout in the micropolitan public health workforce. We discuss addressing specific dimensions of the Six Areas of Worklife model when designing burnout solutions for this essential workforce.
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Erzse A, Karim SA, Rwafa-Ponela T, Kruger P, Hofman K, Foley L, Oni T, Goldstein S. Participatory prioritisation of interventions to improve primary school food environments in Gauteng, South Africa. BMC Public Health 2023; 23:1263. [PMID: 37386466 PMCID: PMC10308686 DOI: 10.1186/s12889-023-16101-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/11/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND In South Africa, overweight and obesity affect 17% of children aged 15-18. School food environments play a vital role in children's health, influencing dietary behaviours and resulting in high obesity rates. Interventions targeting schools can contribute to obesity prevention if evidence-based and context-specific. Evidence suggests that current government strategies are inadequate to ensure healthy school food environments. The aim of this study was to identify priority interventions to improve school food environments in urban South Africa using the Behaviour Change Wheel model. METHODS A three-phased iterative study design was implemented. First, we identified contextual drivers of unhealthy school food environments through a secondary framework analysis of 26 interviews with primary school staff. Transcripts were deductively coded in MAXQDA software using the Behaviour Change Wheel and the Theoretical Domains Framework. Second, to identify evidence-based interventions, we utilised the NOURISHING framework and matched interventions to identified drivers. Third, interventions were prioritised using a Delphi survey administered to stakeholders (n = 38). Consensus for priority interventions was defined as an intervention identified as being 'somewhat' or 'very' important and feasible with a high level of agreement (quartile deviation ≤ 0.5). RESULTS We identified 31 unique contextual drivers that school staff perceived to limit or facilitate a healthy school food environment. Intervention mapping yielded 21 interventions to improve school food environments; seven were considered important and feasible. Of these, the top priority interventions were to: 1) "regulate what kinds of foods can be sold at schools", 2) "train school staff through workshops and discussions to improve school food environment", and affix 3) "compulsory, child-friendly warning labels on unhealthy foods". CONCLUSION Prioritising evidence-based, feasible and important interventions underpinned by behaviour change theories is an important step towards enhanced policy making and resource allocation to tackle South Africa's childhood obesity epidemic effectively.
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Affiliation(s)
- Agnes Erzse
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa.
| | - Safura Abdool Karim
- University of KwaZulu-Natal, Durban, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
| | - Teurai Rwafa-Ponela
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Petronell Kruger
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Karen Hofman
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Louise Foley
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Tolu Oni
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Susan Goldstein
- SAMRC/ Wits Centre for Health Economics and Decision Science, PRICELESS SA, Faculty of Health Sciences, School of Public Health, University of Witwatersrand, Johannesburg, South Africa
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37
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Mitchell J, Cooke P, Arjyal A, Baral S, Jones N, Garbovan L, King R. Exploring the potential for children to act on antimicrobial resistance in Nepal: Valuable insights from secondary analysis of qualitative data. PLoS One 2023; 18:e0285882. [PMID: 37267313 PMCID: PMC10237405 DOI: 10.1371/journal.pone.0285882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 05/03/2023] [Indexed: 06/04/2023] Open
Abstract
This study explores the perceived roles of children in antimicrobial resistance (AMR) in two sites across Nepal. AMR is a global challenge and underpinned by many complex behavioural drivers including how antimicrobial medicines are sourced and used. Because of this social dynamic, several research groups are using community engagement (CE) approaches to understand AMR at community level. However, most data negate the importance of children in behaviours linked to, and potentially driving AMR. In this study, authors apply secondary analysis methods to 10 transcripts representing the views of 23 adults engaged in an AMR-focused film-making project. By focusing on participants' reference to children, we reveal that antimicrobial usage and adherence to health providers' messages can be influenced by the age of the patient. Secondly that children are involved in some of the behaviours which are known to drive antimicrobial resistance such as purchasing over-the-counter antibiotic drugs. Finally, community members discuss that, with careful creation of resources, AMR could be meaningfully presented in educational settings with a view to children acting as agents of change around AMR-driving behaviours. Findings suggest that age-inclusive community engagement projects could be effective in tackling AMR at community level in Nepal and other low resource settings.
