1
|
Karni-Visel Y, Baum N, Schertz M. Understanding autism and its treatment: The child's perspective. Soc Sci Med 2024; 354:117066. [PMID: 38943777 DOI: 10.1016/j.socscimed.2024.117066] [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: 02/16/2024] [Revised: 05/31/2024] [Accepted: 06/20/2024] [Indexed: 07/01/2024]
Abstract
INTRODUCTION While parents' and professionals' perceptions regarding children with autism spectrum disorder (ASD) have been studied extensively, limited data regarding the perspectives of children with ASD on their needs and the challenges they face are available. The study aimed to examine how children with ASD understand their condition and the aims of the interventions they undergo. METHODS Nineteen children and adolescents (ages 5.7-14.2 years) formally diagnosed with ASD, with borderline to high intelligence (range 70-140), and able to converse verbally were interviewed in person at a child development clinic. A qualitative approach was used to capture children's perceptions of their strengths and challenges and their understanding of a novel ASD treatment. The interview included direct and projective open-ended questions on each topic. Interpretive content analysis was used to evaluate the children's answers. Medical data were extracted from medical records. The children's parents completed questionnaires on their children's disability levels, awareness of ASD diagnosis, and sociodemographic details. FINDINGS Children spoke of their embodied sensations and feelings and discussed "normality" vs. "disability." They varied in their awareness of their diagnosis/symptoms, and only one boy named his diagnosis and described its consequences in detail. Most children lacked an understanding of the educational and therapeutic aspects of the goals set for them. DISCUSSION AND CONCLUSIONS Children with ASD are aware of their unique emotional and behavioral challenges. Nevertheless, they are frequently excluded from the process of patient information provision and lack an understanding of the goals of interventions. Findings suggest the need to explore developmentally and emotionally adaptive ways to involve children with ASD in discussions of their condition and possible interventions.
Collapse
Affiliation(s)
- Yael Karni-Visel
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel.
| | - Nehami Baum
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Mitchell Schertz
- Child Development and Pediatric Neurology Service, Meuhedet Health Services, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
2
|
Ali AZ, Wright B, Curran JA, Fawcett-Arsenault J, Newton AS. Co-designing discharge communication interventions for mental health visits to the pediatric emergency department: a mixed-methods study. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:64. [PMID: 38907328 PMCID: PMC11191193 DOI: 10.1186/s40900-024-00594-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 05/31/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Discharge communication is essential to convey information regarding the care provided and follow-up plans after a visit to a hospital emergency department (ED), but it can be lacking for visits for pediatric mental health crises. Our objective was to co-design and conduct usability testing of new discharge communication interventions to improve pediatric mental health discharge communication. METHODS The study was conducted in two phases using experience-based co-design (EBCD). In phase 1 (Sep 2021 to Jan 2022), five meetings were conducted with a team of six parents and two clinicians to co-design new ED discharge communication interventions for pediatric mental health care. Thematic analysis was used to identify patterns in team discussions and participant feedback related to discharge communication improvement and the Capability, Opportunity, Motivation, Behavior (COM-B) model was used to identify strategies to support the delivery of the new interventions. After meeting five, team members completed the Public and Patient Engagement Evaluation Tool (PPEET) to evaluate the co-design experience. In phase 2 (Apr to Jul 2022), intervention usability and satisfaction were evaluated by a new group of parents, youth aged 16-24 years, ED physicians, and nurses (n = 2 of each). Thematic analysis was used to identify usability issues and a validated 5-point Likert survey was used to evaluate user satisfaction. Evaluation results were used by the co-design team to finalize the interventions and delivery strategies. RESULTS Two discharge communication interventions were created: a brochure for families and clinicians to use during the ED visit, and a text-messaging system for families after the visit. There was high satisfaction with engagement in phase 1 (overall mean PPEET score, 4.5/5). In phase 2, user satisfaction was high (mean clinician score, 4.4/5; mean caregiver/youth score, 4.1/5) with both interventions. Usability feedback included in the final intervention versions included instructions on intervention use and ensuring the text-messaging system activates within 12-24 h of discharge. CONCLUSIONS The interventions produced by this co-design initiative have the potential to address gaps in current discharge practices. Future testing is required to evaluate the impact on patients, caregivers, and health care system use after the ED visit.
Collapse
Affiliation(s)
- Amber Z Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Bruce Wright
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.
- Women and Children's Health Research Institute, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.
| | - Janet A Curran
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | | | - Amanda S Newton
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
- Women and Children's Health Research Institute, Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| |
Collapse
|
3
|
Hannah R, Chavasse RJPG, Paton JY, Walton E, Roland D, Foster S, Lyttle MD. Emergency department discharge practices for children with acute wheeze and asthma: a survey of discharge practice and review of safety netting instructions in the UK and Ireland. Arch Dis Child 2024; 109:536-542. [PMID: 38627029 DOI: 10.1136/archdischild-2023-326247] [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: 08/29/2023] [Accepted: 03/31/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Recovery from acute wheeze and asthma attacks should be supported with safety netting, including treatment advice. We evaluated emergency department (ED) discharge practices for acute childhood wheeze/asthma attacks to describe variation in safety netting and recovery bronchodilator dosing. DESIGN Two-phase study between June 2020 and September 2021, comprising (1) Departmental discharge practice survey, and (2) Analysis of written discharge instructions for caregivers. SETTING Secondary and tertiary EDs in rural and urban settings, from Paediatric Emergency Research in the UK and Ireland (PERUKI). MAIN OUTCOME MEASURES Describe practice and variation in discharge advice, treatment recommendations and safety netting provision. RESULTS Of 66/71 (93%) participating sites, 62/66 (93.9%) reported providing written safety netting information. 52/66 (78.8%) 'nearly always' assessed inhaler/spacer technique; routine medication review (21/66; 31.8%) and adherence (16/66; 21.4%) were less frequent. In phase II, 61/66 (92.4%) submitted their discharge documents; 50/66 (81.9%) included bronchodilator plans. 11/66 (18.0%) provided Personalised Asthma Action Plans as sole discharge information. 45/50 (90%) provided 'fixed' bronchodilator dosing regimes; dose tapering was common (38/50; 76.0%). Median starting dose was 10 puffs 4 hourly (27/50, 54.0%); median duration was 4 days (29/50, 58.0%). 13/61 (21.3%) did not provide bronchodilator advice for acute deterioration; where provided, 42/48 (87.5%) recommended 10 puffs immediately. Subsequent dosages varied considerably. Common red flags included inability to speak (52/61, 85.2%), inhalers not lasting 4 hours (51/61, 83.6%) and respiratory distress (49/61, 80.3%). CONCLUSIONS There is variation in bronchodilator dosing and safety netting content for recovery following acute wheeze and asthma attacks. This reflects a lack of evidence, affirming need for further multicentre studies regarding bronchodilator recovery strategies and optimal safety netting advice.
