1
|
Bekaert S, Rawlings M, Shariff D, Sammut D, Cook G. New Modes of Practice: A Framework Analysis of School Nurses' Accounts of Working With Children and Young People During COVID-19. J Adv Nurs 2024. [PMID: 39352004 DOI: 10.1111/jan.16490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 08/19/2024] [Accepted: 09/09/2024] [Indexed: 10/03/2024]
Abstract
AIMS To identify new and accelerated modes of practice used by school nurses during the COVID pandemic. To create a quick reference infographic bringing together experiential evidence on the range and considerations regarding different modes of practice for use by the school nursing community of practice. DESIGN A descriptive qualitative secondary data analysis of open-ended questions in a survey, and focus groups with school nurses. The pragmatic aim was to focus on changes in school nurse modes of practice to ensure continued engagement with children and young people, and school nurses' experience of the benefits and challenges of these modes of practice. METHODS Data were collected from 98 school nurse participants across a United Kingdom-wide survey (n78) in April to May 2022, and focus groups (n20) in June to July 2022, within the School Nursing in the Time of COVID project. Data from the seven open-ended questions in the survey and four questions from the focus group were analysed using the framework approach. RESULTS Modes of practice fell into two categories: individual assessment and support (video-calling platforms, telephone contact, virtual messaging, walk-and-talks and home visits) and group support (wellbeing approaches, social media). Considerations for these modes rooted in school nurses' experience are described. Interpretations were used to create the summarising evidence-based infographic as a quick reference resource for school nurses. CONCLUSION There was no 'one size fits all' approach. The modes used by school nurses were adopted or developed out of necessity or resource availability and in response to the specific needs of individuals or groups. The developed infographic provides a quick reference guide to deliver the expressed need for knowledge exchange within the school nursing community by participants in the original studies and can be used to inform current school nurse practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE The developed evidence-based infographic has stand-alone value. It has the potential to raise awareness of the range of different strategies that can be used to facilitate and/or enhance engagement with children and young people, equip school nurses with knowledge to foster innovative and responsive practice and aid critical reflection in a complex post-pandemic landscape. The infographic is a unique resource and is a first step in knowledge exchange based on experiential learning. The resource will be used as the foundation for future work to develop a co-created training resource for school nurse students (undertaking the Specialist Community Public Health Nurses course) and/or continuing professional development resource for established school nurses. REPORTING METHOD This study has been conducted and reported in accordance with COREQ guidelines for qualitative research. PATIENT OR PUBLIC CONTRIBUTION A consultation group was closely involved with the planning, conduct and analysis of the original studies. This group consisted of representatives from professional organisations SAPHNA (School and Public Health Nurses Association) and the CPHVA (Community Practitioners' and Health Visitors' Association), a school nurse and a member of the public. SAPHNA have continued in their consultative role for this study and has provided content and usability feedback regarding the infographic. Early findings have been presented to the SN community of practice, and feedback invited, through presentation separately at the CPHVA and SAPHNA annual conference.
Collapse
Affiliation(s)
- Sarah Bekaert
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Maisie Rawlings
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Dominic Shariff
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| | - Dana Sammut
- Centre for Healthcare and Communities, University of Coventry, Coventry, UK
| | - Georgia Cook
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
| |
Collapse
|
2
|
Rosin M, Ni Mhurchu C, Mackay S. Implementing healthy food policies in health sector settings: New Zealand stakeholder perspectives. BMC Nutr 2024; 10:119. [PMID: 39244614 PMCID: PMC11380432 DOI: 10.1186/s40795-024-00924-z] [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: 04/21/2024] [Accepted: 08/23/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND In 2016, a voluntary National Healthy Food and Drink Policy was released to improve the healthiness of food and drinks for sale in New Zealand health sector organisations. The Policy aims to role model healthy eating and demonstrate commitment to health and well-being of hospital staff and visitors and the general public. This study aimed to understand the experiences of hospital food providers and public health dietitians/staff in implementing the Policy, and identify tools and resources needed to assist with the implementation. METHODS A maximum variation purposive sampling strategy (based on a health district's population size and food outlet type) was used to recruit participants by email. Video conference or email semi-structured interviews included 15 open-ended questions that focused on awareness, understanding of, and attitudes towards the Policy; level of support received; perceived customer response; tools and resources needed to support implementation; and unintended or unforeseen consequences. Data was analysed using a reflexive thematic analysis approach. RESULTS Twelve participants (eight food providers and four public health dietitians/staff) were interviewed; three from small (< 100,000 people), four from medium (100,000-300,000 people) and five from large (> 300,000 people) health districts. There was agreement that hospitals should role model healthy eating for the wider community. Three themes were identified relating to the implementation of the Policy: (1) Complexities of operating food outlets under a healthy food and drink policy in public health sector settings; (2) Adoption, implementation, and monitoring of the Policy as a series of incoherent ad-hoc actions; and (3) Policy is (currently) not achieving the desired impact. Concerns about increased food waste, loss of profits and an uneven playing field between food providers were related to the voluntary nature of the unsupported Policy. Three tools could enable implementation: a digital monitoring tool, a web-based database of compliant products, and customer communication materials. CONCLUSIONS Adopting a single, mandatory Policy, provision of funding for implementation actions and supportive tools, and good communication with customers could facilitate implementation. Despite the relatively small sample size and views from only two stakeholder groups, strategies identified are relevant to policy makers, healthcare providers and public health professionals.
Collapse
Affiliation(s)
- Magda Rosin
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand.
- Centre for Translational Health Research: Informing Policy and Practice (TRANSFORM), Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
| | - Cliona Ni Mhurchu
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
- Centre for Translational Health Research: Informing Policy and Practice (TRANSFORM), Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Sally Mackay
- Department of Epidemiology and Biostatistics, School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1142, New Zealand
| |
Collapse
|
3
|
Wingood M, Bamonti PM, Moore JB, Picha KJ. Exploring physical therapists' approach to addressing home exercise program-related low self-efficacy: knowledge, strategies, and barriers. Disabil Rehabil 2024:1-10. [PMID: 39158132 DOI: 10.1080/09638288.2024.2390050] [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: 04/23/2024] [Revised: 08/02/2024] [Accepted: 08/03/2024] [Indexed: 08/20/2024]
Abstract
PURPOSE Self-efficacy is the strongest predictor of completing home exercise programs (HEPs). How physical therapists address low levels of self-efficacy is unknown. Our objectives were to determine (1) knowledge and confidence in addressing patients' self-efficacy; (2) strategies used to address low self-efficacy; and (3) barriers. MATERIAL AND METHODS Licensed physical therapists who are actively treating patients in the United States participated in our mixed-methods study consisting of: (1) a survey on knowledge, barriers, and confidence; and (2) interviews on strategies used to address low self-efficacy. Descriptive statistics were calculated on all quantitative data. Braun and Clarke's 6-phase thematic analysis was used for the qualitative data. RESULTS All 37 participants believed that self-efficacy impacts HEP completion. The majority (72.9%) reported addressing low self-efficacy. Barriers that impacted the ability to address low self-efficacy (Theme 1) included lack of knowledge, confidence, tools, guidance, and community resources, patients' past experiences and complexities, inability to follow-up with patients, and reimbursement. Due to these barriers, participants primarily addressed patients' low self-efficacy via communication (Theme 2) and ensuring successful exercise completion (Theme 3). CONCLUSION Instead of using Bandura's fours sources of self-efficacy (i.e., mastery experiences, verbal persuasion, vicarious experiences, physiological state), participants verbalized addressing low self-efficacy via communication and successful exercise completion. Thus, implementation studies evaluating strategies to overcome the identified barriers are needed.
Collapse
Affiliation(s)
- Mariana Wingood
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Patricia M Bamonti
- Research & Development Service, VA Boston Healthcare System, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Justin B Moore
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
- Department of Epidemiology & Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Kelsey J Picha
- Department of Interdisciplinary Health Sciences, A.T. Still University, Mesa, Arizona, USA
| |
Collapse
|
4
|
Betera S, Wispriyono B, Nunu WN. Exploring the water, sanitation and hygiene status and health outcomes in Zimbabwe: a scoping review protocol. BMJ Open 2024; 14:e082224. [PMID: 39160105 PMCID: PMC11337704 DOI: 10.1136/bmjopen-2023-082224] [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: 11/16/2023] [Accepted: 07/31/2024] [Indexed: 08/21/2024] Open
Abstract
BACKGROUND The sixth United Nations Sustainable Development Goal emphasises universal access to clean water, sanitation and hygiene (WASH) to ensure human well-being as a fundamental human right for sustainable development. In Zimbabwe, WASH reforms began more than a century ago from the preindependence to postindependence era. However, countries face pressing challenges in improving their related health outcomes. Therefore, this scoping review aims to explore WASH status and how it influences health outcomes in Zimbabwe. METHODS AND ANALYSIS The leading databases to be searched for relevant sources published in English with an unrestricted search back until May 2024 include PubMed, EBSCO, SAGE, SpringerLink, Cochrane Library, ScienceDirect, Scopus, Web of Science and African Journals Online. A search string was developed for retrieving literature, and reports from key stakeholders in the WASH sector will be included in this study as grey literature. The study will employ a two-step screening process for identifying relevant literature incorporating Cohen's kappa coefficient statistics to estimate the inter-rater reliability between two independent reviewers using Mendeley and Rayyan software. The Strengthening the Reporting of Observational Studies in Epidemiology checklist for observational studies and the Consolidated Standards of Reporting Trials checklist for randomised controlled trials will be used for the quality checks. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews will guide this study in terms of data collection, extraction and analysis from relevant literature. Data charting was used to present and interpret the findings. The entire process is scheduled to commence in June 2024, with the manuscript anticipated to be submitted to a journal in October 2024. ETHICS AND DISSEMINATION This review will use only published data; therefore, no ethical clearance is required. The findings will be disseminated to relevant stakeholders through peer-reviewed journals, meetings, conferences, seminars and forums.
Collapse
Affiliation(s)
- Same Betera
- Department of Environmental Health, Universitas Indonesia, Kota Depok, Jawa Barat, Indonesia
| | - Bambang Wispriyono
- Department of Environmental Health, Universitas Indonesia, Kota Depok, Jawa Barat, Indonesia
| | - Wilfred Njabulo Nunu
- Department of Environmental Health, University of Botswana, Gaborone, Botswana
- Department of Public Health, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
5
|
Johnson G, Singh H, Helewa RM, Sibley KM, Reynolds KA, El-Kefraoui C, Doupe MB. Gastroenterologist and surgeon perceptions of recommendations for optimal endoscopic localization of colorectal neoplasms. Sci Rep 2024; 14:13157. [PMID: 38849393 PMCID: PMC11161634 DOI: 10.1038/s41598-024-63753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 05/31/2024] [Indexed: 06/09/2024] Open
Abstract
National consensus recommendations have recently been developed to standardize colorectal tumour localization and documentation during colonoscopy. In this qualitative semi-structured interview study, we identified and contrast the perceived barriers and facilitators to using these new recommendations according to gastroenterologists and surgeons in a large central Canadian city. Interviews were analyzed according to the Consolidated Framework for Implementation Research (CFIR) through directed content analysis. Solutions were categorized using the Expert Recommendations for Implementing Change (ERIC) framework. Eleven gastroenterologists and ten surgeons participated. Both specialty groups felt that the new recommendations were clearly written, adequately addressed current care practice tensions, and offered a relative advantage versus existing practices. The new recommendations appeared appropriately complex, applicable to most participants, and could be trialed and adapted prior to full implementation. Major barriers included a lack of relevant external or internal organizational incentives, non-existing formal feedback processes, and a lack of individual familiarity with the evidence behind some recommendations. With application of the ERIC framework, common barriers could be addressed through accessing new funding, altering incentive structures, changing record systems, educational interventions, identifying champions, promoting adaptability, and employing audit/feedback processes. Future research is needed to test strategies for feasibility and effectiveness.
Collapse
Affiliation(s)
- Garrett Johnson
- Department of Surgery, Section of General Surgery, University of Manitoba, AE101-820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada.
- Clinician Investigator Program, University of Manitoba, Winnipeg, Canada.
| | - Harminder Singh
- Department of Internal Medicine, University of Manitoba, and CancerCare Manitoba Research Institute, Winnipeg, Canada
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
| | - Ramzi M Helewa
- Department of Surgery, Section of General Surgery, University of Manitoba, AE101-820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada
| | - Kathryn M Sibley
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, MB, Canada
| | - Kristin A Reynolds
- Departments of Psychology and Psychiatry, University of Manitoba, Winnipeg, Canada
| | - Charbel El-Kefraoui
- Department of Surgery, Section of General Surgery, University of Manitoba, AE101-820 Sherbrook St, Winnipeg, MB, R3A 1R9, Canada
| | - Malcolm B Doupe
- Department of Community Health Sciences, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, Department of Community Health Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
6
|
Bennett CJ, Barber C, Rose E, Palermo C, Dart J. Supporting nutrition and dietetics students' relationships with food and body image: Adopting a co-created curricula approach. Nutr Diet 2024; 81:306-315. [PMID: 38246599 DOI: 10.1111/1747-0080.12862] [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: 10/31/2023] [Accepted: 12/20/2023] [Indexed: 01/23/2024]
Abstract
AIMS The aims of this study were to: (1) explore perspectives of university students' and academics' regarding disordered eating, eating disorders and body image in relation to pedagogy and curricula and (2) to evaluate a co-designed student seminar and an academic workshop on these topics. METHODS A participatory action research approach was employed whereby an educational intervention was co-created by academics and students. An online seminar was presented to students and a 1-h workshop was presented to academic staff. Evaluation was conducted via a post-seminar anonymous survey for students and a pre- and post-anonymous workshop survey for academics with a mix of Likert-scale questions and open text boxes. Qualitative data were open coded, both deductively and inductively, and quantitative data were analysed descriptively. RESULTS One hundred and seventeen students attended the voluntary education seminar. Six themes were identified from student qualitative data which included feeling safe, empowered, inspired, connected, emotional and reflective. Problematic aspects of pedagogy and curricula were identified by students and included: using personal data for teaching, demonising language to describe food/bodies and not always feeling safe or supported to discuss disordered eating. Twenty academics shared divergent perspectives-some reported feeling concerned and challenged by the content (exploring disordered eating with students), others noted the complexity of the area, and others reported low/moderate confidence or indifference in the space and felt this content outside of their scope as educators. CONCLUSION Curricula interventions that reduce triggering and shaming and increase space and support for strengthening students' relationships with food and their bodies are valued by nutrition and dietetics students. We encourage academics to consider pedagogical approaches and expand discourse in this space.
