The experience of pregnant women in contexts of vulnerability of prenatal primary nursing care: a descriptive interpretative qualitative study.

BACKGROUND: Prenatal primary nursing care contributes to improving the health outcomes of mothers and unborn babies. Some pregnant women in contexts of vulnerability experience prenatal nursing care in a positive way, while some do not. A better understanding of factors influencing this experience could help improve prenatal nursing care. The aim of this study was to describe factors influencing the prenatal primary nursing care experience of pregnant women in contexts of vulnerability. METHODS: Thorne's qualitative interpretative descriptive approach was used. Twenty-four pregnant women in contexts of vulnerability were recruited in local community service centers in Quebec, Canada, using purposive and snowball samplings, to carry out a semi-structured interview. Participants were 16 years old and over, in their second or third trimester, or had given birth in the previous year, and received prenatal nursing care through community health services. Data collection methods included a logbook, sociodemographic questionnaire and semi-structured interview on vulnerable pregnant women's experience with prenatal primary nursing care. The Qualitative Analysis Guide of Leuven guided the inductive thematic analysis, following a constant comparative iterative process. RESULTS: The women's experience was initially influenced by the fulfillment of their needs and expectations. These stem from their previous or current pregnancy experiences, their motivation to receive prenatal care, their family concerns as well as their contexts of vulnerability. From the pregnant women's perspective, the main factors that influenced their experience were the nurse's approach, characteristics and interventions that all impact on their relationship with nurses, as well as the prenatal primary care organization, including the modalities of prenatal care (i.e. schedule, setting, duration, number and frequency of meetings), the continuity and the program's prenatal care services, such as referral to a nutritionist, social worker or other services. CONCLUSIONS: A conceptual framework is proposed to describe relationships among the factors distributed in three dimensions that influence the experience of pregnant women in contexts of vulnerability and to guide nurses in the improvement of prenatal primary care. Considering the complexity of this experience, a person-centered approach is mandatory to promote a positive experience, equity and a better use of services.

Integrated self-management support provided by primary care nurses to persons with chronic diseases and common mental disorders: a scoping review.

AIM: To map integrated and non-integrated self-management support interventions provided by primary care nurses to persons with chronic diseases and common mental disorders and describe their characteristics. DESIGN: A scoping review. DATA SOURCES: In April 2020, we conducted searches in several databases (Academic Research Complete, AMED, CINAHL, ERIC, MEDLINE, PsycINFO, Scopus, Emcare, HealthSTAR, Proquest Central) using self-management support, nurse, primary care and their related terms. Of the resulting 4241 articles, 30 were included into the analysis. REVIEW METHODS: We used the Rainbow Model of Integrated Care to identify integrated self-management interventions and to analyze the data and the PRISMS taxonomy for the description of interventions. Study selection and data synthesis were performed by the team. Self-management support interventions were considered integrated if they were consistent with the Rainbow model's definition of clinical integration and person-focused care. RESULTS: The 30 selected articles related to 10 self-management support interventions. Among these, five interventions were considered integrated. The delivery of the interventions showed variability. Strategies used were education, problem-solving therapies, action planning, and goal setting. Integrated self-management support intervention characteristics were nurse-person relationship, engagement, and biopsychosocial approach. A framework for integrated self-management was proposed. The main characteristics of the non-integrated self-management support were disease-specific approach, protocol-driven, and lack of adaptability. CONCLUSION: Our review synthesizes integrated and non-integrated self-management support interventions and their characteristics. We propose recommendations to improve its clinical integration. However, further theoretical clarification and qualitative research are needed. IMPLICATION FOR NURSING: Self-management support is an important activity for primary care nurses and persons with chronic diseases and common mental disorders, who are increasingly present in primary care, and require an integrated approach. IMPACT: This review addresses the paucity of details surrounding integrated self-management support for persons with chronic diseases and common mental disorders and provides a framework to better describe its characteristics. The findings could be used to design future research and improve the clinical integration of this activity by nurses.

A Scoping Review on the Experience of Participating in Dignity Therapy for Adults at the End of Life.

