[Nursing practice in palliative care with terminally ill cancer patients in an interdisciplinary team: A case study in Lebanon]. / La pratique infirmière en soins palliatifs auprès de patients atteints de cancer en fin de vie au sein d'une équipe interdisciplinaire : une étude de cas au Liban.

Nurses in Lebanon are poorly prepared to provide palliative care (PC), and practice in this area is poorly documented. This qualitative descriptive study aimed to understand the reality of nursing practice in PC, with terminally ill cancer patients, within an interdisciplinary team. A simple case study was conducted with eleven nurses, three families, an interdisciplinary team, and national experts in PC. Data analysis, carried out with triangulation of both methods and sources, highlighted a humanist relationship characterized by caring, transcending the five central emerging themes : the perception of PC as a means of offering a better quality of life, comprehensive patient care, interdisciplinarity, spirituality, and family support during PC. The results could provide empirical foundations to guide the development of PC nursing practice in the country.

La pratique infirmière en soins palliatifs auprès de patients atteints de cancer en fin de vie au sein d'une équipe interdisciplinaire : une étude de cas au Liban.

Nurses in Lebanon are poorly prepared to provide palliative care (PC), and practice in this area is poorly documented. This qualitative descriptive study aimed to understand the reality of nursing practice in PC, with terminally ill cancer patients, within an interdisciplinary team. A simple case study was conducted with eleven nurses, three families, an interdisciplinary team, and national experts in PC. Data analysis, carried out with triangulation of both methods and sources, highlighted a humanist relationship characterized by caring, transcending the five central emerging themes : the perception of PC as a means of offering a better quality of life, comprehensive patient care, interdisciplinarity, spirituality, and family support during PC. The results could provide empirical foundations to guide the development of PC nursing practice in the country.

[Clinical surveillance process by expert critical care nurses: Illustration of the results of a study in nursing from a clinical vignette]. / Processus de surveillance clinique par des infirmières expertes de soins critiques : illustration des résultats d'une étude en sciences infirmières à partir d'une vignette clinique.

In nursing, surveillance is generally presented as an essential element to ensure patient safety. In order to better understand how clinical surveillance is put into practice by expert nurses, a study in nursing was conducted in 2016. This article aims to present the results of this research with a clinical vignette to make concrete the links that exist between theory and practice. This will result in a better understanding of the surveillance process by expert nurses in critical care settings.

[Knowledge transfer and appropriation processes of nursing students and African settings of care: a multiple case study]. / Processus de transfert et d'appropriation des savoirs d'étudiantes en sciences infirmières et de milieux de soins Africains: une étude de cas multiples.

BACKGROUND: in this era of globalisation and international academic training, many nursing programs offer the possibility of intercultural placement to their students in their initial training. The rise of this phenomena is ubiquitous throughout all Canadian universities, leading to increased student mobility at the international level with increased placements being organised at the international level, on several continents. PURPOSE: this exploratory study aims at better understanding the processes of knowledge transfer and appropriation during international and intercultural placements in nursing in African countries. FRAMEWORK: the models of empowerment and the Cycle of knowledge to practice have guided this study. METHOD: a multiple case study has been conducted with six settings of care from two countries of Africa. Individual interviews were conducted with the nursing students (n = 11) and with the African nurses supervisors (n = 9), and group interviews with the local partners (n = 2). Direct and participant observations were also done by the nursing students while they were in Africa in the summer and by the two principal investigators when they spent a week in the settings of care, the following fall. RESULTS : advantages of this learning activity were noted, especially in regards to personal and professional growth of the nursing students and in regards to knowledge transfer to the host settings. DISCUSSION : four themes emerged and led to recommendations as to the importance of: 1) bidirectional communication, continuity of projects between cohorts of nurses, and support at distance and on site, 2) reinforcement of the emancipatory sociopolitical knowing 3) diversity of care and community sites and expositions, and 4) different phases of the Cycle of knowledge to practice.

