Measuring Health Care Work-Related Contextual Factors: Development of the McGill Context Tool.

INTRODUCTION: Contextual factors can influence healthcare professionals' (HCPs) competencies, yet there is a scarcity of research on how to optimally measure these factors. The aim of this study was to develop and validate a comprehensive tool for HCPs to document the contextual factors likely to influence the maintenance, development, and deployment of professional competencies. METHODS: We used DeVellis' 8-step process for scale development and Messick's unified theory of validity to inform the development and validation of the context tool. Building on results from a scoping review, we generated an item pool of contextual factors articulated around five themes: Leadership and Agency, Values, Policies, Supports, and Demands. A first version of the tool was pilot tested with 127 HCPs and analyzed using the classical test theory. A second version was tested on a larger sample (n = 581) and analyzed using the Rasch rating scale model. RESULTS: First version of the tool: we piloted 117 items that were grouped as per the themes related to contextual factors and rated on a 5-point Likert scale. Cronbach alpha for the set of 12 retained items per scale ranged from 0.75 to 0.94. Second version of the tool included 60 items: Rasch analysis showed that four of the five scales (ie, Leadership and Agency, Values, Policies, Supports) can be used as unidimensional scales, whereas the fifth scale (Demands) had to be split into two unidimensional scales (Demands and Overdemands). DISCUSSION: Validity evidence documented for content and internal structure is encouraging and supports the use of the McGill context tool. Future research will provide additional validity evidence and cross-cultural translation.

Demand management processes to improve access to cognitive-behavioral therapies for anxiety disorders: a grounded theory study.

Introduction: Anxiety disorders are impactful mental health conditions for which evidence-based treatments are available, notably cognitive-behavioral therapies (CBTs). Even when CBTs are available, demand-side factors limit their access, and actors in a position to perform demand management activities lack a framework to identify context-appropriate actions. Methods: We conducted a constructivist grounded theory study in Quebec, Canada, to model demand management targets to improve access to CBTs for anxiety disorders. We recruited key informants with diverse experiences using purposeful, then theoretical sampling. We analyzed data from 18 semi-directed interviews and 20 documents through an iterative coding process centered around constant comparison. Results: The resulting model illustrates how actors can target clinical-administrative processes fulfilling the demand management functions of detection, evaluation, preparation, and referral to help patients progress on the path of access to CBTs. Discussion: Modeling clinical-administrative processes is a promising approach to facilitate leveraging the competency of actors involved in demand management at the local level to benefit public mental health.

Validity as a social imperative: users' and leaders' perceptions.

Introduction: Recently, validity as a social imperative was proposed as an emerging conceptualization of validity in the assessment literature in health professions education (HPE). To further develop our understanding, we explored the perceived acceptability and anticipated feasibility of validity as a social imperative with users and leaders engaged with assessment in HPE in Canada. Methods: We conducted a qualitative interpretive description study. Purposeful and snowball sampling were used to recruit participants for semi-structured individual interviews and focus groups. Each transcript was analyzed by two team members and discussed with the team until consensus was reached. Results: We conducted five focus group and eleven interviews with two different stakeholder groups (users and leaders). Our findings suggest that the participants perceived the concept of validity as a social imperative as acceptable. Regardless of group, participants shared similar considerations regarding: the limits of traditional validity models, the concept's timeliness and relevance, the need to clarify some terms used to characterize the concept, the similarities with modern theories of validity, and the anticipated challenges in applying the concept in practice. In addition, participants discussed some limits with current approaches to validity in the context of workplace-based and programmatic assessment. Conclusion: Validity as a social imperative can be interwoven throughout existing theories of validity and may represent how HPE is adapting traditional models of validity in order to respond to the complexity of assessment in HPE; however, challenges likely remain in operationalizing the concept prior to its implementation.