Collapse
Affiliation(s)
- Romanie Hannah
- Children's Emergency Department, Royal Alexandra Children's Hospital, Brighton, UK
| | - Richard J P G Chavasse
- Respiratory Paediatrics, St George's University Hospitals NHS Foundation Trust, London, UK
| | - James Y Paton
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | - Emily Walton
- Children's Emergency Department, Royal Alexandra Children's Hospital, Brighton, UK
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Steven Foster
- Children's Emergency Department, Royal Hospital for Children, Glasgow, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
| |
Collapse
|
4
|
Hagopian M, Jorgensen MP, Lehmann H, O’Hagan F. Navigating uncertainty: exploring parents' knowledge of concussion management and neuropsychological baseline testing. Front Sports Act Living 2024; 6:1360329. [PMID: 38799030 PMCID: PMC11116697 DOI: 10.3389/fspor.2024.1360329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/28/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Parents play an important role in preventing and managing sport-related concussions among youth sport participants. Research indicates that parents understand the severity and consequences associated with the injury but gaps exist in their knowledge of its management. Neuropsychological baseline testing (NBT) is a modality that has gained interest in youth sport to purportedly better manage concussion injuries. Little is known about parents' perspectives on the use of NBT in the management process. Methods The present qualitative study used Protection Motivation Theory as a guiding framework and employed focus groups (N = 2) with parents (N = 11) to gain insight into parents' perceptions and experiences with concussion management, specifically focusing on NBT. Results Inductive Content Analysis developed a core theme of navigating uncertainty. Participants expressed uncertainty about the nature of concussion and its management process, where concussion was not always easy to identify, youth were not always reliable reporters, and there was no prescribed or proscribed path for recovery. Personal experience and concussion management policy provided participants with a degree of certainty in managing concussions. Participants gave NBT mixed reviews in potentially promoting greater certainty but also held reservations about its usefulness in concussion management. Discussion We discuss findings relative to existing knowledge and theory in youth sport concussion and identify implications for practice.
Collapse
Affiliation(s)
- Matthew Hagopian
- Department of Psychology, Trent University, Peterborough, ON, Canada
| | - Michael P. Jorgensen
- Faculty of Kinesiology and Physical Education, University of Toronto, Toronto, ON, Canada
| | - Hugo Lehmann
- Department of Psychology, Trent University, Peterborough, ON, Canada
| | - Fergal O’Hagan
- Department of Psychology, Trent University, Peterborough, ON, Canada
| |
Collapse
|
5
|
Karni-Visel Y, Dekel R, Sadeh Y, Sherman L, Katz U. "You Have to Find a Way for This Child to Be at the Center": Pediatric Cardiologists' Views on Triadic Communication in Consultations on Congenital Heart Defects. HEALTH COMMUNICATION 2024:1-12. [PMID: 38557305 DOI: 10.1080/10410236.2024.2329422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Congenital heart defects (CHDs) are present at birth and require ongoing management of personal, family, and medical aspects of care, including communication between family and medical staff. Effective communication is considered one of the main objectives of patient-centered care. Communication in pediatric medicine is especially challenging because it includes children and their parent(s), and children's cognitive and communication skills are still developing. Based on the model of behavior in pediatric communication , this study focused on pediatric cardiologists' views of the roles of children, parents, and physicians in the triadic encounter and their experiences in communicating information on pediatric CHDs in medical encounters. Semi-structured interviews were conducted with 17 experienced pediatric cardiologists and cardiac surgeons (five women and 12 men) at three medical centers in Israel. The grounded theory approach was used to identify three main categories: (1) the positioning (centrality) of the child in the setting (ideal vs. actual situation), (2) addressing parents' emotional needs, and (3) the physician's role as mediator between parent(s) and child. In each category, three elements are discussed: The physician's agenda, obstacles and challenges, and the physician's practical methods. Physicians strongly support children's involvement in triadic encounters yet face challenges in effectively integrating them into the information exchange process during cardiology consultations. Struggling to balance the principles of patient- and family-centered care, and without clear guidelines, they rely on their personal beliefs and experiences to formulate communication strategies that address parents' and children's needs.
Collapse
Affiliation(s)
- Yael Karni-Visel
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University
| | - Yaara Sadeh
- School of Social Work, University of Haifa
- Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer
| | - Liat Sherman
- Pediatric Heart Institute, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer
| | - Uriel Katz
- Pediatric Heart Institute, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center at Tel HaShomer
- Sackler School of Medicine, Tel-Aviv University
| |
Collapse
|
6
|
Giannouchos TV, Ukert B, Pirrallo RG, Smith J, Kum HC, Wright B, Dietrich A. Determinants of Persistent, Multi-Year, Frequent Emergency Department Use Among Children and Young Adults in Three US States. Acad Pediatr 2024; 24:442-450. [PMID: 37673206 DOI: 10.1016/j.acap.2023.08.021] [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: 12/24/2022] [Revised: 07/11/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE This study examines the factors associated with persistent, multi-year, and frequent emergency department (ED) use among children and young adults. METHODS We conducted a retrospective secondary analysis using the 2012-2017 Healthcare Cost and Utilization Project State Emergency Department Databases for children and young adults aged 0-19 who visited any ED in Florida, Massachusetts, and New York. We estimated the association between persistent frequent ED use and individuals' characteristics using multivariable logistic regression models. RESULTS Among 1.3 million patients with 1.8 million ED visits in 2012, 2.9% (37,558) exhibited frequent ED use (≥4 visits in 2012) and accounted for 10.2% (181,138) of all ED visits. Longitudinal follow-up of frequent ED users indicated that 15.4% (5770) remained frequent users periodically over the next 1 or 2 years, while 2.2% (831) exhibited persistent frequent use over the next 3-5 years. Over the 6-year study period, persistent frequent users had 31,551 ED visits at an average of 38.0 (standard deviation = 16.2) visits. Persistent frequent ED use was associated with higher intensity of ED use in 2012, public health insurance coverage, inconsistent health insurance coverage over time, residence in non-metropolitan and lower-income areas, multimorbidity, and more ED visits for less medically urgent conditions. CONCLUSIONS Clinicians and policymakers should consider the diverse characteristics and needs of pediatric persistent frequent ED users compared to broader definitions of frequent users when designing and implementing interventions to improve health outcomes and contain ED visit costs.
Collapse
Affiliation(s)
- Theodoros V Giannouchos
- Department of Health Policy & Organization (TV Giannouchos), School of Public Health, The University of Alabama at Birmingham, Birmingham, Ala.
| | - Benjamin Ukert
- Department of Health Policy and Management (B Ukert, H-C Kum), School of Public Health, Texas A and M University, College Station, Tex
| | - Ronald G Pirrallo
- University of South Carolina School of Medicine (RG Pirrallo, J Smith, and A Dietrich), Greenville, SC; Department of Emergency Medicine (RG Pirrallo, J Smith, and A Dietrich), Prisma Health, Greenville, SC
| | - Jeremiah Smith
- University of South Carolina School of Medicine (RG Pirrallo, J Smith, and A Dietrich), Greenville, SC; Department of Emergency Medicine (RG Pirrallo, J Smith, and A Dietrich), Prisma Health, Greenville, SC
| | - Hye-Chung Kum
- Department of Health Policy and Management (B Ukert, H-C Kum), School of Public Health, Texas A and M University, College Station, Tex
| | - Brad Wright
- Department of Health Services Policy and Management (B Wright), Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Ann Dietrich
- University of South Carolina School of Medicine (RG Pirrallo, J Smith, and A Dietrich), Greenville, SC; Department of Emergency Medicine (RG Pirrallo, J Smith, and A Dietrich), Prisma Health, Greenville, SC
| |
Collapse
|
7
|
Curran J, Wozney L, Tavender E, Wilson C, Ritchie KC, Wong H, Gallant A, Somerville M, Archambault PM, Cassidy C, Jabbour M, Mackay R, Plint AC. Implementing Electronic Discharge Communication Tools in Pediatric Emergency Departments: Multicountry, Cross-Sectional Readiness Survey of Nurses and Physicians. JMIR Hum Factors 2023; 10:e46379. [PMID: 37819696 PMCID: PMC10600642 DOI: 10.2196/46379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Pediatric emergency departments (ED) in many countries are implementing electronic tools such as kiosks, mobile apps, and electronic patient portals, to improve the effectiveness of discharge communication. OBJECTIVE This study aimed to survey nurse and physician readiness to adopt these tools. METHODS An electronic, cross-sectional survey was distributed to a convenience sample of currently practicing ED nurses and physicians affiliated with national pediatric research organizations in Canada, Australia, and New Zealand. Survey development was informed by the nonadoption, abandonment, scale-up, spread, sustainability framework. Measures of central tendency, and parametric and nonparametric tests were used to describe and compare nurse and physician responses. RESULTS Out of the 270 participants, the majority were physicians (61%, 164/270), female (65%, 176/270), and had 5 or more years of ED experience (76%, 205/270). There were high levels of consensus related to the value proposition of electronic discharge communication tools (EDCTs) with 82% (221/270) of them agreeing that they help parents and patients with comprehension and recall. Lower levels of consensus were observed for organizational factors with only 37% (100/270) agreeing that their staff is equipped to handle challenges with communication technologies. Nurses and physicians showed significant differences on 3 out of 21 readiness factors. Compared to physicians, nurses were significantly more likely to report that EDs have a responsibility to integrate EDCTs as part of a modern system (P<.001) and that policies are in place to guide safe and secure electronic communication (P=.02). Physicians were more likely to agree that using an EDCT would change their routine tasks (P=.04). One third (33%, 89/270) of participants indicated that they use or have used EDCT. CONCLUSIONS Despite low levels of uptake, both nurses and physicians in multiple countries view EDCTs as a valuable support to families visiting pediatric ED. Leadership for technology change, unclear impact on workflow, and disparities in digital literacy skills require focused research effort.
