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Block H, Tran R, Lockwood K, Manuel K, Laver K, Crotty M, Cameron ID, Kurrle SE. Frailty evidence-practice gaps in acute care hospitals. Australas J Ageing 2024; 43:420-425. [PMID: 38798035 DOI: 10.1111/ajag.13330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 03/14/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVES Frailty is common in hospitalised older people. Clinical practice guidelines for the management of frailty provide recommendations for identification and management; however, adoption into practice in hospitals is limited. This study identified and quantified the evidence-practice gap between frailty guidelines and clinical practice in two hospitals using an audit tool. METHODS A cross-sectional audit of medical records of frail older patients admitted to two hospitals was conducted. Data were collected using an audit tool based on the Asia Pacific Clinical Practice Guidelines for frailty management. Data were analysed using descriptive statistics and inter-rater reliability of the tool was assessed. RESULTS Auditing of n = 70 electronic medical records showed that assessment of frailty in the acute setting did not regularly occur (17%). Few participants received guideline-recommended interventions. Physiotherapy treatment was limited, with 23% of participants receiving progressive resistance strength training. Gaps exist in provision of nutritional supplementation (26%) with limited recordings of weight during the admission for 10% of participants. Pharmacy review of medications was consistently documented on admission (84%) and discharge (93%). Vitamin D was prescribed for 57% of participants. Inter-rater reliability showed a high level of agreement using the audit tool. CONCLUSIONS An audit tool was feasible to assess frailty evidence-practice gaps in the hospital setting. Further understanding of the contextual barriers is needed to inform implementation strategies (dedicated staffing, education and training and ongoing audit of practice cycles) for the uptake of frailty guidelines in hospital settings.
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Affiliation(s)
- Heather Block
- Rehabilitation, Palliative and Aged Care Division, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Rosanna Tran
- Rehabilitation and Aged Care Services, Northern Sydney Local Health District, Sydney, New South Wales, Australia
| | - Keri Lockwood
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Kisani Manuel
- Rehabilitation, Palliative and Aged Care Division, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Kate Laver
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Maria Crotty
- Rehabilitation, Palliative and Aged Care Division, Southern Adelaide Local Health Network, Bedford Park, South Australia, Australia
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
| | - Ian D Cameron
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District and University of Sydney, Sydney, New South Wales, Australia
| | - Susan E Kurrle
- Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Fitzmaurice Y, Beeke S, Isaksen J, Cunningham U, Jagoe C, Shé ÉN, McMenamin R. Communication partner training for student health and social care professionals engaging with people with stroke acquired communication difficulties: A protocol for a realist review. HRB Open Res 2024; 6:60. [PMID: 38384971 PMCID: PMC10879762 DOI: 10.12688/hrbopenres.13783.1] [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] [Accepted: 03/26/2024] [Indexed: 02/23/2024] Open
Abstract
Background Stroke acquired communication impairments impede effective communication. Consequently, in stroke care, communicative interactions can be challenging for both patients and staff and can predispose patients to increased risk of preventable adverse events. Communication partner training (CPT) can mitigate such negative outcomes by optimising communicative interactions. Providing CPT to student health and social care professionals (SH&SCPs) has the potential to enhance their clinical expertise and experiences and enhance the future clinical care of patients with stroke acquired communication impairments. This research aims to expand our understanding of how CPT is operationalised for SH&SCPs in higher education institutions and determine: what works; for whom; in what contexts; how and why? Methods This review is Phase 1 of a research project employing a realist approach with public and patient involvement (PPI). It incorporates five iterative steps: 1.) Clarifying the scope; 2.) Searching for evidence; 3.) Selecting and appraising evidence; 4.) Data extraction; 5.) Synthesising data and developing a middle range theory explaining how CPT is expected to work for SH&SCPs. An advisory panel, including PPI advisors, content advisors, student advisors, realist advisors and educationalist advisor has been set up to consult throughout the review and collaboratively agree the middle range theory. Discussion While there is an evolving evidence base for CPT, including stroke specific CPT for SH&SCPs, it is acknowledged that there are challenges to its implementation in complex real-world settings. In combining empirical evidence with theoretical understanding, realist review permits synthesis of data from diverse sources and goes beyond determining efficacy to explore generative causation and solutions for real world practice. A middle range realist programme theory that coherently explains how CPT is expected to work when teaching SH&SCPs to communicate with people with stroke acquired communication impairments will provide educators with new insights into CPT development and implementation in their higher education institutions.
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Affiliation(s)
- Yvonne Fitzmaurice
- School of Health Sciences, University of Galway, Galway, H91 TK33, Ireland
| | - Suzanne Beeke
- Division of Psychology and Language Sciences, University College London, London, England, WC1E 6BT, UK
| | - Jytte Isaksen
- Department of Language, Culture, History and Communication, University of Souhern Denmark, Odense, Denmark
| | - Una Cunningham
- Mater Misericordiae University Hospital, Dublin, D07 R2WY, Ireland
| | - Caroline Jagoe
- School of Linguistics, Speech and Communication Sciences, The University of Dublin Trinity College, Dublin, Leinster, D02 PN40, Ireland
- Speech Pathology and Audiology, School of Human and Communication Development, University of Witwatersrand, Johannesburg, South Africa
| | - Éidín Ní Shé
- Graduate School of Healthcare Management, RCSI University of Medicine and Health Sciences, Dublin, D02 YN77, Ireland
| | - Ruth McMenamin
- School of Health Sciences, University of Galway, Galway, H91 TK33, Ireland
- PPI Ignite Network @ University of Galway, University of Galway, Galway, H91 TK33, Ireland
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Moloney E, O'Donovan MR, Sezgin D, McGrath K, Timmons S, O'Caoimh R. Frailty Knowledge, Use of Screening Tools, and Educational Challenges in Emergency Departments in Ireland: A Multisite Survey. J Emerg Nurs 2024; 50:22-35. [PMID: 37804277 DOI: 10.1016/j.jen.2023.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/13/2023] [Accepted: 08/24/2023] [Indexed: 10/09/2023]
Abstract
BACKGROUND Recognizing frailty and providing evidenced-based management in busy emergency departments is challenging. Understanding the knowledge and educational needs of ED staff is important to design training that might improve patient outcomes. OBJECTIVE This study aimed to explore frailty knowledge of ED staff, use of frailty screening instruments in Irish emergency departments, and educational challenges in the emergency department. METHODS A multisite survey of ED staff (different specialties) was conducted between April and September 2021. An anonymous online survey was distributed via email. Free-text sections were analyzed using content analysis. RESULTS In total, 168 staff (nursing, medical and allied health) participated, representing 9 of 26 Irish emergency departments (35%). Most respondents were nurses (n = 78, 46%). Less than half of respondents had received frailty identification training (n = 81, 48%). One-fifth of emergency doctors and nurses (20%) were unsure how to define frailty. Major barriers to ED frailty screening were resource deficits, insufficient diagnostic pathways from the emergency departments, and lack of education on suitable instruments. CONCLUSIONS Most of the ED staff surveyed relied on clinical judgment rather than formal training in frailty identification. A high proportion reported poor knowledge and low confidence in recognizing frailty. Dedicated staff with frailty management expertise, bespoke education initiatives, and clearly defined frailty screening pathways may help address the issues identified.
