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Chaudhry MT, McCambridge AB, Rivera EII, William S, Stubbs P, Verhagen A, Ferguson C. A Qualitative Exploration of Stroke Survivors' Experiences of Using a Stroke Helpline. Health Expect 2024; 27:e14141. [PMID: 38990166 PMCID: PMC11238573 DOI: 10.1111/hex.14141] [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: 10/24/2023] [Revised: 04/10/2024] [Accepted: 06/26/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND StrokeLine is a stroke-specific helpline used by stroke survivors and their families in Australia to access professional support. There has been little research exploring stroke survivors' experiences of using helplines and their perceived impact on their stroke recovery. AIM The aim of this study is to explore the reasons prompting stroke survivors to call StrokeLine and their experiences and to describe the perceived impact of calling StrokeLine on their recovery. METHODS An exploratory descriptive qualitative study was undertaken using thematic analysis of data collected through semi-structured interviews of stroke survivors between December 2020 and May 2022. Participants were recruited using purposive sampling. Interviews were conducted via audio-recorded Zoom conference calling and transcribed verbatim for thematic analysis. RESULTS A total of eight callers (four men and women women) participated, with the time since stroke ranging from 3.5 months to 5 years. Four major themes were identified, including 17 sub-themes. Key themes included (1) factors prompting use of StrokeLine; (2) experience of using StrokeLine; (3) perceived impact of using StrokeLine; and (4) conceptualising StrokeLine service provision. CONCLUSIONS Participants perceived their experience of contacting StrokeLine as having a positive impact on their stroke recovery, leaving them feeling empowered and motivated to self-manage their condition. PATIENT OR PUBLIC CONTRIBUTION Stroke survivors with lived experience influenced the conceptualisation of this study through conversations with consumers and the Stroke Foundation. Eight stroke survivors were involved as participants in the research study.
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Affiliation(s)
- Muneeba T Chaudhry
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Alana B McCambridge
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Esminio I I Rivera
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Scott William
- Centre for Chronic & Complex Care Research, School of Nursing, Blacktown Hospital, University of Wollongong & Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Peter Stubbs
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Arianne Verhagen
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Caleb Ferguson
- Centre for Chronic & Complex Care Research, School of Nursing, Blacktown Hospital, University of Wollongong & Western Sydney Local Health District, Sydney, New South Wales, Australia
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Fowler K, Mayock P, Byrne E, Bennett K, Sexton E. "Coming home was a disaster, I didn't know what was going to happen": a qualitative study of survivors' and family members' experiences of navigating care post-stroke. Disabil Rehabil 2024:1-13. [PMID: 38265039 DOI: 10.1080/09638288.2024.2303368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Understanding navigational barriers and facilitators has the potential to advance equitable stroke care delivery. The aim of this study was to explore, using a qualitative study, the experiences of stroke survivors and their families as they journey through the stroke care system, both before and during the COVID-19 pandemic. METHODS In-depth semi-structured interviews were conducted with 18 stroke survivors and 12 family members during 2021 and 2022. Participants were recruited through voluntary organisations, social media, and stroke support groups. Data analysis followed a systematic process guided by the framework method with steps including familiarisation, coding, framework development, and charting and interpretation. RESULTS The experiences of navigating stroke care were particularly challenging following discharge from hospital into the community. Barriers to stroke care continuity included insufficient appropriate services and information, unsatisfactory relationships with healthcare professionals and distressed mental health. There were particular navigational challenges for survivors with aphasia. Facilitators to effective navigation included having prior knowledge of the health system, harnessing support for care co-ordination, and being persistent. CONCLUSION Greater support for patient navigation, and person-centred referral pathways, particularly during times of increased pressure on the system, have the potential to improve access to services and wellbeing among stroke survivors.
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Affiliation(s)
- Karen Fowler
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paula Mayock
- School of Social Work and Social Policy, Trinity College Dublin, Ireland
| | - Elaine Byrne
- Centre for Positive Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Kathleen Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Eithne Sexton
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Chaudhry MT, McCambridge AB, Russell S, Yong K, Inglis SC, Verhagen A, Ferguson C. User profile of people contacting a stroke helpline (StrokeLine) in Australia: a retrospective cohort study. Contemp Nurse 2023; 59:434-442. [PMID: 37823820 DOI: 10.1080/10376178.2023.2262619] [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: 05/30/2023] [Accepted: 09/17/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND StrokeLine is a specialised telephone helpline led by health professionals in Australia. AIMS (i) To describe the profile of StrokeLine callers; (ii) to understand the reasons people engage with the service and (iii) how StrokeLine responded to the caller's needs. METHODS Routine call data were obtained from the StrokeLine between November 2019 and November 2020. Data were extracted and descriptive analyses performed. De-identified free-text data were obtained separately for November 2019 and June 2020 and analysed using qualitative content analysis. RESULTS Of the 1429 calls most were from carers, family and friends (38%) or the stroke survivor themselves (34%). Most calls were made by women (64%) and the average age of the stroke survivor was ≥65 years (33%) with the time since the stroke occurred <1 year. The main reason for calling was to manage stroke-related impairments (40%). Providing information, support and advice was the most common action provided by StrokeLine staff (25%). Content analysis of 225 calls revealed most stroke survivors called for emotional support, while carers sought more practical guidance. StrokeLine provided information for referral to relevant services and guidance on what to do next. CONCLUSIONS Most calls were received from family and carers, as well as stroke survivors. They contacted StrokeLine for information and advice, practical solutions, emotional support, and referral advice to other services.
