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Tierney O, Vasilevski V, Kinsman L, Sweet L. Development of the essential learning outcomes for the midwifery student continuity of care learning model: A Delphi study. Women Birth 2024; 37:101582. [PMID: 38278700 DOI: 10.1016/j.wombi.2024.01.008] [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: 08/02/2023] [Revised: 10/25/2023] [Accepted: 01/16/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND In Australia, midwifery students are required to undertake at least ten Continuity of Care Experiences (CoCE) during their education. The learning outcomes of this experience have never been explicit or standardised resulting in inconsistent assessment. AIM To develop and identify standardised learning outcomes for the CoCE. METHODS A modified Delphi survey was conducted with an expert panel. Intended learning outcome statements were developed, reflecting the learning objectives identified in a previous study. Bloom's taxonomy levels of thinking complexities guided the wording of the outcomes. Participants were asked to rank and rate their level of agreement with each statement over two survey rounds. FINDINGS Round one was completed by 32 participants, with 92.5% of the 40 statements reaching consensus. The second round was completed by 23 participants, with 70.7% of the 33 statements reaching consensus. Content analysis of participant comments from each round identified duplicates that were removed and informed refining the wording of some statements. A final set of 15 learning outcomes were agreed upon. The outcomes were broadly grouped within the themes of accountability, advocacy, and autonomy. DISCUSSION This study has identified agreed learning outcomes for midwifery students undertaking CoCE. The consensus agreement of experts reinforced the learning model enables the development of woman-centred practice that is underpinned by accountability, advocacy, and autonomy. CONCLUSION Purposeful learning outcomes for the CoCE have been developed, informing how the model can be embedded in curricula, guide student learning and assessment to standardise the pedagogy of the model to prepare future midwives.
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Affiliation(s)
- Olivia Tierney
- School of Nursing and Midwifery, Deakin University, Victoria, Australia.
| | - Vidanka Vasilevski
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Victoria, Australia
| | - Leigh Kinsman
- Violet Vines Marshman Centre for Rural Health Research, La Trobe University Bendigo, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Victoria, Australia
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Chan A, Kinsman L, Chan SWC. "I use salt. However, I also use soy sauce, oyster sauce, sometimes chili sauce and….": interviews with Australians of Chinese ancestry regarding reducing salt consumption for hypertension prevention. BMC Nurs 2023; 22:414. [PMID: 37926831 PMCID: PMC10626782 DOI: 10.1186/s12912-023-01576-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/23/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND High dietary salt consumption is a significant health issue in Chinese populations. This study identified the facilitators for and barriers to salt reduction for prevention of hypertension among Chinese Australians. METHODS An inductive qualitative study with semi-structured interviews (n = 8) was conducted with convenience samples recruited from social media. Adults who a) were over 18 years old, b) were of Chinese ancestry and c) had lived in Australia for at least 6 months were eligible for participation. Interview transcripts were transcribed and analysed using content analysis. RESULTS Four facilitators for and eight barriers to reducing salt consumption were synthesised from the narrative materials. The facilitators were: 1) individual perceptions of health benefits, 2) salt alternatives, 3) digital information and 4) increased awareness of negative health impacts from a high-salt diet. The barriers identified were: 1) negative physical changes not apparent, 2) inadequate salt-related health education, 3) hidden salt in food products, 4) inadequate food literacy, 5) pricing, 6) busy lifestyle, 7) low perceived susceptibility and 8) individual food taste preference and cooking habits. Peer and family influence had positive and negative effects on participants' likelihood of reducing salt consumption. CONCLUSIONS The facilitators for and barriers to maintaining a low-salt diet in Chinese Australians were multifaceted and interrelated. Future salt-reduction strategies should focus on the health benefits of reduced salt consumption and practical interventions such as salt alternatives and education on low-salt food choices and cooking methods and changing perceptions about salt reduction to become a social norm in the Chinese community.
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Affiliation(s)
- Alex Chan
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia.
- School of Nursing, University of Wollongong, Wollongong, Australia.
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
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Tierney O, Vasilevski V, Kinsman L, Sweet L. Advocacy, accountability and autonomy; the learning intention of the midwifery student continuity of care experience. Nurse Educ Pract 2023; 72:103772. [PMID: 37634289 DOI: 10.1016/j.nepr.2023.103772] [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: 06/22/2023] [Revised: 08/08/2023] [Accepted: 08/21/2023] [Indexed: 08/29/2023]
Abstract
PROBLEM The Continuity of Care Experience is a mandated inclusion in midwifery education programs leading to registration as a midwife in Australia. The practice-based learning experience has evolved over time, yet there remains no standardised learning intentions, objectives, or outcomes for the model. AIM To identify the key learning intentions of the Continuity of Care Experience by an expert panel to support the development of learning outcomes. METHODS A descriptive qualitative study with two focus groups were conducted with an expert panel (n = 15). Participants were midwifery education subject matter experts on the Continuity of Care Experience with backgrounds in academia, policy development, curriculum design, accreditation, or clinical education. The discussions were transcribed and thematically analysed. FINDINGS Three main themes and six sub-themes describe the learning intentions of the Continuity of Care Experience. The main themes were: (1) advocacy for women; (2) accountability of care; and (3) autonomy in practice. DISCUSSION The education model of continuity of care enables students to develop midwifery practice that involves advocating for women, being accountable for their care and being autonomous in practice. We have established that during the experience students practice in partnership with women and are exposed to the full scope of midwifery care. Importantly students learn holistic woman-centred practice. CONCLUSION The learning intentions of the Continuity of Care Experience reflects woman-centred practice. Having identified a common understanding of the learning intention, these can now be used to design learning, and assessment, through the development of measurable learning outcomes.
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Affiliation(s)
- Olivia Tierney
- School of Nursing and Midwifery, Deakin University, Victoria, Australia.
| | - Vidanka Vasilevski
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Victoria, Australia
| | - Leigh Kinsman
- Violet Vines Marshman Centre for Rural Health Research, La Trobe University Bendigo, Australia
| | - Linda Sweet
- School of Nursing and Midwifery, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research, Institute for Health Transformation, Western Health Partnership, Victoria, Australia
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Chan A, Wai-chi Chan S, Kinsman L. Using the health belief model to understand the factors influencing the perceptions of people of Chinese ancestry about reducing salt consumption for hypertension prevention: A cross-sectional study. PLoS One 2023; 18:e0289867. [PMID: 37585401 PMCID: PMC10431675 DOI: 10.1371/journal.pone.0289867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 07/27/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND High-salt diets are linked to hypertension. Chinese people in Australia, are at increased risk of hypertension due to the combination of routine addition of high quantities of salt to food during cooking and high salt levels in processed western foods. There is a scarcity of salt-related behavioural studies on this population group. This study aimed to explore the habitual salt consumption of Chinese Australians and factors that influence their perceptions about sustaining salt-related behavioural changes for hypertension prevention. METHOD A cross-sectional descriptive study using an adapted Determinants of Salt-Restriction Behaviour Questionnaire was conducted on 188 Chinese Australians. A non-probability sampling method was used to attract participants from different parts of Australia. Statistical analyses such as descriptive analysis, t-tests and Pearson correlation tests were performed in the study. RESULTS Over 97% of participants did not measure the amount of salt added to their meals. Many participants reported that salt was added to their meals based on their experience (39.4%) and food taste (31.9%). Over 80% of participants did not know the recommended level of daily salt consumption. Although salt-related knowledge had no significant correlation with individuals' salty food taste preferences, there were significant correlations with the perceptions of the severity of disease and health benefits of reducing salt consumption (p = .001 and < .001 respectively). People with stronger salty taste preferences perceived a higher level of health threat than people with lighter salty taste preferences (p = .003). CONCLUSION Findings from this study show that knowledge about salt-reduction alone had no significant effects on salt-related behaviours. Adequate culturally relevant practice-based education in salt-reduction strategies may facilitate salt-related behavioural changes in Chinese Australians. Overall, single young Chinese Australian men with stronger salty taste preferences is the group who needs salt reduction interventions the most.
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Affiliation(s)
- Alex Chan
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, Australia
- School of Nursing, University of Wollongong, Wollongong, Australia
| | | | - Leigh Kinsman
- School of Nursing and Midwifery, The University of Newcastle, Newcastle, Australia
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
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Mollart L, Irwin P, Noble D, Kinsman L. Promoting patient safety using electronic medical records in nursing/midwifery undergraduate curricula: Discussion paper. Nurse Educ Pract 2023; 70:103653. [PMID: 37167799 DOI: 10.1016/j.nepr.2023.103653] [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: 08/23/2022] [Revised: 02/12/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
This discussion paper highlights the importance of Australian nursing and midwifery students' lack of exposure to electronic medical records during their undergraduate programs. There is pressure on universities offering nursing and midwifery programs to provide students with opportunities to learn to use patient electronic medical records. This will provide authentic rehearsal with the digital technology prior to clinical placements and increase graduate work readiness. Informed by contemporary literature, we describe the benefits of implementing electronic medical records (eMR) in health organisations and identify the challenges and barriers to implementing and integrating the education of electronic records into undergraduate nursing and midwifery programs. Undergraduate students who had not experienced eMR as part of on-campus learning felt unprepared and lacked confidence when commencing clinical practice. Some international nursing and midwifery programs have found that student's skills improve in decision-making and documenting patient observations when eMR is integrated into their university education program. Successful integration of an eMR program should consider academic/teaching staff skills and confidence in technology use, initial and ongoing costs and technical support required to deliver the program. In conclusion, Australian universities need to embed eMR learning experiences into the nursing and midwifery undergraduate curricula to increase students work-readiness with a focus on patient safety.
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Affiliation(s)
- Lyndall Mollart
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, University Dr, Callaghan, NSW 2308. Australia.
| | - Pauletta Irwin
- School of Nursing, Paramedicine and Health Sciences, Charles Sturt University, Major Innes Rd, Port Macquarie, NSW 2444. Australia
| | - Danielle Noble
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, University Dr, Callaghan, NSW 2308. Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, University Dr, Callaghan, NSW 2308. Australia
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Njoku CM, Hurst JR, Kinsman L, Balogun S, Obamiro K. COPD in Africa: risk factors, hospitalisation, readmission and associated outcomes-a systematic review and meta-analysis. Thorax 2023; 78:596-605. [PMID: 36635039 DOI: 10.1136/thorax-2022-218675] [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: 01/06/2022] [Accepted: 11/30/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND This review aims to synthesise available evidence on the prevalence of chronic obstructive pulmonary disease (COPD), associated risk factors, hospitalisations and COPD readmissions in Africa. METHOD Using the Met-Analyses and Systematic Reviews of Observational Studies guideline, electronic databases were searched from inception to 1 October 2021. The quality of studies was assessed using the Newcastle-Ottawa Scale. Evidence from retrieved articles was synthesised, and a random-effect model meta-analysis was conducted. The protocol was registered on PROSPERO. RESULTS Thirty-nine studies met the inclusion criteria, with 13 included in the meta-analysis. The prevalence of COPD varied between the Global Initiative for Chronic Obstructive Lung Disease (2%-24%), American Thoracic Society/European Respiratory Society (1%-17%) and Medical Research Council chronic bronchitis (2%-11%) criteria, respectively. Increasing age, wheezing and asthma were consistent risk factors for COPD from studies included in the narrative synthesis. Our meta-analysis indicated that prior tuberculosis ((OR 5.98, 95% CI 4.18 to 8.56), smoking (OR 2.80, 95% CI: 2.19 to 3.59) and use of biomass fuel (OR 1.52, 95% CI: 1.39 to 1.67)) were significant risk factors for COPD. Long-term oxygen therapy (HR 4.97, 95% CI (1.04 to 23.74)) and frequent hospitalisation (≥3 per year) (HR 11.48, 95% CI (1.31 to 100.79)) were risk factors associated with 30-day COPD readmission. CONCLUSION This study not only highlights specific risk factors for COPD risk in Africa but also demonstrates the paucity and absence of research in several countries in a continent with substantial COPD-related mortality. Our findings contribute towards the development of evidence-based clinical guidelines for COPD in Africa.PROSPERO registration numberCRD42020210581.
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Affiliation(s)
- Chidiamara Maria Njoku
- College of Health Sciences, Sport and Exercise Science, James Cook University Division of Tropical Health and Medicine, Townsville, Queensland, Australia
| | - John R Hurst
- Academic Unit of Respiratory Medicine, UCL Medical School, London, UK
| | - Leigh Kinsman
- School of Nursing and Midwifery, The University of Newcastle School of Nursing and Midwifery, Callaghan, New South Wales, Australia
| | - Saliu Balogun
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kehinde Obamiro
- Centre for Rural Health, University of Tasmania School of Health Sciences, Launceston, Tasmania, Australia
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Stephens AS, Dinh MM, Kinsman L. Patterns of emergency department use in rural and metropolitan New South Wales by socioeconomic status: A population-based study. Emerg Med Australas 2022; 35:489-495. [PMID: 36571146 DOI: 10.1111/1742-6723.14155] [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: 08/18/2022] [Revised: 10/24/2022] [Accepted: 12/01/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE To investigate the patterns of ED use in metropolitan and rural New South Wales (NSW) by socioeconomic status (SES). METHODS We undertook a retrospective, population-based study of de-identified data from the NSW Emergency Department Data Collection (EDDC). The study population comprised of NSW residents who presented to an NSW public hospital ED in 2013-2019 and were registered in the NSW EDDC. Total ED presentations, negative binomial regression modelled annual changes in ED presentations over 2013-2019, and age- and sex-standardised rates of ED presentations in 2019 were assessed. RESULTS Overall, between 2013 and 2019, ED presentations increased in metropolitan and rural NSW, with mean annual percentage increases of 3.1% (95% confidence interval [CI] 2.8-3.5) and 2.5% (95% CI 2.0-2.9), respectively. This growth varied by SES, with larger increases observed in higher SES groups. The bulk of presentations in rural NSW were from individuals living in disadvantaged areas. Standardised rates of ED presentations were highest in the most disadvantaged quintiles (SES 1) and progressively decreased with increasing SES in both rural and metropolitan NSW (negative gradients). Rates were higher in rural NSW compared to metropolitan NSW across all SES quintiles for total, low acuity and non-low acuity presentations. CONCLUSIONS Negative gradients in rates of ED presentations with increasing SES were observed in both metropolitan and rural NSW. At each SES quintile, rates of ED presentations were higher in rural compared to metropolitan areas. Further research exploring the underlying causal mechanisms leading to increased ED demand in rural NSW and socioeconomically disadvantaged populations is warranted.
