Models for designing health-oriented nursing practice : contributions to nursing practice and the nursing discipline / Des modèles pour concevoir la pratique infirmière pour la santé : quels apports à la pratique et la discipline infirmières ?

Health generally represents what nurses should strive for in their practice. However, due to their general nature, the definitions of health are problematic for designing a health-oriented nursing practice. Rather than attempting to design it through a conceptual definition of what health is, some authors from the human sciences suggest using models that allow for a concrete commitment to health. Although this avenue is little explored in nursing, it is suggested that these practice-oriented health models would make it possible to design actionable mechanisms that generate health through practices, like nursing. The objective of this article is, through existing practice-oriented health models, to propose actionable mechanisms of health-oriented nursing practice. By invoking two models, from the writings of the philosopher Nordenfelt, as well as the sociologist Venkatapuram, two illustrations are proposed, both of which allow us to propose different actionable mechanisms. Anchored in the values that support a health-oriented practice, as well as in a descriptive component, this reflection highlights the potential of such models to concretely pursue a health-oriented nursing practice. These proposals appear to be promising for the participation of nursing science in the transdisciplinary understanding of health.

La santé représente généralement ce vers quoi les infirmières devraient tendre dans leur pratique. Toutefois, par leurs natures générales et parfois divergentes, les définitions du concept de santé s'avèrent problématiques pour concevoir une pratique infirmière engagée pour la santé. Plutôt que de tenter de la concevoir par une définition du concept de santé, certains auteurs des sciences humaines suggèrent de recourir à des modèles qui permettent de s'y engager concrètement. À partir de modèles existants de pratique pour la santé, l'objectif de cet article est de proposer des mécanismes actionnables permettant de générer une pratique infirmière pour la santé. Par l'invocation de deux modèles, provenant des écrits du philosophe Nordenfelt, ainsi que du sociologue Venkatapuram, deux illustrations sont proposées, permettant toutes deux de concevoir différents mécanismes actionnables. Par un ancrage dans les valeurs constitutives d'une pratique pour la santé, et par une composante descriptive, cette réflexion met en évidence le potentiel de tels modèles pour poursuivre concrètement une pratique infirmière pour la santé. Ces propositions semblent porteuses à la participation des sciences infirmières à la compréhension transdisciplinaire du concept de santé.

Nursing activities for health promotion in palliative home care: an integrative review.

Palliative care in community contexts is undergoing significant change as a result of public policy and new models of care, which link health promotion principles with palliative care practices. These models support the creation of partnerships between formal care structures and the communities in which care is provided. Given the central role of nurses in the institutional delivery of palliative care, particularly in the home, it is important to provide a systematic description of the activities of nurses that fall within the principles of health promotion. The objective was to describe the diverse range of nursing activities for health promotion that are provided in the palliative home care setting. This is an integrative review. Fifty-five studies listed in the MEDLINE, CINAHL and EMBASE databases, and published between 1999 and December 2022, were identified. Data analysis and presentation of the results were guided by Kellehear's Health-Promoting Palliative Care (HPPC) model. Six themes were identified to describe nursing activities for health promotion in the context of palliative home care: creating a meaningful relationship, supplying medical information, promoting self-care throughout the trajectory, providing emotional support, involving professional or community services and supporting change. The findings point to nurses focusing more on the individual context and on direct care. The relationship with communities in which they work remains unidirectional. However, some HPPC principles are relevant to nursing activities through the contextualization of nurses' actions and their moral responsibility to work towards the respect of patient's values. Being poorly described, how nurses can truly engage their practice towards health-promoting principles, such as the enhancement of support and control over their lives for people living with serious illness, still requires further empirical research.

Feedback on clinical team performance: how does it work, in what contexts, for whom, and for what changes? A critical realist qualitative multiple case study.

