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Smith E, Fox A, Willmers G, Wright D, Stuart B. Impact of implementing the aseptic compounding management system, Medcura, on internal error rates within an oncology pharmacy aseptic unit: a mixed methods evaluation. Eur J Hosp Pharm 2024; 31:220-226. [PMID: 36241376 DOI: 10.1136/ejhpharm-2022-003377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 09/12/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND As cancer survivorship improves, pressure on oncology services to provide safe, timely treatments increases. Traditional manual compounding processes are error prone, putting patients at risk. Additionally, errors have a detrimental impact on service delivery and staff morale. Information technology is increasingly utilised to improve safety and service delivery of systemic anti-cancer therapy (SACT). The compounding process control system, Medcura, was developed to manage the end-to-end process and reduce transcription and calculation errors. OBJECTIVES To evaluate the impact of implementing Medcura on internal errors and staff perceptions of errors. METHOD An aseptic process control system, Medcura, was implemented in a busy pharmacy chemotherapy production unit. Internal error and severity data were collected and analysed for 14 months before and during implementation, and 24 months after implementation. In addition, one-to-one semi-structured interviews were carried out with pharmacy staff, pre- and post-implementation. Interviews were transcribed and thematically analysed. RESULTS Error rates decreased after implementation from 2.9% to 2.1%. The types of error detected also changed with a decrease in worksheet and labelling errors, and an increase in assembly errors. The severity of the errors, as a percentage of total errors made, also decreased after implementation. Staff were predominantly positive about Medcura; it reduced the number of errors, eased the preparation of worksheets and labels, reduced pressure and work-related stress, and improved job satisfaction. CONCLUSIONS Implementing Medcura has resulted in a reduction in both error rate and severity. Specifically, errors related to label and worksheet generation have seen the largest reduction. Staff have viewed these changes positively and report reduced levels of work-related stress. Further development and roll-out will improve patient safety and staff morale.
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Affiliation(s)
- Emily Smith
- Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Andy Fox
- Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Graeme Willmers
- Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Deborah Wright
- Pharmacy, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Beth Stuart
- University of Southampton Faculty of Medicine, Southampton, Southampton, UK
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O'Brien N, Fernandez Crespo R, O'Driscoll F, Prendergast M, Chana D, Darzi A, Ghafur S. Usability and Feasibility Evaluation of a Web-Based and Offline Cybersecurity Resource for Health Care Organizations (The Essentials of Cybersecurity in Health Care Organizations Framework Resource): Mixed Methods Study. JMIR Form Res 2024; 8:e50968. [PMID: 38603777 PMCID: PMC11046383 DOI: 10.2196/50968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Cybersecurity is a growing challenge for health systems worldwide as the rapid adoption of digital technologies has led to increased cyber vulnerabilities with implications for patients and health providers. It is critical to develop workforce awareness and training as part of a safety culture and continuous improvement within health care organizations. However, there are limited open-access, health care-specific resources to help organizations at different levels of maturity develop their cybersecurity practices. OBJECTIVE This study aims to assess the usability and feasibility of the Essentials of Cybersecurity in Health Care Organizations (ECHO) framework resource and evaluate the strengths, weaknesses, opportunities, and threats associated with implementing the resource at the organizational level. METHODS A mixed methods, cross-sectional study of the acceptability and usability of the ECHO framework resource was undertaken. The research model was developed based on the technology acceptance model. Members of the Imperial College Leading Health Systems Network and other health care organizations identified through the research teams' networks were invited to participate. Study data were collected through web-based surveys 1 month and 3 months from the date the ECHO framework resource was received by the participants. Quantitative data were analyzed using R software (version 4.2.1). Descriptive statistics were calculated using the mean and 95% CIs. To determine significant differences between the distribution of answers by comparing results from the 2 survey time points, 2-tailed t tests were used. Qualitative data were analyzed using Microsoft Excel. Thematic analysis used deductive and inductive approaches to capture themes and concepts. RESULTS A total of 16 health care organizations participated in the study. The ECHO framework resource was well accepted and useful for health care organizations, improving their understanding of cybersecurity as a priority area, reducing threats, and enabling organizational planning. Although not all participants were able to implement the resource as part of information computing technology (ICT) cybersecurity activities, those who did were positive about the process of change. Learnings from the implementation process included the usefulness of the resource for raising awareness and ease of use based on familiarity with other standards, guidelines, and tools. Participants noted that several sections of the framework were difficult to operationalize due to costs or budget constraints, human resource limitations, leadership support, stakeholder engagement, and limited time. CONCLUSIONS The research identified the acceptability and usability of the ECHO framework resource as a health-focused cybersecurity resource for health care organizations. As cybersecurity in health care organizations is everyone's responsibility, there is potential for the framework resource to be used by staff with varied job roles. Future research needs to explore how it can be updated for ICT staff and implemented in practice and how educational materials on different aspects of the framework could be developed.
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Affiliation(s)
- Niki O'Brien
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | | | - Fiona O'Driscoll
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Mabel Prendergast
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Deeph Chana
- Institute for Security Science and Technology, Imperial College London, London, United Kingdom
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
| | - Saira Ghafur
- Institute of Global Health Innovation, Imperial College London, London, United Kingdom
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Gmünder M, Gessler N, Buser S, Feuz U, Fayyaz J, Jachmann A, Keitel K, Brandenberger J. Caregivers with limited language proficiency and their satisfaction with paediatric emergency care related to the use of professional interpreters: a mixed methods study. BMJ Open 2024; 14:e077716. [PMID: 38216184 PMCID: PMC10806666 DOI: 10.1136/bmjopen-2023-077716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 12/14/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Communication is a main challenge in migrant health and essential for patient safety. The aim of this study was to describe the satisfaction of caregivers with limited language proficiency (LLP) with care related to the use of interpreters and to explore underlying and interacting factors influencing satisfaction and self-advocacy. DESIGN A mixed-methods study. SETTING Paediatric emergency department (PED) at a tertiary care hospital in Bern, Switzerland. PARTICIPANTS AND METHODS Caregivers visiting the PED were systematically screened for their language proficiency. Semistructured interviews were conducted with all LLP-caregivers agreeing to participate and their administrative data were extracted. RESULTS The study included 181 caregivers, 14 of whom received professional language interpretation. Caregivers who were assisted by professional interpretation services were more satisfied than those without (5.5 (SD)±1.4 vs 4.8 (SD)±1.6). Satisfaction was influenced by five main factors (relationship with health workers, patient management, alignment of health concepts, personal expectations, health outcome of the patient) which were modulated by communication. Of all LLP-caregivers without professional interpretation, 44.9% were satisfied with communication due to low expectations regarding the quality of communication, unawareness of the availability of professional interpretation and overestimation of own language skills, resulting in low self-advocacy. CONCLUSION The use of professional interpreters had a positive impact on the overall satisfaction of LLP-caregivers with emergency care. LLP-caregivers were not well-positioned to advocate for language interpretation. Healthcare providers must be aware of their responsibility to guarantee good-quality communication to ensure equitable quality of care and patient safety.