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Affiliation(s)
- Alexandre S Stephens
- Northern New South Wales Local Health District, Lismore, New South Wales, Australia.,School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Michael M Dinh
- Emergency Department, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leigh Kinsman
- Mid North Coast Local Health District, Coffs Harbour, New South Wales, Australia.,School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Newcastle, Newcastle, New South Wales, Australia
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Njoku CM, Wimmer BC, Peterson GM, Kinsman L, Bereznicki BJ. Hospital Readmission Due to Chronic Obstructive Pulmonary Disease: A Longitudinal Study. Int J Health Policy Manag 2022; 11:2533-2541. [PMID: 35120405 PMCID: PMC9818089 DOI: 10.34172/ijhpm.2022.5770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/08/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND This study aimed to investigate the prevalence of hospital readmission for chronic obstructive pulmonary disease (COPD) at 30, 90 and 365 days, and to determine demographic and socioeconomic risk factors for 30-day and 90-day readmission and time to COPD-related readmission within 365 days in Tasmania. METHODS Patients ≥40 years admitted for COPD between 2011 and 2015 were identified using administrative data from all major public hospitals in Tasmania, Australia. Factors associated with readmission and time to readmission were identified using logistic and Cox regression, respectively. RESULTS The rates of COPD-related readmission were 6.7% within 30 days, 12.2% within 90 days and 23.7% within 365 days. Being male (odds ratio [OR]: 1.49, CI: 1.06-2.09), Indigenous (OR: 2.47, CI: 1.31-4.66) and living in the lower socioeconomic North-West region of Tasmania (OR: 1.80, CI: 1.20-2.69) were risk factors for 30-day readmission. Increased COPD-related (OR: 1.48, CI: 1.22-1.80; OR: 1.52, CI: 1.29-1.78) and non-COPD-related (OR: 1.12, CI: 1.03- 1.23; OR: 1.11, CI: 1.03-1.21) emergency department (ED) visits in the preceding six months were risk factors for both 30-day and 90-day readmissions. Being Indigenous (hazard ratio [HR]: 1.61, CI: 1.10-2.37) and previous COPD-related ED visits (HR: 1.30, CI: 1.21-1.39) decreased, while a higher Charlson Comorbidity Index (CCI) (OR: 0.91, CI: 0.83- 0.99) increased the time to readmission within 365 days. CONCLUSION Being male, Indigenous, living in the North-West region and previous ED visits were associated with increased risk of COPD readmission in Tasmania. Interventions to improve access to primary healthcare for these groups may reduce COPD-related readmissions.
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Affiliation(s)
- Chidiamara Maria Njoku
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Barbara Caecilia Wimmer
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Gregory Mark Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Port Macquarie, NSW, Australia
| | - Bonnie Jayne Bereznicki
- Tasmanian School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, TAS, Australia
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Chan A, Kinsman L, Chan SWC. Psychometric testing of the Determinants of Salt-Restriction Behaviour Questionnaire in people of Chinese ancestry: a methodological study. BMC Nurs 2022; 21:339. [PMID: 36461075 PMCID: PMC9717568 DOI: 10.1186/s12912-022-01124-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/25/2022] [Indexed: 12/04/2022] Open
Abstract
PURPOSE Nurses play a key role in educating people about a salt-reduced diet to prevent or manage hypertension or cardiac failure. Assessment tools such as the Chinese Determinants of Salt-Restriction Behaviour Questionnaire (DSRBQ) can provide essential evidence to inform education strategies. This study aimed to translate the DSRBQ into English and evaluate the psychometric properties of the Chinese and English versions for people of Chinese ethnicity in Australia. METHODS A two-phase cross-sectional descriptive study was conducted. Phase 1: The questionnaire was translated into English using the back-translation method. The translation equivalence and content relevance were evaluated by an expert panel. Three items were revised and eight items were removed. Phase 2: Internal consistency and stability of the questionnaires were evaluated by a group of Chinese Australians. RESULTS Both the English and Chinese versions had satisfactory psychometric properties. In phase 2, 146 participants completed the questionnaire (test), and 49 participants completed the retest. The Cronbach's alpha scores were 0.638 and 0.584 respectively, and the overall intra-class correlation coefficients were 0.820 and 0.688 respectively for the English and Chinese versions. The Item-Content Validity Index (CVI) ranged from 0.50 to 1.00. The Scale-CVI was 0.94. CONCLUSION The DSRBQ has been translated into English. Both English and Chinese versions have acceptable validity and reliability. The tools can be used in people from a Chinese cultural background living in Australia. Further validation testing may allow the tools to be adapted for use with other Chinese diaspora groups. The validated DSRBQ will support the development of evidence-based salt reduction nursing assessment tool and interventions for Chinese diasporas who reside in a country where Chinese cultural practices are employed by a minority.
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Affiliation(s)
- Alex Chan
- grid.266842.c0000 0000 8831 109XSchool of Nursing and Midwifery, University of Newcastle, Newcastle, Australia ,grid.1007.60000 0004 0486 528XSchool of Nursing, University of Wollongong, 33 Moore Street, Liverpool, NSW 2170 Australia
| | - Leigh Kinsman
- grid.266842.c0000 0000 8831 109XSchool of Nursing and Midwifery, University of Newcastle, Newcastle, Australia ,grid.1018.80000 0001 2342 0938La Trobe Rural Health School, La Trobe University, Melbourne, Australia
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Tranmer J, Rotter T, O'Donnell D, Marciniuk D, Green M, Kinsman L, Li W. Determining the influence of the primary and specialist network of care on patient and system outcomes among patients with a new diagnosis of chronic obstructive pulmonary disease (COPD). BMC Health Serv Res 2022; 22:1210. [PMID: 36171574 PMCID: PMC9520829 DOI: 10.1186/s12913-022-08588-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction Care for patients with chronic obstructive pulmonary disease (COPD) is provided by both family physicians (FP) and specialists. Ideally, patients receive comprehensive and coordinated care from this provider team. The objectives for this study were: 1) to describe the family and specialist physician network of care for Ontario patients newly diagnosed with COPD and 2) to determine the associations between selected characteristics of the physician network and unplanned healthcare utilization. Methods We conducted a retrospective cohort study using Ontario health administrative data housed at ICES (formerly the Institute for Clinical Evaluative Sciences). Ontario patients, ≥ 35 years, newly diagnosed with COPD were identified between 2005 and 2013. The FP and specialist network of care characteristics were described, and the relationship between selected characteristics (i.e., continuity of care) with unplanned healthcare utilization during the first 5 years after COPD diagnosis were determined in multivariate models. Results Our cohort consisted of 450,837 patients, mean age 61.5 (SD 14.6) years. The FP was the predominant provider of care for 86.4% of the patients. Using the Bice-Boxerman’s Continuity of Care Index (COCI), a measure reflecting care across different providers, 227,082 (50.4%) were categorized in a low COCI group based on a median cut-off. In adjusted analyses, patients in the low COCI group were more likely to have a hospital admission (OR = 2.27, 95% CI 2.20,2.22), 30-day readmission (OR = 2.44, 95% CI 2.39, 2.49) and ER visit (OR = 2.27, 95% CI 2.25, 2.29). Conclusion Higher indices of continuity of care are associated with reduced unplanned hospital use for patients with COPD. Primary care-based practice models to enhance continuity through coordination and integration of both primary and specialist care have the potential to enhance the health experience for patients with COPD and should be a health service planning priority.
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Affiliation(s)
- J Tranmer
- From the Department of Medicine, Family Medicine and Nursing ICES-Queen's and Queen's Health Services Policy Research Institute Queen's Health Sciences, Queen's University, Kingston, Canada.
| | - T Rotter
- From the Department of Medicine, Family Medicine and Nursing ICES-Queen's and Queen's Health Services Policy Research Institute Queen's Health Sciences, Queen's University, Kingston, Canada
| | - D O'Donnell
- From the Department of Medicine, Family Medicine and Nursing ICES-Queen's and Queen's Health Services Policy Research Institute Queen's Health Sciences, Queen's University, Kingston, Canada
| | - D Marciniuk
- Respiratory Research Center, University of Saskatchewan, Saskatoon, Canada
| | - M Green
- From the Department of Medicine, Family Medicine and Nursing ICES-Queen's and Queen's Health Services Policy Research Institute Queen's Health Sciences, Queen's University, Kingston, Canada
| | - L Kinsman
- School of Evidence Based Nursing, University of New Castle, New Castle, Australia
| | - W Li
- From the Department of Medicine, Family Medicine and Nursing ICES-Queen's and Queen's Health Services Policy Research Institute Queen's Health Sciences, Queen's University, Kingston, Canada
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Tierney MO, Sweet L, Kinsman L, Vasilevski V. Accountability, Advocacy and Autonomy: the top intentions for midwifery student learning in the Continuity of Care Experience. Women Birth 2022. [DOI: 10.1016/j.wombi.2022.07.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Groot G, Ollegasagrem S, Khakpour M, Panahi A, Goodridge D, Lloyd J, Kinsman L, Rotter T, Tymchak Z, Carr T. Facilitators and Barriers to Clinical Pathway Uptake and Utilization Among Primary Care Providers in Saskatchewan - A Qualitative Study. CLIN INVEST MED 2022; 45:E1-9. [DOI: 10.25011/cim.v45i2.38450] [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: 04/14/2022] [Accepted: 04/14/2022] [Indexed: 11/03/2022]
Abstract
Purpose: Clinical Pathways (CPWs) are multidisciplinary, evidence-based, complex interventions designed to standardize patient care. In Saskatchewan, development, implementation and evaluation of the seven provincial CPWs (Hip & Knee, Spine, Pelvic Floor, Prostate Assessment, Fertility Care, Lower Extremity Wound Care and Acute Stroke) present significant challenges, leading to low utilization. This study aimed to identify facilitators and barriers to CPW utilization by Saskatchewan family physicians.
Methods: To identify the facilitators and barriers to CPWs, a qualitative interpretive approach consisted of eight one-on-one key informant interviews and five focus groups held with 30 family physicians in two larger urban and two smaller Saskatchewan cities. Inductive, thematic analysis of the interviews based on the Theoretical Domain Framework for behavioral changes was used to identify facilitators and barriers to CPW uptake and utilization.
Results: Fifty-one themes were mapped under 14 Theoretical Domain Framework domains. Major barriers included the following: system-level (knowledge and communication, social/professional identity, family physician engagement and education); objective clarification (goals, belief about consequences of implementing CPW); and technical and resource related (administrative, access to local specialists, enforcement and incentives). The most prominent barrier was lack of systematic CPW promotion and inconsistencies in communication between the following: organization-to-practitioner; organization-to-organization; and practitioner-to-practitioner. Facilitators who mitigated barriers were need for optimized and integrated information technology services (i.e., Electronic Medical Records) and optimism towards CPW usage and patient outcomes.
Conclusions: This exploratory study identified specific improvements and recommendations required to promote uptake of CPWs based on perceived facilitators and barriers.
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Chan A, Chan SWC, Khanam M, Kinsman L. Factors affecting reductions in dietary salt consumption in people of Chinese descent: An integrative review. J Adv Nurs 2022; 78:1919-1937. [PMID: 35384036 PMCID: PMC9323495 DOI: 10.1111/jan.15237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/20/2022] [Accepted: 03/13/2022] [Indexed: 11/29/2022]
Abstract
Aims To identify and synthesize the evidence on the perceptions of the health effects of dietary salt consumption and barriers to sustaining a salt‐reduced diet for hypertension in Chinese people. Design A systematic integrated review integrating quantitative and qualitative studies using the PRISMA guidelines. Data sources Three databases, MEDLINE, PubMed and CINAHL, were systematically searched for articles published between January 2001 and July 2020. Review methods The quality of the included studies was appraised using the Joanna Briggs Institute's critical appraisal tools for cross‐sectional and qualitative studies. Descriptive analysis and constant comparison methods were used to analyse the extracted data. Results Fourteen studies met the inclusion criteria. The synthesized results identified that (i) adequate salt‐related health education had a positive influence on dietary behaviour modifications, (ii) the level of educational exposure to the health benefits of salt reduction influenced Chinese people's perceptions of the health impact associated with high salt intake, (iii) the complexity of salt measurement was a barrier to salt reduction, (iv) salt reduction is a challenge to Chinese food culture, and (v) Chinese migrants may experience linguistic and cultural challenges when they seek appropriate dietary education and advice for hypertension management in their host countries. Conclusion There is room for improvement in recognizing and translating the knowledge of salt‐related health issues and the benefits of that knowledge about salt reduction into action. Future nursing interventions should incorporate individuals' cultural needs and the dietary culture of immediate family members. Impact This integrative review reveals that unique Chinese customs and practices reduce the effectiveness of salt reduction campaigns. The effects of education vanish without family support, resulting in suboptimal adherence to dietary salt reduction strategies.
