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Ma Y, Achiche S, Pomey MP, Paquette J, Adjtoutah N, Vicente S, Engler K, Laymouna M, Lessard D, Lemire B, Asselah J, Therrien R, Osmanlliu E, Zawati MH, Joly Y, Lebouché B. Adapting and Evaluating an AI-Based Chatbot Through Patient and Stakeholder Engagement to Provide Information for Different Health Conditions: Master Protocol for an Adaptive Platform Trial (the MARVIN Chatbots Study). JMIR Res Protoc 2024; 13:e54668. [PMID: 38349734 PMCID: PMC10900097 DOI: 10.2196/54668] [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: 11/18/2023] [Revised: 12/27/2023] [Accepted: 12/28/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Artificial intelligence (AI)-based chatbots could help address some of the challenges patients face in acquiring information essential to their self-health management, including unreliable sources and overburdened health care professionals. Research to ensure the proper design, implementation, and uptake of chatbots is imperative. Inclusive digital health research and responsible AI integration into health care require active and sustained patient and stakeholder engagement, yet corresponding activities and guidance are limited for this purpose. OBJECTIVE In response, this manuscript presents a master protocol for the development, testing, and implementation of a chatbot family in partnership with stakeholders. This protocol aims to help efficiently translate an initial chatbot intervention (MARVIN) to multiple health domains and populations. METHODS The MARVIN chatbots study has an adaptive platform trial design consisting of multiple parallel individual chatbot substudies with four common objectives: (1) co-construct a tailored AI chatbot for a specific health care setting, (2) assess its usability with a small sample of participants, (3) measure implementation outcomes (usability, acceptability, appropriateness, adoption, and fidelity) within a large sample, and (4) evaluate the impact of patient and stakeholder partnerships on chatbot development. For objective 1, a needs assessment will be conducted within the setting, involving four 2-hour focus groups with 5 participants each. Then, a co-construction design committee will be formed with patient partners, health care professionals, and researchers who will participate in 6 workshops for chatbot development, testing, and improvement. For objective 2, a total of 30 participants will interact with the prototype for 3 weeks and assess its usability through a survey and 3 focus groups. Positive usability outcomes will lead to the initiation of objective 3, whereby the public will be able to access the chatbot for a 12-month real-world implementation study using web-based questionnaires to measure usability, acceptability, and appropriateness for 150 participants and meta-use data to inform adoption and fidelity. After each objective, for objective 4, focus groups will be conducted with the design committee to better understand their perspectives on the engagement process. RESULTS From July 2022 to October 2023, this master protocol led to four substudies conducted at the McGill University Health Centre or the Centre hospitalier de l'Université de Montréal (both in Montreal, Quebec, Canada): (1) MARVIN for HIV (large-scale implementation expected in mid-2024), (2) MARVIN-Pharma for community pharmacists providing HIV care (usability study planned for mid-2024), (3) MARVINA for breast cancer, and (4) MARVIN-CHAMP for pediatric infectious conditions (both in preparation, with development to begin in early 2024). CONCLUSIONS This master protocol offers an approach to chatbot development in partnership with patients and health care professionals that includes a comprehensive assessment of implementation outcomes. It also contributes to best practice recommendations for patient and stakeholder engagement in digital health research. TRIAL REGISTRATION ClinicalTrials.gov NCT05789901; https://classic.clinicaltrials.gov/ct2/show/NCT05789901. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/54668.
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Affiliation(s)
- Yuanchao Ma
- Department of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Sofiane Achiche
- Department of Biomedical Engineering, Polytechnique Montréal, Montreal, QC, Canada
| | - Marie-Pascale Pomey
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, QC, Canada
- Centre of Excellence on Partnership with Patients and the Public, Montreal, QC, Canada
| | - Jesseca Paquette
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Nesrine Adjtoutah
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
- Department of Health Policy, Management and Evaluation, School of Public Health, University of Montreal, Montreal, QC, Canada
| | - Serge Vicente
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
- Department of Mathematics and Statistics, University of Montreal, Montreal, QC, Canada
| | - Kim Engler
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
| | - Moustafa Laymouna
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - David Lessard
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Benoît Lemire
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
| | - Jamil Asselah
- Department of Medicine, Division of Medical Oncology, McGill University Health Centre, Montreal, QC, Canada
| | - Rachel Therrien
- Research Centre of the University of Montreal Hospital Centre, Montreal, QC, Canada
| | - Esli Osmanlliu
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, Montreal, QC, Canada
| | - Ma'n H Zawati
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Yann Joly
- Centre of Genomics and Policy, McGill University, Montreal, QC, Canada
| | - Bertrand Lebouché
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Infectious Diseases and Immunity in Global Health Program, Research Institute of McGill University Health Centre, Montreal, QC, Canada
- Chronic Viral Illness Service, Division of Infectious Disease, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada
- Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
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Brown P, Scrivener A, Calnan M. The co-construction and emotion management of hope within psychosis services. Front Sociol 2024; 8:1270539. [PMID: 38260114 PMCID: PMC10802842 DOI: 10.3389/fsoc.2023.1270539] [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: 07/31/2023] [Accepted: 10/30/2023] [Indexed: 01/24/2024]
Abstract
Introduction There is a growing acknowledgement of the salience of hope for mental health service-users, in influencing care outcomes and recovery. Understandings of the processes through which hopes are co-constructed, alongside specific conceptualisations of experiences of hoping, remain limited however. Methods This qualitative study explored how a range of stakeholders experienced and dealt with uncertainty within three purposively selected psychosis services in southern England. In this article we focus particularly on the co-construction of hope within participants' narratives and how this emotion work shaped experiences of hoping. In-depth interviews (n = 23) with service-users, professionals, managers and other stakeholders were analysed following a phenomenological approach. Findings Hope was spontaneously identified by participants as a fundamental mechanism through which service-users and professionals managed uncertainty when vulnerable. Professionals were influential in shaping users' hopes, both intentionally and unwittingly, while some professionals also referred to managing their own hopes and those of colleagues. Such management of expectations and emotions enabled motivation and coping amidst uncertainty, for users and professionals, but also entailed difficulties where hope was undermined, exaggerated, or involved tensions between desires and expectations. Discussion Whereas, hope is usually reflected in the caring studies literature as distinctly positive, our findings point to a more ambivalent understanding of hope, as reflected in the accounts of both service-users and professionals where elevated hopes were described as unrealistic and harmful, to the well-being of professionals as well as of service-users. It is concluded that a greater awareness within care contexts of how hopes are co-constructed by professionals and service-users, explicitly and implicitly, can assist in improving health care and healthcare outcomes.
