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Laepple M, Beil-Hildebrand MB. Community Nurses' Perspectives on Conceptual Challenges Related to the Need for Nursing Care in Germany: A Constructivist Grounded Theory Study. Policy Polit Nurs Pract 2024; 25:119-126. [PMID: 38263677 DOI: 10.1177/15271544241228507] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
In Germany, a person's need for nursing care is assessed by evaluators according to the federal legal definition of the statutory long-term care insurance (LTCI). This definition and the associated standardized assessment tool constitute the conditions for providing nursing care in a community care setting in Germany. Furthermore, the community care setting is regulated by state law and negotiations between long-term care funds and associations of providers of nursing care. During nursing care, nurses engage in a variety of interactions with people. The extent to which the legal definition of the need for nursing care leads to challenges in these interactions is unclear. To address this knowledge gap, we conducted 22 problem-centered interviews with nurses in the community and analyzed the data using the constructivist grounded theory. The results revealed that the negotiation processes are settled within professional-family relationships and vary between the constructs of closeness and distance, advocacy and submission of responsibility, and ethos and technocracy; these are the central challenges nurses encounter in this setting. We discuss the implications and questions that arise from the findings for the nursing profession regarding its own current and future role as well as the design of nursing support in the community, to nurture more advanced nurse practitioners and community health nurses.
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Affiliation(s)
- Miriam Laepple
- University of Koblenz - Faculty 1: Educational Sciences, Institute of Nursing Science, Koblenz, Rhineland-Palatinate, Germany
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Leung DYL, Lee CT, Chu SYJ, Ng F, Wen P, Fan J, Cheung DSK, Seto Nielsen L, Guruge S, Wong J. Chinese family care partners of older adults in Canada have grit: A qualitative study. J Adv Nurs 2024; 80:1018-1029. [PMID: 37828729 DOI: 10.1111/jan.15878] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 08/03/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023]
Abstract
AIM To explain the process taken by Chinese family care partners of older adults in the Greater Toronto Area, Canada, to access health and social services in their communities. The research question was: What mechanisms and structures impact the agency of Chinese family care partners of older adults, in the process of assisting them to access health and social services? DESIGN This qualitative study was informed by critical realism. METHODS Chinese family care partners of older adults in the Greater Toronto Area, Canada, were interviewed from August 2020 to June 2021. Transcripts underwent thematic analysis. FINDINGS Twenty-eight Chinese family care partners expressed a firm commitment to maintain caregiving conditions and to judiciously access health and social services. Their commitment was made up of three parts: (a) legislative and cultural norms of family, work, and society; (b) their perseverance to fill gaps with limited social and financial resources; (c) the quality of their relationship to, and illness trajectory of the older adults. The social structures created tension in how Chinese family care partners made decisions, negotiated resources, and ultimately monitored and coordinated timely access with older adults. CONCLUSION Participants' commitment and perseverance were conceptualized as "grit," central to their agency to conform to legislative and cultural norms. Moreover, findings support grit's power to motivate and sustain family caregiving, in order for older adults to age in place as long as possible with finite resources. IMPLICATIONS FOR THE PROFESSION This study highlights the importance of cultural awareness education for nurses, enabling continuity of care at a systems level and for a more resilient healthcare system. IMPACT Family care partners' grit may be crucial for nurses to harness when together, they face limited access to culturally appropriate health and social services in a system grounded in values of equity and inclusion, as in Canada. REPORTING METHOD When writing this manuscript, we adhered to relevant EQUATOR guidelines of the Consolidated Criteria for Reporting Qualitative Research (COREQ). PATIENT OR PUBLIC INVOLVEMENT AND ENGAGEMENT No patient or public involvement.
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Affiliation(s)
- D Y L Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - C T Lee
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - S Y J Chu
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - F Ng
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - P Wen
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - J Fan
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - D S K Cheung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - L Seto Nielsen
- School of Nursing, York University, Toronto, Ontario, Canada
| | - S Guruge
- Daphne Cockwell School of Nursing, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - J Wong
- Stronach Regional Cancer Centre at Southlake, Newmarket, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Dos Santos MR, Abbott-Anderson K, Ponto J, Silva LTP, Ferro TDA, Schweiss C, Eggenberger S, Meiers S, Szylit R. Reframing care while enduring the traumatic nature of witnessing disrupted family-patient-nurses' relationships during COVID-19. J Adv Nurs 2024; 80:186-199. [PMID: 37458269 DOI: 10.1111/jan.15791] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 06/08/2023] [Accepted: 07/03/2023] [Indexed: 12/18/2023]
Abstract
AIM To describe the lived experiences of nurses caring for patients and families in the context of COVID-19 in Brazil and United States. DESIGN A phenomenological philosophical approach following the van Manen analysis method. METHODS Participants were recruited in Brazil and the United States, including nurses working in health care settings caring for COVID-19 patients. Recruitment used purposive and snowball sampling. Participants completed a demographic survey and semi-structured interviews that were audio-recorded and transcribed for analysis. A cross-cultural examination occurred among researchers from each country. RESULTS The result was described (n = 35) by the themes, representing the essences of each lifeworld (relationship, time, space and body). The nurses' lived experience was one of reframing care while enduring repeated trauma of witnessing disrupted patient-family-nurse relationships. Themes were as follows: (a) Living a silent and lonely experience; (b) Providing connectedness for disrupted patient and family relationships; (c) Feeling the burden of the demands; (d) Being a helping connector; (e) Reshaping spaces amidst evolving interventions and policies; (f) Creating safe spaces, surrounded by turmoil, threat, and distress within an unsafe environment; (g) Reorganizing care and reframing time; (h) Reconciling losses, regrets, victories and lessons. CONCLUSION The nurses' lived experience of caring for patients and families during the COVID-19 pandemic prompted the need to respond to repeated traumas and distress posed by interrupted patient-family and nurse-own family relationships, vulnerable bodies, threatened space and dynamic and volatile time. IMPACT Cultural nuances were discovered depending on the practice setting, political discourse and the autonomy of the nurse. Innovative models of care that create structures and processes to support nurses in caring for patients in threatening environments and the commitment to connecting family members have potential to contribute to the ongoing health of the nursing profession.