Collapse
Affiliation(s)
- Janet Curran
- IWK Health Centre, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Pediatric Emergency Research Canada, Alberta Children's Hospital, Calgary, AB, Canada
| | - Lori Wozney
- IWK Health Centre, Halifax, NS, Canada
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Emma Tavender
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Department of Critical Care, University of Melbourne, Victoria, Australia
- Paediatric Research in Emergency Departments International Collaborative, Murdoch Children's Research Institute, Melbourne, Australia
| | - Catherine Wilson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia
- Paediatric Research in Emergency Departments International Collaborative, Murdoch Children's Research Institute, Melbourne, Australia
| | - Krista C Ritchie
- Faculty of Education, Mount Saint Vincent University, Halifax, NS, Canada
| | - Helen Wong
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Allyson Gallant
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | | | - Patrick M Archambault
- Département de médecine familiale et médecine d'urgence, Université Laval, Québec City, QC, Canada
| | | | - Mona Jabbour
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
| | | | - Amy C Plint
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
8
|
Liu X, Du J, Liu X, Tang N. Application of Nursing Intervention Based on Nel Noddings Care Theory for School-Aged Asthmatic Children. Am J Health Behav 2023; 47:130-138. [PMID: 36945093 DOI: 10.5993/ajhb.47.1.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Objectives: The objective of this study was to examine the effect of nursing intervention based on Nel Noddings care theory on self-management behavior and symptomatic improvement in school-age asthmatic children in China. Methods: In this study, a sample of 100 school-aged children suffering from asthma was chosen, and divided into two groups: observation group and control group. Both groups received routine nursing but the observation group was combined with nursing intervention based on Nel Noddings theory.Results:The total scores of social psychologies, daily life, disease medicine and self-management in the observation group before intervention were similar to those in the control group. The self-management scores of the observation group after intervention were higher than those of the control group. The improvement time of wheezing and cough in the observation group was shorter than that in the control group. The total number of complete compliance and partial compliance in the observation group was higher than that in the control group. Conclusion: The application of nursing intervention based on Nel Noddings care theory to the nursing of school-age asthmatic children can improve the self-management ability of children, promote the recovery of cough, wheezing and other symptoms, and is of great significance to improve the compliance and nursing effect of children, with high popularization and application value.
Collapse
Affiliation(s)
- Xuelian Liu
- Department of Pediatric Internal Medicine, Yantai Yuhuangding Hospital, Yantai, China
| | - Junying Du
- Child Health Clinic, Yantai Yuhuangding Hospital, Yantai, China
| | - Xiaoyan Liu
- Department of Pediatric Internal Medicine, Yantai Yuhuangding Hospital, Yantai, China; lxy1234567202204@163. com
| | - Na Tang
- Department of Pediatric Internal Medicine, Yantai Yuhuangding Hospital, Yantai, China;,
| |
Collapse
|
9
|
Kim ME, Kasparian NA, Zang H, Pater C, Chlebowski MM, Marcuccio E, Florez A, Morales DLS, Madsen N, Moore RA. Are Parent Discharge Readiness Scores Effective for the Congenital Heart Disease Patients After Cardiac Surgery? J Pediatr 2023:S0022-3476(23)00120-8. [PMID: 36841508 DOI: 10.1016/j.jpeds.2023.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/23/2023] [Accepted: 02/04/2023] [Indexed: 02/27/2023]
Abstract
OBJECTIVE To assess discharge readiness and clinical engagement post-discharge in familes of children undergoing congenital heart surgery (CHS). STUDY DESIGN This prospective cross-sectional study was performed at a major tertiary pediatric cardiac referral center. Eligible parents and caregivers completed a discharge readiness tool, the Readiness for Hospital Discharge Scale for Parents of Hospitalized Children (PedRHDS), via online survey on the day of discharge. Clinical engagement data included subsequent phone calls, clinic visits, emergency department (ED) visits, and hospital readmissions. PedRHDS scores were measured as follows: Very High (9-10), High (8-8.9), Moderate (7-7.9), and Low (<7). Descriptive statistics were used to describe demographic data. RESULTS 128 families enrolled between April and December 2021. Parent discharge readiness scores ranged from 'High' to 'Very High.' Families with lower socioeconomic status and younger patients (especially single ventricle infants or "interstage") had a higher proportion of clinic visits, ED visits, and hospital readmissions within 30-days post-discharge compared with other groups. CONCLUSIONS Discharge readiness scores were not associated with clinical engagement. We identified vulnerable populations as evidenced by a higher frequency of clinical engagement in the immediate post-operative period, particularly younger patients and first time surgeries. While these visits may be appropriate, novel programs could enhance education and emotional support to prevent delay in seeking care or creating excessive stress and anxiety after discharge.
Collapse
Affiliation(s)
- Michael E Kim
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati, College of Medicine, Cincinnati, OH.
| | - Nadine A Kasparian
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Huaiyu Zang
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Colleen Pater
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Meghan M Chlebowski
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Elisa Marcuccio
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Amy Florez
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - David L S Morales
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati, College of Medicine, Cincinnati, OH
| | - Nicolas Madsen
- The Heart Center, Children's Health, UT Southwestern, Dallas, TX
| | - Ryan A Moore
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Heart Institute, University of Cincinnati, College of Medicine, Cincinnati, OH
| |
Collapse
|
10
|
McIntyre H, Reeves V, Loughhead M, Hayes L, Procter N. Communication pathways from the emergency department to community mental health services: A systematic review. Int J Ment Health Nurs 2022; 31:1282-1299. [PMID: 35598319 PMCID: PMC9790581 DOI: 10.1111/inm.13024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2022] [Indexed: 12/30/2022]
Abstract
This systematic review synthesizes existing peer reviewed evidence reporting on evaluated strategies used for enhancing communication pathways for continuity of care between the emergency department and mental health community supports. Following the PRISMA guidelines and the PICO framework, this review was conducted between January and July 2021. Included articles needed to evaluate communication pathway interventions for continuity of care between the emergency department and mental health community services which support service users with mental health and/or suicidal crisis. The seven included studies identified three support coordination interventions, two motivational interviewing interventions, an electronic record enhanced strategy and results from a phone follow-up study. This review demonstrates that support coordination, motivational interviewing, education, or an enhanced electronic record strategy can improve continuity of care, and in some cases, reduce the need for people to re-present to ED when they are experiencing mental health concerns or suicidal crisis. Results of this review reveal that a multipronged approach of communication pathways for continuity of care would enable more effective connections with mental health community supports and enable better outcomes for people requiring services.