BACKGROUND: Feedback on clinical performance aims to provide teams in health care settings with structured results about their performance in order to improve these results. Two systematic reviews that included 147 randomized studies showed unresolved variability in professional compliance with desired clinical practices. Conventional recommendations for improving feedback on clinical team performance generally appear decontextualized and, in this regard, idealized. Feedback involves a complex and varied arrangement of human and non-human entities and interrelationships. To explore this complexity and improve feedback, we sought to explain how feedback on clinical team performance works, for whom, in what contexts, and for what changes. Our goal in this research was to present a realistic and contextualized explanation of feedback and its outcomes for clinical teams in health care settings. METHODS: This critical realist qualitative multiple case study included three heterogeneous cases and 98 professionals from a university-affiliated tertiary care hospital. Five data collection methods were used: participant observation, document retrieval, focus groups, semi-structured interviews, and questionnaires. Intra- and inter-case analysis performed during data collection involved thematic analysis, analytical questioning, and systemic modeling. These approaches were supported by critical reflexive dialogue among the research team, collaborators, and an expert panel. RESULTS: Despite the use of a single implementation model throughout the institution, results differed on contextual decision-making structures, responses to controversy, feedback loop practices, and use of varied technical or hybrid intermediaries. Structures and actions maintain or transform interrelationships and generate changes that are in line with expectations or the emergence of original solutions. Changes are related to the implementation of institutional and local projects or indicator results. However, they do not necessarily reflect a change in clinical practice or patient outcomes. CONCLUSIONS: This critical realist qualitative multiple case study offers an in-depth explanation of feedback on clinical team performance as a complex and open-ended sociotechnical system in constant transformation. In doing so, it identifies reflexive questions that are levers for the improvement of team feedback.

Passing through end-of-life suffering: Possible or not? Results from a qualitative inquiry.

The objective of this study was to understand the factors associated with "passing through suffering" in terminal illness. We interviewed 19 adults diagnosed with terminal disease in palliative stage. Interviews were analyzed using thematic analysis. Four axes of understanding were generated. In the first, participants discussed the will to "feel alive" despite the disease. The second, the process of acceptance, is based on lucidity and on letting go. The third highlights the importance of relationships with others. The fourth axis describes the consequences of this passage through suffering. This study highlights a phenomenon of adapting to suffering.

How does nursing-sensitive indicator feedback with nursing or interprofessional teams work and shape nursing performance improvement systems? A rapid realist review.

BACKGROUND: Care quality varies between organizations and even units within an organization. Inadequate care can have harmful financial and social consequences, e.g. nosocomial infection, lengthened hospital stays or death. Experts recommend the implementation of nursing performance improvement systems to assess team performance and monitor patient outcomes as well as service efficiency. In practice, these systems provide nursing or interprofessional teams with nursing-sensitive indicator feedback. Feedback is essential since it commits teams to improve their practice, although it appears somewhat haphazard and, at times, overlooked. Research findings suggest that contextual dynamics, initial system performance and feedback modes interact in unknown ways. This rapid review aims to produce a theorization to explain what works in which contexts, and how feedback to nursing or interprofessional teams shape nursing performance improvement systems. METHODS: Based on theory-driven realist methodology, with reference to an innovative combination of Actor-Network Theory and Critical Realist philosophy principles, this realist rapid review entailed an iterative procedure: 8766 documents in French and English, published between 2010 and 2018, were identified via 5 databases, and 23 were selected and analysed. Two expert panels (scientific and clinical) were consulted to improve the synthesis and systemic modelling of an original feedback theorization. RESULTS: We identified three hypotheses, subdivided into twelve generative configurations to explain how feedback mobilizes nursing or interprofessional teams. Empirically founded and actionable, these propositions are supported by expert panels. Each configuration specifies contextualized mechanisms that explain feedback and team outcomes. Socially mediated mechanisms are particularly generative of action and agency. CONCLUSIONS: This rapid realist review provides an informative theoretical proposition to embrace the complexity of nursing-sensitive indicator feedback with nursing or interdisciplinary teams. Building on general explanations previously observed, this review provides insight into a deep explanation of feedback mechanisms. SYSTEMATIC REVIEW REGISTRATION: Prospero CRD42018110128 .