Contexte: Une nouvelle manière de concevoir la validité en matière d'évaluation des apprentissages dans les programmes en sciences de la santé a récemment été proposée : la validité en tant qu'impératif social. Pour mieux la comprendre, nous avons exploré l'acceptabilité perçue et la faisabilité anticipée de la validité en tant qu'impératif social auprès d'utilisateurs et de leaders en matière d'évaluation en éducation des professions de la santé au Canada. Méthodes: Nous avons mené une étude qualitative descriptive interprétative. Pour recruter les participants aux entrevues individuelles semi-structurées et aux groupes de discussion, nous avons utilisé l'échantillonnage par choix raisonné et l'échantillonnage boule de neige. Les transcriptions ont été analysées par deux membres de l'équipe et discutées avec l'ensemble de l'équipe jusqu'à l'obtention d'un consensus. Résultats: Nous avons mené cinq groupes de discussion et onze entretiens avec deux groupes de parties prenantes, l'un composé d'utilisateurs, l'autre de leaders. Nos résultats suggèrent que les participants estiment acceptable le concept de validité comme impératif social. Quel que soit le groupe, les participants ont partagé des considérations similaires concernant : les limites des modèles de validité traditionnels, l'actualité et la pertinence du concept, la nécessité de clarifier certains termes utilisés pour définir le concept, les similitudes avec les théories modernes de la validité, et les défis anticipés de son application. En outre, les participants ont soulevé certaines limites des approches actuelles de la validité dans le contexte de l'évaluation en milieu de travail et de l'évaluation programmatique. Conclusion: La notion de validité comme impératif social peut être incorporée dans les théories existantes pour traduire l'adaptation des modèles traditionnels de la validité à la complexité de l'évaluation en éducation des professions de la santé; cependant, certains défis liés à l'opérationnalisation du concept seraient à résoudre avant sa mise en œuvre.

Nursing Interventions Designed to Improve Healthcare in General Healthcare Settings for Adults Living with Mental Illness: A Scoping Review.

People living with mental illness have difficulty obtaining quality physical care services. Nurses find it hard to fully assume their role and adopt a person-centered approach when they care for people with both physical and mental health problems. A scoping review was carried out to document the breadth and depth of literature on nurse interventions designed to improve nursing care in general healthcare settings for adults living with mental illness. Two researchers independently screened titles, abstracts and full documents to obtain publications, and the relevant data was extracted from individual studies. Of the 384 studies identified, 16 documents were included in the study. Few interventions have been the subject of scientific publications and they are scattered in their objectives and very heterogeneous in their content. Interventions are often included in a large program that may be difficult to apply in various care settings. There are many different nursing roles and activities in care-management and in support of behavioral changes although their main measured outcomes differ. This study highlights a tendency for interventions to relegate people with mental health problems to specialized services, which reinforces the dichotomization of services and does not favor a holistic and person-centered approach. There is an urgent need to develop and evaluate nursing interventions in general healthcare settings for adults living with mental illness. The development of relevant continuing education and training must take into account both the point of view of the people living with mental illness and that of nurses.

Protocol of the Fit-For-Fertility study: a multicentre randomised controlled trial assessing a lifestyle programme targeting women with obesity and infertility.

INTRODUCTION: Women with obesity are at a higher risk of infertility as well as gestational and neonatal complications. Lifestyle changes are universally recommended for women with obesity seeking fertility treatments, but such intervention has only been assessed in very few robust studies. This study's objectives are therefore to assess the clinical outcomes and cost-effectiveness of an interdisciplinary lifestyle intervention (the Fit-For-Fertility Programme; FFFP) targeting women with obesity and subfertility in a diverse population. METHODS AND ANALYSIS: This pragmatic multicentre randomised controlled trial (RCT) will include 616 women with obesity (body mass index ≥30 kg/m2 or ≥27 kg/m2 with polycystic ovary syndrome or at-risk ethnicities) who are evaluated at a Canadian fertility clinic for subfertility. Women will be randomised either to (1) the FFFP (experimental arm) alone for 6 months, and then in combination with usual care for infertility if not pregnant; or (2) directly to usual fertility care (control arm). Women in the intervention group benefit from the programme up to 18 months or, if pregnant, up to 24 months or the end of the pregnancy (whichever comes first). Women from both groups are evaluated every 6 months for a maximum of 18 months. The primary outcome is live birth rate at 24 months. Secondary outcomes include fertility, pregnancy and neonatal outcomes; lifestyle and anthropometric measures; and cost-effectiveness. Qualitative data collected from focus groups of participants and professionals will also be analysed. ETHICS AND DISSEMINATION: This research study has been approved by the Research Ethics Board (REB) of Centre intégré universtaire de santé et des services sociaux de l'Estrie-CHUS (research coordinating centre) on 10 December 2018 and has been or will be approved successively by each participating centres' REB. This pragmatic RCT will inform decision-makers on improving care trajectories and policies regarding fertility treatments for women with obesity and subfertility. TRIAL REGISTRATION NUMBER: NCT03908099. PROTOCOL VERSION: 1.1, 13 April 2019.

