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Physicians’ attitudes and perspectives regarding the uptake of psychosocial aspects and/or patient preferences during multidisciplinary team meetings in oncology 肿瘤学多学科团队会议期间,医生对心理社会方面和/或患者偏好的接受态度和观点
IF 1.4 Q4 NURSING Pub Date : 2020-09-01 DOI: 10.1177/2053434520959678
S. Baes, M. Horlait, S. Dhaene, M. Leys
Introduction Coordinating cancer care is challenging because of its complexity. To partly encounter this complexity, multidisciplinary team meetings (MDTMs) were implemented to evaluate diagnosis, discuss treatment options and collectively decide upon the most optimal patient care and treatment plan. In cancer trajectories, medical professionals have a coordinating role and final decision responsibility. As a consequence patient-centred non-biomedical information are easily overlooked during discussions in MDTMs. This study aims to uncover physicians’ perceived barriers regarding the uptake of psychosocial aspects and/or patient preferences in the cancer treatment decision-making process during Multidisciplinary Oncology Consultations (MOCs), a specific type of MDTM in Belgium. Methods Between March 2019 and May 2019 semi-structured interviews were conducted with twenty medical professionals specialized in oncology. Grounded theory principles were used to detect and classify perceived barriers and patterns emerging regarding the uptake of psychosocial information in the cancer treatment decision-making process. Results Although physicians showed an open attitude towards taking into account psychosocial aspects and patient preferences in treatment decisions, the majority of respondents is not convinced the MOC is the best place to discuss these aspects. Physicians reported organisational, work process, and health system related barriers. Discussion The MOC emerges as a medicalized form of team discussion that, in its current form, does not reach its objective of truly integrated multidisciplinarity as cancer care is demanding. The working practices of the MOC can be optimized to evolve towards a truly interdisciplinary approach.
引言协调癌症护理由于其复杂性而具有挑战性。为了部分解决这种复杂性,实施了多学科团队会议(MDTM),以评估诊断,讨论治疗方案,并共同决定最优化的患者护理和治疗计划。在癌症的发展轨迹中,医疗专业人员具有协调作用和最终决策责任。因此,在MDTM的讨论中,以患者为中心的非生物医学信息很容易被忽视。本研究旨在揭示医生在比利时MDTM的一种特殊类型的多学科肿瘤咨询(MOCs)期间,在癌症治疗决策过程中对心理社会方面和/或患者偏好的理解障碍。方法在2019年3月至2019年5月期间,对20名肿瘤学专业医疗人员进行了半结构化访谈。在癌症治疗决策过程中,使用有根据的理论原则来检测和分类在接受心理社会信息方面出现的感知障碍和模式。结果尽管医生对在治疗决策中考虑心理社会方面和患者偏好表现出开放的态度,但大多数受访者并不相信MOC是讨论这些方面的最佳场所。医生报告了组织、工作流程和卫生系统相关的障碍。讨论MOC作为一种医疗化的团队讨论形式出现,以其目前的形式,并没有达到癌症护理所要求的真正整合多学科的目标。主运行中心的工作实践可以进行优化,以朝着真正跨学科的方法发展。
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引用次数: 4
Diabetes assistance before, during and after Covid-19 in Ferrara, Italy 意大利费拉拉在2019冠状病毒病之前、期间和之后的糖尿病援助
IF 1.4 Q4 NURSING Pub Date : 2020-09-01 DOI: 10.1177/2053434520954614
D. Pelizzola
The COVID-19 pandemic has profoundly changed people's habits and social organization, including the care models of people with chronic diseases. Diabetes care in Ferrara is based on Integrated Care Protocols (ICP) in collaboration with General Practitioners (GPs). The sudden arrival of the Covid-19 pandemic has resulted in the suspension of most of the planned health activities. The Diabetes Services have mainly dedicated themselves to communicating by telephone with their clients to suspend appointments and monitor their health conditions, accepting only urgent situations that could not be managed by telephone. The psychosocial aspects of people with diabetes have led to the fear of contagion taking into account the greater risks related to age and comorbidity and the aspects of loneliness and reduction of social contacts. After the lockdown, the health systems are reactivating the suspended treatment paths even if with all the measures to avoid spreading the infection. Consequently, the assistance activities will be quantitatively less numerous to apply the safety criteria. E-health gives the opportunity to customize monitoring and assistance and to configure a profile of the monitored parameters aimed at revaluations of care in the clinic only when necessary, rather than at predetermined deadlines.