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Affiliation(s)
| | - Kristen Abbott-Anderson
- Glen Taylor Nursing Institute for Family and Society, Minnesota State University - Former Director, School of Nursing, Mankato, Minnesota, USA
- University of Wisconsin Eau Claire, College of Nursing and Health Sciences, Eau Claire, Wisconsin, USA
| | - Julie Ponto
- Winona State University, Rochester, Minnesota, USA
| | | | | | - Cy Schweiss
- Minnesota State University, Mankato, School of Nursing, Mankato, Minnesota, USA
| | - Sandra Eggenberger
- University of Wisconsin Eau Claire, College of Nursing and Health Sciences, Eau Claire, Wisconsin, USA
| | - Sonja Meiers
- University of Wisconsin Eau Claire, College of Nursing and Health Sciences, Eau Claire, Wisconsin, USA
- Winona State University, Rochester, Minnesota, USA
| | - Regina Szylit
- University of São Paulo, School of Nursing, Sao Paulo, Brazil
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Rannikko J, Paananen J, Stolt M, Suhonen R. Quality of interaction between the nursing personnel and the informal caregivers of people with memory disorders: A systematic review and metasummary of qualitative studies. Nurs Open 2023; 10:7566-7584. [PMID: 37828798 PMCID: PMC10643836 DOI: 10.1002/nop2.2029] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/30/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023] Open
Abstract
AIM To explore the factors that affect the quality of interactions between nursing personnel and the informal caregivers of people with memory disorders. DESIGN Systematic review and metasummary of qualitative empirical research. METHODS The literature search targeted studies concerning the professional care interactions between nursing personnel and the informal caregivers of people with progressive memory disorders. The search in PubMed, CINAHL, PsycINFO and Scopus covered records from the earliest possible date up to December 2020. The data were summarised using a qualitative metasummary method. Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) checklist was used to validate the reporting process. RESULTS Ten articles were included. As presented in 33 statements, the factors affecting the quality of interactions were related to (1) expectations, (2) memory disorders, (3) interaction strategies, (4) time and place of interactions and (5) organisational aspects. Meeting the individual interactional needs of informal caregivers is recommended. The results provide guidance for improving the quality of interactions between nursing personnel and informal caregivers.
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Affiliation(s)
| | - Jenny Paananen
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
| | - Minna Stolt
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Satakunta Wellbeing Services CountyPoriFinland
| | - Riitta Suhonen
- Department of Nursing ScienceUniversity of TurkuTurkuFinland
- Turku University Hospital and Wellbeing Services County of Southwest FinlandTurkuFinland
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Pini JDS, Nacamura PAB, Harmuch C, Costa MAR, Giacon-Arruda BCC, Radovanovic CAT, Salci MA, Paiano M. Assessment of the Psychosocial Care Center multidisciplinary team from users' and family members' perspective. Rev Bras Enferm 2023; 76:e20220645. [PMID: 37610952 PMCID: PMC10441209 DOI: 10.1590/0034-7167-2022-0645] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/23/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVES to assess the multidisciplinary team of a Psychosocial Care Center I from users' and family members' perspective. METHODS an evaluative study, anchored in the fourth generation evaluation theoretical-methodological framework, carried out in a Psychosocial Care Center I, from September 2021 to March 2022. Eleven users and 06 family members participated. Data were collected through non-participant observation, individual interviews and negotiation sessions, and analyzed using the Constant Comparative Method, using the MAXQDA software. RESULTS the team develops its care based on individual and collective care, with integrated and complementary work by professionals. They seek to facilitate treatment initiation and continuation, considering health needs and offering support, understanding and guidance to users and their families. FINAL CONSIDERATIONS the multidisciplinary team's work is based on the psychosocial paradigm, which can qualify care and strengthen the service role in the mental health network.
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Affiliation(s)
- Jéssica dos Santos Pini
- Universidade Estadual de Maringá. Maringá, Paraná, Brazil
- Universidade Estadual do Paraná. Paranavaí, Paraná, Brazil
| | | | - Camila Harmuch
- Universidade Estadual de Maringá. Maringá, Paraná, Brazil
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Lee Y, Ryu M. Sleep-related problems as a mediator in the association between depression and work-family conflict in middle-aged female workers: A population-based study. Nurs Open 2023. [PMID: 37114859 DOI: 10.1002/nop2.1783] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 12/24/2022] [Accepted: 04/15/2023] [Indexed: 04/29/2023] Open
Abstract
AIM To investigate the mediating effect of sleep-related problems on the relationship between depression and work-family conflicts (WFCs) among middle-aged female workers. DESIGN Secondary analysis of cross-sectional study. METHODS Overall, 15,718 female workers aged 40-65 years from the Sixth Korean Working Conditions Survey (KWCS) were included. Depression was assessed using the WHO-5 wellbeing index; sleep-related problems and WFCs were measured with five items on a Likert scale. The mediating effect of sleep-related problems between depression and WFCs was analysed using model 4 of Hayes PROCESS macro for SPSS. RESULTS There was a significant positive correlation between depression and both sleep-related problems (r = 0.225, p < 0.001) and WFCs (r = 0.124, p < 0.001). Depression also had a significant effect on sleep-related problems (β = 0.221, p < 0.001) and WFCs (β=0.061, p < 0.001). Sleep-related problems had a significant effect on WFCs (β = 0.282, p < 0.001). The indirect effect of depression on WFCs by mediating sleep-related problems was β = 0.062 (95% bootstrap confidence interval = 0.057-0.068). The study also confirmed the significance of the mediating effect of sleep-related problems in the relationship between depression and WFCs.
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Affiliation(s)
- Yoonjeong Lee
- Department of Nursing, Hyejeon College, Hongseong-gun, Korea
| | - Mikyung Ryu
- Department of Nursing, College of Nursing, Daegu University, Daegu, Korea
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Mei W, Wu J, Zoghbi-Manrique-de-Lara P, Liu L, He Y, Song M. Lose at sunrise, but gain at sunset: Linking social cyberloafing to psychological detachment, personal life enhancement of work, and mental health. Work 2022; 75:339-348. [PMID: 36591686 DOI: 10.3233/wor-220126] [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: 12/31/2022] Open
Abstract
BACKGROUND Previous research has demonstrated that the personal use of social media, i.e., social cyberloafing, is associated with employee mental health. However, the underlying mechanism through which social cyberloafing is related to mental health has received limited attention. OBJECTIVE Drawing on conservation of resource theory and work/nonwork enhancement literatures, we developed and tested a model that examines health effect of social cyberloafing. As such, employees' social cyberloafing is posited as positively related to psychological detachment and personal life enhancement of work, which in turn would act as mediators that explain why social cyberloafing improves mental health. METHODS Data from 375 Chinese employees were analyzed to test research hypotheses using the structural equation modeling and bias-corrected bootstrap method with Mplus 7.4. RESULTS The results found that social cyberloafing is positively related to psychological detachment, but not with personal life enhancement of work. Social cyberloafing was positively related to employees' mental health through both psychological detachment and through psychological detachment and personal life enhancement of work serially. CONCLUSION Psychological detachment alone and alongside personal life enhancement of work form part of the mechanisms explaining how and why engaging in social cyberloafing is positively associated with employees' mental health. These mechanisms offer insights to organizations into how the mental health of employees can be improved in the digital workplace.