Collapse
Affiliation(s)
- Heather McIntyre
- University of South Australia, Adelaide, South Australia, Australia
| | - Verity Reeves
- University of South Australia, Adelaide, South Australia, Australia
| | - Mark Loughhead
- University of South Australia, Adelaide, South Australia, Australia
| | - Laura Hayes
- MIND Australia, Heidelberg, Victoria, Australia
| | | |
Collapse
|
11
|
Crowther D, McCulloch H, Wong H, Mackay R, Johnson C, Chorney J, Ritchie K, Lawrence L, Bishop A, Helwig M, Curran J. Children, young people and parent engagement in health intervention design and implementation: A scoping review. Health Expect 2022; 26:1-15. [PMID: 36346148 PMCID: PMC9854306 DOI: 10.1111/hex.13572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 07/13/2022] [Accepted: 07/14/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Engaging children and young people (CYP) with and without their parents in health research has the potential to improve the development and implementation of health interventions. However, to our knowledge, the scope of engagement activities used with this population and barriers to their engagement is unknown. The objective of this review was to identify and describe CYP engagement with and without their parents in the development and/or implementation of health interventions. METHODS This scoping review included any primary research studies reporting on engaging CYP, with or without parents, in the design and/or implementation of health interventions. Healthcare professionals had to be involved over the course of the study and the study had to take place in either community, primary or tertiary care settings. The following databases were searched in May 2017, May 2020 and June 2021: Medline (OVID), CINAHL (EBSCO) and Embase (Elsevier). Two independent reviewers screened titles, abstracts and full-text articles and used a previously piloted extraction form to extract and summarize information from the included articles. RESULTS Twenty-eight articles discussing twenty-four studies were included. CYP engagement throughout the research cycle was limited. There were no observed differences in the reported presence of engagement, types of interventions or outcomes of engagement between studies engaging CYP or CYP and parents. Studies engaging CYP and parents contained limited information on how these relationships affected outcomes of engagement. Engagement was enabled primarily by the maintenance of resources and relationships among stakeholders. CONCLUSIONS Although CYP engagement often influenced health intervention and implementation design, they are inconsistently engaged across the research cycle. It is unclear whether parental involvement enhances CYP engagement. Future research should consider reporting guidelines to clarify the level of CYP and/or parent engagement, and enhance CYP engagement by fostering synergistic and sustainable partnerships with key stakeholders. PATIENT OR PUBLIC CONTRIBUTION A parent partner with codesign experience contributed to the creation of the research questions, screened titles, abstracts and full texts, helped with data extraction and provided feedback on the manuscript.
Collapse
Affiliation(s)
- Daniel Crowther
- Strengthening Transitions in Care LabIWK HealthHalifaxNova ScotiaCanada
| | - Holly McCulloch
- Strengthening Transitions in Care LabIWK HealthHalifaxNova ScotiaCanada
| | - Helen Wong
- Faculty of HealthDalhousie UniversityHalifaxNova ScotiaCanada
| | - Rebecca Mackay
- Strengthening Transitions in Care LabIWK HealthHalifaxNova ScotiaCanada
| | - Catie Johnson
- Strengthening Transitions in Care LabIWK HealthHalifaxNova ScotiaCanada
| | - Jill Chorney
- Department of Psychiatry I Department of Psychology and NeuroscienceDalhousie UniversityHalifaxNova ScotiaCanada
| | - Krista Ritchie
- Faculty of EducationMount Saint Vincent UniversityHalifaxNova ScotiaCanada
| | - Logan Lawrence
- Research and InnovationNova Scotia HealthHalifaxNova ScotiaCanada
| | - Andrea Bishop
- Policy Development and ResearchNova Scotia College of PharmacistsHalifaxNova ScotiaCanada
| | - Melissa Helwig
- Research & Scholarly CommunicationsDalhousie UniversityHalifaxNova ScotiaCanada
| | - Janet Curran
- Strengthening Transitions in Care LabIWK HealthHalifaxNova ScotiaCanada,Faculty of HealthDalhousie UniversityHalifaxNova ScotiaCanada
| |
Collapse
|
12
|
Nguyen DL, Ambinder EB, Mullen LA, Oluyemi ET, Dunn EA. Comparison of emergency pediatric breast ultrasound interpretations and management recommendations between pediatric radiologists and breast imaging radiologists. Emerg Radiol 2022; 29:987-993. [PMID: 35971026 DOI: 10.1007/s10140-022-02081-x] [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: 05/27/2022] [Accepted: 07/25/2022] [Indexed: 10/15/2022]
Abstract
PURPOSE Pediatric patients with breast-related symptoms often initially present to the emergency department for evaluation. While pediatric radiologists are accustomed to evaluating acute infectious and traumatic etiologies, they may be less familiar with breast-specific findings. This study compares management recommendations of pediatric breast ultrasounds performed in the emergency setting between pediatric and breast imaging radiologists. METHODS This retrospective cohort study reviewed data from all pediatric breast ultrasounds performed in the emergency setting from a single academic institution from 1/1/14 to 12/31/19. During the study period, 12 pediatric radiologists with experience ranging from 1 to 33 years interpreted pediatric breast ultrasounds. Three breast imaging radiologists (with 3, 8, and 25 years of experience) retrospectively reviewed each case and recorded whether further management was recommended. Differences in recommendations were compared using Fisher's exact test. Cohen's kappa was used to assess agreement between subspecialty radiologists. RESULTS This study included 75 pediatric patients, with mean age 13 ± 5.6 years and malignancy rate of 1.3% (1/75). Pediatric radiologists and the most experienced breast imaging radiologist had moderate agreement in management recommendations (k = 0.54). There was no significant difference in recommendations for further management between pediatric radiologists (22/75 [29.3%]) and the most experienced breast imaging radiologist (15/75 [20.0%]), p = 0.26. CONCLUSION Recommendations for pediatric breast complaints in the emergency setting are comparable between subspecialties.
Collapse
Affiliation(s)
- Derek L Nguyen
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Emily B Ambinder
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Lisa A Mullen
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Eniola T Oluyemi
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Emily A Dunn
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
| |
Collapse
|
13
|
Wu JM, Tam MT, Page PM, Lamb EA, Jordan I, Chambers CT, Robillard JM. Pain management communication between parents and nurses after pediatric outpatient surgery. J Pediatr Nurs 2022; 65:e87-e92. [PMID: 35459566 DOI: 10.1016/j.pedn.2022.03.008] [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: 10/19/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to explore parent-nurse pain management communication during a child's discharge process following pediatric outpatient surgery. DESIGN AND METHODS Thirty-two clinical encounters at discharge between parents (N = 40) and nurses (N = 25) at BC Children's Hospital were audio recorded and transcribed verbatim. Content analysis was applied on the audio recordings and corresponding transcripts using MAXQDA qualitative research software and Microsoft Excel. RESULTS Overall, nurses delivered pain management instructions at an average sixth grade readability level and frequently used communication elements of reassurance, optimism, and question-asking. Less consistent communication elements included open-ended questions, interruptions, and promotion of parental decision-making. Parents most frequently asked one to five questions, with pain medication being the most inquired topic. CONCLUSIONS Several strengths of the nurse communication approach were identified, and parent questions highlighted a need for greater understanding around pain medication. PRACTICE IMPLICATIONS These findings will help guide effective pain management communication and care for young patients and their families.
