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Dookeeram D, Seetharaman H, Taylor L, Stoute C, Toppin T, Thomas C, Trim J, Thomas K, Stoute S, Caton K. The Prevalence of Violence Against Healthcare Workers in Trinidad and Tobago. Cureus 2024; 16:e58182. [PMID: 38741873 PMCID: PMC11089584 DOI: 10.7759/cureus.58182] [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] [Accepted: 04/13/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Abuse of healthcare workers (HCWs) and lack of public trust threaten the foundation of the physician-patient relationship. This growing global problem creates an even more difficult professional environment and hinders the delivery of high-quality clinical care. OBJECTIVE The primary aim was to determine the prevalence of violence against Trinbagonian HCWs in the public sector. Secondary objectives included determining risk factors for violence and mistrust between the public and providers. METHOD A cross-sectional analysis of 434 HCWs in the public sector of Trinidad and Tobago was conducted using a modified World Health Organization (WHO) data collection tool, distributed via social media and administrative emails, and snowballed for two months. Fifteen semi-structured interviews were conducted regarding trust in the healthcare system with patients selected from communities. RESULTS Of the 434 respondents, 45.2% experienced violence and 75.8% witnessed violence against HCWs in the past two years. Verbal abuse (41.5%) was most common. Perpetrators were patients (42.2%) and patients' relatives (35.5%). Chi-square analysis highlighted that HCWs with the highest probability of being abused were aged 25-39 (63.8%), had two to five years of work experience (24.9%), specialized in emergency and internal medicine (48.6%), and cared for psychiatric and physically disabled patients (p-value < 0.001). HCWs believed the threat of violence negatively impacted performance (64.5%), and further action was necessary for mitigation (86.4%). Patients interviewed doubted physicians' altruism and competence (80%) and honesty (53.3%), expressed mistrust in their physician (46.7%), and cited poor infrastructure/management (66.7%) and dissatisfaction with care (60.0%) as factors that contributed to violence. CONCLUSION Analysis revealed that violence against Trinbagonian HCWs in the public sector deteriorated patient experience and adversely affected psychological well-being, efficiency, and job satisfaction. Results suggested mistrust of HCWs by the population. Interventions should be instituted to support at-risk HCWs and educate the public to avoid recurrence.
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Affiliation(s)
- Darren Dookeeram
- School of Pharmacy, The University of the West Indies, St. Augustine, TTO
- Department of Emergency Medicine, Eastern Regional Health Authority, Sangre Grande, TTO
| | | | - Lake Taylor
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Cherelle Stoute
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Takiyah Toppin
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Cassy Thomas
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Jakeilia Trim
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Kirtesha Thomas
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Sade Stoute
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, TTO
| | - Kanisha Caton
- Faculty of Medical Sciences, The University of the West Indies, St. Augustine, TTO
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Brewer KC, Dierkes AM, Norful AA. Organizational trust breaches among nurses and aides: A qualitative study. Nurs Ethics 2024:9697330241230520. [PMID: 38417902 DOI: 10.1177/09697330241230520] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
BACKGROUND Healthcare worker retention and burnout are confounding issues. Trust among workers and their employer, that is, organization, is an important yet underexplored concept in research. RESEARCH AIM The aim of this qualitative study is to explore organizational actions and systems that promote or denigrate trust among registered nurses and patient care aides (aides). RESEARCH DESIGN The study uses the Model of Psychological Contract as a theoretical framework. Focus groups were conducted to explore the concept of organizational trust and the consequences of broken trust. PARTICIPANTS Registered nurses (RNs) (n=6) and aides (n=6) participated in the study. Six focus groups (three RN and three aide) were conducted, with two participants per group. Focus groups were conducted online. ETHICAL CONSIDERATIONS The study's methods were reviewed by the University of Pittsburgh Institutional Review Board. FINDINGS Among RNs and aides, a sense of trust and feeling valued were important to their sense of relationship with their employers. Trust was breached when resources were scarce, employees did not feel validated and listened to, and problems were not addressed. RNs and aides described feeling devalued when compensation practices were unjust or inequitable, they had limited autonomy, and the employer created an organizational climate where business needs superceded human caring. Consequences of trust breach included burnout, dejection, and feelings of non-belonging. DISCUSSION Tangible organizational resources (compensation and staffing) and intangible resources (value, respect, autonomy) are important to RNs and aides alike. Inability to provide these resources diminishes trust and even causes a sense of betrayal. CONCLUSION Future research can explore the concepts of organizational justice and interventions to restore lost trust and improve healthcare worker well-being. This is one of only a few identified studies to explore organizational factors and well-being among aides and more research among this healthcare worker population is warranted.
