ABSTRACT
This study aims to describe and understand the care experience for people having undergone a liver transplantation in a Belgian academic hospital and the elements of an ideal care experience for them. The descriptive phenomenological method of the « Relational Caring Inquiry ¼ was used with twelve participants whose stories were collected through three semi-structured individual interviews. These interviews gave an overall picture of their care experience, summarized as « the feeling of having benefited from the support of both the body and mind in a Humanist-Caring dynamic, but with difficulties linked to organizational and environmental factors in finding a new balance. ¼ The essence of their ideal care experience consists of « benefiting from the support of both the body and mind by competent professionals, in a Humanist-Caring climate and a dynamic of partnership with the patient, in an institution that is welcoming in terms of its organization and environment. ¼ Based on these results, it seems essential to limit organizational constraints to consolidate the Humanist-Caring dynamic, to develop the patient partnership, and to pay special attention to the patient's relatives, resulting in structured support.
Cette étude vise à décrire et comprendre l'expérience des soins des personnes ayant vécu une transplantation hépatique dans un hôpital académique belge, ainsi que ce qui constituerait pour eux les éléments d'une expérience idéale des soins. La méthode phénoménologique descriptive « Investigation Relationnelle Caring ¼ a été utilisée auprès de douze participants dont le récit a été recueilli, pour chacun, au moyen de trois entrevues individuelles semi-dirigées. Cela a permis d'élucider l'essence globale de leur expérience des soins, résumée comme « le sentiment d'avoir bénéficié d'un accompagnement du corps et de l'esprit dans une dynamique humaniste-caring, mais d'éprouver cependant des difficultés à retrouver un nouvel équilibre, liées à des facteurs organisationnels et environnementaux ¼. Quant à l'essence de leur expérience idéale des soins, elle consiste à « bénéficier d'un accompagnement du corps et de l'esprit par des professionnels compétents, dans un climat humaniste-caring, et une dynamique de partenariat avec le patient et ses proches, dans une institution accueillante sur le plan organisationnel et environnemental. ¼ Partant de ces résultats, il semble important de limiter les contraintes organisationnelles pour consolider la dynamique humaniste-caring, de développer le partenariat patient et de porter une attention particulière aux proches des patients, qui se traduise par un accompagnement structuré.
Subject(s)
Liver Transplantation , Humans , Belgium , Hospitals , Emotions , HumanismABSTRACT
Much the same as other healthcare services, when the COVID-19 pandemic hit, psychiatric hospitals implemented significant and rapid changes in the organization of their services. The aim of this research study is to describe and understand the experience of nurses and nursing supervisors in psychiatric units in the light of the occupational transformations caused by the first wave of the COVID-19 pandemic, as well as the impact of these events on their relationships with patients. A consensual qualitative research study based on Hill's model was implemented. Sixteen individual interviews were conducted with eleven nurses and five nursing supervisors. The themes discussed can be grouped into five areas: aspects of the caregiving relationship, positive aspects of caregivers' experiences, negative aspects of caregivers' experiences, reflections on the post-pandemic era, and the role of supervisors. These five areas can be subdivided into 11 categories and 31 subcategories. Values, attitudes, and behaviors centered around a humanistic caring approach are identified as integral to future development. They appear to be elements of both the transformation process and the desired outcome. In light of these findings, it seems that an immediate rethink of the organization of care is needed.
Dans les hôpitaux psychiatriques, des modifications importantes et rapides de l'organisation des services ont été décidées dès le début de la pandémie de COVID-19. Le but de cette recherche est de décrire et comprendre le vécu des infirmières et cadres de santé, en unités intrahospitalières de psychiatrie, confrontés aux bouleversements professionnels occasionnés par la première vague de l'épidémie, ainsi que l'impact de cet événement sur la relation avec les patients. Une recherche qualitative consensuelle selon Hill a été mise en Åuvre. Seize entretiens individuels ont été réalisés auprès de onze infirmières et cinq cadres de santé. Les idées exprimées peuvent être regroupées en cinq domaines : les aspects du vécu se rapportant à la relation de soins, les aspects positifs du vécu des soignants, les aspects négatifs du vécu des soignants, les réflexions sur l'après-crise et le rôle du cadre remis en question. Ces cinq domaines peuvent être subdivisés en 11 catégories et 31 sous-catégories. Des valeurs, attitudes et comportements humanistes caring sont identifiés comme faisant partie d'un futur désirable. Ils semblent être à la fois des éléments du processus de transformation et du résultat souhaité. Il parait indispensable de repenser sans délais l'organisation des soins sur cette base.