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Affiliation(s)
- Jessica Mitchell
- Nuffield Centre for International Health and Development, Faculty of Medicine, University of Leeds, Leeds, United Kingdom
| | - Paul Cooke
- Centre for World Cinema and Digital Cultures, Faculty of Arts, Humanities and Cultures, University of Leeds, Leeds, United Kingdom
| | | | | | - Nichola Jones
- Nuffield Centre for International Health and Development, Faculty of Medicine, University of Leeds, Leeds, United Kingdom
| | - Lidis Garbovan
- Centre for World Cinema and Digital Cultures, Faculty of Arts, Humanities and Cultures, University of Leeds, Leeds, United Kingdom
| | - Rebecca King
- Nuffield Centre for International Health and Development, Faculty of Medicine, University of Leeds, Leeds, United Kingdom
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Shapiro LN, Gray MF, Freitag C, Taneja P, Kariya H, Crane PK, O'Hare AM, Vig EK, Taylor JS. Expanding the ethnographic toolkit: Using medical documents to include kinless older adults living with dementia in qualitative research. J Aging Stud 2023; 65:101140. [PMID: 37268383 DOI: 10.1016/j.jaging.2023.101140] [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: 07/01/2022] [Revised: 05/01/2023] [Accepted: 05/02/2023] [Indexed: 06/04/2023]
Abstract
Ethnographic research with cognitively impaired older adults can be challenging, in part because cognitive impairment raises questions about the ability to provide informed consent. Relying on proxy consent is a commonly used strategy, but often excludes people with dementia who lack close kin (de Medeiros, Girling, & Berlinger, 2022). In this paper, we describe how we have analyzed existing research data from a well-established and ongoing prospective cohort study, the Adult Changes in Thought Study, along with unstructured text from the medical records of participants who had no living spouse or adult children when they developed dementia, as a way of studying the circumstances, life trajectories, caregiving resources, and care needs of this vulnerable and difficult-to-research group. In this article, we detail this methodology, exploring what can and cannot be gleaned from it, what the ethical implications may be, and how and whether this type of research can be considered ethnographic. In conclusion, we argue that collaborative interdisciplinary research using existing, longitudinal research data and text from medical records deserves to be considered as a potentially useful addition to the ethnographic toolkit. We anticipate that this is a methodology that could be applied more broadly, and paired with more traditional ethnographic methods, might be one way to make research with this population more inclusive.
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Affiliation(s)
- Lily N Shapiro
- Kaiser Permanente Washington Health Research Institute, USA.
| | | | | | | | | | | | - Ann M O'Hare
- University of Washington and VA Puget Sound Health Care System, USA
| | - Elizabeth K Vig
- University of Washington and VA Puget Sound Health Care System, USA
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Bagautdinova D, Bylund CL, Kastrinos A, Hampton CN, Vasquez TS, Weiss ES, Sae-Hau M, Fisher CL. Adult sibling-related experiences while caring for a parent diagnosed with a blood cancer. FAMILIES, SYSTEMS & HEALTH : THE JOURNAL OF COLLABORATIVE FAMILY HEALTHCARE 2023; 41:140-148. [PMID: 36222643 PMCID: PMC10321271 DOI: 10.1037/fsh0000748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION An older parent's blood cancer diagnosis impacts the entire family system, including adult siblings, an often overlooked subsystem of the family. Yet, adult siblings are typically involved in their parents' care needs. We explored sibling-related experiences adult child caregivers identify while caring for a parent diagnosed with a blood cancer to capture information useful for caregiving intervention development. METHOD Fifteen adult child caregivers with at least 1 sibling participated in an in-depth, semistructured interview. Participants were 87% white and 80% daughters. A majority of caregivers were in midlife (M age = 44), with parents diagnosed between age 56 and 90. A thematic analysis was conducted on transcripts using the constant comparative method. RESULTS Caregivers described 3 types of sibling-related experiences that centered on (a) caregiving responsibilities (e.g., sharing/not sharing tasks; challenging feelings about lack of involvement); (b) expectations about the caregiver role (e.g., gender, family status, and birth order expectations); and (c) coping together and apart (e.g., receiving information together, enhanced relationships, divergent maladaptive coping). DISCUSSION Findings illustrate how a parent's blood cancer diagnosis can enhance the sibling bond and family system as well as contribute to tension, particularly regarding the experiences of not sharing caregiving tasks or having divergent approaches to coping. Findings also provide insight into areas in which supportive interventions or resources are needed (e.g., helping siblings talk about caregiving involvement) to promote healthy family functioning after a blood cancer diagnosis. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | - Carma L. Bylund
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
| | - Amanda Kastrinos
- Memorial Sloan Kettering Cancer Center, New York, New York, United States
| | | | | | - Elisa S. Weiss
- The Leukemia & Lymphoma Society, Rye Brook, New York, United States
| | - Maria Sae-Hau
- The Leukemia & Lymphoma Society, Rye Brook, New York, United States
| | - Carla L. Fisher
- College of Journalism and Communications, University of Florida
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida
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Fang ML, Canham SL, Battersby L. Supporting intersecting cultural needs of gender and age by increasing cultural safety and humility for Housing First initiatives. BMC Public Health 2023; 23:1005. [PMID: 37254119 DOI: 10.1186/s12889-023-15955-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 05/22/2023] [Indexed: 06/01/2023] Open
Abstract
BACKGROUND To sufficiently house and support persons experiencing homelessness (PEH), deeper understandings of the cultural appropriateness and responsiveness of community resources and the service delivery system is essential. In the case of Metro Vancouver, Canada, the cultural appropriateness and responsiveness of Housing First as a service model for supporting PEH was explored. METHODS Local service providers and stakeholders (n = 52) participated in three full day service-mapping workshops to identify Housing First supports for older adults, youth, and women experiencing homelessness, as part of a municipal-wide participatory and action-oriented study. Data were analyzed using a structured framework thematic analysis approach and cultural safety and humility lenses. RESULTS We generated three key themes: (i) insufficient built environments create challenges across gender and age, (ii) cultural safety and humility concerns at the intersection of gender and age, and (iii) implications for a culturally-responsive Housing First implementation. CONCLUSIONS Findings informed the development of a Culturally-Responsive Planning resource to support housing, health, and social service providers who are implementing Housing First initiatives.
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Affiliation(s)
- Mei Lan Fang
- School of Health Sciences, University of Dundee, City Campus, 11 Airlie Pl, Dundee, DD1 4HJ, UK.
- Department of Gerontology, Simon Fraser University, Burnaby, Canada.
| | - Sarah L Canham
- College of Social Work, College of Architecture and Planning, University of Utah, Salt Lake City, USA
| | - Lupin Battersby
- Knowledge Mobilization Hub, Simon Fraser University, Burnaby, Canada
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Cahill PT, Ng S, Dix L, Ferro MA, Turkstra L, Campbell WN. Outcomes management practices in tiered school-based speech-language therapy: A Canadian example. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:786-801. [PMID: 36426768 DOI: 10.1111/1460-6984.12822] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/28/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Measuring, assessing and managing outcomes in school practice environments is difficult due to the complex nature of school communities as well as the recent shift in service-delivery models towards tiered approaches. In tiered approaches, multiple levels of service are offered to better match students' needs. Each level of service may require different outcomes and management techniques. Research to date on outcomes has focused on measuring outcomes in medical settings, leaving a substantive gap in the literature regarding practice in schools. AIMS The first aim was to explore how school-based speech-language therapists approached outcomes management as their clinical programmes transitioned to tiered service-delivery models The second aim was to describe the successes and challenges in outcomes management reported by clinicians in this context. METHODS & PROCEDURES A secondary deductive-inductive content analysis was performed using qualitative interviews with 24 clinical managers and senior therapists from schools across Ontario, Canada. Using a framework of outcomes measurement, assessment and management in schools based on previous research studies, data were grouped into broad categories deductively, and then the content of each category was further explored using inductive coding. Iterative peer debriefing and reflexive journaling were key strategies to increase the trustworthiness of the results. FINDINGS & RESULTS Participants reported measuring and qualitatively assessing seven key outcomes for school-based practice. These included: (1) student progress and achievement, (2) student participation and inclusion in the school community, (3) stakeholder perspectives, (4) 'buy-in', (5) expanded capacities, (6) responsiveness to needs and (7) accountability to systems. Participants reported more challenges than successes in outcomes management during this transition to tiered services. Challenges were attributed to idiosyncratic organizational barriers, the transition to tiered models and the philosophy of working within the educational system. CONCLUSIONS & IMPLICATIONS School-based speech-language therapists measure, assess and manage multiple outcomes relevant to school-based practice in tiered service-delivery models. Many challenges remain. Solutions to support meaningful, systematic and proactive outcomes management in schools should address the broader set of outcomes relevant to tiered service-delivery models and the unique practice context of the educational system, while remaining responsive to idiosyncratic organizational factors. Sustained clinical-research collaboration and knowledge exchange is recommended. WHAT THIS PAPER ADDS What is already known on the subject Systematic, proactive collection and interpretation of outcomes has long been encouraged within speech-language therapy. However, implementing outcomes management in clinical practice remains a substantial challenge. Additionally, research on outcomes to date has focused on medical practice environments, to the exclusion of school-based practice. What are the potential or actual clinical implications of this work? Outcomes management is valued in school practice environments; however, the current repertoire of techniques for outcomes management are a poor match for school-based practice. Clinicians in schools would benefit from the development of contextually relevant, meaningful and feasible outcomes management tools.