Evaluation of patient involvement in a health technology assessment.

OBJECTIVES: We sought to evaluate patient involvement (consultation and direct participation) in the assessment of alternative measures to restraint and seclusion among adults in short-term hospital wards (in psychiatry) and long-term care facilities for the elderly. METHODS: We conducted individual semi-structured interviews with thirteen stakeholders: caregivers, healthcare managers, patient representatives, health technology assessment (HTA) unit members, researchers, and members of the local HTA scientific committee. Data were collected until saturation. We carried out content analysis of two HTA reports and four other documents that were produced in relation with this HTA. We also used field notes taken during formal meetings and informal discussions with stakeholders. We performed thematic analysis based on a framework for assessing patient involvement in HTA. We then triangulated data. RESULTS: For the majority of interviewees, patient consultation enriched the content of the HTA report and its recommendations. This also made it possible to suggest other alternatives that could reduce the use of restraint and seclusion and helped confirm some views and comments from healthcare professionals consulted in this HTA. The direct participation of patient representatives enabled rephrasing of some findings so as to bring the patient perspective to the HTA report. CONCLUSIONS: Patient consultation was seen as having directly influenced the content of the HTA report while direct participation made it possible to rephrase some findings. This is one of few studies to assess the impact of patient involvement in HTA and more such studies are needed to identify the best ways to improve the input of such involvement.

FRAMEWORK FOR USER INVOLVEMENT IN HEALTH TECHNOLOGY ASSESSMENT AT THE LOCAL LEVEL: VIEWS OF HEALTH MANAGERS, USER REPRESENTATIVES, AND CLINICIANS.

OBJECTIVES: The aim of this study was to explore stakeholders' points of views regarding the applicability and relevance of a framework for user involvement in health technology assessment (HTA) at the local level. We tested this framework in the context of the assessment of alternative measures to restraint and seclusion among hospitalized adults and those living in long-term-care facilities. METHODS: Twenty stakeholders (health managers, user representatives, and clinicians) from seven regions of Quebec participated in a semi-structured interview. A thematic analysis of the transcribed interviews was performed. RESULTS: The findings highlighted the relevance and applicability of the framework to this specific HTA. According to interviewees, direct participation of users in the HTA process allows them to be part of the decision-making process. User consultation makes it possible to consider the views of a wide variety of people, such as marginalized and vulnerable groups, who do not necessarily meet the requirements for participating in HTA committees. However, some user representatives emphasized that user consultation should be integrated into a more holistic and participatory perspective. The most frequent barrier associated with user involvement in HTA was the top-down health system, which takes little account of the user's perspective. CONCLUSIONS: The proposed framework was seen as a reference tool for making practitioners and health managers aware of the different mechanisms of user involvement in HTA and providing a structured way to classify and describe strategies. However, there is a need for more concrete instruments to guide practice and support decision making on specific strategies for user involvement in HTA at the local level.

Adaptation and Evaluation of Online Self-learning Modules to Teach Critical Appraisal and Evidence-Based Practice in Nursing: An International Collaboration.

Healthcare professionals need to update their knowledge and acquire skills to continually inform their practice based on scientific evidence. This study was designed to evaluate online self-learning modules on critical appraisal skills to promote the use of research in clinical practice among nurses from Quebec (Canada) and the Basque Country (Spain). The teaching material was developed in Quebec and adapted to the Basque Country as part of an international collaboration project. A prospective pre-post study was conducted with 36 nurses from Quebec and 47 from the Basque Country. Assessment comprised the administration of questionnaires before and after the course in order to explore the main intervention outcomes: knowledge acquisition and self-learning readiness. Satisfaction was also measured at the end of the course. Two of the three research hypotheses were confirmed: (1) participants significantly improved their overall knowledge score after the educational intervention; and (2) they were, in general, satisfied with the course, giving it a rating of seven out of 10. Participants also reported a greater readiness for self-directed learning after the course, but this result was not significant in Quebec. The study provides unique knowledge on the cultural adaptation of online self-learning modules for teaching nurses about critical appraisal skills and evidence-based practice.