Strategies to improve access to cognitive behavioral therapies for anxiety disorders: A scoping review.

BACKGROUND: Strategies to improve access to evidence-based psychological treatments (EBPTs) include but are not limited to implementation strategies. No currently available framework accounts for the full scope of strategies available to allow stakeholders to improve access to EBPTs. Anxiety disorders are common and impactful mental conditions for which EBPTs, especially cognitive-behavioral therapies (CBT), are well-established yet often hard to access. OBJECTIVE: Describe and classify the various strategies reported to improve access to CBT for anxiety disorders. METHODS: Scoping review with a keyword search of several databases + additional grey literature documents reporting on strategies to improve access to CBT for anxiety disorders. A thematic and inductive analysis of data based on grounded theory principles was conducted using NVivo. RESULTS: We propose to classify strategies to improve access to CBT for anxiety disorders as either "Contributing to the evidence base," "Identifying CBT delivery modalities to adopt in practice," "Building capacity for CBT delivery," "Attuning the process of access to local needs," "Engaging potential service users," or "Improving programs and policies." Each of these strategies is defined, and critical information for their operationalization is provided, including the actors that could be involved in their implementation. IMPLICATIONS: This scoping review highlights gaps in implementation research regarding improving access to EBPTs that should be accounted for in future studies.

Evaluating the implementation of interdisciplinary patient-centred care intervention for people with multimorbidity in primary care: a qualitative study.

OBJECTIVE: A patient-centred care interdisciplinary pragmatic intervention to support self-management for patients with multimorbidity was implemented in one region of Quebec, Canada. This embedded study aimed to evaluate the process of implementation. DESIGN: A descriptive qualitative study was conducted in 2016-2017 using semistructured individual interviews. The Consolidated Framework for Implementation Research (CFIR) was used to guide the data coding, analysis and reporting of the findings. SETTING: The study took place in seven Family Medicine Groups in one region (Saguenay-Lac-Saint-Jean) of Quebec, Canada. PARTICIPANTS: Ten managers (including two family physicians) and 19 healthcare professionals (HCPs), nurses, kinesiologists, nutritionists and a respiratory therapist, were interviewed. RESULTS: Many key elements within the five CFIR domains were identified as impacting the implementation of the intervention : (1) intervention characteristics-evidence strength and quality, design quality and packaging, relative advantage and complexity; (2) outer setting-patients' needs and resources, external policies and incentives; (3) inner setting-structural characteristics, networks and communication, culture, compatibility, readiness for implementation and leadership engagement; (4) characteristics of the managers and HCPs-knowledge and belief about the intervention; (5) process-planning, opinion leaders, formally appointed internal implementation leaders, reflecting and evaluating. CONCLUSION: This study revealed the organisational and contextual aspects of the implementation based on different and complementary perspectives. With the growing demand for interdisciplinary teams in primary care, we believe that our insights will be helpful for practices, researchers, and policymakers interested in the implementation of disease prevention and management programmes for people with multiple chronic conditions in primary care. TRIAL REGISTRATION NUMBER: NCT02789800.

Importance of collaboration and contextual factors in the development and implementation of social participation initiatives for older adults living in rural areas.

