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1.
CMAJ Open ; 9(1): E142-E148, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33653769

RESUMO

BACKGROUND: After nonelective (i.e., semiurgent, urgent and emergent) surgeries, patients discharged from hospitals are at risk of readmissions, emergency department visits or death. During the coronavirus disease 2019 (COVID-19) pandemic, we are undertaking the Post Discharge after Surgery Virtual Care with Remote Automated Monitoring Technology (PVC-RAM) trial to determine if virtual care with remote automated monitoring (RAM) compared with standard care will increase the number of days adult patients remain alive at home after being discharged following nonelective surgery. METHODS: We are conducting a randomized controlled trial in which 900 adults who are being discharged after nonelective surgery from 8 Canadian hospitals are randomly assigned to receive virtual care with RAM or standard care. Outcome adjudicators are masked to group allocations. Patients in the experimental group learn how to use the study's tablet computer and RAM technology, which will measure their vital signs. For 30 days, patients take daily biophysical measurements and complete a recovery survey. Patients interact with nurses via the cellular modem-enabled tablet, who escalate care to preassigned and available physicians if RAM measurements exceed predetermined thresholds, patients report symptoms, a medication error is identified or the nurses have concerns they cannot resolve. The primary outcome is number of days alive at home during the 30 days after randomization. INTERPRETATION: This trial will inform management of patients after discharge following surgery in the COVID-19 pandemic and offer insights for management of patients who undergo nonelective surgery in a nonpandemic setting. Knowledge dissemination will be supported through an online multimedia resource centre, policy briefs, presentations, peer-reviewed journal publications and media engagement. TRIAL REGISTRATION: ClinicalTrials.gov, no. NCT04344665.

2.
Nurs Outlook ; 68(6): 745-762, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32912641

RESUMO

BACKGROUND: Chronic conditions are a major contributor to the burden of disease worldwide. Using innovative digital health technologies, nurse scientists are well-positioned to lead efforts to reduce the burden of chronic conditions on individuals, communities, and systems. PURPOSE: The purpose of this review was to summarize the outcomes commonly measured in nurse-led digital health interventions that target chronic conditions and pose recommendations for the education of future nurse scientists to lead these studies. METHODS: A rapid review of the literature was completed using CINAHL and Ovid Emcare. Studies were included if the research: a) was led by a nurse; b) described outcomes of a digital health intervention; and c) included any population with a prevalent chronic condition. FINDINGS: 26 studies were included in this review. Nurse-led digital health interventions are being used to support and manage a range of chronic conditions in varied settings. DISCUSSION: Digital health interventions are changing the delivery of healthcare for individuals living with chronic conditions. These interventions are bridging the gaps between the digital and physical worlds and are rapidly evolving. CONCLUSION: The recommendations posed in this review reiterate the importance of robust content and methods education for nurse scientists to address future research needs in a digital era.

3.
Health Expect ; 23(3): 523-539, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32157777

RESUMO

BACKGROUND: Realizing patient partnership in research requires a shift from patient participation in ancillary roles to engagement as contributing members of research teams. While engaging patient partners is often discussed, impact is rarely measured. OBJECTIVE: Our primary aim was to conduct a scoping review of the impact of patient partnership on research outcomes. The secondary aim was to describe barriers and facilitators to realizing effective partnerships. SEARCH STRATEGY: A comprehensive bibliographic search was undertaken in EBSCO CINAHL, and Embase, MEDLINE and PsycINFO via Ovid. Reference lists of included articles were hand-searched. INCLUSION CRITERIA: Included studies were: (a) related to health care; (b) involved patients or proxies in the research process; and (c) reported results related to impact/evaluation of patient partnership on research outcomes. DATA EXTRACTION AND SYNTHESIS: Data were extracted from 14 studies meeting inclusion criteria using a narrative synthesis approach. MAIN RESULTS: Patient partners were involved in a range of research activities. Results highlight critical barriers and facilitators for researchers seeking to undertake patient partnerships to be aware of, such as power imbalances between patient partners and researchers, as well as valuing of patient partner roles. DISCUSSION: Addressing power dynamics in patient partner-researcher relationships and mitigating risks to patient partners through inclusive recruitment and training strategies may contribute towards effective engagement. Further guidance is needed to address evaluation strategies for patient partnerships across the continuum of patient partner involvement in research. CONCLUSIONS: Research teams can employ preparation strategies outlined in this review to support patient partnerships in their work.

