Mobilizing strategic inflection points for sustainment of an effective intervention in an integrated learning health system: an interpretive description.

BACKGROUND: Innovative models of care have the potential to improve the sustainability of health systems by improving patient and provider experiences and population outcomes while simultaneously reducing costs. Yet, it is challenging to recognize the distinctive points during research and quality improvement processes that contribute to sustainment of effective interventions. The business concept of an inflection point-the position on the curve of a trajectory where the progress in implementation of an intervention is accelerated or decelerated-may be useful to understand implementation and improve sustainability and ultimately sustainment of effective interventions. The purpose of this study was to retrospectively identify and describe strategic inflection points that accelerated the sustainability process and led to the sustainment of Alberta Family Integrated Care. METHODS: This qualitative study was conducted in Alberta, Canada and employed an interpretive description design. Purposively sampled documents (proposals, project management plans, reports to funders and sponsors, meeting minutes, and fidelity audit and feedback checklists) from the Alberta Family Integrated Care cluster randomized controlled trial and quality improvement project constituted data for this study. RESULTS: To accelerate sustainability in the research context, we identified (1) alignment with strategic priorities, (2) iterative, user-centered co-design, and (3) contextualization of implementation as strategic inflection points. To accelerate sustainability in the health system context, we identified (1) the learning health system, (2) enduring partnerships, (3) responsivity to societal and system change, (4) embedded governance, and (5) intentional integration into the health system as strategic inflection points. Capitalizing on these strategic inflection points led to sustainment of Alberta Family Integrated Care in the provincial health system. CONCLUSIONS: We identified key inflection points in the research and health system contexts that led to sustainment of Alberta Family Integrated Care. By anticipating, recognizing, and leveraging inflection points in the sustainability process, researchers may be able to accelerate implementation and achieve sustainment of multi-component interventions in complex systems. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02879799. Registration date: May 27, 2016. Protocol version: June 9, 2016; version 2. Protocol publication: https://doi.org/10.1186/s13063-017-2181-3 .

On a healing journey together and apart: A Swedish critical incident technique study on family involvement from a patient perspective in relation to elective open-heart surgery.

BACKGROUND: As family members affect patient outcomes following open-heart surgery, the objective was to provide updated knowledge on family involvement in to guide future interventions facilitating family involvement. AIM: The aim was to explore and describe the experiences and actions of important situations of family involvement asexpressed by patients who underwent elective open-heart surgery in Sweden. METHODOLOGICAL DESIGN AND JUSTIFICATION: The critical incident technique (CIT) was used, which is a qualitative research method suitable for clinical problems when a phenomenon is known but the experiences and consequences of it are not. ETHICAL ISSUES AND APPROVAL: Considerations for patient integrity were made during the recruitment phase by ensuring that voluntary informed consent was obtained in two steps. RESEARCH METHODS: Individual interviews were conducted with 35 patients who underwent open-heart surgery in Sweden in 2023. Important situations were analysed according to the CIT method. RESULTS: Two main areas emerged: Patients described important situations of family involvement as experiences of mutual dependency while also being independent individuals. These experiences led to balancing healing and risk-taking activities as a family. The positive consequences of family involvement described by patients included improved recovery through practical help at home and emotional support. CONCLUSIONS: As complements to preserving the existing positive aspects of family involvement, social support screening, the establishment of individualised visitation policies and the provision of professional and peer support earlier can improve patient recovery following open-heart surgery.

"Staying connected": Speech-language pathologists' perspectives on the communication needs of people with primary progressive aphasia and their family members.

PURPOSE: The research objectives were to explore the communication needs pertaining to (a) people with primary progressive aphasia (PwPPA); (b) family members of PwPPA; and (c) the different variants of primary progressive aphasia (PPA), from the perspectives of speech-language pathologists (SLPs). METHOD: This investigation used a qualitatively driven concurrent mixed methods research design. Data collection involved semi-structured interviews and mixed methods questionnaires with 14 SLPs. Qualitative content analysis of interview and questionnaire data was used to identify codes and categories related to the research objectives. Quantitative analysis of questionnaire data involved single item summaries and cross item tabulations. RESULT: Analysis revealed eight categories of communication need pertaining to PwPPA and six pertaining to their family members. Results regarding communication needs according to variant of PPA revealed limited findings. CONCLUSION: SLPs perceived several important areas of communication need for PwPPA and their family members, highlighting key clinical implications for proactive communication care across the continuum of care. Future research can build on the current findings and integrate the perspectives of PwPPA and their family members on this topic, to develop interventions and explore models of service delivery to meet their progressive and complex communication needs.