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Affiliation(s)
- Patrick Brown
- Department of Sociology, University of Amsterdam, Amsterdam, Netherlands
| | | | - Michael Calnan
- School of Sociology, Social Policy and Social Research, University of Kent, Canterbury, United Kingdom
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Neuvonen KA, Smith MM, Launonen K, von Tetzchner S. Communication partner strategies in negotiation for meaning in interactions involving aided communication. Clin Linguist Phon 2023; 37:1104-1123. [PMID: 36426778 DOI: 10.1080/02699206.2022.2148130] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 10/21/2022] [Accepted: 11/11/2022] [Indexed: 06/16/2023]
Abstract
Co-constructing meaning is acommon feature of all conversationsbut may have amore specific role in interactions where one of the participants uses aided communication. The present study applies qualitative descriptive analysis supported by quantitative measures in exploring meaning-negotiation strategies of speaking communication partners in task-related aided conversations. The study focuses on identifying and exploring strategies that the communication partners utilise when attempting to interpret the meaning and resolve potential ambiguities of aided utterances in the context of event descriptions. The participants of the study were three aided communicators (age 8 to 11 years), who used graphic communication systems as their main means of communication, and familiar adult communication partners. The results demonstrate that the communication partners employed several strategies in attempting to comprehend, interpret and co-construct the meaning of aided utterances at various phases of interaction. The primary strategy involved clarifying the lexical properties of the aided constructions, reflecting the multidimensional and polysemous nature of graphic communication systems. Structural and referential complexities affected how the elements produced were understood as part of the ongoing context. The study highlights the participants´ shared responsibility in developing and utilising effective meaning-negotiation and repair strategies to support successful communication.
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Affiliation(s)
- Kirsi A Neuvonen
- Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Martine M Smith
- Clinical Speech & Language Studies, University of Dublin, Trinity College, Dublin, Ireland
| | - Kaisa Launonen
- Department of Psychology, University of Oslo, Oslo, Norway
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Bocquier A, Bruel S, Michel M, Le Duc‐Banaszuk A, Bonnay S, Branchereau M, Chevreul K, Chyderiotis S, Gauchet A, Giraudeau B, Hagiu D, Mueller JE, Gagneux‐Brunon A, Thilly N. Co-development of a school-based and primary care-based multicomponent intervention to improve HPV vaccine coverage amongst French adolescents (the PrevHPV Study). Health Expect 2023; 26:1843-1853. [PMID: 37312280 PMCID: PMC10485335 DOI: 10.1111/hex.13778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 05/01/2023] [Accepted: 05/09/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Despite various efforts to improve human papillomavirus (HPV) vaccine coverage in France, it has always been lower than in most other high-income countries. The health authorities launched in 2018 the national PrevHPV research programme to (1) co-develop with stakeholders and (2) evaluate the impact of a multicomponent complex intervention aimed at improving HPV vaccine coverage amongst French adolescents. OBJECTIVE To describe the development process of the PrevHPV intervention using the GUIDance for rEporting of intervention Development framework as a guide. METHODS To develop the intervention, we used findings from (1) published evidence on effective strategies to improve vaccination uptake and on theoretical frameworks of health behaviour change; (2) primary data on target populations' knowledge, beliefs, attitudes, preferences, behaviours and practices as well as the facilitators and barriers to HPV vaccination collected as part of the PrevHPV Programme and (3) the advice of working groups involving stakeholders in a participatory approach. We paid attention to developing an intervention that would maximise reach, adoption, implementation and maintenance in real-world contexts. RESULTS We co-developed three components: (1) adolescents' and parents' education and motivation using eHealth tools (web conferences, videos, and a serious video game) and participatory learning at school; (2) general practitioners' e-learning training on HPV using motivational interviewing techniques and provision of a decision aid tool and (3) easier access to vaccination through vaccination days organised on participating middle schools' premises to propose free of charge initiation of the HPV vaccination. CONCLUSION We co-developed a multicomponent intervention that addresses a range of barriers and enablers of HPV vaccination. The next step is to build on the results of its evaluation to refine it before scaling it up if proven efficient. If so, it will add to the small number of multicomponent interventions aimed at improving HPV vaccination worldwide. PATIENT OR PUBLIC CONTRIBUTION The public (adolescents, their parents, school staff and health professionals) participated in the needs assessment using a mixed methods approach. The public was also involved in the components' development process to generate ideas about potential activities/tools, critically revise the successive versions of the tools and provide advice about the intervention practicalities, feasibility and maintenance.
