The impact of the use of continuous pulse oximetry monitoring to monitor patients at high risk of respiratory depression on nursing practice.

AIM: To describe the impact on nursing practice of using continuous pulse oximetry monitoring to monitor patients at high risk for respiratory depression after surgery. DESIGN: A convergent mixed method design. METHODS: Thirty (30) hours of non-participant structured observation and explanatory interviews were conducted with 10 nurses from the surgery care unit and intensive care unit. RESULTS: We found that nursing practice to evaluate and monitor at-risk patients through continuous pulse oximetry monitoring is mainly linked to technical care. Nurses generally meet the frequency of bedside monitoring required by established protocols. During the structured non-participant observation periods, it was observed that 90% of the alarms were false (unsustained desaturations). This was confirmed by the nurses during the explanatory interviews. Noisy environments, high number of false alarms, poor communication between nurses and various operational failures might have a negative impact on nursing practice. CONCLUSION: Several challenges must be overcome for this technology to achieve the desired outcomes of continuous surveillance and rapid detection of respiratory depression episodes for post-surgical patients. No Patient or Public Contribution.

Reorganizing Pharmaceutical Care in Family Medicine Groups for Older Adults With or at Risk of Major Neurocognitive Disorders: Protocol for a Mixed Methods Study.

BACKGROUND: The latest global figures show that 55 million persons lived with major neurocognitive disorders (MNCDs) worldwide in 2021. In Quebec, Canada, most of these older adults are cared for by family physicians in interdisciplinary primary care clinics such as family medicine groups (FMG). When a person has a MNCD, taking potentially inappropriate medications or polypharmacy (5 different medications or more) increases their vulnerability to serious adverse events. With the recent arrival of pharmacists working in FMGs and their expanded scope of practice and autonomy, new possibilities for optimizing older adults' pharmacotherapy are opening. OBJECTIVE: This project aims to evaluate the impact of involving these pharmacists in the care trajectory of older adults living with MNCD, in an interdisciplinary collaboration with the FMG team, as well as home care nurses and physicians. Pharmacists will provide medication reviews, interventions, and recommendations to improve the pharmacotherapy and support offered to these patients and their caregivers. METHODS: This 2-step mixed methods study will include a quasi-experimental controlled trial (step 1) and semistructured interviews (step 2). Older adults undergoing cognitive assessment, recently diagnosed with MNCD, or receiving care for this at home will be identified and recruited in FMGs in 2 Quebec regions. FMGs implementing the intervention will involve pharmacists in these patients' care trajectory. Training and regular mentoring will be offered to these FMGs, especially to pharmacists. In control FMGs, no FMG pharmacist will be involved with these patients, and usual care will be provided. RESULTS: Medication use (including appropriateness) and burden, satisfaction of care received, and quality of life will be assessed at study beginning and after 6 months of follow-up and compared between groups. At the end of the intervention study, we will conduct semistructured interviews with FMG care team members (pharmacists, nurses, and physicians) who have experienced the intervention. We will ask about the feasibility of integrating the intervention into practice and their satisfaction with and their perception of the intervention's impacts for older adults and their families. We will assess the effect of improved pharmaceutical care for older adults with or at risk of MNCDs through the involvement of FMG pharmacists and a reorganization of pharmaceutical care. CONCLUSIONS: The inclusion of pharmacists in interdisciplinary care teams is recent and rising, strengthened by more substantial pharmacist practice roles. Results will inform the processes required to successfully involve pharmacists and implement developed tools and procedures transposable to other care settings to improve patient care. TRIAL REGISTRATION: ClinicalTrials.gov NCT04889794; https://clinicaltrials.gov/ct2/show/NCT04889794. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/42577.