Development of a family-centred intervention for families and children with hearing loss transitioning into early intervention: application of the Behaviour Change Wheel.

OBJECTIVE: To describe the application of the Behaviour Change Wheel (BCW) to the development of a family-centred intervention for families of children with hearing loss transitioning into early intervention. DESIGN: The BCW was used in a mixed methods design to understand the gaps in family-centred service provision and to identify appropriate intervention functions and implementation options to address these gaps. STUDY SAMPLE: Families and health professionals participated in different steps of the BCW. RESULTS: The qualitative interviews revealed that families required individualised information and support. The quantitative and interview data suggested inconsistencies in the provision of information and support to some families. It was determined that administration of a needs assessment by the support professionals was the most appropriate target behaviour to address this issue. In the analysis of the professionals' capabilities, opportunities, and motivations for administration of a needs assessment, a resource limitation was identified, and therefore, a Minimum Data Set for a Needs Assessment Tool was developed to facilitate the assessment of families' needs during the transition period. CONCLUSIONS: This study provided an example of how the BCW could be successfully applied to the design of a family-centred intervention for families of children with hearing loss.

Navigating childhood hearing loss: the experiences of parents, grandparents and siblings.

PURPOSE: This study aimed to explore the impact of childhood hearing loss on the family unit and their resulting intervention needs. MATERIALS & METHODS: Qualitative descriptive methodology was used, with in-depth interviews analysed using reflexive thematic analysis. Four family units of children with hearing loss participated in the study, including parents (n = 5), grandparents (n = 7), and siblings (n = 5). RESULTS: Five themes were developed from interview data: (1) the daily grind; (2) we're all in this together; (3) family dynamics; (4) the early intervention experience and (5) personal growth and adaptations. Family members were impacted in multi-faceted ways and identified informational and emotional intervention needs, with an integrative theme highlighting the emotional toll of childhood hearing loss on families. CONCLUSIONS: Early intervention services have a crucial role in addressing third-party disability through a multi-disciplinary service delivery model that addresses the needs of all family members, beyond the child with hearing loss.

The diagnosis and management of childhood hearing loss takes an emotional toll on the entire family unit including parents, grandparents, and siblings.Parents, grandparents, and siblings experience a broad ranging and pervasive impact to daily functioning and family dynamics because of hearing loss.It is essential to move beyond a child-centred approach and adopt a truly family-centred approach which both assesses and targets the unique needs of all family members.

Impact of adult cochlear implantation on the partner relationship: a conceptual framework informed by cochlear implant recipient and partner perceptions.

PURPOSE: (1) To understand the impact of adult cochlear implantation on the partner relationship, as perceived by adult cochlear implant (CI) recipients and their intimate partners. (2) To generate a conceptual framework for guiding future research and clinical adult cochlear implantation interventions. METHOD: Concept mapping, a participatory, mixed-method approach, was used for data collection, analysis and interpretation. Participants attended sessions to generate, sort and rate statements describing the changes in their relationship due to cochlear implantation. Participants included 15 CI recipients (mean age: 51.6 years; SD: 8.2) and 12 partners (mean age: 50.9 years; SD: 8.2). RESULTS: Five concepts emerged from the data, describing changes in the partner relationship following cochlear implantation: (1) Social Interactions, (2) Partner Involvement, (3) Communication, (4) Emotional Adjustment, and (5) Relationship Intimacy. The concept Relationship Intimacy was rated the highest in positivity and importance. Findings also underscored improved social interactions, communication dynamics, and emotional adjustment. CONCLUSIONS: The Relationship Intimacy cluster emerged as pivotal, highlighting its essential role in improving post-implantation relationships. CI recipients experienced enhanced autonomy, while partners' roles evolved regarding assistance and support. The diverse effects of implantation on partner relationships highlight the importance of adopting a patient- and family-centered approach to audiological intervention.

These insights on partner relationships and cochlear implantation can inform tailored pre- and ongoing post-operative counselling to support cochlear implant recipients and their partners in navigating relationship changes, emotional adjustments, and addressing communication challenges.Cochlear implantation reduces partner burden, emphasising the need for hearing healthcare professionals to facilitate partner engagement in rehabilitation approaches.Relationship intimacy, deemed the foremost positive outcome, underscores the importance of incorporating these aspects into pre- and post-operative counselling.

"They forget that I'm a human being"-ward round communication with older patients living with frailty and informal caregivers: a qualitative study.