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Affiliation(s)
- Muneeba T Chaudhry
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | | | | | | | - Sally C Inglis
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Arianne Verhagen
- Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Caleb Ferguson
- School of Nursing, University of Wollongong, NSW 2522, Australia
- Western Sydney Local Health District, Blacktown Hospital, Sydney, NSW, Australia
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Damaiyanti M, Amir H, Cahyani DD, Alhidayat NS, Afrianti N, Rahmiati C, Hastuti H, Sari AS, Hidayat R. Improving caregiver preparedness in the care transition of stroke patients: a scoping review. J Med Life 2023; 16:1723-1731. [PMID: 38585525 PMCID: PMC10994610 DOI: 10.25122/jml-2023-0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/11/2023] [Indexed: 04/09/2024] Open
Abstract
Stroke is a life-threatening condition caused by the rupture of a brain blood vessel, potentially causing brain damage within minutes, severe disability, and even death. After initial hospitalization and rehabilitation, most stroke survivors return home, relying on their family members as caregivers for activities of daily living and treatments. This scoping review aimed to evaluate caregivers' readiness for transitioning stroke patient care to a home environment. We conducted a comprehensive search on Scopus, PubMed, ScienceDirect, and Google Scholar databases, followed by a secondary search to identify articles based on predefined criteria. A total of 14 articles were synthesized, leading to a series of findings: (1) there is a need to assess and identify caregiver needs, (2) the process needs relevant information, (3) caregivers are involved in the care process until the patients are discharged from the hospital, and (4) there is a need to offer support to caregivers. These results indicate that implementing strategies to enhance caregiver preparedness is crucial for the effective home-based care of stroke survivors.
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Affiliation(s)
- Mukhripah Damaiyanti
- Faculty of Nursing, Universitas Muhammadiyah Kalimantan Timur, Kalimantan Timur, Indonesia
| | - Haeril Amir
- Faculty of Public Health, Universitas Muslim Indonesia, Makassar, Indonesia
| | - Desy Dwi Cahyani
- Midwifery Department, Poltekkes Kemenkes Malang, Malang, Indonesia
| | | | - Novi Afrianti
- Faculty of Nursing, Universitas Syiah Kuala, Aceh, Indonesia
| | - Cut Rahmiati
- Akademi Keperawatan Kesdam Iskandar Muda Banda Aceh, Aceh, Indonesia
| | - Hera Hastuti
- Sekolah Tinggi Ilmu Kesehatan Fatmawati, Jakarta, Indonesia
| | | | - Rahmat Hidayat
- Faculty of Public Health, Universitas Muslim Indonesia, Makassar, Indonesia
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Corovic S, Vucic V, Mihaljevic O, Djordjevic J, Colovic S, Radovanovic S, Radevic S, Vukomanovic IS, Janicijevic K, Sekulic M, Djukic S, Vukomanovic V, Djordjevic O, Djordjevic G, Milovanovic O. Social support score in patients with malignant diseases-with sociodemographic and medical characteristics. Front Psychol 2023; 14:1160020. [PMID: 37325739 PMCID: PMC10267316 DOI: 10.3389/fpsyg.2023.1160020] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Introduction Social support as a complex construct has a positive influence not only on a patient's condition but also on the process of the patient's emotional adjustment to cancer. The goal of this study is to investigate aspects of the level of social support in oncology patients and its interconnection with sociodemographic and medical variables. Method The study was conducted as a prospective observational study in 2020, including 250 patients aged 19 and over, both sexes, with a diagnosis of oncological disease. The research was conducted in the Department of General Medicine of the Health Center Trstenik, Central Serbia, after approval by the Ethics Committee of the Health Center Trstenik, Central Serbia. A social support assessment questionnaire (Oslo-3 Social Support Scale) was used as a research instrument. Results Data collected from the entire study population showed that bad social support was present in almost 90% of cases. Univariate and multivariate regression analysis showed a statistically significant influence of the following variables on the bad social support: education level, activity limitation, difficulties in performing daily activities, the impact of pain on the performance of activities, the need for additional help with activity, the need for help at home, unfulfilled needs for health care, means of information, anxiety score and depression score. Conclusion Interventions to increase social support may be important for enhancing mental health and quality of life in cancer patients.