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Wilson I, Ukoha-kalu BO, Okoeki M, Clark J, Boland JW, Pask S, Nwulu U, Elliott-Button H, Folwell A, Johnson MJ, Harman D, Murtagh FEM. Experiences of a Novel Integrated Service for Older Adults at Risk of Frailty: A Qualitative Study. J Patient Exp 2023; 10:23743735231199827. [PMID: 37693187 PMCID: PMC10483964 DOI: 10.1177/23743735231199827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
The UK has a significant and growing population of older adults with frailty and complex healthcare needs, necessitating innovative care solutions. This study aimed to explore patients' and carers' experiences of a novel integrated service that was set up to address the increasing healthcare needs of older people living with frailty. A qualitative study that combined free-text survey questions with in-depth interviews. This study is part of a larger non-randomized trial of the service, with evaluation of wellbeing and quality of life at baseline, 2 to 4 weeks, and 10 to 14 weeks. Patients (aged 65 and above) with an electronic Frailty Index in the severe range and their informal family carers participated in this study. Data were collected between April 2019 and March 2020. Free text survey responses and interview data were subjected to reflexive thematic analyses. Four themes were generated: the overall experience of the service; interactions within the service; treatment and interventions; and outcomes due to the service. Most participants wanted further follow-up and more extensive integration with other services. Most participants described their overall experience positively, especially the available time to address their full range of concerns, but opportunities to integrate the service more fully and to extend follow-up remain.
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Affiliation(s)
- Imogen Wilson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Blessing O Ukoha-kalu
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Mabel Okoeki
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Joseph Clark
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Jason W Boland
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Sophie Pask
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Ugochinyere Nwulu
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Helene Elliott-Button
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | | | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | | | - Fliss EM Murtagh
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
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Dowling T, Kennedy S, Foran S. Who Bears Responsibility for the Post-Acute Older Adult: Patient, Family or State? Br J Community Nurs 2023; 28:376-383. [PMID: 37527224 DOI: 10.12968/bjcn.2023.28.8.376] [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: 08/03/2023]
Abstract
AIM This study explores the perceptions of hospital discharge coordinators on the issues raised for the post-acute older adult and their family, using the lens of assisted decision-making and advance directives. BACKGROUND New legislation has been developed in Ireland to support assisted decision-making and advance directives that is largely consistent with other countries around the world. The Assisted Decision-Making Act of 2015 was fully commeced in April 2023, following lengthy debate. However, there is a lot of professional uncertainty regarding how to support and integrate Advance Healthcare Directives and assisted decision-making into the care of adults and into the role of nurses working in the community. METHODS Utilising a qualitative approach, this study conducted a series of five focus groups, with 23 participants, across the South-East of Ireland. Thematic analysis was used to interpret results. The 32-item consolidated criteria for reporting qualitative research checklist was utilised. FINDINGS The central finding in this study concerned the locus of control, as well as findings on burden of care and the role of the nurse. A stark incongruence of beliefs among patient, family and State was identified. CONCLUSION Nurses must learn to circumnavigate the complex terrain involved in supporting the older adult's advance decision-making and advance healthcare directives.
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Affiliation(s)
- Teresa Dowling
- Postgraduate Researcher, Department of Nursing and Healthcare, South East Technological University, Ireland
| | - Sara Kennedy
- Head of Department, Department of Nursing and Healthcare, South East Technological University, Ireland
| | - Sinéad Foran
- Lecturer, Department of Nursing, Dublin City University, Ireland
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6
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Supporting autonomy for people with dementia living in nursing homes: A rapid realist review. Int J Nurs Stud 2023; 137:104382. [PMID: 36402057 DOI: 10.1016/j.ijnurstu.2022.104382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/02/2022] [Accepted: 10/13/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND For people with dementia living in nursing homes, autonomy is important. However, they experience difficulty with being heard as an autonomous person, as well as with expressing their preferences and choices. The question is how to support their autonomy. OBJECTIVE Despite extensive efforts to support autonomy in daily care for people with dementia living in nursing homes, we do not know exactly what works for whom, in which context, how and why. The objective of this realist review is to explore what is known in literature on autonomy support interventions for people with dementia in nursing homes. DESIGN A rapid realist review of literature. REVIEW METHODS To understand how autonomy is supported, a realist approach was applied that entailed identifying the research question, searching for information, performing a quality appraisal, extracting data, synthesizing the evidence and validating the findings with a panel of experts. Causal assumptions were derived from articles found in four bibliographic databases (PubMed, PsychInfo, Cochrane and CINAHL) leading to context (C)-mechanism (M)-outcome (O) configurations. RESULTS Data extraction from the included articles ultimately resulted in sixteen CMO configurations on four themes: a. preferences and choice: interventions for supporting autonomy in nursing homes and their results, b. personal characteristics of residents and family: people with dementia and their family being individuals who have their own character, habits and behaviors, c. competent nursing staff each having their own level of knowledge, competence and need for support, and d. interaction and relationships in care situations: the persons involved are interrelated, continuously interacting in different triangles composed of residents, family members and nursing staff. CONCLUSION The findings showed that results from interventions on autonomy in daily-care situations are likely to be just as related not only with the characteristics and competences of the people involved, but also to how they interact. Autonomy support interventions appear to be successful when the right context factors are considered.