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Affiliation(s)
- Peter T Cahill
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Stella Ng
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Centre for Interprofessional Education, University of Toronto, Toronto, ON, Canada
| | - Leah Dix
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
| | - Mark A Ferro
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Lyn Turkstra
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Wenonah N Campbell
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
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Maehre KS, Bergdahl E, Hemberg J. Patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting in Norway. Nurs Open 2023; 10:2464-2476. [PMID: 36451339 PMCID: PMC10006603 DOI: 10.1002/nop2.1503] [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: 05/12/2022] [Revised: 09/08/2022] [Accepted: 11/16/2022] [Indexed: 12/03/2022] Open
Abstract
PATIENT OR PUBLIC CONTRIBUTION Patients, relatives and nurses were involved in this study. AIM The aim was to explore patients', relatives' and nurses' experiences of palliative care on an advanced care ward in a nursing home setting after implementation of the Coordination Reform in Norway. DESIGN Secondary analysis of qualitative interviews. METHODS Data from interviews with 19 participants in a nursing home setting: severely ill older patients in palliative care, relatives and nurses. Data triangulation influenced by Miles and Huberman was used. RESULTS The overall theme was "Being in an unfamiliar and uncaring culture leaves end-of-life patients in desperate need of holistic, person-centred and co-creative care". The main themes were: "Desire for engaging palliative care in a hopeless and lonely situation", "Patients seeking understanding of end-of-life care in an unfamiliar setting" and "Absence of sufficient palliative care and competence creates insecurity". The patients and relatives included in this study experienced an uncaring culture, limited resources and a lack of palliative care competence, which is in direct contrast to that which is delineated in directives, guidelines and recommendations. Our findings reveal the need for policymakers to be more aware of the challenges that may arise when healthcare reforms are implemented. Future research on palliative care should include patients', relatives' and nurses' perspectives.
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Affiliation(s)
- Kjersti Sunde Maehre
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Elisabeth Bergdahl
- School of Health Sciences, Institution of Health Sciences, Örebro University, Örebro, Sweden
| | - Jessica Hemberg
- Department of Caring Sciences, Faculty of Education and Welfare Studies, Åbo Akademi University, Vaasa, Finland
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Kelly HK, Geller S, Swami V, Shenkman G, Levy S, Ridge D. A relational investigation of Israeli gay fathers' experiences of surrogacy, early parenthood, and mental health in the context of the COVID-19 pandemic. PLoS One 2023; 18:e0282330. [PMID: 36827339 PMCID: PMC9956003 DOI: 10.1371/journal.pone.0282330] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 02/14/2023] [Indexed: 02/25/2023] Open
Abstract
Perinatal distress affects approximately 10% of fathers, but little is known about how gay fathers experience the challenges surrounding childbirth and early parenting of a child. This study explored gay fathers' experiences of having a baby via transnational surrogacy, raising that baby as a gay parent, and the context of the COVID-19 pandemic. In-depth qualitative interviews were conducted with 15 Israeli men to understand their experiences of surrogacy and early parenthood, focusing on the impact on their mental health and the relational factors involved. Secondary narrative analysis revealed that fathers constructed surrogacy as a perilous quest that required strong intentionality to undertake. The first year of parenthood was conceptualised alternately as a joyful experience and/or one that challenged fathers' identities and mental health. A relational framework was applied to better conceptualise the fathers' narratives, revealing that actual connections-and the potentials for links-considerably shaped experiences of surrogacy, perinatal distress and recovery. Implications for research and policy are discussed.