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Affiliation(s)
- Myriam Gmünder
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Noemi Gessler
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Sina Buser
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Ursula Feuz
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Jabeen Fayyaz
- Emergency Department, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne Jachmann
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kristina Keitel
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
| | - Julia Brandenberger
- Division of Paediatric Emergency Medicine, Department of Paediatrics, Inselspital University Hospital, University of Bern, Bern, Switzerland
- Emergency Department, The Hospital for Sick Children, Toronto, Ontario, Canada
- Edwin S. H. Leong Centre for Healthy Children, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
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Sandström C, Mårtensson E, Hellman T. Experiences of the Redesigning Daily Occupation programme - a qualitative study among persons with neurological diseases. Scand J Occup Ther 2024; 31:2304189. [PMID: 38242166 DOI: 10.1080/11038128.2024.2304189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/08/2024] [Indexed: 01/21/2024]
Abstract
BACKGROUND The Redesigning Daily Occupations (ReDO) is a programme targeting persons who need to restructure activities and routines to achieve a healthier balance in everyday life. Issues that often is needed for persons with neurological diseases. AIMS/OBJECTIVES To describe how persons with neurological disease experienced the ReDo-programme and to investigate how their occupational patterns and fatigue changed during the programme. MATERIAL AND METHODS A mixed method study with a convergent parallel design including ten participants. Questionnaires and individual semi-structured interviews have been used and data analysed by descriptive statistics and thematic analysis. RESULTS The findings indicated an increased participation in everyday life after the intervention. Furthermore, the main theme showed that the intervention enabled reflections and new insight. Sub-themes included: feeling pressured to perform, being part of a group and changing occupational pattern. CONCLUSIONS Participants valued being a group; however, they experienced the intensity as being too high. The content of the intervention enabled reflections and new insights regarding their occupational pattern, which was experienced as a starting point towards behavioural changes and re-prioritisation of occupations in everyday life. SIGNIFICANCE A modified version with lower intensity and careful goal setting might be valuable for persons with neurological diseases.
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Affiliation(s)
- Carina Sandström
- Rehabilitation and Pain Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Elin Mårtensson
- Rehabilitation and Pain Centre, Uppsala University Hospital, Uppsala, Sweden
| | - Therese Hellman
- Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden
- Department of Occupational and Environmental Medicine, Uppsala University Hospital, Uppsala, Sweden
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Mahoto SK, Mitonga HK, Oladimeji O. Barriers to the provision of smoking cessation intervention/services: A mixed-methods study among health care workers in Zambezi region, Namibia. J Public Health Afr 2023; 14:1992. [PMID: 37065816 PMCID: PMC10099956 DOI: 10.4081/jphia.2023.1992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 04/25/2022] [Indexed: 03/06/2023] Open
Abstract
Background. Healthcare workers (HCWs) can play a signifi- cant role in tobacco prevention by delivering smoking cessation (SC) interventions to patients who smoke.
Objective: To identify and explore the perceived barriers which prevent healthcare workers from delivering SC counselling to patients in Zambezi region, Namibia.
Methods: A regional-based, concurrent mixed-methods study was conducted between March and October 2020 among HCWs of the 8 constituencies of Zambezi region, Namibia. In the study, 129 respondents, who had been residents of the selected constituencies for over 5 years and aged between 17 to 60 years, participated.
Results: 129 respondents participated in the study. Majority of respondents were females (62.9% and 68.1%) compared to (37.1% and 31.9%) males. The mean age of respondents was 35.91 (SD=9.3) and 36.61 (SD=8.7) respectively and their ages ranged between 18 and 59 years. Key barriers were identified: (i) HCWs- based barriers included lack of time to provide SC, inadequate training and insufficient knowledge on SC interventions; (ii) sys- tem-based barriers identified lack of SC guidelines and educational materials for patients, and specialists to refer patients; and (iii) patient/client-based barriers included lack of patient interest in SC information, patients not adhering to advise given on SC.
Conclusions: This study showed that SC delivery in Zambezi region is inadequate. Barriers were identified regarding the deliv- ery of SC intervention for the first time. Targeted SC interventions are required to combat these identified specific barriers. There is a crucial need to improve HCWs skills and knowledge in providing SC intervention.