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Borz-Baba C, Paranandi A, Alston S. A Growing Mandate in American Medicine: Teaching Our Internal Medicine Residents About Healthcare Administration and Leadership. Cureus 2023; 15:e49487. [PMID: 38152788 PMCID: PMC10752248 DOI: 10.7759/cureus.49487] [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] [Accepted: 11/26/2023] [Indexed: 12/29/2023] Open
Abstract
Leadership training during residency is essential for the successful development of contemporary physicians. Creating a curriculum for healthcare leadership and administration for internal medicine residents is particularly challenging due to the heterogeneity of leadership curricula across programs, the emphasis on individual advancement rather than collective leadership, and the scarcity of published research on the topic. A healthcare administration and leadership rotation for medical residents is a valuable experience that emphasizes the importance of contextualizing education on leadership and building relationships to achieve organizational goals.
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Affiliation(s)
| | - Anupama Paranandi
- Family, Population, and Preventive Medicine, Stony Brook University, New York, USA
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Webber V, Bajzak K, Gustafson DL. The impact of rurality on vulvodynia diagnosis and management: Primary care provider and patient perspectives. Can J Rural Med 2023; 28:107-115. [PMID: 37417041 DOI: 10.4103/cjrm.cjrm_49_22] [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] [Indexed: 07/08/2023]
Abstract
Objective The objective of this study was to better understand how rurality impacts the knowledge, diagnosis and management of vulvodynia by primary care providers (PCPs) practising in the geographically disparate province of Newfoundland and Labrador, Canada. Design This was a qualitative case study using questionnaires and semi-structured interviews with PCPs, compared with semi-structured focus groups and interviews with vulvodynia patients conducted in a previous study phase. Results Ten family physicians and 6 nurse practitioners participated. Over half had baseline knowledge that vulvodynia has a relatively high prevalence, but most underestimated the likelihood they would see a patient with vulvodynia in their practice. Three barriers to discussing and managing vulvodynia emerged: (1) discomfort initiating sexual/vulvar health conversations; (2) concerns about protecting patient privacy and confidentiality; and (3) time constraints and building therapeutic relationships. These issues were largely corroborated by previous findings with vulvodynia patients. Rural-informed solutions might include: (1) supporting increased education in vulvodynia and sexual health more broadly, including funding to attend continuing professional education and developing more clinical tools; (2) following practice guidelines regarding standardised initiation of sexual health conversations; (3) incentivising retention of rural providers and extending appointment times by reconsidering fee-for-service structures; and (4) researching a tailored vulvodynia toolkit and the potential advantage of mobile health units. Conclusion Rurality exacerbates common concerns in the identification and management of vulvodynia. Acting on recommended solutions may address the impact of rurality on the provision of timely care for those experiencing vulvodynia and other sexual health concerns.
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Affiliation(s)
- Valerie Webber
- Division of Community Health and Humanities, Memorial University, St. John's, Canada
| | - Krisztina Bajzak
- Discipline of Obstetrics and Gynecology, Memorial University, St. John's, Canada
| | - Diana L Gustafson
- Division of Community Health and Humanities, Memorial University, St. John's, Canada
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5
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Jen S, Jeong M, Smith M. " Weight of the World" and " I Want Them to Know": Skilled Nursing Facility Administrators' Perspectives on COVID-19 in Research Poems. J Gerontol Soc Work 2023; 66:263-273. [PMID: 35815711 DOI: 10.1080/01634372.2022.2098444] [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: 03/09/2022] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 06/15/2023]
Abstract
COVID-19 has had a drastic, long-lasting impact on skilled nursing facilities (SNFs), forcing communities to continuously adapt to rapidly changing guidelines, restrictions, and challenges. In spring 2020, we conducted a sequential mixed-methods study with administrators of SNFs in the Midwest to understand the experience of administrators, staff, and residents during the pandemic. We collected 60 surveys with open-ended items related to the impact of the pandemic on communities as a whole, staff, and residents. Survey findings informed supplemental interviews with six administrators working in diverse regions. Due to the affective nature of the data, we present the findings in two found poems, which emphasize the lyrical, emotional, and poignant aspects of the participant voices. The first poem, Weight of the World, captures the struggle to adapt during the transition into the pandemic and its negative impacts on the lives of residents and their families. The second, I Want Them to Know, describes the resiliency with which administrators and staff responded to adversity while maintaining motivation to continue the work in the midst of unprecedented challenges. The two poems offer contrasting or balancing narratives of struggle and survival during the pandemic era.