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Green MM, Meyer C, Hutchinson AM, Sutherland F, Lowthian JA. Co-designing Being Your Best program-A holistic approach to frailty in older community dwelling Australians. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e2022-e2032. [PMID: 34747085 DOI: 10.1111/hsc.13636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 09/24/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
Frailty is a condition characterised by increased vulnerability and decline of physical and cognitive reserves, most often affecting older people. This can lead to a cascade of repeated hospitalisations, further decline and ultimately loss of independence. Frailty and pre-frailty are modifiable; interventions such as physical exercise, cognitive training, social connection and improved nutrition, especially in a group setting, can mitigate frailty. Existing healthcare guidelines for managing frailty focus predominantly on falls, delirium, acute confusion and immobility. Uptake of referrals to services following hospital discharge is sub-optimal, indicating that a more proactive, person-centred and integrated approach to frailty is required. The aim was to co-design a program to help pre-frail and frail older people return to their homes following hospital discharge by increasing resilience and promoting independence. We engaged healthcare consumers, and healthcare professionals from three tertiary hospitals in metropolitan Melbourne (Alfred Hospital, Monash Health and Cabrini Health), and from Bolton Clarke home-based support services. Co-design is a process whereby the input of service consumers is included in the development of a program. In the healthcare sector, co-design involves discussions with healthcare consumers alongside healthcare professionals to identify issues and build knowledge to ultimately work on improving the healthcare system. From co-design sessions with 23 healthcare consumers and 17 healthcare professionals, it was apparent that frailty was perceived to affect physical and mental well-being. The co-design process resulted in refinement of the Being Your Best program to incorporate a holistic approach, addressing four domains supported by research evidence, to improve health and well-being through community- or home-based physical activity, cognitive training, social support and nutritional support. Being Your Best was developed in consultation with older people with lived experience as well as healthcare professionals and aims to mitigate the effects of frailty, and will now be tested for feasibility and acceptability.
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Affiliation(s)
- Maja M Green
- Bolton Clarke Research Institute, Bentleigh, Victoria, Australia
| | - Claudia Meyer
- Bolton Clarke Research Institute, Bentleigh, Victoria, Australia
- Rehabilitation, Ageing and Independent Living Research Centre, Monash University, Clayton, Victoria, Australia
- Centre for Health Communication and Participation, La Trobe University, Bundoora, Victoria, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Safety, Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Safety Research, Monash Health - Deakin University Partnership, Clayton, Victoria, Australia
| | - Fran Sutherland
- Healthcare Consumer Representative, Cabrini Health, Malvern, Victoria, Australia
| | - Judy A Lowthian
- Bolton Clarke Research Institute, Bentleigh, Victoria, Australia
- School of Public Health & Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Victoria, Australia
- Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Queensland, Australia
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McAneney H, Shier H, Gibbs L, Davies C, De Brún A, Tisdall KM, Corrigan C, Kelly A, Owens J, Okoli O, Wall T, Alves H, Kongats K, Krishna RN, Sheppard-LeMoine D, Wagner FA, Wang JJ, Mutch C, Kroll T, Somanadhan S. Children as innovators: harnessing the creative expertise of children to address practical and psychosocial challenges of the coronavirus disease 2019 (COVID-19) pandemic – COVISION study protocol. HRB Open Res 2022; 4:104. [PMID: 35391787 PMCID: PMC8968158 DOI: 10.12688/hrbopenres.13290.2] [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: 02/18/2022] [Indexed: 11/20/2022] Open
Abstract
Background: We are currently in a period of transition, from the pre-COVID-19 (coronavirus disease 2019) era and the initial reactive lockdowns, to now the ongoing living with and potentially the after COVID-19 period. Each country is at its own individual stage of this transition, but many have gone through a period of feeling adrift; disconnected from normal lives, habits and routines, finding oneself betwixt and between stages, similar to that of liminality. Children and young people have been particularly affected. Aim: To increase the understanding of home and community-based strategies that contribute to children and young people’s capacity to adjust to societal changes, both during and after pandemics. Moreover, to identify ways in which children’s actions contribute to the capacity of others to adjust to the changes arising from the pandemic. The potential for these activities to influence and contribute to broader social mobilisation will be examined and promoted. Research design: To achieve the aim of this study, a participatory health research approach will be taken. The overarching theoretical framework of the COVISION study is that of liminality. The study design includes four work packages: two syntheses of literature (a rapid realist review and scoping review) to gain an overview of the emerging international context of evidence of psychosocial mitigations and community resilience in pandemics, and more specifically COVID-19; qualitative exploration
of children and young people’s perspective of COVID-19
via creative outlets and reflections; and participatory learning and action through co-production.