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Welch S, Patel B, Williams A, Moles R. Connecting the dots of care: survey of Australian hospital pharmacy departments regarding current initiatives in place to care for Aboriginal and/or Torres Strait Islander inpatients. Pharmacy Practice and Res 2022. [DOI: 10.1002/jppr.1789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Susan Welch
- Pharmacy Department St Vincent's Hospital, Sydney Darlinghurst Australia
- PhD Candidate University of Sydney Camperdown Australia
| | - Bhavini Patel
- Northern Territory Department of Health Charles Darwin University Darwin Australia
- Medicines Management Top End Health Service Darwin Australia
| | - Aleena Williams
- Public Health Directorate Department of Health Northern Territory Government Darwin Australia
| | - Rebekah Moles
- Faculty Medicine and Health School of Pharmacy University of Sydney Camperdown Australia
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Oche O, Wu C, Murry LT, Kennelty KA. Research and Scholarly Methods: Pragmatic Clinical Trials. J Am Coll Clin Pharm 2022; 5:99-106. [PMID: 35274088 PMCID: PMC8903093 DOI: 10.1002/jac5.1557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Onyeche Oche
- University of Iowa, College of Pharmacy, Department of Pharmacy Practice and Science, Iowa City, Iowa, USA
| | - Chaorong Wu
- University of Iowa, Institute for Clinical and Translational Science, Iowa City, Iowa, USA
| | - Logan T. Murry
- University of Iowa, College of Pharmacy, Department of Pharmacy Practice and Science, Iowa City, Iowa, USA
| | - Korey A. Kennelty
- University of Iowa, College of Pharmacy, Department of Pharmacy Practice and Science, Iowa City, Iowa, USA
- University of Iowa, Carver College of Medicine, Department of Family Medicine, Iowa City, Iowa, USA
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ElGeed H, El Hajj MS, Ali R, Awaisu A. The utilization of simulated patients for teaching and learning in the pharmacy curriculum: exploring pharmacy students' and recent alumni's perceptions using mixed-methods approach. BMC Med Educ 2021; 21:562. [PMID: 34742275 PMCID: PMC8571846 DOI: 10.1186/s12909-021-02977-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 10/08/2021] [Indexed: 05/31/2023]
Abstract
BACKGROUND The use of simulated patients (SPs) is considered a significant resource for teaching and assessing clinical and communication skills in health professional education. We conducted this study to explore pharmacy students' perspective towards the utilization of SPs in Qatar and to identify areas that require improvement. METHODS An explanatory sequential mixed-methods design was used among students and recent graduates of the College of Pharmacy at Qatar University (QU-CPH). First, their perspectives toward the current utilization of SPs at QU-CPH was explored using a quantitative cross-sectional study design. Following this, we conducted six focus group discussions based on the analysis of the questionnaire results. The findings of the two phases were interpreted through integration of the quantitative and qualitative phases. RESULTS The majority of the participants (> 90%) reported that interactions with SPs are important in building good communication and counseling skills during professional skills course activities. Similarly, most of the respondents (80%) indicated that interactions with SPs prepared them to apply the clinical skills gained during professional skills and patient assessment sessions in real-life. In addition, they reported that interactions with SPs during competency-based assessments were good experiences. The participants disagreed with the notion that interaction with SPs of opposite gender was uncomfortable for them. Themes identified from the focus groups include: interactions with trained SPs compared to faculty SPs, standardization and consistency of SPs' roles, communication and language barriers, simulations of real-life case scenarios, SPs' competence and preparedness, psychological impact associated with interaction with SPs, proposed strategies for improving the SP program. Identified areas for improvement include the need for strengthening the SP training and orientation program as well as the SP selection criteria. CONCLUSION This study showed a positive impact of the utilization of SPs in this pharmacy curriculum as perceived by students and alumni. However, the SP program needs to be optimized in terms of the training and orientation of SPs.
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Affiliation(s)
- Hager ElGeed
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Maguy Saffouh El Hajj
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Raja Ali
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
| | - Ahmed Awaisu
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar.
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Seyedfatemi N, Ghezeljeh TN, Bolhari J, Rezaei M. Effects of family-based dignity intervention and expressive writing on anticipatory grief of family caregivers of patients with cancer: a study protocol for a four-arm randomized controlled trial and a qualitative process evaluation. Trials 2021; 22:751. [PMID: 34711262 PMCID: PMC8552199 DOI: 10.1186/s13063-021-05718-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Family caregivers of dying cancer patients are affected by grief experiences and bereavement complications. Several approaches such as psycho-emotional care and an increase in spirituality have been suggested to diminish these complications. However, the knowledge about the effects of family-based dignity intervention and expressive writing on anticipatory grief in family caregivers of dying cancer patients is limited. This is a study protocol describing a hospital-based mixed-methods study on the effects of family-based dignity intervention and expressive writing on anticipatory grief in family caregivers of dying cancer patients. METHODS This mixed-methods study will be done in an embedded explanatory design with two quantitative and qualitative phases. In the first phase (quantitative), a randomized clinical trial will be done, in which 200 family caregivers of dying cancer patients will be randomly assigned to one of the four groups: family-based single dignity intervention (group 1), expressive writing intervention (group 2), combined family-based single dignity intervention and expressive writing (group 3), and control (group 4). At baseline, 1 week and 2 weeks after the interventions, anticipatory grief will be assessed by a 13-item anticipatory grief scale. After the quantitative phase, the qualitative phase will be conducted through the conventional content analysis approach of Granheim and Lundman, in which an individual semi-structured interview will be taken from participants in the first phase to collect data on their experiences on interventions. Finally, data from the quantitative and qualitative phases will be analyzed and discussed. DISCUSSION Family caregivers of dying cancer patients usually experience depression, anxiety, and psychological distress due to isolation and inadequate social support. Psychological interventions such as dignity and expressive writing interventions may help caregivers to obtain a better understanding of themselves and to increase their abilities to cope with caregiving difficulties. Therefore, there is a need for a comprehensive study confirming the effects of mentioned interventions on family caregivers of dying cancer patients. TRIAL REGISTRATION Iranian Registry of Clinical Trials ( www.irct.ir ) identifier: IRCT20210111050010N1. Date of trial registration: Feb 6, 2021. This is the first version of this protocol.