Collapse
Affiliation(s)
- Christie Jane Bennett
- Department of Nutrition, Dietetics and Food, Sub-Faculty of Clinical and Molecular Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Charlotte Barber
- Department of Nutrition, Dietetics and Food, Sub-Faculty of Clinical and Molecular Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Estelle Rose
- Department of Nutrition, Dietetics and Food, Sub-Faculty of Clinical and Molecular Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Claire Palermo
- Department of Nutrition, Dietetics and Food, Sub-Faculty of Clinical and Molecular Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Janeane Dart
- Department of Nutrition, Dietetics and Food, Sub-Faculty of Clinical and Molecular Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, Victoria, Australia
| |
Collapse
|
7
|
Brockett CL, Stansen C, Bourke M, Pascoe M, Clements M, Parker AG. Factors that influence mental health and well-being of high-performance athletes from Olympic or Paralympic sport who have transitioned out of national-level or international-level sport: a mixed methods approach. BMJ Open Sport Exerc Med 2024; 10:e001991. [PMID: 38827245 PMCID: PMC11141181 DOI: 10.1136/bmjsem-2024-001991] [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] [Accepted: 05/20/2024] [Indexed: 06/04/2024] Open
Abstract
Transitioning out of elite sports can be a challenging time for athletes. To illuminate the gaps and opportunities in existing support systems and better understand which initiatives may have the greatest benefit in supporting athletes to transition out of elite sport, this study examined the lived experience of retired elite Australian athletes. Using a sequential mixed-methods approach, quantitative data were collected via a self-report online survey, while qualitative data were collected via semistructured interviews. In total 102 retired high-performance athletes (M=27.35, SD=7.25 years) who competed in an Olympic or Paralympic recognised sport at the national and/or international-level participated in the online survey, providing data across domains of well-being and athletic retirement. Eleven survey respondents opted in for the semistructured interview (M=28.9, SD=6.9 years) providing in-depth responses on their retirement experiences. Using partial least squares structural equation modelling (PLS-SEM), latent variables were identified from the survey data and associations between retirement support, retirement difficulties, retirement experiences, well-being and mental health were determined. Interview data were thematically analysed. The structural model had good predictive validity for all nine latent variables, describing positive and negative associations of retirement experiences, mental health and well-being. Building an identity outside of sport, planning for retirement, and having adaptive coping strategies positively impacted retirement experiences. Feeling behind in a life stage and an abrupt loss of athletic identity had a negative impact on retirement experiences. Implications for sports policymakers are discussed, including support strategies that could better assist athletes in successfully transitioning from elite sports.
Collapse
Affiliation(s)
- Camilla L Brockett
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Caroline Stansen
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Matthew Bourke
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
- Health and Wellbeing Centre for Research Innovation, The University of Queensland, Brisbane, Queensland, Australia
| | - Michaela Pascoe
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| | - Matti Clements
- Athlete Wellbeing and Engagement, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
| | - Alexandra G Parker
- Institute for Health and Sport, Victoria University, Melbourne, Victoria, Australia
| |
Collapse
|
8
|
Bailie J, Reed K, Matthews V, Scott KM, Ahern C, Bailie R. Volunteering as prosocial behaviour by medical students following a flooding disaster and impacts on their mental health: A mixed-methods study. MEDICAL EDUCATION 2024; 58:430-442. [PMID: 37661656 DOI: 10.1111/medu.15199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 07/31/2023] [Accepted: 08/14/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Volunteering is a form of prosocial behaviour that has a been recognised as having positive benefits for medical students. However, there is a lack of research on what influences students to volunteer during and after weather-related disasters. Our study (1) explores factors related to medical students' willingness and readiness to volunteer, and (2) describes mental health impacts of the flood events on students. METHODS We conducted a mixed-methods study of medical students on rural clinical placements in a regional area of Australia, 2 to 6 weeks after two major flooding events in 2022. Data were collected through survey and focus groups. Summary statistics were generated from the survey data, and Fisher's exact test was used to determine associations between student experience of the flood and self-rated well-being. Qualitative data were deductively analysed using Byrne and colleagues' theory of prosocial behaviour during an emergency. RESULTS The 36 students who participated in focus groups (including the 34 who completed the survey) (response rates 84% and 79%, respectively) demonstrated high levels of prosocial behaviours and were willing to volunteer. A sense of moral obligation was the primary reason for volunteering, whereas concerns for their physical and psychological safety, and missing key aspects of their training, were the strongest reasons for not continuing to volunteer. Students reported personal stress, anxiety and trauma during this period, with significant associations between self-rated impacts on their well-being and feelings of being terrified, helpless and hopeless during the flooding events and of still being distressed weeks later (p < .05). CONCLUSIONS This study expands on prosocial behaviour theory by applying Byrne and colleagues elaborated model in the context of medical student volunteering during the 2022 major flooding events in Australia. Modifiable barriers to prosocial behaviour are identified along with proposed strategies to address these barriers.
Collapse
Affiliation(s)
- Jodie Bailie
- University Centre for Rural Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Krista Reed
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Veronica Matthews
- University Centre for Rural Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Karen M Scott
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Christine Ahern
- University Centre for Rural Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Ross Bailie
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
9
|
Mitchell S, Turner N, Fryer K, Beng J, Ogden ME, Watson M, Gardiner C, Bayly J, Sleeman KE, Evans CJ. A framework for more equitable, diverse, and inclusive Patient and Public Involvement for palliative care research. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:19. [PMID: 38331966 PMCID: PMC10851547 DOI: 10.1186/s40900-023-00525-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 11/30/2023] [Indexed: 02/10/2024]
Abstract
BACKGROUND There are marked inequalities in palliative care provision. Research is needed to understand how such inequalities can be addressed, so that everyone living with advanced illness can receive the care they need, when they need it. Research into inequalities in palliative care should be guided by Patient and Public Involvement (PPI) that includes people from diverse backgrounds, who are less likely to receive specialist services. Multi-disciplinary research partnerships, bringing together primary care (the main providers of palliative care to diverse communities) and specialist palliative care, have the potential to work together in new ways to do research to address inequalities and improve palliative care in practice. This report describes a research partnership between primary care and palliative care that aimed to: (1) create opportunities for more inclusive PPI in palliative care research, (2) co-design new resources to support more equitable, diverse and inclusive PPI for palliative care, (3) propose a new framework for inclusive PPI in palliative care research. METHODS PPI members were recruited via primary care and palliative care research networks from three diverse areas of the UK. A pragmatic, collaborative approach was taken to achieve the partnership aims. Online workshops were carried out to understand barriers to inclusive PPI in palliative care and to co-design resources. Evaluation included a "you said, we did" impact log and a short survey. The approach was informed by good practice principles from previous PPI, and existing theory relating to equity, equality, diversity, and inclusion. RESULTS In total, 16 PPI members were recruited. Most were White British (n = 10), other ethnicities were Asian (n = 4), Black African (n = 1) and British mixed race (n = 1). The research team co-ordinated communication and activities, leading to honest conversations about barriers to inclusive PPI. Resources were co-designed, including a role description for an Equity, Equality, Diversity and Inclusion Champion, a "jargon buster", an animation and an online recipe book ( http://www.re-equipp.co.uk/ ) to inform future PPI. Learning from the partnership has been collated into a new framework to inform more inclusive PPI for future palliative care research. CONCLUSION Collaboration and reciprocal learning across a multi-disciplinary primary care and palliative care research partnership led to the development of new approaches and resources. Research team commitment, shared vision, adequate resource, careful planning, relationship building and evaluation should underpin approaches to increase equality, diversity and inclusivity in future PPI for palliative care research.
Collapse
Affiliation(s)
- Sarah Mitchell
- Division of Primary Care, Palliative Care and Public Health, Leeds Institute of Health Sciences, University of Leeds, Clarendon Road, Leeds, UK.
| | - Nicola Turner
- School of Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
| | - Kate Fryer
- Academic Unit of Primary Medical Care, University of Sheffield, Herries Road, Sheffield, UK
| | - Jude Beng
- Academic Unit of Primary Medical Care, University of Sheffield, Herries Road, Sheffield, UK
| | - Margaret E Ogden
- Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, Cicely Saunders Institute of Palliative Care, London, UK
| | - Melanie Watson
- Health Sciences School, University of Sheffield, 3a Clarkehouse Rd, Sheffield, UK
| | - Clare Gardiner
- Health Sciences School, University of Sheffield, 3a Clarkehouse Rd, Sheffield, UK
| | - Joanne Bayly
- Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, Cicely Saunders Institute of Palliative Care, London, UK
- St Barnabas Hospices, Worthing, UK
| | - Katherine E Sleeman
- Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, Cicely Saunders Institute of Palliative Care, London, UK
| | - Catherine J Evans
- Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, Kings College London, Cicely Saunders Institute of Palliative Care, London, UK
| |
Collapse
|
10
|
Barnes K, Hall Dykgraaf S, O'Brien K, Douglas K, Eggleton K, Bui N, Wong ST, Etz RS, Goodyear-Smith F. A novel methodological approach to participant engagement and policy relevance for community-based primary medical care research during the COVID-19 pandemic in Australia and New Zealand. Health Res Policy Syst 2024; 22:13. [PMID: 38254197 PMCID: PMC10802036 DOI: 10.1186/s12961-023-01100-8] [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: 06/08/2022] [Accepted: 12/25/2023] [Indexed: 01/24/2024] Open
Abstract
Community-based primary care, such as general practice (GP) or urgent care, serves as the primary point of access to healthcare for most Australians and New Zealanders. Coronavirus disease 2019 (COVID-19) has created significant and ongoing disruptions to primary care. Traditional research methods have contributed to gaps in understanding the experiences of primary care workers during the pandemic. This paper describes a novel research design and method that intended to capture the evolving impact of the COVID-19 pandemic on primary care workers in Australia and New Zealand. Recurrent, rapid cycle surveys were fielded from May 2020 through December 2021 in Australia, and May 2020 through February 2021 in New Zealand. Rapid survey development, fielding, triangulated analysis and dissemination of results allowed close to real-time communication of relevant issues among general practice workers, researchers and policy-makers. A conceptual model is presented to support longitudinal analysis of primary care worker experiences during the COVID-19 pandemic in Australia and New Zealand, and key learnings from applying this novel method are discussed. This paper will assist future research teams in development and execution of policy-relevant research in times of change and may inform further areas of interest for COVID-19 research in primary care.
Collapse
Affiliation(s)
- Katelyn Barnes
- Academic Unit of General Practice, ACT Health Directorate, Canberra, ACT, Australia.
- Academic Unit of General Practice, School of Medicine and Psychology, the Australian National University, Canberra, ACT, Australia.
| | - Sally Hall Dykgraaf
- Rural Clinical School, School of Medicine and Psychology, the Australian National University, Canberra, ACT, Australia
| | - Kathleen O'Brien
- Academic Unit of General Practice, School of Medicine and Psychology, the Australian National University, Canberra, ACT, Australia
| | - Kirsty Douglas
- Academic Unit of General Practice, ACT Health Directorate, Canberra, ACT, Australia
- Academic Unit of General Practice, School of Medicine and Psychology, the Australian National University, Canberra, ACT, Australia
| | - Kyle Eggleton
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Nam Bui
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| | - Sabrina T Wong
- School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, 2211 Westbrook Mall, Vancouver, BC, V6T2B5, Canada
| | - Rebecca S Etz
- Larry A. Green Center for the Advancement of Primary Health Care for the Public Good, Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, VA, United States of America
| | - Felicity Goodyear-Smith
- Department of General Practice & Primary Health Care, University of Auckland, Auckland, New Zealand
| |
Collapse
|
11
|
Smith K, Templeton A. Identity leadership and adherence to COVID-19 safety guidance in hospital settings. PLoS One 2024; 19:e0293002. [PMID: 38241228 PMCID: PMC10798463 DOI: 10.1371/journal.pone.0293002] [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: 03/10/2023] [Accepted: 10/03/2023] [Indexed: 01/21/2024] Open
Abstract
COVID-19 presents unique and complex challenges to the Scottish National Health Service (NHS). As COVID-19 preventative measures are effective at reducing disease spread, promoting staff adherence in high-risk workplaces is vital. The present research explored the role of identity leadership on (a) staff's appraisals of leadership and (b) staff's adherence to and attitudes towards COVID-19 guidance. Semi-structured interviews (N = 25) were conducted with NHS staff across two Scottish hospitals. Using Reflexive Thematic Analysis, two over-arching themes were generated: leadership presence and approachable leadership who act on group concerns, where both created positive appraisals of leadership and were seen to facilitate adherence. Guidance from present leaders was perceived as both practical and applicable. Approachable leaders were viewed to facilitate information sharing, clarify guidance, and allow staff to raise concerns. Leaders who were seen to act on group concerns provided resources or updated guidance to promote adherence. The present study provides theoretical and practical advancements to (a) expand the known role of identity leadership in promoting safety in workplaces and (b) facilitate routes for adherence to safety guidance beyond COVID-19.