Atividades das enfermeiras de ligação na alta hospitalar: uma estratégia para a continuidade do cuidado / Liaison nurse activities at hospital discharge: a strategy for continuity of care / Actividades de las enfermeras de enlace en el alta hospitalaria: una estrategia para la continuidad del cuidado

Objetivo descrever as atividades desenvolvidas pelas enfermeiras de ligação para a continuidade do cuidado após a alta hospitalar. Método estudo descritivo, qualitativo, pautado no referencial teórico Cuidado Baseado nas Forças. A amostra compreendeu 23 enfermeiras de ligação. Os dados foram coletados por meio de um questionário semiestruturado via plataforma eletrônica Survey Monkey e analisados por meio da técnica de Análise de Conteúdo, com categorias pré-definidas. Resultados entre as enfermeiras de ligação, nove (39,14%) possuíam de 35 a 44 anos de idade; 17 (73,91%) eram do sexo feminino; 15 (65,22%) trabalhavam há onze ou mais anos como enfermeira e 11 (47,82%) atuavam de seis a dez anos como enfermeira de ligação. As profissionais participam da identificação dos pacientes que necessitam de cuidados pós-alta hospitalar, coordenam o planejamento da alta hospitalar e transferem as informações do paciente para um serviço extra-hospitalar. Conclusão as atividades desenvolvidas pelas enfermeiras de ligação centram-se nas necessidades do paciente e na articulação com os serviços extra-hospitalares e podem ser adaptadas ao contexto brasileiro como uma estratégia para minimizar a descontinuidade do cuidado por ocasião da alta hospitalar.

Objective to describe the activities developed by the liaison nurses for the continuity of care after hospital discharge. Method descriptive, qualitative study, based on the theoretical reference. Strength Based Care. The sample comprised 23 liaison nurses. The data was collected through a semi-structured questionnaire via Survey Monkey electronic platform and analyzed through the content analysis technique, with pre-defined categories. Results among the liaison nurses, nine (39.14%), between 35 and 44 years of age; 17 (73.91%) were female; 15 (65.22%) were working eleven years or more nurse and 11 (47.82%), were between six and ten years old as a liaison nurse. The professionals participate in the identification of the patients who need care after hospital discharge, coordinate the planning of the hospital discharge and transfer the patient's information to an extra-hospital service. Conclusion the activities developed by the liaison nurses focus on the needs of the patient and the articulation with the extra-hospital services, and can be adapted to the Brazilian context as a strategy to minimize the discontinuity of care at the time of hospital discharge.

Objetivo describir las actividades desarrolladas por las enfermeras de enlace para la continuidad del cuidado después del alta hospitalaria. Método estudio descriptivo, cualitativo, pautado en el referencial teórico Cuidado Basado en las Fuerzas. La muestra comprendió 23 enfermeras de enlace. Los datos fueron recolectados por medio de un cuestionario semiestructurado vía plataforma electrónica Survey Monkey y analizados por medio de la técnica de Análisis de Contenido, con categorías predefinidas. Resultados entre las enfermeras de enlace, nueve (39,14%), tenían 35 a 44 años de edad; 17 (73,91%), eran del sexo femenino; 15 (65,22%), trabajaban hace once o más años como enfermera y 11 (47,82%), actuaban de seis a diez años como enfermera de enlace. Las profesionales participan de la identificación de los pacientes que necesitan cuidados post-alta hospitalaria, coordinan la planificación del alta hospitalaria y transfieren las informaciones del paciente para un servicio extrahospitalario. Conclusión las actividades desarrolladas por las enfermeras de enlace se centran en las necesidades del paciente y en la articulación con los servicios extrahospitalarios, y pueden ser adaptadas al contexto brasileño como una estrategia para minimizar la discontinuidad del cuidado con ocasión del alta hospitalaria.

[Making a safe transition home after a meningioma resection: The impact of nursing care]. / Réussir une saine transition vers le domicile suite à une résection d'un méningiome: l'effet d'interventions infirmières.

