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Herulf Scholander L, Boström AM, Josephsson S, Vikström S. Approved or disregarded? Exploring arenas for narrative relations in geriatric care. Int J Qual Stud Health Well-being 2024; 19:2293130. [PMID: 38085755 DOI: 10.1080/17482631.2023.2293130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE The use of narration in healthcare has been accentuated as a response to the requested shift towards person-centred care. The notion of narrative relations refers to a process of involving several people in mutual and ongoing narrative exchange. This study aimed to explore how and where narrative relations may be adopted and enacted in everyday healthcare practice. METHODS The study has a qualitative, explorative design. Seven interprofessional focus group discussions with healthcare staff were prompted by vignettes. A multidisciplinary team of healthcare staff (n = 31) were recruited on a geriatric ward. Data were analysed using a constant comparative method. RESULTS A core theme shows how narrative relations are adopted and enacted both as part of an approved practice-the work procedures commonly approved as part of healthcare, and as a disregarded practice where covert but important narrative relations take place to support fundamental qualities of healthcare. Moreover, the findings consider arenas of healthcare practice where approved or disregarded practices are enacted in the clinic frontstage and the clinic backstage. CONCLUSIONS Narrative relations may take place in different arenas of healthcare practice yet simultaneously become a cohesive force interconnecting those arenas and uphold continuity. Impeded narrative relations in one arena may have unintended consequences in another.
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Affiliation(s)
- Lisa Herulf Scholander
- Division of Occupational Therapy, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
- R&D unit, Stockholms Sjukhem Foundation, Stockholm, Sweden
| | - Anne-Marie Boström
- R&D unit, Stockholms Sjukhem Foundation, Stockholm, Sweden
- Division of Nursing, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Staffan Josephsson
- Division of Occupational Therapy, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Vikström
- Division of Occupational Therapy, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Mahomed-Asmail F, Metcalfe L, Graham MA, Eccles R. Exploring facilitators and barriers for delivering person-centered care in a socio-economically diverse context: Perspectives of speech-language pathologists and audiologists. PATIENT EDUCATION AND COUNSELING 2024; 124:108250. [PMID: 38503035 DOI: 10.1016/j.pec.2024.108250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/31/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE The study aimed to explore facilitators and barriers in delivering person-centered care from the perspective of speech-language pathologists and audiologists in a socio- economically diverse workplace across micro, meso, and macro levels. METHOD A national cross-sectional e-survey was conducted among pooled speech-language pathologists and/or audiologists from South Africa. The e-survey included quantitative components to describe participant demographics which was analysed using descriptive and inferential statistics. The qualitative data was analyzed using metaphor and thematic analysis approaches to describe respondents' perspectives of barriers and facilitators in delivering person-centered care. RESULTS The e-survey was completed by 63 clinicians (36.5% Audiologists; 36.5% Speech-Language Therapists; 27.0% dually qualified Speech-Language Therapists and Audiologists) mostly between the ages of 26 to 35 years old (33.3%). Respondents were working in various settings including the public sector (41.3%), private sector (44.4%) and in academia (14.3%). Facilitators and barriers were identified within all three systems (macro, meso and micro). The metaphor analysis resulted in six categories: uncertainty of Person centered care; its essential nature; associated challenges; relational aspect; analogies referring to animals; and food-related analogies. Thematic analysis of open-ended questions revealed five barriers, with three relating to micro systems; i) clinician factors, ii) client factors, iii) clinician and client interaction, and two related to factors within the meso system; iv) resources, and v) workplace. Only two themes were identified as facilitators towards PCC, clinician factors (mirco) and workplace factors (meso).' CONCLUSIONS Insights gained from exploring Speech-Language Pathologists' and Audiologists' perceptions of implementing PCC in a socio-economically diverse setting highlight the need to address contextual (meso and macro systems) and personal (micro system) factors to promote and deliver PCC effectively. Notably, for the public sector, resources emerged as a major concern and barrier on the macro system level. Despite these challenges, the investigation revealed two noteworthy facilitators: clinician factors, at the micro level, and workplace factors, at the meso level. This nuanced understanding emphasizes the necessity of tailored interventions targeting both individual and systemic aspects to enhance the successful implementation of person-centered care. PRACTICAL IMPLICATIONS Strategies should focus on enhancing clinicians' communication skills, collaboration, and teamwork, as well as addressing resource limitations through the adaptation of tools and implementation of PCC ISO standards.
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Affiliation(s)
- Faheema Mahomed-Asmail
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa.
| | - Louise Metcalfe
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
| | - Marien Alet Graham
- Department of Science, Mathematics and Technology Education, University of Pretoria, Pretoria, South Africa
| | - Renata Eccles
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Pretoria, South Africa
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Van der Voorden M, Franx A, Ahaus K. Actions for mitigating the negative effects of patient participation in patient safety: a qualitative study. BMC Health Serv Res 2024; 24:700. [PMID: 38831446 PMCID: PMC11149232 DOI: 10.1186/s12913-024-11154-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/29/2024] [Indexed: 06/05/2024] Open
Abstract
BACKGROUND Recent research within the context of Obstetrics shows the added value of patient participation in in-hospital patient safety. Notwithstanding these benefits, recent research within an Obstetrics department shows that four different negative effects of patient participation in patient safety have emerged. However, the approach to addressing these negative effects within the perspective of patient participation in patient safety is currently lacking. For this reason, the aim of this study is to generate an overview of actions that could be taken to mitigate the negative effects of patient participation in patient safety within an Obstetrics department. METHODS This study was conducted in the Obstetrics Department of a tertiary academic center. An explorative qualitative interview study included sixteen interviews with professionals (N = 8) and patients (N = 8). The actions to mitigate the negative effects of patient participation in patient safety, were analyzed and classified using a deductive approach. RESULTS Eighteen actions were identified that mitigated the negative effects of patient participation in patient safety within an Obstetrics department. These actions were categorized into five themes: 'structure', 'culture', 'education', 'emotional', and 'physical and technology'. These five categories reflect the current approach to improving patient safety which is primarily viewed from the perspective of professionals rather than of patients. CONCLUSIONS Most of the identified actions are linked to changing the culture to generate more patient-centered care and change the current reality, which looks predominantly from the perspective of the professionals and too little from that of the patients. Furthermore, none of the suggested actions fit within a sixth anticipated category, namely, 'politics'. Future research should explore ways to implement a patient-centered care approach based on these actions. By doing so, space, money and time have to be created to elaborate on these actions and integrate them into the organizations' structure, culture and practices.
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Affiliation(s)
- Michael Van der Voorden
- Department of Obstetrics and Gynaecology, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Arie Franx
- Department of Obstetrics and Gynaecology, Erasmus MC, Doctor Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Kees Ahaus
- Department of Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Burgemeester Oudlaan 50, Rotterdam, Netherlands
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Jensen K, Maties FM, Nissen HB, Christiansen J, Jørgensen R. Usefulness of working with a person-centred intervention in a group: Perspectives from facilitators and persons with mental illness. J Eval Clin Pract 2024; 30:539-547. [PMID: 38291605 DOI: 10.1111/jep.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 01/11/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND When implementing new interventions into clinical practice, it is of great importance to investigate the implementation process to better understand factors promoting and impeding the implementation to stimulate engagement and sustainability of the intervention. It is essential to consider perspectives both from the health professionals delivering the intervention and those receiving the intervention to be open to their suggestions for enhancing the dissemination and implementation of the intervention. The aim of the study was to evaluate adoption, acceptability and appropriateness of a person-centred group intervention (PCGI) from the perspectives of facilitators and participants with mental illness in mental health outpatient services right after delivery. METHODS A qualitative interview study design was used. Interview data from three individual interviews, one group interview with facilitators and 16 individual interviews with participants were analyzed through content analysis. RESULTS As described in the following three categories, the facilitators and participants found the PCGI overall useful and meaningful to deliver and receive: (1) application of a PCGI in clinical practice, (2) balancing the facilitator role and (3) establishing and maintaining a safe relationship. CONCLUSION Facilitators and participants found the form and structure of the PCGI useful and meaningful. Some participants dropped out as they did not feel comfortable in a group setting. The components in the sessions, questions on cards and reflection sheets together with peer-to-peer interactions provided a safe environment. However, facilitation from facilitators requires appropriate skills and qualifications, which must be provided by the hospital together with supervision and the possibility for peer feedback and exchange of experiences.
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Affiliation(s)
- Kira Jensen
- Clinic North, Aalborg University Hospital - Psychiatry, Aalborg, Denmark
| | - Flavia M Maties
- Clinic South, Aalborg University Hospital - Psychiatry, Aalborg, Denmark
| | - Hanne B Nissen
- Clinic South, Aalborg University Hospital - Psychiatry, Aalborg, Denmark
| | - Jette Christiansen
- Clinic South, Aalborg University Hospital - Psychiatry, Aalborg, Denmark
| | - Rikke Jørgensen
- Unit for Psychiatric Research, Aalborg University Hospital - Psychiatry, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Azzopardi E, Boyce D, Azzopardi E, Sadideen H, Mosahebi A. Unveiling the language of scars: A patient-centric themed framework for comprehensive scar morphology. Burns 2024; 50:1269-1276. [PMID: 38480059 DOI: 10.1016/j.burns.2024.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 01/25/2024] [Accepted: 02/08/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Scarring, a pervasive issue spanning across medical disciplines, lacks a comprehensive terminology for effective communication, patient engagement, and outcome assessment. Existing scar classification systems are constrained by specific pathologies, physician-centric features, and inadequately account for emerging technologies. This study refrains from proposing yet another classification system and instead revisits the foundational language of scar morphology through a theme analysis of primary patient complaints. METHOD Data encompassing five years of a high-volume scar practice was analysed. Primary complaints were aggregated into collective descriptors and further organized into theme domains. The resulting hierarchical map of presenting complaints revealed five key domains: Loss of Function, Contour, Texture, Vector, and Colour Presenting complaints were codified into 42 items, which were then categorised into 14 collective descriptor terms. The latter were in turn organised into five overarching themes. RESULT Loss of Function, accounting for 10% of primary concerns, signifies reduced function attributed solely to the scar. Contour, encompassing 41% of concerns, pertains to scar height, shape, and depth. Texture, representing 12% of concerns, denotes tactile variations such as hardness, roughness, and moisture. Vector, comprising 13% of concerns, refers to scar tissue tension and associated distortions. Colour, the concern in 24% of cases, encompasses variations in pigmentation, vascularity, and exogenous pigments. DISCUSSION Standardized terminology enhances patient care, communication, and research. This study underscores the fundamental question of "what bothers the patient," reviving a patient-centred approach to scar management. By prioritizing themes based on patient complaints, this study innovatively integrates function, aesthetics, and patient experience. In conclusion, this study pioneers a paradigm shift in scar management by presenting a patient-driven theme framework that offers a common language for healthcare professionals and patients. Embracing this language harmonizes scar treatment, fosters innovation, and transforms scars from silent reminders into stories of resilience and healing.
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Affiliation(s)
- Ernest Azzopardi
- London Welbeck Hospital, UK; Consultant Surgeon in Private Practice, UK; University of Malta, Faculty of Medicine and Surgery, UK; University College London, Division of Surgery and Interventional Science, UK; Skinsurgeon Laser Suite, Malta.
| | - Dean Boyce
- Swansea Bay University Local Health Board, UK
| | - Elayne Azzopardi
- Department of Speech and Language Therapy, Department of Health Malta, UK
| | - Hazim Sadideen
- Consultant Surgeon in Private Practice, UK; Imperial College, London, UK
| | - Afshin Mosahebi
- Consultant Surgeon in Private Practice, UK; University College London, Division of Surgery and Interventional Science, UK; Royal Free Hospital Hampstead, UK
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Birtwistle J, Allsop MJ, Bradshaw A, Millares Martin P, Sleeman KE, Twiddy M, Evans CJ. Views of patients with progressive illness and carers about the role of digital advance care planning systems to record and share information: A qualitative study. Palliat Med 2024:2692163241255511. [PMID: 38813756 DOI: 10.1177/02692163241255511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
BACKGROUND Digital approaches are being explored internationally to support the elicitation, documentation and sharing of advance care planning information. However, the views and experiences of patients and carers are little understood, impeding the development and impact of digital approaches to strengthen palliative and end-of-life care. AIM To explore perspectives of patients with progressive illness and their carers on digital approaches to advance care planning, anticipated impact from their use and expectations for their future development. DESIGN A qualitative study employing thematic framework analysis of data collected from focus groups and semi-structured interviews. SETTING/PARTICIPANTS Purposive sample of 29 patients and 15 current or bereaved carers in London and West Yorkshire from hospice settings, non-governmental support and advocacy groups, and care home residents. RESULTS Four generated themes included: 1. 'Why haven't you read what's wrong with me?'; uncertainty around professionals' documenting, sharing and use of information; 2. The art of decision-making relies on the art of conversation; 3. The perceived value in having 'a say in matters': control and responsibility; 4. Enabling patient and carer control of their records: 'custodianship is key'. CONCLUSIONS Lived experiences of information sharing influenced trust and confidence in digital advance care planning systems. Despite scepticism about the extent that care can be delivered in line with their preferences, patients and carers acknowledge digital systems could facilitate care through contemporaneous and accurately documented wishes and preferences. There remains a need to determine how independent patient and public-facing advance care planning resources might be integrated with existing digital health record systems.