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Affiliation(s)
- Snezana Corovic
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | | | - Olgica Mihaljevic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujavac, Serbia
| | - Jelena Djordjevic
- Department of Pathophysiology, Faculty of Medical Sciences, University of Kragujevac, Kragujavac, Serbia
| | - Sofija Colovic
- Department of Communication Skills, Ethics and Psychology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Snezana Radovanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Svetlana Radevic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Ivana Simic Vukomanovic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Katarina Janicijevic
- Department of Social Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Marija Sekulic
- Department of Hygiene and Ecology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Svetlana Djukic
- Department of Internal Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Vladimir Vukomanovic
- Department of Nuclear Medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Ognjen Djordjevic
- Depatment of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Gordana Djordjevic
- Depatment of Epidemiology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Olivera Milovanovic
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Backman C, Papp S, Harley A, Houle S, Skidmore B, Poitras S, Green M, Shah S, Berdusco R, Beaulé P, French-Merkley V. Protocol for a scoping review of patient-clinician digital health interventions for the population with hip fracture. BMJ Open 2022; 12:e064988. [PMID: 36418125 PMCID: PMC9685264 DOI: 10.1136/bmjopen-2022-064988] [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] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Patient-clinician digital health interventions can potentially improve the care of patients with hip fracture transitioning from hospital to rehabilitation to home. Assisting older patients with a hip fracture and their caregivers in managing their postsurgery care is crucial for ensuring the best rehabilitation outcomes. With the increased availability and wide uptake of mobile devices, the use of digital health to better assist patients in their care has become more common. Among the older adult population, hip fractures are a common occurrence and integrated postsurgery care is key for optimal recovery. The overall aims are to examine the available literature on the impact of hip fracture-specific patient-clinician digital health interventions on patient outcomes and healthcare delivery processes; to identify the barriers and enablers to the uptake and implementation of these digital health interventions; and to provide strategies for improved use of digital health technologies. METHODS AND ANALYSIS We will conduct a scoping review using Arksey and O'Malley's methodology framework and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement for the Scoping Reviews reporting format. A search strategy will be developed, and key databases will be searched until approximately May 2022. A two-step screening process and data extraction of included studies will be performed by two reviewers. Any disagreement will be resolved by consensus or by a third reviewer. For the included studies, a narrative data synthesis will be conducted. Barriers and enablers identified will be mapped to the domains of the Theoretical Domains Framework and related strategies will be provided to guide the uptake of future patient-clinician digital health interventions. ETHICS AND DISSEMINATION This review does not require ethics approval. The results will be presented at a scientific conference and published in a peer-reviewed journal. We will also involve relevant stakeholders to determine appropriate approaches for dissemination.
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Affiliation(s)
- Chantal Backman
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Steve Papp
- Division of Orthopaedic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Anne Harley
- Department of Care of the Elderly, Bruyere Continuing Care, Ottawa, Ontario, Canada
| | - Sandra Houle
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Stephane Poitras
- Faculty of Health Sciences, School of Rehabilitation Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Maeghn Green
- Division of Orthopaedic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Soha Shah
- Department of Care of the Elderly, Bruyere Continuing Care, Ottawa, Ontario, Canada
| | - Randa Berdusco
- Division of Orthopaedic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
| | - Paul Beaulé
- Orthopaedic Surgery, Ottawa Hospital, Ottawa, Ontario, Canada
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Kavga A, Kalemikerakis I, Konstantinidis T, Tsatsou I, Galanis P, Karathanasi E, Govina O. Factors associated with social support for family members who care for stroke survivors. AIMS Public Health 2022; 9:142-154. [PMID: 35071674 PMCID: PMC8755957 DOI: 10.3934/publichealth.2022011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/30/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Vascular strokes are a primary cause of long-term disability for adults, with many social consequences for the patient, the family and healthcare systems worldwide. Aim To investigate the relation between patients' and caregivers' characteristics, as well as burden and depression, and the social support received by carers for stroke victims in Greece. Method Patients and caregivers were recruited from community settings in the Attica region of Greece, using purposive sampling. They completed a set of questionnaires during face-to-face interviews. Correlational and multiple regression analyses were performed to identify factors associated with caregivers' perceptions of social support. Results In total, 109 dyads of patients and their respective caregivers were recruited. The patients' mean age was 69.3 years, while caregivers' mean age was 58.0 years; 51.4% of patients were males, whereas 67.9% of the caregivers were females. The majority of both patients and caregivers were married, with an annual family income less than €10,000. The level of perceived social support was significantly associated with patients' or caregivers' annual family income, caregivers' working status and the daily caring hours (p < 0.01). Greater perceived support was significantly associated with a lower care burden BCOS (r = 0.29, p < 0.01) and female gender (p = 0.023), but not with the patient's functional level nor with depression (p > 0.05).
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Affiliation(s)
- Anna Kavga
- Department of Nursing, University of West Attica, Athens, Greece
| | | | | | - Ioanna Tsatsou
- Oncology-Hematology Department, Hellenic Airforce General Hospital, Athens, Greece
| | - Petros Galanis
- Department of Nursing, National and Kapodistrian University, Athens, Greece
| | | | - Ourania Govina
- Department of Nursing, University of West Attica, Athens, Greece
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Lui M, McKellar K, Cooper S, Eng JJ, Bird ML. Evaluating the impact of a training program to support transitioning from the hospital to the community for people after stroke: a community case study. BMC Health Serv Res 2022; 22:30. [PMID: 34986836 PMCID: PMC8729091 DOI: 10.1186/s12913-021-07436-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 12/15/2021] [Indexed: 11/18/2022] Open
Abstract
Background The transitions in care along the stroke recovery path are challenging, particularly in finding mechanisms to continue one’s recovery once at home. We aim to evaluate the impact of training physiotherapists and fitness instructors from one regional community together to deliver an evidence-based group exercise program starting in the hospital and transitioning to the community using an implementation approach. Methods The evidenced based exercise program Fitness and Mobility Exercise (FAME) for stroke was chosen as the intervention. Data from interviews with stakeholders (community centre and health authority hospital staff including a physiotherapy navigator) was transcribed and themes evaluated using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework. These data were supplemented by information collected as a quality assurance project within the health authority. Results Two programs were established; one in the community centre (run over 15 months by fitness instructors) and one in the regional hospital (run over 12 months by a rehabilitation assistant under the direction from a physiotherapist). Transitions in care were facilitated by implementing the same evidence-based group exercise class in both the hospital and community setting, so people living with stroke could seamlessly move from one to another. An existing physiotherapist navigator service also was valued as a support for the transitions between the two centres for people with stroke. The hospital group accessed group-based physiotherapy service on average 31 days earlier than they were able to in a one-to-one format. Conclusions This case study described the implementation of the Fitness and Mobility Exercise (FAME) program in one community and the use of a physiotherapist navigator to assist transition between them. After a community training workshop, FAME programs were established within the health authority and the community centre. FAME program participants within the health authority benefited from reduced wait times to access hospital outpatient physiotherapy service. Improvements in function were measured in and reported by the people after stroke attending either the health authority or community centre FAME groups. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07436-7.