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Affiliation(s)
- Sarah Jen
- University of Kansas School of Social Welfare, Lawrence, Kansas, USA
| | - Mijin Jeong
- University of Kansas School of Social Welfare, Lawrence, Kansas, USA
| | - Madeline Smith
- University of Kansas School of Social Welfare, Lawrence, Kansas, USA
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Moteki Y. Research trends in healthcare and hospital administration in Japan: Content analyses of article titles in the journal of the Japan society for healthcare administration. Front Public Health 2022; 10:1050035. [PMID: 36589972 PMCID: PMC9794998 DOI: 10.3389/fpubh.2022.1050035] [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: 10/04/2022] [Accepted: 11/24/2022] [Indexed: 12/15/2022] Open
Abstract
This study quantitatively analyzed healthcare administration studies in Japan using text mining, focusing on articles published during 1994-2021 in the Journal of the Japan Society for Healthcare Administration (prior to 2008, the journal was called Hospital Administration). Both the co-occurrence network and the correspondence analysis (these are extracted words that refer to the two systems) demonstrate two major changes: (1) the introduction of the long-term care insurance system, which was enacted in 1997 and came into effect in 2000, and (2) the introduction of the late-stage medical care system for the elderly in 2008, both of which had a significant impact on the Japanese public health and welfare system. Co-occurrence network and correspondence analysis were conducted to understand changes in research interests. The analysis used two time periods following a change in the journal's name in 2008. To readily comprehend changing research trends, 10-year segments were considered, resulting in three time periods. The research features and trends during the aforementioned periods were examined using correspondence analysis. Configuration figures derived from this analysis plotted time transition (first dimension) against certain abstract/concrete situations (second dimension). The extracted words displayed in the configuration maps at the axes' intersection were patient, survey, and evaluation. They revealed no distinctive features compared with other words and were commonly used in article titles within this journal during each period. The following results were obtained from the correspondence analysis: first, changes in the geriatric care system of public medical insurance and the introduction of the long-term care insurance system in 2000 were expressed in the characteristics of the extracted words; second, in the 14 years after the journal's name changed, published studies frequently referred to the roles of doctors, nurses, and other healthcare professionals. A chi-squared test on these extracted words and the period classification confirmed a statistically significant relationship between them.
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7
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Friedman NMG, Bartho MJ, Koenig GJ. Promoting a health-centered approach to acute mental health crises on college campuses: The case for collegiate-based emergency medical services. J Am Coll Health 2022:1-3. [PMID: 35943954 DOI: 10.1080/07448481.2022.2104616] [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: 11/06/2021] [Revised: 06/09/2022] [Accepted: 07/17/2022] [Indexed: 06/15/2023]
Abstract
As college and university campuses re-open during the COVID-19 pandemic, there is increased concern for mental health crises. Current trends in campus mental health care emphasize providing quality care in a safe, non-judgmental, and non-punitive manner. Collegiate-based emergency medical services organizations are well-positioned to respond to acute mental health crises on college campuses. Campus health professionals and administrators seeking to promote a health-centered approach toward mental health crises should support the growth and development of collegiate-based emergency medical services organizations.
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Affiliation(s)
- Nicholas M G Friedman
- National Collegiate Emergency Medical Services Foundation, West Sand Lake, New York, USA
- School of Medicine, Stanford University, Stanford, California, USA
| | - Murray J Bartho
- National Collegiate Emergency Medical Services Foundation, West Sand Lake, New York, USA
- Department of Otolaryngology-Head & Neck Surgery, Stanford University, Stanford, California, USA
| | - George J Koenig
- National Collegiate Emergency Medical Services Foundation, West Sand Lake, New York, USA
- Department of Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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8
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Frommeyer TC, Fursmidt RM, Gilbert MM, Bett ES. The Desire of Medical Students to Integrate Artificial Intelligence Into Medical Education: An Opinion Article. Front Digit Health 2022; 4:831123. [PMID: 35633734 PMCID: PMC9135963 DOI: 10.3389/fdgth.2022.831123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 04/11/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Timothy C. Frommeyer
- Boonshoft School of Medicine at Wright State University, Dayton, OH, United States
| | - Reid M. Fursmidt
- Boonshoft School of Medicine at Wright State University, Dayton, OH, United States
| | - Michael M. Gilbert
- Boonshoft School of Medicine at Wright State University, Dayton, OH, United States
| | - Ean S. Bett
- Ohio University College of Osteopathic Medicine, Columbus, OH, United States
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9
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Jen S, Jeong M, Lafountain O, Doll G, Cornelison L. Sexual Expression, Policies, and Practices in Skilled Nursing Settings Serving Older Adults: An Updated Assessment in the State of Kansas. Gerontol Geriatr Med 2022; 8:23337214221113137. [PMID: 35874434 PMCID: PMC9301106 DOI: 10.1177/23337214221113137] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/25/2022] [Accepted: 06/08/2022] [Indexed: 11/17/2022] Open
Abstract
Doll assessed sexual expressions, policies, and practices in Skilled
Nursing Facilities (SNFs) in the state of Kansas. This study provided
an updated and expanded assessment. A mixed-methods survey was
distributed to administrators of all SNFs in the state of Kansas.