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Affiliation(s)
- Wenjuan Mei
- School of Management, Jinan University, Guangzhou, P.R. China
| | - Jinnan Wu
- Research Institute of Decision and Behavior Science, School of Business, Anhui University of Technology, Ma'anshan, P.R. China
| | | | - Lin Liu
- School of Management Science and Engineering, Anhui University of Technology, Ma'anshan, P.R. China
| | - Ying He
- Research Institute of Decision and Behavior Science, School of Business, Anhui University of Technology, Ma'anshan, P.R. China
| | - Mengmeng Song
- School of Management, Xi'an Jiaotong University, Xi'an, P.R. China
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Maaskant JM, van Wessel IME, Seller-Boersma AS, Jongerden I, Paulus F, Eskes AM. Nurses' Attitudes Regarding Family-Centered Care: Psychometric Properties and Survey Findings. J Nurs Meas 2022; 30:733-747. [PMID: 36526421 DOI: 10.1891/jnm-d-21-00024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Background and Purpose: Measuring the attitude of nurses toward the importance of involving families in nursing care is essential to implement family-centered care. We aim to examine the reliability and factor structure of the Families' Importance in Nursing Care-Nurses' Attitudes questionnaire (FINC-NA-R). Methods: The psychometric properties of the FINC-NA-R were tested and the Dutch-revised version was used to assess the attitude of the nurses. Results: Principal component analysis confirmed a four-factor structure and the removal of four items achieved strong evidence of structural validity and internal consistency. Conclusions: The Dutch FINC-NA-R appeared to be a valid instrument to measure the attitude of nurses toward family-centered care.
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Abstract
UNLABELLED Family presence on rounds involves allowing family members to participate in daily healthcare team rounds and is recommended by critical care professional societies. Yet, family presence on rounds is not performed in many institutions. There is a need to synthesize the current evidence base for this practice to inform healthcare providers of the potential benefits and challenges of this approach. The main objective of this study was to explore the impact of family presence on adult ICU rounds on family and healthcare providers. DATA SOURCES Ovid Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, and PubMed databases were last searched on January 28, 2022. Studies published during the COVID-19 pandemic were included. STUDY SELECTION Studies involving family presence during rounds that included family or healthcare provider perspectives or outcomes were selected. There were no limitations on study design. DATA EXTRACTION Qualitative and quantitative family and provider perspectives, barriers and challenges to family presence, and study outcomes were extracted from studies. The JBI Manual for Evidence Synthesis published guidelines were followed. DATA SYNTHESIS There were 16 studies included. Family reported family presence on rounds as a means of information transfer and an opportunity to ask care-related questions. Family presence on rounds was associated with increased family satisfaction with care, physician comfort, and improved physician-family relationship. Healthcare providers reported a positive perception of family presence on rounds but were concerned about patient confidentiality and perceived efficacy of rounds. Family presence was found to increase rounding time and was felt to negatively impact teaching and opportunities for academic discussions. CONCLUSIONS Family presence on rounds has potential advantages for family and healthcare providers, but important challenges exist. Further studies are needed to understand how to best implement family presence on adult ICU rounds.
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Afif IN, Goldberg AJ, Zhao H, O'Shaughnessy GD, Kling SM, Nathan HM, Hasz RD, Dauer ED. Formal Training Improves Resident Understanding and Communication Regarding Brain Death/Death by Neurologic Criteria. J Surg Educ 2022; 79:198-205. [PMID: 34507909 DOI: 10.1016/j.jsurg.2021.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/02/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Residents often are involved in discussions with families regarding brain death/death by neurologic criteria (BD/DNC); however, they receive no standardized training on this topic. We hypothesized that residents are uncomfortable with explaining BD/DNC and that formal didactic and simulated training will improve residents' comfort and skill in discussions surrounding BD/DNC. DESIGN We partnered with our organ procurement organization (OPO) to create an educational program regarding BD/DNC consisting of a didactic component, and role-play scenarios with immediate individualized feedback. Residents completed pre- and post-training surveys. SETTING This study included participants from 16 academic and community institutions across New Jersey, Pennsylvania, and Delaware that are within our OPO's region. PARTICIPANTS Subjects were recruited using convenience sampling based on the institution and training programs' willingness to participate. A total of 1422 residents at participated in the training from 2009 to 2020. 1389 (97.7%) participants competed the pre-intervention survey, while 1361 (95.7%) completed the post-intervention survey. RESULTS Prior to the training, only 56% of residents correctly identified BD/DNC as synonymous with death. Additionally, 40% of residents had explained BD/DNC to families at least once, but 41% of residents reported never having been taught how to do so. The biggest fear reported in discussing BD/DNC with families was being uncomfortable in explaining BD/DNC (48%). After participating in the training, 99% of residents understood the definition of BD/DNC and 92% of residents felt comfortable discussing BD/DNC with families. CONCLUSIONS Participation in a standardized curriculum improves residents' understanding of BD/DNC and their comfort in discussing BD/DNC with families.