Levels of Medical Intervention and End-of-Life Practices in Long-Term Care Centres.

Background: Levels of medical intervention (LMI) are legal documents in which physicians record patient preferences, or those of their designated substitute decision-makers, concerning end-of-life care. Studies suggest that, although LMI are intended to orient clinical practice, their function tends to be limited to logistical aspects of care. How LMI shapes or guides patient-centred, end-of-life care remains unclear. The aim of this study was to examine possible associations between LMI and certain aspects of end-of-life care practices in LTCC, such as nurse-documented patient experiences of pain, and prescription and administration of medication. Methods: A retrospective descriptive study of 100 files retrieved from a clinical database of deceased patients in LTCCs located in an urban integrated health and social service organization in Québec, Canada, was conducted. Results: Significant associations between last documented LMI and frequency of narcotic prescription and administration, at either regular intervals or PRN, are highlighted. The time delay between last LMI assessment and patient death was one week or less for 39.4% of cases. Conclusion: These results suggest that LMI assessment practices may not correspond to their intended use. A short time frame between last LMI (L-LMI) assessment and patient death may suggest less-than-optimal patient comfort in end-of-life care.

Non-somatic Suffering in Palliative Care: A Qualitative Study on Patients' Perspectives.

Objectives: Suffering is intimately linked to the experience of illness, and its relief is a mandate of medicine. Advances in knowledge around terminal illness have enabled better management of the somatic dimension. Nevertheless, there is what can be called "non-somatic" suffering which in some cases may take precedence. Inspired by Paul Ricoeur's thinking on human suffering, our aim in this qualitative study was to better understand the experience of non-somatic suffering. Methods: Semi-structured interviews were conducted with 19 patients. The results were qualitatively analyzed following a continuous comparative analysis approach inspired by grounded theory. Results: Three key themes synthesize the phenomenon: "the being enduring the suffering", "the being whose agency is constrained", and "the being in relationship with others." The first describes what patients endure, the shock and fears associated with their own finitude, and the limits of what can be tolerated. The second refers to the experience of being restricted and of mourning the loss of their capacity to act. The last describes a residual suffering related to their interactions with others, that of loneliness and of abandoning their loved ones, two dimensions that persist even when they have accepted their own death. Conclusions: Non-somatic suffering can be multifarious, even when minimized by the patient. When evaluating suffering, we must keep in mind that patients can reach a "breaking point" that signals the state of unbearable suffering. In managing it, we probably need to make more room for family and friends, as well as a posture of caring based more on presence and listening.

How does feedback shared with interprofessional health care teams shape nursing performance improvement systems? A rapid realist review protocol.

BACKGROUND: Nursing care quality varies between hospitals, and even between departments within the same institution. Suboptimal care can have deleterious consequences for patients such as lengthened hospital stay, nosocomial infection, pressure ulcers or death. Experts recommend the implementation of nursing performance improvement systems to assess team performance and monitor patient outcomes and efficiency savings. In practice, these systems are expected to include feedback processes directed towards nursing teams and interprofessional staff in order to facilitate adjustments and improve their performance. Unfortunately, feedback appears somewhat haphazard and, at times, overlooked. This could be explained by an ongoing absence of clear recommendations. As a result, feedback effects are inconclusive: some teams improve their practice, others do not. Although feedback has been conceptualised and studied from different theoretical perspectives, ongoing empirical inconsistencies remain unexplained. The goal of this rapid realist review protocol is to develop a theory that explains how feedback shared with interprofessional health care teams shape nursing performance improvement systems. METHOD: This study follows standard guidelines established for realist reviews. Mechanisms at work will be analysed using Actor-Network Theory. All scientific documents are selected from five databases, are published in both English and French between 2010 and 2018, and include empirical research, reviews and grey literature. First, selection of documents will proceed on the basis of titles and abstracts; followed by a second selection by reading the remaining full texts. Inclusion criteria and a data extraction form will be pilot tested with 40 articles prior to completion by two reviewers. Data will be summarised in the form of [context, mechanism, outcome] equations to theorise operational feedback. DISCUSSION: The innovative combination of Actor-Network Theory with a realist methodology holds promise for the identification of explanatory equations in complex systems and theory development. A rapid realist review is relevant to address an enduring knowledge gap which requires theory development. This preliminary study lays the groundwork for a pioneering theory on feedback in nursing performance improvement systems that will subsequently inform a multiple case study. SYSTEMATIC REVIEW REGISTRATION: Prospero CRD42018110128.