Collapse
Affiliation(s)
- Julia M Wu
- Department of Medicine, Division of Neurology, The University of British Columbia, Vancouver, British Columbia, Canada; BC Children's and Women's Hospital, Vancouver, British Columbia, Canada.
| | - Mallorie T Tam
- Department of Medicine, Division of Neurology, The University of British Columbia, Vancouver, British Columbia, Canada; BC Children's and Women's Hospital, Vancouver, British Columbia, Canada.
| | - Patricia M Page
- BC Children's Hospital, Vancouver, British Columbia, Canada.
| | - Elizabeth A Lamb
- Department of Procedure and Surgical Services, BC Children's Hospital, Vancouver, British Columbia, Canada.
| | - Isabel Jordan
- BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Christine T Chambers
- Dalhousie University, Department of Pediatrics, Halifax, Nova Scotia, Canada; IWK Health Centre, Centre for Pediatric Pain Research, Halifax, Nova Scotia, Canada.
| | - Julie M Robillard
- Department of Medicine, Division of Neurology, The University of British Columbia, Vancouver, British Columbia, Canada; BC Children's and Women's Hospital, Vancouver, British Columbia, Canada.
| |
Collapse
|
14
|
Wozney L, Curran J, Archambault P, Cassidy C, Jabbour M, Mackay R, Newton A, Plint AC, Somerville M. Electronic Discharge Communication Tools Used in Pediatric Emergency Departments: Systematic Review. JMIR Pediatr Parent 2022; 5:e36878. [PMID: 35608929 PMCID: PMC9270703 DOI: 10.2196/36878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Electronic discharge communication tools (EDCTs) are increasingly common in pediatric emergency departments (EDs). These tools have been shown to improve patient-centered communication, support postdischarge care at home, and reduce unnecessary return visits to the ED. OBJECTIVE This study aimed to map and assess the evidence base for EDCTs used in pediatric EDs according to their functionalities, intended purpose, implementation context features, and outcomes. METHODS A systematic review was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) procedures for identification, screening, and eligibility. A total of 7 databases (EBSCO, MEDLINE, CINAHL, PsycINFO, EMBASE Scopus, and Web of Science) were searched for studies published between 1989 and 2021. Studies evaluating discharge communication-related outcomes using electronic tools (eg, text messages, videos, and kiosks) in pediatric EDs were included. In all, 2 researchers independently assessed the eligibility. Extracted data related to study identification, methodology, settings and demographics, intervention features, outcome implementation features, and practice, policy, and research implications. The Mixed Method Appraisal Tool was used to assess methodological quality. The synthesis of results involved structured tabulation, vote counting, recoding into common metrics, inductive thematic analysis, descriptive statistics, and heat mapping. RESULTS In total, 231 full-text articles and abstracts were screened for review inclusion with 49 reports (representing 55 unique tools) included. In all, 70% (26/37) of the studies met at least three of five Mixed Method Appraisal Tool criteria. The most common EDCTs were videos, text messages, kiosks, and phone calls. The time required to use the tools ranged from 120 seconds to 80 minutes. The EDCTs were evaluated for numerous presenting conditions (eg, asthma, fracture, head injury, fever, and otitis media) that required a range of at-home care needs after the ED visit. The most frequently measured outcomes were knowledge acquisition, caregiver and patient beliefs and attitudes, and health service use. Unvalidated self-report measures were typically used for measurement. Health care provider satisfaction or system-level impacts were infrequently measured in studies. The directionality of primary outcomes pointed to positive effects for the primary measure (44/55, 80%) or no significant difference (10/55, 18%). Only one study reported negative findings, with an increase in return visits to the ED after receiving the intervention compared with the control group. CONCLUSIONS This review is the first to map the broad literature of EDCTs used in pediatric EDs. The findings suggest a promising evidence base, demonstrating that EDCTs have been successfully integrated across clinical contexts and deployed via diverse technological modalities. Although caregiver and patient satisfaction with EDCTs is high, future research should use robust trials using consistent measures of communication quality, clinician experience, cost-effectiveness, and health service use to accumulate evidence regarding these outcomes. TRIAL REGISTRATION PROSPERO CRD42020157500; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=157500.
Collapse
Affiliation(s)
- Lori Wozney
- Mental Health and Addictions, Nova Scotia Health, Dartmouth, NS, Canada
| | - Janet Curran
- IWK Health, Strengthening Transitions in Care Lab, Halifax, NS, Canada
- School of Nursing, Dalhousie University, Halifax, NS, Canada
| | - Patrick Archambault
- Département de médecine d'urgence, Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Levis, QC, Canada
| | | | - Mona Jabbour
- Department of Pediatrics, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Rebecca Mackay
- IWK Health, Strengthening Transitions in Care Lab, Halifax, NS, Canada
| | - Amanda Newton
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Amy C Plint
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Mari Somerville
- IWK Health, Strengthening Transitions in Care Lab, Halifax, NS, Canada
| |
Collapse
|
15
|
Abuaish M, Mirza G, Al-Zamzami W, Atiyah M. The Effect of a Structured Gastroenteritis Discharge Management Plan on Compliance, Prognosis, and Parents' Satisfaction. Cureus 2022; 14:e23240. [PMID: 35449640 PMCID: PMC9012551 DOI: 10.7759/cureus.23240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2022] [Indexed: 12/05/2022] Open
Abstract
Background: Acute gastroenteritis is one of the most common causes of dehydration in children. Parents’ education is an essential part of its management. In this study, we assessed the efficacy of discharge instructions in the pediatric emergency department for parents of children with acute gastroenteritis, together with disease prognosis and parents’ satisfaction. Methods: An observational prospective cohort study was conducted among parents of children with acute gastroenteritis, with mild-to-moderate dehydration, who presented to the pediatric emergency room from March 2018 to July 2018. Parents were interviewed upon their child’s presentation and in follow-up phone calls after one week to assess the parents’ knowledge and the disease’s prognosis. Results: There were a total of 218 parents of children with acute gastroenteritis of mild and moderate dehydration. The mean age was four years and one month ± three years and seven months. Forty-four percent of study participants had reasonable awareness of their child’s condition, and most patients (86%) improved fully. The exact adherence to instructions was 54%, the proportion of children who returned to the emergency department was 13%, and parental satisfaction and appreciation of the provided education was 98%. Conclusion: In the study group, not strictly following fluid rehydration plans in discharge instructions did not negatively affect the course of improvement. This indicates that simple instructions to rehydrate with any fluid a child might accept and give clear red flags for observation are likely to be enough to treat gastroenteritis of mild-to-moderate severity.