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Affiliation(s)
- Iman N Afif
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania.
| | - Amy J Goldberg
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
| | - Huaqing Zhao
- Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | | | - Sarah M Kling
- Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania
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Seifart C, Falch M, Wege M, Maier RF, Pedrosa Carrasco AJ. NEO-SPEAK: A conceptual framework that underpins breaking bad news in neonatology. Front Pediatr 2022; 10:1044210. [PMID: 36440326 PMCID: PMC9681898 DOI: 10.3389/fped.2022.1044210] [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] [Received: 09/14/2022] [Accepted: 10/19/2022] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE Breaking bad news in neonatology is a frequent and difficult challenge. Although there are guidelines for communicating with parents in pediatrics and neonatology, the specific framework for breaking bad news in neonatology has not been studied in more detail. Therefore, we aimed to identify determinants that are important for successful managing breaking bad news in neonatology from professionals' perspective and to develop a conceptual framework that underpins this challenging task. METHODS We conducted seventeen semi-structured interviews with senior neonatologists of six perinatal centers of the highest level of care in Germany. The transcripts were analyzed according to Mayring's method of qualitative content analysis using inductive and deductive coding. RESULTS Eight determinants of breaking bad news in neonatology could be identified from the interviews. From these, we developed the conceptual framework NEO-SPEAK. The first three determinants, Neonatal prognostic uncertainty, Encounter in (triangular-)partnerships, Organization and teamwork (NEO) are directly related to the specific care situation in neonatology, whereas the others, Situational stress, Processuality, Emotional burden, Attention to individuality, Knowledge and experience, play a role for difficult conversations in general, but are subject to special modifications in neonatology (SPEAK). In addition, the results show that the context in neonatology as well as reciprocal effects on the team and the individual level of the physicians are important influencing factors in breaking bad news. CONCLUSION On the one hand, the constitutional framework NEO-SPEAK shows which special aspects play a role in neonatology for the delivery of bad news, and on the other hand, it can help to identify and consider these aspects in clinical routine and training. Considering or reinforcing each NEO-SPEAK element when planning or delivering bad news may guide healthcare professionals through communication with parents of critically ill or premature newborns and support the resilience of the caring team.
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Affiliation(s)
- Carola Seifart
- Faculty of Medicine, Dean's Office, Research Group Medical Ethics (AGEM), Philipps-University of Marburg, Marburg, Germany
| | - Mirjam Falch
- Faculty of Medicine, Dean's Office, Research Group Medical Ethics (AGEM), Philipps-University of Marburg, Marburg, Germany
| | - Mirjam Wege
- Children's Hospital, University Hospital of Marburg, Marburg, Germany
| | - Rolf F Maier
- Faculty of Medicine, Philipps University of Marburg, Marburg, Germany
| | - Anna J Pedrosa Carrasco
- Faculty of Medicine, Dean's Office, Research Group Medical Ethics (AGEM), Philipps-University of Marburg, Marburg, Germany
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Vandewalle J, Debyser B, Deproost E, Verhaeghe S. Family expectations of inpatient mental health services for adults with suicidal ideation: a qualitative study. Int J Ment Health Nurs 2021; 30:1136-1148. [PMID: 33817944 DOI: 10.1111/inm.12864] [Citation(s) in RCA: 1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 12/15/2022]
Abstract
Involvement of family members of adults with suicidal ideation is a key area of improvement in inpatient mental health services. To support family involvement in this context, it is crucial to understand what care and treatment family members expect for their relative. This qualitative study based on grounded theory involved interviews with 14 family members, including partners, parents, adult children and siblings. The family members' expectations of care and treatment in inpatient mental health services were captured by the core element 'Struggling to remain hopeful while looking through the lens of uncertainty'. This core element interacted with four sub-elements: assuming safety as a priority, looking for a healing approach and environment, counting on continuity of care and wanting to be involved and supported. The family members fluctuated between hope and uncertainty depending on whether their expectations were met or unmet. Unmet expectations were common and underpinned by a sense of being marginalized during the admission of their relative with suicidal ideation. Mental health professionals, including nurses, can be more empathetic towards the family members and attuned to their expectations. This can underpin partnerships that help families to deal with their feelings of uncertainty and disempowerment. Such partnerships can flourish in recovery-oriented mental health services that allow meaningful family involvement.
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Affiliation(s)
- Joeri Vandewalle
- University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Psychiatric Centre Sint-Amandus, Beernem, Belgium
| | - Bart Debyser
- University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Centre for Psychiatry and Psychotherapy, Clinic Sint-Jozef, Pittem, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium
| | - Eddy Deproost
- University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Centre for Psychiatry and Psychotherapy, Clinic Sint-Jozef, Pittem, Belgium
| | - Sofie Verhaeghe
- University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium.,Department of Nursing, VIVES University College, Roeselare, Belgium
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13
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Aasen L, Johannessen AK, Ruud Knutsen I, Werner A. The work of nurses to provide good and safe services to children receiving hospital-at-home: A qualitative interview study from the perspectives of hospital nurses and physicians. J Clin Nurs 2021; 31:2495-2506. [PMID: 34570945 DOI: 10.1111/jocn.16062] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 05/31/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 10/20/2022]
Abstract
AIM To explore and describe the work performed by the nurses providing hospital-at-home care to children and their families from the perspectives of hospital nurses and physicians. BACKGROUND To reduce capacity pressure on hospitals, various ambulatory services combining hospital and home treatment have emerged. Studies have shown that children and their families are satisfied with hospital-at-home when the parents experienced the professionals possessed the necessary competences. Knowledge is limited about nurses and physicians' perspectives on the work performed and competence needed when children receive hospital treatment in the family's home. DESIGN A qualitative descriptive design with semi-structured interviews was used. Sixteen nurses and physicians from two hospitals in Norway working in hospital-at-home for children were recruited to interview. Data were analysed using systematic text condensation. In preparing the manuscript, we applied the COREQ guidelines. The theory on 'expert nursing' supported the discussion of results. RESULTS We identified three categories through analysis; building a trustful relationship with the family and the sick child; performing essential skills in paediatric nursing care in hospital-at-home; and nurses serving as the 'hub' between the different parties. CONCLUSION The results demonstrate the complexity of the work performed by hospital nurses when children received hospital-at-home. Building a trustful relationship and alliance with the child and the family formed the cornerstone of accomplishing good and safe paediatric care. The nurses became a coordinating and collaborating 'hub' for actors involved, taking care of patient safety on a daily basis. RELEVANCE TO CLINICAL PRACTICE The way the nurses approached the children and their families, was the core element of the paediatric nursing expertise and important for the service quality and patient safety. The importance of building a trustful relationship needs to be more acknowledged, and the services would benefit to organise this through continuity of care.