Nurse-Environment Interactions in the Development of Cultural Competence.

Studies on the development of cultural competence among healthcare providers tend to focus on the clinical encounter, with little attention paid to the environment. In this paper, results from a grounded theory study conducted with nurses and students to understand cultural competence development are presented; with a focus on findings that call particular attention to nurse-environment interactions. Two concurrent processes, as students and nurses develop cultural competence through interactions with their environment, were identified: "dealing with structural constraints" and "mobilizing social resources". These dynamic interactions between healthcare providers and the larger structures of healthcare systems raise critical questions about the power of healthcare providers to influence the structures that shape their practice. The intersection of nursing theory with social and critical theories is essential to gain a comprehensive understanding of cultural competence development and to transform healthcare providers' education in the service of social justice and health equity.

[Different philosophical traditions for knowledge development in nursing sciences]. / Différentes traditions philosophiques pour le développement des connaissances en sciences infirmières.

INTRODUCTION: doctoral studies in nursing engage a critical reflections about philosophical traditions inherent to knowledge development. BACKGROUND: critical realism, hermeneutics, postmodernism and poststructuralism refer to philosophical traditions that are generally less explored in nursing, although they are attracting greater attention. OBJECTIVE: this paper offers an introductory presentation to these traditions as the authors also reflect upon their contribution to nursing knowledge development in. METHOD: for each tradition, ontological and epistemological properties are presented to provide an overview of their main features. Contributions to nursing knowledge development are then discussed. RESULTS: ontology refers to stratified, fixed and changing, or multiple realities, depending on the philosophical tradition. Likewise, epistemology emphasizes the explanatory power of knowledge, intersubjectivity, or inherent power dynamics. DISCUSSION: the diversity of philosophical traditions represents an asset that can significantly contribute to the advancement of the nursing discipline. CONCLUSION: clarification of the philosophical dimensions that underlie knowledge development is essential for doctoral nursing students in the process of developing their research projects and future programmes of research.

[Not Available]. / Collaboration entre les centres de pédiatrie sociale en communauté et les réseaux des services sociaux public et communautaire pour venir en aide aux familles : quelle place et quels enjeux pour les acteurs?

OBJECTIVES: Over the past twenty years, numerous community social pediatrics centres (CSPCs) have been established in Quebec. Because the needs of the children followed are so complex, collaboration with organizations in social services and public and community health networks is paramount. The purpose of this study is to document CSPCs'level of integration into these networks and the issues and challenges involved in such collaborations. METHOD: Telephone surveys were conducted with 75 respondents from public and community networks and with representatives from CSPCs that have been open for at last one year. Two questionnaires were used to document the depth and quality of connections and an open question helped identify certain collaboration-related issues and challenges. RESULTS: CSPCs perceive a higher level of collaboration with the social services and public health network than with the community network. Similarly, CSPCs want to collaborate more with the public network than with the community network. With respect to the quality of collaborations, the climate is more positive and the level of joint coordination is higher between CSPCs and the public network. Although they are similar, the issues related to collaboration can be seen differently in terms of challenges, depending on the stakeholders' network. CONCLUSION: Results are discussed in light of challenges that characterize the collaborations between CSPCs and the networks, which include the recognition of their identity and the funding of the organizations.

Understanding similarities in the local implementation of a healthy environment programme: insights from policy studies.