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Affiliation(s)
- Hannah Kate Kelly
- School of Social Sciences, University of Westminster, London, United Kingdom
| | - Shulamit Geller
- Statistics Education Unit, The Academic College of Tel Aviv Yaffo, Tel Aviv-Yafo, Israel
| | - Viren Swami
- School of Psychology and Sport Science, Anglia Ruskin University, Cambridge, United Kingdom,Centre for Psychological Medicine, Perdana University, Kuala Lumpur, Malaysia
| | - Geva Shenkman
- School of Psychology, Reichman University (Interdisciplinary Center, IDC), Herzliya, Israel
| | - Sigal Levy
- Statistics Education Unit, The Academic College of Tel Aviv Yaffo, Tel Aviv-Yafo, Israel
| | - Damien Ridge
- School of Social Sciences, University of Westminster, London, United Kingdom,* E-mail:
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McCarthy M, Gillies K, Rousseau N, Wade J, Gamble C, Toomey E, Matvienko-Sikar K, Sydes M, Dowling M, Bryant V, Biesty L, Houghton C. Qualitative data sharing practices in clinical trials in the UK and Ireland: towards the production of good practice guidance. HRB Open Res 2023; 6:10. [PMID: 37456658 PMCID: PMC10345597 DOI: 10.12688/hrbopenres.13667.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 08/17/2023] Open
Abstract
Background: Data sharing enables researchers to conduct novel research with previously collected datasets, thus maximising scientific findings and cost effectiveness, and reducing research waste. The value of sharing, even de-identified, quantitative data from clinical trials is well recognised with a moderated access approach recommended. While substantial challenges to sharing quantitative data remain, there are additional challenges for sharing qualitative data in trials. Incorporating the necessary information about how qualitative data will be shared into already complex trial recruitment and consent processes proves challenging. The aim of this study was to explore whether and how trial teams share qualitative data collected as part of the design, conduct, analysis, or delivery of clinical trials. Methods: Phase 1 involved semi-structured, in-depth qualitative interviews and focus groups with key trial stakeholder groups including trial managers and clinical trialists (n=3), qualitative researchers in trials (n=9), members of research funding bodies (n=2) and trial participants (n=1). Data were analysed using thematic analysis. In Phase 2, we conducted a content analysis of 16 participant information leaflets (PIL) and consent forms (CF) for trials that collected qualitative data. Results: Three key themes were identified from our Phase 1 findings: ' Understanding and experiences of the potential benefits of sharing qualitative data from trials', 'Concerns about qualitative data sharing', and ' Future guidance and funding'. In phase 2, the PILs and CFs received revealed that the benefits of data sharing for participants were only explained in two of the study documents. Conclusions: The value of sharing qualitative data was acknowledged, but there are many uncertainties as to how, when, and where to share this data. In addition, there were ethical concerns in relation to the consent process required for qualitative data sharing in trials. This study provides insight into the existing practice of qualitative data sharing in trials.