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Affiliation(s)
- Helen McAneney
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), University College Dublin, Belfield, Dublin 4, Ireland
| | - Harry Shier
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), University College Dublin, Belfield, Dublin 4, Ireland
| | - Lisa Gibbs
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Carmel Davies
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), University College Dublin, Belfield, Dublin 4, Ireland
| | - Aoife De Brún
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), University College Dublin, Belfield, Dublin 4, Ireland
| | - Kay M. Tisdall
- Childhood & Youth Studies Research Group, Moray House School of Education and Sport, University of Edinburgh, Edinburgh, UK
| | | | - Ayrton Kelly
- UCD Innovation Academy, University College Dublin, Belfield, Dublin 4, Ireland
| | - Jacinta Owens
- UCD Innovation Academy, University College Dublin, Belfield, Dublin 4, Ireland
| | - Onyinye Okoli
- The George Washington University, Washington, DC, USA
| | - Tracey Wall
- Children’s Health Ireland, Dublin 1, Ireland
| | - Hayda Alves
- Rio das Ostras Institute of Humanities and Health, Fluminense Federal University, Rio das Ostras, Brazil
| | - Krystyna Kongats
- Centre for Health Communities, School of Public Health, University of Alberta, Edmonton, Canada
| | - Revathi N. Krishna
- Monash University Accident Research Centre, Monash University, Clayton, Melbourne, Victoria, Australia
| | | | | | | | - Carol Mutch
- The School of Critical Studies in Education, Faculty of Education and Social work, The University of Auckland, Auckland, New Zealand
| | - Thilo Kroll
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), University College Dublin, Belfield, Dublin 4, Ireland
| | - Suja Somanadhan
- UCD School of Nursing, Midwifery & Health Systems, University College Dublin, Belfield, Dublin 4, Ireland
- UCD Centre for Interdisciplinary Research, Education and Innovation in Health Systems (UCD IRIS), University College Dublin, Belfield, Dublin 4, Ireland
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Developing New Methods for Person-Centred Approaches to Adjudicate Context-Mechanism-Outcome Configurations in Realist Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042370. [PMID: 35206560 PMCID: PMC8871803 DOI: 10.3390/ijerph19042370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 01/25/2023]
Abstract
Realist evaluation provides a general method of evaluating the application of interventions including policy, legislation, projects, and new processes in social settings such as law enforcement, healthcare and education. Realist evaluation focuses on what about interventions works, for whom, and in what circumstances, and there is a growing body of work using realist evaluation to analyse interventions in healthcare organizations, including those using Lean Six Sigma improvement methodologies. Whilst realist evaluation facilitates the analysis of interventions using both qualitative and quantitative research, there is little guidance given on methods of data collection and analysis. The purpose of this study is to address this lack of guidance through detailing the use of innovative person-centred methods of data collection and analysis in a realist evaluation that enabled us to understand the contribution of Lean Six Sigma to person-centred care and cultures. This use of person-centred principles in the adjudication of identified program theories has informed novel methods of collecting and analysing data in realist evaluation that facilitate a person-centred approach to working with research participants and a way of making the implicit explicit when adjudicating program theory.
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A Rapid Realist Review of Quality Care Process Metrics Implementation in Nursing and Midwifery Practice. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211932. [PMID: 34831694 PMCID: PMC8621300 DOI: 10.3390/ijerph182211932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/03/2021] [Accepted: 11/09/2021] [Indexed: 12/02/2022]
Abstract
Quality measurement initiatives promote quality improvement in healthcare but can be challenging to implement effectively. This paper presents a Rapid Realist Review (RRR) of published literature on Quality Care-Process Metrics (QCP-M) implementation in nursing and midwifery practice. An RRR informed by RAMESES II standards was conducted as an efficient means to synthesize evidence using an expert panel. The review involved research question development, quality appraisal, data extraction, and evidence synthesis. Six program theories summarised below identify the key characteristics that promote positive outcomes in QCP-M implementation. Program Theory 1: Focuses on the evidence base and accessibility of the QCP-M and their ease of use by nurses and midwives working in busy and complex care environments. Program Theory 2: Examines the influence of external factors on QCP-M implementation. Program Theory 3: Relates to existing cultures and systems within clinical sites. Program Theory 4: Relates to nurses’ and midwives’ knowledge and beliefs. Program Theory 5: Builds on the staff theme of Programme Theory four, extending the culture of organizational learning, and highlights the meaningful engagement of nurses and midwives in the implementation process as a key characteristic of success. Program Theory 6: Relates to patient needs. The results provide nursing and midwifery policymakers and professionals with evidence-based program theory that can be translated into action-orientated strategies to help guide successful QCP-M implementation.
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McAneney H, Shier H, Gibbs L, Davies C, De Brún A, Tisdall KM, Corrigan C, Kelly A, Owens J, Okoli O, Wall T, Alves H, Kongats K, Krishna RN, Sheppard-LeMoine D, Wagner FA, Wang JJ, Mutch C, Kroll T, Somanadhan S. Children as innovators: harnessing the creative expertise of children to address practical and psychosocial challenges of the coronavirus disease 2019 (COVID-19) pandemic – COVISION study protocol. HRB Open Res 2021; 4:104. [DOI: 10.12688/hrbopenres.13290.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 11/20/2022] Open
Abstract
Background: We are currently in a period of transition, from the pre-COVID-19 (coronavirus disease 2019) era and the initial reactive lockdowns, to now the ongoing living with and potentially the after COVID-19 period. Each country is at its own individual stage of this transition, but many have gone through a period of feeling adrift; disconnected from normal lives, habits and routines, finding oneself betwixt and between stages, similar to that of liminality. Children and young people have been particularly affected. Aim: To increase the understanding of home and community-based strategies that contribute to children and young people’s capacity to adjust to societal changes, both during and after pandemics. Moreover, to identify ways in which children’s actions contribute to the capacity of others to adjust to the changes arising from the pandemic. The potential for these activities to influence and contribute to broader social mobilisation will be examined and promoted. Research design: To achieve the aim of this study, a participatory health research approach will be taken. The overarching theoretical framework of the COVISION study is that of liminality. The study design includes four work packages: two syntheses of literature (a rapid realist review and scoping review) to gain an overview of the emerging international context of evidence of psychosocial mitigations and community resilience in pandemics, and more specifically COVID-19; qualitative exploration of children and young people’s perspective of COVID-19 via creative outlets and reflections; and participatory learning and action through co-production.