Among 60 administrations, 84% reported any sexual expression among
residents in their community within the past year and 55% reported
expressions involving an individual with cognitive impairment. In
response to sexual expressions, 70% of administrators believe staff
would treat residents with dignity and respect and about 40%
anticipated staff discomfort. About 40% of administrators reported
having a policy related to sexual expression. Attitudes and responses
of staff and administrators appear to be shifting in a sex-positive
direction. While policies related to sexuality are more common than a
decade ago, there is room for additional uptake, standardization, and
infusion of person-centered language and practices.
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Affiliation(s)
- Sarah Jen
- University of Kansas School of Social Welfare, Lawrence, USA
| | - Mijin Jeong
- University of Kansas School of Social Welfare, Lawrence, USA
| | | | - Gayle Doll
- Kansas State University Center on Aging, Manhattan, USA
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10
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Rowan A, Bates C, Hulme W, Evans D, Davy S, A Kennedy N, Galloway J, E Mansfield K, Bechman K, Matthewman J, Yates M, Brown J, Schultze A, Norton S, J. Walker A, E. Morton C, Bhaskaran K, T. Rentsch C, Williamson E, Croker R, Bacon S, Hickman G, Ward T, Green A, Fisher L, J Curtis H, Tazare J, M. Eggo R, Inglesby P, Cockburn J, I. McDonald H, Mathur R, YS Wong A, Forbes H, Parry J, Hester F, Harper S, J Douglas I, Smeeth L, A Tomlinson L, W Lees C, Evans S, Smith C, M. Langan S, Mehkar A, MacKenna B, Goldacre B. A comprehensive high cost drugs dataset from the NHS in England - An OpenSAFELY-TPP Short Data Report. Wellcome Open Res 2021; 6:360. [PMID: 35634533 PMCID: PMC9120928 DOI: 10.12688/wellcomeopenres.17360.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/20/2022] Open
Abstract
Background: At the outset of the COVID-19 pandemic, there was no routine comprehensive hospital medicines data from the UK available to researchers. These records can be important for many analyses including the effect of certain medicines on the risk of severe COVID-19 outcomes. With the approval of NHS England, we set out to obtain data on one specific group of medicines, "high-cost drugs" (HCD) which are typically specialist medicines for the management of long-term conditions, prescribed by hospitals to patients. Additionally, we aimed to make these data available to all approved researchers in OpenSAFELY-TPP. This report is intended to support all studies carried out in OpenSAFELY-TPP, and those elsewhere, working with this dataset or similar data. Methods: Working with the North East Commissioning Support Unit and NHS Digital, we arranged for collation of a single national HCD dataset to help inform responses to the COVID-19 pandemic. The dataset was developed from payment submissions from hospitals to commissioners. Results: In the financial year (FY) 2018/19 there were 2.8 million submissions for 1.1 million unique patient IDs recorded in the HCD. The average number of submissions per patient over the year was 2.6. In FY 2019/20 there were 4.0 million submissions for 1.3 million unique patient IDs. The average number of submissions per patient over the year was 3.1. Of the 21 variables in the dataset, three are now available for analysis in OpenSafely-TPP: Financial year and month of drug being dispensed; drug name; and a description of the drug dispensed. Conclusions: We have described the process for sourcing a national HCD dataset, making these data available for COVID-19-related analysis through OpenSAFELY-TPP and provided information on the variables included in the dataset, data coverage and an initial descriptive analysis.