INTRODUCTION: This study originated from patients' demands that they be better informed and that their meningioma diagnosis be considered serious. Meningioma are brain tumours that represent about 30% of all primary brain tumours. In 90% of the cases, they are non-cancerous. The objective was to identify whether educational intervention by nurses would have a positive impact on transition. METHOD: The study lasted 12 months and included two groups: intervention and control. Intervention involved the verbal and written delivery of answers to frequently asked questions, as well as patient follow-up for six weeks post-surgery. Nurses were available during the preparation for discharge, as well as the follow-up call 48-72 hours later. RESULTS: Educational nursing care had no demonstrable effect. DISCUSSION: Differences between the groups might have influenced the effect of educational intervention. Our results suggest certain lines of thought as to the doses of information that should be given based on stages of care and individual particularities.

Competências clínicas do enfermeiro assistencial: uma estratégia para gestão de pessoas / Competencias clínicas del enfermero asistencial: una estrategia para gestión de personas / Clinical competences of nursing assistants: a strategy for people management

RESUMO Objetivo: identificar as competências clínicas dos enfermeiros assistenciais de uma organização hospitalar e apreender como os profissionais as adquiriram. Método: estudo exploratório, de abordagem qualitativa, realizado em um hospital privado no sul do Brasil, por meio de uma entrevista semiestruturada, nos meses de maio a junho de 2013, com 20 enfermeiros assistenciais. Resultados: os enfermeiros assistenciais que atuavam por mais tempo em uma mesma unidade de trabalho apresentaram um maior rol de competências clínicas. A aquisição das competências clínicas ocorreu por meio da interação com outros profissionais; no cotidiano da prática de enfermagem; pelas experiências anteriores e pelo aprendizado formal. Considerações finais: a identificação das competências clínicas e o modo como os enfermeiros assistenciais as adquirem podem ser importantes recursos para a gestão de pessoas, que poderá ser utilizado por enfermeiros gestores para melhor alocar esses profissionais e oportunizar o seu desenvolvimento profissional.

RESUMEN Objetivo: identificar las competencias clínicas de los enfermeros asistenciales de una organización hospitalaria y aprehender cómo los profesionales las adquirieron. Método: estudio exploratorio, de enfoque cualitativo, realizado en un hospital privado en el sur de Brasil, por medio de una entrevista semi-estructurada, en los meses de mayo a junio de 2013, con 20 enfermeros asistenciales. Resultados: los enfermeros asistenciales que actuaban por más tiempo en una misma unidad de trabajo presentaron un mayor rol de competencias clínicas. La adquisición de las competencias clínicas fue por medio de la interacción con otros profesionales; en el cotidiano de la práctica de enfermería; por las experiencias anteriores y por el aprendizaje formal. Consideraciones finales: la identificación de las competencias clínicas y el modo cómo los enfermeros asistenciales las adquieren pueden ser importantes recursos para la gestión de personas, que podrá ser utilizado por enfermeros gestores para mejor alocar esos profesionales y dar la oportunidad su desarrollo profesional.

ABSTRACT Objective: to identify the clinical competences of nursing assistants in a hospital organization and to understand how professional acquired these competences. Method: an exploratory study of a qualitative approach, performed at a private hospital in southern Brazil, through a semi-structured interview, in May and June 2013 with 20 nursing assistants. Results: the nursing assistantswho worked longer in the same work unit had a higher list of clinical competences. The acquisition of clinical competences occurred through interaction with other professionals; in daily nursing practice; in previous experiences and in formal learning. Final considerations: the identification of clinical competences and the way nursing assistants acquire these competences can be important resources for managing people, which can be used by nurse managers to better allocate these professionals and provide th e opportunity for their professional development.