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Affiliation(s)
- Jacqueline Birtwistle
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew J Allsop
- Academic Unit of Palliative Care, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Andy Bradshaw
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | | | - Katherine E Sleeman
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
| | - Maureen Twiddy
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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Avilés L, Castillo-Mansilla D, Wang Y, Smith P. Person-centred care and online pedagogy in nursing education: a discussion paper. Nurse Educ Pract 2024; 78:103998. [PMID: 38810351 DOI: 10.1016/j.nepr.2024.103998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/31/2024]
Abstract
AIM To discuss person-centred care in nursing education and the role of online pedagogy to facilitate meaninful learning. BACKGROUND The core principles and values of person-centred care are at the centre of national and international healthcare education. Person-centred care recognises partnerships and relationships between nurses, healthcare practitioners and individual patients, carers and their families and part of the training of healthcare professionals. However, the literature on how person-centred care is taught to facilitate meaningful learning in nursing education particularly in the context of online pedagogy is limited. DESIGN A critical discussion paper. METHODS A critical discussion of person-centred care and online pedagogy that can facilitate teaching practices are presented, drawing on authors' positionality and case exemplars. RESULTS Teaching person-centred care using online pedagogy appears to have a promising impact on undergraduate and postgraduate nursing students' experiences. Engaging students in critical examination and reflection on the complexities of person-centred care in practice creates meaningful experiential learning for both students and educators. CONCLUSION Evidence suggests that the use of online pedagogy is a beneficial and effective way to incorporate the teaching of person-centred care into nursing education, yet more evidence is needed to evaluate its impact on nursing practice.
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Affiliation(s)
- Lissette Avilés
- Nursing Studies, School of Health in Social Sciences, The University of Edinburgh, Doorway 6 Old Medical School, Teviot Place, Edinburgh EH8 9 AG, United Kingdom.
| | - Daniela Castillo-Mansilla
- Nursing Studies, School of Health in Social Sciences, The University of Edinburgh, Doorway 6 Old Medical School, Teviot Place, Edinburgh EH8 9 AG, United Kingdom; Universidad de Chile, Facultad de Medicina, Av. Independencia 1027, Independencia, Santiago, Región Metropolitana 8380453, Chile
| | - Yin Wang
- Nursing Studies, School of Health in Social Sciences, The University of Edinburgh, Doorway 6 Old Medical School, Teviot Place, Edinburgh EH8 9 AG, United Kingdom
| | - Pam Smith
- Nursing Studies, School of Health in Social Sciences, The University of Edinburgh, Doorway 6 Old Medical School, Teviot Place, Edinburgh EH8 9 AG, United Kingdom
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Chen L, Sleeman K, Bradshaw A, Sakharang W, Mo Y, Ellis-Smith C. The Use of Person-Centered Outcome Measures to Support Integrated Palliative Care for Older People: A Systematic Review. J Am Med Dir Assoc 2024:105036. [PMID: 38796168 DOI: 10.1016/j.jamda.2024.105036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 05/28/2024]
Abstract
OBJECTIVES The aim was to synthesize evidence on the use of person-centered outcome measures to facilitate integrated palliative care for older people and build a logic model depicting the mechanisms through which person-centered outcome measures support integrated care. DESIGN Mixed methods systematic review using a data-based convergent synthesis design. SETTING AND PARTICIPANTS Older people aged ≥60 years who are approaching the end of their lives in multiple settings. METHODS The study was underpinned by a conceptual framework of integrated palliative care, which informed the search strategy, data extraction, analysis, and synthesis. A hybrid search strategy was implemented, with database searches (PsycINFO, MEDLINE, CINAHL, and ASSIA) complemented by snowball searches. Qualitative and quantitative data were analyzed by narrative synthesis to summarize and explain the findings. The findings informed a logic model depicting the mechanisms of using person-centered outcome measures to support integrated palliative care. RESULTS Twenty-six studies were included. Three mixed methods studies, 2 qualitative studies, and 21 quantitative studies were included. There was evidence that person-centered outcome measures could support integrated palliative care through informing palliative care policy development (n = 4), facilitating joint working across settings (n = 5), enabling close collaboration of multidisciplinary teams (n = 14), promoting joint education (n = 1), facilitating timing and specialist referral (n = 6), and enhancing patient-centered care (n = 3). CONCLUSIONS AND IMPLICATIONS This review makes an important, novel, and theoretically informed contribution to the delivery of scalable and sustainable integrated palliative care into the care of older people using person-centered outcome measures. The constructed logic model provides a conceptual framework and practical approach to how person-centered outcome measures support multilevel integration. A future area of research is the development of person-centered outcome measure interventions informed by the logic model to meet clinical needs.
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Affiliation(s)
- Linghui Chen
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom.
| | - Katherine Sleeman
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Andy Bradshaw
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Wilailak Sakharang
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Yihan Mo
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Clare Ellis-Smith
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
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Baxter R, Pusa S, Andersson S, Sandgren A. Perils and payoffs for patients in serious illness conversations as described by physicians: a qualitative study. BMJ Open Qual 2024; 13:e002734. [PMID: 38782485 PMCID: PMC11116881 DOI: 10.1136/bmjoq-2023-002734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 05/10/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND The Serious Illness Care Programme was developed to promote more, better and earlier serious illness conversations. Conversations about goals and values are associated with improved experiences and outcomes for seriously ill patients. Clinicians' attitudes and beliefs are thought to influence the uptake and performance of serious illness conversations, yet little is known about how clinicians perceive the impact of these conversations on patients. This study aimed to explore physicians' perceptions regarding the impact of serious illness conversations for patients. METHODS The Serious Illness Care Programme was implemented as a quality improvement project in two hospitals in Southern Sweden. Focus group evaluation discussions were conducted with 14 physicians and inductive thematic analysis was undertaken. RESULTS The results revealed that physicians considered potential perils and optimised potential payoffs for patients when engaging in serious illness conversations. Potential perils encompassed inappropriate timing, damaging emotions and shattering hopes. Potential payoffs included reflection time, secure space, and united understandings. CONCLUSIONS Physicians depicted a balance in evaluating the perils and payoffs of serious illness conversations for patients and recognised the interrelation of these possibilities through continual assessment and adjustment.
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Affiliation(s)
- Rebecca Baxter
- Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Susanna Pusa
- Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Sofia Andersson
- Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
- Department of Nursing, Umeå University, Umeå, Sweden
| | - Anna Sandgren
- Department of Health and Caring Sciences, Linneaus University, Växjö, Sweden
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Yip WKA, Chung PMB, Christensen M. End-of-life conversations for the older person: A concept analysis. Scand J Caring Sci 2024. [PMID: 38778516 DOI: 10.1111/scs.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/29/2024] [Accepted: 04/07/2024] [Indexed: 05/25/2024]
Abstract
AIM The aim of this concept analysis is to seek clarity as to what end-of-life conversations involve by developing a clear working definition and using model cases to conceptualise the defining attributes of an end-of-life conversations with the older person. DESIGN Walker and Avant's eight step approach to Concept Analysis. DATA SOURCES Four databases were searched, including PubMed, CINAHL, PsycINFO, and Scopus. A total of 339 publications were identified with 30 papers meeting the inclusion criteria and put forward for the final conceptual analysis. RESULTS The defining attributes associated with end-of life conversations included (1) an ongoing process of older person empowerment, (2) discussion's concerning values and preferences concerning end-of-life issues, and (3) maintaining an open dialogue between all concerned individuals. Antecedents were associated with the older person is their readiness to talk openly about death and dying. Consequences were identified as having a better understanding of what death and dying may mean to the older person in a more specific manner. CONCLUSIONS End-of-life conversations are vital in understanding an individual's values and preferences at the end of life, and yet, the concept of the end-of-life conversation has not been well defined in the literature. End-of-life conversations with the older person encompass ongoing discussions and maintaining open dialogue around end-of-life care while developing strategies to promote individual empowerment in making informed choices. Using a conceptual model, aides in addressing aspects of end-of-life conversations and an acknowledgment of the dynamic process of end-of-life conversations.
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Affiliation(s)
- Wing Ki Agnes Yip
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
- School of Nursing, Tung Wah College, Kowloon, Hong Kong
| | - Pui Man Betty Chung
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
- Interdisciplinary Centre for Qualitative Research, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Martin Christensen
- School of Nursing, Hong Kong Polytechnic University, Kowloon, Hong Kong
- Interdisciplinary Centre for Qualitative Research, Hong Kong Polytechnic University, Kowloon, Hong Kong
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Pinardi E, Ornago AM, Bianchetti A, Morandi A, Mantovani S, Marengoni A, Colombo M, Arosio B, Okoye C, Cortellaro F, Bellelli G. Optimizing older patient care in emergency departments: a comprehensive survey of current practices and challenges in Northern Italy. BMC Emerg Med 2024; 24:86. [PMID: 38764046 PMCID: PMC11103964 DOI: 10.1186/s12873-024-01004-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 05/10/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND The progressive aging of the population and the increasing complexity of health issues contribute to a growing number of older individuals seeking emergency care. This study aims to assess the state of the art of care provided to older people in the Emergency Departments of Lombardy, the most populous region in Italy, counting over 2 million people aged 65 years and older. METHODS An online cross-sectional survey was developed and disseminated among emergency medicine physicians and physicians affiliated to the Lombardy section of the Italian Society of Geriatrics and Gerontology (SIGG), during June and July 2023. The questionnaire covered hospital profiles, geriatric consultation practices, risk assessment tools, discharge processes and perspectives on geriatric emergency care. RESULTS In this mixed method research, 219 structured interviews were collected. The majority of physicians were employed in hospitals, with 54.7% being geriatricians. Critical gaps in older patient's care were identified, including the absence of dedicated care pathways, insufficient awareness of screening tools, and a need for enhanced professional training. CONCLUSIONS Tailored protocols and geriatric educational programs are crucial for improving the quality of emergency care provided to older individuals. These measures might also help relieve the burden on the Emergency Departments, thereby potentially enhancing overall efficiency and ensuring better outcomes.
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Affiliation(s)
- Elena Pinardi
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy.
| | - Alice Margherita Ornago
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
| | - Angelo Bianchetti
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Medicine and Rehabilitation Department, Istituto Clinico S.Anna Hospital, Gruppo San Donato, Brescia, Italy
| | - Alessandro Morandi
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Intermediate Care and Rehabilitation, Azienda Speciale "Cremona Solidale", Cremona, Italy
- Parc Sanitari Pere Virgili, Vall d'Hebrón Institute of Research, Barcelona, Spain
| | - Stefano Mantovani
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- RSA Don Giuseppe Cuni, Magenta, Italy
| | - Alessandra Marengoni
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Department of Clinical and Experimental Sciences, Geriatric Unit, University of Brescia, Brescia, Italy
| | - Mauro Colombo
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Golgi Cenci Foundation, Abbiategrasso, Italy
| | - Beatrice Arosio
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Chukwuma Okoye
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Acute Geriatrics Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Francesca Cortellaro
- Integrazione Percorsi di Cura Ospedale Territorio, Urgency Emergency Regional Agency (Agenzia Regionale Emergenza Urgenza - AREU), Milan, Italy
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Italian Society of Gerontology and Geriatrics (Società Italiana di Gerontologia e Geriatria - SIGG), Firenze, Italy
- Acute Geriatrics Unit, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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He X, Wang J, Liang Y. Developing integrated person-centered care quality indicators for home health agencies in Shanghai, China: A modified Delphi-analytic hierarchy process study. Geriatr Nurs 2024; 58:1-7. [PMID: 38704927 DOI: 10.1016/j.gerinurse.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 04/03/2024] [Accepted: 04/23/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVES To develop person-centered integrated care quality indicators for home health agencies in Shanghai, China. DESIGN The study combined the Delphi method and the analytic hierarchy process (AHP). MATERIAL AND METHODS The Delphi consultation questionnaire was distributed to experts in home healthcare in Shanghai, China. A panel of experts with experience in home healthcare in Shanghai, China, was selected. Purposive sampling was used to choose experts. In this study, ten experts were selected from within sub-fields of home healthcare, including nursing, health policy, quality improvement, person-centered care (PCC), and integrated care. RESULTS The authority coefficient (Cr) in this study was 0.835. The coordination degree of experts' opinions, which is expressed by Kendall coordination coefficient W (a higher value, better coordination of the item), ranged from 0.352 to 0.386 (p < 0.001). The consistency ratio (CR) values for each level were less than 0.1. The quality indicator system included three first-level indicators, 15 second-level indicators, and 56 third-level indicators. CONCLUSIONS A person-centered integrated care quality indicator system was developed for home health agencies. The findings from this study enable nurses, managers, and policymakers in home and community-based settings to evaluate person-centered integrated care quality using a robust framework. In addition, these indicators can also be used as a standardized tool to guide the development of long-term care services and supports (LTSS) for home-bound elderly.
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Affiliation(s)
- Xiaolin He
- Department of Social Policy, Shanghai Administration Institute, Shanghai, China
| | - Jiali Wang
- School of Nursing, Fudan University, Shanghai, China
| | - Yan Liang
- School of Nursing, Fudan University, Shanghai, China.
