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Riguzzi M, Thaqi Q, Lorch A, Blum D, Peng-Keller S, Naef R. Contextual determinants of guideline-based family support during end-of-life cancer care and subsequent bereavement care: A cross-sectional survey of registered nurses. Eur J Oncol Nurs 2024; 70:102555. [PMID: 38626610 DOI: 10.1016/j.ejon.2024.102555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/09/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE In end-of-life cancer care, 10-20% of bereaved family members experience adverse mental health effects, including prolonged grief disorder. Despite great efforts, evidence-based recommendations to support their grieving process and well-being are often not successfully adopted into routine clinical care. This study identified facilitators and barriers using implementation science methodology. METHODS 81 registered nurses working in cancer care from four hospitals and three home care services in Switzerland assessed their current family support practices in end-of-life care and bereavement care. They then assessed organisational attributes of their institution and their own individual characteristics and skills regarding literature-based factors of potential relevance. Facilitators and barriers to guideline-based family support were determined using fractional logistic regression. RESULTS Service specialisation in palliative care, a culture that supports change, the availability of family support guidelines, billing/reimbursement of bereavement support services, and individual knowledge of family support and skill were systematically associated with higher adoption of guideline-based family support practices. Lack of privacy with families and insufficient training acted as significant barriers. CONCLUSIONS While several potentially relevant factors have emerged in the literature, certain organisational and individual determinants actually empirically predict guideline-based family support according to nurses in end-of-life cancer care, with some determinants having much stronger implications than others. This provides crucial guidance for focussing quality improvement and implementation efforts through tailored strategies, especially with scarce resources. Furthermore, adoption is lower in bereavement care than in end-of-life care, suggesting a particular need for supportive organisational cultures including specific training and billing/reimbursement options.
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Affiliation(s)
- Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland.
| | - Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland
| | - Anja Lorch
- Department of Medical Oncology and Haematology Clinic, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Centre for Palliative Care, City Hospital Zurich, Tièchestrasse 99, 8037 Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Kirchgasse 9, 8001 Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland
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Bourke SL, McKenna L, Cooper S, Lam L. Contextual determinants impacting final year nursing students' emergency team communication during deteriorating patient simulations: A grounded theory study. Nurse Educ Today 2024; 138:106183. [PMID: 38554566 DOI: 10.1016/j.nedt.2024.106183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/07/2024] [Accepted: 03/21/2024] [Indexed: 04/01/2024]
Abstract
BACKGROUND Ability to focus on development of students' team communication and non-technical skills may be reduced in content saturated nursing curricula. Even when communication and simulation-based education is provided, students' utilisation of non-technical skills remains challenging. Although simulation is a recognised means to learn communication skills, little is known about nursing students' team communication in simulated settings. OBJECTIVE To understand the process by which final year undergraduate nursing students communicate in simulated team emergencies. DESIGN Using constructivist grounded theory, data was collected using semi-structured interviews and student observations and analysed using constant comparative analysis. SETTING Simulation laboratories in one university nursing school in Australia. PARTICIPANTS 21 final year nursing students in seven teams. METHODS Data were gathered from interviews and video observations of final year nursing students during simulated team emergencies. RESULTS Interview data and observations of video-recordings revealed contextual determinants that influence communication within teams: the simulation context, the student context and the team context. Team member characteristics, such as cultural and linguistic background, life experiences, gender and age, the ability to shift from leadership to followership as well as environmental factors such as mask wearing and simulation fidelity, contributed to uncertainty in communicating that nursing team effectiveness. CONCLUSIONS Improvement of contextual conditions necessitates implementation of supportive strategies. These include development of educational initiatives, and further research in experiential learning as a modality for learners to experience team communication. Further, simulation context, student context and team context are important considerations. Meeting clinical communication learning needs of students allows better preparation to care for deteriorating patients as graduates.