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Affiliation(s)
- Alex Chan
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia.,School of Nursing, University of Wollongong, Liverpool, New South Wales, Australia
| | | | - Masuma Khanam
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Callaghan, New South Wales, Australia
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14
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Jacob A, Van Vuuren J, Kinsman L, Spelten E. Daily reality of violence in a rural emergency department: Is violence becoming the new normal? Emerg Med Australas 2022; 34:555-558. [PMID: 35212148 DOI: 10.1111/1742-6723.13942] [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: 07/22/2021] [Revised: 12/05/2021] [Accepted: 01/10/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Violence in emergency healthcare is a persistent and concerning problem. The objective of the present study was to explore and understand rural nurses' views on the daily experience and impact of violence, and its perpetrators. METHODS The present study took a descriptive exploratory approach. Two focus groups were held with nurses from an ED at a rural hospital in New South Wales, Australia. RESULTS Violence occurred regularly and had a significant impact on staff. Nurses go to work expecting to search patients for weapons and be physically and verbally abused. Tolerating and being able to manage violence has become a rite of passage. CONCLUSIONS The present study shows that rural workers, like metropolitan workers, feel experiences of violence are a routine part of their roles. Violence in healthcare is a societal issue, that cannot be solved without a multifactor approach that considers the characteristics of the perpetrators.
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Affiliation(s)
- Alycia Jacob
- Murtupuni Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia.,Faculty of Nursing, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Julia Van Vuuren
- Department of Public Health, Latrobe University, Melbourne, Victoria, Australia
| | - Leigh Kinsman
- Faculty of Nursing and Midwifery, The University of Newcastle, Newcastle, New South Wales, Australia.,Mid North Coast Local Health District, Coffs Harbour, New South Wales, Australia
| | - Evelien Spelten
- Department of Public Health, Latrobe University, Bendigo, Victoria, Australia
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15
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Kinsman L, Cooper S, Champion R, Kim JA, Boyle J, Cameron A, Cant RP, Chung C, Connell C, Evans L, McInnes D, McKay A, Norman L, Penz E, Rana M, Rotter T. The impact of web-based and face-to-face simulation education programs on nurses' response to patient deterioration: A multi-site interrupted time series study. Nurse Educ Today 2021; 102:104939. [PMID: 33934038 DOI: 10.1016/j.nedt.2021.104939] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 12/13/2020] [Accepted: 04/19/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Nurses' response to patient deterioration in acute hospital wards is a priority issue. Simulation education programs improve nurses' knowledge and confidence, but the translation into better care is largely unknown for both web based (WB) and face to face (F2F) simulation programs. AIM To measure the impact of simulation education on nurses' response to patient deterioration in acute medical ward settings, and to compare the impact of WB and F2F versions. DESIGN An interrupted time series, non-randomised trial across four medical wards in Victoria, Australia. Wards were allocated to either web-based or face-to-face versions of the same simulation program, FIRST2ACT. Interrupted time series measurement for six fortnights both before and after the intervention were used to measure and compare responses to deterioration. Responses to patient deterioration were extracted from medical records and grouped into outcomes for escalation (e.g. initiation of clinical review), assessment and observation (e.g. increased recording of vital signs, conscious state and pain scores) and clinical interventions (e.g. oxygen administration). RESULTS 126 nurses (89%) participated across the four wards. 946 patient records (506 in the F2F; 440 in the WB group) were included in analyses. There were significant and sustained improvements between pre and post samples in outcomes for escalation (13.0% to 28.8%; p = 0.000) and assessment and observation (conscious state recorded increased from 91.1% to 100%; p = 0.000, and pain score recorded increased from 97.8% to 99.8%; p = 0.000). There were no differences between the web-based and face-to-face groups except in appropriate oxygen application which increased by 7.7% in the F2F group and decreased by 11.8% in the WB group (p = 0.046). CONCLUSIONS There was a significant improvement in nurses' response to patient deterioration following both versions of simulation, indicating that both have a role to play in supporting nurses' response to patient deterioration.
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Affiliation(s)
- Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Port Macquarie Base Hospital, Port Macquarie, NSW 2444, Australia.
| | - Simon Cooper
- Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia.
| | | | - Jeong-Ah Kim
- Federation University Australia, University Drive, Mt Helen, VIC 3350, Australia.
| | - Jayne Boyle
- St John of God Health Care, Bendigo, PO Box 478, Bendigo, Victoria 3350, Australia.
| | - Amanda Cameron
- Latrobe Regional Hospital, 10 Village Ave, Traralgon, VIC 3844, Australia.
| | - Robyn P Cant
- Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia.
| | - Catherine Chung
- Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia.
| | - Cliff Connell
- Monash University, Room E2.31, Building E, Peninsula Campus, McMahons Road, Frankston, P O Box 527, Frankston, VIC, Australia.
| | - Lisa Evans
- St John of God Health Care Berwick, Gibb St, Berwick, Victoria 3806, Australia.
| | - Denise McInnes
- Central Gippsland Health Service, 155 Guthridge Parade, Sale, VIC 3850, Australia.
| | - Angela McKay
- University of Tasmania, Locked Bag 1322, Launceston, TAS 7250, Australia.
| | - Lisa Norman
- St John of God Health Care Berwick, Gibb St, Berwick, Victoria 3806, Australia.
| | - Erika Penz
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Canada.
| | - Masud Rana
- Division of Respirology, Critical Care and Sleep Medicine, University of Saskatchewan, Canada.
| | - Thomas Rotter
- Healthcare Quality Programs, Queens' University, Kingston, Canada.
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16
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Dwyer M, Peterson G, Gall S, Kinsman L, Francis K, Ford K, Castley H, Kitsos A, Hilliard T, English J. Regional differences in access to acute ischaemic stroke care and patient outcomes. Intern Med J 2021; 50:965-971. [PMID: 31566867 DOI: 10.1111/imj.14638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 09/06/2019] [Accepted: 09/07/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Advances in stroke management such as acute stroke units and thrombolysis are not uniformly distributed throughout our population, with rural areas being relatively disadvantaged. It remains unclear, however, whether such disparities have led to corresponding differences in patient outcomes. AIMS To describe the regional differences in acute ischaemic stroke care and outcomes within the Australian state of Tasmania. METHODS A retrospective case note audit was used to assess the care and outcomes of 395 acute ischaemic stroke patients admitted to Tasmania's four major public hospitals. Sixteen care processes were recorded, which covered time-critical treatment, allied health interventions and secondary prevention. Outcome measures were assessed using 30-day mortality and discharge destination, both of which were analysed for differences between urban and rural hospitals using logistic regression. RESULTS No patients in rural hospitals were administered thrombolysis; these hospitals also did not have acute stroke units. With few exceptions, patients' access to the remaining care indicators was comparable between regions. After adjusting for confounders, there were no significant differences between regions in terms of 30-day mortality (odds ratio (OR) = 0.99, 95% confidence interval (CI) 0.46-2.18) or discharge destination (OR = 1.24, 95% CI 0.81-1.91). CONCLUSIONS With the exception of acute stroke unit care and thrombolysis, acute ischaemic stroke care within Tasmania's urban and rural hospitals was broadly similar. No significant differences were found between regions in terms of patient outcomes. Future studies are encouraged to employ larger data sets, which capture a broader range of urban and rural sites and record patient outcomes at extended interval.
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Affiliation(s)
- Mitchell Dwyer
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Greg Peterson
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Seana Gall
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Newcastle, New South Wales, Australia
| | - Karen Francis
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Karen Ford
- Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia
| | - Helen Castley
- Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia
| | - Alex Kitsos
- College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Tamsin Hilliard
- Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia
| | - Jennifer English
- Royal Hobart Hospital, Tasmanian Health Service, Hobart, Tasmania, Australia
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17
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van Vuuren J, Thomas B, Agarwal G, MacDermott S, Kinsman L, O'Meara P, Spelten E. Reshaping healthcare delivery for elderly patients: the role of community paramedicine; a systematic review. BMC Health Serv Res 2021; 21:29. [PMID: 33407406 PMCID: PMC7789625 DOI: 10.1186/s12913-020-06037-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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: 05/17/2020] [Accepted: 12/21/2020] [Indexed: 12/19/2022] Open
Abstract
Background Healthcare systems are overloaded and changing. In response to growing demands on the healthcare systems, new models of healthcare delivery are emerging. Community paramedicine is a novel approach in which paramedics use their knowledge and skills beyond emergency health response to contribute to preventative and rehabilitative health. In our systematic review, we aimed to identify evidence of the community paramedicine role in care delivery for elderly patients, with an additional focus on palliative care, and the possible impact of this role on the wider healthcare system. Methods A systematic review of peer-reviewed literature from MEDLINE, Embase, CINAHL, and Web of Sciences was undertaken to identify relevant full-text articles in English published until October 3, 2019. Additional inclusion criteria were studies focussing on extended care paramedics or community paramedics caring for elderly patients. Case studies were excluded. All papers were screened by at least two authors and underwent a quality assessment, using the Joanna Briggs Institute appraisal checklists for cross sectional, qualitative, cohort, and randomised controlled trial studies to assess the methodological quality of the articles. A process of narrative synthesis was used to summarise the data. Results Ten studies, across 13 articles, provided clear evidence that Community Paramedic programs had a positive impact on the health of patients and on the wider healthcare system. The role of a Community Paramedic was often a combination of four aspects: assessment, referral, education and communication. Limited evidence was available on the involvement of Community Paramedics in palliative and end-of-life care and in care delivery in residential aged care facilities. Observed challenges were a lack of additional training, and the need for proper integration and understanding of their role in the healthcare system. Conclusions The use of community paramedics in care delivery could be beneficial to both patients’ health and the wider healthcare system. They already play a promising role in improving the care of our elderly population. With consistent adherence to the training curriculum and effective integration within the wider healthcare system, community paramedics have the potential to take on specialised roles in residential aged care facilities and palliative and end-of-life care. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06037-0.
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Affiliation(s)
- Julia van Vuuren
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia.
| | - Brodie Thomas
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia
| | - Gina Agarwal
- Department of Family Medicine, McMaster University, Hamilton, Canada.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Sean MacDermott
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia
| | - Leigh Kinsman
- University of Newcastle and Mid-North Coast Local Health District, Port Macquarie Base Hospital, Port Macquarie, Australia
| | - Peter O'Meara
- Department of Paramedicine, Monash University, Peninsula Campus, Melbourne, Australia
| | - Evelien Spelten
- Department of Community Health, Rural Health School, La Trobe University, Melbourne, Australia
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18
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Lower T, Kinsman L, Dinh MM, Lyle D, Cheney R, Allan J, Munro A, Taylor B, Wiggers JH, Bailey A, Weller L, Jacob A, Stephens AS. Patterns of emergency department use in rural and metropolitan New South Wales from 2012 to 2018. Aust J Rural Health 2020; 28:490-499. [DOI: 10.1111/ajr.12668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022] Open
Affiliation(s)
- Tony Lower
- Mid North Coast Local Health District Port Macquarie NSW Australia
| | - Leigh Kinsman
- Mid North Coast Local Health District Port Macquarie NSW Australia
- Faculty of Medicine and Health School of Nursing and Midwifery University of Newcastle Newcastle NSW Australia
| | - Michael M. Dinh
- New South Wales Institute of Trauma and Injury Management Sydney NSW Australia
- Faculty of Medicine and Health Sydney Medical School The University of Sydney Sydney NSW Australia
| | - David Lyle
- Broken Hill University Department of Rural Health Faculty of Medicine and Health School of Medicine The University of Sydney Sydney NSW Australia
| | - Richard Cheney
- Western New South Wales Local Health District Orange NSW Australia
| | - Julaine Allan
- Western New South Wales Local Health District Orange NSW Australia
| | - Alice Munro
- Western New South Wales Local Health District Orange NSW Australia
| | - Barbara Taylor
- Murrumbidgee Local Health District Wagga Wagga NSW Australia
| | - John H. Wiggers
- Faculty of Medicine and Health School of Medicine, and Public Health University of Newcastle Newcastle NSW Australia
- Hunter New England Local Health District New Lambton NSW Australia
| | - Andrew Bailey
- Mid North Coast Local Health District Port Macquarie NSW Australia
| | - Lauren Weller
- New South Wales Rural Health Research Alliance Port Macquarie NSW Australia
| | - Alycia Jacob
- Faculty of Medicine and Health School of Nursing and Midwifery University of Newcastle Newcastle NSW Australia
| | - Alexandre S. Stephens
- Northern New South Wales Local Health District Lismore NSW Australia
- Faculty of Medicine and Health School of Public Health The University of Sydney Sydney NSW Australia
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19
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Kinsman L, Radford J, Elmer S, Ogden K, Randles S, Jacob A, Delphin D, Burr N, Goss M. Engaging "hard-to-reach" men in health promotion using the OPHELIA principles: Participants' perspectives. Health Promot J Austr 2020; 32 Suppl 1:33-40. [PMID: 32794616 DOI: 10.1002/hpja.403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 07/29/2020] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
ISSUE ADDRESSED Men in the Northern Suburbs of Launceston, Tasmania, experience substantially poorer health outcomes and socio-economic disadvantage than most Australians. They are often described as "hard-to-reach," meaning difficult to engage in research, health promotion, policy and planning. This paper summarises the OPHELIA process to combine health literacy profiling with engagement of local men in health promotion, and their experience of the process and outcomes. METHODS Interviews were conducted to explore the experiences of middle-aged men with the OPHELIA process and subsequent interventions. RESULTS Local data and health literacy profiling revealed experiences of isolation, lack of trust in the system, medication non-adherence, mental illness and chronic pain, which formed the basis for generation of ideas to improve their well-being and understanding of health. Tailored interventions were implemented, including suicide prevention, "Numeracy for Life" and "Healthy Sheds" courses. Interviews with six participants revealed that the process contributed to a sense of worth, social support and ability to break "old habits." CONCLUSIONS Prioritising the lived experience of "hard-to-reach" men through the OPHELIA process resulted in co-design of interventions that were valued by participants. SO WHAT?: Health literacy profiling and genuine community engagement can empower vulnerable, under-represented communities to co-design, and engage in, health promotion.
