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Warmbein A, Rathgeber I, Seif J, Mehler-Klamt AC, Schmidbauer L, Scharf C, Hübner L, Schroeder I, Biebl J, Gutmann M, Eberl I, Zoller M, Fischer U. Barriers and facilitators in the implementation of mobilization robots in hospitals from the perspective of clinical experts and developers. BMC Nurs 2023; 22:45. [PMID: 36797701 PMCID: PMC9936640 DOI: 10.1186/s12912-023-01202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Early mobilization can help reduce severe side effects such as muscle atrophy that occur during hospitalization. However, due to time and staff shortages in intensive and critical care as well as safety risks for patients, it is often difficult to adhere to the recommended therapy time of twenty minutes twice a day. New robotic technologies might be one approach to achieve early mobilization effectively for patients and also relieve users from physical effort. Nevertheless, currently there is a lack of knowledge regarding the factors that are important for integrating of these technologies into complex treatment settings like intensive care units or rehabilitation units. METHODS European experts from science, technical development and end-users of robotic systems (n = 13) were interviewed using a semi-structured interview guideline to identify barriers and facilitating factors for the integration of robotic systems into daily clinical practice. They were asked about structural, personnel and environmental factors that had an impact on integration and how they had solved challenges. A latent content analysis was performed regarding the COREQ criteria. RESULTS We found relevant factors regarding the development, introduction, and routine of the robotic system. In this context, costs, process adjustments, a lack of exemptions, and a lack of support from the manufacturers/developers were identified as challenges. Easy handling, joint decision making between the end-users and the decision makers in the hospital, an accurate process design and the joint development of the robotic system of end-users and technical experts were found to be facilitating factors. CONCLUSION The integration and preparation for the integration of robotic assistance systems into the inpatient setting is a complex intervention that involves many parties. This study provides evidence for hospitals or manufacturers to simplify the planning of integrations for permanent use. TRIAL REGISTRATION DRKS-ID: DRKS00023848; registered 10/12/2020.
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Affiliation(s)
- Angelika Warmbein
- Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377, Munich, Germany.
| | - Ivanka Rathgeber
- grid.411095.80000 0004 0477 2585Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Janesca Seif
- grid.411095.80000 0004 0477 2585Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Amrei C. Mehler-Klamt
- grid.440923.80000 0001 1245 5350Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Lena Schmidbauer
- grid.440923.80000 0001 1245 5350Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Christina Scharf
- grid.411095.80000 0004 0477 2585Department of Anesthesiology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Lucas Hübner
- grid.411095.80000 0004 0477 2585Department of Anesthesiology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Ines Schroeder
- grid.411095.80000 0004 0477 2585Department of Anesthesiology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Johanna Biebl
- grid.5252.00000 0004 1936 973XDepartment of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Marcus Gutmann
- grid.5252.00000 0004 1936 973XDepartment of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital LMU Munich, Munich, Germany
| | - Inge Eberl
- grid.440923.80000 0001 1245 5350Professorship of Nursing Science, Faculty of Social Work, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Michael Zoller
- grid.411095.80000 0004 0477 2585Department of Anesthesiology, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Uli Fischer
- grid.411095.80000 0004 0477 2585Clinical Nursing Research and Quality Management Unit, University Hospital LMU Munich, Marchioninistr. 15, 81377 Munich, Germany