新冠肺炎大流行深刻改变了人们的习惯和社会组织,包括慢性病患者的护理模式。费拉拉的糖尿病护理是基于与全科医生合作的综合护理协议(ICP)。新冠肺炎大流行的突然到来导致大多数计划中的卫生活动暂停。糖尿病服务中心主要致力于通过电话与客户沟通,以暂停预约并监测他们的健康状况,只接受无法通过电话管理的紧急情况。糖尿病患者的心理社会方面导致了对传染的恐惧,考虑到与年龄和共病相关的更大风险,以及孤独和减少社交接触的方面。封锁后,卫生系统正在重新启动暂停的治疗途径,即使采取了所有措施来避免感染传播。因此,援助活动的数量将减少,以应用安全标准。电子健康提供了定制监测和协助的机会,并配置监测参数的配置文件,目的是仅在必要时,而不是在预定的截止日期重新评估诊所的护理。
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引用次数: 4
Coordination of a remote mHealth infrastructure for atrial fibrillation management during COVID-19 and beyond: TeleCheck-AF 新冠肺炎期间及以后用于心房颤动管理的远程mHealth基础设施的协调:TeleCheck-AF
IF 1.4 Q4 NURSING Pub Date : 2020-08-27 DOI: 10.1177/2053434520954619
R. V. D. van der Velden, A. Hermans, N. Pluymaekers, M. Gawalko, Bianca Vorstermans, H. Martens, Saskia Buskes, H. Crijns, D. Linz, J. Hendriks
During the coronavirus 2019 (COVID-19) pandemic, outpatient visits for patients with atrial fibrillation (AF), were converted into teleconsultations. As a response to this, a novel mobile health (mHealth) intervention was developed to support these teleconsultations with AF patients: TeleCheck-AF. This approach incorporates three fundamental components: 1) “Tele”: A structured teleconsultation. 2) “Check”: An app-based on-demand heart rate and rhythm monitoring infrastructure. 3) “AF”: comprehensive AF management. This report highlights the significant importance of coordination of the TeleCheck-AF approach at multiple levels and underlines the importance of streamlining care processes provided by a multidisciplinary team, using an mHealth intervention, during the COVID-19 pandemic. Moreover, this report reflects on how the TeleCheck-AF approach has contributed to strengthening the health system in maintaining management of this prevalent sustained cardiac arrhythmia, whilst keeping patients out of hospital, during the pandemic and beyond.
在2019冠状病毒(COVID-19)大流行期间,心房颤动(AF)患者的门诊就诊转化为远程会诊。为此,开发了一种新的移动健康(mHealth)干预措施来支持房颤患者的远程会诊:TeleCheck-AF。这种方法包括三个基本组成部分:1)“远程”:结构化的远程咨询。2)“Check”:基于应用程序的按需心率和节律监测基础设施。3)“AF”:综合AF管理。本报告强调了在多个层面协调TeleCheck-AF方法的重要性,并强调了在2019冠状病毒病大流行期间,使用移动医疗干预措施精简多学科团队提供的护理流程的重要性。此外,本报告反映了在大流行期间和之后,TeleCheck-AF方法如何有助于加强卫生系统维持对这种普遍存在的持续性心律失常的管理,同时使患者无需住院。
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引用次数: 12
Nigerian healthcare workers’ perception of transdisciplinary approach to older adults’ care: A qualitative case study 尼日利亚医护人员对跨学科老年人护理方法的看法:一项定性案例研究
IF 1.4 Q4 NURSING Pub Date : 2020-08-27 DOI: 10.1177/2053434520954362
Augustine E Okoh, O. Akinrolie, H. Bell-Gam, Isreal Adandom, M. Ibekaku, M. Kalu
Introduction There is a growing interest in collaborative care for older adults in Nigeria; however, little is known about the application of a transdisciplinary approach to care in a typical Nigerian geriatric unit. Therefore, we described healthcare professionals’ (HCPs’) perception of a transdisciplinary approach to older adults’ care in Southern Nigeria. Methods Using Stakian’s approach to a qualitative case study, we purposively invited 16 HCPs working in the geriatric unit of a teaching hospital in Nigeria to a single, in-depth, semi-structured interview. We analysed data using Stakian’s approach of categorical aggregation and direct interpretation. Results Our participants identified five-key features of a transdisciplinary approach to care: consolidated consultation, consolidated care documentation, care files accessibility, shared care decision and a designated care manager. HCPs stated that transdisciplinary approach to care allowed for a consolidated consultation of patients, with all the HCPs (in the same room or via telehealth/telemedicine) and care decisions should be shared between all stakeholders and documented in an accessible unified electronic care document that is managed by a care manager. Factors ranging from lack of consensus on time for a consolidation consultation to inter-professional conflicts were perceived as possible hindrances to a transdisciplinary approach to older adults’ care. Discussion The features of transdisciplinary care described in this study partly aligned with the WHO’s integrated care for older people (ICOPE). Additional components not captured in ICOPE were found. While the description of transdisciplinary was from the perceptive of our study participant, caution should be applied when interpreting these findings.