Collapse
|
16
|
Doyle S, Pavlos R, Carlson SJ, Barton K, Bhuiyan M, Boeing B, Borland ML, Hoober S, Blyth CC. Efficacy of Digital Health Tools for a Pediatric Patient Registry: Semistructured Interviews and Interface Usability Testing With Parents and Clinicians. JMIR Form Res 2022; 6:e29889. [PMID: 35037889 PMCID: PMC8804961 DOI: 10.2196/29889] [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: 04/25/2021] [Revised: 10/29/2021] [Accepted: 11/22/2021] [Indexed: 01/23/2023] Open
Abstract
Background Acute respiratory infection (ARI) in childhood is common, but more knowledge on the burden and natural history of ARI in the community is required. A better understanding of ARI risk factors, treatment, and outcomes will help support parents to manage their sick child at home. Digital health tools are becoming more widely adopted in clinical care and research and may assist in understanding and managing common pediatric diseases, including ARI, in hospitals and in the community. We integrated 2 digital tools—a web-based discharge communication system and the REDCap (Research Electronic Data Capture) platform—into the Pragmatic Adaptive Trial for Acute Respiratory Infection in Children to enhance parent and physician engagement around ARI discharge communication and our patient registry. Objective The objective of this study is to determine the efficacy and usability of digital tools integrated into a pediatric patient registry for ARI. Methods Semistructured interviews and software interface usability testing were conducted with 11 parents and 8 emergency department physicians working at a tertiary pediatric hospital and research center in Perth, Western Australia, in 2019. Questions focused on experiences of discharge communication and clinical trial engagement. Responses were analyzed using the qualitative Framework Method. Participants were directly observed using digital interfaces as they attempted predetermined tasks that were then classified as success, failure, software failure, or not observed. Participants rated the interfaces using the System Usability Scale (SUS). Results Most parents (9/11, 82%) indicated that they usually received verbal discharge advice, with some (5/11, 45%) recalling receiving preprinted resources from their physician. Most (8/11, 73%) would also like to receive discharge advice electronically. Most of the physicians (7/8, 88%) described their usual practice as verbal discharge instructions, with some (3/8, 38%) reporting time pressures associated with providing discharge instructions. The digital technology option was preferred for engaging in research by most parents (8/11, 73%). For the discharge communication digital tool, parents gave a mean SUS score of 94/100 (SD 4.3; A grade) for the mobile interface and physicians gave a mean usability score of 93/100 (SD 4.7; A grade) for the desktop interface. For the research data management tool (REDCap), parents gave a mean usability score of 78/100 (SD 11.0; C grade) for the mobile interface. Conclusions Semistructured interviews allowed us to better understand parent and physician experiences of discharge communication and clinical research engagement. Software interface usability testing methods and use of the SUS helped us gauge the efficacy of our digital tools with both parent and physician users. This study demonstrates the feasibility of combining qualitative research methods with software industry interface usability testing methods to help determine the efficacy of digital tools in a pediatric clinical research setting.
Collapse
Affiliation(s)
- Sarah Doyle
- Emergency Department, Perth Children's Hospital, Perth, Australia
| | - Rebecca Pavlos
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Samantha J Carlson
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Katherine Barton
- Emergency Department, Perth Children's Hospital, Perth, Australia
| | - Mejbah Bhuiyan
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Bernadett Boeing
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia
| | - Meredith L Borland
- Emergency Department, Perth Children's Hospital, Perth, Australia.,University of Western Australia, Perth, Australia
| | | | - Christopher C Blyth
- Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, Perth, Australia.,University of Western Australia, Perth, Australia.,Perth Children's Hospital, Perth, Australia
| |
Collapse
|
17
|
OUP accepted manuscript. Health Promot Int 2022:6573373. [DOI: 10.1093/heapro/daac043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
18
|
Sauers-Ford HS, Aboagye JB, Henderson S, Marcin JP, Rosenthal JL. Disconnection in Information Exchange During Pediatric Trauma Transfers: A Qualitative Study. J Patient Exp 2021; 8:23743735211056513. [PMID: 34869838 PMCID: PMC8640298 DOI: 10.1177/23743735211056513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pediatric patients experiencing an emergency department (ED) visit for a traumatic injury often transfer from the referring ED to a pediatric trauma center. This qualitative study sought to evaluate the experience of information exchange during pediatric trauma visits to referring EDs from the perspectives of parents and referring and accepting clinicians through semi-structured interviews. Twenty-five interviews were conducted (10 parents and 15 clinicians) and analyzed through qualitative thematic analysis. A 4-person team collaboratively identified codes, wrote memos, developed major themes, and discussed theoretical concepts. Three interdependent themes emerged: (1) Parents’ and clinicians’ distinct experiences result in a disconnect of information exchange needs; (2) systems factors inhibit effective information exchange and amplify the disconnect; and (3) situational context disrupts the flow of information contributing to the disconnect. Individual-, situational-, and systems-level factors contribute to disconnects in the information exchanged between parents and clinicians. Understanding how these factors’ influence information disconnect may offer avenues for improving patient–clinician communication in trauma transfers.
Collapse
|
19
|
Overmann KM, Vukovic AA, Britto MT. A Content Analysis of Emergency Department Discharge Instructions for Acute Pediatric Febrile Illnesses: The Current State and Opportunities for Improvement. J Patient Exp 2021; 8:23743735211060773. [PMID: 34869843 PMCID: PMC8640326 DOI: 10.1177/23743735211060773] [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] [Indexed: 11/17/2022] Open
Abstract
Quality emergency department (ED) discharge communication is critical to understanding of disease progression, home management, and return instructions. Addressing social aspects of disease burden are important to improving satisfaction and healthcare utilization. The objective of this study was to understand the extent to which written ED discharge instructions address multifaceted aspects of disease to meet the comprehensive needs of families with common childhood illnesses. We analyzed a national sample of 28 written discharge instructions from pediatric EDs using thematic and inductive content analysis. Seven themes were identified. Nearly all discharge instructions devoted a majority of content to themes related to disease physiology. Other themes common to instructions were related to parental instructions for caring for the child and when to return for further care. Content on caregiver reassurance, returning to daily activities, improving well-being, and promoting community health were not a focus of discharge instructions. Inclusion of multifaceted discharge materials which address both medical and social aspects of disease may help improve family-centered emergency care and the quality of care transitions for common childhood illnesses.
Collapse
Affiliation(s)
- Kevin M Overmann
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Adam A Vukovic
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Maria T Britto
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA.,Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
20
|
Abstract
BACKGROUND A collaborative and multidisciplinary shared responsibility with providing discharge information to pediatric patients/families can support successful reassimilation to life posthospitalization. PROBLEM An analysis of the current discharge process at an urban pediatric hospital identified variations in discharge practices and instructions. APPROACH A multidisciplinary taskforce used the Plan-Do-Study-Act methodology to standardize the discharge process including creating a discharge template, adopting a new education platform, enhancing the electronic health record, and implementing strategies to improve discharge. OUTCOMES There was a reduction in 7-day readmission rate from preintervention 4.58 to postintervention for 4 consecutive quarters of 3.92, 4.20, 3.44, and 3.41, respectively. Percentile ranking and top box scores of the patient satisfaction measure of discharge preparation increased from 12th-62nd to 65th-95th percentile postimplementation and 81% to 88%, respectively. CONCLUSIONS A local improvement initiative related to standardization of the discharge process resulted in a reduction in 7-day readmission rate and improved patient satisfaction scores.