Vascular access for chronic hemodialysis in children: arteriovenous fistula or central venous catheter?

BACKGROUND: The choice of vascular access (VA) for hemodialysis (HD) in end-stage renal disease (ESRD) is arteriovenous fistula (AVF) or central venous catheter (CVC). Whereas clinical practice guidelines suggest AVF to preserve the vascular bed, pediatric nephrologists tend to favor CVC for shorter-term dialysis. Our objective was to determine whether pediatric priority allocation policies for deceased-donor kidneys affect VA planning. METHODS: Pediatric priority for deceased-donor kidneys was instituted in Quebec in 2004. We retrospectively compared clinical practice on AVF, CVC, wait time on transplant list, HD duration in pre-policy (group A) and post-policy (group B) from 1997-2011. RESULTS: We identified 78 patients with a median age of 14.7 years (range, 0.7-20.5 years) and weight of 46 kg (12.5-95 kg); AVF decreased from 76 % in group A to 41 % in group B (p = 0.002). Wait times on transplant list were significantly reduced: median 413.5 days (range, 2-1,910 days) in group A vs. 89 days (range, 18-692 days) in group B (p = 0.003). Time on HD for deceased-donor recipients was shorter: 705 (range, 51-1,965 days) group A vs. 349.5 days (range, 158-1,060 days) group B (p = 0.01). CONCLUSIONS: This is the first study to document VA changes related to pediatric priority allocation policy. Our fistula-first center saw a shift toward CVC-first.

Introducing the patient's perspective in hospital health technology assessment (HTA): the views of HTA producers, hospital managers and patients.

BACKGROUND: The recent establishment of health technology assessment (HTA) units in University hospitals in the Province of Quebec (Canada) provides a unique opportunity to foster increased participation of patients in decisions regarding health technologies and interventions at the local level. However, little is known about factors that influence whether the patient's perspective is taken into consideration when such decisions are made. OBJECTIVE: To explore the practices, perceptions and views of the various HTA stakeholders concerning patient involvement in HTA at the local level. METHOD: Data were collected using semi-structured interviews with 24 HTA producers and hospital managers and two focus groups with a total of 13 patient representatives. RESULTS: Patient representatives generally showed considerable interest in being involved in HTA. Our findings support the hypothesis that the patient perspective contributes to a more accurate and contextualized assessment of health technologies and produces HTA reports that are more useful for decision makers. They also suggest that participation throughout the assessment process could empower patients and improve their knowledge. Barriers to patient involvement in HTA at the local level are also discussed as well as potential strategies to overcome them. DISCUSSION AND CONCLUSION: This study contributes to knowledge that could guide interventions in favour of patient participation in HTA activities at the local level. Experimenting with different patient involvement strategies and assessing their impact is needed to provide evidence that will inform future interventions of this kind.

Involving patient in the early stages of health technology assessment (HTA): a study protocol.