在尼日利亚,人们对老年人的合作护理越来越感兴趣;然而,很少有人知道在一个典型的尼日利亚老年单位的跨学科方法的应用。因此,我们描述了医疗保健专业人员(HCPs)对尼日利亚南部老年人护理的跨学科方法的看法。方法采用斯塔基安的定性案例研究方法,我们有目的地邀请了16名在尼日利亚一家教学医院的老年科工作的医护人员进行了一次深入的半结构化访谈。我们使用斯塔克的分类聚合和直接解释方法分析数据。结果:我们的参与者确定了跨学科护理方法的五个关键特征:综合咨询、综合护理文件、护理文件可访问性、共享护理决策和指定护理经理。hcp表示,跨学科的护理方法允许患者进行综合咨询,所有hcp(在同一房间或通过远程医疗/远程医疗)和护理决策应在所有利益相关者之间共享,并记录在由护理经理管理的可访问的统一电子护理文件中。从对合并咨询的时间缺乏共识到专业间冲突等因素被认为是对老年人护理的跨学科方法的可能障碍。本研究中描述的跨学科护理的特点部分符合世卫组织的老年人综合护理(ICOPE)。发现了ICOPE中未捕获的其他组件。虽然跨学科的描述来自我们研究参与者的感知,但在解释这些发现时应谨慎。
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引用次数: 6
Challenges in measuring integrated care models: International knowledge and the case of Québec 衡量综合护理模式的挑战:国际知识和曲氏病案例
IF 1.4 Q4 NURSING Pub Date : 2020-07-28 DOI: 10.1177/2053434520945087
Paul Wankah, Maxime Guillette, Thomas Lemaître, L. Belzile, Y. Couturier
Introduction The implementation of integrated care models requires significant efforts, especially due to institutional and organisational inertial forces that characterize health and social care systems of developed countries. It is therefore crucial to deploy strategies that promote continuous adjustment to these barriers so as to improve the benefits of integrating care. Measuring the implementation and effects of integrated care models are key component of these strategies. However, measuring integrated care also faces major challenges. This study aims to identify and characterise integrated care measurement challenges. Methods A review of reviews on the measurement of integrated care identified 12 papers. A thematic analysis was conducted to identify and categorize measurement challenges. Document analysis was done on the measurement of an integrated care model for older adults in Québec. Results Eight categories of measurement challenges were identified. These challenges include difficulties in measuring structures, processes, and effects of models; conceptual ambiguity and heterogeneity of organisational forms; involving multiple actors in the measurement strategy; and including multiple data sources, amongst others. These challenges revealed and explained potential gaps in the measurement of integrated care for older adults in Québec. For instance, the Québec measurement strategy did not include effects indicators. Conclusion Although the measurement of integrated care is a complex endeavour, there is a need for adequate measurement strategies that allow to appreciate important elements of integrate care. The findings of this study could be used as a reflexive tool in advancing research and practice of measuring integrated care.
综合护理模式的实施需要付出巨大努力,特别是由于发达国家卫生和社会保健系统特有的体制和组织惯性力量。因此,至关重要的是部署促进不断调整这些障碍的战略,以提高综合护理的效益。衡量综合护理模式的实施和效果是这些战略的关键组成部分。然而,衡量综合护理也面临着重大挑战。本研究旨在识别和表征综合护理测量挑战。方法对有关综合护理测量的12篇文献进行综述。进行了专题分析,以确定和分类测量挑战。对曲海省老年人综合护理模式的测量进行文献分析。结果确定了8类测量挑战。这些挑战包括在测量模型的结构、过程和效果方面的困难;组织形式的概念模糊性和异质性在度量策略中涉及多个参与者;包括多个数据源等。这些挑战揭示并解释了在衡量曲海地区老年人综合护理方面的潜在差距。例如,quamesim计量战略没有包括效果指标。结论:虽然综合护理的测量是一项复杂的工作,但仍需要适当的测量策略,以便了解综合护理的重要因素。本研究结果可作为一种反思性工具,推动综合护理的研究和实践。
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引用次数: 8
Physiotherapists’ role during hospital-to-home transition for older adults with hip fracture and mobility limitation: A research protocol 物理治疗师在髋部骨折和行动受限的老年人从医院到家庭过渡过程中的作用:一项研究方案