Collapse
|
21
|
McIntyre H, Loughhead M, Hayes L, Procter NG. National Disability Insurance Scheme and Lived Experience of People Presenting to the Emergency Department: Protocol for a Mixed Methods Study. JMIR Res Protoc 2021; 10:e33268. [PMID: 34554101 PMCID: PMC8603173 DOI: 10.2196/33268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022] Open
Abstract
Background Currently, within Australia, 3.6% of all emergency department (ED) presentations are mental health–related. Information about the context of the person presenting to the ED (beyond immediate needs), including their psychosocial disability (PSD) National Disability Insurance Scheme (NDIS) plan, is reported as incomplete and fragmented. There are missed opportunities for early support and care continuity that could potentially inform ED practitioners to revise current practices. Objective The aims of this study are: (1) to obtain original data from the lived experience voice of those with the PSD NDIS plan and their experience when presenting to an ED, (2) to gather information from NDIS service providers to reveal communication pathways between the ED and NDIS services, and (3) to gain knowledge from ED clinicians around processes for improving continuity of care and consumer experience. Methods This inductive, mixed methods phenomenological study will involve data collection analyzed sequentially, with each stage informing future stages of the research. Interviews will focus on the lived experience voice exploring concerns that have led to an ED presentation, alongside an analysis of associated clinical and administrative documentation and communications. Focus groups with NDIS support workers and support coordinators will provide phenomenological data around the experience from their perspective. National quantitative surveys among those with a PSD NDIS plan and emergency services clinicians will provide insight into current practices within community care and ED presentations. The research project design includes a lived experience advisory group who are assisting with the design of the interview and focus group schedules and national surveys, as well as in shaping the interpretation of qualitative information. All transcripts will be subject to thematic analysis to understand individuals’ meaning-making of these complex and particular phenomena. The research team includes a lived experience researcher and a lived experience carer (PhD candidate). Results This study is funded by MIND Australia as a PhD industry scholarship, which commenced in April 2020. A systematic review as a preresearch activity has been completed and is currently under review. The Human Research Ethics Committee of the University of South Australia has approved this project. An advisory group has been selected, and interview, focus group, and survey schedules are currently being codesigned. Recruitment will commence in November 2021. It is envisaged that data collection will be completed by June 2022. Conclusions Understanding the lived experience of the precare, during care, and postcare stages of ED presentations from the perspective of those with a PSD NDIS plan will inform the research team around current practices and provide information about improvement for pathways of care for consumers and carers, while also informing health policy. International Registered Report Identifier (IRRID) PRR1-10.2196/33268
Collapse
Affiliation(s)
- Heather McIntyre
- Mental Health and Suicide Prevention Research and Education Group, University of South Australia, Adelaide, Australia
| | - Mark Loughhead
- Mental Health and Suicide Prevention Research and Education Group, University of South Australia, Adelaide, Australia
| | | | - Nicholas Gerard Procter
- Mental Health and Suicide Prevention Research and Education Group, University of South Australia, Adelaide, Australia
| |
Collapse
|
22
|
Improving Discharge Instructions Following a Concussion Diagnosis in the Pediatric Emergency Department: A Pre-post Intervention Study. Pediatr Qual Saf 2021; 6:e456. [PMID: 34476308 PMCID: PMC8389964 DOI: 10.1097/pq9.0000000000000456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 03/24/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction Many children are discharged from the pediatric emergency department (PED) with incomplete or inappropriate instructions following a concussion. Our objective was to evaluate the effectiveness of a simple intervention in improving discharge instruction disbursement and completeness following PED diagnosis of concussion. Methods A pre/post intervention study of 935 patients (375 preintervention and 560 postintervention) ages 5-19, diagnosed with a concussion and discharged from the PED between July 2016 and November 2019, was performed at a single United States pediatric tertiary-care center. Dedicated provider education sessions were held, and a consensus guideline-based set of discharge instructions were implemented in the electronic health record. Primary outcomes included the presence of return-to-play (RTP) instructions, return-to-learn (RTL) instructions, follow-up recommendations, and "complete" discharge (ie, all 3 components present). Statistical process control charts were generated and tested for special cause variation. Results More patients received instructions for RTP (87% versus 59%) and RTL (60% versus 3%), and a complete discharge was more frequent (45% versus 2%), following the conclusion of the intervention. Only the improvement in RTP instructions was completely sustained into the following academic year, whereas RTL and complete discharge rates declined to 27% and 20%, respectively. Conclusions A simple, low-cost intervention such as peer-to-peer education and consensus guideline-based discharge instruction templates can significantly improve discharge readiness after pediatric concussion. Further work is needed to maintain progress and continue improvements, at our large academic trauma center.
Collapse
|
23
|
Lacey B, West A, Craig S. Parents' and carers' impression of "quality" within a Paediatric Emergency Department. BMC Pediatr 2021; 21:313. [PMID: 34256736 PMCID: PMC8276454 DOI: 10.1186/s12887-021-02752-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 05/27/2021] [Indexed: 11/21/2022] Open
Abstract
Background Quality improvement systems are needed to overcome the ‘Quality Gap’ – difference between evidence-based guidelines and the care delivered. While there are a large array of potential quality assurance measures exists in the Paediatric Emergency Department, parent’s/carer’s perception of these is unknown. This study aimed to identify what ‘quality of care’ means to parents/carers of Paediatric Emergency Department (PED) patients, further determine which aspects of these are most important to them. Also, to identify which of the existing PED quality measures are most important to parents/carers, and their preferred method of providing feedback. Methods A Modified Rand-Delphi study was performed with parents/carers as the expert group and consensus was obtained from them via three web-based surveys. All parents/carers of children attending a tertiary paediatric hospital during six-week in winter were eligible– no exclusions. Quality measures scoring at least 7 on a 9-point Likert scale during the final survey were considered “very important”, while those scoring at least an 8 were considered “extremely important”. Results One hundred four parents/carers responded from a total of 1095 participants. Parents/carers generated 527 free text entries, to the initial survey on what ‘quality of care’ means. These were mapped to 48 quality measure which they ranked on subsequent surveys. Eighteen quality measures were considered very important by at least 90% of respondents. Of these, six were considered extremely important by at least 70% of respondents: ‘Thorough medical assessment’ (84%); ‘A triage system’ (84%); ‘Experienced and knowledgeable staff that are skilled in paediatrics’ (77%); ‘Resources and equipment available to provide care’ (72%); and ‘Clear follow up plans and reviews that are communicated and scheduled’ (72%). Parents/carers considered existing quality measures as important with ‘timely treatment of a critical condition’ as the most important. Most participants preferred to provide anonymous feedback (N = 69, 66%), online (N = 77, 72%) after discharge (N = 82, 70%). Conclusion We have elicited what ‘quality of care’ means to parents/carers, and which aspects are most important to them. Parents/carers consider commonly used PED quality measure as very important. However, they are less important than outcomes generated by themselves. Further parents/carers in this study preferred to provide feedback that was anonymous and electronically distributed after they leave the ED. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02752-7.
Collapse
Affiliation(s)
- Brendan Lacey
- Paediatric Emergency Department, Emergency Service, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.
| | - Adam West
- Paediatric Emergency Department, Emergency Service, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia
| | - Simon Craig
- Paediatric Emergency Department, Emergency Service, Monash Health, Monash Medical Centre, 246 Clayton Road, Clayton, Victoria, 3168, Australia.,Department of Medicine, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.,Monash Children's Hospital, Locked Bag 29, Clayton South, Victoria, Australia
| |
Collapse
|
24
|
Raghupathy MK, Rao BK, Nayak SR, Spittle AJ, Parsekar SS. Effect of family-centered care interventions on motor and neurobehavior development of very preterm infants: a protocol for systematic review. Syst Rev 2021; 10:59. [PMID: 33602324 PMCID: PMC7890856 DOI: 10.1186/s13643-021-01612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Globally, very preterm birth is a health concern leading to various developmental difficulties such as poor motor and/or cognitive function. For infants born very preterm, family-centered care (FCC) might promote developmental skills over the time in an appropriate enriched environment. The purpose of this study is to systematically review and assess the evidence of FCC interventions on the motor and neurobehavioral development in very preterm infants. Additionally, this review aims to determine the factors that might affect infant development. METHODS Systematic review will be carried out by including (a) quasi-randomized controlled trials and randomized controlled trials (b) of very preterm born infants (born < 32 weeks of gestation), and their primary caregivers will be included in the review (c) who received FCC-based interventions such as collaborative interaction between a healthcare professional and a parent, home program, home visits, and parent education, and (d) measure motor and neurobehavioral function. Electronic databases such as Scopus, PubMed, Embase, Cochrane Library, Web of Science, CINAHL, and PsycINFO will be searched using database-specific terms. Additionally, searches will be carried out in ProQuest, and references of included studies will be searched. Two review authors, independently, will conduct the screening, data extraction, and critical appraisal of included studies. If possible, a meta-analysis will be undertaken to assess the effect of the FCC on the motor and neurobehavior of premature infants. CONCLUSION The review will provide insights regarding the effect of the FCC on preterm infants. This systematic review will guide the clinicians on the feasibility of practicing FCC that might support and promote the integration of parents into various rehabilitation settings. SYSTEMATIC REVIEW REGISTRATION Protocol has been registered in PROSPERO on August 26, 2020.