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12
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Fennelly O, Cunningham C, Grogan L, Cronin H, O'Shea C, Roche M, Lawlor F, O'Hare N. Successfully implementing a national electronic health record: a rapid umbrella review. Int J Med Inform 2020; 144:104281. [PMID: 33017724 PMCID: PMC7510429 DOI: 10.1016/j.ijmedinf.2020.104281] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/27/2020] [Accepted: 09/19/2020] [Indexed: 11/03/2022]
Abstract
AIM To summarize the findings from literature reviews with a view to identifying and exploring the key factors which impact on the success of an EHR implementation across different healthcare contexts. INTRODUCTION Despite the widely recognised benefits of electronic health records (EHRs), their full potential has not always been achieved, often as a consequence of the implementation process. As more countries launch national EHR programmes, it is critical that the most up-to-date and relevant international learnings are shared with key stakeholders. METHODS A rapid umbrella review was undertaken in collaboration with a multidisciplinary panel of knowledge-users and experts from Ireland. A comprehensive literature review was completed (2019) across several search engines (PubMed, CINAHL, Scopus, Embase, Web of Science, IEEE Xplore, ACM Digital Library, ProQuest, Cochrane) and Gray literature. Identified studies (n = 5,040) were subject to eligibility criterion and identified barriers and facilitators were analysed, reviewed, discussed and interpreted by the expert panel. RESULTS Twenty-seven literature reviews were identified which captured the key organizational, human and technological factors for a successful EHR implementation according to various stakeholders across different settings. Although the size, type and culture of the healthcare setting impacted on the organizational factors, each was deemed important for EHR success; Governance, leadership and culture, End-user involvement, Training, Support, Resourcing, and Workflows. As well as organizational differences, individual end-users have varying Skills and characteristics, Perceived benefits and incentives, and Perceived changes to the health ecosystem which were also critical to success. Finally, the success of the EHR technology depended on Usability, Interoperability, Adaptability, Infrastructure, Regulation, standards and policies, and Testing. CONCLUSION Fifteen inter-linked organizational, human and technological factors emerged as important for successful EHR implementations across primary, secondary and long-term care settings. In determining how to employ these factors, the local context, individual end-users and advancing technology must also be considered.
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Affiliation(s)
- Orna Fennelly
- Insight Centre for Data Analytics, University College Dublin, Ireland; School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
| | - Loretto Grogan
- Office of the Nursing and Midwifery Services Director, Health Service Executive (HSE), Ireland.
| | | | - Conor O'Shea
- Irish College of General Practitioners, Ireland..
| | - Miriam Roche
- Maternal and Newborn Clinical Management System National Project Team, HSE, Ireland.
| | | | - Neil O'Hare
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland; Ireland East Hospital Group, HSE, Ireland.
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13
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Ní Shé É, O’Donnell D, O’Shea M, Stokes D. New Ways of Working? A Rapid Exploration of Emerging Evidence Regarding the Care of Older People during COVID19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186442. [PMID: 32899652 PMCID: PMC7558069 DOI: 10.3390/ijerph17186442] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/21/2020] [Accepted: 08/29/2020] [Indexed: 12/15/2022]
Abstract
Health and social care staff have had to quickly adapt, respond and improve teamwork, as a response to the COVID-19 pandemic. Our objective was to rapidly summarize the emerging evidence of new ways of working in the care of older people during this period. We conducted an exploration of the emerging evidence within the timeframe of 1 March 2020 to 11 May 2020. To capture a broad perspective, we undertook thematic analysis of Twitter data which was extracted through a broad search for new ways of working in health and social care. For a more in-depth focus on the health and social care of older people, we undertook a systematic scoping of newspapers using the Nexis UK database. We undertook a validation workshop with members of the interprofessional working group of the Irish National Integrated Care Programme for Older People, and with researchers. A total of 317 tweets were extracted related to six new ways of working. There was evidence of using telehealth to provide ongoing care to patients; interprofessional work; team meetings using online platforms; trust and collaboration within teams; as well as teams feeling empowered to change at a local level. 34 newspaper articles were extracted related to new ways of working in the care of older people, originating in England (n = 17), Wales (n = 6), Scotland (n = 6), Ireland (n = 4) and Germany (n = 1). Four main themes were captured that focused on role expansion, innovations in communication, environmental restructuring and enablement. The results of this exploration of emerging evidence show that health and social care teams can transform very rapidly. Much of the change was based on goodwill as a response to the pandemic. Further analysis of empirical evidence of changing practices should include the perspectives of older people and should capture the resources needed to sustain innovations, as well as evaluate gaps in service provision.
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Affiliation(s)
- Éidín Ní Shé
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield 4 Dublin, Ireland; (É.N.S.); (M.O.)
| | - Deirdre O’Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield 4 Dublin, Ireland; (É.N.S.); (M.O.)
- Correspondence:
| | - Marie O’Shea
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield 4 Dublin, Ireland; (É.N.S.); (M.O.)
| | - Diarmuid Stokes
- Liaison Librarian for Health and Science, University College Dublin, Belfield 4 Dublin, Ireland;
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14
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" What Bothers Me Most Is the Disparity between the Choices that People Have or Don't Have": A Qualitative Study on the Health Systems Responsiveness to Implementing the Assisted Decision-Making (Capacity) Act in Ireland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17093294. [PMID: 32397345 PMCID: PMC7246817 DOI: 10.3390/ijerph17093294] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 12/18/2022]
Abstract
Objective: The Assisted Decision-Making (ADM) (Capacity) Act was enacted in 2015 in Ireland and will be commenced in 2021. This paper is focused on this pre-implementation stage within the acute setting and uses a health systems responsiveness framework. Methods: We conducted face-to-face interviews using a critical incident technique. We interviewed older people including those with a diagnosis of dementia (n = 8), family carers (n = 5) and health and social care professionals (HSCPs) working in the acute setting (n = 26). Results: The interviewees reflected upon a healthcare system that is currently under significant pressures. HSCPs are doing their best, but they are often halted from delivering on the will and preference of their patients. Many older people and family carers feel that they must be very assertive to have their preferences considered. All expressed concern about the strain on the healthcare system. There are significant environmental barriers that are hindering ADM practice. Conclusions: The commencement of ADM provides an opportunity to redefine the provision, practices, and priorities of healthcare in Ireland to enable improved patient-centred care. To facilitate implementation of ADM, it is therefore critical to identify and provide adequate resources and work towards solutions to ensure a seamless commencement of the legislation.