IF 1.4 Q4 NURSING Pub Date : 2020-06-26 DOI: 10.1177/2053434520937408
M. Kalu, Augustine C Okoh, Henrietha C Nwankwo, E. Anieto, Israel I Adandom, Samuel U. Jumbo, Uduonu Ekezie, Emofe Diameta, O. Akinrolie, Perpetua C Obi, Chidinma A Omeje, Sadiq Mohammad, Michael Ajulo, M. Opara, U. Abaraogu
Introduction Functional deficits such as gait speed, muscle strength or reduced activities in daily living after discharge are predictors for hospital readmission for older adults with hip fractures. However, physiotherapists (PTs) who are inherently mobility experts, do not actively participate during the hospital-to-home transition of older adults with hip fractures in the developing countries, including Nigeria. This qualitative study aims to describe and explore how PTs working within inpatient rehabilitation units prepare older adults (≥60 years) with a hip fracture for transfer to their home in the community. Methods We will adopt Sally Thorne’s Interpretive Description approach to purposively select 25 PTs with 5-years experience of participating in discharging older adults with hip fractures from inpatient rehabilitation-to-home. Data collection will include (a) semi-structured, one-on-one interviews with PTs, (b) discharge summaries of two older adults, and (c) final focus group discussion with PTs. We will ask the physiotherapists to provide discharge summaries of two older adults - one that they described as a “difficult” case and one that they described as an “easy” case during inpatient rehabilitation-to-home transition. Data will be analyzed employing Sally Thorne’s “borrowing techniques”- content and thematic analysis for the patients’ discharge summaries and PT interviews, respectively.
引言功能缺陷,如步态速度、肌肉力量或出院后日常生活活动减少,是老年髋部骨折患者再次入院的预测因素。然而,在包括尼日利亚在内的发展中国家,理疗师天生就是行动专家,他们没有积极参与髋关节骨折老年人从医院到家庭的过渡。这项定性研究旨在描述和探索在住院康复室工作的PT如何为老年人(≥60岁)做好准备 年),以便转移到社区的家中。方法我们将采用Sally Thorne的解释性描述方法,有目的地选择25名具有5年参与老年髋部骨折患者出院经验的PT,从住院康复到家庭。数据收集将包括(a)对PT的半结构化一对一访谈,(b)对两名老年人的出院总结,以及(c)与PT的最终焦点小组讨论。我们将要求理疗师提供两名老年人的出院总结——一名被他们描述为“困难”病例,另一名被描述为住院康复过渡到家庭的“容易”病例。数据将采用Sally Thorne的“借用技巧”进行分析,即分别对患者出院总结和PT访谈进行内容和主题分析。
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引用次数: 2
Integrated care in atrial fibrillation – Are we truly integrating? 心房颤动的综合护理——我们真的在综合吗?
IF 1.4 Q4 NURSING Pub Date : 2020-06-24 DOI: 10.1177/2053434520937416
J. Hendriks
Integrated care is an emerging approach to manage patients with chronic complex conditions, such as atrial fibrillation (AF). The current international practice guidelines recommend an integrated care approach in AF, which consists of four fundamentals being patient involvement, a multidisciplinary team approach, the use of technology, and comprehensive management focussing on the treatment of AF, prevention of thromboembolic complications, and the management of co-morbid conditions, cardiovascular risk factors and lifestyle modification. Despite the guideline recommendations, the term integrated care is being used inconsistently within the current available literature. This publication aims to contribute to the clarification of the integrate AF care concept and the consequent appropriate use in clinical practice and research, whilst awaiting an upcoming update of international practice guidelines.