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13
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Viljoen A, Leech R, Heyns T. Consensus on the content of an instrument to measure person-centred teamwork: An e-Delphi study. J Clin Nurs 2024; 33:1786-1797. [PMID: 38284483 DOI: 10.1111/jocn.17042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/07/2024] [Indexed: 01/30/2024]
Abstract
AIMS AND OBJECTIVES To establish consensus on items to be included in an instrument to measure person-centred teamwork in a hospital setting. The objective was to identify the items through a methodological literature review. Refine the items and obtain consensus on the items. BACKGROUND A definition and related attributes of person-centred teamwork have been agreed upon. An instrument is needed to measure and monitor person-centred teamwork in hospital settings. DESIGN Consensus, electronic Delphi design. METHODS Items were identified through a methodological literature review. These items were included in three electronic Delphi rounds. Using purposive and snowball sampling, 16 international experts on person-centred care, teamwork and/or instrument development were invited to participate in three electronic Delphi rounds via Google Forms. Descriptive statistics were used to demonstrate their agreement on the relevance and clarity of each item. Items were included if consensus was 0.75. Content analysis was used to analyse written feedback from experts. RESULTS The response rate was 56% (n = 9/16). Nine experts participated over an 8-week period to reach consensus on the items to be included in an instrument to measure person-centred teamwork in hospital settings. The experts' responses and suggestions for rephrasing, removing and adding items were incorporated into each round. CONCLUSION A Delphi consensus exercise was completed, and experts reached agreement on 38 items to be included in an instrument that can be used to evaluate person-centred teamwork in hospital settings. RELEVANCE TO CLINICAL PRACTICE We engaged with nine international experts in the academic and clinical field of person-centeredness, teamwork and/or instrument development. An online platform was used to allow the experts to give input into the study. The experts engaged from their own environment with full autonomy and anonymity. Person-centred teamwork, aimed at improving practice is now measurable. Person-centred teams improve outcomes of patients. Person-centred teamwork was specifically developed to assist low compliance areas in hospitals.
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Affiliation(s)
- Alida Viljoen
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Ronell Leech
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Tanya Heyns
- Department of Nursing Science, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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14
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Koch GGV, Engel-Hills P, Friedrich-Nel H. Individual patient radiation dose tracking: Perceptions of radiographers in South Africa. Radiography (Lond) 2024; 30:1014-1020. [PMID: 38704978 DOI: 10.1016/j.radi.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/15/2024] [Accepted: 04/22/2024] [Indexed: 05/07/2024]
Abstract
INTRODUCTION Medical imaging examinations that make use of ionising radiation provide valuable information towards patient management. Literature suggests that there is a significant rise in the number of patient referrals for such examinations. The concept "individual patient radiation dose tracking" (IPRDT) is introduced to optimise radiation monitoring. Many countries across the globe explored and implemented methods to enhance and promote the justification and optimisation principles essential for patient radiation safety. In South Africa (SA), however, attention to IPRDT is limited. METHODS A qualitative research design was employed. Radiographers in the Western Cape Province of SA were purposefully sampled for participation in one-on-one, semi-structured interviews. Thematic analysis was applied to the transcribed interview data. RESULTS This paper presents a theme developed from the radiographer cohort of ten (10) participants. The theme: the need for creating awareness and implementing legislative support structures, was developed from the data, with the following supporting subthemes: 1) stakeholder awareness and 'buy-in' 2) continuous professional development and 3) mandated practice. CONCLUSION This study provides findings that are of value for patient radiation safety in SA by giving a voice to local stakeholders. Other countries that are conducting similar research investigations toward the integration of an IPRDT model, method, or framework, may also benefit from these findings. IMPLICATIONS FOR PRACTICE The effective integration of IPRDT into the clinical environment requires unison amongst the relevant stakeholders and clarity on the various professionals' roles and responsibilities. The findings of this study furthermore suggest the involvement of regulatory organisations for the provision of a mandated form of practice at national and international levels.
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Affiliation(s)
- G G V Koch
- Cape Peninsula University of Technology, Faculty of Health and Wellness Sciences, Department of Medical Imaging and Therapeutic Sciences, South Africa.
| | - P Engel-Hills
- Cape Peninsula University of Technology, Faculty of Health and Wellness Sciences, Department of Medical Imaging and Therapeutic Sciences, South Africa
| | - H Friedrich-Nel
- Central University of Technology, Free State, Faculty of Health and Environmental Sciences, Department of Clinical Sciences, South Africa
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15
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Zhang X, Li L, Zhang Q, Le LH, Wu Y. Physician Empathy in Doctor-Patient Communication: A Systematic Review. HEALTH COMMUNICATION 2024; 39:1027-1037. [PMID: 37062918 DOI: 10.1080/10410236.2023.2201735] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
Physician empathy is at the heart of doctor-patient communication and significantly influences patient outcomes. However, the research on how physicians express their empathy and how physician empathy affects patient outcomes and doctor-patient communication has not been well summarized in the latest literature. Thus, we conducted a systematic review to synthesize existing studies on physician empathy and its value to patient outcomes and doctor-patient communication. The systematic review consisted of studies published in English peer-reviewed journals between January 2017 and October 2021. Following the PRISMA procedure, a total of 3055 articles were retrieved, and 11 articles were retained. The thematic analysis revealed three emergent themes: physicians' empathic expressions; patient outcomes (patient functional status, patient safety, and patient satisfaction); and empathy enhancing doctor-patient communication. This study highlighted the different ways empathy may be expressed by physicians and its positive effects on patient outcomes and doctor- patient communication. This study also suggested the under-researched areas that can be expanded in the future.
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Affiliation(s)
- Xin Zhang
- Center for Medical Humanities in the Developing World, Qufu Normal University
| | - Linzi Li
- Department of Gynaecology, Rizhao Maternal and Child Health
| | - Quan Zhang
- School of International Affairs and Public Administration, Ocean University of China
| | | | - Yijin Wu
- Center for Medical Humanities in the Developing World, Qufu Normal University
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16
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Poon FMM, Ward EC, Burns CL. Identifying prioritised actions for improving dysphagia services in Singapore: Insights from concept mapping with patients and caregivers. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2024; 59:1018-1031. [PMID: 37936543 DOI: 10.1111/1460-6984.12977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/13/2023] [Indexed: 11/09/2023]
Abstract
BACKGROUND Person-centred services are inherently related to patients/caregivers' needs. However, the extent to which dysphagia services within Singapore meet consumer needs is largely unknown. Involving patients/caregivers in service evaluation/redesign deepens the understanding of consumer needs. This process also increases the success of implementing service enhancements through relevant and meaningful change. AIM This study aimed to identify aspects of dysphagia services, within acute and subacute settings in Singapore, perceived as highly important and easy to change by patients/caregivers. METHODS & PROCEDURES Using concept mapping methodology, 5 patients and 11 caregivers reflected on their experiences of receiving dysphagia care and proposed 59 unique suggestions to improve dysphagia services within Singapore. Then, each individual sorted the suggestions into groups based on similarity and rated each statement for its perceived importance and changeability for service enhancement. Data were analysed using multidimensional scaling, hierarchical cluster analysis, and bivariate analysis to generate clusters of conceptually similar suggestions and a prioritised list of suggestions for service enhancement. RESULTS Twelve clusters were identified, with most rated as more important than changeable for service improvement. Participants prioritised 23 (39%) of the suggestions as highly important and easy to change, and these focused on ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. CONCLUSION These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients/caregivers. WHAT THIS PAPER ADDS What is already known on this subject Little is known about patients and caregivers' experiences and expectations of receiving dysphagia services in Singapore. Consulting them in service review and improvement deepens understanding of their needs and increases the success of implementing meaningful service enhancements. What this study adds to existing knowledge This study shows that patients and caregivers in Singapore identified a wide range of dysphagia service issues and prioritised a list of suggestions for service improvement. They prioritised four key areas for service optimisation: ensuring effective communication among consumers and healthcare team, enhancing patients and carers' access to support at home, increasing patients and carers' access to educational resources, and improving service quality and access through technology. What are the clinical implications of this work? This research highlights the importance of considering the consumers' perspectives in service review and redesign. Patients and caregivers in Singapore identified four prioritised areas for service enhancements. These findings provide future directions on how to develop and implement dysphagia services in Singapore to better meet the needs of patients and caregivers.
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Affiliation(s)
- Flora M M Poon
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Rehabilitation, Ng Teng Fong General Hospital and Jurong Community Hospital, National University Health System, Singapore, Singapore
| | - Elizabeth C Ward
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - Clare L Burns
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- Speech Pathology & Audiology Department, Royal Brisbane and Women's Hospital, Metro North Health, Brisbane, Queensland, Australia
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de Graaff E, Bennett C, Dart J. Empathy in Nutrition and Dietetics: A Scoping Review. J Acad Nutr Diet 2024:S2212-2672(24)00193-X. [PMID: 38677364 DOI: 10.1016/j.jand.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Empathy is fundamental to the provision of efficacious patient-centered health care. Currently, there is no comprehensive synthesis of peer-reviewed empirical research related to empathy in the nutrition and dietetics profession. Understanding empathy in the context of nutrition and dietetics care may lead to improved teaching practices that support nutrition and dietetics students and practitioners to provide high-quality, empathic, patient-centered care. OBJECTIVE This scoping review aimed to understand the approaches through which empathy is conceptualized, measured, and taught in the field of nutrition and dietetics. METHODS Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Reviews Statement and Checklist, a scoping review process was undertaken. Five databases were searched in February 2023: Cumulative Index to Nursing and Allied Health, Embase, Medline, PsycInfo, and Scopus, with no date limits. Eligible studies were English language-based, peer-reviewed, empirical research exploring or measuring empathy as an outcome in primary data stratified to nutrition and dietetics. Extracted qualitative data were synthesized and analyzed thematically with an inductive, interpretivist approach applied to conceptualize the interrelationship between empathy and dietetic practice. Quantitative data were extracted and summarized in a table. RESULTS Twenty-six studies were included in the scoping review. Analysis identified 2 overarching themes underpinning the current literature on empathy in nutrition and dietetics that described empathy as a key skill in the application of patient-centered care, which was supported by approaches to lifelong cultivation of empathy in the nutrition and dietetics profession. A range of tools has measured empathy in nutrition and dietetics students and practitioners with no clear consensus in findings across studies. CONCLUSIONS This review identified the extent and nature of empathy within nutrition and dietetics, from both practitioner and patient perspectives, and the vast array of approaches used to teach and quantify empathy in students and practitioners. Insights from this review inform the need for future studies. The results of this review suggest that future research include exploring implications of empathic dietetics care on patient outcomes and identification of best practice, evidence-based curricula and strategies to support sustainable cultivation and maintenance of empathic care across the career span of nutrition and dietetics practitioners.
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Affiliation(s)
- Emma de Graaff
- Department of Nutrition, Dietetics, and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
| | - Christie Bennett
- Department of Nutrition, Dietetics, and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
| | - Janeane Dart
- Department of Nutrition, Dietetics, and Food, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia
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Alsop T, Cassimatis M, Williams KL, Gomersall SR. Perspectives of people with myasthenia gravis on physical activity and experience of physical activity advice from health professionals in the Australian context: a qualitative study. Disabil Rehabil 2024:1-8. [PMID: 38613411 DOI: 10.1080/09638288.2024.2338877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 03/31/2024] [Indexed: 04/14/2024]
Abstract
PURPOSE Physical activity is an important modifiable determinant of health. There has been a historical aversion to movement in people with myasthenia gravis (MG) due to the pathophysiology of the disease, however, research suggests engagement in physical activity is safe and does not exacerbate symptoms. There are currently no studies investigating the qualitative perspectives of people with MG on physical activity. The aim of this study was to explore perceptions of physical activity, barriers, enablers, and participants' experiences of physical activity advice from health professionals. MATERIALS AND METHODS Semi-structured interviews were used, with verbatim transcripts analysed using content analysis. RESULTS Ten adults (median age 64.5 years) living in Australia with generalised MG were interviewed. Key findings were identified: (1) Physical activity is perceived to be important for general health and for MG; (2) Medical management and social support are key enablers; (3) Fatigue and pain are potential barriers; and (4) Experiences with healthcare professionals were considered insufficient and failed to provide disease specific advice regarding MG and physical activity. CONCLUSION People with MG have unique barriers and enablers to physical activity engagement that clinicians should consider when providing physical activity behaviour change support to this population.