Contextual determinants of decentralization of epidemiological surveillance for the family health team / Determinantes contextuais da descentralização da vigilância epidemiológica para equipe de saúde da família / Determinantes contextuales de la descentralización de la vigilancia epidemiológica para el equipo de salud de la familia

This study examines the contextual determinants of implementing decentralization of epidemiological surveillance for the family health team, in a municipality in the state of Bahia, Brazil. This was an evaluative study using the political model of implementation analysis. Data were obtained through document analysis and semi-structured interviews with managers and healthcare workers. Five themes emerged: planning; training of human resources; organization of the work process; linkage within institutions; and organization of family healthcare units. The results revealed that there are difficulties such as poor infrastructure of healthcare units, creation of flexibility in labor relations and healthcare worker turnover. The study shows that there is a need for stakeholder participation in the process of implementing the policy of decentralization of epidemiological surveillance for the micro-area of intervention that comprises the family health program.

Este estudo analisa os determinantes contextuais da implantação da descentralização da vigilância epidemiológica para a Equipe de Saúde da Família, em um município do estado da Bahia, Brasil. Trata-se de pesquisa avaliativa, adotando-se o modelo político da análise de implantação. Os dados foram obtidos mediante a análise de documentos e entrevistas semiestruturadas aplicadas a gestores e trabalhadores da saúde. Emergiram cinco temas: Planejamento; capacitação de recursos humanos; organização do processo de trabalho; articulação intrainstitucional; organização da Unidade de Saúde da Família. Os resultados revelam dificuldades tais como: precária infraestrutura das unidades de saúde, flexibilização das relações de trabalho, rotatividade dos trabalhadores da saúde. O estudo aponta para a necessidade de participação dos atores no processo de implementação da política de descentralização da vigilância epidemiológica para um micro-espaço de intervenção que é o Programa de Saúde da Família.

Este estudio analiza las determinantes contextuales de la implantación de la descentralización de la vigilancia epidemiológica para el Equipo de Salud de la Familia, en un municipio de Bahia, Brasil. Se realizó un estudio de evaluación, adaptándose el modelo político del análisis de implantación. Los datos se obtuvieron por medio del análisis de documentos y entrevistas semi-estructuradas realizadas con gestores y trabajadores de la salud. Surgieron cinco temas: Planificación, capacitación de recursos humanos, organización del proceso de trabajo, articulación intra-institucional, organización de la Unidad de Salud de la Familia. Los resultados muestran dificultades: precaria infraestructura de las unidades de salud, flexibilización de las relaciones de trabajo, rotación de los trabajadores de la salud. El estudio señala la necesidad de participación de los actores en el proceso de implementación de la política de descentralización de la vigilancia epidemiológica para un micro espacio de intervención que es el programa de Salud de la Familia.

The use of the Nursing Activities Score in clinical settings: an integrative review / Como o instrumento Nursing Activities Score tem sido utilizado na prática clínica: revisão integrativa / Cómo el instrumento Nursing Activities Score se ha utilizado en la práctica clínica: revisión integradora

ABSTRACT Objective analyze how studies have approached the results obtained from the application of the Nursing Activities Score (NAS) based on Donabedian’s model of healthcare organization and delivery. Method CINAHL and PubMed databases were searched for papers published between 2003 and March 2015. Results 36 articles that met the inclusion criteria were reviewed and double-coded by three independent coders and analyzed based on the three elements of Donabedian’s health care quality framework: structure, process and outcome. The most frequently addressed, but not always tested, variables were those that fell into the structure category. Conclusion variables that fell into the process category were used less frequently. Beside NAS, the most frequently used variables in the outcome category were mortality and length of stay. However, no study used a quality framework for healthcare or NAS to evaluate costs, and it is recommended that further research should explore this approach.