BACKGROUND: Public and patient involvement in the different stages of the health technology assessment (HTA) process is increasingly encouraged. The selection of topics for assessment, which includes identifying and prioritizing HTA questions, is a constant challenge for HTA agencies because the number of technologies requiring an assessment exceeds the resources available. Public and patient involvement in these early stages of HTA could make assessments more relevant and acceptable to them. Involving them in the development of the assessment plan is also crucial to optimize their influence and impact on HTA research. The project objectives are: 1) setting up interventions to promote patient participation in three stages of the HTA process: identification of HTA topics, prioritization, and development of the assessment plan of the topic prioritized; and 2) assessing the impact of patient participation on the relevance of the topics suggested, the prioritization process, and the assessment plan from the point of view of patients and other groups involved in HTA. METHODS: Patients and their representatives living in the catchment area of the HTA Roundtable of Université Laval's Integrated University Health Network (covering six health regions of the Province of Quebec, Canada) will be involved in the following HTA activities: 1) identification of potential HTA topics in the field of cancer; 2) revision of vignettes developed to inform the prioritization of topics; 3) participation in deliberation sessions for prioritizing HTA topics; and 4) development of the assessment plan of the topic prioritized. The research team will coordinate the implementation of these activities and will evaluate the process and outcomes of patient involvement through semi-structured interviews with representatives of the different stakeholder groups, structured observations, and document analysis, mainly involving the comparison of votes and topics suggested by various stakeholder groups. DISCUSSION: This project is designed as an integrated approach to knowledge translation and will be conducted through a close collaboration between researchers and knowledge users at all stages of the project. In response to the needs expressed by HTA producers, the knowledge produced will be directly useful in guiding practices regarding patient involvement in the early phases of HTA.

[Patient participation in the assessment of alternatives to restraint and seclusion]. / La participation des patients à ;'évaluation des mesures alternatives à la contention et à l'isolement.

AIM: To explore the perceptions of members of a working group of caregivers, health technology assessment (HTA) units members, healthcare facilities managers and patients representatives regarding the participation of the latter in the assessment of alternatives to restraint and seclusion among adults in short-term psychiatric wards and in long-term care facilities for the elderly, in Quebec. METHODS: A descriptive design was used for this research based on fifteen semi-structured interviews with caregivers, healthcare managers, patient representatives and HTA unit members. The direct observation of two meetings of the working group and informal discussions with participants at these meetings was also performed. Data analysis was based on a framework developed to assess patients' involvement in HTA. RESULTS: Information resources and human resources were mobilized to support the participation of patients' representatives. Nevertheless, this participation was uneven between patients' representatives due to their personal characteristics, the understanding of their role in this working group and expectations of the committee. The presence of patient representatives led caregivers and managers to focus the assessment on patients' concerns and to adjust the language used during the meeting. Moreover, organizational and political context has been identified as a facilitator for this participation. CONCLUSION: Involving patients' representatives in HTA activities is thus possible. However, some resources must be mobilized to equip patients' representatives who participate in these activities and personal characteristics should be considered when selecting them to favour their involvement

[Description of factors facilitating and restricting the use of research results: the point of view of Tunisian nurses]. / Description des facteurs facilitants et contraignants l'utilisation des résultats de la recherche: le point de vue d'infirmiers tunisiens.

BACKGROUND: The written agree on the importance of nursing research as a means to improve the quality effectiveness and efficiency of care and contribute to advance in the nursing discipline. Studies from different countries have attempted to describe the barriers and facilitating the use of researcher by staff nurse, however, no original studies have been conducted in Tunisia. PURPOSE AND FRAMEWORK: According to the theory of innovation of Rogers, this study aims to identify factors facilitating and contraining the use of research as an innovation from the point of view of Tunisian nurses. METHODS: A mixed descriptive design allowed to raise perceptions of 5 manager nurses and 37 clinicians nurses in 2 care units of the university hospital of Sousse in Tunisia. Three methods of data collection were used either semistructured interviews (n = 5), a self-reported questionnaire including the scale of measurement of Funk and al., on the barriers of using the research (n = 37) and an observation grid units of participating care (n = 2). RESULTS: A triangulation of data revealed that they are organizational factors that seem to be the main determinants of using the research. In fact, the average of score calculated for the four factors of the scale of Funk showed that for the interviewed nurses, the characteristic of the organization present the highest average (3,01), followed by those with relation to the characteristic of the nurse (2,86) of the research (2,73) and of the diffusion (2,55). The qualitative analysis support these results. DISCUSSION: The recommendations for the value of using the results of research in Tunisia were formulated followed by limitations of the study.

The impact of blended teaching on knowledge, satisfaction, and self-directed learning in nursing undergraduates: a randomized, controlled trial.