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Affiliation(s)
- Anna Rowan
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Chris Bates
- TPP, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - William Hulme
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - David Evans
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Simon Davy
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Nicholas A Kennedy
- Department of Gastroenterology, Royal Devon & Exeter NHS Foundation Trust, Exeter, UK
- IBD Research Group, University of Exeter, Exeter, UK
| | - James Galloway
- Centre of Rheumatic Diseases, King's College London, London, UK
| | - Kathryn E Mansfield
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Katie Bechman
- Centre of Rheumatic Diseases, King's College London, London, UK
| | - Julian Matthewman
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Mark Yates
- Centre of Rheumatic Diseases, King's College London, London, UK
| | - Jeremy Brown
- Centre of Rheumatic Diseases, King's College London, London, UK
| | - Anna Schultze
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Sam Norton
- TPP, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - Alex J. Walker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Caroline E. Morton
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Krishnan Bhaskaran
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Christopher T. Rentsch
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Elizabeth Williamson
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Richard Croker
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Seb Bacon
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - George Hickman
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Tom Ward
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Amelia Green
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Louis Fisher
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Helen J Curtis
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - John Tazare
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Rosalind M. Eggo
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Peter Inglesby
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Helen I. McDonald
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Rohini Mathur
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Angel YS Wong
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Harriet Forbes
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - John Parry
- TPP, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - Frank Hester
- TPP, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - Sam Harper
- TPP, 129 Low Lane, Horsforth, Leeds, LS18 5PX, UK
| | - Ian J Douglas
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Liam Smeeth
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Laurie A Tomlinson
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Charlie W Lees
- Centre for Genomics and Experimental Medicine, University of Edinburgh, Edinburgh, UK
| | - Stephen Evans
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
| | - Catherine Smith
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Sinéad M. Langan
- Electronic Health Records Research Group, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, WC1E 7HT, UK
- St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, SE1 9RT, UK
| | - Amir Mehkar
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Brian MacKenna
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Ben Goldacre
- The DataLab, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
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Ashcraft K, Moretz C, Schenning C, Rojahn S, Vines Tanudtanud K, Magoncia GO, Reyes J, Marquez B, Guo Y, Erdemir ET, Hall TO. Unmanaged Pharmacogenomic and Drug Interaction Risk Associations with Hospital Length of Stay among Medicare Advantage Members with COVID-19: A Retrospective Cohort Study. J Pers Med 2021; 11:jpm11111192. [PMID: 34834543 PMCID: PMC8617857 DOI: 10.3390/jpm11111192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/15/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 12/12/2022] Open
Abstract
Unmanaged pharmacogenomic and drug interaction risk can lengthen hospitalization and may have influenced the severe health outcomes seen in some COVID-19 patients. To determine if unmanaged pharmacogenomic and drug interaction risks were associated with longer lengths of stay (LOS) among patients hospitalized with COVID-19, we retrospectively reviewed medical and pharmacy claims from 6025 Medicare Advantage members hospitalized with COVID-19. Patients with a moderate or high pharmacogenetic interaction probability (PIP), which indicates the likelihood that testing would identify one or more clinically actionable gene–drug or gene–drug–drug interactions, were hospitalized for 9% (CI: 4–15%; p < 0.001) and 16% longer (CI: 8–24%; p < 0.001), respectively, compared to those with low PIP. Risk adjustment factor (RAF) score, a commonly used measure of disease burden, was not associated with LOS. High PIP was significantly associated with 12–22% longer LOS compared to low PIP in patients with hypertension, hyperlipidemia, diabetes, or chronic obstructive pulmonary disease (COPD). A greater drug–drug interaction risk was associated with 10% longer LOS among patients with two or three chronic conditions. Thus, unmanaged pharmacogenomic risk was associated with longer LOS in these patients and managing this risk has the potential to reduce LOS in severely ill patients, especially those with chronic conditions.
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Affiliation(s)
- Kristine Ashcraft
- Invitae Corporation, San Francisco, CA 94103, USA; (C.M.); (C.S.); (S.R.)
- Correspondence: ; Tel.: +1-415-374-7782
| | - Chad Moretz
- Invitae Corporation, San Francisco, CA 94103, USA; (C.M.); (C.S.); (S.R.)
| | | | - Susan Rojahn
- Invitae Corporation, San Francisco, CA 94103, USA; (C.M.); (C.S.); (S.R.)
| | - Kae Vines Tanudtanud
- OptumLabs at UnitedHealth Group, Minnetonka, MN 55343, USA; (K.V.T.); (G.O.M.); (J.R.); (B.M.); (Y.G.); (E.T.E.); (T.O.H.)
| | - Gwyn Omar Magoncia
- OptumLabs at UnitedHealth Group, Minnetonka, MN 55343, USA; (K.V.T.); (G.O.M.); (J.R.); (B.M.); (Y.G.); (E.T.E.); (T.O.H.)