Collapse
Affiliation(s)
- Kayleigh Smith
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| | - Anne Templeton
- Department of Psychology, University of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
12
|
Parajuli A, Garbovan L, Bhattarai B, Arjyal A, Baral S, Cooke P, Latham S, Barrington DJ, Mitchell J, King R. Exploring community insights on antimicrobial resistance in Nepal: a formative qualitative study. BMC Health Serv Res 2024; 24:57. [PMID: 38212733 PMCID: PMC10782613 DOI: 10.1186/s12913-023-10470-2] [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: 04/24/2023] [Accepted: 12/12/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is the process by which microbes evolve mechanisms to survive the medicines designed to destroy them i.e. antimicrobials (AMs). Despite being a natural process, AMR is being hastened by the abuse of AMs. In context of Nepal, there is limited information on drivers of AMR and barriers in addressing it from a community perspective. This study explores the local language and terminology used around AMs in the community, commonly used AMs and reasons for their usage, how these AMs are sourced, and the perceived barriers to addressing AMR via One Health approach. METHODS A phenomenological study design was utilized with applied qualitative research theoretically framed as pragmatism. Twelve in-depth interviews and informal discussions with a One Health focus, were purposively conducted with wide range of stakeholders and community resident of Kapilvastu municipality of Nepal during April 2022. The acquired data was analyzed manually via a thematic framework approach. The study obtained ethical approval from ethical review board of Nepal Health Research Council and University of Leeds. RESULTS Nepali and Awadhi languages does not have specific words for AMs or AMR, which is understandable by the community people. Rather, community use full explanatory sentences. People use AMs but have incomplete knowledge about them and they have their own local words for these medicines. The knowledge and usage of AMs across human and animal health is impacted by socio-structural factors, limited Government regulation, inadequate supply of AMs in local government health facilities and the presence of various unregulated health providers that co-exist within the health system. Novel ideas such as the use of visual and smart technology, for instance mobile phones and social media exposure, can enable access to information about AMs and AMR. CONCLUSION This study shows that terminology that is understandable by the community referring to AMs and AMR in Nepali and Awadhi languages does not exist, but full explanatory sentences and colloquial names are used. Despite regular utilisation, communities have incomplete knowledge regarding AMs. Since, knowledge alone cannot improve behaviour, behavioural interventions are required to address AMR via community engagement to co-produce their own solutions. TRIAL REGISTRATION Not applicable.
Collapse
Affiliation(s)
| | - Lidis Garbovan
- Centre for World Cinema and Digital Cultures, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | | | | | | | - Paul Cooke
- Centre for World Cinema and Digital Cultures, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Sophia Latham
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Chester High Road, Neston, Liverpool, CH64 7TE, UK
| | - Dani J Barrington
- School of Population and Global Health, University of Western Australia, 35 Stirling Highway, Crawley, Perth, Western, 6009, Australia
| | - Jessica Mitchell
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| | - Rebecca King
- Nuffield Centre for International Health and Development, University of Leeds, Woodhouse Lane, Leeds, LS2 9JT, UK
| |
Collapse
|
13
|
Bray M, Heruc G, Evans L, Wright ORL. The imperative of collaboration: Lived experience perspectives on team approaches in outpatient eating disorder treatment. Int J Eat Disord 2024; 57:116-123. [PMID: 37902406 DOI: 10.1002/eat.24084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Across healthcare broadly, team treatment approaches range from siloed multidisciplinary treatment to synergistic Interprofessional Collaborative Practice (IPCP), with IPCP increasingly favored. In eating disorders, clinical practice guidelines endorse team outpatient treatment, and these approaches are widely used in clinical practice. However, there is limited evidence to describe attitudes toward and experiences of team approaches, including IPCP, among individuals with a lived experience. METHOD Twenty-seven participants (aged 20-51 years) with a formal eating disorder diagnosis were recruited. Each had received outpatient eating disorder treatment from a team or teams comprising a mental health professional, dietitian, and general practitioner (GP) in the past 2 years. Qualitative data were collected via semi-structured interviews and analyzed using Braun and Clarke's reflexive thematic analysis. RESULTS Four themes were derived from the qualitative analysis. Themes included: (1) working together is better; (2) the linchpin of teamwork is communication; (3) teams should foster autonomy with limit-setting; and (4) systemic failures negatively affect team treatment. Participants favored highly collaborative treatment from a team including a mental health professional, dietitian, and GP at a minimum, where the team engaged in high-quality communication and fostered autonomy with limit-setting. Systemic failures negatively affecting team treatment were reported across the care continuum. DISCUSSION Findings endorse the application of IPCP to outpatient eating disorder treatment as a strategy to improve treatment satisfaction, engagement, and outcomes. Given the paucity of evidence exploring IPCP in this field, however, the development and evaluation of interprofessional education and treatment models is a foundational necessity. PUBLIC SIGNIFICANCE Team eating disorder treatment is widely used in clinical practice, although there is limited evidence to guide interventions. This study explores attitudes toward and experiences of team outpatient eating disorder treatment among individuals with a lived experience. Understanding preferred team treatment characteristics delivers important information to improve treatment satisfaction, engagement, and outcomes for individuals receiving outpatient eating disorder treatment.
Collapse
Affiliation(s)
- Megan Bray
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Gabriella Heruc
- Eating Disorders and Nutrition Research Group (ENRG), Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, New South Wales, Australia
| | - Lacey Evans
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| | - Olivia R L Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, Queensland, Australia
| |
Collapse
|
14
|
Lackey S, Burnham S, Watson Hyatt G, Shepherd T, Pinder S, Davies TC, Batorowicz B. Voices from the field: exploring service providers' insights into service delivery and AAC use in Canada. Augment Altern Commun 2023:1-14. [PMID: 38146943 DOI: 10.1080/07434618.2023.2295929] [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: 05/30/2023] [Accepted: 12/03/2023] [Indexed: 12/27/2023] Open
Abstract
Use of augmentative and alternative communication (AAC) often relies on the involvement of AAC service providers; however little is known about how AAC services are delivered across Canada. This study aimed to explore AAC service provision and factors influencing use of AAC from the perspectives of service providers across Canada who are involved in providing and/or supporting use of AAC systems. The 22 participants from nine (of the 10) provinces participated in online focus groups. Participants were speech-language pathologists, occupational therapists, communicative disorders assistants, and a teacher. Transcripts of the audio recordings were analyzed using reflexive thematic analysis. Four themes were generated that reflect service-related factors contributing to the use of AAC in Canada: Support of Organizational Structures, Concordant Relationships and Goals, Making the Right Decisions, and Influence of Knowledge and Attitudes. These themes highlight how government systems, key stakeholders, assessment practices, and knowledge of AAC influence service provision and use of AAC. Voices from across Canada highlighted shared experiences of services providers as well as revealed variability in service delivery processes. The findings bring to attention a need for further research and development of service provision guidelines to support consistency, quality in practice, and equity in AAC services.
Collapse
Affiliation(s)
- Stephanie Lackey
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| | - Seamus Burnham
- Department of Mechanical and Materials Engineering, Faculty of Engineering and Applied Science, Queen's University, Kingston, Canada
| | - Glenda Watson Hyatt
- Department of Mechanical and Materials Engineering, Faculty of Engineering and Applied Science, Queen's University, Kingston, Canada
| | - Tracy Shepherd
- Centralized Equipment Pool, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Shane Pinder
- Department of Mechanical and Materials Engineering, Faculty of Engineering and Applied Science, Queen's University, Kingston, Canada
| | - T Claire Davies
- Department of Mechanical and Materials Engineering, Faculty of Engineering and Applied Science, Queen's University, Kingston, Canada
| | - Beata Batorowicz
- School of Rehabilitation Therapy, Faculty of Health Sciences, Queen's University, Kingston, Canada
| |
Collapse
|
15
|
Wingood M, Gell NM, Vincenzo JL, Peters DM. Exploring the implementation potential of physical activity assessment and prescription tools in physical therapy practice: a mixed-method study. Physiother Theory Pract 2023; 39:2676-2687. [PMID: 35844146 PMCID: PMC9845423 DOI: 10.1080/09593985.2022.2100849] [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] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 06/04/2022] [Accepted: 06/29/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Despite the benefits of physical activity (PA), especially related to aging, physical therapists do not perform regular PA prescriptions secondary to various barriers, including lack of tools. Therefore, we developed the Inventory of Physical Activity Barriers (IPAB). OBJECTIVE Explore potential solutions that could address the current lack of PA prescription among United States-based physical therapists treating patients 50 years and older. METHOD A convergent parallel mixed-method design consisting of focus groups and self-report questionnaires. Descriptive statistics were used for all quantitative variables. Focus groups were thematically coded. RESULTS The 26 participants had 8.6 years (SD = 6.4) of clinical experience, 88.4% (n = 23) reported they regularly have PA conversations with patients, 65.4% (n = 17) regularly assess PA levels, and 19.2% (n = 5) regularly provide PA prescriptions. We identified three themes: 1) opportunities and challenges related to PA prescriptions; 2) lack of standardization in PA assessments and interventions; and 3) implementation potential for innovative solutions that address the current informal PA assessments and interventions. CONCLUSION Physical therapists are amenable to incorporating innovative solutions that support physical activity prescription behavior. Therefore, we recommend the continued development and implementation of PA assessment and prescription tools.
Collapse
Affiliation(s)
- Mariana Wingood
- University of Vermont, Department of Rehabilitation and Movement Science, 106 Carrigan Dr. Rowell Building, Burlington, VT 05405, USA
| | - Nancy M. Gell
- University of Vermont, Department of Rehabilitation and Movement Science, 106 Carrigan Dr. Rowell Building, Burlington, VT 05405, USA
| | - Jennifer L. Vincenzo
- University of Arkansas for Medical Sciences, Department of Physical Therapy, 1125 N College Ave, Fayetteville, AR 72701, USA
| | - Denise M. Peters
- University of Vermont, Department of Rehabilitation and Movement Science, 106 Carrigan Dr. Rowell Building, Burlington, VT 05405, USA
| |
Collapse
|
16
|
Birt L, Dalgarno L, Poland F, Wright D, Bond C. What happens when pharmacist independent prescribers lead on medicine management in older people's care homes: a qualitative study. BMJ Open 2023; 13:e068678. [PMID: 37907299 PMCID: PMC10619113 DOI: 10.1136/bmjopen-2022-068678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 09/28/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVE Older people in care homes frequently experience polypharmacy, increasing the likelihood of medicine-related burden. Pharmacists working within multidisciplinary primary care teams are ideally placed to lead on medication reviews. A randomised controlled trial placed pharmacists, with independent prescribing rights (PIPs), into older people care homes. In the intervention service, PIPs worked with general practitioners (GPs) and care home staff for 6 months, to optimise medicine management at individual resident and care home level. PIP activity included stopping medicines that were no longer needed or where potential harms outweighed benefits. This analysis of qualitative data examines health and social care stakeholders' perceptions of how the service impacted on care home medicine procedures and resident well-being. DESIGN Pragmatic research design with secondary analysis of interviews. SETTING Primary care pharmacist intervention in older people care homes in England, Scotland and Northern Ireland. PARTICIPANTS Recruited from intervention arm of the trial: PIPs (n=14), GPs (n=8), care home managers (n=9) and care home staff (n=6). RESULTS There were resonances between different participant groups about potential benefits to care home residents of a medicine service provided by PIPs. There were small differences in perceptions about changes related to communication between professionals. Results are reported through three themes (1) 'It's a natural fit'-pharmacists undertaking medication review in care homes fitted within multidisciplinary care; (2) 'The resident is cared for'-there were subjective improvements in residents' well-being; (3) 'Moving from "firefighting" to effective systems'-there was evidence of changes to care home medicine procedures. CONCLUSION This study suggests that pharmacist independent prescribers in primary care working within the multidisciplinary team can manage care home residents' medicines leading to subjective improvements in residents' well-being and medicine management procedures. Care home staff appreciated contact with a dedicated person in the GP practice. TRIAL REGISTRATION ISRCTN 17847169.
Collapse
Affiliation(s)
- Linda Birt
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- School Healthcare, University of Leicester, Leicester, UK
| | - Lindsay Dalgarno
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Fiona Poland
- School of Health Sciences, University of East Anglia, Norwich, UK
| | - David Wright
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
- School Healthcare, University of Leicester, Leicester, UK
| | - Christine Bond
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| |
Collapse
|
17
|
Harrison M, Hall L, Alberti H. How will the Covid-19 pandemic shape the future of primary care undergraduate teaching? Understanding modifications and developments deployed by UK academic units of primary care, and their implications for the future. BMC MEDICAL EDUCATION 2023; 23:746. [PMID: 37817183 PMCID: PMC10566052 DOI: 10.1186/s12909-023-04710-6] [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] [Received: 11/21/2022] [Accepted: 09/21/2023] [Indexed: 10/12/2023]
Abstract
BACKGROUND Primary care has been under-represented in its contribution to the academic literature base on Covid-19 developments. We sought to understand how teaching and learning was modified and developed by primary care academic leaders to support the continuation of primary care-orientated learning during the Covid-19 pandemic; and explore how these changes may shape future educational delivery in primary care. METHODS We adopted a qualitative approach, using semi-structured interviews of seven General Practice Heads of Teaching (GP HoTs) from UK medical schools. We used mixed deductive and inductive coding to analyse interview transcripts. Modifications and developments were coded to four a priori themes (clinical off-site; clinical on-site; synchronous remote; asynchronous remote). We concurrently used inductive coding to identify developments that did not readily fit into these categories. To understand how participants perceived the developments may shape primary care teaching in the future, we carried out an inductive thematic analysis. RESULTS A range of modifications and developments were described. Examples of developments include: GP practices being provided with increased flexibility to support ongoing provision of clinical placements (on-site clinical), examples of initiatives enabling students to consult remotely from their homes (off-site clinical), transfer of face-to-face teaching to remote formats (synchronous remote) and development of new, interactive on-line teaching materials (asynchronous remote). One additional theme arose inductively: collaboration and co-operation. For future implications, five themes arose: the evolution of flexible and hybrid clinical placement models; an increased role for telemedicine; increased networking and collaboration; increased active student involvement in patient care; and opportunities for community-based teaching afforded by the pandemic. CONCLUSION This study highlights how teaching was modified to support the continuation of primary care-based learning during the Covid-19 pandemic, and implications for the future. Collaboration and placement flexibility were notable features in the response. Participants perceived that flexible placement models containing a mixture of clinical on-site with remote synchronous and asynchronous teaching and learning activities, may persist into the post-Covid era. Further research is required to understand which developments become routinely embedded into primary care teaching in the post-Covid era and explain how and why this occurs.