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Affiliation(s)
- Naima Seyedfatemi
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran.,Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Jafar Bolhari
- Spiritual Health Research Center, School of Behavioral Sciences and Mental Health, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Rezaei
- Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
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Huang YM, Shiyanbola OO. Investigation of Barriers and Facilitators to Medication Adherence in Patients With Type 2 Diabetes Across Different Health Literacy Levels: An Explanatory Sequential Mixed Methods Study. Front Pharmacol 2021; 12:745749. [PMID: 34690778 PMCID: PMC8527013 DOI: 10.3389/fphar.2021.745749] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/13/2021] [Indexed: 01/09/2023] Open
Abstract
Type 2 diabetes (T2D) incurs tremendous healthcare costs associated with various complications due to poor blood sugar control. Medication adherence, which is correlated with patients’ health literacy, should be consistently practiced to achieve optimal control of blood sugar. A comprehensive understanding of specific communication and psychosocial factors related to medication-taking behaviors across different levels of health literacy among people with T2D will guide the development of effective interventions and strategies to enhance medication adherence. To understand barriers and facilitators to medication adherence in people with T2D across different health literacy levels, the Health Literacy Pathway Model was used to identify the psychosocial and communication factors that may influence medication adherence. This mixed methods study used an explanatory sequential design, including a quantitative survey followed by qualitative semi-structured interviews. Two hundred and five participants completed the survey questionnaire, and 23 participants completed semi-structured interviews. Confirmed by quantitative and qualitative data, having stronger self-efficacy and fewer concerns about medications, as well as experiencing fewer perceived barriers to medication-taking, are necessary for better medication adherence among those with low adherence. Our findings will be useful to tailor interventions for diabetes care through addressing concerns among low-adherent patients with low health literacy and emphasizing self-efficacy and perceived barriers to medication adherence among all low-adherent patients with T2D.
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Affiliation(s)
- Yen-Ming Huang
- Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Olayinka O Shiyanbola
- Division of Social and Administrative Sciences, School of Pharmacy, University of Wisconsin-Madison, Madison, WI, United States
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Albabtain B, Hadi MA, Bawazeer G, Alqahtani A, Bahatheq A, Alhossan A, Cheema E. Evaluation of a community pharmacy-based medication therapy management programme: A study protocol of a pilot randomized controlled trial with an embedded qualitative study. Saudi Pharm J 2021; 29:706-712. [PMID: 34400865 PMCID: PMC8347677 DOI: 10.1016/j.jsps.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 05/03/2021] [Indexed: 11/28/2022] Open
Abstract
Objectives The main objectives are: to evaluate the feasibility and effectiveness of a community-pharmacy based medication therapy management programme; to explore patients’ experiences and views towards medication therapy management service delivered by community pharmacists. Research design and methods A mixed-methods research design consisting of a pilot randomized controlled trial embedded with qualitative study will be used in this study. The study consists of two phases: a 6-month follow-up pilot randomized control trial (quantitative approach) to assess the feasibility and effectiveness of a community pharmacy-based medication therapy management programme. The primary outcome is HbA1C and secondary outcomes include: clinical and health services utilization and process measures, medication adherence, diabetes distress as well as satisfaction with care. Phase two consists of an embedded qualitative study using semi-structured interviews to explore patients’ experiences and views with the medication therapy management programme. Study data collection will be collected between April 2021 and December 2021. Ethics consideration The study has been approved by institutional review boards from Princess Nourah bent Abdulrahman University (Approval # 20–0240), King Fahad Medical City (Approval # 20-388E) and Birmingham University (Approval # ERN_20-0768).
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Affiliation(s)
- Basmah Albabtain
- Department of Pharmaceutical Practice, College of Pharmacy, Princess Nourah Bint Abdulrahaman University, Riyadh, Saudi Arabia.,School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Muhammad Abdul Hadi
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Ghada Bawazeer
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | | | - Ahmed Bahatheq
- R&D Director of Saudi Innova Healthcare Company, Riyadh, Saudi Arabia
| | - Abdulaziz Alhossan
- Clinical Pharmacy Department, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ejaz Cheema
- School of Pharmacy, Institute of Clinical Sciences, University of Birmingham, Birmingham, United Kingdom
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Lee SYD, Iott B, Banaszak-Holl J, Shih SF, Raj M, Johnson KE, Kiessling K, Moore-Petinak N. Application of Mixed Methods in Health Services Management Research: A Systematic Review. Med Care Res Rev 2021; 79:331-344. [PMID: 34253078 DOI: 10.1177/10775587211030393] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mixed methods research (MMR) is versatile, pragmatic, and adaptable to constraints and opportunities during a research process. Although MMR has gain popularity in health services management research, little is known about how the research approach has been used and the quality of research. We conducted a systematic review of 198 MMR articles published in selected U.S.-based and international health services management journals from 2000 through 2018 to examine the extent of MMR application and scientific rigor. Results showed limited, yet increasing, use of MMR and a high degree of correspondence between MMR designs and study purposes. However, most articles did not clearly justify using MMR designs and the reporting of method details and research integration were inadequate in a significant portion of publications. We propose a checklist to assist the preparation and review of MMR manuscripts. Additional implications and recommendations to improve transparency, rigor, and quality in MMR are discussed.
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Affiliation(s)
| | - Bradley Iott
- University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | | | - Minakshi Raj
- University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Kimson E Johnson
- University of Michigan School of Public Health, Ann Arbor, MI, USA
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Hellman T, Molin F, Svartengren M. A Mixed-Method Study of Providing and Implementing a Support Model Focusing on Systematic Work Environment Management. J Occup Environ Med 2020; 62:e160-6. [PMID: 32032185 DOI: 10.1097/JOM.0000000000001829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIMS To explore how a support model (Stamina) targeting the systematic work environment management was experienced, provided and implemented in Swedish municipalities. METHODS A mixed method approach was applied, including material from interviews and questionnaire. The questionnaire was answered by 123 persons (67.5%), and 18 participants were interviewed twice during a one year period. Data were analysed using descriptive statistics and qualitative content analysis. RESULTS The participants followed the structure of the Stamina model in their practical work. Still, there was variation in the practical provision of the model. The implementation was supported by their organizations and was influenced by various actors. Creating commitment was an essential part to facilitate implementation. CONCLUSION To promote implementation of the Stamina model, there is a need to create commitment among stakeholders that will participate in the implementation.