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Affiliation(s)
| | - Sébastien Bruel
- Department of General Practice, Jacques Lisfranc Faculty of MedicineSaint‐Etienne‐Lyon UniversitySaint‐EtienneFrance
- Health, Systemic, Process UR 4129 Research Unit, University Claude BernardUniversity of LyonLyonFrance
| | - Morgane Michel
- ECEVE UMR 1123, Université de Paris CitéParisFrance
- Assistance Publique‐Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile‐de‐France/Hôpital Robert DebréUnité d'épidémiologie cliniqueParisFrance
| | | | | | - Marion Branchereau
- Centre Régional de Coordination des Dépistages des cancers‐Pays de la LoireAngersFrance
| | - Karine Chevreul
- ECEVE UMR 1123, Université de Paris CitéParisFrance
- Assistance Publique‐Hôpitaux de Paris, Hôtel Dieu, URC Eco Ile‐de‐France/Hôpital Robert DebréUnité d'épidémiologie cliniqueParisFrance
| | - Sandra Chyderiotis
- Emerging Disease Epidemiology Unit, Institut PasteurUniversité Paris CitéParisFrance
| | - Aurélie Gauchet
- LIP/PC2SUniversité Grenoble AlpesGrenobleFrance
- LIP/PC2SUniversité Savoie Mont BlancChambéryFrance
| | - Bruno Giraudeau
- SPHERE U1246, Université de Tours, Université de NantesINSERMToursFrance
- INSERM CIC 1415CHRU de ToursToursFrance
| | - Dragos‐Paul Hagiu
- Department of General Practice, Jacques Lisfranc Faculty of MedicineSaint‐Etienne‐Lyon UniversitySaint‐EtienneFrance
- CIC‐INSERM 1408, CHU deSaint‐EtienneFrance
| | - Judith E. Mueller
- Emerging Disease Epidemiology Unit, Institut PasteurUniversité Paris CitéParisFrance
- Univ. Rennes, EHESP, CNRS, Inserm, Arènes ‐ UMR 6051RSMS (Recherche sur les Services et Management en Santé) ‐ U 1309RennesFrance
| | - Amandine Gagneux‐Brunon
- Centre International de Recherche en Infectiologie, Team GIMAP, Univ Lyon, Université Jean Monnet, Université Claude Bernard Lyon 1, Inserm, U1111, CNRS, UMR530, CIC INSERM 1408 VaccinologieCHU de Saint‐EtienneSaint‐EtienneFrance
| | - Nathalie Thilly
- APEMACUniversité de LorraineNancyFrance
- Département Méthodologie, Promotion, InvestigationUniversité de Lorraine, CHRU‐NancyNancyFrance
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Frizelle P, O’Donovan S, Jolley M, Martin L, Hart N. The co-construction of a reading assessment measure with adults with Down syndrome: a meaningful literacy approach. Front Psychol 2023; 14:1173300. [PMID: 37546441 PMCID: PMC10399224 DOI: 10.3389/fpsyg.2023.1173300] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 06/20/2023] [Indexed: 08/08/2023] Open
Abstract
Introduction The need to develop appropriate measures of broad-based reading-related literacy skills for adults with Down syndrome has been highlighted in the literature. In this study we aimed to co-construct a valid and reliable assessment measure that can be used to document meaningful everyday reading, in adolescents and adults with Down syndrome. Methods The study was carried out in two stages. Stage 1 used an inclusive participatory design in which individuals with Down syndrome were research collaborators (n = 46). Items to be included in the measure were identified and ecological, face and content validity were established through an iterative process. In stage 2 we examined the reliability of the tool and explored potential relationships between meaningful reading score and (1) age, (2) receptive vocabulary, and (3) reading ability as measured by standardized assessments. In addition, we profiled what a pilot cohort of adults with Down syndrome read (n = 33) and how they experience reading in their everyday lives. Results Results showed that 46 items were generated for inclusion in the Meaningful Reading Measure (MRM). Our preliminary data showed that the tool has internal and external reliability and ecological and content validity. There were no associations between meaningful reading score and any of the other variables examined. There was considerable variability in items read (range 12-44) which reflected a broad range of reading practices. Adults with Down syndrome identified the importance of reading as a pleasurable activity and as something that aids learning. Conclusion The MRM developed here can be used (1) as a reading intervention outcome measure to complement existing standardized tools, (2) to profile meaningful reading in adults with Down syndrome, (3) to guide reading module content, and (4) to capture change in adults' perceptions of themselves as readers. Future work is needed to establish the tool's sensitivity to change over time.
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Affiliation(s)
- Pauline Frizelle
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
| | - Sean O’Donovan
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
| | - Mary Jolley
- Department of Speech and Hearing Sciences, University College Cork, Cork, Ireland
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Burke A, Kumpulainen K, Smith C. Children's digital play as collective family resilience in the face of the pandemic. J Early Child Lit 2023; 23:8-34. [PMID: 38603379 PMCID: PMC9978233 DOI: 10.1177/14687984221124179] [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] [Indexed: 04/13/2024]
Abstract
In this article we explore how digital play as conducted through various social media and online meeting platforms facilitated resiliency and confidence building in children during the COVID-19 pandemic. Using day-in-the-life methodology and narrative inquiry, we disseminate and examine observations collected on children aged 2-10 during lockdown in a Newfoundland neighbourhood. Children utilized platforms such as TikTok, YouTube, and Zoom to embrace their agentic digital play in ways that repurposed the platforms to fulfil life milestones and social needs otherwise impacted and disrupted by pandemic restrictions. Through a series of vignettes and interviews, our research not only examines how such digital play benefits children and their healthy development, but how parents reacted to and assisted with their children's agentic digital platform manipulation and how this provided positive benefits and enriching experiences to the entire family. We additionally explore the conflicts and tensions both children and parents encountered in securely implementing free play via digital platforms, including fears of excess screen-time, digital dependency, and online threats, all of which risk limiting children's ability to independently explore their creativity and identities through digital play if not handled sensitively. Despite the hurdles to implementing digital play, this study exposes why it is essential for families to navigate this online terrain; this study ultimately poses that digital play and online platforms not only were beneficial to maintaining and building family resilience during the pandemic but will be vital assets in sustaining resiliency and positive mindsets moving forward with pandemic recovery.
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Lemaire N, Mayans A, Truelle G. [Experiments to renew the organization of care]. Soins 2022; 67:30-31. [PMID: 36442921 DOI: 10.1016/j.soin.2022.09.010] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
While the need to test new ways of organizing our healthcare system has long been recognized, successive initiatives have not always been up to the challenge. Drawing lessons from past experiences, as well as foreign examples, Article 51 of the Social Security Financing Act for 2018 created a new framework for innovative health experiments. Actors in the field now have the opportunity to develop innovative projects while relying on a support and evaluation system for the duration of their trials, according to a logic of co-construction between all stakeholders.