This paper reports findings from an evaluation of the local implementation of a procedural public health programme whose objective is to create healthy environments (HE) for vulnerable families in the province of Quebec (Canada) through the funding of local projects. Considering the potential issue of programme-context interaction, our research question was the following: Does the procedural nature of this HE programme result in variation between local cases in terms of the types of projects and collaborations it subsidizes? Given that the creation of healthy environments requires intersectoral health action to address social determinants of health, the data were analysed with respect to intersectorality and cooperation. Results of this qualitative multiple case study (n = 8), for the period 2004-2009, show that the majority of subsidized projects were in the health and social services sector and focused on parenting, parent-child attachment, nutrition and the social networks of families. Only a few initiatives reached beyond the health and social services sector to address social health determinants such as education, housing and transportation. Membership and mandates of the local groups responsible for programme implementation also showed little intersectorality. The limited variation between these eight cases can be attributed to the configuration of the local networks, as well as to specific issues in urban and rural areas. To explain the overall similarity of results across cases, we turned to the literature on policy instruments which suggests that particular characteristics of a programme may produce effects that are independent of its intended objective. In our study, several programme mechanisms, such as those framing the definition of «healthy environment¼ and budget management rules, could have encouraged the local development of initiatives that focus on individual skills related to parenting and attachment rather than the development of intersectoral health action to address social determinants of health.

Advancing population-based health-promotion and prevention practice in community-health nursing: key conditions for change.

Community-health nursing practice is a pivotal aspect of present-day health reforms. In Quebec, Canada, the recent introduction of a population-based approach has entailed increasing the resources allocated to health promotion and disease prevention. Semistructured interviews were conducted with nurses and managers (N = 69) in an effort to understand how these new resources are reflected in nursing practice. Three classes of factors emerged as key conditions for change: contextual and historical, training and professional-development, and work-organization factors. The authors propose courses of action respecting these conditions to provide support for community-health nursing practices that incorporate a contemporary population-based approach.

Transitioning care of an adolescent with cystic fibrosis: development of systemic hypothesis between parents, adolescents, and health care professionals.

This qualitative study explored the experience of parents and adolescents living with cystic fibrosis prior to the transfer of the adolescent's care from a pediatric to an adult health care facility. Semistructured interviews were conducted with seven families receiving care from a specialized cystic fibrosis clinic; parents and adolescents were interviewed separately, followed by a group interview with members of a health care team comprising eight professionals from the clinic. Interviews were analyzed through a systemic lens which accounts for interaction and reciprocity in relationships. The parents' experience was marked by suffering and uncertainty that remained unexpressed to the health care team, even though team members had known the family since the child was first diagnosed. Findings led to identifying a systemic hypothesis that accounted for the interactions and relational processes between parents and the health care team. This hypothesis may guide the development of systemic family nursing interventions that target this complex, relational, transition process.

Health promotion and disease prevention among nurses working in local public health organizations in Montréal, Québec.

OBJECTIVE: This study investigates conceptualizations of disease prevention and health promotion (DPHP) among nurses from local public health organizations in Montréal, Québec. DESIGN AND SAMPLE: A collaborative qualitative study was conducted among a purposive sample of 41 nurses. MEASURES: Semi-structured interviews investigated two themes: meanings attributed to DPHP as well as nurses' recent DPHP activities. RESULTS: Although the meaning attributed to prevention referred to standard definitions, health promotion was often defined as large-scale health education oriented toward the attainment of positive results, such as health and well-being. Almost completely absent from participants' discourse were central notions such as empowerment and health determinants, including socioenvironmental dimensions of health. With regard to activity descriptions, there was a very partial coverage of the full spectrum of DPHP. Participants rarely went beyond traditional health education activities aimed at an individual target. Finally, a sizeable number of participants appeared to be unable to provide a clear distinction between the terms "health promotion" and "prevention." CONCLUSIONS: The results are consistent with a conclusion frequently drawn by commentators and researchers alike that highlight a narrow range of DPHP nursing practices.