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Affiliation(s)
- Leigh Kinsman
- Nursing and Midwifery, University of Newcastle, Port Macquarie, NSW, Australia.,Nursing and Midwifery, Mid North Coast Local Health District, Port Macquarie, NSW, Australia
| | - Jan Radford
- Launceston Clinical School, University of Tasmania, Hobart, TAS, Australia
| | - Shandell Elmer
- Faculty Health Arts and Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Kathryn Ogden
- Launceston Clinical School, University of Tasmania, Hobart, TAS, Australia
| | - Sarah Randles
- Launceston Clinical School, University of Tasmania, Hobart, TAS, Australia
| | - Alycia Jacob
- Nursing and Midwifery, University of Newcastle, Port Macquarie, NSW, Australia
| | - Denise Delphin
- Northern Suburbs Community Centre, Launceston, TAS, Australia
| | - Nettie Burr
- Starting Point Neighbourhood House, Launceston, TAS, Australia
| | - Mick Goss
- Men's Health Ambassador, Launceston, TAS, Australia
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20
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Alqahtani JS, Njoku CM, Bereznicki B, Wimmer BC, Peterson GM, Kinsman L, Aldabayan YS, Alrajeh AM, Aldhahir AM, Mandal S, Hurst JR. Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis. Eur Respir Rev 2020; 29:29/156/190166. [PMID: 32499306 DOI: 10.1183/16000617.0166-2019] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 12/18/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Readmission rates following hospitalisation for COPD exacerbations are unacceptably high, and the contributing factors are poorly understood. Our objective was to summarise and evaluate the factors associated with 30- and 90-day all-cause readmission following hospitalisation for an exacerbation of COPD. METHODS We systematically searched electronic databases from inception to 5 November 2019. Data were extracted by two independent authors in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Study quality was assessed using a modified version of the Newcastle-Ottawa Scale. We synthesised a narrative from eligible studies and conducted a meta-analysis where this was possible using a random-effects model. RESULTS In total, 3533 abstracts were screened and 208 full-text manuscripts were reviewed. A total of 32 papers met the inclusion criteria, and 14 studies were included in the meta-analysis. The readmission rate ranged from 8.8-26.0% at 30 days and from 17.5-39.0% at 90 days. Our narrative synthesis showed that comorbidities, previous exacerbations and hospitalisations, and increased length of initial hospital stay were the major risk factors for readmission at 30 and 90 days. Pooled adjusted odds ratios (95% confidence intervals) revealed that heart failure (1.29 (1.22-1.37)), renal failure (1.26 (1.19-1.33)), depression (1.19 (1.05-1.34)) and alcohol use (1.11 (1.07-1.16)) were all associated with an increased risk of 30-day all-cause readmission, whereas being female was a protective factor (0.91 (0.88-0.94)). CONCLUSIONS Comorbidities, previous exacerbations and hospitalisation, and increased length of stay were significant risk factors for 30- and 90-day all-cause readmission after an index hospitalisation with an exacerbation of COPD.
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Affiliation(s)
- Jaber S Alqahtani
- UCL Respiratory, University College London, London, UK .,Dept of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Chidiamara M Njoku
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Bonnie Bereznicki
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Barbara C Wimmer
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Gregory M Peterson
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Port Macquarie, Australia
| | - Yousef S Aldabayan
- UCL Respiratory, University College London, London, UK.,Dept of Respiratory Care, King Faisal University, Al Ahsa, Saudi Arabia
| | - Ahmed M Alrajeh
- UCL Respiratory, University College London, London, UK.,Dept of Respiratory Care, King Faisal University, Al Ahsa, Saudi Arabia
| | - Abdulelah M Aldhahir
- UCL Respiratory, University College London, London, UK.,Respiratory Care Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, Saudi Arabia
| | - Swapna Mandal
- UCL Respiratory, University College London, London, UK.,Royal Free London NHS Foundation Trust, London, UK
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
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21
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Khanam MA, Kitsos A, Stankovich J, Kinsman L, Wimmer B, Castelino R, Jose M, Zaidi STR, Radford J, M Peterson G. Chronic kidney disease monitoring in Australian general practice. Aust J Gen Pract 2020; 48:132-137. [PMID: 31256479 DOI: 10.31128/ajgp-07-18-4630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Kidney Health Australia recommends regular monitoring of patients with chronic kidney disease (CKD) to reduce progression and prevent complications such as cardiovascular disease. The objective of this study was to examine how practice aligns with the recommendations in Kidney Health Australia's CKD guidelines. METHOD Australian general practice data from the NPS MedicineWise MedicineInsight program (1 January 2013 - 1 June 2016) for 19,712 adults with laboratory evidence of stage 3 CKD were analysed. Complete monitoring in these individuals was defined as having at least one recorded assessment of blood pressure, urine albumin-to-creatinine ratio, estimated glomerular filtration rate and serum lipids over an 18-month period. RESULTS Complete monitoring was performed for 25% of the cohort; 54.9% among patients with concomitant diabetes and 14.1% among patients without diabetes. Patients with diabetes, hypertension and a documented diagnosis of CKD were more likely to have complete monitoring. DISCUSSION There is room for improvement in monitoring of patients with stage 3 CKD, particularly for albuminuria, which was monitored in fewer than 50% of these patients.
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Affiliation(s)
- Masuma A Khanam
- MBBS, MPH, PhD, Post-doctoral Research Fellow, School of Health Sciences, University of Tasmania, Hobart, Tas
| | - Alex Kitsos
- BPhty(Hons), MMedStat, Health Analyst, College of Health and Medicine, University of Tasmania, Hobart, Tas
| | - Jim Stankovich
- PhD, Statistician, Monash University and Health Services Innovation Tasmania, School of Medicine, University of Tasmania, Hobart, Tas
| | - Leigh Kinsman
- BHlthSc, MHlthSc, PhD, Professor of Healthcare Improvement and Associate Head Research (Nursing), University of Tasmania, Tas
| | - Barbara Wimmer
- BPharm, MSc, PhD, Lecturer of Pharmacy, College of Health and Medicine, University of Tasmania, Hobart, Tas
| | - Ronald Castelino
- BPharm, MPharm, PhD, Lecturer in Pharmacy, University of Sydney and Adjunct Lecturer, University of Tasmania, Hobart, Tas
| | - Matthew Jose
- MBBS, FRACP, PhD, FASN, AFRACMA, Professor of Medicine, University of Tasmania; Consultant Nephrologist, Royal Hobart Hospital, Hobart, Tas
| | - Syed Tabish R Zaidi
- BPharm, MPharm, PhD, Lecturer of Pharmacy, College of Health and Medicine, University of Tasmania, Hobart, Tas
| | - Jan Radford
- MBBS, FRACGP, MPsychMed, MEd, FARGP, Associate Professor of General Practice, Launceston Clinical School, University of Tasmania,@Launceston, Tas
| | - Gregory M Peterson
- BPharm, PhD, MBA, FSHP, FACP, GAICD, AACPA, ARPharmS, MPS, Professor of Pharmacy and Director of Health Services Innovation Tasmania, School of Medicine, University of Tasmania, Hobart, Tas
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22
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Njoku CM, Alqahtani JS, Wimmer BC, Peterson GM, Kinsman L, Hurst JR, Bereznicki BJ. Risk factors and associated outcomes of hospital readmission in COPD: A systematic review. Respir Med 2020; 173:105988. [PMID: 33190738 DOI: 10.1016/j.rmed.2020.105988] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 04/10/2020] [Accepted: 04/19/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a leading cause of unplanned readmission. There is need to identify risk factors for, and strategies to prevent readmission in patients with COPD. AIM To systematically review and summarise the prevalence, risk factors and outcomes associated with rehospitalisation due to COPD exacerbation. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Five databases were searched for relevant studies. RESULTS Fifty-seven studies from 30 countries met the inclusion criteria. The prevalence of COPD-related readmission varied from 2.6 to 82.2% at 30 days, 11.8-44.8% at 31-90 days, 17.9-63.0% at 6 months, and 25.0-87.0% at 12 months post-discharge. There were differences in the reported factors associated with readmissions, which may reflect variations in the local context, such as the availability of community-based services to care for exacerbations of COPD. Hospitalisation in the previous year prior to index admission was the key predictor of COPD-related readmission. Comorbidities (in particular asthma), living in a deprived area and living in or discharge to a nursing home were also associated with readmission. Relative to those without readmissions, readmitted patients had higher in-hospital mortality rates, shorter long-term survival, poorer quality of life, longer hospital stay, increased recurrence of subsequent readmissions, and accounted for greater healthcare costs. CONCLUSIONS Hospitalisation in the previous year was the principal risk factor for COPD-related readmissions. Variation in the prevalence and the reported factors associated with COPD-related readmission indicate that risk factors cannot be generalised, and interventions should be tailored to the local healthcare environment.
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Affiliation(s)
- Chidiamara M Njoku
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia.
| | - Jaber S Alqahtani
- UCL Respiratory, University College London, London, UK; Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, Saudi Arabia
| | - Barbara C Wimmer
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Gregory M Peterson
- School of Pharmacy and Pharmacology, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Leigh Kinsman
- School of Nursing and Midwifery, University of Newcastle, Port Macquarie, New South Wales, Australia
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Bonnie J Bereznicki
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Rotter T, Plishka C, Lawal A, Fiander M, Harrison EL, Flynn R, Chan JG, Kinsman L. Lean management in health care: effects on patient outcomes, professional practice, and healthcare systems. Hippokratia 2020. [DOI: 10.1002/14651858.cd012831.pub2] [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: 11/11/2022]
Affiliation(s)
- Thomas Rotter
- School of Nursing, Queen's University; Healthcare Quality Programs; 82-84 Barrie Stret Kingston, Ontario Ontario Canada K7L 3N6
- Queen’s University School of Nursing; Healthcare Quality Programs; Kingston Canada
| | - Christopher Plishka
- University of Saskatchewan; College of Pharmacy and Nutrition; E3315 Health Sciences Building, 104 Clinic Place Saskatoon SK Canada S7N 5E5
| | - Adegboyega Lawal
- University of Saskatchewan; College of Pharmacy and Nutrition; E3315 Health Sciences Building, 104 Clinic Place Saskatoon SK Canada S7N 5E5
| | | | - Elizabeth L Harrison
- University of Saskatchewan; School of Physical Therapy, College of Medicine; School of Physical Therapy, College of Medicine Suite 3400, 3rd Floor, 104 Clinic Place, University of Saskatchewan Saskatoon SK Canada
| | - Rachel Flynn
- University of Alberta; Faculty of Nursing; 11405 87 Avenue, level 3, Edmonton Clinic Health Academy Edmonton Alberta Canada T6G1C9
| | - James G Chan
- University of Northern British Columbia; School of Health Sciences; Prince George BC Canada
| | - Leigh Kinsman
- The University of Newcastle and Mid North Coast Local Health District; School of Nursing and Midwifery; Port Macquarie New South Wales Australia 2444
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Rotter T, Plishka C, Lawal A, Harrison L, Sari N, Goodridge D, Flynn R, Chan J, Fiander M, Poksinska B, Willoughby K, Kinsman L. What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review. Eval Health Prof 2019; 42:366-390. [PMID: 29635950 PMCID: PMC6659584 DOI: 10.1177/0163278718756992] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization's mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.
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Affiliation(s)
- Thomas Rotter
- Healthcare Quality Programs, School of Nursing, Queen's University,
Kingston, Canada
| | - Christopher Plishka
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon,
Canada
| | - Adegboyega Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon,
Canada
| | - Liz Harrison
- School of Rehabilitation Science, College of Medicine, University of
Saskatchewan, Saskatoon, Canada
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Saskatoon, Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Rachel Flynn
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - James Chan
- School of Health Sciences, University of Northern British Columbia,
Canada
| | - Michelle Fiander
- Assistant Research Professor, College of Pharmacy, Department of
Pharmacotherapy, University of Utah
| | - Bonnie Poksinska
- Department of Management and Engineering, Linköping University, Sweden
| | - Keith Willoughby
- Edwards School of Business, University of Saskatchewan, Saskatoon,
Canada
| | - Leigh Kinsman
- University of Tasmania and Tasmanian Health Service (North), Launceston,
Tasmania, Australia
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Lawal AK, Groot G, Goodridge D, Scott S, Kinsman L. Development of a program theory for clinical pathways in hospitals: protocol for a realist review. Syst Rev 2019; 8:136. [PMID: 31176372 PMCID: PMC6556023 DOI: 10.1186/s13643-019-1046-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 05/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Despite the increased utilization of clinical pathways (CPWs) as a strategy to improve patient and system outcomes in hospitals, there remain ongoing challenges with their conceptualization, implementation, and evaluation. Theories that explain how CPWs work in hospitals are lacking, making it difficult to identify important factors for sustaining changes arising from CPWs implemented in hospitals. The objective of this realist review is to develop a program theory for CPWs in hospitals. METHODS This is a protocol for a realist review. The review will use a six-step iterative process to develop a program theory for CPWs in hospitals: (1) development of a preliminary program theory; (2) search strategy and literature search; (3) study selection and appraisal; (4) data extraction; (5) data analysis and synthesis; and (6) stakeholder engagement. In addition to searching the gray literature and contacting authors, we will search electronic databases such as MEDLINE, NHSEED, CINAHL EBSCO, HMIC, and PsycINFO. Studies will be included based on their ability to provide data that test some aspect of the program theory. Two independent reviewers will select, screen, and extract data related to the program theory from all relevant sources. A realist logic of analysis will be used to identify all context-mechanism-outcome heuristics that explains how CPWs implemented in hospitals translates to better health system outcomes. DISCUSSION Overall, the review aims to develop a program theory for CPWs in hospitals and to explore how, why, to what extent, and in what contexts does the implementation of CPWs in hospitals contribute to better health system outcomes. As a result, the review will provide a theoretical framework of how CPWs work in hospitals. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018103220.