INTRODUCTION: To encourage isolated and vulnerable older adults to accomplish meaningful social activities, occupational therapists and other healthcare workers must collaborate with community organisations and municipalities to develop and implement initiatives fostering social participation. In a rural Regional County Municipality in Quebec (Canada), four social participation initiatives were selected and implemented: (1) Benevolent Community, (2) urban transportation system, (3) creation of a website on social participation activities, and (4) social participation workshop. Little is known about contextual factors such as the structures and organisations, stakeholders, and physical environment that influence the development and implementation of such initiatives. METHODS: Led by an academic occupational therapist, an action research to implement social participation initiatives was initiated by community stakeholders. The 26 stakeholders were involved in a Management and Partnership Committee, two focus groups and an interview with a trainer, which documented and analysed contextual factors and the implementation process. FINDINGS AND DISCUSSION: Development and implementation were facilitated by stakeholder collaboration, mission of the community organisations, and stakeholders' shared desire to reduce older adults' isolation and vulnerability. The established partnerships and predefined orientations as well as the leadership, motivation, and professional skills of the stakeholders also fostered the initiatives. Among the challenges encountered, the stakeholders' limited involvement in implementation tasks was attributable to important changes in the key stakeholders' organisations and structures and the number of organisations involved. Difficulty reaching a consensus resulting from the different attitudes, vision, and understanding of the stakeholders delayed the development and implementation of some initiatives. Despite regular meetings between stakeholders, geographic distance limited spontaneous exchanges. CONCLUSION: This action research highlighted the importance of collaboration and contextual factors in developing and implementing social participation initiatives with community organisations and municipalities.

Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial.

PURPOSE: To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. METHODS: A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medicine groups (FMGs) in Quebec, Canada. Health care professionals (nurses, nutritionists, kinesiologists) from the FMGs were trained to deliver the patient-centered intervention based on a motivational approach and self-management support. Primary outcomes: self-management (Health Education Impact Questionnaire); and self-efficacy. SECONDARY OUTCOMES: health status, quality of life, and health behaviors. Quantitative analyses used multi-level mixed effects and generalized linear mixed models controlling for clustering within FMGs. We also conducted in-depth interviews with patients, family members, and health care professionals. RESULTS: The trial randomized 284 patients (144 in intervention group, 140 in control group). The groups were comparable. After 4 months, the intervention showed a neutral effect for the primary outcomes. There was significant improvement in 2 health behaviors (healthy eating with odds ratios [OR] 4.36; P = .006, and physical activity with OR 3.43; P = .023). The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. CONCLUSIONS: Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.

Social participation needs of older adults living in a rural regional county municipality: toward reducing situations of isolation and vulnerability.

BACKGROUND: Social participation is restricted for approximately half the older adult population but is critical in fostering community vitality, promoting health, and preventing disabilities. Although targeted through interventions by community organizations, healthcare professionals and municipalities, little is known about the needs of older adults to participate socially, especially in rural areas. This study thus aimed to identify and prioritize the social participation needs of older adults living in a rural regional county municipality. METHODS: A participatory action research was conducted in a rural regional county municipality (RCM) in Quebec, Canada, with a convenience sample of 139 stakeholders, including older adults, caregivers, healthcare and community organization managers, healthcare and community organization workers, community partners and key informants. RESULTS: Facilitators and barriers to social participation are related to personal factors (e.g., health, interests, motivation), the social environment (e.g., availability of assistance or volunteers) and the physical environment (e.g., distance to resources, recreational facilities and social partners). Nine older adults' needs emerged and were prioritized as follows: 1) having access to and being informed about transportation options, 2) being informed about available activities and services, 3) having access to activities, including volunteering opportunities, suited to their interests, schedule, cost, language and health condition, 4) being accompanied to activities, 5) having access to meeting places near home and adapted to their health condition, and 6-9 (no preferred order) being reached when isolated, being personally invited and welcomed to activities, having a social support network, and being valued and recognized. Differences emerged when prioritizing needs of older adults with disabilities (greater need for assistance, accessibility and adapted activities) and older adults living in a rural area (greater need for transportation). CONCLUSIONS: To promote active participation in the community, the social participation needs of older women and men living in rural areas must be addressed, especially in regard to transportation, information, adapted activities, assistance and accessibility. The first part of this action research will be followed by community selection and implementation of initiatives designed to ultimately foster their social participation.

Factors impacting the transition to adulthood of youth with fragile X syndrome and their families: Facilitators, obstacles and needs.