Confianza, vigilancia y responsabilización: cambios en el desarrollo de la autonomía en las familias que viven con un adolescente que padece de fibrosis quística / Confidence, supervision and taking responsibility: changes in the development of autonomy in families who live with an adolescent with cystic fibrosis

Objetivo Un creciente número de familias con un adolescente que padece de fibrosis quística ahora puede tener la esperanza de que su hijo haga la transición de la adolescencia a la edad adulta. A la fecha, se han llevado a cabo muy pocas investigaciones con respecto a la naturaleza de las interacciones entre adolescentes y sus padres relacionadas con el desarrollo de la autonomía del adolescente.MétodoLa meta de este estudio cualitativo de casos era la de explorar la experiencia de las familias con un adolescente que padece de fibrosis quística, en la etapa de pretransferencia de una clínica pediátrica a un sistema de cuidados para adultos. Se aplicó un marco sistémico para obtener una mejor comprensión de este fenómeno. Se llevaron a cabo entrevistas semidirigidas con 7 familias y se realizó un análisis de contenido.ResultadosLas características del desarrollo de la autonomía se definen a través de 3 dimensiones de la experiencia paternal: a) la confianza que se debe establecer entre el adolescente y los padres, b) el incremento gradual de la responsabilidad del adolescente y c) la supervisión del adolescente por parte de los padres.ConclusionesEl presente estudio proporciona nueva información sobre la experiencia parental en relación con el desarrollo de autonomía en adolescentes que sufren de fibrosis quística. Los resultados subrayan la importancia de tomar en cuenta la experiencia parental para apoyar a las familias en el desarrollo de la autonomía del adolescente(AU)

Objective A growing number of families with an adolescent who has cystic fibrosis can now envisage their child making the transition from adolescence to adulthood. Limited research has been conducted to date regarding the nature of the interactions between adolescents and their parents during the development of the adolescent's independence.MethodThe aim of this qualitative case study was to explore the experience of families with an adolescent who has cystic fibrosis, at the pre-transfer stage from a paediatric clinic to adult care. A systemic framework was used to get a better understanding of this phenomenon. Semi-directed interviews with seven families were conducted and a content analysis was performed.ResultsFeatures of the development of autonomy are characterised by three dimensions of the parental experience: (a) confidence that must be established between the adolescent and the parent, (b) adolescent's gradual increase of responsibility and (c) parent's supervision of the adolescent.ConclusionsThis study gives new information on parental experience as regards the development of autonomy in adolescents who have cystic fibrosis. The results underline the importance of taking parental experience into consideration in order to support families in the development of the adolescent's autonomy(AU)

[Confidence, supervision and taking responsibility: changes in the development of autonomy in families who live with an adolescent with cystic fibrosis]. / Confianza, vigilancia y responsabilización: cambios en el desarrollo de la autonomía en las familias que viven con un adolescente que padece de fibrosis quística.

OBJECTIVE: A growing number of families with an adolescent who has cystic fibrosis can now envisage their child making the transition from adolescence to adulthood. Limited research has been conducted to date regarding the nature of the interactions between adolescents and their parents during the development of the adolescent's independence. METHOD: The aim of this qualitative case study was to explore the experience of families with an adolescent who has cystic fibrosis, at the pre-transfer stage from a paediatric clinic to adult care. A systemic framework was used to get a better understanding of this phenomenon. Semi-directed interviews with seven families were conducted and a content analysis was performed. RESULTS: Features of the development of autonomy are characterised by three dimensions of the parental experience: (a) confidence that must be established between the adolescent and the parent, (b) adolescent's gradual increase of responsibility and (c) parent's supervision of the adolescent. CONCLUSIONS: This study gives new information on parental experience as regards the development of autonomy in adolescents who have cystic fibrosis. The results underline the importance of taking parental experience into consideration in order to support families in the development of the adolescent's autonomy.