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Affiliation(s)
- Tahlia Alsop
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Marianna Cassimatis
- School of Human Movement and Nutrition Sciences, Health and Wellbeing Centre for Research Innovation, The University of Queensland, Brisbane, Australia
| | - Katrina L Williams
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Sjaan R Gomersall
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
- School of Human Movement and Nutrition Sciences, Health and Wellbeing Centre for Research Innovation, The University of Queensland, Brisbane, Australia
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Holm MS, Fålun N, Bendz B, Fridlund B, Langørgen J, Pettersen TR, Sandau KE, Norekvål TM. The patient experience of in-hospital telemetry monitoring: a qualitative analysis. Eur J Cardiovasc Nurs 2024; 23:258-266. [PMID: 37590960 DOI: 10.1093/eurjcn/zvad082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/19/2023]
Abstract
AIMS In-hospital telemetry monitoring has been an integrated part of arrhythmia monitoring for decades. A substantial proportion of patients require arrhythmia monitoring during stays in non-intensive care units. However, studies exploring patients' experiences of telemetry monitoring are scarce. Therefore, the aim was to explore and describe patients' experiences of in-hospital telemetry monitoring in a non-intensive care setting. METHODS AND RESULTS Twenty face-to-face, semi-structured interviews were conducted. Interviews were conducted before discharge at two university hospitals in Norway. The patients were purposively sampled, resulting in a well-balanced population comprising 11 men and nine women, mean age 62 years (range 25-83). Average monitoring time was 9 days (range 3-14). Data were audiotaped, transcribed verbatim, and coded using NVivo software. Qualitative content analysis using an inductive approach was performed. Patients expressed a need for individualized information during telemetry monitoring. Their feelings of safety were related to responses from nurses from the central monitoring station when alarms from the telemetry were triggered. Despite perceived physical restrictions and psychological limitations associated with telemetry monitoring, they found monitoring to be beneficial because it facilitated the diagnosis of arrhythmia. Moreover, they expressed a need for improvements in wearable monitoring equipment. Patients expressed ambivalent feelings about discontinuing the telemetry and their readiness for discharge. CONCLUSION Patients need individualized information about the results of their telemetry monitoring in order to better understand the arrhythmia management and to increase their experience of safety after discharge. The limitations patients experienced should be taken into consideration in further upgrades of telemetry monitoring equipment.
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Affiliation(s)
- Marianne Sætrang Holm
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, postboks 7030, N-5020 Bergen, Norway
| | - Nina Fålun
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, postboks 7030, N-5020 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Bjørn Bendz
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Centre of Interprofessional Collaboration within Emergency Care (CICE), Linnaeus University, Kalmar, Sweden
| | - Jørund Langørgen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Trond R Pettersen
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, postboks 7030, N-5020 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | | | - Tone M Norekvål
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, postboks 7030, N-5020 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Rommerskirch-Manietta M, Manietta C, Hoffmann-Hoffrichter AL, Purwins D, Van Haitsma K, Abbott KM, Roes M. The PELI-D II Study: Development and Preliminary Validation of the Preferences for Leisure Activities Inventory (P-LAI) for Adult Day Services. Clin Gerontol 2024:1-14. [PMID: 38594970 DOI: 10.1080/07317115.2024.2341110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVES The current study aimed to develop and preliminarily validate an initial version of an instrument to assess the leisure activity preferences of people receiving adult day services (ADS). METHODS Based on previously conducted concept mapping steps, we identified 12 clusters of preferences for leisure activities. We adopted the structure of the Preferences for Everyday Living Inventory and phrased our cluster labels as questions to develop a first draft of the Preferences for Leisure Activities Inventory (P-LAI). We conducted cognitive interviews (n = 8) to revise, preliminarily validate, and preliminarily finalize the P-LAI. RESULTS The draft of the P-LAI included 25 questions. Based on the results of the cognitive interviews, the number of questions was reduced to 21, three questions were rephrased, and evidence to support the preliminary validity of the P-LAI based on the response processes was provided. CONCLUSIONS The P-LAI is the first instrument to assess preferences for leisure activities in the ADS environment. CLINICAL IMPLICATIONS The preliminary results of the P-LAI allow ADS providers and healthcare professionals to assess the preferences for leisure activities of people who receive ADS in a structured way. Based on these results, preference-based services can be designed and planned, and the person-centered philosophy of care can be further operationalized in the ADS environment.
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Affiliation(s)
- Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Christina Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Anna Louisa Hoffmann-Hoffrichter
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
| | - Daniel Purwins
- Diakonie Osnabrück, Stadt und Land gGmbh, Osnabrück, Germany
| | - Kimberly Van Haitsma
- College of Nursing, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Katherine M Abbott
- Department of Sociology and Gerontology, Miami University, Oxford, Ohio, USA
- Scripps Gerontology Center, Miami University, Oxford, Ohio, USA
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- Faculty of Health, School of Nursing Science, Witten/Herdecke University, Witten, Germany
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Murry LT, Desselle SP. Barriers to person-centered service design in pharmacy practice: examples, lessons, and potential solutions. Int J Clin Pharm 2024; 46:542-547. [PMID: 38194008 DOI: 10.1007/s11096-023-01689-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/09/2023] [Indexed: 01/10/2024]
Abstract
Despite increased attention to, and frameworks conceptualizing person-centered care, systematic, organizational, and provider-level barriers continue to discourage the development and delivery of person-centered care (PCC) in pharmacy practice and beyond. This commentary describes existing pharmacy-specific literature related to PCC, barriers to PCC within the context of pharmacy practice, and potential solutions to increase person-centeredness in pharmacy services. Literature to substantiate and describe barriers and potential solutions was identified from 2008 to 2023, a period where the emphasis on PCC in pharmacy practice dramatically increased. Overall, pharmacy-specific literature was identified describing four key barriers to PCC. Several potential solutions were identified, including: using innovative and theory-informed approaches to collecting individual need and preference information, employing processes and equipping providers to facilitate trust, changing organizational culture, and aligning quality metrics and financial incentives with PCC. Identified solutions may be used to address individual, organizational, and systematic barriers to promote PCC.
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Affiliation(s)
- Logan T Murry
- The University of Iowa College of Pharmacy, 180 S Grand Ave, Iowa City, IA, 52242, USA.
- The Accreditation Council for Pharmacy Education, Chicago, IL, 60603, USA.
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Culmer NP, Smith TB, Berryhill MB, Gurenlian J, Simpson L, Ogden S, Parrish J, Ryan L, White N, Bettis M, Greenwood C. Mental health screening and referral to treatment in dental practices: A scoping review. J Dent Educ 2024; 88:445-460. [PMID: 38282325 DOI: 10.1002/jdd.13444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 12/15/2023] [Indexed: 01/30/2024]
Abstract
OBJECTIVE The purpose of this study was to conduct a scoping review to examine and summarize the characteristics of research related to mental health (MH) screenings and/or referrals to treatment in dental practices. METHODS We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for Scoping Reviews and searched multiple databases for terms connected with dental care, MH concerns, screening, and referral. Included articles: (1) described care provided in a dental practice, (2) described a situation where the patient is experiencing the potential MH problem, (3) did not involve dental anxiety exclusively, and (4) involved some form of MH screening and/or referral to treatment. Article analysis included a summary of key study characteristics, types of evidence, study design, and central concepts and definitions. RESULTS The search generated 2050 records, with 26 ultimately included. Most studies involved only adults (22, 85%), but only three (12%) reported on rurality (two urban; one mixed) and only two each (8%) reported race or ethnicity. Fifteen (58%) articles were prospective and 11 (42%) were retrospective. The studies varied widely in study designs, from 11 (42%) cross-sectional methodologies to only one (4%) randomized controlled trial. Thirty-four screening tools were used to screen for symptoms of 43 MH conditions, with depression and anxiety screened for most frequently. Few articles discussed making referrals, practice workflows, or follow-up outcomes. CONCLUSIONS Included studies provide evidence of viable options for dental practitioners regarding MH screening, referring, and conducting follow-up, but lack specificity regarding these processes. Overall, more research is needed to clarify what workflows are most efficient for dental practitioners and efficacious in identifying patients with MH concerns.
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Affiliation(s)
- Nathan P Culmer
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Todd Brenton Smith
- Capstone College of Nursing, The University of Alabama, Tuscaloosa, Alabama, USA
| | - M Blake Berryhill
- Department of Human Development and Family Studies, The University of Alabama, Tuscaloosa, Alabama, USA
| | - JoAnn Gurenlian
- Education and Research Division, American Dental Hygienists' Association, Chicago, Illinois, USA
- Department of Dental Hygiene, Idaho State University, Pocatello, Idaho, USA
| | - Lance Simpson
- University Libraries, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Shawnna Ogden
- College of Community Health Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Jonathan Parrish
- College of Dental Medicine, Roseman University of Health Sciences, South Jordan, Utah, USA
- College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Lacey Ryan
- College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Nicole White
- Department of Psychology, The University of Mississippi, Oxford, Mississippi, USA
| | - Merrill Bettis
- College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
| | - Charlotte Greenwood
- College of Arts and Sciences, The University of Alabama, Tuscaloosa, Alabama, USA
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Aronowitz T, Peterson KS, Morris NS. Moving the Disparity Needle: Resourcing Care Delivery for Those With Greatest Needs. Med Care 2024; 62:213-216. [PMID: 38315884 DOI: 10.1097/mlr.0000000000001986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Affiliation(s)
- Teri Aronowitz
- Department of Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, MA
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Bastiaens F, Wegener JT, Ostelo RWJG, van Roosendaal BKWP, Vissers KCP, van Hooff ML. Clinical Patient-Relevant Outcome Domains for Persistent Spinal Pain Syndrome-A Scoping Review and Expert Panels. J Clin Med 2024; 13:1975. [PMID: 38610739 PMCID: PMC11012536 DOI: 10.3390/jcm13071975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/14/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Large variation exists in the monitoring of clinical outcome domains in patients with persistent spinal pain syndrome (PSPS). Furthermore, it is unclear which outcome domains are important from the PSPS patient's perspective. The study objectives were to identify patient-relevant outcome domains for PSPS and to establish a PSPS outcomes framework. PubMed, CINAHL, Cochrane, and EMBASE were searched to identify studies reporting views or preferences of PSPS patients on outcome domains. The Arksey and O'Malley framework was followed to identify outcome domains. An expert panel rated the domains based on the importance for PSPS patients they have treated. A framework of relevant outcome domains was established using the selected outcome domains by the expert panel. No studies were found for PSPS type 1. Five studies with 77 PSPS type 2 patients were included for further analysis. Fourteen outcome domains were identified. An expert panel, including 27 clinical experts, reached consensus on the domains pain, daily activities, perspective of life, social participation, mobility, mood, self-reliance, and sleep. Eleven domains were included in the PSPS type 2 outcomes framework. This framework is illustrative of a more holistic perspective and should be used to improve the evaluation of care for PSPS type 2 patients. Further research is needed on the prioritization of relevant outcome domains.
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Affiliation(s)
- Ferdinand Bastiaens
- Department of Research, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Anesthesiology and Pain Medicine, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
| | - Jessica T. Wegener
- Department of Anesthesiology and Pain Medicine, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
| | - Raymond W. J. G. Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam University Medical Centre, Vrije Universiteit, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Bert-Kristian W. P. van Roosendaal
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - Kris C. P. Vissers
- Department of Anesthesiology, Pain, and Palliative Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
- Department of Anesthesiology and Pain Medicine, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
| | - Miranda L. van Hooff
- Department of Research, Sint Maartenskliniek, 9500 GM Nijmegen, The Netherlands
- Department of Orthopedics, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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Husain L, Finlay T, Husain A, Wherton J, Hughes G, Greenhalgh T. Developing user personas to capture intersecting dimensions of disadvantage in older patients who are marginalised: a qualitative study. Br J Gen Pract 2024:BJGP.2023.0412. [PMID: 38242714 PMCID: PMC10947364 DOI: 10.3399/bjgp.2023.0412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 12/11/2023] [Indexed: 01/21/2024] Open
Abstract
BACKGROUND Remote and digital services must be equitable, but some patients have difficulty using these services. Designing measures to overcome digital disparities can be challenging for practices. Personas (fictional cases) are a potentially useful tool in this regard. AIM To develop and test a set of personas to reflect the lived experiences and challenges that older people who are disadvantaged face when navigating remote and digital primary care services. DESIGN AND SETTING Qualitative study of digital disparities in NHS community health services offering video appointments. METHOD Following familiarisation visits and interviews with service providers, 17 older people with multiple markers of disadvantage (limited English, health conditions, and poverty) were recruited and interviewed using narrative prompts. Data were analysed using an intersectionality lens, underpinned by sociological theory. Combining data across all participant interviews, we produced personas and refined these following focus groups involving health professionals, patients, and advocates (n = 12). RESULTS Digital services create significant challenges for older patients with limited economic, social, and linguistic resources and low digital, health, or system literacy. Four contrasting personas were produced, capturing the variety and complexity of how dimensions of disadvantage intersected and influenced identity and actions. The personas illustrate important themes including experience of racism and discrimination, disorientation, discontinuity, limited presence, weak relationships, loss of agency, and mistrust of services and providers. CONCLUSION Personas can illuminate the multiple and intersecting dimensions of disadvantage in patient populations who are marginalised and may prove useful when designing or redesigning digital primary care services. Adopting an intersectional lens may help practices address digital disparities.