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Hashmi F, Hassali MA, Saleem F, Saeed H, Islam M, Malik UR, Atif N, Babar ZUD. Perspectives of community pharmacists in Pakistan about practice change and implementation of extended pharmacy services: a mixed method study. Int J Clin Pharm 2021; 43:1090-1100. [PMID: 33411180 DOI: 10.1007/s11096-020-01221-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
Background Community pharmacists' role in the primary health care, patient-centered services, beyond traditional dispensing services is well established in the developed world. However, this role is not fully established in low-middle-income countries including Pakistan. Objective To explore community pharmacists' perspectives and preparedness about practice change and associated facilitators and barriers to extended services. Setting A study was conducted involving community pharmacists of Lahore, Pakistan. Method Two phased studies were conducted using mixed-method sequential design. The first phase involved qualitative semi-structured face-to-face interviews with the community pharmacists, while the second phase constituted a questionnaire-based cross-sectional study. Main outcome measure Pharmacists' perspectives about extended pharmacy services, facilitators, barriers and preparedness for the practice change. Results For the first phase, pharmacists were purposively sampled and the saturation yielded a final sample size of fifteen pharmacists (N = 15). The thematic content analysis yielded four distinct themes; (1) current practices and familiarity with extended pharmacy services (2) practice gap between Pakistan and the developed countries (3) facilitators and the preparedness, and (4) barriers towards its implementation and provision. The second part was a questionnaire-based cross-sectional phase, where a total of 348 community pharmacists were approached, while only 242 responded, yielding a response rate of 69.5%. The triangulation of qualitative and quantitative data identified several barriers such as; shortage of pharmacists, lack of knowledge and skills, poor collaboration with general practitioners, failure of customers to pay for extended services. Facilitators and preparedness for the provision of extended pharmacy services were; access to patient notes, follow-up, separate counselling areas, accreditation of specific services and sufficient resources. Conclusion This study's findings call for the implementation and enforcement of Punjab Drug Sale Rules 2007 to facilitate the practice change and provision of comprehensive pharmacy services in Punjab, Pakistan. There is a need for additional laws to define community pharmacists' roles, uniform job description, training, new funding model, separate area, and accreditation of extended pharmacy services in Pakistan.
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Affiliation(s)
- Furqan Hashmi
- University College of Pharmacy, University of the Punjab Allama Iqbal Campus, Lahore, Pakistan.
| | - Mohamed Azmi Hassali
- Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Minden, Pulau Penang, Malaysia
| | - Fahad Saleem
- Faculty of Pharmacy, University of Balochistan, Sariab Road, Quetta, Pakistan
| | - Hamid Saeed
- University College of Pharmacy, University of the Punjab Allama Iqbal Campus, Lahore, Pakistan
| | - Muhammad Islam
- University College of Pharmacy, University of the Punjab Allama Iqbal Campus, Lahore, Pakistan
| | | | - Naveel Atif
- School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, University of Huddersfield, Huddersfield, HD1 3DH, UK
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Katoue MG, Ker J. Pharmacists' experiences and perceptions about simulation use for learning and development of clinical skills in Kuwait. Int J Clin Pharm 2019; 41:1451-1461. [PMID: 31564042 DOI: 10.1007/s11096-019-00904-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/07/2019] [Indexed: 11/28/2022]
Abstract
Background There has been a worldwide exponential rise in simulation use in health professions education. Most of the evidence about simulation-based education (SBE) comes from Western educational systems. Little is known about simulation use in the education and training of pharmacy students and pharmacists in the Middle Eastern countries. Objective To explore pharmacists' experiences, perceptions and attitudes toward simulation use for learning clinical skills in Kuwait. Setting Different governmental hospitals across the State of Kuwait. Method This was an exploratory descriptive study of pharmacists' perceptions about SBE. A mixed-method research design was employed whereby 110 hospital pharmacists participated in focus groups and completed self-administered surveys. The focus group interviews were audio-recorded, transcribed verbatim and analysed using framework analysis. Descriptive statistics were used to describe characteristics of study participants and survey findings. Main outcome measure Pharmacists' experiences, perceptions and attitudes toward SBE. Results A total of 110 pharmacists participated in the focus groups, of whom 88 completed the survey (80% response rate). The focus groups revealed that pharmacists had different experiences in relation to simulation use which included learning, assessment, and less frequently reported in their training as practitioners. They identified many benefits of simulation such as enhancing knowledge retention and allowing learners practice and rehearse clinical skills in safe environments. Participants' perceived barriers to simulation use in pharmacy students' training included the need for qualified faculty and simulated patients, time constrains to incorporate simulation in faculty teaching and reluctance of learners/educators to use simulation. Most participants expressed positive attitudes toward simulation and welcomed its integration in pharmacy students' learning. In response to survey, 26.1% of pharmacists reported having no prior experience in the use of simulation. The top reported barriers to using simulation for learning were time constrains (22.7%) and the need for qualified faculty (6.8%). Conclusion Pharmacists in Kuwait have diverse experiences regarding simulation use for learning. They expressed positive attitudes toward simulation use for learning clinical skills. Efforts are needed to standardize and expand simulation use in the education and training of pharmacy students, trainees and practitioners to equip them with the clinical skills essential for pharmacy practice.
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Affiliation(s)
- Maram Gamal Katoue
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, P.O. Box 24923, SAFAT, 13110, Kuwait, Kuwait.