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Yoon S, Wee S, Loh DHF, Bee YM, Thumboo J. Facilitators and Barriers to Uptake of Community-Based Diabetes Prevention Program Among Multi-Ethnic Asian Patients With Prediabetes. Front Endocrinol (Lausanne) 2022; 13:816385. [PMID: 35295990 PMCID: PMC8919042 DOI: 10.3389/fendo.2022.816385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/03/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE This study aimed to identify facilitators and barriers to the uptake of a community-based diabetes prevention program (DPP) from the perspectives of decliners with prediabetes in a multi-ethnic Asian community. METHODS Semi-structured interviews were conducted with 29 individuals with prediabetes who declined participation in a large community-based diabetes prevention program in Singapore. Thematic analysis was undertaken to identify themes, which were subsequently mapped onto the Capacity-Opportunity-Motivation and Behavior model (COM-B). RESULTS We identified 16 key themes under three COM-B domains. Health status at the time of invitation, perceived ability of self-management, understanding of prediabetes condition and/or the program intention (Capability) were important determinants. Family commitment had the strong potential to enable or hinder physical and social Opportunity related to participation. Many participants desired involvement of physician as part of program invitation and component. Fear of exacerbation coupled with an automatic aversion for suffering influenced Motivation for participation. CONCLUSION Identifying facilitators and barriers embedded in the COM-B will assist systematic program modifications to increase participation of individuals with prediabetes. How information about modifiable risk factors is communicated by physicians at the point of diagnosis and program introduction is key to participation. Co-locating programs with family activity, development of mHealth, readiness assessment, and tailored explanation of program purpose may increase participation. These findings will be used to guide future national interventions in the community to ensure successful implementation.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- *Correspondence: Sungwon Yoon,
| | - Sharon Wee
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Dionne H. F. Loh
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
| | - Yong Mong Bee
- Department of Endocrinology, Singapore General Hospital, Singapore, Singapore
| | - Julian Thumboo
- Health Services and Systems Research, Duke-NUS Medical School, Singapore, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
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Yilmaz Y, Carey R, Chan TM, Bandi V, Wang S, Woods RA, Mondal D, Thoma B. Developing a dashboard for faculty development in competency-based training programs: a design-based research project. CANADIAN MEDICAL EDUCATION JOURNAL 2021; 12:48-64. [PMID: 34567305 PMCID: PMC8463237 DOI: 10.36834/cmej.72067] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Canadian specialist residency training programs are implementing a form of competency-based medical education (CBME) that requires frequent assessments of entrustable professional activities (EPAs). Faculty struggle to provide helpful feedback and assign appropriate entrustment scores. CBME faculty development initiatives rarely incorporate teaching metrics. Dashboards could be used to visualize faculty assessment data to support faculty development. METHODS Using a design-based research process, we identified faculty development needs related to CBME assessments and designed a dashboard containing elements (data, analytics, and visualizations) meeting these needs. Data was collected within the emergency medicine residency program at the University of Saskatchewan through interviews with program leaders, faculty development experts, and faculty participating in development sessions. Two investigators thematically analyzed interview transcripts to identify faculty needs that were audited by a third investigator. The needs were described using representative quotes and the dashboard elements designed to address them. RESULTS Between July 1, 2019 and December 11, 2020 we conducted 15 interviews with nine participants (two program leaders, three faculty development experts, and four faculty members). Three needs emerged as themes from the analysis: analysis of assessments, contextualization of assessments, and accessible reporting. We addressed these needs by designing an accessible dashboard to present contextualized quantitative and narrative assessment data for each faculty member. CONCLUSIONS We identified faculty development needs related to EPA assessments and designed dashboard elements to meet them. The resulting dashboard was used for faculty development sessions. This work will inform the development of CBME assessment dashboards for faculty.