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Affiliation(s)
- Michelle Lui
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, Vancouver, BC, V6T 2B5, Canada
| | - Katherine McKellar
- Kelowna General Hospital, 2268 Pandosy Street, Kelowna, BC, V1Y 1T2, Canada
| | - Shari Cooper
- Parkinson's Recreation Centre, 1800 Parkinsons way, Kelowna, V17 4P9, Canada
| | - Janice J Eng
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.,Rehabilitation Research Program, GF Strong Rehabilitation Research Laboratory, Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC, V5Z 2G9, Canada
| | - Marie-Louise Bird
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada. .,Rehabilitation Research Program, GF Strong Rehabilitation Research Laboratory, Vancouver Coastal Health Research Institute, 4255 Laurel Street, Vancouver, BC, V5Z 2G9, Canada. .,School of Health Sciences, University of Tasmania, Newnham Drive, Launceston, Tasmania, 7250, Australia.
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Kyriazidou E, Alevizopoulos N, Dokutsidou E, Kavga A, Kalemikerakis I, Konstantinidis T, Tsatsou I, Govina O. Health-Related Quality of Life and Social Support of Elderly Lung and Gastrointestinal Cancer Patients Undergoing Chemotherapy. SAGE Open Nurs 2022; 8:23779608221106444. [PMID: 35720207 PMCID: PMC9201296 DOI: 10.1177/23779608221106444] [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: 02/22/2022] [Accepted: 05/22/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Increasing life expectancy has led to a higher incidence of cancer in the elderly, thus making them vulnerable and worsening their health-related quality of life (HRQoL) and their need for support. Objective The aim of this study was to examine the HRQoL and social support in elderly Greek lung and gastrointestinal cancer patients undergoing chemotherapy. Methods This was a descriptive, cross-sectional study of 104 elderly cancer patients, who were receiving chemotherapy in the outpatient department and inpatient ward of a General Hospital in Athens. The data were collected using purposive sampling between December 2019 and May 2020, and included demographic and clinical characteristics, the HRQoL questionnaire, Short Form 36 (SF36), and the Personal Resource Questionnaire (PRQ-2000). Results The participants' median age was 72 years; the majority were male (62.5%) and had lung cancer (57.7%). The SF36 data revealed a relatively moderate (42.7-62.61) HRQoL in most subscales. The "Pain" subscale recorded the highest score (75.0), and the "social function" subscale the lowest (42.79). The PQR-2000 indicated a satisfactory level of social support (81.65), with values ranging between 48 and 105; married patients with higher education scored more highly (p < .05). Patients aged 65-75 years reported better HRQoL and greater social support than older patients. In addition, patients with their own family and a relatively high income reported better HRQoL and social support compared to single individuals, with low income, who were cared for by their children. Positive and statistically significant (p < .05) correlations were found between the SF36 subscales of role functioning/physical, vitality, general health, emotional well-being and the PRQ-2000. Conclusion The HRQoL and social support of elderly cancer patients positively affect the course of their health. Healthcare systems and social services should address the multiplying needs of these patients with targeted interventions to support their well-being.
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Affiliation(s)
- Eleni Kyriazidou
- Oncology Department, "Evangelismos" General Hospital of Athens, Athens, Greece
| | | | - Eleni Dokutsidou
- Department of Nursing, University of West Attica, Athens, Greece
| | - Anna Kavga
- Department of Nursing, University of West Attica, Athens, Greece
| | | | | | - Ioanna Tsatsou
- Oncology-Hematology Department, Hellenic Airforce General Hospital, Athens, Greece
| | - Ourania Govina
- Department of Nursing, University of West Attica, Athens, Greece
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Tarihoran DETAU, Honey M, Slark J. Educational Strategies for Secondary Stroke Prevention: An Integrative Literature Review. AMERICAN JOURNAL OF HEALTH EDUCATION 2021. [DOI: 10.1080/19325037.2021.1973616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ljungholm L, Klinga C, Edin-Liljegren A, Ekstedt M. What matters in care continuity on the chronic care trajectory for patients and family carers?-A conceptual model. J Clin Nurs 2021; 31:1327-1338. [PMID: 34351651 DOI: 10.1111/jocn.15989] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 07/12/2021] [Accepted: 07/15/2021] [Indexed: 01/19/2023]
Abstract
AIMS AND OBJECTIVES To describe essential aspects of care continuity from the perspectives of persons with complex care needs and their family carers. BACKGROUND Continuity of care is an important aspect of quality, safety and efficiency. For people with multiple chronic diseases and complex care needs, care must be experienced as connected and coherent, and consistent with medical and individual needs. The more complex the need for care, the greater the need for continuity across different competencies, services and roles. DESIGN A constructivist grounded theory approach was applied. METHODS Sixteen patients with one or more chronic diseases needing both health care and social care, living in their private homes, and twelve family carers, were recruited. Semi-structured interviews were conducted and analysed with constructivist grounded theory. The COREQ checklist was followed. RESULTS A conceptual model of care continuity was constructed, consisting of five categories that were interconnected through the core category: time and space. Patients' and family carers' experiences of care continuity were closely related to timely personalised care delivery, where access to tailored information, regardless of who was performing a care task, was essential for mutual understanding. This required clarity in responsibilities and roles, interprofessional collaboration and achieving a trusting relationship between each link in the chain of care, over time and space. To achieve care continuity, all the identified categories were important, as they worked in synergy, not in isolation. CONCLUSION Care continuity for people with complex care needs and family carers is experienced as multidimensional, with several essential aspects that work in synergy, but varies over time and depends on each person's own resources and situational and contextual circumstances. RELEVANCE TO CLINICAL PRACTICE The findings promote understanding of patients' and family carers' experiences of care continuity and may guide the delivery of care to people with complex care needs.