BACKGROUND: The transition from school to adulthood is a critical time for families of youth with disabilities. Few studies have focused on the needs of families of youths with fragile X syndrome. This syndrome is often associated with intellectual disability and autism spectrum disorder, which creates specific needs that must be documented to improve transition planning. The aim of the current study was to document factors impacting transition planning and describe parents' experiences during this period. METHOD: Individual interviews were conducted with thirteen parents of young people with fragile X syndrome. Two research team members analysed the interviews separately. RESULTS: Factors related to the youth, the youth's family and the steps taken by the various institutions involved during this period seem to impact this transition and contributed to families' anxiety. A clear, uniform transition planning process, initiated early enough to have time for exploratory work placements, and gradual integration emerged as crucial facilitators for the parents in this study. CONCLUSIONS: Understanding the reality of people with fragile X syndrome and their families will help to adapt services and develop concrete plans for their future.

Elements of group dynamics that influence learning in small groups in undergraduate students: A scoping review.

BACKGROUND: Learning in small groups is a frequent activity in undergraduate programs to enrich learning, as well as in nursing programs during clinical experiences. Being in a small group adds elements of group dynamics that influence learning. Research into the influence of these elements on learning in small groups is not clear in the literature. This makes it challenging for educators to promote the optimal environment for learning. OBJECTIVE: To explore the literature on elements of group dynamics that influence learning in small groups among undergraduate students. DESIGN AND DATA SOURCES: A scoping review was performed, inspired by the five-stage approach of Arksey and O'Malley and the methodology outlined by the Joanna Briggs Institute. Various databases were used including CINAHL, ERIC, psycINFO, PubMed and Science Direct. REVIEW METHOD: Our research question was: What are the elements of group dynamics that influence learning in small groups among undergraduate students? At least two authors analyzed the relevant studies and data were extracted to describe the elements of group dynamics that influence learning in small groups among undergraduate students. RESULTS: Thirty papers were included in our review. Five elements emerged: engagement, openness, support, quality of communication and style of dominant behavior. CONCLUSIONS: The results suggested the utilization of these elements in establishing a group dynamic favorable for learning in small groups. Since little research has been done into group dynamics in nursing education, it was useful to explore this concept in other disciplines. Further research is needed with a focus on clinical education for nursing students.

Patients, caregivers and health-care professionals' experience with an interdisciplinary intervention for people with multimorbidity in primary care: A qualitative study.

BACKGROUND: Multimorbidity challenges the health-care system and requires innovative approaches. In 2015, a 4-month patient-centred interdisciplinary pragmatic intervention was implemented in primary care with the aim of supporting self-management for patients with multimorbidity. OBJECTIVE: To explore the perceptions and experiences of health-care professionals, patients and their caregivers with a 4-month patient-centred interdisciplinary pragmatic intervention in primary care. DESIGN: A descriptive, qualitative study using semi-structured interviews was conducted. SETTING AND PARTICIPANTS: A purposive sample of 30 participants was recruited from seven family medicine groups including patients, caregivers and health-care professionals (HCPs). Interviews were analysed using Thorne's interpretive description approach. RESULTS: Findings were grouped into the benefits and challenges of participating in the intervention. The programme allowed patients to adopt realistic and adapted objectives; to customize interventions to the patient's reality; and to help patients gain confidence, improve their knowledge, skills and motivation to manage their condition. Interprofessional collaboration eased the exchange of information via team meetings and electronic medical records. Challenges were related to collaboration, communication, coordination of work and integration of newly relocated HCPs mainly due to part-time assignments and staff turnover. HCPs part-time schedules limited their availability and hindered patients' follow-up. DISCUSSION AND CONCLUSION: This intervention was useful and rewarding from the HCPs, patients and caregivers' perspective. However, to ensure the success of this complex interdisciplinary intervention, implementers and managers should anticipate organizational barriers such as availability and time management of relocated HCPs.

Nursing activities for patients with chronic disease in family medicine groups: A multiple-case study.

Family Medicine Groups (FMGs) are the most recently developed primary care organizations in Quebec (Canada). Nurses within FMGs play a central role for patients with chronic diseases (CD). However, this complex role and the nursing activities related to this role vary across FMGs. Inadequate knowledge of nursing activities limits the implementation of exemplary nursing practices. This study aimed to describe FMG nursing activities with patients with CD and to describe the facilitators and barriers to these activities. A multiple-case study was performed with ten nurses practicing among patients with CD in FMGs. Five data sources were used to provide an in-depth description of nursing activities and the facilitators and barriers to the development of these activities. After qualitative data analysis, findings show that nursing activities are clustered into five domains: Global assessment of the patient, Care management, Health promotion, Nurse-physician collaboration, and Planning services for patients with CD. Activities vary depending on contextual factors identified in each case. This multiple-case study provides a clear description of nursing activities with patients with CD. There is a need for improved nursing activities and expertise in domains of activities that are less present in FMGs, such as case management and interprofessional collaboration.