Subject(s)
COVID-19 , Nurses , Humans , Pandemics , COVID-19/epidemiology , Patients , Qualitative ResearchABSTRACT
OBJECTIVES: Lupus nephritis (LN) is a frequent complication of systemic lupus erythematosus (SLE). Severe (proliferative) forms of LN are treated with induction immunosuppressive therapy (IST), followed by maintenance IST, to target remission and avoid relapses. The optimal duration of maintenance IST is unknown. The WIN-Lupus trial tested whether IST discontinuation after 2â3 years was non-inferior to IST continuation for two more years in proliferative LN. METHODS: WIN-Lupus was an investigator-initiated multicentre randomised controlled trial. Patients receiving maintenance IST with azathioprine or mycophenolate mofetil for 2-3 years, and hydroxychloroquine, were randomised (1:1) into two groups: (1) IST continuation and (2) IST discontinuation. The primary endpoint was the relapse rate of proliferative LN at 24 months. Main secondary endpoints were the rate of severe SLE flares, survival without renal relapse or severe flare, adverse events. RESULTS: Between 2011 and 2016, 96 patients (out of 200 planned) were randomised in WIN-Lupus: IST continuation group (n=48), IST discontinuation group (n=48). Relapse of proliferative LN occurred in 5/40 (12.5%) patients with IST continuation and in 12/44 (27.3%) patients with IST discontinuation (difference 14.8% (95% CI -1.9 to 31.5)). Non-inferiority was not demonstrated for relapse rate; time to relapse did not differ between the groups. Severe SLE flares (renal or extrarenal) were less frequent in patients with IST continuation (5/40 vs 14/44 patients; p=0.035). Adverse events did not differ between the groups. CONCLUSIONS: Non-inferiority of maintenance IST discontinuation after 2â3 years was not demonstrated for renal relapse. IST discontinuation was associated with a higher risk of severe SLE flares. TRIAL REGISTRATION NUMBER: NCT01284725.
Subject(s)
Lupus Erythematosus, Systemic , Lupus Nephritis , Azathioprine/therapeutic use , Humans , Immunosuppression Therapy , Immunosuppressive Agents/therapeutic use , Lupus Erythematosus, Systemic/chemically induced , Lupus Nephritis/drug therapy , Mycophenolic Acid/therapeutic use , Recurrence , Treatment Outcome , WeaningABSTRACT
The COVID-19 pandemic has created unprecedented working conditions, with repercussions on the daily lives of nurses. The events experienced positively or negatively in their clinical practice have aroused a variety of emotions for them. The objective of this research is to describe and categorize the events that provoked emotions in nurses who volunteered to accompany COVID-19 victims in a Belgian academic hospital during the first wave of the pandemic by identifying what these emotions were. The researchers used Hill's Consensual Qualitative Research method. Nineteen semi-structured individual interviews were conducted. After the full transcription of the recordings, the data were analyzed by the research team. The results show that the emotions felt by the participants were caused by thirty-seven types of events (categories) grouped into nine families (domains). COVID-19 is viewed negatively by the participants who express fear of this serious and contagious disease. When they talk about the experiences of patients and their families, their discourse alternates between joy at having been able to provide help and care and sadness at not having been able to be effective in all circumstances. Participants share a positive experience and express joy in recalling the COVID-19 outbreak as an exceptional event that they coped with through their personal and professional experience and resources, their relationships with colleagues on the interprofessional team, and the responses of the nursing department and hospital.
Subject(s)
COVID-19 , Nurses , Adaptation, Psychological , Emotions , Humans , Pandemics , Qualitative ResearchABSTRACT
While being integrated into a public health policy which is extending their role, advanced practice nurses should operate within a discipline-specific approach, which takes account of their professional identity and ensures their added value for the health care system. Conceptual models of nursing care and other nursing theories are there to guide their practice and enable them to stay focused on their specific discipline.