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15
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Anjara SG, Ní Shé É, O'Shea M, O'Donoghue G, Donnelly S, Brennan J, Whitty H, Maloney P, Claffey A, Quinn S, McMahon N, Bourke N, Lang D, Reilly P, McGuigan C, Cosgrave S, Lawlor L, O'Shea D, McAuliffe E, O'Donnell D. Embedding collective leadership to foster collaborative inter-professional working in the care of older people (ECLECTIC): Study protocol. HRB Open Res 2020; 3:8. [PMID: 32789287 PMCID: PMC7359747 DOI: 10.12688/hrbopenres.13004.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 11/20/2022] Open
Abstract
Background: The National Integrated Care Programme for Older People (NICPOP), formerly NCPOP aims to support older people to live well in their homes by developing primary and secondary care services for older people, especially those with complex needs. The programme develops integrated intermediate care which traverses both hospital and community settings through multidisciplinary and interagency teams. This team-based approach to the integration of health services is a novel innovation in Irish health service delivery and will require, over time, a shift in cultures of care to allow for the development of competencies for inter-professional collaboration across the care continuum. The ECLECTIC project will develop an implementation framework for achieving, maintaining and monitoring competencies for interprofessional collaboration among multi-disciplinary teams charged with delivering care for older people across the continuum from acute to community settings. Design: The ECLECTIC research design has been developed in collaboration with the NICPOP. In phase one of the project, a co-design team will collaborate to define and shape competencies for interprofessional collaboration. Phase two will involve the delivery of a collective leadership intervention over a 10-month period with multidisciplinary professionals working with older people across two geographical regions (Mullingar/Midlands and Beaumont/Dublin North). Each group will comprise of members of two multidisciplinary teams charged with coordinating and delivering care to older people across the continuum of acute to community care. Observations of collaborative inter-professional working will take place before, during, and after intervention. In phase three of the study, analysis of the interview and observation data will be presented to the co-design team in order to develop an implementation framework for future teams. Discussion: The co-design process will develop core competencies and performance indicators for collaborative interprofessional working. The resulting implementation framework will be implemented nationally as part of the NICPOP.
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Affiliation(s)
- Sabrina G Anjara
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Éidín Ní Shé
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Marie O'Shea
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Gráinne O'Donoghue
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Belfield, Dublin, 4, Ireland
| | - John Brennan
- National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, 2, Ireland
| | - Hellen Whitty
- National Clinical Programme for Older People, Royal College of Physicians of Ireland, Dublin, 2, Ireland
| | | | - Anne Claffey
- Regional Hospital Mullingar, Mullingar, N91 NA43, Ireland
| | | | - Niamh McMahon
- St. James's University Hospital, Dublin, 8, Ireland.,School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, Dublin, 2, Ireland
| | - Noeleen Bourke
- Regional Hospital Mullingar, Mullingar, N91 NA43, Ireland.,Health Service Executive CHO 8 (Longford and Westmeath), Mullingar, Ireland
| | | | - Patrice Reilly
- Health Service Executive CHO 9 (Dublin North City and County), Dublin, Ireland
| | | | | | | | | | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
| | - Deirdre O'Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Belfield, Dublin, 4, Ireland
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16
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Primary care interventions to address physical frailty among community-dwelling adults aged 60 years or older: A meta-analysis. PLoS One 2020; 15:e0228821. [PMID: 32032375 PMCID: PMC7006935 DOI: 10.1371/journal.pone.0228821] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/23/2020] [Indexed: 02/08/2023] Open
Abstract
Introduction The best interventions to address frailty among older adults have not yet been fully defined, and the diversity of interventions and outcome measures makes this process challenging. Consequently, there is a lack of guidance for clinicians and researchers regarding which interventions are most likely to help older persons remain robust and independent. This paper uses meta-analysis to assess effectiveness of primary care interventions for physical frailty among community-dwelling adults aged 60+ and provides an up-to-date synthesis of literature in this area. Methods PubMed, CINAHL, Cochrane Register of Controlled Trials, and PEDro databases were searched, and RCTs, controlled pilot studies, or trials with similar study designs addressing frailty in the primary care setting among persons aged 60+ were chosen. Study data was abstracted following PRISMA guidelines, then meta-analysis was performed using the random effects model. Results 31 studies with a total of 4794 participants were analysed. Interventions using predominantly resistance-based exercise and nutrition supplementation seemed to improve frailty status versus control (RR = 0.62 (CI 0.48–0.79), I2 = 0%). Exercise plus nutrition education also reduced frailty (RR = 0.69 (CI 0.58–0.82), I2 = 0%). Exercise alone seemed effective in reducing frailty (RR = 0.63 (CI 0.47–0.84), I2 = 0%) and improving physical performance (RR = 0.43 (CI 0.18–0.67), I2 = 0%). Exercise alone also appeared superior to control in improving gait speed (SMD = 0.36 (CI 0.10–0.61, I2 = 74%), leg strength (SMD = 0.61 (CI 0.09–1.13), I2 = 87%), and grip strength (Mean Difference = 1.08 (CI 0.02–2.15), I2 = 71%) though a high degree of heterogeneity was observed. Comprehensive geriatric assessment (RR = 0.77 (CI 0.64–0.93), I2 = 0%) also seemed superior to control in reducing frailty. Conclusion Exercise alone or with nutrition supplementation or education, and comprehensive geriatric assessment, may reduce physical frailty. Individual-level factors and health systems resource availability will likely determine configuration of future interventions.
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17
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Davies C, Fattori F, O'Donnell D, Donnelly S, Ní Shé É, O Shea M, Prihodova L, Gleeson C, Flynn Á, Rock B, Grogan J, O'Brien M, O'Hanlon S, Cooney MT, Tighe M, Kroll T. What are the mechanisms that support healthcare professionals to adopt assisted decision-making practice? A rapid realist review. BMC Health Serv Res 2019; 19:960. [PMID: 31831003 PMCID: PMC6909502 DOI: 10.1186/s12913-019-4802-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 12/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) establishes a right to legal capacity for all people, including those with support needs. People with disabilities have a legal right to be given the appropriate supports to make informed decisions in all aspects of their lives, including health. In Ireland, the Assisted Decision-Making (Capacity) Act (2015) ratifies the Convention and has established a legal framework for Assisted Decision Making (ADM). The main provisions of the Act are not yet implemented. Codes of Practice to guide health and social care professionals are currently being developed. Internationally, concerns are expressed that ADM implementation is poorly understood. Using realist synthesis, this study aims to identify Programme Theory (PT) that will inform ADM implementation in healthcare. METHODS A Rapid Realist Review using collaborative methods was chosen to appraise relevant literature and engage knowledge users from Irish health and social care. The review was led by an expert panel of relevant stakeholders that developed the research question which asks, 'what mechanisms enable healthcare professionals to adopt ADM into practice?' To ensure the PT was inclusive of local contextual influences, five reference panels were conducted with healthcare professionals, family carers and people with dementia. PT was refined and tested iteratively through knowledge synthesis informed by forty-seven primary studies, reference panel discussions and expert panel refinement and consensus. RESULTS The review has developed an explanatory PT on ADM implementation in healthcare practice. The review identified four implementation domains as significant. These are Personalisation of Health & ADM Service Provision, Culture & Leadership, Environmental & Social Re-structuring and Education, Training & Enablement. Each domain is presented as an explanatory PT statement using realist convention that identifies context, mechanism and outcome configurations. CONCLUSIONS This realist review makes a unique contribution to this field. The PT can be applied by policymakers to inform intervention development and implementation strategy. It informs the imminent policy and practice developments in Ireland and has relevance for other worldwide healthcare systems dealing with similar legislative changes in line with UNCRPD.