RESUMO Objetivo Analisar como os estudos têm abordado os resultados obtidos com a aplicação do Nursing Acivities Score (NAS) na perspectiva de organização do cuidado em saúde, de acordo com o modelo de Donabedian. Método A pesquisa bibliográfica foi realizada a partir das bases de dados CINAHL e PubMed, no período compreendido entre 2003 e março de 2015. Os 36 artigos incluídos foram revisados e codificados duplamente por três avaliadores independentes e analisados à luz dos três elementos do modelo de qualidade de cuidados de saúde: Estrutura, Processo e Resultado. Resultados As variáveis relacionadas à Estrutura foram as mais frequentes, mas nem sempre foram testadas em relação ao NAS. Além do NAS variáveis relativas ao Processo foram menos utilizadas. No que concerne à etapa Resultado, as variáveis mortalidade e tempo de hospitalização foram as mais comuns. Conclusão Nenhum estudo testou a hipóteses sob a perspectiva de um modelo de cuidados de saúde, assim como de custos, uma abordagem que deve ser explorada em estudos posteriores.

RESUMEN Objetivo Analizar cómo los estudios se han ocupado de los resultados obtenidos con la aplicación del Nursing Acivities Score (NAS) en la perspectiva de organización de cuidados en salud, de acuerdo con el modelo de Donabedian. Método Una búsqueda bibliográfica se realizó a partir de las bases de datos CINAHL y PubMed para el período entre 2003 y marzo de 2015. Resultados El 36 artículos retenidos fueron revisados y codificados en dos ocasiones por tres evaluadores independientes y analizados a la luz de los tres elementos del modelo de calidad cuidado de la salud de Donabedian: Estructura, Proceso y Resultado. Conclusión Las variables relacionadas con la Estructura fueron el más común, pero no siempre se probaron para el NAS. Adémas del NAS, las variables relacionadas con el Proceso fueron menos recurrentes. En cuanto a la etapa de Resultado, las variables mortalidad y duración de la estancia hospitalaria fueron los más comunes. Sin embargo, ningún estudio probó hipótesis desde la perspectiva de un modelo de organisation de la atención de salud, así como de costos, un enfoque que debe ser explorado en estudios futuros.

Politics in nursing: an essential learning for postgraduate students / Políticas em enfermagem: um aprendizado essencial para estudantes de pós-graduação / Políticas en enfermería: un aprendizaje esencial para alumnos de posgrado

In Canada, as elsewhere, nurses must face many challenges if they want to participate as an influential group within health care organizations, but there are some facilitators; among them are the ability to analyze the context, issues and the right course of actions from a political perspective. This article shares the learning outcomes of postgraduate students during a seminar on policies related to nursing services administration at Université Laval, Québec, Canada. The aim of this article is to present the learning achieved from themes and issues discussed in the seminar and introduce tools for political analysis that are useful to draw the current state of nursing in the healthcare system. At the end of the seminar, the learning achieved allowed students to comprehend different elements that must be taken into account to assess the current situation concerning important issues for the nursing profession and consider courses of action to influence their evolution.

No Canadá, como em outros lugares, enfermeiros devem enfrentar muitos desafios caso queiram participar como um grupo que influencia em organizações de cuidados em saúde. Contudo, existem alguns facilitadores, entre eles estão a habilidade de analisar o contexto, assuntos e percurso correto de ações sob a perspectiva política. Este artigo compartilha o resultado de aprendizado de estudantes de pós-graduação durante um seminário em politicas relacionadas aos serviços de administração de enfermagem na Universidade Laval, Quebec, Canadá. O objetivo deste artigo é apresentar o aprendizado alcançado sobre temas e assuntos discutidos e introduzir ferramentas para análise política, úteis para descrever a atual posição de enfermagem no sistema de saúde. No final do seminário, o aprendizado permitiu aos estudantes compreender diferentes elementos que devem ser considerados para avaliar a atual situação no que diz respeito a assuntos importantes para a profissão, e considerar percursos de ação para influenciar seu desenvolvimento.