| | - Justine Reyes
- OptumLabs at UnitedHealth Group, Minnetonka, MN 55343, USA; (K.V.T.); (G.O.M.); (J.R.); (B.M.); (Y.G.); (E.T.E.); (T.O.H.)
| | - Bernardo Marquez
- OptumLabs at UnitedHealth Group, Minnetonka, MN 55343, USA; (K.V.T.); (G.O.M.); (J.R.); (B.M.); (Y.G.); (E.T.E.); (T.O.H.)
| | - Yinglong Guo
- OptumLabs at UnitedHealth Group, Minnetonka, MN 55343, USA; (K.V.T.); (G.O.M.); (J.R.); (B.M.); (Y.G.); (E.T.E.); (T.O.H.)
| | - Elif Tokar Erdemir
- OptumLabs at UnitedHealth Group, Minnetonka, MN 55343, USA; (K.V.T.); (G.O.M.); (J.R.); (B.M.); (Y.G.); (E.T.E.); (T.O.H.)
| | - Taryn O. Hall
- OptumLabs at UnitedHealth Group, Minnetonka, MN 55343, USA; (K.V.T.); (G.O.M.); (J.R.); (B.M.); (Y.G.); (E.T.E.); (T.O.H.)
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Vivian E, Brooks MR, Longoria R, Lundberg L, Mallow J, Shah J, Vo A, Mejia A, Tarnasky P, Puri V. Improving the Standard of Care for All-A Practical Guide to Developing a Center of Excellence. Healthcare (Basel) 2021; 9:777. [PMID: 34205635 DOI: 10.3390/healthcare9060777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/04/2021] [Accepted: 06/15/2021] [Indexed: 11/17/2022] Open
Abstract
Pancreatic surgery is one of the more challenging procedures performed by surgeons. The operations are technically complex and have historically been accompanied by a substantial risk for mortality and postoperative complications. Other pancreatic pathologies require advanced therapeutic procedures that are highly endoscopist-dependent, requiring specific, knowledge-based training for optimal outcomes. An increase in diagnosed pancreatic pathologies every year reinforces a critical need for experienced surgeons, gastroenterologists/endoscopists, hospitals, and support personnel in the management of complex pancreatic cases and thus, well-designed Centers of Excellence (CoE). In this paper, we outline the framework for a Pancreas CoE across three developmental domains: (1) establishing the foundation; (2) formalizing the program; (3) solidifying the CoE status. This framework can likely be translated to any disease or procedure-specific service-line and facilitate the development of a successful CoE.
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Spear B, Kinart AC, Beauvais B, Kim FS. Renovating Healthcare Facility Maintenance Planning: A Case Study From Walter Reed National Military Medical Center (WRNMMC). HERD 2021; 14:416-428. [PMID: 34114496 DOI: 10.1177/19375867211019749] [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] [Indexed: 11/17/2022]
Abstract
PURPOSE This article documents the development and implementation of a new approach for health facilities construction and maintenance planning, the use of a Facilities and Clinical Coordination (FCC) Council, at Walter Reed National Military Medical Center (WRNMMC). BACKGROUND WRNMMC is preparing for the largest and most complex renovation project in recent Department of Defense history. There is sparse documentation demonstrating stepwise frameworks for the implementation of effective and efficient health facilities maintenance management tools and techniques. METHOD This study discusses the development and evaluation of the FCC Council. Clarity to the literature sources guiding the development of the FCC Council is provided, followed by the survey approach undertaken to assess Council efficacy based on participants' perceptions. Data are analyzed using descriptive and inferential statistics. RESULTS Our study suggests routine cross-functional synchronous FCC Council meetings improve perceptions of safety and communication, encourage teamwork, and are more productive when conducted using synchronous rather than asynchronous communication. Clinician participants strongly supported the face-to-face meeting approach and considered such meetings more effective as they are perceived to maintain staff and patient safety as a constant organizational focus. CONCLUSION The FCC's perceived effectiveness toward improving healthcare facilities maintenance planning centers on engaged leadership, the inclusion of diverse subject matter experts, and structured group facilitation. Our results inform health facilities planners of the value the FCC Council brings to an organization by helping to develop organizational buy-in for major facilities renovation projects.