4.
J Med Internet Res ; 22(3): e15548, 2020 03 18.
Artigo em Inglês | MEDLINE | ID: mdl-32186521

RESUMO

BACKGROUND: Cardiac and major vascular surgeries are common surgical procedures associated with high rates of postsurgical complications and related hospital readmission. In-hospital remote automated monitoring (RAM) and virtual hospital-to-home patient care systems have major potential to improve patient outcomes following cardiac and major vascular surgery. However, the science of deploying and evaluating these systems is complex and subject to risk of implementation failure. OBJECTIVE: As a precursor to a randomized controlled trial (RCT), this user testing study aimed to examine user performance and acceptance of a RAM and virtual hospital-to-home care intervention, using Philip's Guardian and Electronic Transition to Ambulatory Care (eTrAC) technologies, respectively. METHODS: Nurses and patients participated in systems training and individual case-based user testing at two participating sites in Canada and the United Kingdom. Participants were video recorded and asked to think aloud while completing required user tasks and while being rated on user performance. Feedback was also solicited about the user experience, including user satisfaction and acceptance, through use of the Net Promoter Scale (NPS) survey and debrief interviews. RESULTS: A total of 37 participants (26 nurses and 11 patients) completed user testing. The majority of nurse and patient participants were able to complete most required tasks independently, demonstrating comprehension and retention of required Guardian and eTrAC system workflows. Tasks which required additional prompting by the facilitator, for some, were related to the use of system features that enable continuous transmission of patient vital signs (eg, pairing wireless sensors to the patient) and assigning remote patient monitoring protocols. NPS scores by user group (nurses using Guardian: mean 8.8, SD 0.89; nurses using eTrAC: mean 7.7, SD 1.4; patients using eTrAC: mean 9.2, SD 0.75), overall NPS scores, and participant debrief interviews indicated nurse and patient satisfaction and acceptance of the Guardian and eTrAC systems. Both user groups stressed the need for additional opportunities to practice in order to become comfortable and proficient in the use of these systems. CONCLUSIONS: User testing indicated a high degree of user acceptance of Philips' Guardian and eTrAC systems among nurses and patients. Key insights were provided that informed refinement of clinical workflow training and systems implementation. These results were used to optimize workflows before the launch of an international RCT of in-hospital RAM and virtual hospital-to-home care for patients undergoing cardiac and major vascular surgery.


Assuntos
Doenças Cardiovasculares/cirurgia , Serviços de Assistência Domiciliar/normas , Hospitais/normas , Monitorização Fisiológica/métodos , Interface Usuário-Computador , Idoso , Feminino , Humanos , Masculino , Período Pós-Operatório
5.
J Prof Nurs ; 36(2): 50-55, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32204860

RESUMO

Nurse researchers-in-training learn that traditional research methods aligning with the positivist paradigm are suitable for evaluating the effects of clinical interventions. Preferred research methods (such as the randomized controlled trial) are based on assumptions that linear cause-and-effect relationships are discoverable through careful manipulation of variables under controlled conditions. Yet clinical intervention trials in practice are much more often done in environments which are in constant states of flux, with dynamic and unpredictable variables rather than settings where uniformity and control are routine. Graduate nursing programs should expose students with interests in clinical research to methods that will enable them to make sense of how to evaluate clinical interventions in real world conditions. In this paper, we discuss the relevance of concepts from the field of Complexity Science-with a focus on Complex Adaptive Systems-to clinical research and examine their potential value to guide nursing research that informs evidence-based nursing interventions. We argue that the introduction of these concepts into graduate nursing curricula is fundamental to the preparation of future nurse scientists who will address the complex healthcare problems of this century.


Assuntos
Enfermeiras Clínicas , Pesquisa em Enfermagem/educação , Projetos de Pesquisa , Ciência/educação , Currículo , Educação de Pós-Graduação em Enfermagem , Enfermagem Baseada em Evidências , Humanos
6.
JMIR Pediatr Parent ; 2(2): e15106, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31750840

RESUMO

BACKGROUND: Use of synchronous digital health technologies for care delivery to children with special health care needs (having a chronic physical, behavioral, developmental, or emotional condition in combination with high resource use) and their families at home has shown promise for improving outcomes and increasing access to care for this medically fragile and resource-intensive population. However, a comprehensive description of the various models of synchronous home digital health interventions does not exist, nor has the impact of such interventions been summarized to date. OBJECTIVE: We aim to describe the various models of synchronous home digital health that have been used in pediatric populations with special health care needs, their outcomes, and implementation barriers. METHODS: A systematic scoping review of the literature was conducted, guided by the Arksey and O'Malley Scoping Review Framework. MEDLINE, CINAHL, and EMBASE databases were searched from inception to June 2018, and the reference lists of the included systematic reviews and high-impact journals were hand-searched. RESULTS: A total of 38 articles were included in this review. Interventional articles are described as feasibility studies, studies that aim to provide direct care to children with special health care needs, and studies that aim to support family members to deliver care to children with special health care needs. End-user involvement in the design and implementation of studies is evaluated using a human-centered design framework, and factors affecting the implementation of digital health programs are discussed in relation to technological, human, and systems factors. CONCLUSIONS: The use of digital health to care for children with special health care needs presents an opportunity to leverage the capacity of technology to connect patients and their families to much-needed care from expert health care providers while avoiding the expenses and potential harms of the hospital-based care system. Strategies to scale and spread pilot studies, such as involving end users in the co-design techniques, are needed to optimize digital health programs for children with special health care needs.