AIM: This study aimed to assess the effectiveness of a blended-teaching intervention using Internet-based tutorials coupled with traditional lectures in an introduction to research undergraduate nursing course. Effects of the intervention were compared with conventional, face-to-face classroom teaching on three outcomes: knowledge, satisfaction, and self-learning readiness. METHOD: A two-group, randomized, controlled design was used, involving 112 participants. Descriptive statistics and analysis of covariance (ANCOVA) were performed. RESULTS: The teaching method was found to have no direct impact on knowledge acquisition, satisfaction, and self-learning readiness. However, motivation and teaching method had an interaction effect on knowledge acquisition by students. Among less motivated students, those in the intervention group performed better than those who received traditional training. CONCLUSION: These findings suggest that this blended-teaching method could better suit some students, depending on their degree of motivation and level of self-directed learning readiness.

Involving patients in HTA activities at local level: a study protocol based on the collaboration between researchers and knowledge users.

BACKGROUND: The literature recognizes a need for greater patient involvement in health technology assessment (HTA), but few studies have been reported, especially at the local level. Following the decentralisation of HTA in Quebec, Canada, the last few years have seen the creation of HTA units in many Quebec university hospital centres. These units represent a unique opportunity for increased patient involvement in HTA at the local level. Our project will engage patients in an assessment being carried out by a local HTA team to assess alternatives to isolation and restraint for hospitalized or institutionalized adults. Our objectives are to: 1) validate a reference framework for exploring the relevance and applicability of various models of patient involvement in HTA, 2) implement strategies that involve patients (including close relatives and representatives) at different stages of the HTA process, 3) evaluate intervention processes, and 4) explore the impact of these interventions on a) the applicability and acceptability of recommendations arising from the assessment, b) patient satisfaction, and c) the sustainability of this approach in HTA. METHODS: For Objective 1, we will conduct individual interviews with various stakeholders affected by the use of alternatives to isolation and restraint for hospitalized or institutionalized adults. For Objective 2, we will implement three specific strategies for patient involvement in HTA: a) direct participation in the HTA process, b) consultation of patients or their close relatives through data collection, and c) patient involvement in the dissemination of HTA results. For Objectives 3 and 4, we will evaluate the intervention processes and the impact of patient involvement strategies on the recommendations arising from the HTA and the understanding of the ethical and social implications of the HTA. DISCUSSION: This project is likely to influence future HTA practices because it directly targets knowledge users' need for strategies that increase patient involvement in HTA. By documenting the processes and outcomes of these involvement strategies, the project will contribute to the knowledge base related to patient involvement in HTA.

Development of a shared theory in palliative care to enhance nursing competence.

AIM: This discussion article focuses on the theoretical development of a shared theory in the field of palliative care nursing through a process of comparison between Bandura's social cognitive theory and Orem's conceptual model. BACKGROUND: In many countries, nurses are little prepared to provide care to patients with life-limiting illness. Bandura's theory provides an appropriate framework for evaluating the impact of training programmes aimed at improving nursing competence in palliative care. However, this borrowed psychological theory is not specific to nursing contexts. Orem's self-care deficit theory seems to be an appropriate nursing model to guide the use of Bandura's theory in palliative care nursing situations. DATA SOURCES: A review of the literature published between 1987 and 2011 was conducted to evaluate how Bandura's social cognitive theory and Orem's conceptual model have been linked at a theoretical level in the past. DISCUSSION: Bandura's theory has been linked with Orem's model essentially at the patient level. A new shared theory that combines Bandura's social cognitive theory and Orem's conceptual model at the nursing level is thus proposed. Palliative care nursing self-competence is hypothesized to influence the quality of nursing interventions in palliative care situations. CONCLUSION: To further demonstrate the relevance of this proposed shared theory in palliative care nursing contexts, empirical studies are recommended. This shared theory has the potential to provide a solid theoretical framework for evaluating nursing training programmes and, eventually, to improve quality of care and quality of life for patients with life-limiting illness.