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Affiliation(s)
- Yusuf Yilmaz
- Continuing Professional Development Office and McMaster Education Research, Innovation, and Theory (MERIT) Program, McMaster University, Ontario, Canada
- Department of Medical Education, Ege University, Izmir, Turkey
| | - Robert Carey
- Department of Emergency Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Teresa M Chan
- Continuing Professional Development Office and McMaster Education Research, Innovation, and Theory (MERIT) Program, McMaster University, Ontario, Canada
- Emergency Medicine, Department of Medicine, McMaster University, Ontario, Canada
| | - Venkat Bandi
- Department of Computer Science, University of Saskatchewan, Saskatchewan, Canada
| | - Shisong Wang
- Department of Computer Science, University of Saskatchewan, Saskatchewan, Canada
| | - Robert A Woods
- Department of Emergency Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Debajyoti Mondal
- Department of Computer Science, University of Saskatchewan, Saskatchewan, Canada
| | - Brent Thoma
- Department of Emergency Medicine, University of Saskatchewan, Saskatchewan, Canada
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Verberne LM, Fahner JC, Sondaal SFV, Schouten–van Meeteren AYN, de Kruiff CC, van Delden JJM, Kars MC. Anticipating the future of the child and family in pediatric palliative care: a qualitative study into the perspectives of parents and healthcare professionals. Eur J Pediatr 2021; 180:949-957. [PMID: 33030601 PMCID: PMC7886816 DOI: 10.1007/s00431-020-03824-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 09/15/2020] [Accepted: 10/01/2020] [Indexed: 11/24/2022]
Abstract
Preparing for future scenarios in pediatric palliative care is perceived as complex and challenging by both families and healthcare professionals. This interpretative qualitative study using thematic analysis aims to explore how parents and healthcare professionals anticipate the future of the child and family in pediatric palliative care. Single and repeated interviews were undertaken with 42 parents and 35 healthcare professionals of 24 children, receiving palliative care. Anticipating the future was seen in three forms: goal-directed conversations, anticipated care, and guidance on the job. Goal-directed conversations were initiated by either parents or healthcare professionals to ensure others could align with their perspective regarding the future. Anticipated care meant healthcare professionals or parents organized practical care arrangements for future scenarios with or without informing each other. Guidance on the job was a form of short-term anticipation, whereby healthcare professionals guide parents ad hoc through difficult situations.Conclusion: Anticipating the future of the child and family is mainly focused on achievement of individual care goals of both families and healthcare professionals, practical arrangements in advance, and short-term anticipation when a child deteriorates. A more open approach early in disease trajectories exploring perspectives on the future could allow parents to anticipate more gradually and to integrate their preferences into the care of their child. What is Known: • Anticipating the future in pediatric palliative care occurs infrequently and too late. What is New: • Healthcare professionals and parents use different strategies to anticipate the future of children receiving palliative care, both intentionally and unwittingly. Strategies to anticipate the future are goal-directed conversations, anticipated care, and guidance on the job. • Parents and healthcare professionals are engaged to a limited extent in ongoing explorative conversations that support shared decision-making regarding future care and treatment.
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Affiliation(s)
- Lisa M. Verberne
- Department of pediatrics, Catharina Hospital, Michelangelolaan 2, 5623 EJ Eindhoven, The Netherlands
| | - Jurrianne C. Fahner
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Stephanie F. V. Sondaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | | | - Chris C. de Kruiff
- Emma Children’s Hospital, Amsterdam University Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Johannes J. M. van Delden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Marijke C. Kars
- Center of Expertise Palliative Care, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
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Carey R, Wilson G, Bandi V, Mondal D, Martin LJ, Woods R, Chan T, Thoma B. Developing a dashboard to meet the needs of residents in a competency-based training program: A design-based research project. CANADIAN MEDICAL EDUCATION JOURNAL 2020; 11:e31-e45. [PMID: 33349752 PMCID: PMC7749685 DOI: 10.36834/cmej.69682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Canadian specialty programs are implementing Competence By Design, a competency-based medical education (CBME) program which requires frequent assessments of entrustable professional activities. To be used for learning, the large amount of assessment data needs to be interpreted by residents, but little work has been done to determine how visualizing and interacting with this data can be supported. Within the University of Saskatchewan emergency medicine residency program, we sought to determine how our residents' CBME assessment data should be presented to support their learning and to develop a dashboard that meets our residents' needs. METHODS We utilized a design-based research process to identify and address resident needs surrounding the presentation of their assessment data. Data was collected within the emergency medicine residency program at the University of Saskatchewan via four resident focus groups held over 10 months. Focus group discussions were analyzed using a grounded theory approach to identify resident needs. This guided the development of a dashboard which contained elements (data, analytics, and visualizations) that support their interpretation of the data. The identified needs are described using quotes from the focus groups as well as visualizations of the dashboard elements. RESULTS Resident needs were classified under three themes: (1) Provide guidance through the assessment program, (2) Present workplace-based assessment data, and (3) Present other assessment data. Seventeen dashboard elements were designed to address these needs. CONCLUSIONS Our design-based research process identified resident needs and developed dashboard elements to meet them. This work will inform the creation and evolution of CBME assessment dashboards designed to support resident learning.