Background: As the proportion of aging population is increasing, so is the need for palliative care services. The end of life is marked by suffering and currently it is not well addressed in palliative care. Dignity therapy (DT) is one of the most popular therapies aimed at reducing suffering at the life and yet the quantitative evidence supporting its effectiveness is mixed. Also, no study has looked extensively at the qualitative literature. Objective: To describe the experience of participating in DT for adults in end of life. Design: A scoping review was conducted on the experience of DT among adults at their end of life. We searched electronic databases between 2002 and 2020. Two reviewers independently screened, extracted, and coded the data. They were analyzed using a thematic framework approach. Results: Twelve articles were included in the final analysis and were published between 2010 and 2019. The articles originated from the United States (3), Canada (3), Poland (2), Australia (2), the United Kingdom (2), Italy (1), and Germany (1). Two main categories of themes emerged from our analysis: themes mentioned during the DT intervention and themes following the DT intervention. The primary themes found during the DT intervention are discussions relating to the end of life, reflection on life, and creating a life narrative. The themes found following the DT intervention are that it opened a reflection on the past, that this was a helpful intervention, and that it was difficult, but important. Conclusions: Few qualitative studies assessed the experience of participating in DT following the intervention. This gap in the literature could explain the difficulties we currently have in understanding the effects of DT. Future studies should aim to assess how the effects of DT are perceived by patients after the intervention.

The Prenatal Primary Nursing Care Experience of Pregnant Women in Contexts of Vulnerability: A Systematic Review With Thematic Synthesis.

The contexts of vulnerability are diversified and cover a wide range of situations where pregnant women are likely to experience threats or disparities. Nurses should consider the particular circumstances of women in contexts of vulnerability. We used a qualitative thematic synthesis to describe the experience of these women regarding their prenatal primary nursing care. We identified that the women's experience is shaped by the prenatal care. The fulfillment of their needs and expectations will guide their decision regarding the utilization of their prenatal care. We propose a theoretical model to guide nurses, promoting person-centered delivery of prenatal care.

Adoption of care management activities by primary care nurses for people with common mental disorders and physical conditions: A multiple case study.

WHAT IS KNOWN ON THE SUBJECT?: The collaborative care model is a well-known model to improve care quality for people with common mental disorders and physical conditions in primary care. The role of care manager is central to the collaborative care model, and primary care nurses are well-positioned to play that role. Adopting the role of care manager by primary care nurses is challenging due to several contextual factors; however, few implementation studies examined the context and current practices before implementing the role of care manager and the collaborative care model. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper contributes to the advancement of knowledge about the pre-assessment of current practices before implementing the collaborative care model and the role of care manager. The paper offers a better understanding of the relationships between the context and the performance of care management activities by primary care nurses. The paper describes an innovative analysis technique to assess the gap between care management activities recommended in the collaborative care model and actual nursing activities. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Primary care nurses would benefit from having timely access to clinical support from mental health nurse practitioners in order to build their competency. Determinants of practice and the analysis technique to assess current practices will help other researchers or quality improvement teams to develop their plan when implementing the role of care manager. ABSTRACT: Introduction Few studies assessed current nursing practices before implementing the collaborative care model and the role of care manager for people with common mental disorders (CMDs) and physical conditions in primary care settings. Aim Evaluate the main determinants of practice that influence the adoption of care management activities by primary care nurses for people with CMDs and physical conditions. Methods A qualitative multiple case study was conducted in three primary care clinics. A total of 33 participants were recruited. Various data sources were combined: interviews (n = 32), nurse-patient encounters' observations (n = 7), documents and summaries of meetings with stakeholders (n = 8). Results Seven determinants were identified (1) access to external mental health resources; (2) clarification of local CMD care trajectory; (3) compatibility between the coordination of nursing work and the role of care manager; (4) availability of mental health resources within the primary care clinic; (5) competency in care management and competency building; (6) responsibility sharing between the general practitioner and the primary care nurse; and (7) common understanding of the patient treatment plan. Implications for practice To build their competency in care management for people with CMDs, primary care nurses would benefit from having clinical support from mental health nurse practitioners.