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Affiliation(s)
- Adegboyega K Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.
| | - Gary Groot
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Donna Goodridge
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Shannon Scott
- Faculty of Nursing, University of Alberta Edmonton, Edmonton, Canada
| | - Leigh Kinsman
- University of Newcastle and Mid-North Coast Local Health District, Port Macquarie Base Hospital, Port Macquarie, Australia
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Butler M, Schultz TJ, Halligan P, Sheridan A, Kinsman L, Rotter T, Beaumier J, Kelly RG, Drennan J. Hospital nurse-staffing models and patient- and staff-related outcomes. Cochrane Database Syst Rev 2019; 4:CD007019. [PMID: 31012954 PMCID: PMC6478038 DOI: 10.1002/14651858.cd007019.pub3] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Nurses comprise the largest component of the health workforce worldwide and numerous models of workforce allocation and profile have been implemented. These include changes in skill mix, grade mix or qualification mix, staff-allocation models, staffing levels, nursing shifts, or nurses' work patterns. This is the first update of our review published in 2011. OBJECTIVES The purpose of this review was to explore the effect of hospital nurse-staffing models on patient and staff-related outcomes in the hospital setting, specifically to identify which staffing model(s) are associated with: 1) better outcomes for patients, 2) better staff-related outcomes, and, 3) the impact of staffing model(s) on cost outcomes. SEARCH METHODS CENTRAL, MEDLINE, Embase, two other databases and two trials registers were searched on 22 March 2018 together with reference checking, citation searching and contact with study authors to identify additional studies. SELECTION CRITERIA We included randomised trials, non-randomised trials, controlled before-after studies and interrupted-time-series or repeated-measures studies of interventions relating to hospital nurse-staffing models. Participants were patients and nursing staff working in hospital settings. We included any objective reported measure of patient-, staff-related, or economic outcome. The most important outcomes included in this review were: nursing-staff turnover, patient mortality, patient readmissions, patient attendances at the emergency department (ED), length of stay, patients with pressure ulcers, and costs. DATA COLLECTION AND ANALYSIS We worked independently in pairs to extract data from each potentially relevant study and to assess risk of bias and the certainty of the evidence. MAIN RESULTS We included 19 studies, 17 of which were included in the analysis and eight of which we identified for this update. We identified four types of interventions relating to hospital nurse-staffing models:- introduction of advanced or specialist nurses to the nursing workforce;- introduction of nursing assistive personnel to the hospital workforce;- primary nursing; and- staffing models.The studies were conducted in the USA, the Netherlands, UK, Australia, and Canada and included patients with cancer, asthma, diabetes and chronic illness, on medical, acute care, intensive care and long-stay psychiatric units. The risk of bias across studies was high, with limitations mainly related to blinding of patients and personnel, allocation concealment, sequence generation, and blinding of outcome assessment.The addition of advanced or specialist nurses to hospital nurse staffing may lead to little or no difference in patient mortality (3 studies, 1358 participants). It is uncertain whether this intervention reduces patient readmissions (7 studies, 2995 participants), patient attendances at the ED (6 studies, 2274 participants), length of stay (3 studies, 907 participants), number of patients with pressure ulcers (1 study, 753 participants), or costs (3 studies, 617 participants), as we assessed the evidence for these outcomes as being of very low certainty. It is uncertain whether adding nursing assistive personnel to the hospital workforce reduces costs (1 study, 6769 participants), as we assessed the evidence for this outcome to be of very low certainty. It is uncertain whether primary nursing (3 studies, > 464 participants) or staffing models (1 study, 647 participants) reduces nursing-staff turnover, or if primary nursing (2 studies, > 138 participants) reduces costs, as we assessed the evidence for these outcomes to be of very low certainty. AUTHORS' CONCLUSIONS The findings of this review should be treated with caution due to the limited amount and quality of the published research that was included. We have most confidence in our finding that the introduction of advanced or specialist nurses may lead to little or no difference in one patient outcome (i.e. mortality) with greater uncertainty about other patient outcomes (i.e. readmissions, ED attendance, length of stay and pressure ulcer rates). The evidence is of insufficient certainty to draw conclusions about the effectiveness of other types of interventions, including new nurse-staffing models and introduction of nursing assistive personnel, on patient, staff and cost outcomes. Although it has been seven years since the original review was published, the certainty of the evidence about hospital nurse staffing still remains very low.
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Affiliation(s)
- Michelle Butler
- Dublin City UniversityFaculty of Science and HealthCollins Avenue, GlasnevinDublinIrelandDublin 9
| | - Timothy J Schultz
- University of AdelaideDiscipline of NursingAdelaideSouth AustraliaAustralia
| | - Phil Halligan
- University College DublinSchool of Nursing, Midwifery and Health SystemsDublinIreland
| | - Ann Sheridan
- University College DublinSchool of Nursing, Midwifery and Health SystemsDublinIreland
| | - Leigh Kinsman
- The University of Newcastle and Mid North Coast Local Health DistrictSchool of Nursing and MidwiferyPort MacquarieNew South WalesAustralia2444
| | - Thomas Rotter
- School of Nursing, Queen's UniversityHealthcare Quality Programs82‐84 Barrie StretKingston, OntarioOntarioCanadaK7L 3N6
| | - Jonathan Beaumier
- University of British ColumbiaSchool of Population and Public Health2206 East MallVancouverBCCanadaV6T 1Z3
| | - Robyn Gail Kelly
- University of TasmaniaSchool of Health SciencesLocked Bag 1322NewnhamTasmaniaAustralia7250
| | - Jonathan Drennan
- Brookfield Health Sciences Complex, University College CorkSchool of Nursing and Midwifery, College of Medicine and HealthCollege RoadCorkIrelandT12 AK54
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27
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Dwyer M, Rehman S, Ottavi T, Stankovich J, Gall S, Peterson G, Ford K, Kinsman L. Urban-rural differences in the care and outcomes of acute stroke patients: Systematic review. J Neurol Sci 2018; 397:63-74. [PMID: 30594105 DOI: 10.1016/j.jns.2018.12.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 09/26/2018] [Revised: 12/14/2018] [Accepted: 12/16/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe literature pertaining to urban-rural differences in both the quality of care and outcomes of acute stroke patients. METHODS We systematically searched CINAHL, PubMed, ProQuest Dissertations & Theses, and Scopus for published and unpublished literature until 9th December 2017. Studies were included if they compared the acute care provided to, or outcomes of, patients hospitalised for stroke in urban versus rural settings. Abstract, full-text review, and data extraction were conducted in duplicate. Findings are presented in the form of narrative syntheses. RESULTS A total of 28 studies were included in the review (16 on care, 12 on outcomes). With few exceptions, studies addressing the provision of care suggested that rural patients have less access to most aspects of acute stroke care. Studies reporting urban-rural differences in patient outcomes were inconsistent in their findings, however, few of these studies were primarily focused on the issue of urban-rural disparities. Overall, study findings did not appear to differ in line with study quality ratings, stroke subtypes included, or how inter-facility patient transfers were accounted for. CONCLUSIONS There is convincing, albeit not unanimous, evidence to suggest that stroke patients in rural areas receive less acute care than their urban counterparts. Despite this, the available data and methodology have largely not been used to study urban-rural differences in patient outcomes. PROSPERO registration information: URL: https://www.crd.york.ac.uk/prospero. Unique identifier: CRD42017073262.
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Morley C, Unwin M, Peterson GM, Stankovich J, Kinsman L. Emergency department crowding: A systematic review of causes, consequences and solutions. PLoS One 2018; 13:e0203316. [PMID: 30161242 PMCID: PMC6117060 DOI: 10.1371/journal.pone.0203316] [Citation(s) in RCA: 519] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 08/17/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Emergency department crowding is a major global healthcare issue. There is much debate as to the causes of the phenomenon, leading to difficulties in developing successful, targeted solutions. AIM The aim of this systematic review was to critically analyse and summarise the findings of peer-reviewed research studies investigating the causes and consequences of, and solutions to, emergency department crowding. METHOD The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A structured search of four databases (Medline, CINAHL, EMBASE and Web of Science) was undertaken to identify peer-reviewed research publications aimed at investigating the causes or consequences of, or solutions to, emergency department crowding, published between January 2000 and June 2018. Two reviewers used validated critical appraisal tools to independently assess the quality of the studies. The study protocol was registered with the International prospective register of systematic reviews (PROSPERO 2017: CRD42017073439). RESULTS From 4,131 identified studies and 162 full text reviews, 102 studies met the inclusion criteria. The majority were retrospective cohort studies, with the greatest proportion (51%) trialling or modelling potential solutions to emergency department crowding. Fourteen studies examined causes and 40 investigated consequences. Two studies looked at both causes and consequences, and two investigated causes and solutions. CONCLUSIONS The negative consequences of ED crowding are well established, including poorer patient outcomes and the inability of staff to adhere to guideline-recommended treatment. This review identified a mismatch between causes and solutions. The majority of identified causes related to the number and type of people attending ED and timely discharge from ED, while reported solutions focused on efficient patient flow within the ED. Solutions aimed at the introduction of whole-of-system initiatives to meet timed patient disposition targets, as well as extended hours of primary care, demonstrated promising outcomes. While the review identified increased presentations by the elderly with complex and chronic conditions as an emerging and widespread driver of crowding, more research is required to isolate the precise local factors leading to ED crowding, with system-wide solutions tailored to address identified causes.
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Affiliation(s)
- Claire Morley
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Maria Unwin
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Tasmanian Health Service–North, Launceston, Tasmania, Australia
| | - Gregory M. Peterson
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Jim Stankovich
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Department of Neurosciences, Central Clinical School, Monash University, Melbourne, Australia
| | - Leigh Kinsman
- School of Health Sciences, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
- Tasmanian Health Service–North, Launceston, Tasmania, Australia
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Unwin M, Crisp E, Rigby S, Kinsman L. Investigating the referral of patients with non-urgent conditions to a regional Australian emergency department: a study protocol. BMC Health Serv Res 2018; 18:647. [PMID: 30126396 PMCID: PMC6102868 DOI: 10.1186/s12913-018-3411-4] [Citation(s) in RCA: 4] [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: 12/07/2017] [Accepted: 07/23/2018] [Indexed: 11/10/2022] Open
Abstract
Background Australia’s only island state, Tasmania, experiences one of the nation’s highest incidences of non-urgent emergency department (ED) presentations in a healthcare system regularly faced with service demands that exceed resource availability. Service-demand mismatches are acknowledged to contribute to ED crowding which in turn, has been documented to have a correlation with poorer patient outcomes. Crowding within EDs is complex, non-urgent presentations alone are not the primary cause, but have been reported to be a contributing factor. In 2015–16 Tasmania recorded over 153,000 ED attendances, 55% of these fell into the two least urgent triage categories. Recent research in the State’s North established that 29% of non-urgent presentations were referred, formally or informally, from primary healthcare providers and that, for many patients (39%), the ED was not their first choice of service provider. This study aims to identify the service needs of patients referred to a regional Australian ED and subsequently triaged as non-urgent. Method In order to achieve this aim, three objectives have been identified. The first two objectives use an explanatory sequential mixed-method approach while the third objective will incorporate an implementation science approach. These three objectives are: first, a retrospective analysis of seven years of routinely collected hospital data to identify trends in referral of patients with non-urgent conditions; second, focus group interviews with patients and primary care providers to further understand perceived need and service requirements of those referred to the ED, and third, translation of findings into local health service recommendations. Discussion Identification of the needs of patients referred to the ED with non-urgent conditions will inform future service planning aiming to facilitate access to the right service at the right time and in the right place.