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Affiliation(s)
- Sharon L Bourke
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia.
| | - Simon Cooper
- The Health Innovation and Transformation Centre (HITC), Institute of Health and Wellbeing, Federation University Australia, Berwick Campus, Clyde Road, Berwick, Victoria, Australia.
| | - Louisa Lam
- School of Nursing, Midwifery and Paramedicine (VIC), Faculty of Health Sciences, Australian Catholic University, Victoria Parade, Fitzroy, VIC 3065, Australia.
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Adserà A, Andersen S, Tønnessen M. Does One Municipality Fit All?The Employment of Refugees in Norway Across Municipalities of Different Centrality and Size. Eur J Popul 2022; 38:547-575. [PMID: 35966359 PMCID: PMC9363537 DOI: 10.1007/s10680-022-09618-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 04/12/2022] [Indexed: 06/09/2023]
Abstract
Refugees coming to Norway are assigned to a municipality where they start their integration process. These municipalities offer very different contexts for refugees' access to employment. Using rich register data, we study how the employment of a refugee varies by both the centrality and population size of the municipality to which he/she is assigned, conditional on existing local labor market conditions and the share of non-Western immigrants. Results show that refugees assigned to the least central municipalities are most likely to be employed the first years after arrival. However, one municipality type does not fit all: Population size matters more for men than it does for women, and there is persistent disadvantage for low-educated men assigned to large municipalities. For women, a high share of non-Western immigrants correlates with lower long-term employment. Municipality context seems to matter the least for highly educated refugees of both genders. Supplementary Information The online version contains supplementary material available at 10.1007/s10680-022-09618-3.
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Affiliation(s)
- Alícia Adserà
- School of Public and International Affairs, Princeton University, A29 JRR Building, Princeton, NJ 08544 USA
| | | | - Marianne Tønnessen
- Norwegian Institute for Urban and Regional Research (NIBR), Oslo Metropolitan University, Oslo, Norway
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Ailabouni NJ, Reeve E, Helfrich CD, Hilmer SN, Wagenaar BH. Leveraging implementation science to increase the translation of deprescribing evidence into practice. Res Social Adm Pharm 2021; 18:2550-2555. [PMID: 34147372 DOI: 10.1016/j.sapharm.2021.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 04/29/2021] [Accepted: 05/31/2021] [Indexed: 11/28/2022]
Abstract
Implementation science may address some of the limitations that impede the translation of deprescribing recommendations into practice and policy. Application of principles and standard terminologies from implementation science could improve understanding and interpretation of deprescribing research findings. As such, in this commentary we propose three main avenues to help achieve this. These include: The application of these concepts derived from implementation science could help inform future deprescribing needs for clinicians and researchers. Ultimately, this could help ensure the quality use of medications and examination of meaningful outcomes in deprescribing studies. This could result in more consistent and widespread translation of deprescribing evidence into practice and policy across various healthcare settings.
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Affiliation(s)
- Nagham J Ailabouni
- University of South Australia, UniSA: Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Adelaide, SA, Australia.