Coconstruction d'une intervention infirmière centrée sur la personne pour soutenir l'autogestion des individus vivant avec le diabète de type 2.

Introduction : People living with type 2 diabetes are brought to make demanding behavioral changes that can lead to self-management difficulties.Background : The guidelines recommend that healthcare professionals follow a person-centered approach (PCA) when caring. However, this approach seems difficult to adopt in practice.Objective : Coconstruct an intervention inspired by the concept map (CM) to promote the adoption of PCA by nurses during self-management support encounters.Method : This study is based on a model for developing evidence-based nursing interventions. Five experts (2 patients, 2 nurses, 1 educational specialist) collaborated in the coconstruction of the intervention.Results : The Person-Centered Approach Diabetes Self-Management Support (PCA-DSMS) intervention has been developed in accordance with the foundations of a PCA and the CM. It includes four steps : 1) Introduce the intervention ; 2) Develop the Needs Map ; 3) Intervene according to priority needs ; 4) Conclude and plan a follow-up.Discussion : More studies are needed to explore whether the intervention is acceptable and feasible as well as its ability to lead nurses to adopt PCA.Conclusion : The PCA-DSMS could bring nurses to adopt a PCA.

[Adapted education for the elderly : An evolutionary concept analysis] / L'enseignement adapté à la personne âgée : une analyse évolutionniste de concept.

Many health programs provide "counseling" services that aim to support clients in their self-care. Although the concept of adapted education for the elderly is important for nursing practice, there is currently no consensus of its definition. An analysis of "adapted education for the elderly" following the six steps of Rodgers' evolutionary approach was conducted in order to identify the essential characteristics of the concept and to define its use in nursing. A literature review drawing upon several databases (Abstract in Social Gerontology, AgeLine, CINAHL, ERIC, and PsycINFO) identified twenty-six papers on this subject published between 1988 and 2016. After analysis, four key characteristics were identified to describe the concept: the uniqueness of the older learner, the presence of a competent and aware educator, the four-step process of the session, and the use of adapted teaching strategies for the older learner. Finally, the use of this concept in nursing remains erratic. To facilitate its operationalization, more studies and theories must be developed on the subject.

L'enseignement adapté à la personne âgée : une analyse évolutionniste de concept.

Many health programs provide "counseling" services that aim to support clients in their self-care. Although the concept of adapted education for the elderly is important for nursing practice, there is currently no consensus of its definition. An analysis of "adapted education for the elderly" following the six steps of Rodgers' evolutionary approach was conducted in order to identify the essential characteristics of the concept and to define its use in nursing. A literature review drawing upon several databases (Abstract in Social Gerontology, AgeLine, CINAHL, ERIC, and PsycINFO) identified twenty-six papers on this subject published between 1988 and 2016. After analysis, four key characteristics were identified to describe the concept: the uniqueness of the older learner, the presence of a competent and aware educator, the four-step process of the session, and the use of adapted teaching strategies for the older learner. Finally, the use of this concept in nursing remains erratic. To facilitate its operationalization, more studies and theories must be developed on the subject.

Physically aggressive behaviors in older people living with cognitive disorders: a systematic scoping review protocol.