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Affiliation(s)
- Maria Unwin
- College of Health and Medicine, University of Tasmania c/- Level 2, Northern Integrated Care Services, 41 Frankland St, Launceston, TAS, 7250, Australia. .,Emergency Department, Launceston General Hospital, Tasmanian Health Service, 274-280 Charles St, Launceston, Tasmania, Australia.
| | - Elaine Crisp
- College of Health and Medicine, University of Tasmania, 1 Newham Close, Newnham, Tasmania, 7248, Australia
| | - Scott Rigby
- Emergency Department, Launceston General Hospital, Tasmanian Health Service, 274-280 Charles St, Launceston, Tasmania, Australia
| | - Leigh Kinsman
- College of Health and Medicine, University of Tasmania c/- Level 2, Northern Integrated Care Services, 41 Frankland St, Launceston, TAS, 7250, Australia.,Tasmanian Health Service c/-Level 2, Northern Integrated Care Services, 41 Frankland St, Launceston, Tasmania, 7250, Australia
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Siddiqui N, Dwyer M, Stankovich J, Peterson G, Greenfield D, Si L, Kinsman L. Hospital length of stay variation and comorbidity of mental illness: a retrospective study of five common chronic medical conditions. BMC Health Serv Res 2018; 18:498. [PMID: 29945622 PMCID: PMC6020383 DOI: 10.1186/s12913-018-3316-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/19/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND With the increasing burden of mental illness globally, it is becoming common for hospitalised patients with chronic medical conditions to have a comorbidity of mental illness. This combination could prolong length of stay (LOS) of this patient cohort. We conducted an investigation in Tasmania, Australian hospitals to characterise this cohort and assess if co-morbidity of mental illness is a distinguishing factor that generates LOS variation across different chronic medical conditions. METHODS The retrospective study analysed 16,898 admissions of patients with a primary diagnosis of one of five chronic medical conditions: lung or colorectal cancer, chronic obstructive pulmonary disease (COPD), type II diabetes, ischaemic heart disease (IHD) and stroke. Data were from July 2010 to June 2015, across four hospitals that collectively cover 95% of public hospital admissions in Tasmania, Australia. Descriptive statistics were used to compare characteristics of patients between the scenarios of with and without co-morbidity of mental illness. We used negative binomial regression models to assess whether co-morbidity of mental illness, along with its sub-types, after adjustment for potential confounding variables, associated with LOS variation in patients of each medical condition. Based on the adjusted LOS variation, we estimated differences in bed days' use between patients with and without comorbidity of mental illness. RESULTS Patients with co-morbidity of mental illness were significantly younger in comparison to patients without mental illness. With each medical condition, patients with comorbidity of mental illness had incurred higher bed days' use than for those without mental illness. In cancer and stroke cohorts, co-morbidity of mental illness unfavourably affected the LOS variation by as high as 97% (CI: 49.9%-159%) and 109% (78%-146%), respectively. Though mental and behavioural disorders due to psychoactive substances was a dominant sub-type of mental illness across the medical conditions, it contributed significant unfavourable LOS variation only in the stroke patients i.e. 36.3% (CI: 16.2%-59.9%). CONCLUSIONS Mental illness consistently produced unfavourable LOS variation. Upskilling of healthcare teams and greater reporting and analysis of LOS variation for this patient cohort, and the sub-cohorts within it, are necessary to provide improved medical care and achieve system efficiencies.
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Affiliation(s)
- Nazlee Siddiqui
- Australian Institute of Health Services Management (AIHSM), Tasmanian School of Business and Economics, University of Tasmania, Rozelle campus, Cnr Glover and Church Streets, Sydney, NSW 2039 Australia
| | - Mitchell Dwyer
- School of Health Sciences, University of Tasmania, Tasmania, Australia
| | - Jim Stankovich
- Health Services Innovation Tasmania, School of Medicine, University of Tasmania, Tasmania, Australia
| | - Gregory Peterson
- Health Services Innovation Tasmania, School of Medicine, University of Tasmania, Tasmania, Australia
| | - David Greenfield
- Australian Institute of Health Services Management (AIHSM), Tasmanian School of Business and Economics, University of Tasmania, Rozelle campus, Cnr Glover and Church Streets, Sydney, NSW 2039 Australia
| | - Lei Si
- Centre for the Health Economy, Macquarie University, Sydney, Australia
| | - Leigh Kinsman
- Conjoint appointment, University of Tasmania and Tasmanian Health Service (North), Tasmania, Australia
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Chung C, Cooper SJ, Cant RP, Connell C, McKay A, Kinsman L, Gazula S, Boyle J, Cameron A, Cash P, Evans L, Kim JA, Masud R, McInnes D, Norman L, Penz E, Rotter T, Tanti E, Breakspear T. The educational impact of web-based and face-to-face patient deterioration simulation programs: An interventional trial. Nurse Educ Today 2018; 64:93-98. [PMID: 29459198 DOI: 10.1016/j.nedt.2018.01.037] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 10/16/2017] [Accepted: 01/31/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND There are international concerns relating to the management of patient deterioration. The "failure to rescue" literature identifies that nursing staff miss cues of deterioration and often fail to call for assistance. Simulation-based educational approaches may improve nurses' recognition and management of patient deterioration. OBJECTIVES To investigate the educational impact of the First2Act web-based (WB) and face-to-face (F2F) simulation programs. DESIGN & SETTING A mixed methods interventional cohort trial with nursing staff from four Australian hospitals. PARTICIPANTS Nursing staff working in four public and private hospital medical wards in the State of Victoria. METHODS In 2016, ward nursing staff (n = 74) from a public and private hospital completed three F2F laboratory-based team simulations with a patient actor in teams of three. 56 nursing staff from another public and private hospital individually completed a three-scenario WB simulation program (First2ActWeb) [A 91% participation rate]. Validated tools were used to measure knowledge (multi-choice questionnaire), competence (check-list of actions) and confidence (self-rated) before and after the intervention. RESULTS Both WB and F2F participants' knowledge, competence and confidence increased significantly after training (p ≤0.001). Skill performance for the WB group increased significantly from 61% to 74% (p ≤ 0.05) and correlated significantly with post-test knowledge (p = 0.014). No change was seen in the F2F groups' performance scores. Course evaluations were positive with median ratings of 4/5 (WB) and 5/5 (F2F). The F2F program received significantly more positive evaluations than the WB program (p < 0.05), particularly with regard to quality of feedback. CONCLUSION WB and F2F simulation are effective education strategies with both programs demonstrating positive learning outcomes. WB programs increase ease of access to training whilst F2F enable the development of tactile hands on skills and teamwork. A combined blended learning education strategy is recommended to enhance competence and patient safety.
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Affiliation(s)
- Catherine Chung
- Nursing, Midwifery and Healthcare, Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia.
| | - Simon J Cooper
- Nursing, Midwifery and Healthcare, Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia
| | - Robyn P Cant
- Nursing, Midwifery and Healthcare, Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia
| | - Cliff Connell
- Nursing and Midwifery, Monash University, McMahons Rd, Frankston, VIC 3199, Australia
| | - Angela McKay
- Nursing and Midwifery, University of Tasmania, Locked Bag 1322, Launceston, TAS 7250, Australia
| | - Leigh Kinsman
- Nursing and Midwifery, University of Tasmania, Locked Bag 1322, Launceston, TAS 7250, Australia
| | - Swapnali Gazula
- Nursing, Midwifery and Healthcare, Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia
| | - Jayne Boyle
- St John of God Health Care, 133-145 Lily St, Bendigo, VIC 3550, Australia
| | - Amanda Cameron
- Latrobe Regional Hospital, 10 Village Ave, Traralgon, VIC 3844, Australia
| | - Penny Cash
- Nursing, Midwifery and Healthcare, Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia
| | - Lisa Evans
- St John of God Health Care, Gibb St, Berwick, VIC 3806, Australia
| | - Jeong-Ah Kim
- Nursing, Midwifery and Healthcare, Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia
| | - Rana Masud
- University of Saskatchewan, Saskatoon, SK S7N 5C5, Canada
| | - Denise McInnes
- Central Gippsland Health Service, 155 Guthridge Parade, Sale, VIC 3850, Australia
| | - Lisa Norman
- St John of God Health Care, Gibb St, Berwick, VIC 3806, Australia
| | - Erika Penz
- University of Saskatchewan, Saskatoon, SK S7N 5C5, Canada
| | - Thomas Rotter
- University of Saskatchewan, Saskatoon, SK S7N 5C5, Canada
| | - Erin Tanti
- Nursing, Midwifery and Healthcare, Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia
| | - Tom Breakspear
- Nursing, Midwifery and Healthcare, Federation University Australia, Northways Rd., Churchill, VIC 3842, Australia
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Morley C, Stankovich J, Peterson G, Kinsman L. Planning for the future: Emergency department presentation patterns in Tasmania, Australia. Int Emerg Nurs 2018; 38:34-40. [DOI: 10.1016/j.ienj.2017.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 08/03/2017] [Accepted: 09/03/2017] [Indexed: 11/30/2022]
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Rotter T, Plishka C, Hansia MR, Goodridge D, Penz E, Kinsman L, Lawal A, O'Quinn S, Buchan N, Comfort P, Patel P, Anderson S, Winkel T, Lang RL, Marciniuk DD. The development, implementation and evaluation of clinical pathways for chronic obstructive pulmonary disease (COPD) in Saskatchewan: protocol for an interrupted times series evaluation. BMC Health Serv Res 2017; 17:782. [PMID: 29183318 PMCID: PMC5704544 DOI: 10.1186/s12913-017-2750-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Accepted: 11/21/2017] [Indexed: 01/25/2023] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) has substantial economic and human costs; it is expected to be the third leading cause of death worldwide by 2030. To minimize these costs high quality guidelines have been developed. However, guidelines alone rarely result in meaningful change. One method of integrating guidelines into practice is the use of clinical pathways (CPWs). CPWs bring available evidence to a range of healthcare professionals by detailing the essential steps in care and adapting guidelines to the local context. Methods/design We are working with local stakeholders to develop CPWs for COPD with the aims of improving care while reducing utilization. The CPWs will employ several steps including: standardizing diagnostic training, unifying components of chronic disease care, coordinating education and reconditioning programs, and ensuring care uses best practices. Further, we have worked to identify evidence-informed implementation strategies which will be tailored to the local context. We will conduct a three-year research project using an interrupted time series (ITS) design in the form of a multiple baseline approach with control groups. The CPW will be implemented in two health regions (experimental groups) and two health regions will act as controls (control groups). The experimental and control groups will each contain an urban and rural health region. Primary outcomes for the study will be quality of care operationalized using hospital readmission rates and emergency department (ED) presentation rates. Secondary outcomes will be healthcare utilization and guideline adherence, operationalized using hospital admission rates, hospital length of stay and general practitioner (GP) visits. Results will be analyzed using segmented regression analysis. Discussion Funding has been procured from multiple stakeholders. The project has been deemed exempt from ethics review as it is a quality improvement project. Intervention implementation is expected to begin in summer of 2017. This project is expected to improve quality of care and reduce healthcare utilization. In addition it will provide evidence on the effects of CPWs in both urban and rural settings. If the CPWs are found effective we will work with all stakeholders to implement similar CPWs in surrounding health regions. Trial registration Clinicaltrials.gov (NCT03075709). Registered 8 March 2017.
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Affiliation(s)
- Thomas Rotter
- College of Pharmacy and Nutrition, University of Saskatchewan E3315 Health Sciences Building, 104 Clinic Place, Saskatoon, SK, S7N 5E5, Canada.,Healthcare Quality Programs, Queen's University School of Nursing, Kingston, Canada
| | - Christopher Plishka
- College of Pharmacy and Nutrition, University of Saskatchewan E3315 Health Sciences Building, 104 Clinic Place, Saskatoon, SK, S7N 5E5, Canada.
| | | | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada.,University of Saskatchewan Respiratory Research Centre, Saskatoon, Canada
| | - Erika Penz
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Leigh Kinsman
- University of Tasmania and Tasmanian Health Organisation (North), Launceston, TAS, Australia
| | - Adegboyega Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan E3315 Health Sciences Building, 104 Clinic Place, Saskatoon, SK, S7N 5E5, Canada
| | | | | | | | | | | | | | | | - Darcy D Marciniuk
- College of Medicine, University of Saskatchewan, Saskatoon, Canada.,University of Saskatchewan Respiratory Research Centre, Saskatoon, Canada
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Rotter T, Plishka CT, Adegboyega L, Fiander M, Harrison EL, Flynn R, Chan JG, Kinsman L. Lean management in health care: effects on patient outcomes, professional practice, and healthcare systems. Cochrane Database Syst Rev 2017; 2017:CD012831. [PMCID: PMC6486096 DOI: 10.1002/14651858.cd012831] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/12/2023]
Abstract
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess effects of Lean management in health care on patient, professional, and systems outcomes by addressing the following question. What are the effects of Lean management interventions in health care on patient outcomes, professional practice, and healthcare systems? What are the effects of Lean management interventions in health care on patient outcomes, professional practice, and healthcare systems? To answer the following questions in addressing secondary objectives: What are the effects of Lean management interventions in combination with other management systems (e.g. Six Sigma) on patient outcomes, professional practice, and healthcare systems (utilisation and access, adverse effects, cost)? Is the effectiveness of Lean interventions influenced by the setting (e.g. Emergency Department, Laboratory, Pharmacy) in which they are implemented? What are the effects of Lean management interventions in combination with other management systems (e.g. Six Sigma) on patient outcomes, professional practice, and healthcare systems (utilisation and access, adverse effects, cost)? Is the effectiveness of Lean interventions influenced by the setting (e.g. Emergency Department, Laboratory, Pharmacy) in which they are implemented?