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Affiliation(s)
- Robert Carey
- Department of Emergency Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Grayson Wilson
- Department of Emergency Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Venkat Bandi
- Department of Computer Science, University of Saskatchewan, Saskatchewan, Canada
| | - Debajyoti Mondal
- Department of Computer Science, University of Saskatchewan, Saskatchewan, Canada
| | - Lynsey J. Martin
- Department of Emergency Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Rob Woods
- Department of Emergency Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Teresa Chan
- Division of Emergency Medicine, Department of Medicine, McMaster University, Ontario, Canada
- McMaster program for Education Research, Innovation, and Theory (MERIT), McMaster University, Ontario, Canada
| | - Brent Thoma
- Department of Emergency Medicine, University of Saskatchewan, Saskatchewan, Canada
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Gonçalves JL, Fuertes M, Alves MJ, Antunes S, Almeida AR, Casimiro R, Santos M. Maternal pre and perinatal experiences with their full-term, preterm and very preterm newborns. BMC Pregnancy Childbirth 2020; 20:276. [PMID: 32375667 PMCID: PMC7204281 DOI: 10.1186/s12884-020-02934-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 04/13/2020] [Indexed: 01/07/2023] Open
Abstract
Background Mothers’ reports about pregnancy, maternity and their experiences during the perinatal period have been associated with infants’ later quality of attachment and development. Yet, there has been little research with mothers of very preterm newborns. This study aimed to explore mothers’ experiences related to pregnancy, premature birth, relationship with the newborn, and future perspectives, and to compare them in the context of distinct infants’ at-birth-risk conditions. Methods A semi-structured interview was conducted with women after birth, within the first 72 h of the newborn’s life. A total of 150 women participated and were divided in three groups: (1) 50 mothers of full-term newborns (Gestational Age (GA) ≥ 37 weeks; FT), (2) 50 mothers of preterm newborns (GA 32–36 weeks; PT) and (3) 50 mothers of very preterm newborns (GA < 32 weeks; VPT). Results Mothers of full-term infants responded more often that their children were calm and that they did not expect difficulties in taking care of and providing for the baby. Mothers of preterm newborns although having planned and accepted well the pregnancy (with no mixed or ambivalent feelings about it) and while being optimistic about their competence to take care of the baby, mentioned feeling frightened because of the unexpected occurrence of a premature birth and its associated risks. Mothers of very preterm newborns reported more negative and distressful feelings while showing more difficulties in anticipating the experience of caring for their babies. Conclusion The results indicate that Health Care Systems and Neonatal Care Policy should provide differentiated psychological support and responses to mothers, babies and families, taking into account the newborns’ GA and neonatal risk factors.
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Affiliation(s)
- Joana L Gonçalves
- Center for Psychology at University of Porto (CPUP), Rua Alfredo Allen, 4200-135, Porto, Portugal.
| | - Marina Fuertes
- Center for Psychology at University of Porto (CPUP), Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - Maria João Alves
- Center for Psychology at University of Porto (CPUP), Rua Alfredo Allen, 4200-135, Porto, Portugal
| | - Sandra Antunes
- School of Health Technology, Polytechnic Institute of Lisbon, Lisbon, Portugal
| | - Ana Rita Almeida
- Lisbon School of Education/CIED, Polytechnic Institute of Lisbon, Lisbon, Portugal
| | - Rute Casimiro
- Lisbon School of Education/CIED, Polytechnic Institute of Lisbon, Lisbon, Portugal
| | - Margarida Santos
- School of Health Technology, Polytechnic Institute of Lisbon, Lisbon, Portugal.,Faculty of Psychology and Education Sciences, University of Lisbon, Lisbon, Portugal
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