En Canadá, como en otros sitios, enfermeros deben pasar por muchos desafíos si desean participar como un grupo que influencia organizaciones de cuidados en salud. Sin embargo, hay algunos facilitadores, entre los cuales están la habilidad de analizar el contexto, asuntos y camino correcto de acciones bajo la perspectiva política. Este artículo comparte el resultado del aprendizaje de estudiantes de posgrado durante un congreso de políticas relacionadas a los servicios de administración de enfermería en la Universidad Laval, Quebec, Canadá. El objetivo del artículo fue presentar el aprendizaje alcanzado acerca de temas y asuntos discutidos así como introducir herramientas para análisis político, útiles para describir la actual posición de la enfermería en el sistema de salud. En el final del evento, el aprendizaje permitió a los estudiantes comprender diferentes elementos que deben ser considerados para evaluar la actual situación acerca de asuntos importantes para la profesión, y considerar caminos de acción para influenciar su desarrollo.

[Functions of nurses in hematopoietic stem cell transplantation units]. / Fonctions des infirmières dans les unitiés de transplantation de cellules souches hématopoïétiques.

INTRODUCTION: nurses working at the hematopoietic stem cells transplantation (HSCT) unit execute very specialized activities since transplantation is more than just being complex but involves a set of procedural techniques. OBJECTIVE: describe activities completed by nurses working at HSCT units and classify them according to the frame of reference of a Brazilian HSTC unit. METHOD: A qualitative descriptive research was carried out in May 2011 with 12 nurses using systematic observation techniques of their daily activities for a total of 77 hours. RESULTS: staff nurses principally carry out caregiving activities and education whereas those related to cooperation, coordination and supervision are mainly executed by the nurse manager and visiting nurses. CONCLUSION: nurses carry out all functions. They take charge of all transplant patients treatments and services. In some way, nurses exceed the scope of the profession.

Funções desempenhadas pelo enfermeiro em Unidade de Terapia Intensiva / Functions developed by nurse in an intensive care unit

Pesquisa exploratória de abordagem qualitativa com objetivo geral de identificar as funções desempenhadas pelo enfermeiro em Unidade de Terapia Intensiva, seguindo o referencial teórico canadense de funções do enfermeiro (cuidar, educar, coordenar, colaborar e supervisionar). A coleta de dados ocorreu em 2009 pela aplicação de um questionário e pela observação sistemática com nove enfermeiros de uma unidade de terapia intensiva de uma instituição hospitalar privada do município de Curitiba. Os dados coletados foram categorizados pela técnica de análise de conteúdo. Os resultados indicam que os enfermeiros são majoritariamente jovens do sexo feminino e que não possuem especialização em unidade de terapia intensiva. A observação das atividades permitiu constatar que todas as funções descritas no referencial utilizado são desempenhadas pelos enfermeiros deste serviço, sendo as funções de coordenação, supervisão e cuidado técnico especializado as mais expressivas.

Colaboração internacional entre programas de pós graduação strictu sensu / IInternational collaboration between post-graduate programs strictu sensu

O presente trabalho pretende relatar a experiência de colaboração entre professores de programas de pós-graduação strictusensu em Enfermagem que acontece entre a Universidade Federal do Paraná e a Universidade Laval no Canadá. Esta colaboração iniciou-se ao final de 2008 e as estratégias incluem a participação em bancas de qualificação e defesa, oportunidades de apresentação e participação em congressos internacionais financiados pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Fundação Araucária e Universidade Federal do Paraná, co-orientação de estudantes e oferta de disciplinas à distância. Elementos técnicos e facilitadores permitiram contornar as distâncias geográficas e culturais e fazer avançar a parceria. Os desafios são numerosos e se relacionam ao custeio das ações de integração, domínio de língua estrangeira, dificuldade em conciliar abordagens e objetos de pesquisa. Os benefícios se relacionam à discussão e análise da prática profissional em enfermagem sob novas abordagens em diferentes contextos

From hospital to home after cardiac surgery: evaluation of a community nursing care management model.