Collapse
Affiliation(s)
- Michael Harrison
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK.
| | - Lauren Hall
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Hugh Alberti
- School of Medical Education, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| |
Collapse
|
18
|
Jarvis T, Smith RW, Sandhu HS, Mac-Seing M, O'Neill M, Rosella L, Allin S, Pinto AD. Promise and peril: how health system reforms impacted public health in three Canadian provinces. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2023; 114:714-725. [PMID: 37410363 PMCID: PMC10484823 DOI: 10.17269/s41997-023-00785-2] [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] [Received: 10/07/2022] [Accepted: 05/09/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES Several Canadian provinces and territories have reformed their health systems by centralizing power, resources, and responsibilities. Our study explored motivating factors and perceived impacts of centralization reforms on public health systems and essential operations. METHODS A multiple case study design was used to examine three Canadian provinces that have undergone, or are in the process of undergoing, health system reform. Semi-structured interviews were conducted with 58 participants within public health at strategic and operational levels, from Alberta, Ontario, and Québec. Data were analyzed using a thematic analytical approach to iteratively conceptualize and refine themes. RESULTS Three major themes were developed to describe the context and impacts of health system centralization reforms on public health: (1) promising "value for money" and consolidating authority; (2) impacting intersectoral and community-level collaboration; and (3) deprioritizing public health operations and contributing to workforce precarity. Centralization highlighted concerns about the prioritization of healthcare sectors. Some core public health functions were reported to operate more efficiently, with less duplication of services, and improvements in program consistency and quality, particularly in Alberta. Reforms were also reported to have diverted funding and human resources away from core essential functions, and diminished the public health workforce. CONCLUSION Our study highlighted that stakeholder priorities and a limited understanding about public health systems influenced how reforms were implemented. Our findings support calls for modernized and inclusive governance, stable public health funding, and investment in the public health workforce, which may help inform future reforms.
Collapse
Affiliation(s)
- Tamika Jarvis
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- North American Observatory On Health Systems and Policies, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Robert W Smith
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Harman Singh Sandhu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Muriel Mac-Seing
- Centre for Global Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Meghan O'Neill
- Population Health Analytics Lab, University of Toronto, Toronto, Ontario, Canada
| | - Laura Rosella
- Population Health Analytics Lab, University of Toronto, Toronto, Ontario, Canada
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Sara Allin
- North American Observatory On Health Systems and Policies, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Andrew D Pinto
- Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada.
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Ontario, Canada.
- Division of Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
19
|
Mete R, Shield A, Murray K, Bacon R, Kellett J. Healthy eating blog readership: A cross-sectional survey in Australian adults. Nutr Diet 2023; 80:362-371. [PMID: 37199026 DOI: 10.1111/1747-0080.12816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 04/18/2023] [Accepted: 04/21/2023] [Indexed: 05/19/2023]
Abstract
AIMS To investigate whether members of the public read blogs for the purpose of accessing healthy eating information; examine demographic predictors of healthy eating blog readership, specifically education, gender, age, body mass index, and residential location; and explore the reasons for reading, and not reading, healthy eating blogs. METHODS This study used a cross-sectional online self-reported survey design collected over three time points (round 1: December 2017-March 2018, round 2: August 2018-December 2018, round 3: December 2021-March 2022). The total sample of participants comprised of 238 respondents with a mean age of 46 years old, who mostly reported gender as female (82%), being educated with a university degree (69%), and predominantly resided in urban and city areas (84%). RESULTS Fifty-one percent of respondents reported reading healthy eating blogs, suggesting that consumers were proactively seeking healthy eating information through this avenue. Participants who identified as female were 3.2 times more likely to read healthy eating blogs. Commonly, healthy eating blogs were read to receive practical information that aligned with current food choices. The main reason participants reported not reading healthy eating blogs was not thinking about using them (29%). CONCLUSIONS Understanding who is seeking healthy eating information through blogs, and their reasons doing so, is important to continue research into the potential effectiveness of blogs as a platform to communicate healthy eating and nutrition messages. This study provides direction for further investigation into how dietetics professionals could effectively use blogs to disseminate healthy eating information and positively influence consumer food choices and dietary intake.
Collapse
Affiliation(s)
- Rebecca Mete
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Alison Shield
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Kristen Murray
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
| | - Rachel Bacon
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| | - Jane Kellett
- Faculty of Health, University of Canberra, Bruce, ACT, Australia
| |
Collapse
|
20
|
Hughes RC, Muendo R, Bhopal SS, Onyango S, Kimani-Murage E, Kirkwood BR, Hill Z, Kitsao-Wekulo P. Parental experiences of the impacts of Covid-19 on the care of young children; qualitative interview findings from the Nairobi Early Childcare in Slums (NECS) project. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001127. [PMID: 37647351 PMCID: PMC10468034 DOI: 10.1371/journal.pgph.0001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 04/10/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION The Covid-19 pandemic, and societal attempts to control it, have touched almost every aspect of people's lives around the world, albeit in unequal ways. In particular, there is considerable concern about the way that stringent 'lockdowns', as implemented in Kenya and many other countries, affected young children, especially those living in informal settlements. However, to date, there has been little research attempting to unpack and understand how the pandemic has impacted on the care of young children. METHODS In-depth telephone interviews were conducted with 21 parents/carers of children aged under five years living in three Nairobi slums between May and September 2021 exploring the ways in which Covid-19, and policies to control the pandemic, impacted on their household and the care of their child/children. RESULTS The impacts of Covid-19 control measures on the care of children have been widely felt, deep and multiple. The impact of economic hardship has been significant, reportedly undermining food security and access to services including healthcare and childcare. Respondents reported an associated increase in domestic and community violence. Many people relied on help from others; this was most commonly reported to be in the form of variable levels of flexibility from landlords and help from other community members. No direct harms from Covid-19 disease were reported by respondents. CONCLUSION The impacts of Covid-19 control measures on the care of young children in informal settlements have been indirect but dramatic. Given the breadth and depth of these reported impacts, and the particular vulnerability of young children, deeper consideration ought to inform decisions about approaches to implementation of stringent disease control measures in future. In addition, these findings imply a need for both short- and long-term policy responses to ameliorate the impacts described.
Collapse
Affiliation(s)
- Robert C. Hughes
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Ruth Muendo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Sunil S. Bhopal
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Silas Onyango
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Elizabeth Kimani-Murage
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Betty R. Kirkwood
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Zelee Hill
- Institute for Global Health, University College London, London, United Kingdom
| | - Patricia Kitsao-Wekulo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| |
Collapse
|
21
|
Nigatu AM, Yilma TM, Gezie LD, Gebrewold Y, Gullslett MK, Mengiste SA, Tilahun B. Medical imaging consultation practices and challenges at public hospitals in the Amhara regional state, Northwest Ethiopia: a descriptive phenomenological study. BMC Health Serv Res 2023; 23:787. [PMID: 37488569 PMCID: PMC10367423 DOI: 10.1186/s12913-023-09652-9] [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: 11/07/2022] [Accepted: 06/06/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Medical imaging plays a vital role in the accurate diagnosis, treatment and outcome prediction of many diseases and injuries. However, in many African countries, deserving populations do not have access to the proper medical imaging specialists' services. As a result, clinicians continue to struggle to provide medical imaging via consultation. However, little is known about conventional referral consultation practices and their challenges. This study, therefore, aimed to explore the practice and challenges of medical imaging service consultation among health professionals and patients in the context of the Ethiopian public healthcare delivery system. METHODS Descriptive phenomenological study was employed to explore the practice of medical imaging service consultation among health professionals and patients in public hospitals of Amhara region from October 12, 2021 to December 29, 2021. Semi-structured interview guides were prepared separately for key-informant and in-depth interviews. A total of 21 participants (6 hospital managers, 4 medical directors, 4 department heads, 3 medical imaging coordinators and 4 patients) were selected using the maximum variation sampling technique. All interviews were audio-recorded, transcribed verbatim and subjected to inductive thematic analysis using Open Code 4.02 software. RESULTS Six major themes emerged following the thematic analysis: (1) medical image service delivery practices; (2) medical imaging consultation modalities; (3) benefits and drawbacks of the consultation modalities; (4) challenges; (5) challenge mitigation strategies; and (6) future recommendations. Image films, compact disks, and telegram apps were the consultation modalities used by the referring clinicians to send the medical images to radiologists. Frequent failure of imaging machines, delayed equipment maintenance, inadequate infrastructure, shortage of budget, lack of radiologists, and low-quality of printed image films were among the challenges influencing the medical imaging consultation service. CONCLUSIONS This research explored onsite and referral imaging consultation practices. However, there are many challenges encountered by the referring clinicians and the radiologists during the consultation process. These challenges could potentially affect clinicians' ability to provide timely diagnosis and treatment services which would ultimately affects patient health status and service delivery. Virtual consultation via teleradiology and enhancing clinicians' competence through long-term and short-term trainings are recommended to improve the referral consultation practice.
Collapse
Affiliation(s)
- Araya Mesfin Nigatu
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Tesfahun Melese Yilma
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Lemma Derseh Gezie
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Yonathan Gebrewold
- Department of Radiology, College of Medicine, Author's Information, University of Gondar, Gondar, Ethiopia
| | | | | | - Binyam Tilahun
- Department of Health Informatics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
22
|
Anderson NE, Kyte D, McMullan C, Cockwell P, Aiyegbusi OL, Verdi R, Calvert M. Global use of electronic patient-reported outcome systems in nephrology: a mixed methods study. BMJ Open 2023; 13:e070927. [PMID: 37438075 DOI: 10.1136/bmjopen-2022-070927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES The use of electronic patient-reported outcome (ePRO) systems to support the management of patients with chronic kidney disease is increasing. This mixed-methods study aimed to comprehensively identify existing and developing ePRO systems, used in nephrology settings globally, ascertaining key characteristics and factors for successful implementation. STUDY DESIGN ePRO systems and developers were identified through a scoping review of the literature and contact with field experts. Developers were invited to participate in a structured survey, to summarise key system characteristics including: (1) system objectives, (2) population, (3) PRO measures used, (4) level of automation, (5) reporting, (6) integration into workflow and (7) links to electronic health records/national registries. Subsequent semistructured interviews were conducted to explore responses. SETTING AND PARTICIPANTS Eligible systems included those being developed or used in nephrology settings to assess ePROs and summarise results to care providers. System developers included those with a key responsibility for aspects of the design, development or implementation of an eligible system. ANALYTICAL APPROACH Structured survey data were summarised using descriptive statistics. Interview transcripts were analysed using Codebook Thematic Analysis using domains from the Consolidated Framework for Implementation Research. RESULTS Fifteen unique ePRO systems were identified across seven countries; 10 system developers completed the structured survey and 7 participated in semistructured interviews. Despite system heterogeneity, reported features required for effective implementation included early and sustained patient involvement, clinician champions and expanding existing electronic platforms to integrate ePROs. Systems demonstrated several common features, with the majority being implemented within research settings, thereby affecting system implementation readiness for real-world application. CONCLUSIONS There has been considerable research investment in ePRO systems. The findings of this study outline key system features and factors to support the successful implementation of ePROs in routine kidney care.Cite Now.
Collapse
Affiliation(s)
- Nicola Elizabeth Anderson
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Research, Development and Innovation, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- NIHR Applied Research Collaboration, West Midlands, University of Birmingham, Birmingham, UK
| | - Derek Kyte
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- School of Allied Health and Community, University of Worcester, Worcester, UK
| | - Christel McMullan
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR SRMRC, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
| | - Paul Cockwell
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Olalekan Lee Aiyegbusi
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration, West Midlands, University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| | - Rav Verdi
- Patient Partner, Institute of Applied Health Research,Centre for Patient-Reported Outcomes Research (CPROR), University of Birmingham, Birmingham, UK
| | - Melanie Calvert
- Institute of Applied Heath Research, Centre for Patient Reported Outcomes Research, University of Birmingham, Birmingham, UK
- NIHR Applied Research Collaboration, West Midlands, University of Birmingham, Birmingham, UK
- NIHR SRMRC, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
- NIHR Blood and Transplant Research Unit (BTRU) in Precision Transplant and Cellular Therapeutics, University of Birmingham, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Birmingham, UK
- Birmingham Health Partners Centre for Regulatory Science and Innovation, University of Birmingham, Birmingham, UK
| |
Collapse
|
23
|
Suleman S, O'Brien JM, McIlduff C, Benson B, Labine N, Khan S, Tse T, Kawchuk J, Kapur P, Abramyk C, Reimche E, Valiani S. Understanding equitable and affirming communication moments and relationship milestones during the intensive care unit journey: findings from stage 1 of a design thinking project. Can J Anaesth 2023; 70:995-1007. [PMID: 37188836 PMCID: PMC10184968 DOI: 10.1007/s12630-023-02456-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 06/21/2022] [Accepted: 07/06/2022] [Indexed: 05/17/2023] Open
Abstract
PURPOSE Communication is vital to facilitate patient and family-centred care (PFCC) and to build trusting relationships between intensive care unit (ICU) health care providers, the patient, and their loved ones in the ICU. The focus of this investigation was to identify, define, and refine key moments of communication, connection, and relationship building in the ICU through a lens of Equity, Diversity, Decolonization, and Inclusion (EDDI) to encourage meaningful communication and development of trusting relationships. METHODS We conducted 13 journey mapping interviews with ICU health care providers, patients, and their loved ones as the first stage in a design thinking project. We used directed content analysis to identify intersections where principles of EDDI directly or indirectly impacted communication, relationships, and trust throughout the ICU journey. To serve diverse patients and their loved ones, accessibility, inclusivity, and cultural safety were foundational pillars of the design thinking project. RESULTS Thirteen ICU health care providers, patients, and their loved ones participated in journey mapping interviews. We defined and refined 16 communication moments and relationship milestones in the journey of a patient through the ICU (e.g., admission, crises, stabilization, discharge), and intersections where EDDI directly or indirectly impacted communication and connection during the ICU journey. CONCLUSION Our findings highlight that diverse intersectional identities impact communication moments and relationship milestones during an ICU journey. To fully embrace a paradigm of PFCC, consideration should be given to creating an affirming and safe space for patients and their loved ones in the ICU.