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Affiliation(s)
- Linda Ljungholm
- Department of Health and Caring Sciences, Linnaeus University Kalmar, Kalmar, Sweden
| | - Charlotte Klinga
- Department of Health and Caring Sciences, Linnaeus University Kalmar, Kalmar, Sweden.,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Anette Edin-Liljegren
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden.,Department of Nursing, Umeå University, Umeå, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University Kalmar, Kalmar, Sweden.,Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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Peckham A, Wright JG, Marani H, Abdelhalim R, Laxer D, Allin S, Alam N, Marchildon G. Putting the Patient First: A Scoping Review of Patient Desires in Canada. Healthc Policy 2021; 16:46-69. [PMID: 34129478 PMCID: PMC8200834 DOI: 10.12927/hcpol.2021.26499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Patient-centred care is a key priority for governments, providers and stakeholders, yet little is known about the care preferences of patient groups. We completed a scoping review that yielded 193 articles for analysis. Five health states were used to account for the diversity of possible preferences based on health needs. Five broad themes were identified and expressed differently across the health states, including personalized care, navigation, choice, holistic care and care continuity. Patients' perspectives must be considered to meet the diverse needs of targeted patient groups, which can inform health system planning, quality improvement initiatives and targeting of investments.
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Affiliation(s)
- Allie Peckham
- Assistant Professor, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ; North American Observatory on Health Systems and Policies, University of Toronto, Toronto, ON
| | - James G Wright
- Chief, Economics, Policy and Research, Ontario Medical Association, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Husayn Marani
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Reham Abdelhalim
- Research Assistant, North American Observatory on Health Systems and Policies, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public HealthUniversity of Toronto, Toronto, ON
| | - Dara Laxer
- Executive Director, Health Policy and Promotion, Ontario Medical Association, Toronto, ON
| | - Sara Allin
- Director of Operations, North American Observatory on Health Systems and Policies; Assistant Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
| | - Nadia Alam
- Past President, Ontario Medical Association, Toronto, ON
| | - Greg Marchildon
- Director, North American Observatory on Health Systems and Policies; Professor, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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Chen L, Xiao LD, Chamberlain D, Newman P. Enablers and barriers in hospital-to-home transitional care for stroke survivors and caregivers: A systematic review. J Clin Nurs 2021; 30:2786-2807. [PMID: 33872424 DOI: 10.1111/jocn.15807] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/24/2021] [Accepted: 03/30/2021] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To synthesise qualitative research evidence on the experience of stroke survivors and informal caregivers in hospital-to-home transitional care. BACKGROUND Due to a shortened hospital stay, stroke survivors/caregivers must take over complex care on discharge from hospital to home. Gaps in the literature warrant a meta-synthesis of qualitative studies on perceived enablers and barriers during this crucial period. DESIGN A systematic review and meta-synthesis. METHODS A review was guided by Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) checklist where six databases were searched from April to June 2020 including CINAHL Plus, MEDLINE, PsycINFO, Scopus, Web of Science and ProQuest and ProQuest Dissertations and Theses. There was no date limit to the search. Selected studies were critically appraised. A thematic synthesis approach was applied. RESULTS The synthesis of 29 studies identified three major findings. First, partnerships with stroke survivors/caregivers empower discharge preparation, foster competence to navigate health and social care systems and activate self-management capabilities. Second, gaps in discharge planning and the lack of timely postdischarge support contribute to unmet care needs for stroke survivors/caregivers and affect their ability to cope with poststroke changes. Third, stroke survivors/caregivers expect integrated transitional care that promotes shared decision-making and enables long-term self-management at home. CONCLUSIONS Hospital-to-home transition is a challenging period in the trajectory of poststroke rehabilitation and recovery. Further research is required to deepen understandings of all stakeholders' views and address unmet needs during transitional care. RELEVANCE TO CLINICAL PRACTICE Protocols and clinical guidelines relating to discharge planning and transitional care need to be reviewed to ensure partnership approach with survivors/caregivers in the design and delivery of individualised transitional care. Stroke nurses are in a unique position to lead timely support for survivors/caregivers and to bridge service gaps in hospital-to-home transitional care.