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Affiliation(s)
- Carmel Davies
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
| | - Francesco Fattori
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Deirdre O'Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Sarah Donnelly
- School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland
| | - Éidín Ní Shé
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Marie O Shea
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | | | - Áine Flynn
- Decision Support Service, Mental Health Commission, Dublin, Ireland
| | | | | | - Michelle O'Brien
- Medicine for the Elderly, St. Vincent's University Hospital, Dublin, Ireland
| | - Shane O'Hanlon
- Medicine for the Elderly, St. Vincent's University Hospital, Dublin, Ireland
| | | | | | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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18
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O’Donnell D, Ní Shé É, McCarthy M, Thornton S, Doran T, Smith F, O’Brien B, Milton J, Savin B, Donnellan A, Callan E, McAuliffe E, Gray S, Carey T, Boyle N, O’Brien M, Patton A, Bailey J, O’Shea D, Cooney Marie T. Enabling public, patient and practitioner involvement in co-designing frailty pathways in the acute care setting. BMC Health Serv Res 2019; 19:797. [PMID: 31690304 PMCID: PMC6833297 DOI: 10.1186/s12913-019-4626-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 10/10/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Although not an inevitable part of ageing, frailty is an increasingly common condition in older people. Frail older patients are particularly vulnerable to the adverse effects of hospitalisation, including deconditioning, immobility and loss of independence (Chong et al, J Am Med Dir Assoc 18:638.e7-638.e11, 2017). The 'Systematic Approach to improving care for Frail older patients' (SAFE) study co-designed, with public and patient representatives, quality improvement initiatives aimed at enhancing the delivery of care to frail older patients within an acute hospital setting. This paper describes quality improvement initiatives which resulted from a co-design process aiming to improve service delivery in the acute setting for frail older people. These improvement initiatives were aligned to five priority areas identified by patients and public representatives. METHODS The co-design work was supported by four pillars of effective and meaningful public and patient representative (PPR) involvement in health research (Bombard et al, Implement Sci 13:98, 2018; Black et al, J Health Serv Res Policy 23:158-67, 2018). These pillars were: research environment and receptive contexts; expectations and role clarity; support for participation and inclusive representation and; commitment to the value of co-learning involving institutional leadership. RESULTS Five priority areas were identified by the co-design team for targeted quality improvement initiatives: Collaboration along the integrated care continuum; continence care; improved mobility; access to food and hydration and improved patient information. These priority areas and the responding quality improvement initiatives are discussed in relation to patient-centred outcomes for enhanced care delivery for frail older people in an acute hospital setting. CONCLUSIONS The co-design approach to quality improvement places patient-centred outcomes such as dignity, identity, respectful communication as well as independence as key drivers for implementation. Enhanced inter-personal communication was consistently emphasised by the co-design team and much of the quality improvement initiatives target more effective, respectful and clear communication between healthcare personnel and patients. Measurement and evaluation of these patient-centred outcomes, while challenging, should be prioritised in the implementation of quality improvement initiatives. Adequate resourcing and administrative commitment pose the greatest challenges to the sustainability of the interventions developed along the SAFE pathways. The inclusion of organisational leadership in the co-design and implementation teams is a critical factor in the success of interventions targeting service delivery and quality improvement.
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Affiliation(s)
- Deirdre O’Donnell
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Éidín Ní Shé
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Mary McCarthy
- Expert by Experience Representing the Older People’s Empowerment Network, Dublin, Ireland
| | - Shirley Thornton
- Expert by Experience Representing Family Carer’s Ireland, Dublin, Ireland
| | - Thelma Doran
- Expert by Experience Representing the Older People’s Empowerment Network, Dublin, Ireland
| | - Freda Smith
- Expert by Experience Representing Sage Advocacy, Dublin, Ireland
| | - Barry O’Brien
- Expert by Experience Representing Sage Advocacy, Dublin, Ireland
| | - Jim Milton
- Expert by Experience Representing Sage Advocacy, Dublin, Ireland
| | | | - Anne Donnellan
- Expert by Experience Representing Glór and Age Action Ireland, Dublin, Ireland
| | - Eugene Callan
- Expert by Experience Representing the Disability Federation of Ireland, Dublin, Ireland
| | - Eilish McAuliffe
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Simone Gray
- St. Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Therese Carey
- St. Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Nicola Boyle
- St. Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | | | - Andrew Patton
- St. Vincent’s University Hospital, Elm Park, Dublin, Ireland
| | - Jade Bailey
- School of Medicine, University College Dublin, Dublin, Ireland
| | - Diarmuid O’Shea
- St. Vincent’s University Hospital, Elm Park, Dublin, Ireland
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19
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Ní Shé É, Morton S, Lambert V, Ní Cheallaigh C, Lacey V, Dunn E, Loughnane C, O'Connor J, McCann A, Adshead M, Kroll T. Clarifying the mechanisms and resources that enable the reciprocal involvement of seldom heard groups in health and social care research: A collaborative rapid realist review process. Health Expect 2019; 22:298-306. [PMID: 30729621 PMCID: PMC6543157 DOI: 10.1111/hex.12865] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/16/2018] [Accepted: 12/12/2018] [Indexed: 12/01/2022] Open
Abstract
Objective Public and patient involvement is increasingly embedded as a core activity in research funding calls and best practice guidelines. However, there is recognition of the challenges that prevail to achieve genuine and equitable forms of engagement. Our objective was to identify the mechanisms and resources that enable the reciprocal involvement of seldom heard groups in health and social care research. Methods A rapid realist review of the literature that included: (a) a systematic search of CINAHL, PsycINFO, PubMed and Open Grey (2007‐2017); (b) documents provided by expert panel members of relevant journals and grey literature. Six reference panels were undertaken with homeless, women's, transgender, disability and Traveller and Roma organizations to capture local insights. Data were extracted into a theory‐based grid linking context to behaviour change policy categories. Main results From the review, 20 documents were identified and combined with the reference panel summaries. The expert panel reached consensus about 33 programme theories. These relate to environmental and social planning (7); service provision (6); guidelines (4); fiscal measures (6); communication and marketing (4); and regulation and legislation (6). Conclusions While there is growing evidence of the merits of undertaking PPI, this rarely extends to the meaningful involvement of seldom heard groups. The 33 programme theories agreed by the expert panel point to a variety of mechanisms and resources that need to be considered. Many of the programme theories identified point to the need for a radical shift in current practice to enable the reciprocal involvement of seldom heard groups.