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Affiliation(s)
- Megan McCarthy
- School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Katie Gillies
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nikki Rousseau
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Julia Wade
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Carrol Gamble
- Health Data Science, University of Liverpool, Liverpool, UK
| | - Elaine Toomey
- School of Allied Health, University of Limerick, Limerick, Ireland
| | | | - Matthew Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, UCL, UK
- BHF Data Science Centre, Health Data Research UK, London, UK
| | - Maura Dowling
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
| | - Val Bryant
- No particular affiliation, No particular affiliation, UK
| | - Linda Biesty
- School of Nursing and Midwifery, University of Galway, Galway, Ireland
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Kushniruk A, Heidebrecht C, Zettler A, Pearce J, Cunha R, Quan S, Mansfield E, Tang T. The Perceived Ease of Use and Perceived Usefulness of a Web-Based Interprofessional Communication and Collaboration Platform in the Hospital Setting: Interview Study With Health Care Providers. JMIR Hum Factors 2023; 10:e39051. [PMID: 36689261 PMCID: PMC9947815 DOI: 10.2196/39051] [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: 04/27/2022] [Revised: 09/12/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Hospitalized patients with complex care needs require an interprofessional team of health professionals working together to support their care in hospitals and during discharge planning. However, interprofessional communication and collaboration in inpatient settings are often fragmented and inefficient, leading to poor patient outcomes and provider frustration. Health information technology can potentially help improve team communication and collaboration; however, to date, evidence of its effectiveness is lacking. There are also concerns that current implementations might further fragment communication and increase the clinician burden without proven benefits. OBJECTIVE In this study, we aimed to generate transferrable lessons for future designers of health information technology tools that facilitate team communication and collaboration. METHODS A secondary analysis of the qualitative component of the mixed methods evaluation was performed. The electronic communication and collaboration platform was implemented in 2 general internal medicine wards in a large community teaching hospital in Mississauga, Ontario, Canada. Fifteen inpatient clinicians in those wards, including nurses, physicians, and allied health care providers, were recruited to participate in semistructured interviews about their experience with a co-designed electronic communication and collaboration tool. Data were analyzed using the Technology Acceptance Model, and themes related to the constructs of perceived ease of use (PEOU) and perceived usefulness (PU) were identified. RESULTS A secondary analysis guided by the Technology Acceptance Model highlighted important points. Intuitive design precluded training as a barrier to use, but lack of training may hinder participants' PEOU if features designed for efficiency are not discovered by users. Organized information was found to be useful for creating a comprehensive clinical picture of each patient and facilitating improved handovers. However, information needs to be both comprehensive and succinct, and information overload may negatively impact PEOU. The mixed paper and electronic practice environment also negatively impacted PEOU owing to unavoidable double documentation and the need for printing. Participants perceived the tool to be useful as it improved efficiency in information retrieval and documentation, improved the handover process, afforded another mode of communication when face-to-face communication was impractical, and improved shared awareness. The PU of this tool depends on its optimal use by all team members. CONCLUSIONS Electronic tools can support communication and collaboration among interprofessional teams caring for patients with complex needs. There are transferable lessons learned that can improve the PU and PEOU of future systems.
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Affiliation(s)
| | | | - Andrea Zettler
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Jacklyn Pearce
- Bellwoods Centres for Community Living Inc, Toronto, ON, Canada
| | - Rafael Cunha
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | | | - Elizabeth Mansfield
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada.,Department of Medicine, University of Toronto, Toronto, ON, Canada
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M Kokorelias K, L Sheppard C, L Hitzig S. The role of patient navigation in supporting low-income older adults in their housing needs during hospital to home transitions: A qualitative descriptive study from Ontario, Canada. INTERNATIONAL JOURNAL OF CARE COORDINATION 2023. [DOI: 10.1177/20534345231151209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Introduction Housing is an important determinant of health. Little research has explored hospital and community agency staff perspectives on how to support the housing needs of low-income older adults. Therefore, this paper examines the challenges associated with supporting low-income seniors as they transition from hospital to home and explores what role, if any, patient navigation models of care could have in addressing housing needs. Methods A thematic secondary analysis that triangulated data from two qualitative studies was used. In total, interviews and/or focus groups with 109 hospital and community care workers were re-analyzed, applying a new interpretive lens to the data to reveal new insights. Data were collected in Ontario, Canada. Results Participants described how low-income older adults have increasing complex care needs that influence their housing, but housing supports are limited and difficult to navigate. Participants believed further support was needed and suggested that a housing-specific patient navigation model of care may be beneficial, but difficult to implement due to the limitations of existing services. Discussion Our findings provide a unique perspective on the challenges hospital and community staff face in caring for older adults with housing needs. Patient navigation with a focus on housing may support these older adults. Further work needs to be undertaken to better understand how to best implement sustainable housing patient navigation models of care.