Using the theory of planned behaviour to predict nurses' intention to integrate research evidence into clinical decision-making.

AIMS: Using an extended theory of planned behaviour, this article is a report of a study to identify the factors that influence nurses' intention to integrate research evidence into their clinical decision-making. BACKGROUND: Health professionals are increasingly asked to adopt evidence-based practice. The integration of research evidence in nurses' clinical decision-making would have an important impact on the quality of care provided for patients. Despite evidence supporting this practice and the availability of high quality research in the field of nursing, the gap between research and practice is still present. DESIGN: A predictive correlational study. METHODS: A total of 336 nurses working in a university hospital participated in this research. Data were collected in February and March 2008 by means of a questionnaire based on an extension of the theory of planned behaviour. Descriptive statistics of the model variables, Pearson correlations between all the variables and multiple linear regression analysis were performed. RESULTS/FINDINGS: Nurses' intention to integrate research findings into clinical decision-making can be predicted by moral norm, normative beliefs, perceived behavioural control and past behaviour. The moral norm is the most important predictor. Overall, the final model explains 70% of the variance in nurses' intention. CONCLUSION: The present study supports the use of an extended psychosocial theory for identifying the determinants of nurses' intention to integrate research evidence into their clinical decision-making. Interventions that focus on increasing nurses' perceptions that using research is their responsibility for ensuring good patient care and providing a supportive environment could promote an evidence-based nursing practice.

Introducing patients' and the public's perspectives to health technology assessment: A systematic review of international experiences.

OBJECTIVES: The aim of this study was to review international experiences of patient or public involvement in the field of health technology assessment (HTA). METHODS: A systematic review of the scientific literature was conducted. A literature search was performed across nine databases. Other literature was identified through citation tracking, government websites (HTA agencies), and Internet search engines. Characteristics of the studies, description of the activities related to patient or public involvement, impact of these activities on the HTA process, and factors facilitating or limiting involvement were abstracted independently by two reviewers. RESULTS: A total of 1,441 potentially relevant papers were identified by the main search strategy. Among these, seventeen papers met the inclusion criteria; other search strategies identified seven additional documents. The findings reveal that patient or public involvement in HTA activities was reported in two domains, research and HTA process. In the research domain, patients are consulted to gather evidence about their perspectives, experiences, or preferences about a health technology. These perspectives could add key dimensions to the evaluation of health technologies that might otherwise be overlooked. In the domain of the HTA process, patients or public representatives participate in different stages of this process: prioritization, evidence assessment, or dissemination of findings. CONCLUSIONS: There are few published examples of experiences involving patients and the public in HTA. These examples show that patients' or the public's perspectives could add important dimensions to the evaluation of health technologies. However, there is a need to develop more systematic approaches to considering patients' and the public's perspectives in HTA.

[The nursing practice informed by research: leader training in health organizations, a promising path]. / La pratique infirmière informée par des résultats de recherche: la formation de leaders dans les organisations de santé, une avenue prometteuse.

PROBLEM: Despite the recognition by nurses of the importance of supporting their experiential knowledge on scientific data, evidence-based nursing research is seldom integrated in their practice. An important limitation is the nurses' general lack of basic abilities to use research to better inform their clinical decision making. The objective of this pilot study was to evaluate a leader training intervention on research results integration in nursing practice. INTERVENTION: Seven advanced practice nurses and 12 clinical nurses from six care specialties jointly participated to training activities on knowledge transfer and exchange. METHOD: Nineteen nurses went through a 20-day training internship and 14 participated to two interviews, before and after the intervention. RESULTS AND CONCLUSION: Overall, nurses were very positive about their participation to the training. Difficulties encountered during the internship and the prior negative perception about the research process, were largely offset by the acquired capabilities and the clinical results of the intervention. Furthermore, the beginning of change in the organization and in relations with some health professionals were noted and seen as positive.