Collapse
Affiliation(s)
- Salima Suleman
- Speech Language Pathologist, Independent Research Consultant, Edmonton, AB, Canada
| | - Jennifer M O'Brien
- Department of Anesthesiology, Perioperative Medicine and Pain Management, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada.
| | - Cari McIlduff
- Department of Community Health and Epidemiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Brittany Benson
- Department of Anesthesiology, Perioperative Medicine and Pain Management, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Nicole Labine
- Department of Surgery, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sahar Khan
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Tiffanie Tse
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Joann Kawchuk
- Department of Anesthesiology, Perioperative Medicine and Pain Management, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Puneet Kapur
- Department of Emergency Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Candace Abramyk
- Patient and Family Partners, Saskatchewan Center for Patient Oriented Research, Saskatoon, SK, Canada
| | - Eileen Reimche
- Patient and Family Partners, Saskatchewan Center for Patient Oriented Research, Saskatoon, SK, Canada
| | - Sabira Valiani
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| |
Collapse
|
24
|
Kirkegaard A, Mitchell L, Ball L, Williams LT. Developing the EQUIPED approach to quality management using multi-grounded theory. Nutr Diet 2023; 80:273-283. [PMID: 36278267 PMCID: PMC10953428 DOI: 10.1111/1747-0080.12780] [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: 05/26/2022] [Revised: 09/05/2022] [Accepted: 09/16/2022] [Indexed: 11/28/2022]
Abstract
AIM This study aimed to develop a theoretical approach to quality management for dietetics services operating in primary care settings in Australia. METHODS Multi-grounded theory was used to develop a theoretical approach to quality management across three phases. A preliminary approach was developed in the first phase using empirical data outlining quality management activities employed by primary care dietetics services. In the second phase, the preliminary approach was matched to theoretical data captured from the Australian National Safety and Quality in Primary and Community Healthcare Standards, the Quality in Nutrition Care Model for Dietitians, and complex adaptive systems theory. Central concepts were defined and described in the final phase. RESULTS Seventeen small (n = 7) and medium-large (n = 10) dietetics services from all Australian states and territories, except Tasmania, participated. The theoretical approach to quality management comprised 107 rules organised into six attractors (culture, integrated care, evidence-based care, safe environment and care, client partnerships and personalised care) and 10 governance elements. Rules had one or more foci that aimed to: improve quality within the service (internally focused), improve care by influencing other healthcare professionals (externally focused), improve the client relationship (client-focused), or monitor and respond to external systems (system-focused). CONCLUSIONS The theoretical approach developed in this study produced a set of rules that primary care dietetics services can use to inform quality management activities. The use of multi-grounded theory should be investigated in other healthcare disciplines and settings to address quality.
Collapse
Affiliation(s)
- Amy Kirkegaard
- Menzies Health Institute of Queensland, Griffith HealthGriffith UniversitySouthportQueenslandAustralia
- School of Health Sciences and Social Work, Griffith HealthGriffith University, Gold Coast CampusSouthportQueenslandAustralia
| | - Lana Mitchell
- Menzies Health Institute of Queensland, Griffith HealthGriffith UniversitySouthportQueenslandAustralia
- School of Health Sciences and Social Work, Griffith HealthGriffith University, Gold Coast CampusSouthportQueenslandAustralia
| | - Lauren Ball
- Menzies Health Institute of Queensland, Griffith HealthGriffith UniversitySouthportQueenslandAustralia
- School of Health Sciences and Social Work, Griffith HealthGriffith University, Gold Coast CampusSouthportQueenslandAustralia
| | - Lauren T. Williams
- Menzies Health Institute of Queensland, Griffith HealthGriffith UniversitySouthportQueenslandAustralia
- School of Health Sciences and Social Work, Griffith HealthGriffith University, Gold Coast CampusSouthportQueenslandAustralia
| |
Collapse
|
25
|
Breckons M, Thorne S, Walsh R, Bhopal S, Owens S, Rankin J. Parental perspectives on emergency health service use during the first wave of the COVID-19 pandemic in the United Kingdom: A qualitative study. PLoS One 2023; 18:e0285375. [PMID: 37256845 PMCID: PMC10231793 DOI: 10.1371/journal.pone.0285375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 04/23/2023] [Indexed: 06/02/2023] Open
Abstract
UK 'Lockdown' measures introduced in March 2020 aimed to mitigate the spread of COVID-19. Although seeking healthcare was still permitted within restrictions, paediatric emergency department attendances reduced dramatically and led to concern over risks caused by delayed presentation. Our aim was to gain insight into healthcare decisions faced by parents during the first wave of the COVID-19 pandemic and to understand if use of urgent healthcare, self-care, and information needs differed during lockdown as well as how parents perceived risks of COVID-19. We undertook qualitative telephone interviews with a purposive sample of parents living in the North East of England recruited through online advertising. We used a semi-structured interview schedule to explore past and current healthcare use, perceptions of risk and the impact of the pandemic on healthcare decisions. Interviews were transcribed and analysed using Thematic Analysis. Three major themes were identified which concerned (i) how parents made sense of risks posed to, and by their children, (ii) understanding information regarding health services and (iii) attempting to make the right decision. These themes contribute to the understanding of the initial impact of COVID-19 and associated restrictions on parental decisions about urgent healthcare for children. These findings are important to consider when planning for potential future public health emergencies but also in the wider context of encouraging appropriate use of urgent healthcare.
Collapse
Affiliation(s)
- Matthew Breckons
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration North East & North Cumbria, Newcastle-upon-Tyne, United Kingdom
| | - Sophie Thorne
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Rebecca Walsh
- Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Sunil Bhopal
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration North East & North Cumbria, Newcastle-upon-Tyne, United Kingdom
- Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Stephen Owens
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- Great North Children’s Hospital, Newcastle upon Tyne, United Kingdom
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
- NIHR Applied Research Collaboration North East & North Cumbria, Newcastle-upon-Tyne, United Kingdom
| |
Collapse
|
26
|
Hughes RC, Muendo R, Bhopal SS, Onyango S, Kimani-Murage EW, Kirkwood BR, Hill Z, Kitsao-Wekulo P. Parental experiences of childcare in an informal urban settlement: qualitative interview findings from the Nairobi Early Childcare in Slums (NECS) project. BMJ Open 2023; 13:e071627. [PMID: 37105687 PMCID: PMC10152052 DOI: 10.1136/bmjopen-2023-071627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVES To gain an in-depth understanding of parent/carers' perspectives on, and decision-making about, early childhood care in general, and paid childcare specifically, in informal settlements in Nairobi. DESIGN In-depth telephone interviews, conducted using a topic guide, were analysed through a combination of deductive and inductive thematic analysis and regular reflexivity meetings. We explored parents' childcare needs and experiences over time, and their perspectives on the provision of paid childcare in the slums. SETTING Three informal settlements or slums in Nairobi: Kibera; Kawangware; and Mukuru-Viwandani. PARTICIPANTS A purposively selected sample of 21 parental and non-parental carers of children aged under 5 years who were currently living in three Nairobi slums, including men and women, and users and non-users of paid childcare. RESULTS Childcare is complex, with a plurality of approaches being used. Common strategies include family member provided care (often but not exclusively by mothers, at home or at a place of work), paid childcare and informal or ad hoc arrangements with neighbours. Childcare decision-making in these settings is constrained by economics and the broader context of living in the slum. Paid childcare is frequently used, but is widely understood to be lacking in quality, especially for the poorest. Quality of childcare is understood to comprise a combination of structural factors, such as the physical space, play and learning resources and processes such as interactions between the care provider and children or parents. CONCLUSIONS These findings suggest a need, and opportunity, to improve early childhood care in slums. Understanding parental perspectives on both the deficiencies and valued features of childcare is likely to be vital to informing efforts to improve childcare in these settings.
Collapse
Affiliation(s)
- Robert C Hughes
- Maternal & Child Health Intervention Research Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Ruth Muendo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | - Sunil S Bhopal
- Maternal & Child Health Intervention Research Group, London School of Hygiene & Tropical Medicine, London, UK
- Newcastle upon Tyne, Population Health Sciences Institute, Newcastle upon Tyne, UK
| | - Silas Onyango
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| | | | - Betty R Kirkwood
- Maternal & Child Health Intervention Research Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Zelee Hill
- Institute for Global Health, University College London, London, UK
| | - Patricia Kitsao-Wekulo
- Maternal and Child Wellbeing Unit, African Population and Health Research Center, Nairobi, Kenya
| |
Collapse
|
27
|
Meloncelli N, Shipton E, Doust J, D'Emden M, McIntyre HD, Callaway L, de Jersey S. Clinicians' perspectives on gestational diabetes screening during the global COVID-19 pandemic in Australia. Aust N Z J Obstet Gynaecol 2023; 63:163-170. [PMID: 35962532 PMCID: PMC9538873 DOI: 10.1111/ajo.13601] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 07/03/2022] [Indexed: 11/30/2022]
Abstract
AIM There is no international consensus for the screening and diagnosis of gestational diabetes mellitus (GDM). In March 2020, modified screening and diagnostic recommendations were rapidly implemented in Queensland, Australia, in response to the COVID-19 pandemic. How clinicians perceived and used these changes can provide insights to support high-quality clinical practice and provide lessons for future policy changes. The aim of this study was to understand clinicians' perceptions and use of COVID-19 changes to GDM screening and diagnostic recommendations. METHODS Queensland healthcare professionals responsible for diagnosing or caring for women with GDM were recruited for semi-structured telephone interviews. Data analysis of transcribed interviews used inductive reflexive thematic analysis. RESULTS Seventeen interviews were conducted with the following participants: six midwives/nurses, three endocrinologists, two general practitioners, two general practitioners/obstetricians, two diabetes educators, one dietitian and one obstetrician. Three themes emerged: communication and implementation, perceptions and value of evidence and diversity in perceptions of GDM screening. Overall, clinicians welcomed the rapid changes during the initial uncertainty of the pandemic, but as COVID-19 became less of a threat to the Queensland healthcare system, some questioned the underlying evidence base. In areas where GDM was more prevalent, clinicians more frequently worried about missed diagnoses, whereas others who felt that overdiagnosis had occurred in the past continued to support the changes. CONCLUSIONS These findings highlight the challenges to changing policy when clinicians have diverse (and often strongly held) views.
Collapse
Affiliation(s)
- Nina Meloncelli
- Faculty of Medicine, Centre for Clinical Research and Perinatal Research CentreThe University of QueenslandBrisbaneQueenslandAustralia
| | - Emma Shipton
- Women's and Newborn Services Royal Brisbane and Women's HospitalMetro North Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Jenny Doust
- Faculty of Medicine, Centre for Longitudinal and Life Course Research, School of Public HealthThe University of QueenslandBrisbaneQueenslandAustralia
| | - Michael D'Emden
- Department of Endocrinology and DiabetesRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Harold David McIntyre
- Mater Research, Faculty of MedicineThe University of QueenslandBrisbaneQueenslandAustralia
| | - Leonie Callaway
- Faculty of Medicine, Centre for Clinical Research and Perinatal Research CentreThe University of QueenslandBrisbaneQueenslandAustralia
- Women's and Newborn Services Royal Brisbane and Women's HospitalMetro North Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Susan de Jersey
- Faculty of Medicine, Centre for Clinical Research and Perinatal Research CentreThe University of QueenslandBrisbaneQueenslandAustralia
- Department of Nutrition and Dietetics, Royal Brisbane and Women's HospitalMetro North Hospital and Health ServiceBrisbaneQueenslandAustralia
| |
Collapse
|
28
|
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.
Collapse
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
| |
Collapse
|
29
|
Banwell E, Humphrey N, Qualter P. Reformed child and adolescent mental health services in a devolved healthcare system: a mixed-methods case study of an implementation site. FRONTIERS IN HEALTH SERVICES 2023; 3:1112544. [PMID: 37213205 PMCID: PMC10196272 DOI: 10.3389/frhs.2023.1112544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/17/2023] [Indexed: 05/23/2023]
Abstract
Background Efforts are being made to reform and reconceptualise children and young people's (CYP) mental health services. This is in response to a rapid increase in mental health difficulties in this population, and the shortcomings of current service provision. The present study seeks to comprehensively evaluate the local implementation of the THRIVE Framework for System Change in Greater Manchester, UK (GM i-THRIVE) from 2018 to 2021. The framework was designed to change the way mental health is perceived, and subsequently how support is allocated. The current study focusses on the implementation of the framework's principles into CYP mental health support in the region. Methods The study comprised three methodological components, beginning with examination of the GM i-THRIVE implementation plan and self-assessment questionnaire measure using the Quality Implementation Tool. This was to provide a wider backdrop of implementation method adequacy to the rest of the study's findings. Subsequently, evaluation measures completed by professionals across Greater Manchester were examined to establish implementation progress, before corroborating key items from this measure with thematically analysed interview data from six CYP (13-22 years) who recently received mental health support in the region. Levels of agreement between staff and CYP were examined. Results GM i-THRIVE's implementation plan and self-assessment measure were respectively deemed a strong guiding foundation, and a suitable way of evaluating implementation progress. Every principle within the self-assessment measure demonstrated closer alignment with the THRIVE Framework as time progressed. Two themes were developed from the qualitative interview data, each overarching four subthemes: (1) Qualities of the service: information and decision sharing; communication and continuity; needs-based support; compassion and trust, and (2) The mental health journey: beginnings; endings; waiting; satisfaction with support. A good level of agreement between CYP testimony and staff progress reports was found. Conclusions Findings suggested that the experiences of the CYP in the sample, who were interviewed in the spring to summer period of 2022, were overwhelmingly positive. The rich insights into mental health support offered by the young participants lead us to recommend continued qualitative research with service-users as GM i-THRIVE's embedding period continues, with focus on representing a wide range of experiences in future research samples. Methodological limitations were explored, including the extent to which true cross-references could be made between professional and CYP accounts.