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Affiliation(s)
- Line Aasen
- Faculty of Health Sciences, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Anne-Kari Johannessen
- Faculty of Health Sciences, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway.,Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Ingrid Ruud Knutsen
- Faculty of Health Sciences, Institute of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Anne Werner
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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14
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Thirsk LM, Vandall-Walker V, Rasiah J, Keyko K. A Taxonomy of Supports and Barriers to Family-Centered Adult Critical Care: A Qualitative Descriptive Study. J Fam Nurs 2021; 27:199-211. [PMID: 33769127 PMCID: PMC8361475 DOI: 10.1177/1074840721999372] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Family-centered care (FCC) improves the quality and safety of health care provision, reduces cost, and improves patient, family, and provider satisfaction. Despite several decades of advocacy, research, and evidence, there are still challenges in uptake and adoption of FCC practices in adult critical care. The objective of this study was to understand the supports and barriers to family-centered adult critical care (FcACC). A qualitative descriptive design was used to develop a taxonomy. Interviews and focus groups were conducted with 21 participants in Alberta, Canada, from 2013 to 2014. Analysis revealed two main domains of supports and barriers to FcACC: PEOPLE and STRUCTURES. These domains were further classified into concepts and subconcepts that captured all the reported data. Many factors at individual, group, and organizational levels influenced the enactment of FcACC. These included health care provider beliefs, influence of primary versus secondary tasks, perceptions of family work, nurses' emotional labor, and organizational culture.
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Affiliation(s)
| | | | | | - Kacey Keyko
- Edmonton Southside Primary Care
Network, Alberta, Canada
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15
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Haine-Schlagel R, Rieth S, Dickson KS, Brookman-Frazee L, Stahmer A. Adapting parent engagement strategies for an evidence-based parent-mediated intervention for young children at risk for autism spectrum disorder. J Community Psychol 2020; 48:1215-1237. [PMID: 32237157 DOI: 10.1002/jcop.22347] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 06/15/2019] [Revised: 01/31/2020] [Accepted: 03/11/2020] [Indexed: 06/11/2023]
Abstract
AIMS Aims included (a) characterizing provider feedback on parent engagement strategies integrated into a parent-mediated intervention for toddlers at risk for autism spectrum disorder (ASD) and (b) identifying provider characteristics that predict attitudes about parent engagement strategies. METHODS A mixed method approach was utilized, including gathering quantitative data via survey (breadth) and collecting qualitative data via interview (depth). Acceptability, utility, appropriateness, sustainment, generalizability, and perceived effectiveness were examined. Fourteen agency leaders and 24 therapists provided input. RESULTS Providers perceived the integration of parent engagement strategies as having a positive impact on implementation. Providers considered the strategies to be acceptable, appropriate, and effective, though barriers of time and complexity were noted. Provider characteristics did not consistently predict attitudes about the engagement strategies. CONCLUSIONS Incorporating parent engagement strategies into parent-mediated interventions for ASD is well-received by providers and may improve quality of service delivery for families served in early intervention for ASD.
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Affiliation(s)
- Rachel Haine-Schlagel
- Department of Child and Family Development, San Diego State University, San Diego, California
- Child & Adolescent Services Research Center, San Diego, California
| | - Sarah Rieth
- Department of Child and Family Development, San Diego State University, San Diego, California
- Child & Adolescent Services Research Center, San Diego, California
| | - Kelsey S Dickson
- Department of Child and Family Development, San Diego State University, San Diego, California
- Child & Adolescent Services Research Center, San Diego, California
| | - Lauren Brookman-Frazee
- Child & Adolescent Services Research Center, San Diego, California
- Department of Psychiatry, University of California, San Diego, California
| | - Aubyn Stahmer
- Child & Adolescent Services Research Center, San Diego, California
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, California
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16
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Wilson ME, Dobler CC, Zubek L, Gajic O, Talmor D, Curtis JR, Hinds RF, Banner-Goodspeed VM, Mueller A, Rickett DM, Elo G, Filipe M, Szucs O, Novotny PJ, Piers RD, Benoit DD. Prevalence of Disagreement About Appropriateness of Treatment Between ICU Patients/Surrogates and Clinicians. Chest 2019; 155:1140-1147. [PMID: 30922949 DOI: 10.1016/j.chest.2019.02.404] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [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: 07/30/2018] [Revised: 01/24/2019] [Accepted: 02/19/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND ICU patients/surrogates may experience adverse outcomes related to perceived inappropriate treatment. The objective was to determine the prevalence of patient/surrogate-reported perceived inappropriate treatment, its impact on adverse outcomes, and discordance with clinicians. METHODS We conducted a multicenter, prospective, observational study of adult ICU patients. RESULTS For 151 patients, 1,332 patient, surrogate, nurse, and physician surveys were collected. Disagreement between patients/surrogates and clinicians regarding "too much" treatment being administered occurred in 26% of patients. Disagreement regarding "too little" treatment occurred in 10% of patients. Disagreement about perceived inappropriate treatment was associated with prognostic discordance (P = .02) and lower patient/surrogate satisfaction (Likert scale 1-5 of 4 vs 5; P = .02). Patient/surrogate respondents reported "too much" treatment in 8% of patients and "too little" treatment in 6% of patients. Perceived inappropriate treatment was associated with moderate or high respondent distress for 55% of patient/surrogate respondents and 35% of physician/nurse respondents (P = .30). Patient/surrogate perception of inappropriate treatment was associated with lower satisfaction (Family Satisfaction in the ICU Questionnaire-24, 69.9 vs 86.6; P = .002) and lower trust in the clinical team (Likert scale 1-5 of 4 vs 5; P = .007), but no statistically significant differences in depression (Patient Health Questionnaire-2 of 2 vs 1; P = .06) or anxiety (Generalized Anxiety Disorder-7 Scale of 7 vs 4; P = .18). CONCLUSIONS For approximately one-third of ICU patients, there is disagreement between clinicians and patients/surrogates about the appropriateness of treatment. Disagreement about appropriateness of treatment was associated with prognostic discordance and lower patient/surrogate satisfaction. Patients/surrogates who reported inappropriate treatment also reported lower satisfaction and trust in the ICU team.