Validity as a social imperative for assessment in health professions education: a concept analysis.

CONTEXT: Assessment can have far-reaching consequences for future health care professionals and for society. Thus, it is essential to establish the quality of assessment. Few modern approaches to validity are well situated to ensure the quality of complex assessment approaches, such as authentic and programmatic assessments. Here, we explore and delineate the concept of validity as a social imperative in the context of assessment in health professions education (HPE) as a potential framework for examining the quality of complex and programmatic assessment approaches. METHODS: We conducted a concept analysis using Rodgers' evolutionary method to describe the concept of validity as a social imperative in the context of assessment in HPE. Supported by an academic librarian, we developed and executed a search strategy across several databases for literature published between 1995 and 2016. From a total of 321 citations, we identified 67 articles that met our inclusion criteria. Two team members analysed the texts using a specified approach to qualitative data analysis. Consensus was achieved through full team discussions. RESULTS: Attributes that characterise the concept were: (i) demonstration of the use of evidence considered credible by society to document the quality of assessment; (ii) validation embedded through the assessment process and score interpretation; (iii) documented validity evidence supporting the interpretation of the combination of assessment findings, and (iv) demonstration of a justified use of a variety of evidence (quantitative and qualitative) to document the quality of assessment strategies. CONCLUSIONS: The emerging concept of validity as a social imperative highlights some areas of focus in traditional validation frameworks, whereas some characteristics appear unique to HPE and move beyond traditional frameworks. The study reflects the importance of embedding consideration for society and societal concerns throughout the assessment and validation process, and may represent a potential lens through which to examine the quality of complex and programmatic assessment approaches.

How to facilitate transition to adulthood? Innovative solutions from parents of young adults with profound intellectual disability.

BACKGROUND: At age 21, access to specialised services for youth with profound intellectual disability is reduced. Few studies have focused on parents' views concerning potential solutions to ease the transition to adulthood, and most existing solutions target young adults with less severe intellectual disability. The aim of this study is to propose realistic solutions to meet the needs of young adults with profound intellectual disability and their families during and after the transition to adulthood. METHOD: Using a descriptive qualitative design, two individual semi-structured interviews were conducted with 14 parents. RESULTS: Ideas for innovative solutions included responses to parents' informational, material, intellectual and emotional needs during and after transition period. The majority of these solutions involve knowledge sharing, improved inter-institutional collaboration and social participation of young adults, and offering parents emotional support. CONCLUSION: Some solutions could be implemented within existing transition planning programs, based on their strengths and limitations.

Nursing Activities for Patients With Chronic Disease in Primary Care Settings: A Practice Analysis.

BACKGROUND: Nurses in primary care organizations play a central role for patients with chronic disease. Lack of clarity in role description may be associated with underutilization of nurse competencies that could benefit the growing population of patients with chronic disease. OBJECTIVE: The purpose of the research was to describe nursing activities in primary care settings with patients with chronic disease. METHODS: A Web-based survey was sent to nurses practicing in Family Medicine Groups in the Canadian Province of Québec. Participants rated the frequency with which they carried out nursing activities in five domains: (a) global assessment, (b) care and case management, (c) health promotion, (d) nurse-physician collaboration, and (e) planning services for patients with chronic disease. Findings were summarized with descriptive statistics (means, standard deviations, and ranges). RESULTS: The survey was completed by 266 of the 322 nurses who received the survey (82.6%). Activities in the health promotion and global assessment of the patient domains were carried out most frequently. Planning services for patients with chronic disease were least frequently performed. DISCUSSION: This study provides a broad description of nursing activities with patients with chronic disease in primary care. The findings provide a baseline for clinicians and researchers to document and improve nursing activities for optimal practice for patients with chronic disease.

Specific needs of families of young adults with profound intellectual disability during and after transition to adulthood: What are we missing?