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Affiliation(s)
- Kristina M Kokorelias
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christine L Sheppard
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Occupational Science & Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Koh WQ, Vandemeulebroucke T, Gastmans C, Miranda R, Van den Block L. The ethics of pet robots in dementia care settings: Care professionals' and organisational leaders' ethical intuitions. Front Psychiatry 2023; 14:1052889. [PMID: 36756218 PMCID: PMC9899814 DOI: 10.3389/fpsyt.2023.1052889] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 01/05/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Pet robots are gaining momentum as a technology-based intervention to support the psychosocial wellbeing of people with dementia. Current research suggests that they can reduce agitation, improve mood and social engagement. The implementation of pet robots in care for persons with dementia raises several ethical debates. However, there is a paucity of empirical evidence to uncover care providers' ethical intuitions, defined as individuals' fundamental moral knowledge that are not underpinned by any specific propositions. OBJECTIVES Explore care professionals' and organisational leaders' ethical intuitions before and when implementing pet robots in nursing homes for routine dementia care. MATERIALS AND METHODS We undertook a secondary qualitative analysis of data generated from in-depth, semi-structured interviews with 22 care professionals and organisational leaders from eight nursing homes in Ireland. Data were analysed using reflexive thematic analysis. Ethical constructs derived from a comprehensive review of argument-based ethics literature were used to guide the deductive coding of concepts. An inductive approach was used to generate open codes not falling within the pre-existing concepts. FINDINGS Ethical intuitions for implementing pet robots manifested at three levels: an (1) individual-relational, (2) organisational and (3) societal level. At the individual-relational level, ethical intuitions involved supporting the autonomy of residents and care providers, using the robots to alleviate residents' social isolation, and the physical and psychosocial impacts associated with their use. Some care providers had differing sentiments about anthropomorphizing pet robots. At the organisational level, intuitions related to the use of pet robots to relieve care provision, changes to the organisational workflow, and varying extents of openness amongst care providers to use technological innovations. At the societal level, intuitions pertained conceptions of dementia care in nursing homes, and social justice relating to the affordability and availability of pet robots. Discrepancies between participants' ethical intuitions and existing philosophical arguments were uncovered. CONCLUSION Care professionals and organisational leaders had different opinions on how pet robots are or should be implemented for residents with dementia. Future research should consider involving care practitioners, people with dementia, and their family members in the ethics dialogue to support the sustainable, ethical use of pet robots in practice.
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Affiliation(s)
- Wei Qi Koh
- College of Nursing, Medicine, and Health Sciences, University of Galway, Galway, Ireland
| | - Tijs Vandemeulebroucke
- Sustainable AI Lab, Institut für Wissenschaft und Ethik, University of Bonn, Bonn, Germany
| | - Chris Gastmans
- Centre for Biomedical Ethics and Law, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | - Rose Miranda
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) and Ghent University, Brussels, Belgium
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Sultan MAS, Khorram-Manesh A, Sørensen JL, Berlin J, Carlström E. Disaster Collaborative Exercises for Healthcare Teamwork in a Saudi Context. INTERNATIONAL JOURNAL OF DISASTER RISK SCIENCE 2023; 14:183-193. [PMCID: PMC10088626 DOI: 10.1007/s13753-023-00484-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/26/2023] [Indexed: 07/10/2024]
Abstract
This study aimed to evaluate the development of healthcare teamwork during and after the collaboration tabletop exercises, through observation and interview methods. Integration and maturity theoretical models were employed to explain the collaborative challenges in teams that may suffer from unequally distributed power, hierarchies, and fragmentation. Using three-level collaboration tabletop exercises and the Command and control, Safety, Communication, Assessment, Treatment, Triage, Transport (CSCATTT) instrument, 100 healthcare workers were observed during each step in the implementation of the CSCATTT instrument using two simulated scenarios. The results show a lack of integration and team maturity among participants in the first scenario, leading to the delayed start of the activity, task distribution, and decision making. These shortcomings were improved in the second scenario. In-depth interviews with 20 participants in the second phase of the study revealed improved knowledge and practical skills, self-confidence, and ability in team building within trans-professional groups in the second scenario, which in concordance with the integration theory, was due to the attempts made in the first scenario. Additionally, there was an improvement in the team’s maturity, which in concordance with the maturity theory, was due to the knowledge and practical skills during scenario plays. These results indicate the importance of continuous tabletop training, and the use of CSCATTT as a collaborative instrument, to promote the development of collaboration and to test the concept of preparedness.