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Affiliation(s)
- Michael E Wilson
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.
| | | | - Laszlo Zubek
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Ognjen Gajic
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Daniel Talmor
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - J Randall Curtis
- Division of Pulmonary, Critical Care, and Sleep Medicine, Harborview Medical Center, University of Washington, Seattle, WA
| | - Richard F Hinds
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Valerie M Banner-Goodspeed
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Ariel Mueller
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Dee M Rickett
- Department of Critical Care and Palliative Care, Henry Mayo Hospital, Valencia, CA
| | - Gabor Elo
- Department of Anesthesiology and Intensive Therapy, Semmelweis University, Budapest, Hungary
| | - Mario Filipe
- Department of Anesthesiology and Intensive Therapy, St. Stephen and St. Ladislaus Combined Hospital, Budapest, Hungary
| | - Orsolya Szucs
- Department of Surgery, Semmelweis University, Budapest, Hungary
| | - Paul J Novotny
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN
| | - Ruth D Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Dominique D Benoit
- Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium
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17
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Sarantópoulos A, Pereira JDA, Lamas JLT, Silva EM. Healthcare and discourse: exploration of interprofessional learning within a Brazilian context. J Interprof Care 2018; 33:570-572. [PMID: 30358456 DOI: 10.1080/13561820.2018.1538939] [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: 10/28/2022]
Abstract
This paper reports a qualitative study on the contribution of a Program of Education through Work (PET) in Healthcare, based at a Brazilian State University, to interprofessional education. Data were collected from ten undergraduate students of Nursing, Medicine, and Phonoaudiology (speech therapy), who were part of PET at the University. Data were analyzed using the Discourse of the Collective Subject technique. Central ideas were gathered into three categories: (1) teamwork and interprofessionality; (2) PET influences on SUS (Brazilian Unified Health System); (3) teaching-service-community integration. The study found evidence that PET enabled the students with opportunities to be involved in an education that supported the SUS principles and guidelines and to engage with interprofessional learning where there were exchanges of different professional experiences. The PET also supported the development of critical thinking for professional performance, as well as an integrated teaching experience that could support community development.
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Affiliation(s)
- Alice Sarantópoulos
- School of Medical Sciences, University of Campinas , Campinas , São Paulo , Brazil
| | | | | | - Eliete Maria Silva
- School of Nursing, University of Campinas , Campinas , São Paulo , Brazil
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18
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Abstract
The therapeutic alliance between pediatricians and parents begins at the initial encounter. The manner in which pediatricians greet family members influences this relationship. This study evaluated whether parents are addressed using generic titles and investigated perceptions of parents regarding how they are addressed by medical staff. Written surveys of 137 parents of pediatric inpatients collected opinions about greetings during medical encounters. Parents were asked if they have been addressed as Mom/Dad/Mommy/Daddy during past medical encounters and which generic titles they would prefer. Using a Likert-type scale, the parents' perceptions of various salutations were assessed and compared. In this sample, 86% of parents were previously called Mom/Dad/Mommy/Daddy. Parents preferred to be addressed as Mom or Dad over other generic titles. Many disliked being addressed as Mommy/Daddy, Ma'am/Sir, or without a name, suggesting that providers should avoid the use of these salutations.
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Affiliation(s)
- Lisa Wilks-Gallo
- 1 Stony Brook Children's Hospital, Stony Brook, NY, USA.,2 Stony Brook University School of Medicine, Stony Brook, NY, USA.,3 Stony Brook Medicine, Stony Brook, NY, USA
| | - Chaim Zev Aron
- 1 Stony Brook Children's Hospital, Stony Brook, NY, USA.,2 Stony Brook University School of Medicine, Stony Brook, NY, USA.,3 Stony Brook Medicine, Stony Brook, NY, USA
| | - Catherine R Messina
- 1 Stony Brook Children's Hospital, Stony Brook, NY, USA.,2 Stony Brook University School of Medicine, Stony Brook, NY, USA.,3 Stony Brook Medicine, Stony Brook, NY, USA
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19
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Armoiry X, Sturt J, Phelps EE, Walker CL, Court R, Taggart F, Sutcliffe P, Griffiths F, Atherton H. Digital Clinical Communication for Families and Caregivers of Children or Young People With Short- or Long-Term Conditions: Rapid Review. J Med Internet Res 2018; 20:e5. [PMID: 29305339 PMCID: PMC5775486 DOI: 10.2196/jmir.7999] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [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: 05/22/2017] [Revised: 09/15/2017] [Accepted: 11/04/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The communication relationship between parents of children or young people with health conditions and health professionals is an important part of treatment, but it is unclear how far the use of digital clinical communication tools may affect this relationship. OBJECTIVE The objective of our study was to describe, assess the feasibility of, and explore the impact of digital clinical communication between families or caregivers and health professionals. METHODS We searched the literature using 5 electronic databases. We considered all types of study design published in the English language from January 2009 to August 2015. The population of interest included families and caregivers of children and young people aged less than 26 years with any type of health condition. The intervention was any technology permitting 2-way communication. RESULTS We included 31 articles. The main designs were randomized controlled trials (RCTs; n=10), cross-sectional studies (n=9), pre- and postintervention uncontrolled (pre/post) studies (n=7), and qualitative interview studies (n=2); 6 had mixed-methods designs. In the majority of cases, we considered the quality rating to be fair. Many different types of health condition were represented. A breadth of digital communication tools were included: videoconferencing or videoconsultation (n=14), and Web messaging or emails (n=12). Health care professionals were mainly therapists or cognitive behavioral therapists (n=10), physicians (n=8), and nurses (n=6). Studies were very heterogeneous in terms of outcomes. Interventions were mainly evaluated using satisfaction or acceptance, or outcomes relating to feasibility. Clinical outcomes were rarely used. The RCTs showed that digital clinical communication had no impact in comparison with standard care. Uncontrolled pre/post studies showed good rates of satisfaction or acceptance. Some economic studies suggested that digital clinical communication may save costs. CONCLUSIONS This rapid review showed an emerging body of literature on the use of digital clinical communication to improve families' and caregivers' involvement in the health management of children or young people. Further research with appropriate study designs and longer-term outcome measures should be encouraged. TRIAL REGISTRATION PROSPERO CRD42016035467; http://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD 42016 035467(Archived by WebCite at http://www.webcitation.org/6vpgZU1FU).