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Affiliation(s)
- Bryan Spear
- Soldier for Life, United States Army, Pentagon, Washington, DC, USA
| | - Angela C Kinart
- Organizational Project Management Office (O-PMO), Defense Health Agency, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Brad Beauvais
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Forest S Kim
- Robbins MBA in Healthcare Administration, Hankamer School of Business, Baylor University, Waco, TX, USA
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14
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Pridmore W. 'I can see clearly now': clarifying the role of psychiatry in global disaster. Australas Psychiatry 2021; 29:337-339. [PMID: 33434047 DOI: 10.1177/1039856220986725] [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
OBJECTIVE First, to review the principles and practice of disaster psychiatry, in light of recent global events. Second, to identify opportunities for research. METHOD A literature review of the MEDLINE database, UpToDate and the Cochrane Library was conducted. Reference lists were also reviewed. RESULTS Psychiatrists are well-positioned to contribute to positive outcomes at all stages of the disaster response. These contributions derive from their roles as doctors, mental illness specialists and clinical leaders. CONCLUSION A novel framework for the psychiatrist's contributions was proposed. Specific knowledge of disaster psychiatry may be worthwhile, and establishment of a public disaster psychiatry centre is reasonable. Research should further examine the role of tele-psychiatry and pursue a best practice for community and front-line employee psychological preparedness.
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Zhang Y, Koru G. Understanding and detecting defects in healthcare administration data: Toward higher data quality to better support healthcare operations and decisions. J Am Med Inform Assoc 2020; 27:386-395. [PMID: 31841149 DOI: 10.1093/jamia/ocz201] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 08/22/2019] [Revised: 10/06/2019] [Accepted: 10/26/2019] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Development of systematic approaches for understanding and assessing data quality is becoming increasingly important as the volume and utilization of health data steadily increases. In this study, a taxonomy of data defects was developed and utilized when automatically detecting defects to assess Medicaid data quality maintained by one of the states in the United States. MATERIALS AND METHODS There were more than 2.23 million rows and 32 million cells in the Medicaid data examined. The taxonomy was developed through document review, descriptive data analysis, and literature review. A software program was created to automatically detect defects by using a set of constraints whose development was facilitated by the taxonomy. RESULTS Five major categories and seventeen subcategories of defects were identified. The major categories are missingness, incorrectness, syntax violation, semantic violation, and duplicity. More than 3 million defects were detected indicating substantial problems with data quality. Defect density exceeded 10% in five tables. The majority of the data defects belonged to format mismatch, invalid code, dependency-contract violation, and implausible value types. Such contextual knowledge can support prioritized quality improvement initiatives for the Medicaid data studied. CONCLUSIONS This research took the initial steps to understand the types of data defects and detect defects in large healthcare datasets. The results generally suggest that healthcare organizations can potentially benefit from focusing on data quality improvement. For those purposes, the taxonomy developed and the approach followed in this study can be adopted.
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Affiliation(s)
- Yili Zhang
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, Maryland, USA.,Postdoctoral Fellow the Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Güneş Koru
- Department of Information Systems, University of Maryland, Baltimore County, Baltimore, Maryland, USA
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16
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Gong CL, Zangwill KM, Hay JW, Meeker D, Doctor JN. Behavioral Economics Interventions to Improve Outpatient Antibiotic Prescribing for Acute Respiratory Infections: a Cost-Effectiveness Analysis. J Gen Intern Med 2019; 34:846-854. [PMID: 29740788 PMCID: PMC6544688 DOI: 10.1007/s11606-018-4467-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/14/2017] [Revised: 03/06/2018] [Accepted: 04/13/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND Behavioral economics interventions have been shown to effectively reduce the rates of inappropriate antibiotic prescriptions for acute respiratory infections (ARIs). OBJECTIVE To determine the cost-effectiveness of three behavioral economic interventions designed to reduce inappropriate antibiotic prescriptions for ARIs. DESIGN Thirty-year Markov model from the US societal perspective with inputs derived from the literature and CDC surveillance data. SUBJECTS Forty-five-year-old adults with signs and symptoms of ARI presenting to a healthcare provider. INTERVENTIONS (1) Provider education on guidelines for the appropriate treatment of ARIs; (2) Suggested Alternatives, which utilizes computerized clinical decision support to suggest non-antibiotic treatment choices in lieu of antibiotics; (3) Accountable Justification, which mandates free-text justification into the patient's electronic health record when antibiotics are prescribed; and (4) Peer Comparison, which sends a periodic email to prescribers about his/her rate of inappropriate antibiotic prescribing relative to clinician colleagues. MAIN MEASURES Discounted costs, quality-adjusted life years (QALYs), and incremental cost-effectiveness ratios. KEY RESULTS Each intervention has lower costs but higher QALYs compared to provider education. Total costs for each intervention were $178.21, $173.22, $172.82, and $172.52, and total QALYs were 14.68, 14.73, 14.74, and 14.74 for the control, Suggested Alternatives, Accountable Justification, and Peer Comparison groups, respectively. Results were most sensitive to the quality-of-life of the uninfected state, and the likelihood and costs for antibiotic-associated adverse events. CONCLUSIONS Behavioral economics interventions can be cost-effective strategies for reducing inappropriate antibiotic prescriptions by reducing healthcare resource utilization.