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Affiliation(s)
- Laiba Husain
- The Healthcare Improvement Studies Institute research fellow
| | - Teresa Finlay
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Arqam Husain
- School of Medicine, Wayne State University, Detroit, MI, US
| | - Joseph Wherton
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Gemma Hughes
- School of Business, University of Leicester, Leicester, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Rommerskirch-Manietta M, Manietta C, Purwins D, Van Haitsma K, Abbott KM, Roes M. "This is Slowly Becoming my Interest…": The Understanding of Leisure and Preferences for Leisure Activities of People Receiving Adult Day Services. Res Aging 2024; 46:210-227. [PMID: 38087875 PMCID: PMC10868149 DOI: 10.1177/01640275231221162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Currently it is unknown what people receiving adult day services (ADS) understand as leisure and the activities they prefer remain unknown. To address these gaps, we investigated the understanding of leisure of people receiving ADS. We conducted semistructured interviews with 15 people receiving ADS in Germany. Interviews were analyzed using reflexive thematic analysis. The sweet bitter symphony emphasizes the sensations that shape participant's understanding of leisure. Young, wild & free! describes the types of preferred activities. Is this our last tango? refers to the barriers. Anchors aweigh! the [ongoing] voyage describes the process by which leisure is transferred from private domain to the ADS environment. The beginning is the end is the beginning illustrates the paradox of understanding the ADS as offering a form of leisure and the adaptation to engage in nonpreference-based activities. Our findings indicate the importance in offering leisure activities that enable preference-based engagement in the ADS.
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Affiliation(s)
- Mike Rommerskirch-Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Christina Manietta
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Daniel Purwins
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | | | - Katherine M. Abbott
- Department of Sociology and Gerontology, Miami University, Oxford, OH, USA
- Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | - Martina Roes
- Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), Witten, Germany
- School of Nursing Science, Faculty of Health, Witten/Herdecke University, Witten, Germany
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Dardess P, Dokken DL, Unaka NI, Casillas CA, Rouse L, Patel U, Rodriguez LR, Beck AF. Diversity, Equity, and Inclusion in Patient and Family Advisory Councils: Advancing Best Practice in Children's Hospitals. J Pediatr Health Care 2024; 38:184-193. [PMID: 38429030 DOI: 10.1016/j.pedhc.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 09/29/2023] [Accepted: 11/18/2023] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This qualitative research study explored practices that support and advance diverse membership in Patient and Family Advisory Councils (PFACs) in children's hospitals and the involvement of PFACs in organization-level diversity, equity, and inclusion work. METHOD This study consisted of a focused literature review and 17 key informant interviews. The study sought to identify important learnings about (1) recruiting and supporting patient and family advisors (PFAs) from historically marginalized populations and (2) ways to develop and sustain meaningful partnerships with PFAs and PFACs in diversity, equity, and inclusion work. RESULTS The study findings highlighted a number of best practices for hospitals to adopt, including more actively reaching out to communities served, addressing barriers to participation through approaches and structures such as specialty PFACs and "tiered" options for participation by PFAs, and co-creation of inclusive environments. DISCUSSION To move forward with this work, additional research, true commitment from health care organizations, and shared guidance and tools for the field are needed.
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Worthington MA, Christie RH, Masino AJ, Kark SM. Identifying Unmet Needs in Major Depressive Disorder Using a Computer-Assisted Alternative to Conventional Thematic Analysis: Qualitative Interview Study With Psychiatrists. JMIR Form Res 2024; 8:e48894. [PMID: 38427407 PMCID: PMC10943432 DOI: 10.2196/48894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 01/16/2024] [Accepted: 01/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND The development of digital health tools that are clinically relevant requires a deep understanding of the unmet needs of stakeholders, such as clinicians and patients. One way to reveal unforeseen stakeholder needs is through qualitative research, including stakeholder interviews. However, conventional qualitative data analytical approaches are time-consuming and resource-intensive, rendering them untenable in many industry settings where digital tools are conceived of and developed. Thus, a more time-efficient process for identifying clinically relevant target needs for digital tool development is needed. OBJECTIVE The objective of this study was to address the need for an accessible, simple, and time-efficient alternative to conventional thematic analysis of qualitative research data through text analysis of semistructured interview transcripts. In addition, we sought to identify important themes across expert psychiatrist advisor interview transcripts to efficiently reveal areas for the development of digital tools that target unmet clinical needs. METHODS We conducted 10 (1-hour-long) semistructured interviews with US-based psychiatrists treating major depressive disorder. The interviews were conducted using an interview guide that comprised open-ended questions predesigned to (1) understand the clinicians' experience of the care management process and (2) understand the clinicians' perceptions of the patients' experience of the care management process. We then implemented a hybrid analytical approach that combines computer-assisted text analyses with deductive analyses as an alternative to conventional qualitative thematic analysis to identify word combination frequencies, content categories, and broad themes characterizing unmet needs in the care management process. RESULTS Using this hybrid computer-assisted analytical approach, we were able to identify several key areas that are of interest to clinicians in the context of major depressive disorder and would be appropriate targets for digital tool development. CONCLUSIONS A hybrid approach to qualitative research combining computer-assisted techniques with deductive techniques provides a time-efficient approach to identifying unmet needs, targets, and relevant themes to inform digital tool development. This can increase the likelihood that useful and practical tools are built and implemented to ultimately improve health outcomes for patients.
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Affiliation(s)
- Michelle A Worthington
- AiCure, New York, NY, United States
- Department of Psychology, Yale University, New Haven, CT, United States
| | | | - Aaron J Masino
- AiCure, New York, NY, United States
- The School of Computing, Clemson University, Clemson, SC, United States
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Champendal M, Borg Grima K, Costa P, Andersson C, Baun C, Gorga RG, Murphy S, Kedves A, Santos A, Geao A. A scoping review of person-centred care strategies used in diagnostic Nuclear Medicine. Radiography (Lond) 2024; 30:448-456. [PMID: 38211452 DOI: 10.1016/j.radi.2023.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/28/2023] [Accepted: 12/19/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Person-centred care (PCC) emphasises the need for the health care professional to prioritise individual patient needs, thereby fostering a collaborative and emphatic environment that empowers patients to actively participate in their own care. This article will explore the purpose of PCC in Nuclear Medicine (NM), while discussing strategies that may be used to implement PCC during diagnostic NM examinations performed on adult patients. METHODS The scoping review was conducted in accordance with the Joanna Briggs Institute methodology. The search was performed on PubMed, Embase and Cinhal in June 2023 and included studies in English, Spanish, Portuguese and Italian. The research equation combined keywords and Medical Subject Heading terms (MeSH) related to person-centred care (PCC), for all types of nuclear medicine diagnostic examinations performed. Three independent review authors screened all abstracts and titles, and all eligible full-text publications were included in this scoping review. RESULTS Fifty-three articles, published between 1993 and 2022, met the inclusion criteria for this scoping review. Seven articles were published in 2015 while 56.6 % of all included studies were performed in Europe. Most studies (n = 39/53) focused on the patients only, with the identified patient benefits being: improve patient experience (67.9 %), increase patient comfort (13.2 %), increase patient knowledge (5.7 %), reduction of patient anxiety (9.4 %) and reduction of waiting/scan time (3.8 %). CONCLUSION The scoping review identified a lack of research investigating the use of person-centred care strategies in NM. Future research will focus on using an international survey to explore this topic in nuclear medicine departments overseas. IMPLICATIONS FOR PRACTICE By applying PCC principles, the NM professional can improve the patient care pathway and increase patient satisfaction, leading to enhanced clinical outcomes.
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Affiliation(s)
- M Champendal
- Department of Radiologic Medical Imaging Technology, School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland (HES-SO), Lausanne, Switzerland; European Federation of Radiographer Societies Nuclear Medicine Committee, Austria
| | - K Borg Grima
- University of Malta, Faculty of Health Sciences, Department of Radiography, Malta; European Federation of Radiographer Societies Nuclear Medicine Committee, Austria.
| | - P Costa
- Department of Nuclear Medicine, ESS, Polytechnic University of Porto, Porto, Portugal; European Federation of Radiographer Societies Nuclear Medicine Committee, Austria
| | - C Andersson
- Dept. of Surgical Sciences, Uppsala University Uppsala, Sweden; European Federation of Radiographer Societies Nuclear Medicine Committee, Austria
| | - C Baun
- Department of Nuclear Medicine, Odense University Hospital, Odense, Denmark; European Federation of Radiographer Societies Nuclear Medicine Committee, Austria
| | - R G Gorga
- Servei de Medicina Nuclear, Hospital Universitari Parc Taulí, Sabadell, Spain; European Federation of Radiographer Societies Nuclear Medicine Committee, Austria
| | - S Murphy
- Radiography and Diagnostic Imaging Unit, College of Health and Agricultural Sciences, School of Medicine, University College Dublin (UCD), Dublin, Ireland; European Federation of Radiographer Societies Nuclear Medicine Committee, Austria
| | - A Kedves
- University of Pécs Faculty of Engineering and Information Technology, Hungary; European Association of Nuclear Medicine Technologists Committee, Austria
| | - A Santos
- Nuclear Medicine Department, Hospital Cuf Descobertas, Lisbon, Portugal; European Association of Nuclear Medicine Technologists Committee, Austria
| | - A Geao
- Nuclear Medicine Department, Hospital Cuf Descobertas, Lisbon, Portugal; European Federation of Radiographer Societies Nuclear Medicine Committee, Austria
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Naqvi WM, Gabr M, Arora SP, Mishra GV, Pashine AA, Quazi Syed Z. Bridging, Mapping, and Addressing Research Gaps in Health Sciences: The Naqvi-Gabr Research Gap Framework. Cureus 2024; 16:e55827. [PMID: 38590484 PMCID: PMC10999783 DOI: 10.7759/cureus.55827] [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: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 04/10/2024] Open
Abstract
Innovations pertaining to the ever-evolving needs of the medical and healthcare sciences remain constant. This creates a gap between the rationalized needs of the study and the proposed research question. However, classifying, identifying, and addressing these research gaps require a systematic and precise structured map. Using the Medical Subject Heading (MeSH) terms "Research Gaps" AND "Healthcare" AND "Framework" in MEDLINE, Scopus, and CINAHL databases with the filters yielded no relevant literature. Therefore, this review aims to fill this practical and clinical knowledge gap by developing the Naqvi-Gabr Research Gap Framework through critical synthesis based on extensive research on medical and healthcare research gaps. Fourteen research gaps are distributed for allocation as per the healthcare delivery system approach: developing new treatments or prevention strategies, improving diagnostic tools and techniques, addressing health disparities, and improving access to healthcare services. This structured framework determines the strategic mapping of research gaps corresponding to the nature of the research. The identification and classification of the appropriate research gap led to precise and concise conclusions corresponding to the research process proposed in this study. Hence, the Naqvi-Gabr Research Gap Framework is a valuable tool for determining the potential application of gaps by researchers, policymakers, and other stakeholders with a productive address.
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Affiliation(s)
- Waqar M Naqvi
- Faculty of Interdisciplinary Sciences, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, ARE
| | - Mamdouh Gabr
- Department of Physiotherapy, College of Health Sciences, Gulf Medical University, Ajman, ARE
| | - Sakshi P Arora
- Faculty of Interdisciplinary Sciences, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Gaurav V Mishra
- Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aishwarya A Pashine
- Department of Cardiorespiratory Physiotherapy, Career College Bhopal, Bhopal, IND
| | - Zahiruddin Quazi Syed
- Department of Community Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Valestrand EA, Kvernenes M, Kinsella EA, Hunskaar S, Schei E. Transforming self-experienced vulnerability into professional strength: a dialogical narrative analysis of medical students' reflective writing. ADVANCES IN HEALTH SCIENCES EDUCATION : THEORY AND PRACTICE 2024:10.1007/s10459-024-10317-3. [PMID: 38401015 DOI: 10.1007/s10459-024-10317-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 02/04/2024] [Indexed: 02/26/2024]
Abstract
Medical students' efforts to learn person-centered thinking and behavior can fall short due to the dissonance between person-centered clinical ideals and the prevailing epistemological stereotypes of medicine, where physicians' life events, relations, and emotions seem irrelevant to their professional competence. This paper explores how reflecting on personal life experiences and considering the relevance for one's future professional practice can inform first-year medical students' initial explorations of professional identities. In this narrative inquiry, we undertook a dialogical narrative analysis of 68 essays in which first-year medical students reflected on how personal experiences from before medical school may influence them as future doctors. Students wrote the texts at the end of a 6-month course involving 20 patient encounters, introduction to person-centered theory, peer group discussions, and reflective writing. The analysis targeted medical students' processes of interweaving and delineating personal and professional identities. The analysis yielded four categories. (1) How medical students told their stories of illness, suffering, and relational struggles in an interplay with context that provided them with new perspectives on their own experiences. Students formed identities with a person-centered orientation to medical work by: (2) recognizing and identifying with patients' vulnerability, (3) experiencing the healing function of sharing stories, and (4) transforming personal experiences into professional strength. Innovative approaches to medical education that encourage and support medical students to revisit, reflect on, and reinterpret their emotionally charged life experiences have the potential to shape professional identities in ways that support person-centered orientations to medical work.
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Affiliation(s)
- Eivind Alexander Valestrand
- Center for Medical Education, Faculty of Medicine, University of Bergen, Bergen, Norway.