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Affiliation(s)
- Xavier Armoiry
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, Kings College London, London, United Kingdom
| | | | | | - Rachel Court
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Frances Taggart
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Paul Sutcliffe
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Frances Griffiths
- Warwick Medical School, University of Warwick, Coventry, United Kingdom.,Centre for Health Policy, University of the Witwatersrand, Johannesburg, South Africa
| | - Helen Atherton
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
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20
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Andersen IC, Thomsen TG, Bruun P, Bødtger U, Hounsgaard L. Patients' and their family members' experiences of participation in care following an acute exacerbation in chronic obstructive pulmonary disease: A phenomenological-hermeneutic study. J Clin Nurs 2017; 26:4877-4889. [PMID: 28722760 DOI: 10.1111/jocn.13963] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2017] [Indexed: 12/01/2022]
Abstract
AIM AND OBJECTIVES To explore the experiences of patients with chronic obstructive pulmonary disease and their family members relating both to participation in care during hospitalisation for an acute exacerbation in chronic obstructive pulmonary disease, and to the subsequent day-to-day care at home. BACKGROUND When recovering from an exacerbation, the challenges associated with an unpredictable health condition dominate everyday life for patients and can involve their family members. Proper patient and family participation in care during discharge and follow-up can help patients to improve self-management. However, knowledge of the significance of patient and family participation for recovery and subsequent everyday life is still limited. DESIGN This study adopted a longitudinal design informed by ethnographic fieldwork principles. METHODS Participant observations and interviews with 15 patients and 12 family members were conducted on a Danish hospital ward and twice at the participants' homes. A phenomenological-hermeneutic approach inspired by Ricoeur's theory of interpretation guided the data analysis. RESULTS Participation in care was perceived as valuable, but could be associated with tensions and increased uncertainty. While patients mostly demonstrated a reactive approach to care, family members strived to be more proactive. In hospital, preparing for discharge included an effort to find a balance between powerlessness and influence during interactions with healthcare professionals. At home, managing further recovery and self-management were characterised by navigating between mutual pressure and consideration within the family. CONCLUSION Family members play an important role in ensuring that patients are seen, heard and understood, but want to be acknowledged more by healthcare professionals. Appropriate interactions with healthcare professionals are crucial in order to support discharge and daily self-management. RELEVANCE TO CLINICAL PRACTICE Knowledge of the challenges that patients with chronic obstructive pulmonary disease and their family members face in participating in care activities could inform future development of family-centred care approaches tailored to individual needs.
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Affiliation(s)
- Ingrid Charlotte Andersen
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Department of Medicine, Slagelse Hospital, Slagelse, Denmark
| | - Thora Grothe Thomsen
- Zealand University Hospital, Roskilde and Koege, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Poul Bruun
- Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark
| | - Uffe Bødtger
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Department of Respiratory Medicine, Naestved Hospital, Denmark
| | - Lise Hounsgaard
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Health Sciences Research Center, University College Lillebaelt, Vejle, Denmark
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21
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Kasthurirathne SN, Mamlin BW, Cullen T. Leveraging the Value of Human Relationships to Improve Health Outcomes. Lessons learned from the OpenMRS Electronic Health Record System. Appl Clin Inform 2017; 8:108-121. [PMID: 28144679 DOI: 10.4338/aci-2016-08-ra-0139] [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: 08/15/2016] [Accepted: 11/30/2016] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES Despite significant awareness on the value of leveraging patient relationships across the healthcare continuum, there is no research on the potential of using Electronic Health Record (EHR) systems to store structured patient relationship data, or its impact on enabling better healthcare. We sought to identify which EHR systems supported effective patient relationship data collection, and for systems that do, what types of relationship data is collected, how this data is used, and the perceived value of doing so. MATERIALS AND METHODS We performed a literature search to identify EHR systems that supported patient relationship data collection. Based on our results, we defined attributes of an effective patient relationship model. The Open Medical Record System (OpenMRS), an open source medical record platform for underserved settings met our eligibility criteria for effective patient relationship collection. We performed a survey to understand how the OpenMRS patient relationship model was used, and how it brought value to implementers. RESULTS The OpenMRS patient relationship model has won widespread adoption across many implementations and is perceived to be valuable in enabling better health care delivery. Patient relationship information is widely used for community health programs and enabling chronic care. Additionally, many OpenMRS implementers were using this feature to collect custom relationship types for implementation specific needs. CONCLUSIONS We believe that flexible patient relationship data collection is critical for better healthcare, and can inform community care and chronic care initiatives across the world. Additionally, patient relationship data could also be leveraged for many other initiatives such as patient centric care and in the field of precision medicine.
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Affiliation(s)
- Suranga N Kasthurirathne
- Suranga N. Kasthurirathne, Indiana University School of Informatics and Computing, Indianapolis, IN,
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22
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Riley JL 3rd, Gordan VV, Hudak-Boss SE, Fellows JL, Rindal DB, Gilbert GH; National Dental Practice-Based Research Network Collaborative Group. Concordance between patient satisfaction and the dentist's view: findings from The National Dental Practice-Based Research Network. J Am Dent Assoc 2014; 145:355-62. [PMID: 24686969 DOI: 10.14219/jada.2013.32] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In this study, the authors examined the dentist's view of the patient's experience and concordance with the patient's rating of satisfaction. METHODS Practitioners from 197 practices in The National Dental Practice-Based Research Network recruited consecutively seen patients who had defective restorations that were replaced or repaired. At the end of the dental visit, the treating dentist and 5,315 patients completed and returned a survey that asked about the patient's satisfaction. RESULTS Most dentists viewed their patients as having been satisfied with the treatment experience (n = 4,719 [89 percent]) and as having perceived them as friendly (n = 5,136 [97 percent]). Dentists had less strong feelings about whether patients had a preference for the restorative material (n = 2,271 [43 percent]) or an interest in obtaining information about the procedure (n = 1,757 [33 percent]). Overall, patients were satisfied, and most of the time dentists correctly predicted this outcome. Among patients who were less than satisfied, there was a substantial subset of cases in which dentists were not aware of this dissatisfaction. CONCLUSION For improved patient-centered care, dentists should assess patients' desires, expectations and perceptions of the dental care experience and then manage or correct the expectations and perceptions as needed. PRACTICAL IMPLICATIONS By taking a patient-centered approach, dentists should seek to understand how patients evaluate and rate the services provided, thereby enabling them to focus on what each patient values most.