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Affiliation(s)
- Langduo Chen
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Lily Dongxia Xiao
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Diane Chamberlain
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Peter Newman
- College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
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Sauvé-Schenk K, Duong P, Savard J, Durand F. A systematic review of social service and community resource interventions following stroke. Disabil Rehabil 2020; 44:2948-2957. [PMID: 33280453 DOI: 10.1080/09638288.2020.1851780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Finding and accessing social services and community resources are a challenge for stroke survivors and care partners. The purpose of this systematic review was to identify and review interventions that aimed to increase access and use of such services and resources post stroke. METHOD A systematic review of the published literature was performed using MEDLINE, CINAHL, PsycINFO, and ProQuest Nursing and Allied Health (January 2008 to May 2020). Studies were included if they were quantitative designs and reported on outcomes of interventions addressing post-stroke access to social services or community resources. Results were synthesised narratively. RESULTS 3566 titles and abstracts were reviewed. Ten articles met the inclusion criteria. The interventions included in this review varied in terms of target group, timing, and type of support provided (passive or active tailored information provision, referral service, navigation assistance). Outcome measures, for social service and community resource access, included discharge preparedness measures, service counts, observations, satisfaction evaluations, interviews, and open-ended questions. CONCLUSION Overall, interventions demonstrated some improvements in information received and access to social services and community resources following stroke. Future research should focus on carrying out high quality studies that examine the effectiveness of various social service and community resource interventions, and on setting valid and reliable outcome measures.IMPLICATIONS FOR REHABILITATIONStroke survivors and care partners have unmet social service and community resource needs.Stroke survivors and care partners can benefit from interventions that provide information, referrals, and ongoing support to access services and resources.Clearly identifying social service and community resource needs is important for tailoring interventions to individual situations.Interventions should ideally be provided throughout the hospital stay, in acute care and rehabilitation, and continue on in the community.
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Affiliation(s)
- Katrine Sauvé-Schenk
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | - Patrick Duong
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada
| | - Jacinthe Savard
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, Canada.,Institut du Savoir Montfort, Ottawa, Canada
| | - François Durand
- Institut du Savoir Montfort, Ottawa, Canada.,Telfer School of Management, University of Ottawa, Ottawa, Canada
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15
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Chamberlain SA, Duggleby W, Teaster PB, Fast J, Estabrooks CA. Challenges in Caring for Unbefriended Residents in Long-term Care Homes: A Qualitative Study. J Gerontol B Psychol Sci Soc Sci 2020; 75:2050-2061. [PMID: 32530034 DOI: 10.1093/geronb/gbaa079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study examined challenges experienced by long-term care staff in caring for unbefriended residents who are incapacitated and alone. These residents often are estranged from or have no living family or live geographically distant from them and require a public guardian as their surrogate decision-maker. To date, research on unbefriended older adults has focused on those living in acute care and community settings. Little is known about those living in long-term care homes. METHOD We conducted semi-structured interviews with 39 long-term care staff (e.g., registered nurses, care aides, social workers) and 3 public guardians. Staff were sampled from seven long-term care homes in Alberta, Canada. We analyzed interview transcripts using content analysis and then using the theoretical framework of complex adaptive systems. RESULTS Long-term care staff experience challenges unique to unbefriended residents. Guardians' responsibilities did not fulfill unbefriended residents' needs, such as shopping for personal items or accompanying residents to appointments. Consequently, the guardians rely on long-term care staff, particularly care aides, to provide increased levels of care and support. These additional responsibilities, and organizational messages dissuading staff from providing preferential care, diminish quality of work life for staff. DISCUSSION Long-term care homes are complex adaptive systems. Within these systems, we found organizational barriers for long-term care staff providing care to unbefriended residents. These barriers may be modifiable and could improve the quality of care for unbefriended residents and quality of life of staff. Implications for practice include adjusting public guardian scope of work, improving team communication, and compensating staff for additional care.
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Affiliation(s)
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Pamela B Teaster
- College of Liberal Arts and Human Sciences, Virginia Polytechnic Institute and State University, Blacksburg
| | - Janet Fast
- Department of Human Ecology, Faculty of Agricultural Life and Environmental Sciences, University of Alberta, Edmonton, Canada
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16
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Leslie M, Gray RP, Khayatzadeh-Mahani A. What is 'care quality' and can it be improved by information and communication technology? A typology of family caregivers' perspectives. Scand J Caring Sci 2020; 35:220-232. [PMID: 32168399 DOI: 10.1111/scs.12837] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/11/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION With governments worldwide reducing their involvement in the provision of institutional long-term elder care, community-based family caregivers (FCs) have become a key element in policies aimed at improving the quality of healthcare systems and maintaining their financial sustainability. This paper uses data from focus groups with FCs providing care to older adults to describe their approaches to and priorities for achieving care quality and sustainability as they work with formal health and social care systems. It describes FCs' views on information and communications technology (ICT) as potential supports for achieving these care quality and sustainability goals. METHODS We held 10 focus groups from May 2017 to August 2018 and recruited 25 FCs through a mix of convenience and snowball sampling strategies. We employed an inductive approach and used qualitative thematic content analysis methods to examine and interpret the resulting data. We used NVIVO 12 software for data analysis. RESULTS Quality of care - as delivered by both FCs themselves, and formal health and social care systems - was a major preoccupation for our participants. They saw communications quality as a key aspect of the broader concept of care quality. Our data analysis produced a typology of communications quality from the FC perspective. Analysis of our data also revealed ICT development opportunities and available products in key areas. CONCLUSIONS Our findings suggest that the formal care system providers could be more caregiver-oriented in their communications by engaging FCs in the decision-making process and allowing them to express their own concerns and goals. The implication of our findings for those seeking to develop policies and ICT products in support of FCs is that these should focus on human relationships and seek to expand facilitative communications.