| | - Emily Reeve
- University of South Australia, UniSA: Clinical and Health Sciences, Quality Use of Medicines and Pharmacy Research Centre (QUMPRC), Adelaide, SA, Australia; Dalhousie University and Nova Scotia Health Authority, Geriatric Medicine Research, Faculty of Medicine, And College of Pharmacy Halifax, Canada
| | - Christian D Helfrich
- University of Washington, School of Public Health, Veterans Administration Puget Sound Health Care System, Seattle, WA, USA
| | - Sarah N Hilmer
- Kolling Institute of Medical Research, Royal North Shore Hospital and Northern Clinical School, Faculty of Medicine and Health, University of Sydney, St Leonards, New South Wales, Australia
| | - Bradley H Wagenaar
- University of Washington, Department of Global Health, Seattle, WA, USA; University of Washington, Department of Epidemiology, Seattle, WA, USA
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Zdunek K, Schröder-Bäck P, Alexander D, Rigby M, Blair M. Contextual determinants of CHILDREN'S health care and policy in Europe. BMC Public Health 2019; 19:839. [PMID: 31248395 PMCID: PMC6598362 DOI: 10.1186/s12889-019-7164-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Accepted: 06/13/2019] [Indexed: 11/22/2022] Open
Abstract
Background The main objective of this study was to explore the contextual determinants of child health policies. Methods The Horizon 2020 Models of Child Health Appraised (MOCHA) project has one Country Agent (CA) in all 30 EU and EEA countries. A questionnaire designed by MOCHA researchers as a semi-structured survey instrument asked CAs to identify and report the predominating public and professional discussions related to child health services within the last 5 years in their country and the various factors which may have influenced these. The survey was issued to CAs following validation by an independent Expert Advisory Board. The data were collected between July and December 2016. The data was qualitatively analysed using software Nvivo11 for data coding and categorization and constructing the scheme for identified processes or elements. Results Contextual determinants of children’s health care and policy were grouped into four categories. 1) Socio-cultural determinants: societal activation, awareness, communication, trust, freedom, contextual change, lifestyle, tolerance and religion, and history. 2) Structural determinants which were divided into: a) external determinants related to elements indirectly correlated with health care and b) internal determinants comprising interdependent health care and policy processes. 3) International determinants such as cross-nationality of child health policy issues. 4) The specific situational determinants: events which contributed to intensification of debates which were reflected by behavioural, procedural, institutional and global factors. Conclusions The influence of context across European countries, in the process of children’s health policy development is clearly evident from our research. A number of key categories of determinants which influence child health policy have been identified and can be used to describe this context. Child health policy is often initiated in reaction to public discontentment. The multiple voices of society resulted, amongst others, in the introduction of new procedures, action plans and guidelines; raising levels of awareness, intensifying public scrutiny, increasing access and availability of services and provoking introduction of structural changes or withdrawing unfavourable changes.
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Affiliation(s)
- Kinga Zdunek
- Public Health Department, Faculty of Health Sciences, Medical University of Lublin, 1 Chodźki Street, 20-093, Lublin, Poland.
| | - Peter Schröder-Bäck
- Department of International Health, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | | | - Michael Rigby
- Department of Paediatrics, Imperial College London, London, UK
| | - Mitch Blair
- Department of Paediatrics, Imperial College London, London, UK
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Garcia AR, Kim M, Palinkas LA, Snowden L, Landsverk J. Socio- contextual Determinants of Research Evidence Use in Public-Youth Systems of Care. Adm Policy Ment Health 2018; 43:569-78. [PMID: 25702145 DOI: 10.1007/s10488-015-0640-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Recent efforts have been devoted to understanding the conditions by which research evidence use (REU) is facilitated from the perspective of system leaders in the context of implementing evidence-based child mental health interventions. However, we have limited understanding of the extent to which outer contextual factors influence REU. Outer contextual factors for 37 counties in California were gathered from public records in 2008; and child welfare, juvenile justice, and mental health system leaders' perceptions of their REU were measured via a web-based survey from 2010 to 2012. Results showed that leaders with higher educational attainment and in counties with lower expenditures on inpatient mental health services were significantly associated with higher REU. Positive relationships between gathering research evidence and racial minority concentration and poverty at the county level were also detected. Results underscore the need to identify the organizational and socio-political factors by which mental health services and resources meet client demands that influence REU, and to recruit and retain providers with a graduate degree to negotiate work demands and interpret research evidence.