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Svendsen EJ, Moen A, Pedersen R, Bjørk IT. Parent-healthcare provider interaction during peripheral vein cannulation with resistive preschool children. J Adv Nurs 2015; 72:620-30. [PMID: 26577353 DOI: 10.1111/jan.12852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [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: 10/05/2015] [Indexed: 12/28/2022]
Abstract
AIM The aim of this study was to increase understanding of parent-healthcare provider interaction in situations where newly admitted preschool children resist peripheral vein cannulation. BACKGROUND Parent-healthcare provider interaction represents an important context for understanding children's resistance to medical procedures. Knowledge about this interaction can provide a better understanding of how restraint is used and talked about. Symbolic interactionism informed the understanding of interaction. DESIGN An exploratory, qualitative study was chosen because little is known about these interactions. METHODS During 2012-2013, 14 naturalistic peripheral vein cannulation -attempts with six newly hospitalized preschool children were video recorded. Eight parents/relatives, seven physicians and eight nurses participated in this study. The analytical foci of turn-taking and participant structure were used. RESULTS The results comprised three patterns of interactions. The first pattern, 'parents supported the interaction initiated by healthcare providers', was a response to the children's expressed resistance and they performed firm restraint together. The second pattern, 'parents create distance in interaction with healthcare providers', appeared after failed attempts and had a short time span. Parents stopped following up on the healthcare providers' interaction and their restraint became less firm. In the third pattern, 'healthcare providers reorient in interaction', healthcare providers took over more of the restraint and either helped each other to continue the interaction or they stopped it. CONCLUSION Knowledge about the identified patterns of interactions can help healthcare providers to better understand and thereby prepare both parents and themselves for situations with potential use of restraint.
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Affiliation(s)
| | - Anne Moen
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Oslo, Norway
| | - Reidar Pedersen
- Centre for Medical Ethics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway
| | - Ida Torunn Bjørk
- Institute of Nursing and Health Sciences, Faculty of Medicine, University of Oslo, Norway
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24
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Hobbs GS, Landrum MB, Arora NK, Ganz PA, van Ryn M, Weeks JC, Mack JW, Keating NL. The role of families in decisions regarding cancer treatments. Cancer 2015; 121:1079-87. [PMID: 25708952 DOI: 10.1002/cncr.29064] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 08/14/2014] [Accepted: 08/26/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Shared decision-making is an important component of patient-centered care and is associated with improved outcomes. To the authors' knowledge, little is known concerning the extent and predictors of the involvement of a patient's family in decisions regarding cancer treatments. METHODS The Cancer Care Outcomes Research and Surveillance (CanCORS) Consortium is a large, multiregional, prospective cohort study of the cancer care and outcomes of patients with lung and colorectal cancer. Participants reported the roles of their families in decision-making regarding treatment. Multinomial logistic regression was used to assess patient factors associated with family roles in decisions. RESULTS Among 5284 patients, 80 (1.5%) reported family-controlled decisions, with the highest adjusted rates (12.8%) noted among non-English-speaking Asians. Among the 5204 remaining patients, 49.4% reported equally sharing decisions with family, 22.1% reported some family input, and 28.5% reported little family input. In adjusted analyses, patients who were married, female, older, and insured more often reported equally shared decisions with family (all P <.001). Adjusted family involvement varied by race/ethnicity and language, with Chinese-speaking Asian (59.8%) and Spanish-speaking Hispanic (54.8%) patients equally sharing decisions with family more often than white individuals (47.6%). Veterans Affairs patients were least likely to report sharing decisions with family, even after adjustment for marital status and social support (P <.001). CONCLUSIONS The majority of patients with newly diagnosed lung or colorectal cancer involve family members in treatment decisions. Non-English-speaking Asians and Hispanics rely significantly on family. Further studies are needed to determine the impact of family involvement in treatment decisions on outcomes; until then, physicians should consider eliciting patients' preferences for family involvement.
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Affiliation(s)
- Gabriela S Hobbs
- Department of Medical Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts
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25
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Maring J, Croarkin E, Morgan S, Plack M. Perceived effectiveness and barriers to physical therapy services for families and children with Friedreich ataxia. Pediatr Phys Ther 2013; 25:305-13. [PMID: 23685741 DOI: 10.1097/PEP.0b013e31828ed7cb] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe the frequency, type, and perceived effectiveness of physical therapy interventions for children with Friedreich ataxia (FA); identify barriers to therapy; and solicit advice from parents. METHOD Parents of 30 children with FA participated in semistructured interviews. Qualitative and quantitative methods were used to analyze the data. RESULTS Sixty-seven percent of children received direct physical therapy service. Stretching and strengthening exercises were used most frequently, and their perceived usefulness increased as the children aged. Seventy-three percent received home exercise programs; 9% implemented these consistently. External barriers included a lack of expert providers and limited reimbursement. Internal barriers included limited time and energy, lack of awareness of services, and children's preferences not to be treated differently. Parents advised therapists to become experts, advocates, and use approaches based on family and child preferences. CONCLUSIONS Outcomes provide a starting point for developing further research, education, and effective interventions for children with FA.
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26
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Baggs JG, Norton SA, Schmitt MH, Dombeck MT, Sellers CR, Quinn JR. Intensive care unit cultures and end-of-life decision making. J Crit Care 2007; 22:159-68. [PMID: 17548028 PMCID: PMC2214829 DOI: 10.1016/j.jcrc.2006.09.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2006] [Revised: 07/23/2006] [Accepted: 09/26/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE Prior researchers studying end-of-life decision making (EOLDM) in intensive care units (ICUs) often have collected data retrospectively and aggregated data across units. There has been little research, however, about how cultures differ among ICUs. This research was designed to study limitation of treatment decision making in real time and to evaluate similarities and differences in the cultural contexts of 4 ICUs and the relationship of those contexts to EOLDM. MATERIALS AND METHODS Ethnographic field work took place in 4 adult ICUs in a tertiary care hospital. Participants were health care providers (eg, physicians, nurses, and social workers), patients, and their family members. Participant observation and interviews took place 5 days a week for 7 months in each unit. RESULTS The ICUs were not monolithic. There were similarities, but important differences in EOLDM were identified in formal and informal rules, meaning and uses of technology, physician roles and relationships, processes such as unit rounds, and timing of initiation of EOLDM. CONCLUSIONS As interventions to improve EOLDM are developed, it will be important to understand how they may interact with unit cultures. Attempting to develop one intervention to be used in all ICUs is unlikely to be successful.
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Affiliation(s)
- Judith Gedney Baggs
- School of Nursing, Oregon Health and Science University, Portland, OR 97239-2941, USA.
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