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Affiliation(s)
- Natacha Lemaire
- Ministère de la Santé et de la Prévention, 14 avenue Duquesne, 75016 Paris, France.
| | - Augusta Mayans
- Ministère de la Santé et de la Prévention, 14 avenue Duquesne, 75016 Paris, France
| | - Gabrielle Truelle
- Ministère de la Santé et de la Prévention, 14 avenue Duquesne, 75016 Paris, France
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Dhainaut JF, Saporta M. [Innovating in the hospital of tomorrow]. Soins 2022; 67:41-45. [PMID: 36253064 DOI: 10.1016/j.soin.2022.07.010] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The hospital of tomorrow must aim not only to be an innovative establishment, but also to become an establishment that innovates. The objective is to bring up initiatives and the expression of needs of the hospital community, to evaluate and prioritize them, and then to implement the selected projects.
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Affiliation(s)
- Jean-François Dhainaut
- Liberté Living-Lab, 9 rue d'Alexandrie, 75002 Paris, France; Lab Santé, 29 rue du Faubourg-Saint-Jacques, 75014 Paris, France.
| | - Maud Saporta
- Lab Santé, 29 rue du Faubourg-Saint-Jacques, 75014 Paris, France
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Dallos R, Carder-Gilbert H, McKenzie R. Developing bonds: An exploration of the development of bonds between mentors and young people. Clin Child Psychol Psychiatry 2021; 26:1214-1226. [PMID: 34392722 DOI: 10.1177/13591045211027567] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article describes a piece of research exploring young people's experience of a mentoring service (PROMISE). The scheme has been developed to offer vulnerable young people a supportive relationship to assist their lives. This article explores the nature of the mentoring relationship, including how mentors and mentees view its development. Conjoint interviews were conducted which also permitted an analysis of the nature of the conversational processes between the pairs, including how they constructed shared meanings of the development of their relationship. This provided a window into the emotional dynamics of their mentoring relationships. Implications for similar mentoring programmes are discussed alongside wider implications for assisting this group of young people.
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Affiliation(s)
- Rudi Dallos
- Department of Psychology, 6633University of Plymouth, Plymouth, UK
| | - Hassina Carder-Gilbert
- Department of Psychology, Faculty of Health and Human Sciences, 62641University of Plymouth, Plymouth, UK
| | - Rebecca McKenzie
- Department of Psychology, 6633University of Plymouth, Plymouth, UK
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Pomey M, Clavel N, Normandin L, Del Grande C, Philip Ghadiri D, Fernandez‐McAuley I, Boivin A, Flora L, Janvier A, Karazivan P, Pelletier J, Fernandez N, Paquette J, Dumez V. Assessing and promoting partnership between patients and health-care professionals: Co-construction of the CADICEE tool for patients and their relatives. Health Expect 2021; 24:1230-1241. [PMID: 33949739 PMCID: PMC8369086 DOI: 10.1111/hex.13253] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/25/2021] [Accepted: 03/22/2021] [Indexed: 12/01/2022] Open
Abstract
CONTEXT Partnership between patients and health-care professionals (HCPs) is a concept that needs a valid, practical measure to facilitate its use by patients and HCPs. OBJECTIVE To co-construct a tool for measuring the degree of partnership between patients and HCPs. DESIGN The CADICEE tool was developed in four steps: (1) generate key dimensions of patient partnership in clinical care; (2) co-construct the tool; (3) assess face and content validity from patients' and HCPs' viewpoints; and (4) assess the usability of the tool and explore its measurement performance. RESULTS The CADICEE tool comprises 24 items under 7 dimensions: 1) relationship of Confidence or trust between the patient and the HCPs; 2) patient Autonomy; 3) patient participation in Decisions related to care; 4) shared Information on patient health status or care; 5) patient personal Context; 6) Empathy; and 7) recognition of Expertise. Assessment of the tool's usability and measurement performance showed, in a convenience sample of 246 patients and relatives, high face validity, acceptability and relevance for both patients and HCPs, as well as good construct validity. CONCLUSIONS The CADICEE tool is developed in co-construction with patients to evaluate the degree of partnership in care desired by patients in their relationship with HCPs. The tool can be used in various clinical contexts and in different health-care settings. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in determining the importance of constructing this questionnaire. They co-constructed it, pre-tested it and were part of the entire questionnaire development process. Three patients participated in the writing of the article.