| | - Jean Ker
- National Lead for Clinical Skills and Simulation, NHS Education for Scotland, Ninewells Hospital and Medical School, University of Dundee, Dundee, Scotland, UK
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McLeod M, Karampatakis GD, Heyligen L, McGinley A, Franklin BD. The impact of implementing a hospital electronic prescribing and administration system on clinical pharmacists' activities - a mixed methods study. BMC Health Serv Res 2019; 19:156. [PMID: 30866925 PMCID: PMC6417214 DOI: 10.1186/s12913-019-3986-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 03/04/2019] [Indexed: 11/15/2022] Open
Abstract
Background The increasing adoption of hospital electronic prescribing and medication administration (ePA) systems has driven a wealth of research around the impact on patient safety. Yet relatively little research has sought to understand the effects on staff, particularly pharmacists. We aimed to investigate the effects of ePA on pharmacists’ activities, including interactions with patients and health professionals, and their perceptions of medication safety risks. Methods A mixed methods study comprising quantitative direct observations of ward pharmacists before and after implementation of ePA in an English hospital, and semi-structured interviews post-ePA. Quantitative data comprised multi-dimensional work activity sampling to establish the proportion of time ward pharmacists spent on different tasks, with whom and where. These data were extrapolated to estimate task duration. Qualitative interviews with pharmacists explored perceived impact on (i) ward activities, (ii) interactions with patients and different health professionals, (iii) locations where tasks were carried out, and (iv) medication errors. Results Observations totalled 116 h and 50 min. Task duration analysis suggested screening inpatient medication increased by 16 mins per 10 patients reviewed (p = 0.002), and searching for paper drug charts or computer decreased by 2 mins per 10 patients reviewed (p = 0.001). Pharmacists mainly worked alone (58% of time pre- and 65% post-ePA, p = 0.17), with patient interactions reducing from 5 to 2% of time (p = 0.03). Seven main themes were identified from the interviews, underpinned by a core explanatory concept around the enhanced and shifting role of the ward pharmacist post-ePA. Pharmacists perceived there to be a number of valuable safety features with ePA. However, paradoxically, some of these may have also inadvertently contributed to medication errors. Conclusion This study provides quantitative and qualitative insights into the effects of implementing ePA on ward pharmacists’ activities. Some tasks took longer while others reduced, and pharmacists may spend less time with patients with ePA. Pharmacists valued a number of safety features associated with ePA but also perceived an overall increase in medication risk. Pharmacy staff demonstrated a degree of resilience to ensure ‘business as usual’ by enhancing and adapting their role. Electronic supplementary material The online version of this article (10.1186/s12913-019-3986-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Monsey McLeod
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | | | - Lore Heyligen
- Faculty of Pharmaceutical Sciences, Catholic University of Leuven, Campus Gasthuisberg, O&N II, Herestraat 49 bus 420, 3000, Leuven, Belgium
| | - Ann McGinley
- Pharmacy Department, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK. .,Research Department of Practice and Policy, UCL School of Pharmacy, Brunswick Square, London, WC1N 1AX, UK.
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Katoue MG, Ker J. Simulation for Continuing Pharmacy Education: Development and Implementation of a Simulation-Based Workshop on Medicines Reconciliation for Pharmacists. J Contin Educ Health Prof 2019; 39:185-193. [PMID: 31166221 DOI: 10.1097/ceh.0000000000000257] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Simulation has been increasingly used to train health care professionals on clinical skills. Little is published on simulation-based education in the context of continuing pharmacy education (CPE) of pharmacists. This article describes the development implementation and evaluation of simulation-based workshop to train hospital pharmacists on medicines reconciliation in Kuwait. The study aimed to explore pharmacists' perceptions about simulation use in CPE. It also assessed the impact of the workshops on pharmacists' attitudes toward, knowledge, and comfort level to apply medicines reconciliation. METHODS One hundred ten pharmacists attended 11 simulation-based workshops. Data were collected using focus groups and self-administered surveys in a mixed-method research design. Focus groups were audio-recorded, transcribed verbatim, and analyzed for content. Descriptive statistics were used to report surveys' findings. RESULTS The workshops were well-received by pharmacists. Few pharmacists recalled previous exposure to simulation in CPE activities. Pharmacists' perceived challenges to simulation integration into their professional training were the need for good preparation/setting, qualified faculty, well-trained simulated patients, and time constrains. Participants felt that simulation enhanced their attitudes toward, knowledge, and comfort level to apply medicines reconciliation. They rated their knowledge level as having increased by 62.3% and comfort level as having increased by 37.0%. They overwhelmingly welcomed more integration of simulation in CPE activities. DISCUSSION A simulation-based continuing education workshop was well-received by pharmacists and enhanced their self-reported knowledge, comfort level, and preparedness to apply medicines reconciliation. Efforts are needed to expand simulation use in the development, refinement, and maintenance of clinical skills of pharmacists throughout their educational continuum including CPE.
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Affiliation(s)
- Maram G Katoue
- Miss Katoue: Associate Teaching Assistant, Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, Kuwait. Professor Ker: National Lead for Clinical Skills and Simulation, NHS Education for Scotland, and Emeritus Professor of Medical Education, University of Dundee, Ninewells Hospital, Dundee, Scotland, United Kingdom
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Harutyunyan A, Abrahamyan A, Hayrumyan V, Petrosyan V. Perceived barriers of tobacco dependence treatment: a mixed-methods study among primary healthcare physicians in Armenia. Prim Health Care Res Dev 2019; 20:e17. [PMID: 30421696 PMCID: PMC6476393 DOI: 10.1017/s1463423618000828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Revised: 08/22/2018] [Accepted: 10/04/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Despite compelling evidence that physicians play a prominent role in smoking cessation, most smokers do not receive the recommended smoking cessation counseling.AimTo identify perceived barriers that hinder primary healthcare physicians (PHPs) from providing smoking cessation treatment to patients in Armenia. METHODS A sequential exploratory mixed-methods study was conducted among PHPs from two Armenian cities (Yerevan and Gyumri). We implemented qualitative phase through focus group discussions (FGDs) using a semi-structured guide. For the subsequent quantitative phase, the data were collected through cross-sectional survey. A directed deductive content analysis technique was used to analyze the FGDs and questionnaires were analyzed descriptively. Following the data collection (March 2015-May 2016) and descriptive analysis, the qualitative and quantitative data sets were merged by drawing quantitative data onto qualitative categories.FindingsOverall, 23 PHPs participated in five FGDs and 108 participants completed the survey. Three main categories of barriers were identified: physician-based, patient-based, and system-based barriers. The main physicians-based barriers were insufficient knowledge and inadequate training on tobacco-dependence treatment. Lack of patients' motivation to quit, poor compliance with the treatment, patients' withdrawal symptoms were identified as patient-based disincentives. System-based barriers included lack of reimbursement for providing smoking cessation counseling, high price and low availability of smoking cessation medications. Most of the qualitative descriptions were confirmed by quantitative findings. CONCLUSIONS Targeted interventions are needed to address barriers that limited PHPs' involvement in providing smoking cessation services in Armenia. There is an urgent need to enhance PHPs' knowledge and skills in delivering smoking cessation counseling, to increase patients' demand for smoking cessation services, and to ensure availability and affordability of smoking cessation services in Armenia.