综合护理是一种新兴的方法来管理慢性复杂疾病的患者,如心房颤动(AF)。目前的国际实践指南推荐房颤的综合护理方法,包括四个基本原则:患者参与、多学科团队方法、技术的使用、以房颤治疗为重点的综合管理、血栓栓塞并发症的预防、合并症的管理、心血管危险因素和生活方式的改变。尽管有指南建议,但在目前可用的文献中,综合护理一词的使用并不一致。本出版物旨在澄清综合房颤护理概念,并在临床实践和研究中适当使用,同时等待即将更新的国际实践指南。
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引用次数: 4
The status of cultural care among nurses working in different wards of teaching hospitals in Ardabil, Iran: A cross-sectional survey study 伊朗阿达比尔教学医院不同病房护士的文化护理状况:一项横断面调查研究
IF 1.4 Q4 NURSING Pub Date : 2020-06-18 DOI: 10.1177/2053434520933433
F. Firoozi, N. Mozaffari, S. Iranpour, B. Molaei, M. Shamshiri
Introduction Culture is an important determinant in providing appropriate and coordinated health care for people from different ethnicities. The present study aimed to evaluate the status of cultural care among nurses working in teaching hospitals affiliated to Ardabil University of Medical Sciences. Methods In this descriptive-correlational study, 350 nurses completed the Persian version of Cultural Care Inventory (PCCI). This tool consists of 51 items and measures cultural care process in four domains including cultural preparation, cultural attitude, cultural awareness and cultural competence. Data were analyzed by IBM SPSS Statistics for Windows, version 22. Results The grand item mean of cultural care was 2.60 ± 0.621, which is considered poor. The grand item mean was 2.64 ± 0.78 in the subscale of cultural preparation, 3.45 ± 0.559 in cultural attitude, 2.81 ± 0.736 in cultural awareness and 2.58 ± 0.834 in cultural competence. Cultural competence was significantly related to cultural preparation (r = 0.80), cultural attitude (r = 0.62) and cultural awareness (r = 0.87). Discussion Based on the present findings, cultural care and its dimensions (with the exception of cultural attitude) were at a poor level. It can also be claimed that there is a direct and strong relationship between the dimensions of cultural care including cultural preparation, awareness, attitude and competence, which indicates the interdependence of these dimensions on each other. Nurses need to improve their cultural competence to ensure of providing patient-centered and culturally coordinated care.
在为不同种族的人提供适当和协调的卫生保健方面,文化是一个重要的决定因素。本研究旨在了解阿达比尔医科大学附属教学医院护士文化关怀的现状。方法在这项描述性相关研究中,350名护士完成了波斯语版文化护理量表(PCCI)。该工具包括51个项目,从文化准备、文化态度、文化意识和文化能力四个领域衡量文化关怀过程。数据采用IBM SPSS Statistics for Windows, version 22进行分析。结果文化关怀的单项平均值为2.60±0.621,为较差。文化准备分项均值为2.64±0.78,文化态度分项均值为3.45±0.559,文化意识分项均值为2.81±0.736,文化能力分项均值为2.58±0.834。文化能力与文化准备(r = 0.80)、文化态度(r = 0.62)和文化意识(r = 0.87)显著相关。基于目前的研究结果,文化关怀及其维度(文化态度除外)处于较差的水平。也可以说,文化关怀的维度包括文化准备、意识、态度和能力之间存在着直接而密切的关系,这表明这些维度相互依存。护士需要提高文化能力,以确保提供以患者为中心和文化协调的护理。
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引用次数: 6
Why do evaluations of integrated care not produce the results we expect? 为什么综合护理的评估不能产生我们期望的结果?
IF 1.4 Q4 NURSING Pub Date : 2020-03-01 DOI: 10.1177/2053434520909089
S. Kumpunen, N. Edwards, T. Georghiou, G. Hughes
A number of evaluations of models of integrated care have not produced the expected result of reduced hospital admissions, and in some cases have even found people receiving integrated care services using hospitals more than matched controls. We tested three hypotheses for these surprising results with a group of 50 integrated care experts in a seminar: (1) problems with the model; (2) problems of implementation; and (3) problems of evaluation. Our group of experts did not rule out any of these hypotheses and came up with some advice as to manage these issues. For example, model designers should rigorously test the underlying logic; commissioners should seek out advice from experts and patients/professionals; and evaluators should choose outcomes wisely, use mixed methods approaches, and provide regular feedback loops to implementation sites. Evaluating integrated care is a skilled task that requires multiple approaches in terms of the design and implementation of the models. National research funders or other appropriate bodies might consider developing an advisory service to provide support to local systems planning evaluations.
对综合护理模式的一些评估并没有产生减少住院人数的预期结果,在某些情况下,甚至发现接受综合护理服务的人使用的医院比对照组更合适。在一次研讨会上,我们与50名综合护理专家一起测试了这些令人惊讶的结果的三个假设:(1)模型存在问题;(2) 执行问题;(3)评价问题。我们的专家小组没有排除这些假设中的任何一个,并就如何处理这些问题提出了一些建议。例如,模型设计者应该严格测试底层逻辑;委员应向专家和患者/专业人士寻求建议;评估人员应明智地选择结果,采用混合方法,并定期向实施地点提供反馈。评估综合护理是一项技术性任务,需要在模型的设计和实施方面采用多种方法。国家研究资助者或其他适当机构可以考虑开发一项咨询服务,为地方系统规划评估提供支持。
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引用次数: 29
Reviewer's list 2019 2019年审稿人名单
IF 1.4 Q4 NURSING Pub Date : 2020-03-01 DOI: 10.1177/2053434520916172
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引用次数: 0
期刊
International Journal of Care Coordination
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