Subject(s)
Advanced Practice Nursing , Delivery of Health Care/organization & administration , Health Policy , Humans , Nurse's RoleABSTRACT
Aim: The aim of the study was to describe and compare feeling of competence regarding humanistic caring in Registered Nurses (RN) and nursing students (NS). Design: A quantitative comparative cross-sectional research design was used. Methods: A convenience sample of 196 RN and 47 NS in a teaching hospital in Belgium completed a self-administered questionnaire composed of a sociodemographic survey and the Caring Nurse-Patient Interactions Scale (CNPI-23) developed by Cossette et al. Results: The four dimensions of the CNPI-23 were compared using the Skillings-Mack test. Both groups scored higher on "humanistic" and "comforting" than on "clinical" and "relational" care and both scored lowest on this last dimension. Linear regressions showed that none of the variables had a statistically significant influence on the CNPI-23 scores, except for NS "state of health," which influenced their feeling of competence regarding "relational care."
Subject(s)
Nurses , Students, Nursing , Belgium , Cross-Sectional Studies , Hospitals, Teaching , HumansABSTRACT
Considering that traumatic injuries are the leading cause of death among young adults across the globe, emergency department care of polytrauma patients is a crucial aspect of optimized care and premature death prevention. Unfortunately, many studies have highlighted important gaps in collaboration among different trauma team professionals, posing a major quality-of-care challenge. Using the conceptual framework for interprofessional teamwork (IPT) of , the aim of this qualitative descriptive exploratory study was to better understand IPT from the perspective of health professionals in emergency department care of polytrauma patients, specifically by identifying factors that facilitate and impede IPT. Data were collected from a sample of 7 health professionals involved in the care of polytrauma patients through individual interviews and a focus group. In the second phase, 2 structured observations of polytrauma patient care were conducted. Following a thematic analysis, results revealed multiple factors affecting IPT, which can be divided into 5 broad categories: individual, relational, processual, organizational, and contextual. Individual factors, a category that is not part of the conceptual framework of , also emerged as playing a major part in IPT.
Subject(s)
Critical Care/psychology , Emergency Medical Services/organization & administration , Health Personnel/psychology , Interprofessional Relations , Multiple Trauma/psychology , Multiple Trauma/therapy , Patient Care Team/organization & administration , Adult , Attitude of Health Personnel , Female , Humans , Male , Middle Aged , Multiple Trauma/diagnosis , Quebec , Young AdultABSTRACT
BACKGROUND: In the context of an ageing population and an increase in the appearance of chronic diseases, the commitment of caregivers makes it possible for people confronted with disease to remain at home. Over time, they need support to overcome their difficulties. They also show a need for recognition for their participation in the economic maintenance of the health system. To promote this support, so-called "win/win" partnerships are envisaged. Research is needed to identify the building blocks of an innovative intervention. METHODS: A cross-sectional descriptive study was carried out with health institutions in the canton of Geneva to identify the proportion of institutions with a positive opinion on partnership with caregivers. It has also identified potential partnerships with caregivers of people facing dementia and possible compensation in exchange for the provision of their skills. Descriptive statistics are presented according to their frequencies and relative percentages (categorical variables), as well as by their mean, standard deviation and median (continuous variables). Logistic regression models were used to assess the factors associated with a favorable opinion towards win/win partnerships. RESULTS: The proportion of executives of health-related institutions with a positive opinion of partnership with caregivers is high: 74.7% (95% CI: 64.8-83.1%). Several types of potential partnerships have been identified between health institutions and caregivers. Areas in which certain activities have been identified as being able to be carried out by caregivers include governance, care, provision of services, accompaniment and support, training and research. Types of compensation for caregivers have also been highlighted. CONCLUSION: This study shows that some areas activities of health facilities in the canton of Geneva could be the subject of win-win partnerships with caregivers of people with dementia. Positive view of health executives on partnership with caregivers is encouraging. In the future, innovative projects can emerge to meet the needs of each party.
Subject(s)
Caregivers/organization & administration , Community Networks , Dementia/therapy , Health Facilities , Intersectoral Collaboration , Aged , Caregivers/psychology , Cross-Sectional Studies , Female , Humans , Male , SwitzerlandABSTRACT
Today's patients wish to establish a dialogue with the health professional and aspire to become partners in their care. A dedicated tool can help patients with cancer create such a partnership. Cooperative research to improve transitions in cancer care focused on this question.