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway.
| | - Monika Kvernenes
- Center for Medical Education, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Elizabeth Anne Kinsella
- Institute of Health Sciences Education, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Edvin Schei
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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Hindi AMK, Campbell SM, Jacobs S, Schafheutle EI. Developing a quality framework for community pharmacy: a systematic review of international literature. BMJ Open 2024; 14:e079820. [PMID: 38365299 PMCID: PMC10875530 DOI: 10.1136/bmjopen-2023-079820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/31/2024] [Indexed: 02/18/2024] Open
Abstract
OBJECTIVE To identify the defining features of the quality of community pharmacy (CP) services and synthesise these into an evidence-based quality framework. DESIGN Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES International research evidence (2005 onwards) identified from six electronic databases (Embase, PubMed, Scopus, CINAHL, Web of Science and PsycINFO) was reviewed systematically from October 2022 to January 2023. Search terms related to 'community pharmacy' and 'quality'. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Titles and abstracts were screened against inclusion or exclusion criteria, followed by full-text screening by at least two authors. Qualitative, quantitative and mixed-method studies relevant to quality in CP were included. DATA EXTRACTION AND SYNTHESIS A narrative synthesis was undertaken. Following narrative synthesis, a patient and public involvement event was held to further refine the quality framework. RESULTS Following the title and abstract screening of 11 493 papers, a total of 81 studies (qualitative and quantitative) were included. Of the 81 included studies, 43 investigated quality dimensions and/or factors influencing CP service quality; 21 studies assessed patient satisfaction with and/or preferences for CP, and 17 studies reported the development and assessment of quality indicators, standards and guidelines for CPs, which can help define quality.The quality framework emerging from the global literature consisted of six dimensions: person-centred care, access, environment, safety, competence and integration within local healthcare systems. Quality was defined as having timely and physical access to personalised care in a suitable environment that is safe and effective, with staff competent in the dispensing process and pharmacy professionals possessing clinical knowledge and diagnostic skills to assess and advise patients relative to pharmacists' increasingly clinical roles. CONCLUSION The emerging framework could be used to measure and improve the quality of CP services. Further research and feasibility testing are needed to validate the framework according to the local healthcare context.
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Affiliation(s)
- Ali M K Hindi
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
| | - Stephen M Campbell
- Centre for Primary Care, University of Manchester, Manchester, UK
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa
| | - Sally Jacobs
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
| | - Ellen Ingrid Schafheutle
- Centre for Pharmacy Workforce Studies, Division of Pharmacy and Optometry, The University of Manchester, Manchester, UK
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Naylor J, Killingback C, Green A. An exploration of person-centredness among emergency department physiotherapists: a mixed methods study. Disabil Rehabil 2024:1-14. [PMID: 38329070 DOI: 10.1080/09638288.2024.2310179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024]
Abstract
PURPOSE There is a growing number of primary contact physiotherapists based in United Kingdom emergency departments (ED) who are expected to deliver person-centred practices. Perceptions of physiotherapists working in these high-pressure environments on person-centredness are currently unknown. A mixed methods exploration of person-centredness among ED physiotherapists targeted this knowledge gap to inform future clinical practice. METHODS Online survey and semi-structured interviews followed a convergent mixed methods design with sequential explanatory features. Data sets were analysed separately using descriptive statistics and thematic analysis, respectively, before merged analysis using joint display. RESULTS Twenty-six surveys and 11 in-depth interviews were completed. The three overarching themes of ED patients, ED physiotherapists, and ED environment were generated. Themes were integrated and analysed alongside quantitative survey findings. This produced three novel contributions that further our understanding of person-centred practices among ED physiotherapists. CONCLUSION ED physiotherapists were mindful of an apparent, yet unspoken struggle between the competing philosophies of biomedicine and person-centredness. The results here support entering a patient's world as a person-centred approach to help navigate the line between what an ED attender wants and the clinical need of their visit.
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Affiliation(s)
- John Naylor
- Department of Physiotherapy, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Clare Killingback
- Faculty of Health Sciences, University of Hull, Hull, United Kingdom
| | - Angela Green
- Department of Physiotherapy, Hull University Teaching Hospitals NHS Trust, Hull, United Kingdom
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Cavanagh FC, Chevalier N, Timmermans KE, Killam LA. How to Partner With Persons Living With Mental Health Conditions: A Guide for Meaningful Simulation Cocreation. Simul Healthc 2024:01266021-990000000-00102. [PMID: 38265069 DOI: 10.1097/sih.0000000000000777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
SUMMARY STATEMENT Screen-based simulation is an effective educational strategy that can enhance health care students' engagement with content and critical thinking across various topics, including mental health. To create relevant and realistic simulations, best-practice guidelines recommend the involvement of experts in the development process. We collaborated with persons with lived experience and community partners to cocreate a mental health-focused screen-based simulation. Cocreating meant establishing a nonhierarchical partnership, with shared decision-making from start to finish.In this article, we present 8 principles developed to guide our cocreation with persons with lived experience: person-centeredness, trauma-informed approaches and ethical guidance, supportive environment, two-way partnership, mutual respect, choice and flexibility, open communication, and room to grow. These principles provide practical guidance for educators seeking to engage the expertise of persons who have been historically disadvantaged in society. By sharing these principles, we strive to contribute to a more equitable process in simulation development and promote meaningful, respectful, and safer collaborations.
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Affiliation(s)
- Frances C Cavanagh
- From the School of Health Sciences, Nursing and Emergency Services, Cambrian College, Sudbury, Ontario, Canada
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Fernández-Salido M, Alhambra-Borrás T, Casanova G, Garcés-Ferrer J. Value-Based Healthcare Delivery: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:134. [PMID: 38397625 PMCID: PMC10888410 DOI: 10.3390/ijerph21020134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024]
Abstract
Healthcare systems are transforming from the traditional volume-based model of healthcare to a value-based model of healthcare. Value generation in healthcare is about emphasising the health outcomes achieved by patients and organisations while maintaining an optimal relationship with costs. This scoping review aimed to identify the key elements and outcomes of implementing value-based healthcare (VBHC). The review process included studies published from 2013 to 2023 in four different databases (SpringerLink, PubMed, ProQuest and Scopus). Of the 2801 articles retrieved from the searches, 12 met the study's inclusion criteria. A total of 11 studies referred to value as the relationship between the outcomes achieved by patients and the costs of achieving those outcomes. Most of the studies highlighted the presence of leadership, the organisation of care into integrated care units, the identification and standardisation of outcome measures that generate value for the patient, and the inclusion of the patient perspective as the most prominent key elements for optimal VBHC implementation. Furthermore, some benefits were identified from VBHC implementation, which could shed light for future implementation actions. Therefore, the VBHC model is a promising approach that may contribute to an improvement in the efficiency and sustainability of healthcare.
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Affiliation(s)
- Mirian Fernández-Salido
- Instituto de Investigación en Políticas de Bienestar Social (POLIBIENESTAR)—Research Institute on Social Welfare Policy, Universitat de València, 46022 Valencia, Spain; (T.A.B.); (J.G.F.)
| | - Tamara Alhambra-Borrás
- Instituto de Investigación en Políticas de Bienestar Social (POLIBIENESTAR)—Research Institute on Social Welfare Policy, Universitat de València, 46022 Valencia, Spain; (T.A.B.); (J.G.F.)
| | - Georgia Casanova
- Centre for Socio-Economic Research on Ageing, IRCCS-INRCA National Institute of Health & Science on Ageing, 60124 Ancona, Italy;
| | - Jorge Garcés-Ferrer
- Instituto de Investigación en Políticas de Bienestar Social (POLIBIENESTAR)—Research Institute on Social Welfare Policy, Universitat de València, 46022 Valencia, Spain; (T.A.B.); (J.G.F.)
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Cahill PT, Ng S, Turkstra LS, Ferro MA, Campbell WN. Exploring the valued outcomes of school-based speech-language therapy services: a sequential iterative design. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1290800. [PMID: 38313699 PMCID: PMC10834652 DOI: 10.3389/fresc.2024.1290800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024]
Abstract
Background Achieving outcomes that community members value is essential to high-quality, family-centred care. These valued outcomes should inform the production and interpretation of research evidence. To date, outcomes included in studies of service delivery models for speech-language services in schools have been narrowly defined, and do not match the outcomes suggested as important by families, teachers, and children. The most important outcomes of school-based, speech-languages services have not been directly and systematically investigated. We aimed to address this gap by asking school community members what outcomes were most relevant to evaluating and improving the delivery of speech-language services in schools. Methods A sequential, iterative mixed-method study was conducted using interviews with 14 family members, educators, and speech-language therapists that asked what outcomes or impacts of school-based services they considered most important or valuable. Summative content analysis was used to analyse the data. Structural topic modelling between rounds of qualitative analysis was used to describe both the quality and the quantity of the interview content. School community members' perspectives were compared through estimation of topic proportions within interviews from each member group and through qualitative comparison. Results Structural topic modelling diagnostics and qualitative interpretation of topic output suggested a six-topic solution. This solution was estimated successfully and yielded the following topics: (1) meeting all needs appropriately, (2) teamwork and collaboration, (3) building capacities, (4) supporting individual student needs in context, (5) coordinating care, and finally (6) supporting core educational goals. Families focused on school-based services meeting all needs appropriately and coordinating care, while educators highlighted supporting individual student needs in context. By contrast, speech-language therapists emphasized building capacities and supporting core educational goals. All school community members agreed that current assessment tools and outcome measures were inadequate to capture the most important impacts of school-based services. Conclusions Outcomes identified by school community members as important or valuable were broad, and included individual student outcomes, interpersonal outcomes, and systems-level outcomes. Although these outcomes were discussed by all member groups, each group focused on different outcomes in the interviews, suggesting differences in the prioritization of outcomes. We recommend building consensus regarding the most important outcomes for school-based speech-language services, as well as the prioritization of outcomes for measure development.
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Affiliation(s)
- Peter T. Cahill
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Stella Ng
- Department of Speech-Language Pathology, University of Toronto, Toronto, ON, Canada
- Centre for Interprofessional Education, University of Toronto, Toronto, ON, Canada
| | - Lyn S. Turkstra
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
| | - Mark A. Ferro
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
| | - Wenonah N. Campbell
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- CanChild Centre for Childhood Disability Research, Hamilton, ON, Canada
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Sterckx A, Delbaere B, De Blust G, Spacova I, Samson R, Remmen R, Keune H. Quality criteria of nature-based interventions in healthcare facilities: a scoping review. Front Public Health 2024; 11:1327108. [PMID: 38274513 PMCID: PMC10808570 DOI: 10.3389/fpubh.2023.1327108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/26/2023] [Indexed: 01/27/2024] Open
Abstract
Introduction Implementing integrated nature-based interventions that simultaneously serve human health and the restoration of biodiversity in healthcare facilities is considered a promising strategy. As an emerging field of research and practice in healthcare, identification of quality criteria is necessary to support desired outcomes related to biodiversity, human health and intervention processes. This study is part of a larger research project in collaboration with the Flemish Agency of Nature and Forest in Belgium. Methods A scoping review was conducted in accordance with the Joanna Briggs Institute methodology for scoping reviews, in PubMed, Medline, Web of Science and Scopus. A step-by-step tabular screening process was conducted to identify relevant studies and reviews of nature-based interventions, published in English between January 2005 and April 2023. A qualitative content analysis was conducted and the results were then presented to the project steering group and a panel of stakeholders for refinement. Results After filtering on the eligibility criteria, and with focus on healthcare facilities, 14 articles were included in this study. A preliminary nature-based interventions quality framework with a set of quality indicators has been developed. Discussion When designing integrated nature-based interventions, a needs analysis of users and the outdoor environment should be conducted. Next, the integration of a One Health and biodiversity perspective and the application of a complex intervention framework, could support the quality of the design and implementation of nature-based interventions in healthcare facilities and facilitate their assessment. In future work, more rigorous research into the design and implementation of integrated nature-based interventions is needed to test and refine the quality criteria in practice.
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Affiliation(s)
- Ann Sterckx
- Chair Care and the Natural Living Environment, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ben Delbaere
- Chair Care and the Natural Living Environment, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Geert De Blust
- Chair Care and the Natural Living Environment, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Irina Spacova
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Roeland Samson
- Department of Bioscience Engineering, University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Hans Keune
- Chair Care and the Natural Living Environment, Department of Primary and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Carrier JD, Gallagher F, Vanasse A, Roberge P. Demand management processes to improve access to cognitive-behavioral therapies for anxiety disorders: a grounded theory study. FRONTIERS IN HEALTH SERVICES 2024; 3:1266987. [PMID: 38274712 PMCID: PMC10808741 DOI: 10.3389/frhs.2023.1266987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/28/2023] [Indexed: 01/27/2024]
Abstract
Introduction Anxiety disorders are impactful mental health conditions for which evidence-based treatments are available, notably cognitive-behavioral therapies (CBTs). Even when CBTs are available, demand-side factors limit their access, and actors in a position to perform demand management activities lack a framework to identify context-appropriate actions. Methods We conducted a constructivist grounded theory study in Quebec, Canada, to model demand management targets to improve access to CBTs for anxiety disorders. We recruited key informants with diverse experiences using purposeful, then theoretical sampling. We analyzed data from 18 semi-directed interviews and 20 documents through an iterative coding process centered around constant comparison. Results The resulting model illustrates how actors can target clinical-administrative processes fulfilling the demand management functions of detection, evaluation, preparation, and referral to help patients progress on the path of access to CBTs. Discussion Modeling clinical-administrative processes is a promising approach to facilitate leveraging the competency of actors involved in demand management at the local level to benefit public mental health.