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Affiliation(s)
- Arusyak Harutyunyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Armine Abrahamyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Varduhi Hayrumyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
| | - Varduhi Petrosyan
- Gerald and Patricia Turpanjian School of Public Health, American University of Armenia, Yerevan, Armenia
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Algoso M, Ramjan L, East L, Peters K. Undergraduate nursing assistant employment in aged care has benefits for new graduates. J Adv Nurs 2018; 74:1932-1954. [PMID: 29676527 DOI: 10.1111/jan.13691] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2018] [Indexed: 12/01/2022]
Abstract
AIMS To determine how undergraduate assistant in nursing employment in aged care helps to prepare new graduates for clinical work as a Registered Nurse. BACKGROUND The amount and quality of clinical experience afforded by university programs has been the subject of constant debate in the nursing profession. New graduate nurses are often deemed inadequately prepared for clinical practice and so many nursing students seek employment as assistants in nursing whilst studying to increase their clinical experience. DESIGN This paper presents the first phase of a larger mixed-methods study to explore whether undergraduate assistant in nursing employment in aged care prepares new graduate nurses for the clinical work environment. The first phase involved the collection of quantitative data from a modified Preparation for Clinical Practice survey, which contained 50-scaled items relating to nursing practice. METHODS Ethics approval was obtained prior to commencing data collection. New graduate nurses who were previously employed as assistants in nursing in aged care and had at least 3 months' experience as a Registered Nurse, were invited to complete the survey. Social media and professional networks were used to distribute the survey between March 2015 - May 2016 and again in January 2017-February 2017. Purposeful and snowballing sampling methods using social media and nursing networks were used to collect survey responses. Data were analysed using principal components analysis. RESULTS 110 completed surveys were returned. Principal components analysis revealed four underlying constructs (components) of undergraduate assistant in nursing employment in aged care. These were emotional literacy (component 1), clinical skills (component 2), managing complex patient care (component 3) and health promotion (component 4). CONCLUSION The four extracted components reflect the development of core nursing skills that transcend that of technical skills and includes the ability to situate oneself as a nurse in the care of an individual and in a healthcare team.
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Affiliation(s)
- Maricris Algoso
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Lucie Ramjan
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
- Centre for Applied Nursing Research, Liverpool, NSW, Australia
- Ingham Institute of Applied Medical Research, Liverpool, NSW, Australia
| | - Leah East
- University of New England, Armidale, NSW, Australia
| | - Kath Peters
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
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20
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Furniss D, Lyons I, Franklin BD, Mayer A, Chumbley G, Wei L, Cox AL, Vos J, Galal-Edeen G, Blandford A. Procedural and documentation variations in intravenous infusion administration: a mixed methods study of policy and practice across 16 hospital trusts in England. BMC Health Serv Res 2018; 18:270. [PMID: 29636034 PMCID: PMC5894189 DOI: 10.1186/s12913-018-3025-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Accepted: 03/16/2018] [Indexed: 11/20/2022] Open
Abstract
Background Procedural and documentation deviations relating to intravenous (IV) infusion administration can have important safety consequences. However, research on such deviations is limited. To address this we investigated the prevalence of procedural and documentation deviations in IV infusion administration and explored variability in policy and practice across different hospital trusts. Methods We conducted a mixed methods study. This involved observations of deviations from local policy including quantitative and qualitative data, and focus groups with clinical staff to explore the causes and contexts of deviations. The observations were conducted across five clinical areas (general medicine, general surgery, critical care, paediatrics and oncology day care) in 16 National Health Service (NHS) trusts in England. All infusions being administered at the time of data collection were included. Deviation rates for procedural and documentation requirements were compared between trusts. Local data collectors and other relevant stakeholders attended focus groups at each trust. Policy details and reasons for deviations were discussed. Results At least one procedural or documentation deviation was observed in 961 of 2008 IV infusions (deviation rate 47.9%; 95% confidence interval 45.5–49.8%). Deviation rates at individual trusts ranged from 9.9 to 100% of infusions, with considerable variation in the prevalence of different types of deviation. Focus groups revealed lack of policy awareness, ambiguous policies, safety and practicality concerns, different organisational priorities, and wide variation in policies and practice relating to prescribing and administration of IV flushes and double-checking. Conclusions Deviation rates and procedural and documentation requirements varied considerably between hospital trusts. Our findings reveal areas where local policy and practice do not align. Some policies may be impractical and lack utility. We suggest clearer evidence-based standardisation and local procedures that are contextually practical to address these issues. Electronic supplementary material The online version of this article (10.1186/s12913-018-3025-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dominic Furniss
- UCL Interaction Centre, 66-72 Gower Street, London, WC1E 6BT, UK.