Collapse
Affiliation(s)
- Manasa Kolibylu Raghupathy
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Bhamini Krishna Rao
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, India.
| | - Shubha R Nayak
- Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, 576104, India
| | - Alicia J Spittle
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia
| | - Shradha S Parsekar
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| |
Collapse
|
25
|
Austin EE, Blakely B, Tufanaru C, Selwood A, Braithwaite J, Clay-Williams R. Strategies to measure and improve emergency department performance: a scoping review. Scand J Trauma Resusc Emerg Med 2020; 28:55. [PMID: 32539739 PMCID: PMC7296671 DOI: 10.1186/s13049-020-00749-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022] Open
Abstract
Background Over the last two decades, Emergency Department (ED) crowding has become an increasingly common occurrence worldwide. Crowding is a complex and challenging issue that affects EDs’ capacity to provide safe, timely and quality care. This review aims to map the research evidence provided by reviews to improve ED performance. Methods and findings We performed a scoping review, searching Cochrane Database of Systematic Reviews, Scopus, EMBASE, CINAHL and PubMed (from inception to July 9, 2019; prospectively registered in Open Science Framework https://osf.io/gkq4t/). Eligibility criteria were: (1) review of primary research studies, published in English; (2) discusses a) how performance is measured in the ED, b) interventions used to improve ED performance and their characteristics, c) the role(s) of patients in improving ED performance, and d) the outcomes attributed to interventions used to improve ED performance; (3) focuses on a hospital ED context in any country or healthcare system. Pairs of reviewers independently screened studies’ titles, abstracts, and full-texts for inclusion according to pre-established criteria. Discrepancies were resolved via discussion. Independent reviewers extracted data using a tool specifically designed for the review. Pairs of independent reviewers explored the quality of included reviews using the Risk of Bias in Systematic Reviews tool. Narrative synthesis was performed on the 77 included reviews. Three reviews identified 202 individual indicators of ED performance. Seventy-four reviews reported 38 different interventions to improve ED performance: 27 interventions describing changes to practice and process (e.g., triage, care transitions, technology), and a further nine interventions describing changes to team composition (e.g., advanced nursing roles, scribes, pharmacy). Two reviews reported on two interventions addressing the role of patients in ED performance, supporting patients’ decisions and providing education. The outcomes attributed to interventions used to improve ED performance were categorised into five key domains: time, proportion, process, cost, and clinical outcomes. Few interventions reported outcomes across all five outcome domains. Conclusions ED performance measurement is complex, involving automated information technology mechanisms and manual data collection, reflecting the multifaceted nature of ED care. Interventions to improve ED performance address a broad range of ED processes and disciplines.
Collapse
Affiliation(s)
- Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia.
| | - Brette Blakely
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Catalin Tufanaru
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Amanda Selwood
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| |
Collapse
|
26
|
Curran JA, Cassidy C, Bishop A, Wozney L, Plint AC, Ritchie K, Straus SE, Wong H, Newton A, Jabbour M, MacPhee S, Breneol S, Burns E, Chorney J, Lawton J, Doyle M, MacKay R, Zemek R, Penney T, Grimshaw J. Codesigning discharge communication interventions with healthcare providers, youth and parents for emergency practice settings: EDUCATE study protocol. BMJ Open 2020; 10:e038314. [PMID: 32398342 PMCID: PMC7223275 DOI: 10.1136/bmjopen-2020-038314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/14/2020] [Accepted: 04/17/2020] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Discharge communication is an important aspect of patient care but frequently has shortcomings in emergency departments (EDs). In a paediatric context, youth or parents with young children often leave the ED with minimal opportunity to ask questions or to ensure comprehension of important information. Strategies for improving discharge communication have primarily targeted patients and/or parents, although neither group has been engaged in intervention design or implementation. Furthermore, ED healthcare providers (HCPs), important actors in discharge communication practice, are rarely consulted regarding intervention design decisions. We will generate evidence to enhance discharge communication by engaging youth, parents and HCPs in the codesign of ED discharge communication strategies (EDUCATE) for asthma and minor head injury. METHODS AND ANALYSIS This mixed methods study will take place at two academic paediatric EDs in Canada. The study will occur in two phases: (A) codesign and refinement of the intervention prototypes; and (B) usability testing of the prototypes. During the first phase, two codesign teams (one for each condition) will follow a series of structured design meetings based on the Behavior Change Wheel to develop the EDUCATE interventions. Each codesign team (composed of youth, parents, HCPs and study researchers) will collaborate to identify priority target behaviours and acceptable components to include in the interventions. During the second phase, we will conduct usability testing in two EDs with a group of youth, parents and HCPs to refine the interventions. Two cycles of usability testing will be conducted with intervention refinement occurring at the end of each cycle. ETHICS AND DISSEMINATION Informed consent will be obtained from all participants. Ethics approval for this study has been obtained from the Research Ethics Board, IWK Health Centre. Results from this study will form the basis of a future effectiveness implementation trial. Key findings will be presented at national and international conferences and published within peer-reviewed journals.
Collapse
Affiliation(s)
- Janet A Curran
- Department of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Christine Cassidy
- Department of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Lori Wozney
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Amy C Plint
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Krista Ritchie
- Faculty of Education, Mount Saint Vincent University, Halifax, Nova Scotia, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute, Saint Mike's, Toronto, Ontario, Canada
| | - Helen Wong
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Amanda Newton
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Mona Jabbour
- Division of Emergency Medicine, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Sydney Breneol
- Department of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Emma Burns
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | | | | | | | - Roger Zemek
- Department of Pediatrics, CHEO, Ottawa, Ontario, Canada
| | | | - Jeremy Grimshaw
- Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
| |
Collapse
|
27
|
Zanobini P, Lorini C, Baldasseroni A, Dellisanti C, Bonaccorsi G. A Scoping Review on How to Make Hospitals health Literate Healthcare Organizations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031036. [PMID: 32041282 PMCID: PMC7037285 DOI: 10.3390/ijerph17031036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 01/27/2020] [Accepted: 02/04/2020] [Indexed: 12/13/2022]
Abstract
The concept of health literacy is increasingly being recognised as not just an individual trait, but also as a characteristic related to families, communities, and organisations providing health and social services. The aim of this study is to identify and describe, through a scoping review approach, the characteristics and the interventions that make a hospital a health literate health care organisation (HLHO), in order to develop an integrated conceptual model. We followed Arksey and O’Malley’s five-stage scoping review framework, refined with the Joanna Briggs Institute methodology, to identify the research questions, identify relevant studies, select studies, chart the data, and collate and summarize the data. Of the 1532 titles and abstracts screened, 106 were included. Few studies have explored the effect of environmental support on health professionals, and few outcomes related to staff satisfaction/perception of helpfulness have been reported. The most common types of interventions and outcomes were related to the patients. The logical framework developed can be an effective tool to define and understand priorities and related consequences, thereby helping researchers and policymakers to have a wider vision and a more homogeneous approach to health literacy and its use and promotion in healthcare organizations.
Collapse
Affiliation(s)
- Patrizio Zanobini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
- Correspondence: ; Tel.: +39-3663435179
| | - Chiara Lorini
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
| | - Alberto Baldasseroni
- Tuscany Regional Centre for Occupational Injuries and Diseases (CeRIMP), Central Tuscany LHU, Via di San Salvi, 12, 50135 Florence, Italy;
| | - Claudia Dellisanti
- Department of Epidemiology, Regional Health Agency of Tuscany, Via Pietro Dazzi, 1, 50141 Florence, Italy;
| | - Guglielmo Bonaccorsi
- Department of Health Sciences, University of Florence, Viale GB Morgagni 48, 50134 Florence, Italy; (C.L.); (G.B.)
| |
Collapse
|