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Affiliation(s)
- Jean-Daniel Carrier
- PRIMUS Research Group, Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Department of Psychiatry, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Frances Gallagher
- School of Nursing, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Alain Vanasse
- PRIMUS Research Group, Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada
| | - Pasquale Roberge
- PRIMUS Research Group, Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Department of Psychiatry, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du CHUS, Sherbrooke, QC, Canada
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Sagen JS, Kjeken I, Habberstad A, Linge AD, Simonsen AE, Lyken AD, Irgens EL, Framstad H, Lyby PS, Klokkerud M, Dagfinrud H, Moe RH. Patient Involvement in the Rehabilitation Process Is Associated with Improvement in Function and Goal Attainment: Results from an Explorative Longitudinal Study. J Clin Med 2024; 13:320. [PMID: 38256454 PMCID: PMC10816630 DOI: 10.3390/jcm13020320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/22/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
The objective was to explore the associations between patient involvement in the rehabilitation process and improvements in function and goal attainment in the first year after rehabilitation. The longitudinal multicenter study RehabNytte provided data from participants who had been referred to rehabilitation (n = 2113). Quality indicator (QI) pass rates (% yes) were used to assess patient involvement in the rehabilitation process. The Patient-Specific Functional Scale (PSFS) (10 = best possible) was used to assess function. The outcome QI on goal achievement (response options of yes/no) was used to assess goal attainment. Logistic regression and paired sample t-tests were used to examine associations and mean changes in function from rehabilitation admission up to 3, 6, and 12 months. Most participants (95%) were involved in goal-setting, which was positively associated with younger age (OR 0.97, 95% CI 0.95-0.99) and female sex (OR 1.87, 95% CI 1.15-3.02). Function improved over the follow-up period, with greater improvements in the active goal-setting group. Being involved in goal planning almost tripled the odds of goal attainment (OR 2.78, 95% CI 1.60-4.83) and involvement in the rehabilitation plan almost doubled it (OR 1.99, 95% CI 1.41-2.81). Most participants were involved in rehabilitation goal-setting/planning and being involved was associated with beneficial functional outcomes and greater goal attainment.
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Affiliation(s)
- Joachim Støren Sagen
- Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass 4, 0130 Oslo, Norway;
- Diakonhjemmet Hospital, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology (NKRR), Diakonveien 12, 0370 Oslo, Norway; (I.K.); (H.D.); (R.H.M.)
| | - Ingvild Kjeken
- Diakonhjemmet Hospital, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology (NKRR), Diakonveien 12, 0370 Oslo, Norway; (I.K.); (H.D.); (R.H.M.)
| | - Andreas Habberstad
- The Norwegian Federation of Organizations of Disabled People, Mariboesgate 13, 0183 Oslo, Norway;
| | - Anita Dyb Linge
- Muritunet Rehabilitation Center, Grandegata 58, 6210 Sylte, Norway;
| | | | - Anne Dorte Lyken
- Sørlandet Rehabilitation Center, Ola Garsons vei 1, 4596 Eiken, Norway;
| | - Eirik Lind Irgens
- Helsepartner Rehabilitation Center, Follumsvei 1, 9510 Alta, Norway;
| | - Heidi Framstad
- Røysumtunet Rehabilitation Center, Røysumlinna 41, 2770 Jaren, Norway; (A.E.S.); (H.F.)
| | - Peter Solvoll Lyby
- Catosenteret Rehabilitation Center, Kvartsveien 2, 1555 Store Brevik, Norway;
| | - Mari Klokkerud
- Faculty of Health Sciences, Oslo Metropolitan University, St. Olavs plass 4, 0130 Oslo, Norway;
| | - Hanne Dagfinrud
- Diakonhjemmet Hospital, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology (NKRR), Diakonveien 12, 0370 Oslo, Norway; (I.K.); (H.D.); (R.H.M.)
| | - Rikke Helene Moe
- Diakonhjemmet Hospital, Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Norwegian National Advisory Unit on Rehabilitation in Rheumatology (NKRR), Diakonveien 12, 0370 Oslo, Norway; (I.K.); (H.D.); (R.H.M.)
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White SJ, Ho K, Maini K, Liang R. "Sorry for Holding You Up": Surgeons' Apologies for Lateness in Clinic Settings. HEALTH COMMUNICATION 2024:1-12. [PMID: 38177980 DOI: 10.1080/10410236.2023.2299888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
Doctors running late may convey a lack of respect which can impair the therapeutic relationship. This study examines how surgeons address lateness in consultations with patients. We analyzed 52 consultation recordings from a range of surgical specialties in an Australian metropolitan setting. Conversation analysis was used to analyze interactional sequences where lateness was addressed. Six sequences were identified within four recordings. The two consultations with two apologies include a surgeon and registrar apologizing in a neurosurgical consultation and a surgeon apologizing twice within a colorectal consultation. Apologies were either accepted or responded to with an account for not accepting the apology. When these accounts were made, consultations could only progress when patients accepted an explanation for lateness or the degree of complainability about lateness was reduced. The infrequent occurrence of apologies for lateness, and the way in which these sequences unfolded when they did occur, suggest that there is greater acceptability of lateness for surgeons than in ordinary social situations.
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Affiliation(s)
- Sarah J White
- Centre for Social Impact, University of New South Wales
| | - Ken Ho
- Faculty of Health Sciences & Medicine, Bond University
| | | | - Rhea Liang
- Faculty of Health Sciences & Medicine, Bond University
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Kelsall-Knight L, Stevens R. Exploring the implementation of person-centred care in nursing practice. Nurs Stand 2024; 39:70-75. [PMID: 38093586 DOI: 10.7748/ns.2023.e12190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 01/04/2024]
Abstract
Person-centred care involves nurses working in partnership with patients to ensure their needs and preferences are at the centre of their healthcare, as well as considering the biographical and social factors that are relevant to the person's health. This aims to support patients in developing the knowledge, confidence and skills to make informed decisions about treatment and to manage their own care where possible. This article discusses the concept of person-centred care and considers some of the facilitators and barriers that may affect its implementation in healthcare practice. It also explores some of the approaches that nurses can use to support person-centred care, such as cultural humility and role modelling.
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Affiliation(s)
| | - Rhian Stevens
- College of Medical and Dental Sciences, University of Birmingham, Edgbaston, England
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Krause KR, Calderón A, Pino VG, Edbrooke-Childs J, Moltrecht B, Wolpert M. What treatment outcomes matter in adolescent depression? A Q-study of priority profiles among mental health practitioners in the UK and Chile. Eur Child Adolesc Psychiatry 2024; 33:151-166. [PMID: 36719524 PMCID: PMC10806045 DOI: 10.1007/s00787-023-02140-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 01/05/2023] [Indexed: 02/01/2023]
Abstract
Evidence-based and person-centred care requires the measurement of treatment outcomes that matter to youth and mental health practitioners. Priorities, however, may vary not just between but also within stakeholder groups. This study used Q-methodology to explore differences in outcome priorities among mental health practitioners from two countries in relation to youth depression. Practitioners from the United Kingdom (UK) (n = 27) and Chile (n = 15) sorted 35 outcome descriptions by importance and completed brief semi-structured interviews about their sorting rationale. By-person principal component analysis (PCA) served to identify distinct priority profiles within each country sample; second-order PCA examined whether these profiles could be further reduced into cross-cultural "super profiles". We identified three UK outcome priority profiles (Reduced symptoms and enhanced well-being; improved individual coping and self-management; improved family coping and support), and two Chilean profiles (Strengthened identity and enhanced insight; symptom reduction and self-management). These could be further reduced into two cross-cultural super profiles: one prioritized outcomes related to reduced depressive symptoms and enhanced well-being; the other prioritized outcomes related to improved resilience resources within youth and families. A practitioner focus on symptom reduction aligns with a long-standing focus on symptomatic change in youth depression treatment studies, and with recent measurement recommendations. Less data and guidance are available to those practitioners who prioritize resilience outcomes. To raise the chances that such practitioners will engage in evidence-based practice and measurement-based care, measurement guidance for a broader set of outcomes may be needed.
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Affiliation(s)
- Karolin Rose Krause
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK.
- Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
| | - Ana Calderón
- Facultad de Psicología y Humanidades, Universidad San Sebastián, Sede Santiago, Chile
| | - Victor Gomez Pino
- Facultad de Medicina, Departamento de Psiquiatría Norte, Hospital Clínico, Clínica Psiquiátrica Universitaria, Universidad de Chile, Avenida La Paz 1003, Recoleta, Chile
| | - Julian Edbrooke-Childs
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK
| | - Bettina Moltrecht
- Evidence-Based Practice Unit, Anna Freud National Centre for Children and Families, 4-8 Rodney Street, London, N1 9JH, UK
- Centre for Longitudinal Studies, University College London, 55-59 Gordon Square, London, WC1H 0NU, UK
| | - Miranda Wolpert
- Research Department for Clinical, Educational and Health Psychology, University College London, Gower Street, Bloomsbury, London, WC1E 6BT, UK
- Wellcome Trust, 215 Euston Rd, Bloomsbury, London, NW1 2BE, UK
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Majcherek D, Hegerty SW, Kowalski AM, Lewandowska MS, Dikova D. Opportunities for healthcare digitalization in Europe: Comparative analysis of inequalities in access to medical services. Health Policy 2024; 139:104950. [PMID: 38061175 DOI: 10.1016/j.healthpol.2023.104950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/18/2023] [Accepted: 11/27/2023] [Indexed: 12/31/2023]
Abstract
Digitalization of healthcare systems is a great opportunity to address inequalities in access to healthcare in the European Union. There is an urgent need to build on what we learned from the COVID-19 pandemic, where digital health technologies were integrated swiftly to limit challenges in healthcare delivery. We created a database for the 27 European Union countries from the European Health Interview Survey (EHIS), the Digital Economy and Society Index (DESI), and other Eurostat databases. We performed k-means cluster analysis to group EU countries along two dimensions: inequalities in access to medical services and level of digitalization. We identified five distinct clusters: two clusters with high, two clusters with moderate, and one cluster with low unmet need for healthcare. Regarding digitalization, only one cluster comprising the Nordic countries, Spain and Cyprus exhibit high digital readiness. A cluster comprising the most developed countries in Western Europe represents moderate levels of both unmet need for healthcare and digitalization. For most EU countries, there is still a need to build digital infrastructure for the healthcare industry, which in the long term may increase the number of digital solutions used by both patients and healthcare professionals. Policy makers across the EU need to consider investing in initiatives that would support digital health solutions as an effective means of healthcare provision and healthcare management.
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Slachevsky A, Grandi F, Thumala D, Baez S, Santamaria-García H, Schmitter-Edgecombe M, Parra MA. A Multidimensional, Person-Centered Framework for Functional Assessment in Dementia: Insights from the 'What', 'How', 'To Whom', and 'How Much' Questions. J Alzheimers Dis 2024; 99:1187-1205. [PMID: 38758997 DOI: 10.3233/jad-230376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024]
Abstract
Dementia is a syndrome characterized by cognitive and neuropsychiatric symptoms associated with progressive functional decline (FD). FD is a core diagnostic criterion for dementia, setting the threshold between its prodromal stages and the full-blown disease. The operationalization of FD continues to generate a great deal of controversy. For instance, the threshold of FD for the diagnosis of dementia varies across diagnostic criteria, supporting the need for standardization of this construct. Moreover, there is a need to reconsider how we are measuring FD to set boundaries between normal aging, mild cognitive impairment, and dementia. In this paper, we propose a multidimensional framework that addresses outstanding issues in the assessment of FD: i) What activities of daily living (ADLs) are necessary to sustain an independent living in aging? ii) How to assess FD in individuals with suspected neurocognitive disorders? iii) To whom is the assessment directed? and iv) How much does FD differentiate healthy aging from mild and major neurocognitive disorders? Importantly, the To Whom Question introduces a person-centered approach that regards patients and caregivers as active agents in the assessment process of FD. Thus, once impaired ADLs have been identified, patients can indicate how significant such impairments are for them in daily life. We envisage that this new framework will guide future strategies to enhance functional assessment and treatment of patients with dementia and their caregivers.