| | - Imogen Lyons
- UCL Interaction Centre, 66-72 Gower Street, London, WC1E 6BT, UK
| | - Bryony Dean Franklin
- Centre for Medication Safety and Service Quality, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, UK.,Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, UK
| | - Astrid Mayer
- Royal Free London NHS Foundation Trust & UCL Medical School, Pond Street, London, NW3 2QG, UK
| | - Gillian Chumbley
- Pain Management Centre, Imperial College Healthcare NHS Trust, London, UK
| | - Li Wei
- Research Department of Practice and Policy, UCL School of Pharmacy, Mezzanine Floor, BMA House, Tavistock Square, London, UK
| | - Anna L Cox
- UCL Interaction Centre, 66-72 Gower Street, London, WC1E 6BT, UK
| | - Jolien Vos
- UCL Interaction Centre, 66-72 Gower Street, London, WC1E 6BT, UK
| | - Galal Galal-Edeen
- UCL Interaction Centre, 66-72 Gower Street, London, WC1E 6BT, UK.,Information Systems Department, Faculty of Computers and Information, Cairo University, Cairo, Egypt
| | - Ann Blandford
- UCL Interaction Centre, 66-72 Gower Street, London, WC1E 6BT, UK
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Katoue MG, Ker J. Implementing the medicines reconciliation tool in practice: challenges and opportunities for pharmacists in Kuwait. Health Policy 2018; 122:404-411. [PMID: 29475740 DOI: 10.1016/j.healthpol.2017.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 11/20/2017] [Accepted: 12/30/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Using the medicines reconciliation tool which involves preparing an updated list of patient's medications at each transition of care can significantly enhance patient safety. The pharmacist has been leading this process in western healthcare systems. Little is known about pharmacists' role in medicines reconciliation in Middle Eastern Countries. OBJECTIVES To explore the implementation of medicines reconciliation in Kuwait hospitals, pharmacists' role in this process and perceptions of the challenges in implementing it in practice. METHODS This was an exploratory descriptive study of medicines reconciliation practices at eleven secondary/tertiary hospitals in Kuwait. A mixed-methods research design was used whereby 110 hospital pharmacists participated in 11 focus groups and 88 of them completed self-administered surveys. RESULTS Participants reported that medicines reconciliation is poorly applied in hospitals and that they had limited role in the process. The current medicines reconciliation policy does not assign any responsibilities for pharmacists in this process. The most significant barriers to applying medicines reconciliation by pharmacists were inadequate staff numbers, lack of time, difficult access to patient information, lack of policy to support pharmacist role and patients' poor knowledge about their medications. CONCLUSIONS Hospital pharmacists in Kuwait advocate implementing medicines reconciliation but report significant strategic/operational barriers to its application. Efforts are needed in policy reform and team training to enable pharmacists provide effective patient care services including medicines reconciliation.
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Affiliation(s)
- Maram G Katoue
- Department of Pharmacology and Therapeutics, Faculty of Pharmacy, Kuwait University, P.O. Box 24923, SAFAT 13110, Kuwait.
| | - Jean Ker
- National Lead for Clinical Skills and Simulation, NHS Education for Scotland and University of Dundee Ninewells Hospital, Dundee, Scotland, UK.
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Abstract
Introduction Mixed-methods methodology, as the name suggests refers to mixing of elements of both qualitative and quantitative methodologies in a single study. In the past decade, mixed-methods methodology has gained popularity among healthcare researchers as it promises to bring together the strengths of both qualitative and quantitative approaches. Methodology A number of mixed-methods designs are available in the literature and the four most commonly used designs in healthcare research are: the convergent parallel design, the embedded design, the exploratory design, and the explanatory design. Each has its own unique advantages, challenges and procedures and selection of a particular design should be guided by the research question. Guidance on designing, conducting and reporting mixed-methods research is available in the literature, so it is advisable to adhere to this to ensure methodological rigour. When to use it is best suited when the research questions require: triangulating findings from different methodologies to explain a single phenomenon; clarifying the results of one method using another method; informing the design of one method based on the findings of another method, development of a scale/questionnaire and answering different research questions within a single study. Two case studies have been presented to illustrate possible applications of mixed-methods methodology. Limitations Possessing the necessary knowledge and skills to undertake qualitative and quantitative data collection, analysis, interpretation and integration remains the biggest challenge for researchers conducting mixed-methods studies. Sequential study designs are often time consuming, being in two (or more) phases whereas concurrent study designs may require more than one data collector to collect both qualitative and quantitative data at the same time.
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Affiliation(s)
- Muhammad Abdul Hadi
- Department of Clinical Pharmacy, College of Pharmacy, Umm-Al-Qura University, Al-Abdia, Mecca, 13578, Saudi Arabia.
| | - S José Closs
- School of Healthcare, University of Leeds, Leeds, LS2 9UT, UK
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Hadi MA, Alldred DP, Briggs M, Marczewski K, Closs SJ. Effectiveness of a community based nurse-pharmacist managed pain clinic: A mixed-methods study. Int J Nurs Stud 2016; 53:219-27. [DOI: 10.1016/j.ijnurstu.2015.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 11/15/2022]
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Badawi DA, Alkhamis Y, Qaddoumi M, Behbehani K. National transparency assessment of Kuwait's pharmaceutical sector. Health Policy 2015; 119:1275-83. [PMID: 26229022 DOI: 10.1016/j.healthpol.2015.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 06/10/2015] [Accepted: 07/03/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Corruption is one of several factors that may hinder the access to pharmaceuticals. Since Kuwait has the highest per-capita spending on pharmaceuticals in the region, we wanted to evaluate the level of transparency in its pharmaceutical sector using an established assessment tool adapted by the World Health Organization. METHODS Standardized questionnaires were conducted via semi-structured interviews with key informants to measure the level of transparency in eight functions of the public pharmaceutical sector. RESULTS The scores for the degree of vulnerability to corruption reflected marginal to moderate venerability to corruption for most pharmaceutical sectors. The perceived strengths included availability of appropriate laws, the presence of clear standard operating procedures, and the use of an efficient registration/distribution system. Weaknesses included lack of conflict of interest guidelines and written terms of reference, absence of pharmacoeconomic studies, and inconsistencies in law enforcement. CONCLUSIONS Findings reveal that few functions of Kuwait pharmaceutical sector remain fairly vulnerable to corruption. However, the willingness of Kuwait Ministry of Health to adopt the assessment study and the acknowledgement of the weaknesses of current processes of the pharmaceutical sector may assist to achieve a transparent pharmaceutical system in the near future.
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Affiliation(s)
- Dalia A Badawi
- Director of Healthcare Planning & Development department, Dasman Diabetes Institute, Kuwait
| | - Yousif Alkhamis
- Senior Healthcare Planning & Information Team leader, Dasman, Diabetes Institute, Kuwait.
| | - Mohammad Qaddoumi
- Assistant Professor of Pharmacology and Therapeutics at Kuwait, University School of Pharmacy, Kuwait
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