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Affiliation(s)
- Antonio R Garcia
- School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104-6214, USA.
| | - Minseop Kim
- School of Social Policy and Practice, University of Pennsylvania, 3701 Locust Walk, Philadelphia, PA, 19104-6214, USA
| | - Lawrence A Palinkas
- School of Social Work, University of Southern California, 669 W. 34th Street, Los Angeles, CA, 90089-0411, USA
| | - Lonnie Snowden
- School of Public Health, University of California-Berkeley, 235 University Hall, 1090 Warfield Avenue, Oakland, CA, 94610, USA
| | - John Landsverk
- Child & Adolescent Services Research Center, 3665 Kearny Villa Road, Suite 200, San Diego, CA, 92123, USA
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Kirakoya-Samadoulougou F, Jean K, Maheu-Giroux M. Uptake of HIV testing in Burkina Faso: an assessment of individual and community-level determinants. BMC Public Health 2017; 17:486. [PMID: 28532440 PMCID: PMC5441086 DOI: 10.1186/s12889-017-4417-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/12/2017] [Indexed: 01/01/2023] Open
Abstract
Background Previous studies have highlighted a range of individual determinants associated with HIV testing but few have assessed the role of contextual factors. The objective of this paper is to examine the influence of both individual and community-level determinants of HIV testing uptake in Burkina Faso. Methods Using nationally representative cross-sectional data from the 2010 Demographic and Health Survey, the determinants of lifetime HIV testing were examined for sexually active women (n = 14,656) and men (n = 5680) using modified Poisson regression models. Results One third of women (36%; 95% Confidence Interval (CI): 33–37%) reported having ever been tested for HIV compared to a quarter of men (26%; 95% CI: 24–27%). For both genders, age, education, religious affiliation, household wealth, employment, media exposure, sexual behaviors, and HIV knowledge were associated with HIV testing. After adjustment, women living in communities where the following characteristics were higher than the median were more likely to report uptake of HIV testing: knowledge of where to access testing (Prevalence Ratio [PR] = 1.41; 95% CI: 1.34–1.48), willing to buy food from an infected vendor (PR = 2.06; 95% CI: 1.31–3.24), highest wealth quintiles (PR = 1.18; 95% CI: 1.10–1.27), not working year-round (PR = 0.90; 95% CI: 0.84–0.96), and high media exposure (PR = 1.11; 95% CI: 1.03–1.19). Men living in communities where the proportion of respondents were more educated (PR = 1.23; 95% CI: 1.07–1.41) than the median were more likely to be tested. Conclusions This study shed light on potential mechanisms through which HIV testing could be increased in Burkina Faso. Both individual and contextual factors should be considered to design effective strategies for scaling-up HIV testing.
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Affiliation(s)
- Fati Kirakoya-Samadoulougou
- Centre de Recherche en Epidémiologie, Biostatistiques et Recherche Clinique, École de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
| | - Kévin Jean
- Department of Infectious Disease Epidemiology, Imperial College London, St Mary's Hospital, London, UK.,Laboratoire MESuRS (EA 4628), Conservatoire National des Arts et Métiers, Paris, France.,Conservatoire National des Arts et Métiers, Unité PACRI, Institut Pasteur, Paris, France
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
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Magadi MA. Multilevel determinants of teenage childbearing in sub-Saharan Africa in the context of HIV/AIDS. Health Place 2017; 46:37-48. [PMID: 28463709 DOI: 10.1016/j.healthplace.2017.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 04/12/2017] [Accepted: 04/21/2017] [Indexed: 11/29/2022]
Abstract
This paper examined national variations and multilevel determinants of teenage childbearing in sub-Saharan Africa (SSA) in the context of HIV/AIDS using data from recent Demographic and Health Surveys conducted in 29 countries of SSA. Results showed significant community and national variations in teenage childbearing, partly explained by socio-economic and HIV/AIDS context. At community level, lower HIV/AIDS stigma, higher wealth and female education were associated with lower teenage childbearing. However, national socio-economic status had an intricate relationship with teenage childbearing. Higher national GDP per-capita was generally associated with higher teenage childbearing, and this relationship was stronger in lower HIV prevalence countries.
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Affiliation(s)
- Monica A Magadi
- School of Education and Social Sciences, University of Hull, Hull HU6 7RX, UK.
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