Subject(s)
Neoplasms/therapy , Personal Autonomy , Physician-Patient Relations , HumansABSTRACT
A literature review was undertaken to describe the experience of people with cancer with regard to the different transitions of their care pathway. It enables all these transitions to be identified, documented and mapped out. The aim is to improve the quality of the care provided to this vulnerable population, all along the pathway.
Subject(s)
Continuity of Patient Care/organization & administration , Neoplasms/therapy , HumansSubject(s)
C-Reactive Protein/metabolism , Eosinophilia/diagnosis , Granulomatosis with Polyangiitis/diagnosis , Hypereosinophilic Syndrome/diagnosis , Antibodies, Antineutrophil Cytoplasmic/metabolism , Churg-Strauss Syndrome/diagnosis , Diagnosis, Differential , Female , Humans , Male , Middle AgedABSTRACT
INTRODUCTION: The aim of this study was to evaluate the ability of eight color vision tests to screen for and accurately measure hereditary color-deficiency in order to improve color vision assessment methods for aircraft pilots. METHODS: This prospective study included 29 color-deficient subjects and 23 healthy subjects. All performed the following tests: Ishihara plates, Farnsworth D15, Lanthony desaturated 15 Hue, Munsell 100 Hue, Beyne and Fletcher-Evans CAM lanterns, Nagel anomaloscope, and the Color Assessment and Diagnosis (CAD) test. The sensitivity and specificity of color-deficiency diagnosis were evaluated for each test, as well as the test's relevance for assessing aircraft pilots. RESULTS: The Ishihara plate test demonstrated a sensitivity of 0.97 and a specificity of 1.00 for color-deficiency screening. The CAD test and anomaloscope showed both a sensitivity and specificity of 1.00. The Beyne lantern, Fletcher lantern, Farnsworth D15, and the Lanthony 15 Hue tests all showed a specificity of 1.00 and sensitivities of, respectively, 0.69, 0.97, 0.58, and 0.79. During aircraft pilot selection tests, the CAD test classified 10% of color-deficient subjects as safe to fly, the anomaloscope 17%, and the Beyne and Fletcher lantern tests, respectively, 31% and 3%. DISCUSSION: The discrepancy in results confirms that current color vision test protocols need to be reassessed. The CAD test could be an interesting alternative to the series of tests used to assess flight crew, but it seems more selective than current tests.Marechal M, Delbarre M, Tesson J, Lacambre C, Lefebvre H, Froussart-Maille F. Color vision tests in pilots' medical assessments. Aerosp Med Hum Perform. 2018; 89(8):737-743.
Subject(s)
Aerospace Medicine , Color Perception Tests , Color Vision Defects/diagnosis , Pilots , Adult , Color Perception Tests/methods , Color Perception Tests/standards , Color Vision Defects/genetics , Female , Humans , Male , Prospective Studies , Sensitivity and Specificity , Young AdultABSTRACT
INTRODUCTION: Asthma remains a major public health problem, with 300 million people affected worldwide and a low rate of adherence to treatment. CONTEXT: Few authors have considered one of the determinants of asthmatic patients' adherence to treatment : the accompaniment offered by health care professionals. AIM: To describe the expectations and needs of people living with chronic asthma regarding their accompaniment. METHODS: A descriptive qualitative approach with reasoned sampling. Eight individual semi-structured interviews were conducted among chronic asthmatic adult patients and analyzed by an inductive approach. This was submitted to participants for validation. RESULTS: Needs and expectations are branched out into six main themes : the wish to establish a trusting relationship, the need to perceive professional competence, the importance of the professional's availability, the wish to be more involved in one's life with the disease, the desire for the professional to adopt a humanist posture and to take into account patient singularity. CONCLUSION: A better understanding of non-met expectations would help the adherence to treatment rate to improve. This qualitative research opens various avenues for reflection that are worth thinking about and provides the breeding ground for other studies.