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Affiliation(s)
- Myles Leslie
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,School of Public Policy, University of Calgary, Calgary, AB, Canada
| | | | - Akram Khayatzadeh-Mahani
- School of Public Policy, University of Calgary, Calgary, AB, Canada.,Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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17
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Kokorelias KM, Lu FKT, Santos JR, Xu Y, Leung R, Cameron JI. "Caregiving is a full-time job" impacting stroke caregivers' health and well-being: A qualitative meta-synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:325-340. [PMID: 31769128 DOI: 10.1111/hsc.12895] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 06/10/2023]
Abstract
Family caregivers contribute to the sustainability of healthcare systems. Stroke is a leading cause of adult disability and many people with stroke rely on caregiver support to return home and remain in the community. Research has demonstrated the importance of caregivers, but suggests that caregiving can have adverse consequences. Despite the body of qualitative stroke literature, there is little clarity about how to incorporate these findings into clinical practice. This review aimed to characterise stroke caregivers' experiences and the impact of these experiences on their health and well-being. We conducted a qualitative meta-synthesis. Four electronic databases were searched to identify original qualitative research examining stroke caregivers' experiences. In total, 4,481 citations were found, with 39 studies remaining after removing duplicates and applying inclusion and exclusions criteria. Articles were appraised for quality using the Critical Appraisal Skills Programme (CASP), coded using NVivo software, and analysed through thematic synthesis. One overarching theme, 'caregiving is a full-time job' was identified, encompassing four sub-themes: (a) restructured life, (b) altered relationships, (c) physical challenges, and (d) psychosocial challenges. Community and institution-based clinicians should be aware of the physical and psychosocial consequences of caregiving and provide appropriate supports, such as education and respite, to optimise caregiver health and well-being. Future research may build upon this study to identify caregivers in most need of support and the types of support needed across a broad range of health conditions.
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Affiliation(s)
- Kristina M Kokorelias
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada
| | - Fiana K T Lu
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer R Santos
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Yi Xu
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Robin Leung
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Jill I Cameron
- Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
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18
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Pereira CM, Greenwood N, Jones F. From recovery to regaining control of life - the perspectives of people with stroke, their carers and health professionals. Disabil Rehabil 2020; 43:2897-2908. [PMID: 32036730 DOI: 10.1080/09638288.2020.1722263] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Aim: To understand how people with stroke and carers adapt over time, and how health professionals support transition to home.Method: A multi-perspective, prospective, qualitative, longitudinal study was conducted using in-depth semi-structured interviews one and six months after inpatient discharge. Twenty-four participants (eight triads, including people with stroke, carers and health professionals) were included. Thematic and narrative analysis facilitated identification of cross-cutting themes according to individual trajectories post-stroke.Findings: A major theme: "regaining control of life" suggested a shift in perspective after six months at home. Four sub-themes help to understand the triads' perspectives over time: i) importance of team involvement; ii) differences in perceived roles within the triad; iii) differences in expectations and collaboration within the triad and iv) planning a different future. People who were involved in supporting adaptation and rehabilitation processes were reported differently between triads and over time, showing the complexity of interrelations. A reduction in professional involvement was matched by changes in participants' goals and expectations.Conclusion: Findings suggest the importance of a dyadic perspective and a gradual increase in people with stroke and carers' active engagement. Professionals' approach throughout rehabilitation should be modified according to people with stroke and carers' changing needs and expectations.IMPLICATIONS FOR REHABILITATIONDivergence in perspectives about priorities and goals between the person with stroke their carers and healthcare professionals can lead to the creation of different agendas within rehabilitation.An open dialogue and decision-making process that involves both the person with stroke and carers is highly recommended for the identification of shared rehabilitation goals and to support ongoing recovery post discharge.A tailored approach to rehabilitation is required which focusses on shared priorities and includes individual or collective support for the person with stroke and their carers.Ongoing consultation about the desires of the person with stroke about rehabilitation, priorities and goals is important in order to tailor the professional approach to the stage individuals are at with their coping and adjustment post stroke.