Collapse
|
30
|
Wurz A, Culos-Reed SN, Franklin K, DeMars J, Wrightson JG, Twomey R. "I feel like my body is broken": exploring the experiences of people living with long COVID. Qual Life Res 2022; 31:3339-3354. [PMID: 35816258 PMCID: PMC9272651 DOI: 10.1007/s11136-022-03176-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE Long COVID, an illness affecting a subset of individuals after COVID-19, is distressing, poorly understood, and reduces quality of life. The objective of this sub-study was to better understand and explore individuals' experiences with long COVID and commonly reported symptoms, using qualitative data collected from open-ended survey responses. METHODS Data were collected from adults living with long COVID who participated in a larger observational online survey. Participants had the option of answering seven open-ended items. Data from the open-ended items were analyzed following guidelines for reflective thematic analysis. RESULTS From 213 participants who were included in the online survey, 169 participants who primarily self-identified as women (88.2%), aged 40-49 (33.1%), who had been experiencing long COVID symptoms for ≥ 6 months (74%) provided open-ended responses. Four overlapping and interconnected themes were identified: (1) Long COVID symptoms are numerous and wearing, (2) The effects of long COVID are pervasive, (3) Physical activity is difficult and, in some cases, not possible, and (4) Asking for help when few are listening, and little is working. CONCLUSION Findings reaffirm prior research, highlighting the complex nature of long COVID. Further, results show the ways individuals affected by the illness are negatively impacted and have had to alter their daily activities. Participants recounted the challenges faced when advocating for themselves, adapting to new limitations, and navigating healthcare systems. The varied relapsing-remitting symptoms, unknown prognosis, and deep sense of loss over one's prior identity suggest interventions are needed to support this population.
Collapse
Affiliation(s)
- Amanda Wurz
- School of Kinesiology, University of the Fraser Valley, Chilliwack, BC, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Oncology, Cumming School of Medicine, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
| | | | | | - James G Wrightson
- Department of Clinical Neurosciences, University of Calgary and Alberta Children's Hospital, Calgary, AB, Canada
| | - Rosie Twomey
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
31
|
Taylor F, Galloway S, Irons K, Mess L, Pemberton L, Worton K, Chambers M. Barriers and enablers to implementation of the therapeutic engagement questionnaire in acute mental health inpatient wards in England: A qualitative study. Int J Ment Health Nurs 2022; 31:1467-1479. [PMID: 35976724 PMCID: PMC9804631 DOI: 10.1111/inm.13047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/03/2022] [Indexed: 01/09/2023]
Abstract
A strong association exists between the quality of nurse-service user therapeutic relationship and care outcomes on acute mental health inpatient wards. Despite evidence that service users desire improved therapeutic engagement, and registered mental health nurses recognize the benefits of therapeutic relationships, such interactions remain sub-optimal. There is a dearth of evidence on factors influencing implementation of interventions to support and encourage therapeutic engagement. This study aimed to understand the barriers and enablers to implementation of the Therapeutic Engagement Questionnaire (TEQ), across fifteen acute inpatient wards in seven English mental health organizations. Qualitative methods were used in which data were collected from ethnographic field notes and documentary review, coded, and analysed using thematic analysis. Theoretical framing supported data analysis and interpretation. Reporting adheres to the Standards for Reporting Qualitative Research. The TEQ as an evidence-based intervention co-produced with service users and nurses was valued and welcomed by many nurse directors, senior clinicians, and ward managers. However, a range of practical and perceptual factors impeded implementation. Furthermore, many existing contextual challenges for intervention implementation in acute inpatient wards were magnified by the COVID-19 pandemic. Suitable facilitation to address these barriers can help support implementation of the TEQ, with some transferability to implementation of other interventions in these settings. Our study suggests several facilitation methods, brought together in a conceptual model, including encouragement of reflective, facilitative discussion meetings among stakeholders and researchers, effort put into winning nurse 'buy-in' and identifying and supporting ward-level agents of change.
Collapse
Affiliation(s)
- Francesca Taylor
- Joint Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Sarah Galloway
- South-West London and St George's Mental Health NHS Trust, London, UK
| | | | - Lorna Mess
- North-East London NHS Foundation Trust, London, UK
| | | | - Karen Worton
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, London, UK
| | - Mary Chambers
- Joint Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| |
Collapse
|
32
|
Inter-Organisational Entanglements in Migrant Support Ecologies: Action and Collaboration Supporting Labour Market Integration. JOURNAL OF INTERNATIONAL MIGRATION AND INTEGRATION 2022. [DOI: 10.1007/s12134-022-01001-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
AbstractThis paper examines inter-organisational behaviours in what we call ‘migrant support ecologies’ – shared physical and abstract spaces where multiple organisations work to help migrants access and transition within the labour market. Drawing on composite data generated through studies conducted in the UK and Brazil, we argue that actors and organisations in such environments operate in ‘common goal domains’, in which objectives are related but not necessarily integrated or coordinated, and they consequently adopt diverse interactional practices. We distinguish between four ideal types of migrant support organisation based on their activity scope and stakeholder focus before outlining how different organisations and their constituent actors engage in tactical and strategic coupling practices, reflecting shorter and more episodic interactions alongside complex, multithreaded ones. The findings show how different forms of cooperative arrangements may be pursued based on organisations’ capacities, focus and the types of value they seek to create for organisations, migrants and wider societies.
Collapse
|
33
|
Reflections on How to Apply Norbert Elias’ Philosophy of Figurations to Problems of Marketing. PHILOSOPHY OF MANAGEMENT 2022. [DOI: 10.1007/s40926-022-00223-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
34
|
McConnell D, Phelan SK. Intimate partner violence against women with intellectual disability: A relational framework for inclusive, trauma-informed social services. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5156-e5166. [PMID: 35906864 DOI: 10.1111/hsc.13932] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 06/06/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
Women with intellectual disability experience intimate partner violence at higher rates and tend to remain in abusive relationships longer than non-disabled women. The purpose of this inquiry was to generate a preliminary set of principles and delineate domains of support as a general guide for social service workers supporting women with intellectual disability through the difficult, often stop-start process of ending an abusive relationship and creating a desired future. Taking a pragmatic inquiry approach, guiding principles and domains of support were generated through a triangulated engagement with relational theory, relevant published research, and original data gathered through interviews with five experienced social service workers. The results comprise a relational framework for inclusive, trauma-informed services aimed at fostering the relational autonomy of women with intellectual disability. Enacting relational principles of reflexivity, recognition, solidarity and safety, social service workers can support women with intellectual disability with safety planning, securing basic life needs, strengthening social relationships, acquiring new skills and nurturing self-affective attitudes of self-respect, self-efficacy and self-esteem.
Collapse
Affiliation(s)
- David McConnell
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Shanon K Phelan
- School of Occupational Therapy, Faculty of Health, Dalhousie University, Halifax, Canada
| |
Collapse
|
35
|
Gurung G, Jaye C, Gauld R, Stokes T. Lessons learnt from the implementation of new models of care delivery through alliance governance in the Southern health region of New Zealand: a qualitative study. BMJ Open 2022; 12:e065635. [PMID: 36316079 PMCID: PMC9628683 DOI: 10.1136/bmjopen-2022-065635] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/18/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES To explore the process of implementation of the primary and community care strategy (new models of care delivery) through alliance governance in the Southern health region of New Zealand (NZ). DESIGN Qualitative semistructured interviews were undertaken. A framework-guided rapid analysis was conducted, informed by implementation science theory-the Consolidated Framework for Implementation Research. SETTING Southern health region of NZ (Otago and Southland). PARTICIPANTS Eleven key informants (Alliance Leadership Team members and senior health professionals) who were involved in the development and/or implementation of the strategy. RESULTS The large number of strategy action plans and interdependencies of activities made implementation of the strategy complex. In the inner setting, communication and relationships between individuals and organisations were identified as an important factor for joint and integrated working. Key elements of a positive implementation climate were not adequately addressed to better align the interests of health providers, and there were multiple competing priorities for the project leaders. A perceived low level of commitment from the leadership of both organisations to joint working and resourcing indicated poor organisational readiness. Gaps in the implementation process included no detailed implementation plan (reflected in poor execution), ambitious targets, the lack of a clear performance measurement framework and an inadequate feedback mechanism. CONCLUSIONS This study identified factors for the successful implementation of the PCSS using an alliancing approach in Southern NZ. A key enabler is the presence of a stable and committed senior leadership team working through high trust relationships and open communication across all partner organisations. With alliances, partnerships and networks increasingly held up as models for integration, this evaluation identifies important lessons for policy makers, managers and services providers both in NZ and internationally.
Collapse
Affiliation(s)
- Gagan Gurung
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Centre for Health Systems and Technology (CHeST), University of Otago, Dunedin, New Zealand
| | - Chrystal Jaye
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- CARE Research Theme, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Centre for Health Systems and Technology (CHeST), University of Otago, Dunedin, New Zealand
- Otago Business School, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Centre for Health Systems and Technology (CHeST), University of Otago, Dunedin, New Zealand
| |
Collapse
|
36
|
Steeves-Reece AL, Nicolaidis C, Richardson DM, Frangie M, Gomez-Arboleda K, Barnes C, Kang M, Goldberg B, Lindner SR, Davis MM. "It Made Me Feel like Things Are Starting to Change in Society:" A Qualitative Study to Foster Positive Patient Experiences during Phone-Based Social Needs Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12668. [PMID: 36231967 PMCID: PMC9566653 DOI: 10.3390/ijerph191912668] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/26/2022] [Accepted: 09/29/2022] [Indexed: 06/16/2023]
Abstract
Many healthcare organizations are screening patients for health-related social needs (HRSN) to improve healthcare quality and outcomes. Due to both the COVID-19 pandemic and limited time during clinical visits, much of this screening is now happening by phone. To promote healing and avoid harm, it is vital to understand patient experiences and recommendations regarding these activities. We conducted a pragmatic qualitative study with patients who had participated in a HRSN intervention. We applied maximum variation sampling, completed recruitment and interviews by phone, and carried out an inductive reflexive thematic analysis. From August to November 2021 we interviewed 34 patients, developed 6 themes, and used these themes to create a framework for generating positive patient experiences during phone-based HRSN interventions. First, we found patients were likely to have initial skepticism or reservations about the intervention. Second, we identified 4 positive intervention components regarding patient experience: transparency and respect for patient autonomy; kind demeanor; genuine intention to help; and attentiveness and responsiveness to patients' situations. Finally, we found patients could be left with feelings of appreciation or hope, regardless of whether they connected with HRSN resources. Healthcare organizations can incorporate our framework into trainings for team members carrying out phone-based HRSN interventions.
Collapse
Affiliation(s)
- Anna L. Steeves-Reece
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Christina Nicolaidis
- School of Social Work, Portland State University, Portland, OR 97201, USA
- Division of General Internal Medicine and Geriatrics, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Dawn M. Richardson
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
| | - Melissa Frangie
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Katherin Gomez-Arboleda
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Chrystal Barnes
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Minnie Kang
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Bruce Goldberg
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
| | - Stephan R. Lindner
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Center for Health Systems Effectiveness, Department of Emergency Medicine, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| | - Melinda M. Davis
- School of Public Health, Portland State University—Oregon Health & Science University, Portland, OR 97201, USA
- Oregon Rural Practice-Based Research Network, School of Medicine, Oregon Health & Science University, Portland, OR 97201, USA
- Department of Family Medicine, School of Medicine, Oregon Health & Science University, Portland, OR 97239, USA
| |
Collapse
|
37
|
Aromataris E, Stern C, Lockwood C, Barker TH, Klugar M, Jadotte Y, Evans C, Ross-White A, Lizarondo L, Stephenson M, McArthur A, Jordan Z, Munn Z. JBI series paper 2: tailored evidence synthesis approaches are required to answer diverse questions: a pragmatic evidence synthesis toolkit from JBI. J Clin Epidemiol 2022; 150:196-202. [PMID: 35429608 DOI: 10.1016/j.jclinepi.2022.04.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/15/2021] [Accepted: 04/09/2022] [Indexed: 12/16/2022]
Abstract
Evidence synthesis is critical in evidence-based healthcare and is a core program of JBI. JBI evidence synthesis is characterised by a pluralistic view of what constitutes evidence and is underpinned by a pragmatic ethos to facilitate the use of evidence to inform practice and policy. This second paper in this series provides a descriptive overview of the JBI evidence synthesis toolkit with reference to resources for 11 different types of reviews. Unique methodologies such as qualitative syntheses, mixed methods reviews, and scoping reviews are highlighted. Key features include standardised and collaborative processes for development of methodologies and a broad range of tailored resources to facilitate the conduct of a JBI evidence synthesis, including appraisal and data extraction tools, software to support the conduct of a systematic review and an intensive systematic review training program. JBI is one of the leading international protagonists for evidence synthesis, providing those who want to answer health-related questions with a toolkit of resources to synthesize the evidence.