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Affiliation(s)
- Marie‐Pascale Pomey
- School of Public HealthUniversity of MontrealMontrealQCCanada
- Centre de recherche du Centre Hospitalier de l’Université de MontréalMontrealQCCanada
- Centre of Excellence on Partnership with Patients and the PublicMontrealQCCanada
| | | | - Louise Normandin
- Centre de recherche du Centre Hospitalier de l’Université de MontréalMontrealQCCanada
| | - Claudio Del Grande
- School of Public HealthUniversity of MontrealMontrealQCCanada
- Centre de recherche du Centre Hospitalier de l’Université de MontréalMontrealQCCanada
| | | | | | - Antoine Boivin
- Department of Family MedicineUniversity of MontrealMontrealQCCanada
| | - Luigi Flora
- Faculté de MédecineUniversité Nice Sophia AntipolisNiceFrance
| | - Annie Janvier
- Department of PediatricsUniversity of MontrealMontrealQCCanada
| | - Philippe Karazivan
- Centre of Excellence on Partnership with Patients and the PublicMontrealQCCanada
- Department of ManagementHEC MontréalMontrealQCCanada
| | | | - Nicolas Fernandez
- Department of EducationUniversité du Québec à MontréalMontrealQCCanada
| | - Jesseca Paquette
- Centre de recherche du Centre Hospitalier de l’Université de MontréalMontrealQCCanada
| | - Vincent Dumez
- Centre of Excellence on Partnership with Patients and the PublicMontrealQCCanada
- Faculty of MedicineUniversity of MontrealMontrealQCCanada
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Bordier M, Goutard FL, Antoine-Moussiaux N, Pham-Duc P, Lailler R, Binot A. Engaging Stakeholders in the Design of One Health Surveillance Systems: A Participatory Approach. Front Vet Sci 2021; 8:646458. [PMID: 34109232 PMCID: PMC8180848 DOI: 10.3389/fvets.2021.646458] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/26/2020] [Accepted: 03/02/2021] [Indexed: 12/30/2022] Open
Abstract
Many One Health surveillance systems have proven difficult to enforce and sustain, mainly because of the difficulty of implementing and upholding collaborative efforts for surveillance activities across stakeholders with different values, cultures and interests. We hypothesize that only the early engagement of stakeholders in the development of a One Health surveillance system can create an environment conducive to the emergence of collaborative solutions that are acceptable, accepted and therefore implemented in sustainable manner. To this end, we have designed a socio-technical framework to help stakeholders develop a common vision of their desired surveillance system and to forge the innovation pathway toward it. We implemented the framework in two case studies: the surveillance of antimicrobial resistance in Vietnam and that of Salmonella in France. The socio-technical framework is a participatory and iterative process that consists of four distinct steps implemented during a workshop series: (i) definition of the problem to be addressed, (ii) co-construction of a common representation of the current system, (iii) co-construction of the desired surveillance system, (iv) identification of changes and actions required to progress from the current situation to the desired situation. In both case studies, the process allowed surveillance stakeholders with different professional cultures and expectations regarding One Health surveillance to gain mutual understanding and to reconcile their different perspectives to design the pathway toward their common vision of a desired surveillance system. While the proposed framework is structured around four essential steps, its application can be tailored to the context. Workshop facilitation and representativeness of participants are key for the success of the process. While our approach lays the foundation for the further implementation of the desired One Health surveillance system, it provides no guarantee that the proposed actions will actually be implemented and bring about the required changes. The engagement of stakeholders in a participatory process must be sustained in order to ensure the implementation of co-constructed solutions and evaluate their effectiveness and impacts.
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Affiliation(s)
- Marion Bordier
- ASTRE, Univ Montpellier, CIRAD, INRAE, Montpellier, France.,CIRAD, UMR ASTRE, Montpellier, France
| | - Flavie Luce Goutard
- ASTRE, Univ Montpellier, CIRAD, INRAE, Montpellier, France.,Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand.,CIRAD, UMR ASTRE, Bangkok, Thailand
| | - Nicolas Antoine-Moussiaux
- Fundamental and Applied Research for Animals and Health Research Unit, Faculty of Veterinary Medicine, University of Liege, Liege, Belgium
| | - Phuc Pham-Duc
- Center for Public Health and Ecosystem Research, Hanoi University of Public Health, Hanoi, Vietnam.,Institute of Environmental Health and Sustainable Development (IEHSD), Hanoi, Vietnam
| | - Renaud Lailler
- Laboratoire de Sécurité des Aliments, Agence Nationale de Sécurité Sanitaire de l'Alimentation, de l'Environnement et du Travail (ANSES), Maisons-Alfort, France.,Université Paris-Est Créteil Val de Marne, Créteil, France
| | - Aurelie Binot
- ASTRE, Univ Montpellier, CIRAD, INRAE, Montpellier, France.,CIRAD, UMR ASTRE, Montpellier, France
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12
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Cloppet-Fontaine A, Montheard M, Besseiche A, Monnet C, Simzac AB, Dufour I. [Towards a better acceptance of gerontotechnologies]. Soins Gerontol 2021; 26:10-14. [PMID: 33894907 DOI: 10.1016/j.sger.2021.01.005] [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] [Indexed: 11/30/2022]
Abstract
Gerontotechnologies are becoming increasingly important for the elderly, their relatives and the professionals who accompany them. However, this deployment raises a large number of questions, fears and reluctance - or "technoscepticism" - including in the health and medico-social sectors. There are levers that could promote the successful implementation of these technologies.
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Affiliation(s)
| | - Melody Montheard
- Gérond'if, gérontopôle d'Île-de-France, 33 rue du Fer-à-Moulin, 75005 Paris, France
| | - Adrien Besseiche
- Gérond'if, gérontopôle d'Île-de-France, 33 rue du Fer-à-Moulin, 75005 Paris, France
| | - Clotilde Monnet
- Gérond'if, gérontopôle d'Île-de-France, 33 rue du Fer-à-Moulin, 75005 Paris, France
| | - Anne-Bérénice Simzac
- Gérond'if, gérontopôle d'Île-de-France, 33 rue du Fer-à-Moulin, 75005 Paris, France
| | - Isabelle Dufour
- Gérond'if, gérontopôle d'Île-de-France, 33 rue du Fer-à-Moulin, 75005 Paris, France
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Pomey MP, Brouillard P, Ganache I, Lambert L, Boothroyd L, Collette C, Bédard S, Grégoire A, Pelaez S, Demers-Payette O, Goetghebeur M, de Guise M, Roy D. Co-construction of health technology assessment recommendations with patients: An example with cardiac defibrillator replacement. Health Expect 2019; 23:182-192. [PMID: 31691439 PMCID: PMC6978850 DOI: 10.1111/hex.12989] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 06/18/2019] [Revised: 08/29/2019] [Accepted: 10/03/2019] [Indexed: 01/08/2023] Open
Abstract
CONTEXT The National Institute of Excellence in Health and Social Services (INESSS), which functions as the Québec health technology assessment (HTA) agency, tested a new way to engage patients along with health-care professionals in the co-construction of recommendations regarding implantable cardioverter-defibrillator replacement. OBJECTIVE The objective of this article was to describe the process of co-construction of recommendations and to propose methods of building best practices for patient involvement (PI) in HTA. DESIGN Throughout the process, documents were collected and participant observations were made. Individual interviews were conducted with patients, health-care professionals and the INESSS scientific team, from January to March 2018. RESULTS Three committees were established: an expert patient committee to reflect on patient experience literature; an expert health professional committee to reflect on medical literature; and a co-construction committee through which both patients and health-care professionals contributed to develop the recommendations. The expert patients validated and contextualized a literature review produced by the scientific team. This allowed the scientists to consider aspects related to the patient experience and to integrate the feedback from patients into HTA recommendations. The most important factor contributing to a positive PI experience was the structured methodology for selecting patient participants, and a key factor that inhibited the process was a lack of training in PI on the part of the scientific team. CONCLUSIONS This experience demonstrates that it is possible to co-construct recommendations, even for technically complex HTA subjects, through a more democratic process than usual which led to more patient-focused guidance.