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Affiliation(s)
- Carla Mendes Pereira
- Department of Physiotherapy, School of Health Care, Setubal Polytechnic Institute, Setúbal, Portugal
| | - Nan Greenwood
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
| | - Fiona Jones
- Faculty of Health, Social Care and Education, Kingston University and St George's University of London, London, UK
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Kable A, Baker A, Pond D, Southgate E, Turner A, Levi C. Health professionals’ perspectives on the discharge process and continuity of care for stroke survivors discharged home in regional Australia: A qualitative, descriptive study. Nurs Health Sci 2018; 21:253-261. [DOI: 10.1111/nhs.12590] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 11/15/2018] [Accepted: 11/20/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Ashley Kable
- School of Nursing and Midwifery; University of Newcastle; Newcastle New South Wales Australia
| | - Amanda Baker
- School of Medicine and Public Health; University of Newcastle; Newcastle New South Wales Australia
| | - Dimity Pond
- School of Medicine and Public Health; University of Newcastle; Newcastle New South Wales Australia
| | - Erica Southgate
- School of Education; University of Newcastle; Newcastle New South Wales Australia
| | - Alyna Turner
- School of Medicine and Public Health; University of Newcastle; Newcastle New South Wales Australia
| | - Christopher Levi
- School of Medicine and Public Health; University of Newcastle; Newcastle New South Wales Australia
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20
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Kable A, Pond D, Baker A, Turner A, Levi C. Evaluation of discharge documentation after hospitalization for stroke patients discharged home in Australia: A cross-sectional, pilot study. Nurs Health Sci 2017; 20:24-30. [DOI: 10.1111/nhs.12368] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 05/15/2017] [Accepted: 06/01/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Ashley Kable
- Faculty of Health and Medicine; University of Newcastle; Newcastle New South Wales Australia
- Hunter Medical Research Institute; University of Newcastle; Newcastle New South Wales Australia
| | - Dimity Pond
- Faculty of Health and Medicine; University of Newcastle; Newcastle New South Wales Australia
- Hunter Medical Research Institute; University of Newcastle; Newcastle New South Wales Australia
| | - Amanda Baker
- Faculty of Health and Medicine; University of Newcastle; Newcastle New South Wales Australia
- Hunter Medical Research Institute; University of Newcastle; Newcastle New South Wales Australia
| | - Alyna Turner
- Faculty of Health and Medicine; University of Newcastle; Newcastle New South Wales Australia
| | - Christopher Levi
- Faculty of Health and Medicine; University of Newcastle; Newcastle New South Wales Australia
- Hunter Medical Research Institute; University of Newcastle; Newcastle New South Wales Australia
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21
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Analysing a Chinese Regional Integrated Healthcare Organisation Reform Failure using a Complex Adaptive System Approach. Int J Integr Care 2017; 17:3. [PMID: 28970744 PMCID: PMC5624080 DOI: 10.5334/ijic.2420] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: China’s organised health system has remained outdated for decades. Current health systems in many less market-oriented countries still adhere to traditional administrative-based directives and linear planning. Furthermore, they neglect the responsiveness and feedback of institutions and professionals, which often results in reform failure in integrated care. Complex adaptive system theory (CAS) provides a new perspective and methodology for analysing the health system and policy implementation. Methods: We observed the typical case of Qianjiang’s Integrated Health Organization Reform (IHO) for 2 years to analyse integrated care reforms using CAS theory. Via questionnaires and interviews, we observed 32 medical institutions and 344 professionals. We compared their cooperative behaviours from both organisational and inter-professional levels between 2013 and 2015, and further investigated potential reasons for why medical institutions and professionals did not form an effective IHO. We discovered how interested parties in the policy implementation process influenced reform outcome, and by theoretical induction, proposed a new semi-organised system and corresponding policy analysis flowchart that potentially suits the actual realisation of CAS. Results: The reform did not achieve its desired effect. The Qianjiang IHO was loosely integrated rather than closely integrated, and the cooperation levels between organisations and professionals were low. This disappointing result was due to low mutual trust among IHO members, with the main contributing factors being insufficient financial incentives and the lack of a common vision. Discussion and Conclusions: The traditional organised health system is old-fashioned. Rather than being completely organised or adaptive, the health system is currently more similar to a semi-organised system. Medical institutions and professionals operate in a middle ground between complete adherence to administrative orders from state-run health systems and completely adapting to the market. Thus, decision-making, implementation and analysis of health policies should also be updated according to this current standing. The simplest way to manage this new system is to abandon linear top-down orders and patiently wait for an explicit picture of IHO mechanisms to be revealed after complete and spontaneous negotiation between IHO allies is reached. In the meantime, bottom-up feedback from members should be paid attention to, and common benefits and fluid information flow should be prioritised in building a successful IHO.
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22
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Jeffs L, Saragosa M, Law MP, Kuluski K, Espin S, Merkley J. The role of caregivers in interfacility care transitions: a qualitative study. Patient Prefer Adherence 2017; 11:1443-1450. [PMID: 28860727 PMCID: PMC5572948 DOI: 10.2147/ppa.s136058] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A qualitative design was used to explore the nature of caregiver involvement in care transitions of patients being transferred from an acute care hospital to a rehabilitation hospital. Participants included older adults (n=13), informal caregivers (n=9), and health care professionals (n=50) from inpatient orthopedic units in two academic health science centers and one orthopedic inpatient rehabilitation unit. Semistructured interviews were conducted, audio-taped, and transcribed. Directed content analysis revealed the following four themes: watching, being an active care provider, advocating, and navigating the health care system. Participants described being actively involved in the care of their family member, yet they were not actively engaged by health care professionals to be involved in the care of their family member. There is a need to reconcile the tension between the level of involvement of caregivers in the care of family members who are patients and the level of engagement throughout the care transition. By providing relevant information and authentically engaging caregivers as equal partners in the care transition, they are better able to navigate the health care system post-transfer to the rehabilitation setting and discharge to home.
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Affiliation(s)
- Lianne Jeffs
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto
- Correspondence: Lianne Jeffs, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Room 720, 209 Victoria Street, Toronto, ON M5B 1T8, Canada, Tel +1 416 864 6060 ext 77644, Email
| | - Marianne Saragosa
- Keenan Research Centre of the Li Ka Shing Knowledge Institute, St Michael’s Hospital, Toronto
| | - Madelyn P Law
- Department of Health Science, Brock University, St Catharines
| | - Kerry Kuluski
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System
| | - Sherry Espin
- Daphne Cockwell School of Nursing, Ryerson University
| | - Jane Merkley
- Executive Offices, Sinai Health System, Toronto, ON, Canada
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