INTRODUCTION: At the age of 21, the trajectory of services offered to youth with profound intellectual disability (ID) change significantly since access to specialised services is more limited. Despite the desire of parents to avoid any impact on their child, several factors can influence the course of this transition. However, there is little research on facilitators and obstacles to the transition to adulthood, and impacts on people with a profound ID. It is therefore difficult to provide solutions that meet their specific needs. OBJECTIVE: The study aimed to document the needs of parents and young adults with profound ID during and after the transition to adulthood by exploring their transitioning experience and factors that influenced it. METHOD: Using a descriptive qualitative design, two individual semi-structured interviews were conducted with fourteen (14) parents of young adults aged between 18 and 26 with a profound ID. RESULTS: At this point, many material, informative, cognitive and emotional needs of young adults and their parents are not met. Obstacles, mainly organisational, persist and result in a particularly difficult transition to adulthood experience. CONCLUSION: By knowing the specific needs of these families, it is possible to develop and implement solutions tailored to their reality. WHAT THE PAPERS ADDS?: The transition to adulthood is a critical period for families with young adults with an intellectual disability (ID), a reality observed internationally. Current literature on all levels of ID suggests some barriers to transition that lead to negative impacts on both parents and young adults with ID. However, presently, very little research exists on the reality of families of young adults with profound ID and factors influencing transition to adult life. Most of studies target people with mild to moderate ID. Considering the significant disabilities of people with profound ID, it is possible to imagine that their experience of transition will be even more difficult and they will present specific needs. The lack of understanding of these needs makes it difficult to introduce solutions tailored to their reality. The results of this current study suggest that many needs of young adults with profound ID and their parents are not met despite existent transition planning services. Transition to adulthood seems particularly difficult for these families who face many challenges. Parents in this study proposed different obstacles during transition to adulthood that could be improved for creation of future solutions adapted to their reality.

Not feeling sick from breast cancer: A framework on health status perceptions transition process.

PURPOSE: In what state of health do women with breast cancer consider themselves to be? Health professionals classify them as cancer victims but few studies have examined women's perceptions of their own health following a breast cancer diagnosis. We looked at the transition in health status perceptions between before and after receiving the diagnosis. METHODS: A grounded theory design was chosen to develop a framework. RESULTS: From an analysis of semi-structured individual interviews with 32 women, it emerged that 1) over a two-year period, the participants went through four iterative steps between receipt of the official diagnosis and the return of the level of energy once the treatments are done. Theses four steps are: reacting emotionally, facing the situation, constructing a new identity and reacting to social representations of cancer, 2) the participants did not feel sick from breast cancer. CONCLUSION: This study shows learning to live with a sword of Damocles over the head during the transition process. The emergent steps of the health status perceptions transition process in breast cancer trajectory give direction for care.

How to report professional practice in nursing? A scoping review.

BACKGROUND: Nursing professional practice in different contexts of care has been widely described in evidence-based literature. Currently, there is no consensus on a common structure for these descriptions. Understanding and comparing similar practices is made difficult by the varying nature of descriptions provided in scientific literature. PURPOSE OF THE STUDY: 1) to report research methods found in the scientific literature that were used to describe the practice of different health professionals; 2) to report on the main concepts used to describe the practice of these health professionals; 3) to propose a structure for the description of the practice in nursing. METHODS: A scoping review following a five-stage approach: 1) identifying the research question; 2) identifying relevant studies; 3) selecting studies; 4) charting data; 5) reporting results. The Medline, CINAHL, psychARTICLES, psyCRITIQUES, psycEXTRA, Psychology and Behavioral Science Collection and psycINFO databases were searched. Each study was analyzed and extracted data were classified by categories and structures used to describe the health professional practices. RESULTS: Forty-nine studies were included. In these studies, quantitative, qualitative or mixed methods were used to describe professional practice in different health disciplines. Three major concepts were reported most frequently in describing professional practice: roles, domains and activities. The concepts varied greatly among authors. We found that to define roles or to characterize a professional practice, activities must be described and organized on the basis of different domains. CONCLUSIONS: A promising structure for describing nursing professional practice is proposed by the authors of this review. The structure facilitates the accurate description of all domains and activities performed by nurses in different contexts of practice, and will contribute to the development of knowledge about nursing practice in different contexts based on shared concepts.