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Affiliation(s)
- Marie-Pascale Pomey
- School of Public Health, Université de Montréal, Montreal, Québec, Canada.,Institut national d'excellence en santé et services sociaux, Montreal, Québec, Canada.,Center of Excellence on Partnership with Patients and the Public, Montreal, Québec, Canada.,Centre hospitalier universitaire l'université de Montréal research center (CRCHUM), Montreal, Québec, Canada
| | | | - Isabelle Ganache
- School of Public Health, Université de Montréal, Montreal, Québec, Canada.,Institut national d'excellence en santé et services sociaux, Montreal, Québec, Canada
| | - Laurie Lambert
- School of Public Health, Université de Montréal, Montreal, Québec, Canada
| | - Lucy Boothroyd
- School of Public Health, Université de Montréal, Montreal, Québec, Canada
| | - Caroline Collette
- School of Public Health, Université de Montréal, Montreal, Québec, Canada
| | - Sylvain Bédard
- Center of Excellence on Partnership with Patients and the Public, Montreal, Québec, Canada
| | - Alexandre Grégoire
- Center of Excellence on Partnership with Patients and the Public, Montreal, Québec, Canada
| | | | | | | | - Michèle de Guise
- Institut national d'excellence en santé et services sociaux, Montreal, Québec, Canada
| | - Denis Roy
- Institut national d'excellence en santé et services sociaux, Montreal, Québec, Canada
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14
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Pratt B. Engagement as co-constructing knowledge: A moral necessity in public health research. Bioethics 2019; 33:805-813. [PMID: 31099899 DOI: 10.1111/bioe.12591] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 11/11/2018] [Accepted: 02/05/2019] [Indexed: 06/09/2023]
Abstract
Undertaking engagement in public health research is ethically essential. There is a growing emphasis on practicing engagement as the co-construction of knowledge, which goes beyond other common forms of engagement in health research practice: consulting and informing. Taking such an approach means researchers jointly construct knowledge with research users and beneficiaries; all parties design and conduct research together and share decision-making power. This article makes the normative argument that such engagement is necessary to achieve the foundational moral aims of public health research-building relations of equality and addressing the health needs of those considered disadvantaged-which reflect the field's underlying commitment to social justice. It next identifies and discusses three ways in which co-constructing knowledge advances those moral aims: by facilitating self-determination, supporting individuals' right to research, and maximizing social knowledge to address cognitive and epistemic injustice. Objections to the arguments presented in the article are then articulated and defended against.
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Affiliation(s)
- Bridget Pratt
- Centre for Health Equity, School of Population and Global Health, University of Melbourne, Australia
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15
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Khoury E. Recovery Attitudes and Recovery Practices Have an Impact on Psychosocial Outreach Interventions in Community Mental Health Care. Front Psychiatry 2019; 10:560. [PMID: 31616321 PMCID: PMC6764511 DOI: 10.3389/fpsyt.2019.00560] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 07/17/2019] [Indexed: 11/13/2022] Open
Abstract
The most recent mental health policies implemented in the province of Québec, Canada, have emphasized recovery-oriented mental health practice. Part of this impetus has resulted in significant importance placed on the development of community mental health models in the public health system. The forms of community mental health programs have evolved considerably over time in Québec but are largely inspired by the evidence-based model of Assertive Community Treatment (ACT). However, if mental health policies and programs in Québec are now emphasizing the role of community mental health, it is also clear that actors on the field are implementing the evolving practice paradigms that dominate our mental health policies, such as recovery, participation, citizenship, in a variable way (1, 2). This article presents an ethnographic inspired research study conducted in 2014 and aims to contribute to the understanding of how recovery-oriented mental health policies are understood and implemented in an ACT team in downtown Montréal, Québec. With the aim of developing integrated knowledge on the issue of recovery in mental health and the conditions it presupposes, this research draws on field experiences from various actors, including service users with severe mental health problems, typically with concomitant disorders and complicated by substance use and/or living in a situation of homelessness. Using a critical constructivist approach, the research sought to a) explore how participants (stakeholders, users, and psychiatrists) achieve their social order; b) understand the meaning of recovery in mental health for participants and the actions associated with recovery as a process or as a practice; c) apprehend the potential of community interventions to connect the individual to the collective. The results indicate that the (over)use of medicolegal tools and the unchanging conception of "madness" represent obstacles to the sustained development of interventions centered on the person, his living conditions, and his recovery. Nevertheless, many interactions between service providers and service users indicate the potential for emerging recovery-oriented practice interventions, particularly when those interactions are based on positive and egalitarian conceptions between service providers and service users that led to the development of spaces for the co-construction innovative practice approaches.