Collapse
Affiliation(s)
- Edoardo Aromataris
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, 5006, Adelaide, Australia.
| | - Cindy Stern
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, 5006, Adelaide, Australia
| | - Craig Lockwood
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, 5006, Adelaide, Australia
| | - Timothy H Barker
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, 5006, Adelaide, Australia
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Czech EBHC: A JBI Centre of Excellence, Cochrane Czech Republic, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic
| | - Yuri Jadotte
- The Northeast Institute for Evidence Synthesis and Translation (NEST), a JBI Centre of Excellence, School of Nursing, Rutgers University, and the Department of Family, Population and Preventive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Catrin Evans
- Nottingham Centre for Evidence Based Healthcare, JBI Centre of Excellence, University of Nottingham, School of Health Sciences, QMC, Nottingham, NG7 2HA, UK
| | - Amanda Ross-White
- Queen's Collaboration for Health Care Quality: A JBI Centre of Excellence, School of Nursing, Queen's University Library, Kingston, Ontario, Canada
| | - Lucylynn Lizarondo
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, 5006, Adelaide, Australia
| | - Matthew Stephenson
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, 5006, Adelaide, Australia
| | - Alexa McArthur
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, 5006, Adelaide, Australia
| | - Zoe Jordan
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, 5006, Adelaide, Australia
| | - Zachary Munn
- JBI, Faculty of Health and Medical Sciences, The University of Adelaide, 5006, Adelaide, Australia
| |
Collapse
|
38
|
Radzi S, Chandrasekaran R, Peh ZK, Rajalingam P, Yeong WY, Mogali SR. Students' learning experiences of three-dimensional printed models and plastinated specimens: a qualitative analysis. BMC MEDICAL EDUCATION 2022; 22:695. [PMID: 36171608 PMCID: PMC9520930 DOI: 10.1186/s12909-022-03756-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/16/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Traditional cadaveric dissection is declining whilst plastinated and three-dimensional printed (3DP) models are increasingly popular as substitutes to the conventional anatomy teaching and learning methods. It is unclear about the pros and cons of these new tools and how they impact students' learning experiences of anatomy including humanistic values such as respect, care and empathy. METHODS: Ninety-six students' views were sought immediately after a randomized cross-over study. Pragmatic design was used to investigate the learning experiences of using plastinated and 3DP models of cardiac (in Phase 1, n = 63) and neck (in Phase 2, n = 33) anatomy. Inductive thematic analysis was conducted based on 278 free text comments (related to strengths, weaknesses, things to improve), and focus group (n = 8) transcriptions in full verbatim about learning anatomy with these tools. RESULTS Four themes were found: perceived authenticity, basic understanding versus complexity, attitudes towards respect and care, and multimodality and guidance. CONCLUSIONS Overall, students perceived plastinated specimens as more real and authentic, thus perceived more respect and care than 3DP models; whereas 3DP models were easy to use and prefered for learning basic anatomy.
Collapse
Affiliation(s)
- Shairah Radzi
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Ramya Chandrasekaran
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Zhen Kai Peh
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Preman Rajalingam
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore
| | - Wai Yee Yeong
- Singapore Centre for 3D Printing, School of Mechanical and Aerospace Engineering, Nanyang Technological University Singapore, Singapore, Singapore
| | - Sreenivasulu Reddy Mogali
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Singapore, Singapore.
| |
Collapse
|
39
|
Laird P, Burr C, Gill FJ, Schultz A. Spring-infusors: How a simple and small solution can create king-sized complexity. Nurs Open 2022; 10:1125-1134. [PMID: 36166454 PMCID: PMC9834515 DOI: 10.1002/nop2.1380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/11/2022] [Accepted: 09/06/2022] [Indexed: 01/16/2023] Open
Abstract
AIM The aims of the study were to investigate family and hospital staff views about the use of spring-infusor devices for administration of intravenous antibiotic medications, to examine if the device is acceptable and feasible and to map a process for implementation. DESIGN A qualitative study with a pragmatist approach, within a larger, mixed methods knowledge translation study. METHODS Data were collected by semi-structured interviews with patients who have cystic fibrosis and their parents and focus groups and interviews with hospital staff. Interviews were concluded when no new themes were identified. Thematic analysis and process mapping was undertaken. RESULTS Six parents, nine children and 30 staff were interviewed. Families preferred spring-infusors. Staff knowledge, experience and attitudes toward spring-infusor use was varied. All staff acknowledged that their role is to support patient-centred care. Spring-infusors are preferred by families and clinicians above other IV administration devices but misconceptions about spring-infusor use and numerous procedural challenges reduced their use.
Collapse
Affiliation(s)
- Pamela Laird
- Wal‐yan Respiratory Research Centre, Telethon Kids InstituteUniversity of Western Australia, Perth Children's HospitalNedlandsWestern AustraliaAustralia,Department of PhysiotherapyPerth Children's HospitalNedlandsWestern AustraliaAustralia,Division of Paediatrics, Faculty of MedicineUniversity of Western AustraliaCrawleyWestern AustraliaAustralia
| | - Charlotte Burr
- Department of Respiratory and Sleep MedicinePerth Children's HospitalNedlandsWestern AustraliaAustralia
| | - Fenella J. Gill
- Nursing ResearchPerth Children's HospitalNedlandsWestern AustraliaAustralia,School of Nursing, Faculty of Health SciencesCurtin UniversityPerthWestern AustraliaAustralia
| | - André Schultz
- Wal‐yan Respiratory Research Centre, Telethon Kids InstituteUniversity of Western Australia, Perth Children's HospitalNedlandsWestern AustraliaAustralia,Division of Paediatrics, Faculty of MedicineUniversity of Western AustraliaCrawleyWestern AustraliaAustralia,Department of Respiratory and Sleep MedicinePerth Children's HospitalNedlandsWestern AustraliaAustralia
| |
Collapse
|
40
|
de Melo ÉS, Vieira D, Bredillet C. Investigating the Dynamics of Engineering Design Rework for a Complex Aircraft Development Project: Lessons Learned From a Soft Systems Thinking Lens. PROJECT MANAGEMENT JOURNAL 2022. [DOI: 10.1177/87569728221118342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Organizations still struggle to efficiently manage their complex product development projects (PDPs). A contributor to poor project performance is the dynamics of engineering design rework (EDR), due both to the necessity of adjusting the product being developed and the disruption it causes to the development process. The purpose of this research is to evaluate the dynamics of EDR that negatively impacts the performance of complex PDPs and to suggest actions to overcome those problems. The soft systems thinking methodology underpins the research approach. The dynamics of EDR of an aircraft development project were modeled in a causal loop model.
Collapse
Affiliation(s)
| | - Darli Vieira
- Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada
| | | |
Collapse
|
41
|
Devery K, Yin H, Rawlings D. End-of-Life Essentials education modules: a quality and safety initiative to improve health professionals end-of-life care knowledge, skills, attitude and confidence. BMJ Open Qual 2022. [PMCID: PMC9454072 DOI: 10.1136/bmjoq-2022-001925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background There is a need for expanded end-of-life (EOL) care education and resources for health professionals in acute hospitals to help them increase EOL care skills and knowledge, and build capacity and confidence to provide high-quality EOL care. End-of-Life Essentials (EOLE) is an Australian government-funded project, which offers free peer-reviewed online education modules and implementation resources on EOL care to health professionals in acute hospitals, aiming to help support the provision of high-quality EOL care. Methods The development of EOLE education modules included seven major steps and two peer-review processes. In total, ten EOLE education modules and associated toolkits had been developed by the end of 2018. To evaluate the effectiveness of EOLE education modules, premodule and postmodule survey data from all ten modules and registration data were extracted from the EOLE learning management system for a 4-month period. The significance of difference in learners’ self-perceived EOL care knowledge, skills, attitude and confidence before and after module learning were tested by Wilcoxon Signed Ranks Tests. Results Results from Wilcoxon Signed Ranks Tests revealed statistically significant improvement in learners’ self-perceived EOL care knowledge, skill, attitude and confidence after completion of EOLE modules regardless of their discipline (p<0.001). The learners from different disciplines also reported a high level of intention (median=4, IQR=1) to change their practice after completion of EOLE module learning. Conclusion The evaluation results show a positive impact of EOLE module learning on allied health professionals, doctors and nurses, suggesting that EOLE could be a reliable and accessible online EOL care education resources for health professionals of all disciplines to improve their EOL care knowledge, skills and confidence, build up their capacities in providing quality EOL care to patients and their families, in turn, improve the quality and safety of EOL care in health settings.
Collapse
Affiliation(s)
- Kim Devery
- Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, South Australia, Australia
| | - Huahua Yin
- Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
| | - Deb Rawlings
- Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia
- Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, South Australia, Australia
| |
Collapse
|
42
|
Singh H, Gray CS, Nelson MLA, Nie JX, Thombs R, Armas A, Fortin C, Molla Ghanbari H, Tang T. A qualitative study of hospital and community providers’ experiences with digitalization to facilitate hospital-to-home transitions during the COVID-19 pandemic. PLoS One 2022; 17:e0272224. [PMID: 35980960 PMCID: PMC9387844 DOI: 10.1371/journal.pone.0272224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/14/2022] [Indexed: 11/18/2022] Open
Abstract
Background The COVID-19 pandemic has triggered substantial changes to the healthcare context, including the rapid adoption of digital health to facilitate hospital-to-home transitions. This study aimed to: i) explore the experiences of hospital and community providers with delivering transitional care during the COVID-19 pandemic; ii) understand how rapid digitalization in healthcare has helped or hindered hospital-to-home transitions during the COVID-19 pandemic; and, iii) explore expectations of which elements of technology use may be sustained post-pandemic. Methods Using a pragmatic qualitative descriptive approach, remote interviews with healthcare providers involved in hospital-to-home transitions in Ontario, Canada, were conducted. Interviews were analyzed using a team-based rapid qualitative analysis approach to generate timely results. Visual summary maps displaying key concepts/ideas were created for each interview and revised based on input from multiple team members. Maps that displayed similar concepts were then combined to create a final map, forming the themes and subthemes. Results Sixteen healthcare providers participated, of which 11 worked in a hospital, and five worked in a community setting. COVID-19 was reported to have profoundly impacted healthcare providers, patients, and their caregivers and influenced the communication processes. There were several noted opportunities for technology to support transitions. Interpretation Several challenges with technology use were highlighted, which could impact post-pandemic sustainability. However, the perceived opportunities for technology in supporting transitions indicate the need to investigate the optimal role of technology in the transition workflow.
Collapse
Affiliation(s)
- Hardeep Singh
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michelle L. A. Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jason X. Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Rachel Thombs
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Alana Armas
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management & Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Christian Fortin
- Hennick Bridgepoint Hospital, Sinai Health, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Canada
| | - Hedieh Molla Ghanbari
- Division of Hospital Medicine, Sinai Health System, Toronto, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Terence Tang
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
43
|
Johnston K, Baker J. Sources of information used by elite distance running coaches for selection decisions. PLoS One 2022; 17:e0268554. [PMID: 35939423 PMCID: PMC9359569 DOI: 10.1371/journal.pone.0268554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/03/2022] [Indexed: 11/19/2022] Open
Abstract
Talent identification and selection are critical components of competitive sport success. Despite the time, effort, and resources invested, the accuracy of selection decisions remains generally poor. While much of the scholarship in this area has focused on the factors discriminating skilled and less-skilled individuals, limited research exists on what information is used in the decision-making process for athlete selection. The current study seeks to gain a better understanding of the information used by elite distance running coaches when forming judgements for athlete selection. Ten semi-structured interviews with elite distance running coaches from across Canada were transcribed and analyzed using inductive thematic analysis. It was interpreted that coaches mainly gather information using their coach’s eye to determine an athlete’s ‘fit’ to the team. Coaches also use more objective information such as race times and movement analyses to assess performance and judge future ‘potential’. As well, the decisions were believed to be influenced by situational considerations at the time of the selection procedure. Specifically, these considerations affecting a coach’s selection included length of time to make a decision, personal limitations in decision-making abilities, and team circumstances. Interestingly, coaches recognized limitations in their selection practices and procedures and discussed some of their personal and system-level biases, highlighting their awareness of potential selection inefficiencies/inaccuracies. Overall, distance running coaches used a variety of techniques to gather information before a selection was made, relying on both subjective and objective information for crafting judgments. Findings are discussed in relation to implications for coaches, sport organizations, and talent identification and selection programs.
Collapse
Affiliation(s)
- Kathryn Johnston
- Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| | - Joseph Baker
- Kinesiology and Health Science, York University, Toronto, Ontario, Canada
| |
Collapse
|
44
|
Vočanec D, Lončarek K, Sović S, Džakula A. Nurse coordinator of care as a facilitator of integration processes in palliative care. J Clin Nurs 2022. [PMID: 35799376 DOI: 10.1111/jocn.16435] [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: 03/14/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES This paper investigates the feasibility and the perception of the nurse's role as the palliative care coordinator. BACKGROUND Integrated care is a global imperative in all healthcare improvement processes. Due to Andrija Štampar's success in the organisation of public health services, Croatia today has more than hundred years of experience in care integration. The palliative care system has been continuously developing since 2014 as an integrated care model, with nurses as care coordinators. METHODS The study used a mixed methodology based on pragmatic research principles, including an analysis of strategic and policy documents and reports, and thematic analysis of focus group conducted with palliative care coordinators, following COREQ checklist. RESULTS Although a legal, professional and financial regulation of nurse coordinators has been achieved, a number of implementation challenges remain. These challenges arise as a result of long-term fragmentation of the health and social care, and can be found in both horizontal and vertical integration of care, that is in the dimensions of functional, clinical, cultural and social integration. CONCLUSIONS Nurses play a central role in care coordination. Coordination and integration promote professionalisation with clear roles and tasks. However, even with the legal, professional and financial implementation of the nurse coordinator model, it has to be further promoted as an equally important job in the healthcare system, with nurses as competent professionals in charge of care coordination. RELEVANCE TO CLINICAL PRACTICE Palliative care provides a range of individualised, coordinated services that meet the medical and non-medical needs of seriously ill patients. Described model of palliative care in Croatia is particularly important because it was developed as an integrated part of health care (and partly social welfare) system, indicating with the nurse's role as palliative care coordinator that coordination is a continuous process that requires a dedicated professional role.