7.
J Multidiscip Healthc ; 12: 827-839, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31632051

RESUMO

Purpose: Few validated instruments are available to measure team functioning in acute and primary care teams. To address this, we developed a questionnaire measuring healthcare provider perceptions of team effectiveness (Provider-PTE) and assessed its psychometric properties. Patients and methods: Empirical evidence and a conceptual model were used for item generation. The 41-item self-completed questionnaire was developed. A cross-sectional survey of healthcare providers (n=283) across a range of settings was performed. Psychometric properties were assessed for French and English language questionnaires using Cronbach alpha (α) for reliability, the feedback form for face validity, expert opinion for content validity, and the known-group technique for construct validity. Responsiveness was examined by comparing scores in high and low functioning teams. Results: The mean time needed to complete the questionnaire was less than 9 mins. Respondents were typically female (84%), and employed full time (80%) in urban settings (82%). Cronbach α values were as follows: Team Processes = 0.88; PTE-Overall = 0.91; Outcomes = 0.72. Significant differences were found by professional group (p = 0.017), length of time in the team (p = 0.025), and presence of nurse practitioners. Responses to Outcomes varied by employment status (p = 0.017). Differences were identified in high and low functioning teams (p<0.001). Feedback indicated that two questions related to team meetings needed to be added. Conclusion: The study produced evidence of validity for English and French language Provider-PTE questionnaires. The revised 43-item instrument represents an important contribution by providing a validated questionnaire to measure team functioning across a range of settings that is consistent with a conceptual framework.

8.
J Nurs Educ ; 58(5): 290-293, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31039263

RESUMO

BACKGROUND: A simulated research practicum was developed in our nursing program to increase the number of quality research placements for our students. In order to evaluate the success of this simulation activity, we compared students' experiences in simulated and traditional mentored research placements. METHOD: A convenience sample of baccalaureate nursing students enrolled in an introductory research course in Ontario, Canada, was surveyed. A two-group posttest survey design was used to assess the research activities students experienced and their satisfaction with placements. Data were compared between the traditional mentored research placements (MRP) and simulated research placements (SRP) using descriptive and inferential statistical testing. RESULTS: Students in the SRP group had a statistically significant higher level of exposure to several aspects of the research process, although course satisfaction ratings were slightly better in the MRP group. CONCLUSION: The simulated practicum provided our organization with a feasible means of providing high-quality research placements by exposing undergraduate nursing students to several aspects of the research process. [J Nurs Educ. 2019;58(5):290-293.].


Assuntos
Bacharelado em Enfermagem/métodos , Aprendizagem , Tutoria , Pesquisa em Enfermagem/educação , Treinamento por Simulação , Estudantes de Enfermagem/psicologia , Currículo , Humanos , Pesquisa em Educação de Enfermagem , Pesquisa em Avaliação de Enfermagem , Satisfação Pessoal , Inquéritos e Questionários
9.
J Nurs Educ ; 58(2): 114-116, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30721313

RESUMO

BACKGROUND: An understanding of the research process and familiarity with research methods is essential to nursing curricula to prepare graduates to participate in the generation of new nursing knowledge. A research practicum with nurse researchers is one way of providing intensive hands-on training. At our institution, research placements for students has become difficult for a number of reasons. METHOD: To solve the problem related to the low number of quality research placements available, simulation was used to create an innovative research practicum. RESULTS: The simulated research practicum increased the number of quality research projects available to students and allowed students to participate in a small study from start to finish. It also used fewer faculty resources. CONCLUSION: The simulated research practicum is an innovative strategy to provide practical research experience to undergraduate students and requires fewer faculty resources than traditional placements. [J Nurs Educ. 2019;58(2):114-116.].


Assuntos
Bacharelado em Enfermagem/organização & administração , Avaliação Educacional/métodos , Aprendizagem Baseada em Problemas/organização & administração , Estudantes de Enfermagem/psicologia , Competência Clínica , Currículo , Humanos , Pesquisa em Educação de Enfermagem
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