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Affiliation(s)
- Emmanuelle Khoury
- École de travail social, Université de Sherbrooke, Sherbrooke, QC, Canada
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16
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Farrell L, Bourgeois-Law G, Buydens S, Regehr G. Your Goals, My Goals, Our Goals: The Complexity of Coconstructing Goals with Learners in Medical Education. Teach Learn Med 2019; 31:370-377. [PMID: 30873879 DOI: 10.1080/10401334.2019.1576526] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Phenomenon: Despite a long-standing recognition of the importance of learning goals in feedback, there has been relatively little research on how to address mismatches between learner goals and preceptor goals in medical education. Our study addresses this gap by reporting on challenges and strategies around goal coconstruction as identified by clinical educators who were learning and attempting to implement a goal-oriented feedback approach in their own teaching contexts. Approach: We employed a qualitative, design-based research methodology to study how 5 clinician educators incorporated goal-oriented feedback into their teaching practice. Participants attended workshops on goal-oriented feedback and reflective writing. They then narratively reflected over a 6-month period on their attempts with goal-oriented feedback and shared these reflections in periodic facilitated group discussions. Themes were developed using iterative thematic analysis of group discussions and individual exit interviews. Findings: Participants identified several benefits of goal setting in all environments. They perceived improved rapport with learners and developed empathy for the vastness of learner goals. However, they experienced several struggles especially when learner and preceptor goals did not match. These included (a) how to address learner goals that were not easily amenable to a coconstruction, (b) how to coconstruct goals while actively running a clinical practice, and (c) how to remain learner centered while raising preceptor goals based on perceived gaps. Insights: Mismatches between learner and preceptor goals are inevitable and frequent. Preceptors must find ways to coconstruct goals with learners in various learning environments. That said, in enacting goal-oriented feedback, preceptors are effectively using feedback throughout the teaching and learning interaction to coconstruct the learning environment, resulting in improved rapport with learners and emphasizing why it is important to focus feedback around goals.
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Affiliation(s)
- Laura Farrell
- a Department of Medicine, University of British Columbia , Victoria , British Columbia , Canada
| | - Gisele Bourgeois-Law
- b Department of Obstetrics and Gynecology, University of British Columbia , Vancouver , British Columbia , Canada
| | - Sarah Buydens
- c Department of Family Practice, Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
| | - Glenn Regehr
- c Department of Family Practice, Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
- d Department of Surgery, Faculty of Medicine, University of British Columbia , Vancouver , British Columbia , Canada
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17
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Mah K, Gladstone B, King G, Reed N, Hartman LR. Researching experiences of childhood brain injury: co-constructing knowledge with children through arts-based research methods. Disabil Rehabil 2019; 42:2967-2976. [PMID: 30973787 DOI: 10.1080/09638288.2019.1574916] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/27/2022]
Abstract
Objective: In the knowledge base examining experiences of childhood brain injury, the perspectives of children with brain injury are notably lacking. This failure to represent the voices of pediatric clients has resulted in an incomplete knowledge base from which to inform evidence-based rehabilitation practice. In this paper, we examine why the perspectives of children with brain injury are rarely sought and propose a new way forward.Methods: We draw upon current evidence and practices in related fields and present an exemplar from an in-progress qualitative arts-based research project with children with brain injury.Results: Assumptions ingrained in research practices, particularly those surrounding the capacity of 'doubly vulnerable' children with brain injury to produce knowledge, have resulted in the relative exclusion of this group from research that concerns them. For the field to evolve, research practices must value children's first-hand accounts, engage them in co-constructing knowledge about their lives, and invite methods that meet their interests and abilities.Conclusion: By reframing how we think about the capacities of children with disabilities and shifting our research practices to include children with brain injury as knowledgeable participants, it becomes possible to expand the knowledge base upon which clinical rehabilitation practices are built.Implications for RehabilitationCurrent research practices preclude 'doubly vulnerable' pediatric populations, including children with brain injury, from actively contributing to research that concerns them.As a result, the perspectives of children with brain injury are virtually absent from research, rendering the evidence base upon which rehabilitative practices are built incomplete.Reframing how we think about the capacities of children with brain injury can shift how we engage with them, both in research and clinic, and may subsequently impact the knowledge available to us.Implications for client-centred rehabilitation are discussed, including the need to understand children as capable of insight into their own experience, as able to contribute to a more complete understanding of the health phenomena that affect them, and as invaluable and active participants in research and clinical care.
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Affiliation(s)
- Katie Mah
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
| | - Brenda Gladstone
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Canada
| | - Gillian King
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Nick Reed
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada.,Department of Occupational Science & Occupational Therapy, University of Toronto, Toronto, Canada
| | - Laura R Hartman
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
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Santangelo P, Procter N, Fassett D. Mental health nursing: Daring to be different, special and leading recovery-focused care? Int J Ment Health Nurs 2018; 27:258-266. [PMID: 29318772 DOI: 10.1111/inm.12316] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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] [Accepted: 12/05/2016] [Indexed: 11/29/2022]
Abstract
How mental health nursing is differentiated from other disciplines and professions, and what special contribution mental health nurses make to health services, is a question at the heart of contemporary practice. One of the significant challenges for mental health nurses is identifying, developing and advancing those aspects of their practice that they consider differentiate them in the multi-disciplinary mental health care team and to articulate clearly what a mental health nurse is and does. This paper draws on data from interviews with 36 mental health nurses in Australia who identified their practice as autonomous. Participants were asked the question, "What's special about mental health nursing?" Constructivist grounded theory techniques were applied to the research process. Findings were formulated and expressed as the 'Ten P's of the professional profile that is mental health nursing', which are 'present', 'personal', 'participant partnering', 'professional', 'phenomenological', 'pragmatic', 'power-sharing', 'psycho-therapeutic', 'proud' and 'profound'. The combined elements of the findings present a theoretical construct of mental health nursing practice as something distinctive and special. It provides a model and exemplar for contemporary practice in mental health nursing, embracing the role of mental health nurses in the health care workforce as being well placed as providers of productive and effective care.