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Affiliation(s)
- Mohammed Ali Salem Sultan
- Model of Care, Healthcare Transformation, Regional Health Directorate, Najran, 66255 Saudi Arabia
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
| | - Amir Khorram-Manesh
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
- Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45 Gothenburg, Sweden
| | - Jarle Løwe Sørensen
- USN School of Business, University of South-Eastern Norway, 3199 Borre, Norway
| | - Johan Berlin
- Department of Social and Behavioural Studies, University West, 461 86 Trolhättan, Sweden
| | - Eric Carlström
- Institute of Health and Care Sciences, Sahlgrenska Academy, Gothenburg University, 405 30 Gothenburg, Sweden
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska Academy, 413 45 Gothenburg, Sweden
- USN School of Business, University of South-Eastern Norway, 3199 Borre, Norway
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Kitzmüller G, Wiklund Gustin L, Kalhovde AM. Filling the Void: The Role of Adult Siblings Caring for a Brother or Sister With Severe Mental Illness. Glob Qual Nurs Res 2023; 10:23333936231162230. [PMID: 37020709 PMCID: PMC10068502 DOI: 10.1177/23333936231162230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 04/03/2023] Open
Abstract
Little is known about the role of adult siblings’ caregiver role within the context of mental illness. Therefore, our purpose was to explore how siblings narrate their experiences of being the main caregivers of a brother or sister with severe mental illness and how they cooperate with their ill sibling and their family of origin. We used a narrative hermeneutic approach and performed a secondary analysis of two interviews of siblings derived from a study of peoples’ experiences of hearing voices. The findings illuminate the participants’ multifaceted roles and how differently siblings might deal with the multiple challenges of caring for an ill sibling. The mediating role between their ill sibling and their family of origin to reestablish the broken family bonds was a significant aspect. Nurses’ awareness of the important and multidimensional role of caregiving siblings can improve the provision of family support and promote involvement of siblings in the treatment of an ill family member.
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Affiliation(s)
- Gabriele Kitzmüller
- UiT, the Arctic University of Norway,
Narvik, Norway
- Gabriele Kitzmüller, UiT, the Arctic
University of Norway, Lodve Langesgt., Narvik, 8505, Norway.
| | - Lena Wiklund Gustin
- UiT, the Arctic University of Norway,
Narvik, Norway
- Mälardalen University, Västerås,
Sweden
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Baldwin CD, Lewis V, Thorndyke LE, Morahan PS, Gusic ME. Becoming by doing: How women in academic health sciences build a leadership identity through project experiences. MEDICAL TEACHER 2023; 45:73-79. [PMID: 35914521 DOI: 10.1080/0142159x.2022.2102469] [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: 06/15/2023]
Abstract
PURPOSE Leadership development programs often use institutional projects to activate learning. We explored how project work shaped leadership identity formation in senior women leaders from one academic health science center who enrolled in The Hedwig von Ameringen Executive Leadership in Academic Medicine (ELAM®) program. MATERIALS AND METHODS We interviewed ELAM Fellows and conducted a qualitative analysis of transcripts. Our primary analysis focused on the influences of projects on Fellows and institutions. Leadership identity formation emerged as a distinct pattern, so this narrative content was separated for secondary analysis. All authors approved the final assignment of themes and codes. RESULTS Participants described a multi-dimensional process for developing a leadership identity. Themes encompassed participants' View of Self and One's Image as a Leader, Interpersonal Relationships, and Commitment to a Value-based Goal. These internal factors grounded external influences, such as interactions with colleagues and institutional leaders, and the world beyond the institution. CONCLUSIONS We examined the process of leadership identity formation from the perspective of women leaders in academic health sciences who completed an institutional project during a leadership development program. Findings illustrate how internal and external forces, experienced in the context of project work, combine to influence leadership identity formation in women.
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Affiliation(s)
- Constance D Baldwin
- Division of General Pediatrics, University of Rochester Medical Center, Rochester, NY, USA
| | - Vivian Lewis
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Page S Morahan
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Maryellen E Gusic
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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