Subject(s)
Asthma/therapy , Needs Assessment , Adult , Asthma/psychology , Belgium , Chronic Disease , Humans , Motivation , Qualitative ResearchABSTRACT
INTRODUCTION: The challenges of global ageing and the growing burden of chronic diseases require innovative interventions acting on health determinants like social participation. Many older adults do not have equitable opportunities to achieve full social participation, and interventions might underempower their personal and environmental resources and only reach a minority. To optimise current practices, the Accompagnement-citoyen Personnalisé d'Intégration Communautaire (APIC), an intervention demonstrated as being feasible and having positive impacts, needs further evaluation. METHODS AND ANALYSIS: A pragmatic multicentre, prospective, two-armed, randomised controlled trial will evaluate: (1) the short-term and long-term effects of the APIC on older adults' health, social participation, life satisfaction and healthcare services utilisation and (2) its cost-effectiveness. A total of 376 participants restricted in at least one instrumental activity of daily living and living in three large cities in the province of Quebec, Canada, will be randomly assigned to the experimental or control group using a centralised computer-generated random number sequence procedure. The experimental group will receive weekly 3-hour personalised stimulation sessions given by a trained volunteer over the first 12 months. Sessions will encourage empowerment, gradual mobilisation of personal and environmental resources and community integration. The control group will receive the publicly funded universal healthcare services available to all Quebecers. Over 2 years (baseline and 12, 18 and 24 months later), self-administered questionnaires will assess physical and mental health (primary outcome; version 2 of the 36-item Short-Form Health Survey, converted to SF-6D utility scores for quality-adjusted life years), social participation (Social Participation Scale) and life satisfaction (Life Satisfaction Index-Z). Healthcare services utilisation will be recorded and costs of each intervention calculated. ETHICS AND DISSEMINATION: The Research Ethics Committee of the CIUSSS Estrie - CHUS has approved the study (MP-31-2018-2424). An informed consent form will be read and signed by all study participants. Findings will be published and presented at conferences. TRIAL REGISTRATION NUMBER: NCT03161860; Pre-results.
Subject(s)
Chronic Disease , Delivery of Health Care/statistics & numerical data , Quality of Life , Social Participation , Aged , Cost-Benefit Analysis , Humans , Personal Satisfaction , Prospective Studies , Quebec , Research Design , Urban PopulationABSTRACT
A research project brought together patient partners, nurse leaders from six clinical settings in Quebec and researchers to develop and test a web technology, the Forum for Knowledge Exchange (FKE), in order to improve discharge planning practices and oncological care transitions. The project led to the creation of a FKE accessible to the oncology sector of the Francophonie. It revealed an innovative strategy of knowledge transfer (KT) based on the FKE and was fed by collaborative work among partners, where the patient partners played a vital role. The results highlighted the importance, for health research, of giving a voice to patient partners in close collaboration with clinicians and researchers so that clinical practices are better adapted to the actual needs of patients and of their relatives.
ABSTRACT
The use of a Nursing Model (NM) for nursing administration offers direct and indirect benefits for patients as for nurses. Depending the chosen NM, the concepts of person, health, nursing and environment are very different. Each NM has its special vision of the practice of nursing. The study investigated whether the Chief Nursing Officers (CNO) of the bilingual and French speaking Belgian hospitals integrate Nursing Models in the politics of their department. A quantitative descriptive and correlational survey was conducted. 97.5 % of the concerned CNO (78/80) participated to the research. It appears that a Nursing Model underlies the action of the nursing department in only 38 % of the departments (30/78). Where a Nursing Model is used, it is explicitly communicated to staff (26/30). Among the Models used, that of Virginia Henderson dominates (26/30). The seniority of the CNO in its function as well as variables related to educational courses and clinical context appear to influence the results. The Nursing Models of the paradigm of transformation remain rarely used. A qualitative research would be relevant to deepen the understanding of the experience of CNO related to Nursing Models.
Subject(s)
Models, Nursing , Belgium , Hospitals , MultilingualismABSTRACT
INTRODUCTION: interprofessional collaboration (IPC) in the context of trauma remains a challenge for health care professionals who must react quickly and prioritize interventions according to trauma practice standards. METHODS: a review of the literature was conducted by exploring the CINAHL, Scopus, Web of Science and Pubmed databases in relation to trauma and IPC in order to report on IPC knowledge in the context of traumatology. RESULTS: a significant number of articles related to traumatology (n = 14), to IPC (n = 38) and then related to these two themes (n = 15) were identified and analyzed. CONCLUSION: few studies have addressed IPC in the context of trauma. The authors did seem to pay particular attention to the role of the trauma team leader and to the leadership competence, while others are more interested in communication and perceptions of the different health professional roles. In addition, these papers mainly demonstrate that many gaps remain within interprofessional trauma teams, such as communication, coordination of care and role clarification.