PURPOSE/OBJECTIVES: This quasi-experimental research aims to (1) evaluate the implementation process of a community nursing care management model and (2) assess the effects of this model on patients followed at home. PRIMARY PRACTICE SETTING: Two community healthcare centers had introduced a community nursing care management model in their practice (experimental groups), whereas another health community care center with no experience with such a model served as a control group. The community nursing care management model included clinical pathways designed for a clientele who had been hospitalized for cardiac surgery. FINDINGS/CONCLUSIONS: Even though the implementation process was challenging, the community nursing care management model was found useful enough to be integrated into routine nursing home care practice after cardiac surgery. Although the effects produced by this systematic home care program on the clientele did not differ significantly from those produced by usual nursing care, there was a positive effect for the clientele recorded on all measurement indicators used. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: The introduction of the nursing care management model enabled nurses to structure the care provided and reduced interindividual variation. The application of this program also proved to be an opportunity to initiate and assimilate new professional roles. Additional studies should be conducted to assess its effectiveness in home care for other health problems.

[Loan of services developing palliative care skills based on the apprentice model]. / La mesure de prêt de services. Le développement des compétences en soins palliatifs basé sur le modèle d'apprenti.

For over 25 years, the Maison Michel-Sarrazin, a private palliative care institution in the Quebec City region, has had an original agreement with other establishments in the healthcare network (hospitals, long-term residential centres and CLSCs), in the form of the loan of nursing services. Based on the findings of a study as part of a research program, this article describes the loan of nursing services and qualitatively assesses its effects on the development of nurses' palliative care skills. An evaluative descriptive approach based on two conceptual frameworks (Giddens; Patton) was used to compile the views of 79 players. The findings demonstrate the innovative nature of the loan of nursing services and its considerable influence on the development of nursing skills, thanks to training based on the apprenticeship model (learning through observation and imitation), and on nursing practice at the Maison Michel-Sarrazin. Nevertheless, the controversy surrounding training using the apprenticeship model and the lack of recognition of this training on the part of the lending institutions raise questions despite the general satisfaction with the loan of nursing services.

The benefits of a palliative care network: a case study in Quebec, Canada.

This article aims to present the beneficial effects associated with the local implementation of an integrated network in palliative care, as perceived by diverse constituency groups. A case study was conducted in the province of Quebec, Canada, using individual (n=16) and group (n=16) interviews, with a total of 106 participants (i.e. managers and formal and informal caregivers). From a content analysis, two categories of beneficial effects emerged: those associated with professional practice and those with patient services. The most important effects of this organisational initiative were found to be the recognition of the palliative care domain necessitating specialized competencies, an improved interdisciplinary collaboration, and more efficient circulation of information between care settings, as well as improved accessibility, continuity and quality of care and services to patients at the end of life.

Healthy public policy A conceptual cognitive framework.

More than three decades ago, the report A New Perspective on the Health of Canadians (1974) highlighted the significance of other determinants than the healthcare system. The adoption of healthy public policy was identified in the Ottawa Charter (1986) as one of five strategies aiming to promote health. It must now be acknowledged that even if we have a better understanding of health determinants, the latter are not necessarily taken into consideration when developing public policies. The purpose of this paper is to help foster a better understanding of the healthy public policies by presenting a conceptual framework that is inspired by the Advocacy Coalition Framework developed by Sabatier and Jenkins-Smith (1999). On the one hand, this paper intends to show the relevance of the notion of subsystem of public policies in healthy public policy process. On the other, it aims to convince that it is necessary to channel the analysis around the decision-making process, the prospective evaluation of public policies and the knowledge transfer and appropriation process. Finally, the purpose of this paper is to contribute to the ongoing debate about the role of knowledge, values or beliefs in the formulation and adoption of public policies. After briefly summarizing the theoretical developments in studies on public policies, the logic and components of the ACF are introduced. The main criticisms regarding the ACF are then examined, followed by an introduction of the conceptual framework that is adapted to the reality of healthy public policies. The notions of the subsystem of public policy(ies), of process and of learning process are central to this framework.