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Affiliation(s)
- Cynthia L Gong
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA.
| | - Kenneth M Zangwill
- Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Los Angeles, CA, USA
| | - Joel W Hay
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA
| | - Daniella Meeker
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA.,University of Southern California Keck School of Medicine, Los Angeles, CA, USA
| | - Jason N Doctor
- University of Southern California Leonard D. Schaeffer Center for Health Policy & Economics, Los Angeles, CA, USA
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Altizer Z, Canar WJ, Redemske D, Fullam F, Lamont M. Utilization of a Standardized Post-Occupancy Evaluation to Assess the Guiding Principles of a Major Academic Medical Center. HERD 2019; 12:168-178. [PMID: 30626220 DOI: 10.1177/1937586718820712] [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: 11/17/2022]
Abstract
Facility planning for healthcare organizations has become increasingly important in recent years, due primarily to the complicated needs of patient rooms and the escalating pressure to provide high-quality care to satisfy patients. Concurrently, there has been a considerable development in the field of evidence-based design (EBD) on the impact the healthcare environment has on patients and the operations of clinical staff. Although tools are being developed to assist in measuring EBD principles, they have not been universally adopted by organizations regarding how they either develop or assess healthcare facilities. This case study focuses on our attempt to implement an internal facilities evaluation process and a Post-Occupancy Evaluation (POE) on a major Academic Medical Center's (AMC) new bed tower. An assembled auditing team comprised of diverse professional healthcare backgrounds performed an audit on three patient rooms using a Center for Health Design POE Questionnaire. The results of this evaluation were then compared to the guiding principles developed for the hospital during its design. Results indicated that the project narrowly missed the threshold score agreed upon by the AMC's facilities leadership. This project demonstrated the difficulty in implementing a POE without prior experience, while highlighting the value of a standardized evaluation tool to assess past and future facilities projects.
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Affiliation(s)
| | - William J Canar
- 2 Department of Health Systems Management, Rush University Medical Center, Chicago, IL, USA
| | | | - Francis Fullam
- 2 Department of Health Systems Management, Rush University Medical Center, Chicago, IL, USA
| | - Mike Lamont
- 4 Rush University Medical Center, Chicago, IL, USA
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Udod SA, Racine L. Empirical and pragmatic adequacy of grounded theory: Advancing nurse empowerment theory for nurses' practice. J Clin Nurs 2017; 26:5224-5231. [PMID: 28543705 DOI: 10.1111/jocn.13887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2017] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVE To draw on the findings of a grounded theory study aimed at exploring how power is exercised in nurse-manager relationships in the hospital setting, this paper examines the empirical and pragmatic adequacy of grounded theory as a methodology to advance the concept of empowerment in the area of nursing leadership and management. BACKGROUND The evidence on staff nurse empowerment has highlighted the magnitude of individual and organisational outcomes, but has not fully explicated the micro-level processes underlying how power is exercised, shared or created within the nurse-manager relationship. Although grounded theory is a widely adopted nursing research methodology, it remains less used in nursing leadership because of the dominance of quantitative approaches to research. Grounded theory methodology provides the empirical and pragmatic relevance to inform nursing practice and policy. Grounded theory is a relevant qualitative approach to use in leadership research as it provides a fine and detailed analysis of the process underlying complexity and bureaucracy. DESIGN Discursive paper. METHOD A critical examination of the empirical and pragmatic relevance of grounded theory by (Corbin & Strauss, , ) as a method for analysing and solving problems in nurses' practice is provided. CONCLUSIONS This paper provides evidence to support the empirical and pragmatic adequacy of grounded theory methodology. Although the application of the ontological, epistemological and methodological assumptions of grounded theory is challenging, this methodology is useful to address real-life problems in nursing practice by developing theoretical explanations of nurse empowerment, or lack thereof, in the workplace. RELEVANCE TO CLINICAL PRACTICE Grounded theory represents a relevant methodology to inform nursing leadership research. Grounded theory is anchored in the reality of practice. The strength of grounded theory is to provide results that can be readily applied to clinical practice and policy as they arise from problems that affect practice and that are meaningful to nurses.
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Affiliation(s)
- Sonia A Udod
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
| | - Louise Racine
- College of Nursing, University of Saskatchewan, Saskatoon, SK, Canada
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