BACKGROUND: Physically aggressive behaviors are very common among older people living with cognitive impairment. These behaviors may have significant consequences for family and formal caregivers, as well as for the other people in the older people's environment, and are also a frequent cause of institutionalization. Two relevant systematic reviews have been published on the subject but do not specifically target physically aggressive behaviors or only focus on care in nursing homes. Moreover, they do not address the causes, associated factors, and consequences of these behaviors, even though these should indeed be considered when developing interventions. Thus, the purpose of this scoping review is to map the state of knowledge on these physically aggressive behaviors with a view to developing personalized interventions. Offering a humanist and relational perspective by which these behaviors may be examined, the Senses Framework will guide this review. METHODS: The scoping review method of Levac, Colquhoun, and O'Brien will be used. Several databases (e.g., CINAHL, PubMed, PsycINFO, SCOPUS, Grey Literature Report, clinical trials registries) will be searched for literature published in the past 15 years, using a combination of keywords and descriptors. Other data sources will be used to identify non-indexed literature or unpublished results (e.g., articles references, journal tables of content, contact with key authors). The literature will be selected regardless of setting, if it concerns older people, aged 65, or older with cognitive impairment who present physically aggressive behaviors. Data will be extracted systematically by the research team. A quality assessment of the literature will be done to consider this aspect in the data synthesis. A content analysis will be used to synthesize the results. DISCUSSION: No scoping review has been found on the physically aggressive behaviors of older people living with cognitive impairment in various settings. The results of this review will identify needs for further research and for clinical and training development on this problem from a humanist standpoint. SYSTEMATIC REVIEW REGISTRATION: Currently, it is not possible to register a systematic scoping review protocol (e.g., PROSPERO).

Challenges of adopting the role of care manager when implementing the collaborative care model for people with common mental illnesses: A scoping review.

This review aimed to identify the main factors influencing the adoption of the role of care manager (CM) by nurses when implementing the collaborative care model (CCM) for common mental illnesses in primary care settings. A total of 19 studies met the inclusion criteria, reporting on 14 distinct interventions implemented between 2000 and 2017 in five countries. Two categories of factors were identified and described as follows: (i) strategies for the CCM implementation (e.g. initial care management training and supervision by a mental health specialist) and (ii) context-specific factors (e.g. organizational factors, collaboration with team members, nurses' care management competency). Identified implementation strategies were mainly aimed towards improving the nurse's care management competency, but their efficacy in developing the set of competencies needed to fulfil a CM role was not well demonstrated. There is a need to better understand the relationship between the nurses' competencies, the care management activities, the strategies used to implement the CCM and the context-specific factors. Strategies to optimize the adoption of the CM role should not be solely oriented towards the individual's competency in care management, but also consider other context-specific factors. The CM also needs a favourable context in order to perform his or her activities with competency.

[Difficulties related to self-care among people living with type 2 diabetes: a narrative literature review based on Audulv Asplund and Norbergh's model.]

Introduction : self-care activities require a lot of adaptation from people living with type 2 diabetes.Context : existing interventions to support self-care are often determined by a conventional vision focused on managing the disease.Objective : this article aims to present the difficulties of people living with type 2 diabetes in relation with the Audulv, Asplund and Norbergh self-care integration model.Method : a narrative review of the literature on self-care in adults with type 2 diabetes was conducted on the CINAHL, MEDLINE, PsycINFO, PASCAL and FRANÇIS databases.Results : 29 articles were selected. The main difficulties related to self-care are identified according to the four phases of the self-care integration model and the four factors related to the person's life context.Discussion : nurses could pull out some benefits from using the Audulv model by understanding the difficulties that the patients are living with and using this method, they could intervene with a better understanding towards the patients.Conclusion : further studies are needed to elaborate strategies to support people according to each of the identified difficulties.

[The health-within-illness experience: an encounter between the suffering and the power to exist for adults living with systemic scleroderma]. / L'expérience de santé-dans-la-maladie : une rencontre entre la souffrance et le pouvoir d'exister pour des adultes vivant avec a sclérodermie systémique.

This article presents the results of a study whose purpose was to understand and describe the experience of systemic sclerosis as well as that of health-within-illness in adults living with this chronic disease. The Watson's human caring philosophy supported the research process. In accordance with this author, van Manen's phenomenological methodology was chosen as the basis of the research process. Data was mainly collected from the experience of adult Quebeckers living with systemic sclerosis, through 34 in-depth interviews with 17 participants (14 women and three men). The results allowed the identification of four themes that describe, on the one hand, the essence of the experience of systemic sclerosis, and on the other hand, two themes emerged showing the essence of the experience of health-within-illness. The two essences were interrelated in order to develop a conceptualisation of the experience of health-within-illness in adult Quebeckers living with systemic sclerosis. This new conceptualisation of the experience of health- within-illness can contribute to a renewal of health care practice.