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Affiliation(s)
- Andrea Slachevsky
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Memory and Neuropsychiatric Center (CMYN) Neurology Department, Hospital del Salvador & Faculty of Medicine, University of Chile, Santiago, Chile
- Physiopathology Department - ICBM, Neuroscience and East Neuroscience Departments, Faculty of Medicine, Neuropsychology and Clinical Neuroscience Laboratory (LANNEC), University of Chile, Providencia, Santiago, Chile
- Servicio de Neurología, Departamento de Medicina, Clínica Alemana-Universidad del Desarrollo, Santiago, Chile
| | - Fabrissio Grandi
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- School of Psychology, Universidad de los Andes, Santiago, Chile
| | - Daniela Thumala
- Gerosciences Center for Brain Health and Metabolism (GERO), Santiago, Chile
- Psychology Department, Faculty of Social Sciences, Universidad de Chile, Santiago, Chile
| | - Sandra Baez
- Universidad de los Andes, Bogotá, Colombia
- Atlantic Fellow for Equity in Brain Health at the Global Brain Health Institute (GBHI), Trinity College Dublin (TCD), Dublin, Ireland
| | - Hernando Santamaria-García
- PhD Program of Neuroscience, Pontificia Universidad Javeriana, Bogotá, Colombia
- Center for Brain and Memory Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia
| | | | - Mario A Parra
- Department of Psychological Sciences and Health, University of Strathclyde, Glasgow, UK
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Yaxley A, Pankhurst M, Morgillo S, Miller M. A world-first food service satisfaction questionnaire for use with family members of nursing home residents: expanding the toolkit of valid and reliable aged care food service satisfaction questionnaires. J Nutr Health Aging 2024; 28:100015. [PMID: 38267157 DOI: 10.1016/j.jnha.2023.100015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/05/2023] [Accepted: 12/17/2023] [Indexed: 01/26/2024]
Abstract
OBJECTIVES This study aimed to develop a valid and reliable food service satisfaction questionnaire for use by family members of residents in nursing homes. DESIGN Questionnaire development and validation study conducted using COSMIN® benchmarks for excellence. SETTING Nursing homes. PARTICIPANTS Family members of residents in nursing homes. MEASUREMENTS Content validity was established based on a review of the literature, qualitative interviews with family members (n = 9) and expert review (n = 10). Face validity was established in pilot testing with family members (n = 5). A 40-item questionnaire was developed for psychometric testing. Data from 414 family members was used to establish construct validity (Principal Components Analysis), with data from 101 of those family members used to evaluate reliability (internal consistency (Cronbach's alpha [α]) and temporal stability [weighted Kappa]). RESULTS A two factor 24-item scale resulted, with excellent internal consistency (factor one: 11 items related to food and meals (α = 0.960); factor two: 13 items related to the mealtime experience (α = 0.907)). Temporal stability was moderate to near perfect (weighted Kappa: 0.461-0.875; p < 0.001). CONCLUSION This world-first, valid and reliable, food service satisfaction questionnaire for use with family members of nursing home residents meets COSMIN® standards for excellence and complements the Flinders University resident and workforce food service satisfaction questionnaires also available for use in nursing homes.
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Affiliation(s)
- Alison Yaxley
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia.
| | - Morgan Pankhurst
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Stephanie Morgillo
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Michelle Miller
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Adjei ANA, Donkor A, Wiafe YA, Anyitey-Kokor IC, Hyde E. Elements of person-centred diagnostic imaging care in low-and middle-income countries: A systematic review. Radiography (Lond) 2024; 30:394-407. [PMID: 38176130 DOI: 10.1016/j.radi.2023.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/21/2023] [Accepted: 12/25/2023] [Indexed: 01/06/2024]
Abstract
INTRODUCTION Diagnostic imaging professionals are trained to deliver safe and high-quality person-centred radiographic diagnostic imaging care. The term person-centred care has been described as a confused concept without a unified definition. This systematic review identified the elements that have been used to measure person-centred care in diagnostic imaging in low- and middle-income countries (LMICs). METHODS A systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Embase, MEDLINE and Cochrane library were searched. Bias was assessed using the Critical Appraisal Skill Programme and Mixed Method Appraisal Tool. A narrative synthesis guided by the Picker Principles of person-centred care was undertaken. RESULTS Of the 4482 articles identified, 26 articles were included. The studies were from 12 LMICs. Synthesis of the literature generated six themes, namely access to high quality and safe diagnostic imaging care, effective communication and shared diagnostic imaging decision making, suitable diagnostic imaging environment for physical comfort, respectful and compassionate diagnostic radiographers, effective coordination of diagnostic imaging care process, and family and friends' involvement in diagnostic imaging care. CONCLUSION Medical imaging facilities in most LMICs continue to struggle with issues of access, safety, quality, and responsiveness to the needs of patients. The need for innovative person-centred diagnostic imaging care interventions in LMICs has become urgent. IMPLICATIONS FOR PRACTICE If diagnostic imaging services in LMICs are to move beyond the current models of limited person-centred access to care, a greater focus on systems thinking is required. It is imperative to involve all stakeholders, not only patients and radiographers, but also policymakers whose works impact on equitable access to diagnostic imaging services.
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Affiliation(s)
- A N A Adjei
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - A Donkor
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; IMPACCT, Faculty of Health, University of Technology Sydney, Australia.
| | - Y A Wiafe
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - I C Anyitey-Kokor
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
| | - E Hyde
- Provost for Learning & Teaching, University of Derby, United Kingdom.
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Palmer A, Schwan D. More Process, Less Principles: The Ethics of Deploying AI and Robotics in Medicine. Camb Q Healthc Ethics 2024; 33:121-134. [PMID: 37092348 DOI: 10.1017/s0963180123000087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Current national and international guidelines for the ethical design and development of artificial intelligence (AI) and robotics emphasize ethical theory. Various governing and advisory bodies have generated sets of broad ethical principles, which institutional decisionmakers are encouraged to apply to particular practical decisions. Although much of this literature examines the ethics of designing and developing AI and robotics, medical institutions typically must make purchase and deployment decisions about technologies that have already been designed and developed. The primary problem facing medical institutions is not one of ethical design but of ethical deployment. The purpose of this paper is to develop a practical model by which medical institutions may make ethical deployment decisions about ready-made advanced technologies. Our slogan is "more process, less principles." Ethically sound decisionmaking requires that the process by which medical institutions make such decisions include participatory, deliberative, and conservative elements. We argue that our model preserves the strengths of existing frameworks, avoids their shortcomings, and delivers its own moral, practical, and epistemic advantages.
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Affiliation(s)
- Amitabha Palmer
- University of Texas, MD Anderson Cancer Center, Houston, Texas, USA
| | - David Schwan
- Department of Philosophy and Comparative Religion, Central Washington University, Ellensburg, Washington, USA
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Bertelsen N, Dewulf L, Ferrè S, Vermeulen R, Schroeder K, Gatellier L, Sargeant I, Luzuriaga D, Chapman H, Brooke N. Patient Engagement and Patient Experience Data in Regulatory Review and Health Technology Assessment: A Global Landscape Review. Ther Innov Regul Sci 2024; 58:63-78. [PMID: 37743397 PMCID: PMC10764510 DOI: 10.1007/s43441-023-00573-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/09/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Working with patients through meaningful patient engagement (PE) and incorporating patient experience data (PXD) is increasingly important in medicines and medical device development. However, PE in the planning, organization, generation, and interpretation of PXD within regulatory and health technology assessment (HTA) decision-making processes remains challenging. We conducted a global review of the PE and PXD landscape to identify evolving resources by geography to support and highlight the potential of integration of PE and PXD in regulatory assessment and HTA. METHODS A review of literature/public information was conducted (August 2021-January 2023), led by a multistakeholder group comprising those with lived or professional experience of PE and PXD, to identify relevant regulatory and HTA initiatives and resources reviewed and categorized by geography and focus area. RESULTS Overall, 53 relevant initiatives/resources were identified (global, 14; North America, 11; Europe, 11; Asia, nine; UK, six; Latin America, one; Africa, one). Most focused either on PE (49%) or PXD (28%); few (11%) mentioned both PE and PXD (as largely separate activities) or demonstrated an integration of PE and PXD (11%). CONCLUSIONS Our analysis demonstrates increasing interest in PE, PXD, and guidance on their use individually in decision-making. However, more work is needed to offer guidance on maximizing the value of patient input into decisions by combining both PE and PXD into regulatory and HTA processes; the necessity of integrating PE in the design and interpretation of PXD programs should be highlighted. A co-created framework to achieve this integration is part of a future project.
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Affiliation(s)
- Neil Bertelsen
- HTAi Patient & Citizen Involvement in HTA Interest Group, Neil Bertelsen Consulting, Berlin, Germany
| | - Lode Dewulf
- Independent Expert, Les Contamines-Montjoie, France
| | | | | | | | - Laureline Gatellier
- National Cancer Center Japan, Tokyo, Japan
- NPO Japan Brain Tumor Alliance, Yokohama, Japan
| | | | | | - Hayley Chapman
- Patient Focused Medicines Development (PFMD), Brussels, Belgium.
| | - Nicholas Brooke
- Patient Focused Medicines Development (PFMD), Brussels, Belgium
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Skelton E, Cromb D, Smith A, van Poppel MPM, Morland C, Harrison G, Rutherford M, Malamateniou C, Ayers S. "It's not just the medical aspects that are important": A qualitative exploration of first-time parents' experiences of antenatal imaging and their influence on parent-fetal bonding. Radiography (Lond) 2024; 30:288-295. [PMID: 38064765 DOI: 10.1016/j.radi.2023.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 11/16/2023] [Accepted: 11/22/2023] [Indexed: 01/15/2024]
Abstract
INTRODUCTION Antenatal imaging provides clinical information regarding fetal growth and development. The additional benefit afforded by imaging for expectant parents in developing an emotional connection (bond) to the unborn baby is also acknowledged. However, the relationship between imaging and bonding is not fully understood, particularly where there are differing parental and pregnancy circumstances, for example use of advanced imaging techniques or the prenatal diagnosis of a congenital fetal condition. This study aimed to explore the role of antenatal imaging in enhancing the developing parent-fetal bond in first-time parents. METHODS A descriptive, qualitative methodology was used. Semi-structured telephone interviews were conducted with first-time expectant parents attending a London hospital for clinical ultrasound (n = 20) or research MRI (n = 8) imaging during pregnancy. The sample included parents receiving specialist antenatal care for a diagnosed fetal cardiac condition (n = 8). Thematic analysis was conducted. RESULTS The analysis generated three themes: 1) Our baby, our scan too; 2) Destination parenthood; and 3) Being in the dark, then finding the light. These themes highlight the important, but transient role of antenatal imaging in enhancing parent-fetal bonding, as well as the differing care needs of expectant parents. The integral role of healthcare professionals in providing a personalised, supportive, imaging experience to facilitate bonding is also reflected. CONCLUSION Adopting parent-centred care approaches which involve expectant parents in fetal imaging influences bonding by helping parents to consider the reality of their impending parenthood. Knowledge acquired during scans is used to create an identity for the unborn baby, which parents can develop an emotional connection to. IMPLICATIONS FOR PRACTICE To optimise the potential for enhanced parent-fetal bonding, care provision in fetal imaging should be tailored to the individual needs of expectant parents.
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Affiliation(s)
- E Skelton
- Division of Radiography and Midwifery, School of Health and Psychological Sciences, City, University of London, EC1V 0HB, UK.
| | - D Cromb
- Perinatal Imaging and Health, King's College London, SE1 7EH, UK; Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - A Smith
- Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - M P M van Poppel
- Perinatal Imaging and Health, King's College London, SE1 7EH, UK; Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - C Morland
- Guy's & St Thomas' NHS Foundation Trust, London, SE1 7EH, UK
| | - G Harrison
- Division of Radiography and Midwifery, School of Health and Psychological Sciences, City, University of London, EC1V 0HB, UK; Society and College of Radiographers, London, SE1 2EW, UK
| | - M Rutherford
- Perinatal Imaging and Health, King's College London, SE1 7EH, UK
| | - C Malamateniou
- Division of Radiography and Midwifery, School of Health and Psychological Sciences, City, University of London, EC1V 0HB, UK
| | - S Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences City, University of London, EC1V 0HB, UK
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Abugre D, Bhengu BR. Nurse managers' perceptions of patient-centred care and its influence on quality nursing care and nurse job satisfaction: Empirical research qualitative. Nurs Open 2024; 11:e2071. [PMID: 38268255 PMCID: PMC10733610 DOI: 10.1002/nop2.2071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 11/14/2023] [Accepted: 12/02/2023] [Indexed: 01/26/2024] Open
Abstract
AIM To explore nurse managers' perceptions of patient-centered care (PCC), its influence on quality nursing care, nurse job satisfaction, and to provide baseline data for a context-driven PCC model. DESIGN The study utilized a qualitative, phenomenological design, employing individual in-depth interviews to collect data on nurse managers' PCC perceptions until data saturation. METHODS Sampling involved purposive selection of Northern Ghana, random selection of the tertiary hospital cluster with the three participating hospitals, and purposive sampling of the nine nurse managers. Data analysis employed thematic analysis based on a six-phase framework. Methodological trustworthiness was ensured through various strategies including prolonged engagement, supervisor discussions and crosschecking with interviewees. RESULTS Three main themes emerged from the study including nurse managers' conceptualization of PCC, perceived patient-centred practices and its influence on nursing quality and job satisfaction. The findings emphasized the patient's individuality, cultural values, holistic care, the importance of strong nurse-patient relationships and a patient-centric environment. The nurse managers perceived PCC as positively influencing quality nursing care and nurse job satisfaction. The findings offer nuanced insights into nurse managers' perspectives on patient-centeredness and highlight areas for improvement.
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Affiliation(s)
- Dominic Abugre
- School of Nursing and Public Health, Howard College CampusUniversity of KwaZulu‐NatalDurbanSouth Africa
- Department of General Nursing, School of Nursing and MidwiferyUniversity for Development Studies, Tamale CampusTamaleGhana
| | - Busisiwe R. Bhengu
- School of Nursing and Public Health, Howard College CampusUniversity of KwaZulu‐NatalDurbanSouth Africa
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