Collapse
Affiliation(s)
- Dorja Vočanec
- Department of Social Medicine and Organization of Health Care, Andrija Štampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Karmen Lončarek
- Department of Integrated and Palliative Care, Rijeka University Hospital Center, Rijeka, Croatia
| | - Slavica Sović
- Department of Medical Statistics, Epidemiology and Medical Informatics, Andrija Štampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia
| | - Aleksandar Džakula
- Department of Social Medicine and Organization of Health Care, Andrija Štampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia
| |
Collapse
|
45
|
Squires A, Clark-Cutaia M, Henderson MD, Arneson G, Resnik P. "Should I stay or should I go?" Nurses' perspectives about working during the Covid-19 pandemic's first wave in the United States: A summative content analysis combined with topic modeling. Int J Nurs Stud 2022; 131:104256. [PMID: 35544991 PMCID: PMC9020864 DOI: 10.1016/j.ijnurstu.2022.104256] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The COVID-19 pandemic had its first peak in the United States between April and July of 2020, with incidence and prevalence rates of the virus the greatest in the northeastern coast of the country. At the time of study implementation, there were few studies capturing the perspectives of nurses working the frontlines of the pandemic in any setting as research output in the United States focused largely on treating the disease. OBJECTIVE The purpose of this study was to capture the perspectives of nurses in the United States working the frontlines of the COVID-19 pandemic's first wave. We were specifically interested in examining the impact of the pandemic on nurses' roles, professional relationships, and the organizational cultures of their employers. DESIGN We conducted an online qualitative study with a pragmatic design to capture the perspectives of nurses working during the first wave of the United States COVID-19 pandemic. Through social networking recruitment, frontline nurses from across the country were invited to participate. Participants provided long form, text-based responses to four questions designed to capture their experiences. A combination of Latent Dirichlet Allocation--a natural language processing technique--along with traditional summative content analysis techniques were used to analyze the data. SETTING The United States during the COVID-19 pandemic's first wave between May and July of 2020. RESULTS A total of 318 nurses participated from 29 out of 50 states, with 242 fully completing all questions. Findings suggested that the place of work mattered significantly in terms of the frontline working experience. It influenced role changes, risk assumption, interprofessional teamwork experiences, and ultimately, likelihood to leave their jobs or the profession altogether. Organizational culture and its influence on pandemic response implementation was a critical feature of their experiences. CONCLUSIONS Findings suggest that organizational performance during the pandemic may be reflected in nursing workforce retention as the risk for workforce attrition appears high. It was also clear from the reports that nurses appear to have assumed higher occupational risks during the pandemic when compared to other providers. The 2020 data from this study also offered a number of signals about potential threats to the stability and sustainability of the US nursing workforce that are now manifesting. The findings underscore the importance of conducting health workforce research during a crisis in order to discern the signals of future problems or for long-term crisis response. TWEETABLE ABSTRACT Healthcare leaders made the difference for nurses during the pandemic. How many nurses leave their employer in the next year will tell you who was good, who wasn't.
Collapse
Affiliation(s)
- Allison Squires
- Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th Floor, New York, NY 10010, United States of America,Corresponding author
| | - Maya Clark-Cutaia
- Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th Floor, New York, NY 10010, United States of America
| | - Marcus D. Henderson
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States of America
| | - Gavin Arneson
- Rory Meyers College of Nursing, New York University, 433 First Avenue, 6th Floor, New York, NY 10010, United States of America
| | - Philip Resnik
- Department of Linguistics and Institute for Advanced Computer Studies, University of Maryland, College Park, MD, United States of America
| |
Collapse
|
46
|
Kirkegaard A, Ball L, Mitchell L, Williams LT. A novel perspective of Australian primary care dietetics: Insights from an exploratory study using complex adaptive systems theory. Nutr Diet 2022; 79:469-480. [PMID: 35692187 PMCID: PMC9545103 DOI: 10.1111/1747-0080.12742] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/29/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
Aims Effective quality improvement strategies are essential to enhancing outcomes of dietetic care. Interventions informed by complex adaptive systems theory have demonstrated effectiveness in other healthcare settings. This study aimed to explore primary care dietetics practice using complex adaptive systems theory and to identify factors that individuals across the healthcare system can examine and address to improve the quality of dietetic care. Methods Qualitative analysis of semi‐structured interviews of healthcare consumers and professionals involved in the provision of dietetic care. Data collection and analysis was guided by a complexity‐informed conceptual framework. The Framework Method was used to code transcripts and identify themes describing primary care dietetics. Results Twenty‐three consumers and 26 primary care professionals participated. Participants described dietetic care as being delivered by individuals organised into formal and informal systems that were influenced by the wider environment, including legal, economic, and socio‐cultural systems. Dietitians described interactions with consumers as a learning opportunity and sought education, mentoring, or supervision to address knowledge and skill gaps. Relationships underpinned transfer of information between individuals. Conclusion Complex adaptive systems theory proved to be a useful conceptual framework for primary care dietetics. Factors identified at the macro (e.g., funding), meso (e.g., professional networks), and micro (e.g., consumer education) levels should be examined and addressed to improve the quality of dietetic care.
Collapse
Affiliation(s)
- Amy Kirkegaard
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Lauren Ball
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Lana Mitchell
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| | - Lauren T Williams
- Menzies Health Institute of Queensland, Griffith University, Southport, QLD, Australia.,School of Health Sciences and Social Work, Griffith University, Gold Coast Campus, Southport, QLD, Australia
| |
Collapse
|
47
|
Salem V, Hirani D, Lloyd C, Regan L, Peters CJ. Why are women still leaving academic medicine? A qualitative study within a London Medical School. BMJ Open 2022; 12:e057847. [PMID: 35672065 PMCID: PMC9174775 DOI: 10.1136/bmjopen-2021-057847] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 05/13/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To identify factors that influenced women who chose to leave academic medicine. DESIGN AND MAIN OUTCOME MEASURES Independent consultants led a focus group of women in medicine who had left academia after completion of their postgraduate research degree at Imperial College London Faculty of Medicine. Thematic analysis was performed on the transcribed conversations. PARTICIPANTS AND SETTING Nine women physicians who completed a postgraduate degree (MD or PhD) at a large London Medical School and Academic Health Sciences Centre, Imperial College London, but did not go on to pursue a career in academic medicine. RESULTS Influences to leave clinical academia were summarised under eight themes-career intentions, supervisor support, institutional human resources support, inclusivity, work-life balance, expectations, mentors and role models, and pregnancy and maternity leave. CONCLUSION The women in our focus group reported several factors contributing to their decision to leave clinical academia, which included lack of mentoring tailored to specific needs, low levels of acceptance for flexible working to help meet parental responsibilities and perceived explicit gender biases. We summarise the multiple targeted strategies that Imperial College London has implemented to promote retention of women in academic medicine, although more research needs to be done to ascertain the most effective interventions.
Collapse
Affiliation(s)
- Victoria Salem
- Department of Bioengineering, Imperial College London, London, UK
| | - Dhruti Hirani
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Clare Lloyd
- National Heart & Lung Institute, Imperial College London, London, UK
| | - Lesley Regan
- Department of Surgery and Cancer, Imperial College London, London, UK
| | | |
Collapse
|
48
|
Armstrong VG, Ross J. The Experiences of Parents and Infants Using a Home-Based Art Intervention Aimed at Improving Wellbeing and Connectedness in Their Relationship. Front Psychol 2022; 13:732562. [PMID: 35664138 PMCID: PMC9161640 DOI: 10.3389/fpsyg.2022.732562] [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] [Received: 06/29/2021] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
During the period of COVID-19 restrictions, we offered vulnerable families with 0 to 3 year old children boxes of art resources and guided creative activities to do together at home. This paper explores families' experiences of this intervention, highlighting their perceptions of change in wellbeing and attachment. There is a developing case for the social benefits of art, including the impact of arts on mental health and on the wellbeing of children. However, we know that social factors impact upon arts participation, and existing inequalities and mental health difficulties have been exacerbated in the context of the pandemic. This project aimed to adapt to restrictions, to provide a meaningful remote intervention, supporting parent-infant dyads to have positive interactions through art making. We sought to explore the benefits of this intervention for infants and parents with a view to understanding more about the psychological benefits of art participation and about ways to engage families into art making, as well as thinking about how best we can evidence these kinds of arts in health interventions. Preliminary findings showed promising outcomes from the art boxes and this paper brings together the full results, primarily based on interviews with sixteen parents and four referrers alongside collected feedback. We highlight potential mechanisms for change within the intervention and detail the perceived impact of the art boxes in supporting attachment. Parents felt that the art-boxes facilitated changes in their own wellbeing that would make them more available to connection, and recognised changes for babies that reflected their increased capacity to mentalise about their child. Importantly, there were also concrete changes for the dyad that represented improved connection, such as more playful time together and increased shared attention and eye contact. Our observations suggest that the quality of the parent-infant relationship benefited from home-based art intervention, and we speculate about the potential efficacy of this approach beyond the pandemic.
Collapse
|
49
|
Devery K, Winsall M, Rawlings D. Teams and continuity of end-of-life care in hospitals: managing differences of opinion. BMJ Open Qual 2022; 11:bmjoq-2021-001724. [PMID: 35443999 PMCID: PMC9021766 DOI: 10.1136/bmjoq-2021-001724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 03/31/2022] [Indexed: 11/21/2022] Open
Abstract
Background Recognised as an essential element in end-of-life care by the Australian Commission on Safety and Quality in Health Care, effective teamwork can enhance the quality and safety of end-of-life care for patients in hospitals. End-of-Life Essentials (EOLE) is a Commonwealth funded project that delivers peer-reviewed, evidence-based, online education and practice change resources for doctors, nurses and allied health professionals working in hospitals. ‘Teams and Continuity for the Patient’ features in the suite of EOLE modules and includes education around effective teamwork in end-of-life care. The aim of this study was to explore the views of module learners on managing differences of opinion among staff regarding patient care management. Methods Participants were learners (health professionals) who registered to the EOLE website and engaged with the Teams module. Learner responses to a question posed at the end of the module ‘How do you manage differences of opinion among staff regarding patient care management?’ were extracted for a 12-month period. Qualitative data were analysed thematically in NVivo V.12, with pragmatism as an overarching theoretical framework. Data were coded using an inductive, open approach, and axial coding was used to organise the codes into themes and subthemes. Findings A total of 293 learner statements were analysed, with subthemes organised into three overarching themes: prioritising the patient, team collaboration and communication skills and emotional awareness. Conclusion In complex, fast-paced, hospital environments, the potential for conflict among teams is high. Quality care relies on team members who work in unison, who can also recognise conflict emerging and respond in respectful and appropriate ways. In this study, the management actions reported by health professionals as proving helpful when differences of opinion among team members arise, are valuable to organisations who are considering how to prepare for quality and safety accreditation.
Collapse
Affiliation(s)
- Kim Devery
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
| | - Megan Winsall
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
| | - Deb Rawlings
- Palliative and Supportive Services, Flinders University, Bedford Park, South Australia, Australia
| |
Collapse
|
50
|
Gill FJ, Cooper AL, Laird P, Leslie GD. Aboriginal perspectives on recognising clinical deterioration in their child and communicating concerns to clinicians. J Pediatr Nurs 2022; 63:e10-e17. [PMID: 34801328 DOI: 10.1016/j.pedn.2021.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 10/13/2021] [Accepted: 11/09/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To explore the perspectives of family members of Aboriginal children about a) their involvement in recognising clinical deterioration in a hospital setting and b) the effectiveness of a poster designed to promote family involvement. BACKGROUND To assist in the early recognition and response to clinical deterioration for hospitalised children, many escalation of care processes now include family involvement. Little is currently known about the perspectives of Australian Aboriginal families in recognising deterioration in their child and raising the alarm, or if current escalation of care systems meet the needs of Aboriginal families. DESIGN Qualitative pragmatist approach using semi-structured interviews. METHODS Seven interviews were conducted with five mothers and two grandmothers of Aboriginal children who were inpatients at a children's hospital. Thematic analysis was undertaken. FINDINGS Two themes were identified: Theme one was: Family role in recognising and responding to clinical deterioration, with two subthemes of knowing when to worry and communicating concerns. Participants reported that some families needed more knowledge to recognise clinical deterioration. Communication barriers between families and clinicians were identified. Theme two was: Effective visual communication with three subthemes of linguistic clarity, visual appeal and content. CONCLUSIONS Additional strategies are needed to promote effective communication between clinicians and families of Aboriginal children in hospital. Posters were considered effective, particularly if including a cultural connection, images and simplified language. PRACTICE IMPLICATIONS These insights provide important information for health professionals and health service managers to be aware that additional communication strategies are required to support Aboriginal family involvement in recognising clinical deterioration and escalation of care.
Collapse
Affiliation(s)
- Fenella J Gill
- Nursing Research, Perth Children's Hospital, 15 Hospital Avenue, Nedlands 6009, WA, Australia; School of Nursing, Curtin University, Perth 6102, WA, Australia; Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia.
| | - Alannah L Cooper
- School of Nursing, Curtin University, Perth 6102, WA, Australia.
| | - Pamela Laird
- Physiotherapy Department, Perth Children's Hospital, 15 Hospital Avenue, Nedlands 6009, WA, Australia; Breath Team, Wal-Yan Respiratory Research Centre, Telethon Kids Institute, 15 Hospital Avenue, Nedlands 6009, WA, Australia; School of Medicine, University of Western Australia, 35 Stirling Highway, Crawley 6009, WA, Australia.
| | - Gavin D Leslie
- School of Nursing, Curtin University, Perth 6102, WA, Australia.
| |
Collapse
|