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Affiliation(s)
| | - Christopher T Plishka
- University of SaskatchewanCollege of Pharmacy and NutritionE3315 Health Sciences Building, 104 Clinic PlaceSaskatoonCanadaS7N 5E5
| | - Lawal Adegboyega
- University of SaskatchewanCollege of Pharmacy and NutritionE3315 Health Sciences Building, 104 Clinic PlaceSaskatoonCanadaS7N 5E5
| | | | - Elizabeth L Harrison
- University of SaskatchewanSchool of Physical Therapy, College of MedicineSchool of Physical Therapy, College of MedicineSuite 3400, 3rd Floor, 104 Clinic Place, University of SaskatchewanSaskatoonCanada
| | - Rachel Flynn
- University of AlbertaFaculty of Nursing11405 87 Avenue, level 3, Edmonton Clinic Health AcademyEdmontonCanadaT6G1C9
| | - James G Chan
- University of Northern British ColumbiaSchool of Health SciencesPrince GeorgeCanada
| | - Leigh Kinsman
- University of TasmaniaHealthLaunceston Clinical School, Locked Bag 1377HobartAustralia7250
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Lawton JK, Kinsman L, Dalton L, Walsh F, Bryan H, Williams S. Right service, right place: optimising utilisation of a community nursing service to reduce planned re-presentations to the emergency department. BMJ Open Qual 2017; 6:e000150. [PMID: 29450293 PMCID: PMC5699151 DOI: 10.1136/bmjoq-2017-000150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Congruent with international rising emergency department (ED) demand, a focus on strategies and services to reduce burden on EDs and improve patient outcomes is necessary. Planned re-presentations of non-urgent patients at a regional Australian hospital exceeded 1200 visits during the 2013-2014 financial year. Planned re-presentations perpetuate demand and signify a lack of alternative services for non-urgent patients. The Community Nursing Enhanced Connections Service (CoNECS) collaboratively evolved between acute care and community services in 2014 to reduce planned ED re-presentations. OBJECTIVE This study aimed to investigate the evolution and impact of a community nursing service to reduce planned re-presentations to a regional Australian ED and identify enablers and barriers to interventionist effectiveness. METHODS A mixed-methods approach evaluated the impact of CoNECS. Data from hospital databases including measured numbers of planned ED re-presentations by month, time of day, age, gender and reason were used to calculate referral rates to CoNECS. These results informed two semistructured focus groups with ED and community nurses. The researchers used a theoretical lens, 'diffusion of innovation', to understand how this service could inform future interventions. RESULTS Analyses showed that annual ED planned re-presentations decreased by 43% (527 presentations) after implementation. Three themes emerged from the focus groups. These were right service at the right time, nursing uncertainty and system disconnect and medical disengagement. CONCLUSIONS CoNECS reduced overall ED planned re-presentations and was sustained longer than many complex service-level interventions. Factors supporting the service were endorsement from senior administration and strong leadership to drive responsive quality improvement strategies. This study identified a promising alternative service outside the ED, highlighting possibilities for other hospital emergency services aiming to reduce planned re-presentations.
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Affiliation(s)
| | - Leigh Kinsman
- University of Tasmania, Launceston, Tasmania, Australia
- Tasmanian Health Service, Department of Health and Human Services, Launceston, Tasmania, Australia
| | - Lisa Dalton
- University of Tasmania, Launceston, Tasmania, Australia
| | - Fay Walsh
- Primary Health Tasmania, Department of Health and Human Services, Tasmania, Australia
| | - Helen Bryan
- Tasmanian Health Service, Department of Health and Human Services, Launceston, Tasmania, Australia
| | - Sharon Williams
- Primary Health Tasmania, Department of Health and Human Services, Tasmania, Australia
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Sari N, Rotter T, Goodridge D, Harrison L, Kinsman L. An economic analysis of a system wide Lean approach: cost estimations for the implementation of Lean in the Saskatchewan healthcare system for 2012-2014. BMC Health Serv Res 2017; 17:523. [PMID: 28774301 PMCID: PMC5543735 DOI: 10.1186/s12913-017-2477-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 07/27/2017] [Indexed: 11/10/2022] Open
Abstract
Background The costs of investing in health care reform initiatives to improve quality and safety have been underreported and are often underestimated. This paper reports direct and indirect cost estimates for the initial phase of the province-wide implementation of Lean activities in Saskatchewan, Canada. Methods In order to obtain detailed information about each type of Lean event, as well as the total number of corresponding Lean events, we used the Provincial Kaizen Promotion Office (PKPO) Kaizen database. While the indirect cost of Lean implementation has been estimated using the corresponding wage rate for the event participants, the direct cost has been estimated using the fees paid to the consultant and other relevant expenses. Results The total cost for implementation of Lean over two years (2012–2014), including consultants and new hires, ranged from $44 million CAD to $49.6 million CAD, depending upon the assumptions used. Consultant costs accounted for close to 50% of the total. The estimated cost of Lean events alone ranged from $16 million CAD to $19.5 million CAD, with Rapid Process Improvement Workshops requiring the highest input of resources. Conclusions Recognizing the substantial financial and human investments required to undertake reforms designed to improve quality and contain cost, policy makers must carefully consider whether and how these efforts result in the desired transformations. Evaluation of the outcomes of these investments must be part of the accountability framework, even prior to implementation. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2477-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nazmi Sari
- Department of Economics, University of Saskatchewan, Arts 815, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada.
| | - Thomas Rotter
- College of Pharmacy & Nutrition, University of Saskatchewan, Saskatoon, SK, S7N 5A5, Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Liz Harrison
- School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Leigh Kinsman
- University of Tasmania and Tasmanian Health Organisation (North), Launceston, TAS, Australia
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Kinsman L, Torero JL, Gerhard JI. Organic liquid mobility induced by smoldering remediation. J Hazard Mater 2017; 325:101-112. [PMID: 27915098 DOI: 10.1016/j.jhazmat.2016.11.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 11/03/2016] [Accepted: 11/17/2016] [Indexed: 06/06/2023]
Abstract
Laboratory column experiments plus analytical and numerical modeling together suggest that, under certain conditions, downward organic liquid mobilization can occur and impact smoldering behavior. This applies for organic liquids mixed with inert sand subjected to smoldering as thermal treatment. The observed effects include increased peak temperatures (here by up to 35%) and increased treatment times (here by up to 30%). Downward organic liquid migration occurs when (i) injected Darcy air flux is less than a threshold value (here less than 3cm/s), (ii) treatment systems are tall (here 90cm, not 30cm), and (iii) the organic liquid is temperature-sensitive (viscosity less than 0.01Pas at 150°C). The developed analytical equation provides the applied air flux that can negate the downwards organic liquid gradient required for migration. Smoldering behavior is demonstrated to adjust to liquid migration and thereby still destroy all the organic waste in the system. Smoldering is a relatively new, energy-efficient thermal treatment for organic liquid waste and these results are important for designing field applications of smoldering treatment.
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Affiliation(s)
- L Kinsman
- Department of Civil and Environmental Engineering, University of Western Ontario, London, Ontario N6A 5B9, Canada
| | - J L Torero
- School of Civil Engineering, University of Queensland, St. Lucia Campus, Queensland 4072, Australia
| | - J I Gerhard
- Department of Civil and Environmental Engineering, University of Western Ontario, London, Ontario N6A 5B9, Canada.
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Unwin M, Kinsman L, Rigby S. Why are we waiting? Patients’ perspectives for accessing emergency department services with non-urgent complaints. Int Emerg Nurs 2016; 29:3-8. [DOI: 10.1016/j.ienj.2016.09.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 07/29/2016] [Accepted: 09/11/2016] [Indexed: 11/28/2022]
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Kinsman L, Rotter T, Stevenson K, Bath B, Goodridge D, Harrison L, Dobson R, Sari N, Jeffery C, Bourassa C, Westhorp G. "The largest Lean transformation in the world": the implementation and evaluation of lean in Saskatchewan healthcare. ACTA ACUST UNITED AC 2016; 17:29-32. [PMID: 25191805 DOI: 10.12927/hcq.2014.23880] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The Saskatchewan Ministry of Health has committed to a multi-million dollar investment toward the implementation of Lean methodology across the province's healthcare system. Originating as a production line discipline (the Toyota Production System), Lean has evolved to encompass process improvements including inventory management, waste reduction and quality improvement techniques. With an initial focus on leadership, strategic alignment, training and the creation of a supportive infrastructure (Lean promotion offices), the goal in Saskatchewan is a whole health system transformation that produces "better health, better value, better care, and better teams." Given the scope and scale of the initiative and the commitment of resources, it is vital that a comprehensive, longitudinal evaluation plan be implemented to support ongoing decision-making and program design. The nature of the initiative also offers a unique opportunity to contribute to health quality improvement science by advancing our understanding of the implementation and evaluation of complex, large-scale healthcare interventions. The purpose of this article is to summarize the background to Lean in Saskatchewan and the proposed evaluation methods.
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Affiliation(s)
- Leigh Kinsman
- Member of the School of Rural Health, Monash University, in Victoria, Australia
| | - Thomas Rotter
- Member of the College of Pharmacy and Nutrition, University of Saskatchewan, in Saskatoon, Saskatchewan
| | - Katherine Stevenson
- Member of the School of Physical Therapy, College of Medicine, University of Saskatchewan
| | - Brenna Bath
- Member of the School of Physical Therapy, College of Medicine, University of Saskatchewan
| | - Donna Goodridge
- Member of the College of Nursing, University of Saskatchewan
| | - Liz Harrison
- Member of the School of Physical Therapy, College of Medicine, University of Saskatchewan
| | - Roy Dobson
- Member of the College of Pharmacy and Nutrition, University of Saskatchewan
| | - Nazmi Sari
- Member of the Department of Economics, University of Saskatchewan
| | - Cathy Jeffery
- Member of the College of Nursing, University of Saskatchewan
| | - Carrie Bourassa
- Member of the Department of Indigenous Education, Health and Social Work, First Nations University of Canada, in Regina, Saskatchewan
| | - Gill Westhorp
- Member of Community Matters, in Unley, South Australia
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Cooper SJ, Kinsman L, Chung C, Cant R, Boyle J, Bull L, Cameron A, Connell C, Kim JA, McInnes D, McKay A, Nankervis K, Penz E, Rotter T. The impact of web-based and face-to-face simulation on patient deterioration and patient safety: protocol for a multi-site multi-method design. BMC Health Serv Res 2016; 16:475. [PMID: 27604599 PMCID: PMC5013569 DOI: 10.1186/s12913-016-1683-0] [Citation(s) in RCA: 8] [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: 03/01/2016] [Accepted: 08/17/2016] [Indexed: 11/21/2022] Open
Abstract
Background There are international concerns in relation to the management of patient deterioration which has led to a body of evidence known as the ‘failure to rescue’ literature. Nursing staff are known to miss cues of deterioration and often fail to call for assistance. Medical Emergency Teams (Rapid Response Teams) do improve the management of acutely deteriorating patients, but first responders need the requisite skills to impact on patient safety. Methods/design In this study we aim to address these issues in a mixed methods interventional trial with the objective of measuring and comparing the cost and clinical impact of face-to-face and web-based simulation programs on the management of patient deterioration and related patient outcomes. The education programs, known as ‘FIRST2ACT’, have been found to have an impact on education and will be tested in four hospitals in the State of Victoria, Australia. Nursing staff will be trained in primary (the first 8 min) responses to emergencies in two medical wards using a face-to-face approach and in two medical wards using a web-based version FIRST2ACTWeb. The impact of these interventions will be determined through quantitative and qualitative approaches, cost analyses and patient notes review (time series analyses) to measure quality of care and patient outcomes. Discussion In this 18 month study it is hypothesised that both simulation programs will improve the detection and management of deteriorating patients but that the web-based program will have lower total costs. The study will also add to our overall understanding of the utility of simulation approaches in the preparation of nurses working in hospital wards. (ACTRN12616000468426, retrospectively registered 8.4.2016).
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Affiliation(s)
- Simon J Cooper
- School of Nursing Midwifery and Healthcare, Federation University Australia, Churchill, Victoria 3842 and Mt. Helen, Victoria 3350, Australia.
| | - Leigh Kinsman
- School of Nursing, The University of Tasmania, PO Box 1322, Launceston, Tasmania, 7250, Australia
| | - Catherine Chung
- School of Nursing Midwifery and Healthcare, Federation University Australia, Churchill, Victoria 3842 and Mt. Helen, Victoria 3350, Australia
| | - Robyn Cant
- School of Nursing Midwifery and Healthcare, Federation University Australia, Churchill, Victoria 3842 and Mt. Helen, Victoria 3350, Australia
| | - Jayne Boyle
- St John of God Health Care Berwick, Gibb St, Berwick, Victoria, 3806, Australia
| | - Loretta Bull
- Department of Nursing and Midwifery Education and Strategy, Monash Health, Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Amanda Cameron
- Latrobe Regional Hospital, 10 Village Ave, Traralgon, VIC, 3844, Australia
| | - Cliff Connell
- Nursing and Midwifery, Monash University, McMahons Rd, Frankston, Victoria, 3199, Australia
| | - Jeong-Ah Kim
- School of Nursing Midwifery and Healthcare, Federation University Australia, Churchill, Victoria 3842 and Mt. Helen, Victoria 3350, Australia
| | - Denise McInnes
- Central Gippsland Health Service, 155 Guthridge Parade, Sale, VIC, 3850, Australia
| | - Angela McKay
- School of Nursing, The University of Tasmania, PO Box 1322, Launceston, Tasmania, 7250, Australia
| | - Katrina Nankervis
- Department of Nursing and Midwifery Education and Strategy, Monash Health, Clayton Rd, Clayton, Victoria, 3168, Australia
| | - Erika Penz
- College of Medicine, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada
| | - Thomas Rotter
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, SK, S7N 5E5, Canada
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Tham R, Buykx P, Kinsman L, Ward B, Humphreys JS, Asaid A, Tuohey K, Jenner R. Staff perceptions of primary healthcare service change: influences on staff satisfaction. AUST HEALTH REV 2016; 38:580-3. [PMID: 25283371 DOI: 10.1071/ah14015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 08/20/2014] [Indexed: 11/23/2022]
Abstract
Strong primary healthcare (PHC) services are efficient, cost-effective and associated with better population health outcomes. However, little is known about the role and perspectives of PHC staff in creating a sustainable service. Staff from a single-point-of-entry primary health care service in Elmore, a small rural community in north-west Victoria, were surveyed. Qualitative methods were used to collect data to show how the key factors associated with the evolution of a once-struggling medical service into a successful and sustainable PHC service have influenced staff satisfaction. The success of the service was linked to visionary leadership, teamwork and community involvement while service sustainability was described in terms of inter-professional linkages and the role of the service in contributing to the broader community. These factors were reported to have a positive impact on staff satisfaction. The contribution of service delivery change and ongoing service sustainability to staff satisfaction in this rural setting has implications for planning service change in other primary health care settings. WHAT IS KNOWN ABOUT THIS TOPIC?: Integrated PHC services have an important role to play in achieving equitable population health outcomes. Many rural communities struggle to maintain viable PHC services. Innovative PHC models are needed to ensure equitable access to care and reduce the health differential between rural and metropolitan people. WHAT DOES THIS PAPER ADD?: Multidisciplinary teams, visionary leadership, strong community engagement combined with service partnerships are important factors in the building of a rural PHC service that substantially contributes to enhanced staff satisfaction and service sustainability. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Understanding and engaging local community members is a key driver in the success of service delivery changes in rural PHC services.