PURPOSE: Skilful communication prompts quality patient care. Informal caregivers occupy a crucial role when caring for hospitalised older patients living with frailty. However, skilful communication with both patients and informal caregivers during ward rounds has not been studied. Thus, we aimed to explore communication preferences of patients and informal caregivers during ward rounds. METHODS: We conducted semi-structured interviews with hospitalized patients and informal caregivers until information redundancy occurred. We used inductive coding of the transcribed interviews followed by a reflexive thematic analysis. RESULTS: The study included 15 patients and 15 informal caregivers. Patients had a median age of 85 years (range 75-100 years) and seven patients were females. Informal caregivers' median age were 45 years (range 38-80 years) and 13 were females. Three themes were generated: (1) building relationships and conveying information, (2) alleviating informal caregiver strain and (3) sharing the decision-making process. Themes highlighted the importance of collaborative and empathetic approaches in healthcare interactions, emphasizing interpersonal communication skills, such as fostering professional relationships. The interviews unveiled informal caregiver burden stemming from disempowerment during hospital discharge process and managing mistrust within the healthcare system. The shared decision-making process should address patients' and informal caregivers' needs and circumstances. CONCLUSIONS: Communication preferences of a population of older patients living with frailty and informal caregivers during ward rounds encompass interpersonal communication, demonstrating ample time, and being seen as a human being. Informal caregivers value being included in the decision-making process. Skilful communication includes for doctors to recognize informal caregivers' narratives and burdens.

Assessing the maturity of the "Family Centered Care" concept: A review of concept analyses studies.

BACKGROUND: Concept analysis studies play major role in clarifying and operationalizing concepts. This approach has been used to clarify and advance knowledge about the concept of Family Centred Care (FCC). The concept of FCC has been studied by many nursing scholars using different methods. AIM: This review aimed to combine outcomes of concept analysis studies to assess the level of maturity of the concept of Family Centred Care. METHODS: Formal electronic databases (MEDLINE and CINAHL) and informal (Google Scholar) were searched using the terms "Family Centred Care" and "concept analysis". The Morse concept maturity evaluation approach was used to appraise the retrieved studies. RESULTS: 35studies were identified of which12 met the inclusion criteria and were included in the analysis. Three studies used Walker and Avant concept analysis methodology, three applied the Rodgers evolutionary model while six applied modified mixed/hybrid approaches. While a few provided a definition of FCC, none have been able to confirm the maturity of the concept. This review summarized the different trials to analyze the concept of FCC supporting the rethinking of the model and emergence of new models such as Child and Family Centred Care (CFCC). IMPLICATIONS: Concept analyses should be done periodically to assess the maturity of emerging concepts. Previously published FCC concept analyses manuscripts show the concept has evolved and gained significant recognition and acceptance over time. A clearer definition of FCC supports its positive impact on patient outcomes. A comprehensive FCC tool that can evaluate the effective delivery of FCC is needed.

Exploring critically ill patients' functional recovery through family partnerships: A descriptive qualitative study.

BACKGROUND: Early mobilisation interventions play a role in preventing intensive care unit-acquired weakness in critically ill patients and may contribute to improved recovery. Patient-and-family-centred care includes collaborative partnerships between healthcare professionals and families and is a potential strategy to promote early mobilisation in critical care; however, we currently do not know family member preferences for partnering and involvement in early mobilisation interventions. OBJECTIVES: The objective of this study was to explore family member perspectives on the acceptability and feasibility of partnering with healthcare professionals in early mobilisation interventions for adult critically ill patients. METHODS: A descriptive qualitative design. Semistructured interviews were conducted with family members of adult critically ill patients admitted to an intensive care unit. Data were collected through individual audio-recorded interviews. Interview data were analysed using the six phases of thematic analysis described by Braun and Clark. This study is reported following the Consolidated Criteria for Reporting Qualitative Research guidelines. RESULTS: Most family members of critically ill patients found the idea of partnering with healthcare professionals in early mobilisation interventions acceptable and feasible, although none had ever considered a partnership before. Participants thought their involvement in early mobilisation would have a positive impact on both the patient's and their own wellbeing. Themes uncovered showed that understanding family-member readiness and their need to feel welcome and included in the unfamiliar critical care environment are required before family member and healthcare professional partnerships in early mobilisation interventions can be enacted. CONCLUSIONS: Family members found partnering with healthcare professionals in early mobilisation interventions acceptable and feasible to enact, but implementation is influenced by their readiness and sense of belonging.