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Affiliation(s)
- Éidín Ní Shé
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Sarah Morton
- School of Social Policy, Social Work and Social Justice, University College Dublin, Dublin, Ireland
| | - Veronica Lambert
- School of Nursing and Human Sciences, Dublin City University, Dublin, Ireland
| | - Cliona Ní Cheallaigh
- Consultant in General Medicine and Infectious Diseases, St James's Hospital, Dublin, Ireland.,School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Vanessa Lacey
- Transgender Equality Network Ireland, Dublin, Ireland
| | | | | | | | - Amanda McCann
- UCD Conway Institute of Biomolecular and Biomedical Science and UCD School of Medicine, University College Dublin UCD, Dublin, Ireland
| | - Maura Adshead
- School of Politics and Public Administration, University of Limerick, Limerick, Ireland
| | - Thilo Kroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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20
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Ní Shé É, Davies C, Blake C, Crowley R, McCann A, Fullen B, O'Donnell D, O'Connor J, Kelly S, Darcy M, Bolger F, Ziebland S, Taylor M, Watt P, O'Sullivan D, Day M, Mitchell D, Donnelly S, McAuliffe E, Gallagher WM, Walsh J, Kodate N, Cutlar L, Cooney MT, Kroll T. What are the mechanisms that enable the reciprocal involvement of seldom heard groups in health and social care research? A rapid realist review protocol. HRB Open Res 2018. [DOI: 10.12688/hrbopenres.12790.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The University College Dublin (UCD) PPI Ignite Connect Network will fundamentally embed public and patient involvement (PPI) in health-related research, education and training, professional practice and administration in UCD’s institutional structures and procedures. A significant focus of the programme of work is on actively engaging and developing long-term reciprocal relationships with seldom heard groups, via our ten inaugural partners. Methods: This rapid realist review will explore what are the mechanisms that are important in actively engaging seldom heard groups in health and social care research. The review process will follow five iterative steps: (1) clarify scope, (2) search for evidence, (3) appraise primary studies and extract data, (4) synthesise evidence and draw conclusions, and (5) disseminate findings. The reviewers will consult with expert and reference panels to focus the review, provide local contextual insights and develop a programme theory consisting of context–mechanism–outcome configurations. The expert panel will oversee the review process and agree, via consensus, the final programme theory. Review findings will follow the adopted RAMESES guideline and will be disseminated via a report, presentations and peer-reviewed publication. Discussion: The review will update and consolidate evidence on the mechanisms that enable the reciprocal engagement and participation of ‘seldom heard’ groups in health and social care research. Via the expert and reference process, we will draw from a sizeable body of published and unpublished research and grey literature. The local contextual insights provided will aid the development of our programme theories. This new evidence will inform the design and development of the UCD PPI Ignite program focused on ensuring sustained reciprocal partnerships.
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21
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O'Donnell D, Ní Shé É, Davies C, Donnelly S, Cooney T, O'Coimin D, O'Shea D, Kyne L, O'Sullivan D, Rock B, O'Shea M, McAuliffe E, O'Shaughnessy A, Kroll T. Promoting assisted decision-making in acute care settings for care planning purposes: Study protocol. HRB Open Res 2018. [DOI: 10.12688/hrbopenres.12797.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: The Assisted Decision-Making (ADM) (Capacity) Act 2015 was enacted by Dáil Éireann in December 2015. The purpose of the act, as it applies to healthcare, is to promote the autonomy of persons in relation to their treatment choices, to enable them to be treated according to their will and preferences, and to provide healthcare professionals with important information about persons and their choices in relation to treatment. In practice, those patients with cognitive impairment, particularly dementia, and those with complex needs requiring composite decisions present the greatest challenge to healthcare professionals practicing in accordance with this legislation. Patients with complex needs requiring multifaceted decisions are often over 70 years of age and present in acute hospitals experiencing some form of cognitive impairment. Objectives: The aim of this project is to develop an educational tool which will promote understanding of ADM among healthcare professionals working in acute care settings, and encourage their adoption of this understanding into their care planning with older people. Research design: The study design for this project is mapped out over four consecutive work packages combining a multimethod approach including rapid realist review, qualitative exploration, participatory learning and action sets and intervention trialling and revision. This incremental and context sensitive approach to research design is appropriate for the exploration, development and evaluation of a complex behaviour change intervention. Conclusion: The targeted beneficiaries of this project are healthcare professionals working within acute care settings as well as older people and their family carers who are interacting with the acute care system. The potential impact is improved communication between healthcare professionals and their patients in relation to assisted decision-making and care planning. This educational intervention will be embedded into the pedagogic strategies of the RCPI in their postgraduate education curricula as well as the continuous professional development scheme.
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