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Affiliation(s)
- Rachel Tham
- School of Rural Health, Monash University, PO Box 666, Bendigo, Vic. 3552, Australia. ; ;
| | - Penny Buykx
- School of Rural Health, Monash University, PO Box 666, Bendigo, Vic. 3552, Australia. ; ;
| | - Leigh Kinsman
- School of Rural Health, Monash University, PO Box 666, Bendigo, Vic. 3552, Australia. ; ;
| | - Bernadette Ward
- School of Rural Health, Monash University, PO Box 666, Bendigo, Vic. 3552, Australia. ; ;
| | - John S Humphreys
- Centre of Research Excellence in Rural and Remote Primary Health Care, Monash University, Bendigo, Vic. 3552, Australia
| | - Adel Asaid
- Elmore Primary Health Service, Elmore, Vic. 3558, Australia. ;
| | - Kathy Tuohey
- Elmore Primary Health Service, Elmore, Vic. 3558, Australia. ;
| | - Rohan Jenner
- Elmore Primary Health Service, Elmore, Vic. 3558, Australia. ;
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Plishka C, Rotter T, Kinsman L, Hansia MR, Lawal A, Goodridge D, Penz E, Marciniuk DD. Effects of clinical pathways for chronic obstructive pulmonary disease (COPD) on patient, professional and systems outcomes: protocol for a systematic review. Syst Rev 2016; 5:135. [PMID: 27516179 PMCID: PMC4981985 DOI: 10.1186/s13643-016-0311-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 08/02/2016] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a respiratory syndrome characterized by progressive, partially reversible airway obstruction and lung hyperinflation. COPD has a substantial burden which is seen in both patient quality of life and healthcare costs. One proposed method of minimizing this burden is the implementation of clinical pathways (CPWs). CPWs aim to guide evidence-based practice and improve the interaction between health services. They bring the best available evidence to a range of healthcare professionals by adapting evidence-based clinical guidelines to a local context and detailing the essential steps in the assessment and care of patients. METHODS The aim of this systematic review is to synthesize existing literature on the effects of CPWs for the treatment or management of COPD. We will screen search hits from search strategies developed for a Cochrane Effective Practice and Organisation of Care (EPOC) systematic review on the use of CPWs in primary care and a Cochrane EPOC review on the use of CPWs in hospitals. These searches were run in a range of databases. Studies will be screened independently by two reviewers. All studies identified by our search strategy will be considered regardless of study design as long as they meet the operational definition for clinical pathways developed by Kinsman et al. (BMC Medicine 8, 2010) and focus on the treatment or management of COPD. All included studies will be evaluated for risk of bias utilizing methodologies set out by the Cochrane collaboration. Data regarding patient, professional and systems outcomes will be extracted from all included studies. Data will be presented in both narrative and tabular form. DISCUSSION The systematic review outlined in this protocol aims to identify, assess and synthesise all available evidence on the effects of CPWs regarding the treatment and management of COPD. As a result, this review will provide an evidence base for decision makers regarding the practicality, cost effectiveness, patient benefit and best practices regarding the implementation of CPWs for the care of COPD.
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Affiliation(s)
- Christopher Plishka
- College of Pharmacy and Nutrition, University of Saskatchewan, E3315 Health Sciences Building, Saskatoon, SK S7N 5E5, Canada.
| | - Thomas Rotter
- College of Pharmacy and Nutrition, University of Saskatchewan, E3315 Health Sciences Building, Saskatoon, SK S7N 5E5, Canada
| | - Leigh Kinsman
- University of Tasmania and Tasmanian Health Organisation (North), Launceston, Tasmania, Australia
| | | | - Adegboyega Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, E3315 Health Sciences Building, Saskatoon, SK S7N 5E5, Canada
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Erika Penz
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Darcy D Marciniuk
- Respirology, Critical Care and Sleep Medicine, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Chung C, Cooper S, Kinsman L, Evans L, Cahill A. RESEARCH: PATIENT DETERIORATION -- PATIENT SAFETY. Aust Nurs Midwifery J 2016; 24:41. [PMID: 29240391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Inadequate management of deteriorating patients is of international concern. In order to tackle this issue there has been an increasing effort to upskill nursing and medical staff (Australian Commission on Safety and Quality in Healthcare, 2012).
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Lawal AK, Rotter T, Kinsman L, Machotta A, Ronellenfitsch U, Scott SD, Goodridge D, Plishka C, Groot G. What is a clinical pathway? Refinement of an operational definition to identify clinical pathway studies for a Cochrane systematic review. BMC Med 2016; 14:35. [PMID: 26904977 PMCID: PMC4765053 DOI: 10.1186/s12916-016-0580-z] [Citation(s) in RCA: 114] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 02/12/2016] [Indexed: 02/02/2023] Open
Abstract
Clinical pathways (CPWs) are a common component in the quest to improve the quality of health. CPWs are used to reduce variation, improve quality of care, and maximize the outcomes for specific groups of patients. An ongoing challenge is the operationalization of a definition of CPW in healthcare. This may be attributable to both the differences in definition and a lack of conceptualization in the field of clinical pathways. This correspondence article describes a process of refinement of an operational definition for CPW research and proposes an operational definition for the future syntheses of CPWs literature. Following the approach proposed by Kinsman et al. (BMC Medicine 8(1):31, 2010) and Wieland et al. (Alternative Therapies in Health and Medicine 17(2):50, 2011), we used a four-stage process to generate a five criteria checklist for the definition of CPWs. We refined the operational definition, through consensus, merging two of the checklist's criteria, leading to a more inclusive criterion for accommodating CPW studies conducted in various healthcare settings. The following four criteria for CPW operational definition, derived from the refinement process described above, are (1) the intervention was a structured multidisciplinary plan of care; (2) the intervention was used to translate guidelines or evidence into local structures; (3) the intervention detailed the steps in a course of treatment or care in a plan, pathway, algorithm, guideline, protocol or other 'inventory of actions' (i.e. the intervention had time-frames or criteria-based progression); and (4) the intervention aimed to standardize care for a specific population. An intervention meeting all four criteria was considered to be a CPW. The development of operational definitions for complex interventions is a useful approach to appraise and synthesize evidence for policy development and quality improvement.
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Affiliation(s)
- Adegboyega K Lawal
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.
| | - Thomas Rotter
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.
| | - Leigh Kinsman
- University of Tasmania and Tasmanian Health Organisation (North), Launceston, Tasmania, Australia.
| | - Andreas Machotta
- Department of Anesthesiology, Sophia Children's Hospital, Erasmus Medical Centre Rotterdam, Rotterdam, Netherlands.
| | - Ulrich Ronellenfitsch
- University Medical Center Mannheim, Medical Faculty Mannheim of the University of Heidelberg, Department of Surgery, Mannheim, Germany.
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada.
| | - Donna Goodridge
- College of Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Christopher Plishka
- College of Pharmacy and Nutrition, University of Saskatchewan, Saskatoon, Canada.
| | - Gary Groot
- College of Medicine, University of Saskatchewan, Saskatoon, Canada.
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Kinsman L, Tham R, Symons J, Jones M, Campbell S, Allenby A. Prevention of cardiovascular disease in rural Australian primary care: an exploratory study of the perspectives of clinicians and high-risk men. Aust J Prim Health 2016; 22:510-516. [DOI: 10.1071/py15091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/15/2015] [Indexed: 11/23/2022]
Abstract
Rural primary care services have the potential to play a major role in reducing the gap in cardiovascular disease (CVD) outcomes between rural and metropolitan Australians, particularly in men at high risk of CVD. The aim of this study was to explore the self-reported behaviours and satisfaction with their general practice/practitioner of men at high risk of CVD, and attitudes of rural primary care clinicians regarding the role of primary care in CVD prevention. This observational research was addressed through survey questionnaires with rural men at high risk of CVD and semi-structured interviews with rural primary care clinicians. Fourteen rural primary care practices from towns with populations less than 25000 participated. One hundred and fifty-eight high-risk men completed the questionnaire. Their responses demonstrated poorly controlled risk factors despite a willingness to change. Alternatively, rural primary care clinicians (n=20) reported that patients were unlikely to change and that illness-based funding models inhibited cardiovascular preventive activities. Australians living in rural areas have worse CVD outcomes. In addition, there is a disparity in the assumptions of health providers and male patients at high risk of CVD in rural areas. This necessitates innovative rural primary care models that include a blended payment system that incentivises or funds preventive care alongside an emphasis on lifestyle advice, as well as an explicit strategy to influence clinician and patient behaviour to help address the disparity.
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Allenby A, Kinsman L, Tham R, Symons J, Jones M, Campbell S. The quality of cardiovascular disease prevention in rural primary care. Aust J Rural Health 2015; 24:92-8. [PMID: 26255899 PMCID: PMC5042085 DOI: 10.1111/ajr.12224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2015] [Indexed: 12/01/2022] Open
Abstract
Objective Design Setting Participants Main outcome measures Results Conclusions
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Affiliation(s)
- Ann Allenby
- School of Rural Health Monash University Bendigo Victoria Australia
| | - Leigh Kinsman
- School of Rural Health Monash University Bendigo Victoria Australia
| | - Rachel Tham
- School of Rural Health Monash University Bendigo Victoria Australia
| | - Julie Symons
- School of Rural Health Monash University Bendigo Victoria Australia
| | - Mike Jones
- Psychology Department Macquarie University Sydney Australia
| | - Stephen Campbell
- Institute of Population Health, Centre for Primary Care University of Manchester Manchester UK
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Ingham G, Morgan S, Kinsman L, Fry J. Are GP supervisors confident they can assess registrar competence and safety, and what methods do they use? Aust Fam Physician 2015; 44:236-240. [PMID: 25901397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The new Royal Australian College of General Practitioners' vocational training standards emphasise patient safety and matching the level of supervision to registrar competence. METHODS All supervisors attending a regional training provider's annual education workshop were surveyed about their overall confidence in assessing the safety of their registrars' patients, their registrars' competence across the five RACGP domains of general practice and supervision methods used. RESULTS Of 84 supervisors, 92.8% expressed overall confidence in their ability to assess their registrars' competence and 10.7% were totally confident. Consultation observation and audit techniques were infrequently used in their assessments. DISCUSSION Supervisors reported confidence in their ability to assess their registrars' competence, suggesting readiness for outcomes-based standards. The low frequency of using supervision methods considered more effective in targeting registrars' 'unknown unknowns' and the reduction in confidence with greater experiences as a supervisor raises concerns about the accuracy of this self-assessment.
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Affiliation(s)
- Gerard Ingham
- MBBS, FRACGP, DRANZCOG, GP Supervisor, Daylesford, VIC; Director of Education for Supervisors, Beyond Medical Education, Bendigo, VIC
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Gavriel J, Booker MJ, Morgan S, Ingham G, Kinsman L, Fry J, Fisher P. Teaching exchange. Education for Primary Care 2015; 26:34-6. [DOI: 10.1080/14739879.2015.11494307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Morgan S, Ingham G, Kinsman L, Fry J. Clinical supervision using random case analysis in general practice training. Educ Prim Care 2015; 26:40-46. [PMID: 25654805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Simon Morgan
- General Practice Training Valley to Coast, Newcastle, PO Box 573, Hunter Regional Medical Centre, New South Wales 2310, Australia.
| | - Gerald Ingham
- Daylesford, Victoria and Medical Educator, Beyond Medical Education, Bendigo, Victoria, Australia
| | - Leigh Kinsman
- Centre of Research Excellence in Rural and Remote Primary Health Care, (CRERRPHC) and Director of the Office of Research at the School of Rural Health, Bendigo, Australia
| | - Jennifer Fry
- Beyond Medical Education, Bendigo, Victoria, Australia
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Campbell AM, Brown J, Simon DR, Young S, Kinsman L. Leading the rebirth of the rural obstetrician. Med J Aust 2014; 201:667-70. [PMID: 25495313 DOI: 10.5694/mja14.00278] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/29/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Alison M Campbell
- School of Rural Health, Monash University, Bendigo, VIC
- Palliative and Supportive Services, Flinders University, Adelaide, VIC
| | - James Brown
- General Practice, Southern General Practice Training, Churchill, VIC
| | | | - Sari Young
- School of Rural Health, Monash University, Bendigo, VIC
| | - Leigh Kinsman
- School of Rural Health, Monash University, Bendigo, VIC
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