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Affiliation(s)
- Peter Santangelo
- Faculty of Health, School of Health Sciences, Nursing and Midwifery, University of Tasmania, Hobart, Tasmania, Australia
| | - Nicholas Procter
- Mental Health Nursing University of South Australia, Adelaide, South Australia, Australia
| | - Denise Fassett
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
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Santangelo P, Procter N, Fassett D. Seeking and defining the 'special' in specialist mental health nursing: A theoretical construct. Int J Ment Health Nurs 2018; 27:267-275. [PMID: 29318769 DOI: 10.1111/inm.12317] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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] [Accepted: 12/05/2016] [Indexed: 11/28/2022]
Abstract
In the context of an enduring debate about the distinct identity of mental health nursing, this qualitative study explored the nature, scope and consequences of mental health nursing practice. Data for interpretation were generated through interviews with 36 mental health nurses, five of their clients and one health care colleague, each of whom were asked to speak in as much detail as possible about what they believe is special about mental health nursing and what had influenced them to arrive at this understanding. Using a constructivist grounded theory approach, the study generated a substantive theory of recovery-focused mental health nursing expressed as 'Being in the here and now, side by side, co-constructing care'. The study revealed that the distinct nature and identity of mental health nursing provides the foundation that primes and drives practice scope and consequences. Conceptual interpretations of the data emphasized the mental health nursing perspective of care as an acquired lens founded in nursing as a profession and enhanced by the relational interplay between the nurse and the client that facilitates the nurse to adopt recovery-focused practices. This theoretical construct holds the potential to be the mediating connection between client and mental health nurse. By situating mental health nursing and its central role in practice as something co-constructed, findings from this study can be expanded beyond the Australian context, particularly in terms of mental health nursing's distinct professional identity and practice.
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Affiliation(s)
- Peter Santangelo
- Faculty of Health, School of Health Sciences, Nursing and Midwifery, University of Tasmania, Hobart, Tasmania, Australia
| | - Nicholas Procter
- Mental Health Nursing University of South Australia, Adelaide, South Australia, Australia
| | - Denise Fassett
- Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
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Abstract
In their daily practice, psychiatric caregivers seek an encounter with the patient. This involves trying to understand the patient's suffering, to give meaning and to make the clinical connection. This equates to constructing together. Some care organisations are working to create spaces within units which are suited to receiving patients with an atmosphere favouring the encounter. The story of Baptiste illustrates this approach. Testimony.
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Affiliation(s)
- Lionnel Beteille
- Centre hospitalier Sainte-Marie, 12, rue de l'Hermitage, CS 20099, 63407 Chamalières, France.
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21
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Abstract
This paper argues that self-disclosure is intimately related to traumatic experience and the pressures on the analyst not to re-traumatize the patient or repeat traumatic dynamics. The paper gives a number of examples of such pressures and outlines the difficulties the analyst may experience in adopting an analytic attitude - attempting to stay as closely as possible with what the patient brings. It suggests that self-disclosure may be used to try to disconfirm the patient's negative sense of themselves or the analyst, or to try to induce a positive sense of self or of the analyst which, whilst well-meaning, may be missing the point and may be prolonging the patient's distress. Examples are given of staying with the co-construction of the traumatic early relational dynamics and thus working through the traumatic complex; this attitude is compared and contrasted with some relational psychoanalytic attitudes.
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Pawelczyk J, Talarczyk M. 'What should a woman do and imagine to have bulimia?': Co-constructing patient expertise in psychotherapy with bulimia patients. Commun Med 2017; 14:135-149. [PMID: 29958355 DOI: 10.1558/cam.30380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/20/2022]
Abstract
One of the goals of psychotherapy with bulimia patients is identification of the functions of the eating disorder in their lives. Thus, as in any psychotherapeutic approach, the therapist should facilitate the patient's disclosure of his or her experience of living with bulimia. Talking about one's dysphoric experiences and, particularly in the case of bulimia, symptoms and experiences that commonly deprive people with bulimia of dignity, constitutes an emotional challenge for the patient and an equally challenging interactional task for the therapist. Using the example of one therapy session with a female bulimia patient, we examine how the therapist and the patient interactionally engage in co-constructing the patient's expertise - involving epistemics of experience as well as epistemics of expertise - concerning the illness in the interactional here-and-now. Applying tools and insights from discourse and conversation analysis, we examine the sequences in which the patient shifts the topical focus from a general observation concerning bulimia to her personal experience, to be further pursued interactionally by the therapist. We also discuss how the therapist downgrades her epistemic position and (concurrently) foregrounds and bolsters the patient's voice as expert to accomplish the session's therapeutic goals.
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Abstract
The present study compares the ways in which conversational partners manage expressive linguistic problems produced by participants with fluent vs. non-fluent aphasia. Both everyday conversations with family members and institutional conversations with speech-language therapists were examined. The data consisted of 110 conversational sequences in which the conversational partners addressed expressive aphasic problems. Most problems of the speaker with fluent aphasia were locally restricted phonological and word-finding errors, which were immediately repaired. In contrast, the sparse expression of the speaker with non-fluent aphasia was co-constructed by conversational partners in long negotiation sequences to establish shared understanding. Some differences between recipient participation in everyday and institutional conversation were found. The results emphasise the relevance of the nature of the expressive linguistic problems on participation in interaction. They also add to the clinical knowledge of handling aphasic problems in conversation. This knowledge can be used for developing interaction-focused intervention.
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Affiliation(s)
- Minna Laakso
- a Department of Psychology and Speech-Language Pathology , University of Turku , Turku , Finland
| | - Sisse Godt
- b Department of Behavioural Sciences , University of Helsinki , Helsinki , Finland
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West M. Working in the borderland: early relational trauma and Fordham's analysis of 'K'. J Anal Psychol 2016; 61:44-62. [PMID: 26785412 DOI: 10.1111/1468-5922.12191] [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: 08/06/2015] [Accepted: 11/02/2015] [Indexed: 11/30/2022]
Abstract
This paper outlines a view of early relational trauma as underlying borderline states of mind, and argues that Knox's paper on internal working models and the complex provides a basis for understanding such states of mind. The author argues that in addition to internal working models, the complex also embodies and contains primitive defences of the core self. He outlines how these apply on the objective, subjective, transference and archetypal levels, and in direct and reversed forms and applies this to the account of Fordham's analysis of his patient 'K', which ended in impasse. The paper explores the dynamic that emerged in that analysis and suggests that it could be helpfully accounted for in terms of the co-construction and re-construction of early relational trauma in the analytic relationship.
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