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1.
Prim Health Care Res Dev ; 23: e35, 2022 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-35678200

RESUMO

AIM: To understand healthcare providers' experiences with video recording of patient consultations. BACKGROUND: Video recordings have been recognised to be an effective method to evaluate in situ interactions in clinical practice. The video recordings are often conducted by researchers, but active involvement of healthcare providers into the process of recording is evolving. Still, little is known of how video recordings by healthcare providers may influence daily clinical practice and potentials for direct use to guide practice development. METHODS: A qualitative design was used, conducting two focus group interviews including 12 healthcare providers representing eight different healthcare services who provide municipal cardiac rehabilitation. Interpretive description was used as the methodological framework, and symbolic interactionism served as the theoretical lens. FINDINGS: Three themes were identified reflecting healthcare providers' experiences with video recording of patient consultations: 'Concerns of compromising primary work tasks', 'Exposing professional and personal skills' and 'A new learning dimension'. Overall, the three themes represent the process of video recording own practices attached to patient consultations and the personal investment attached to the video data. Also, how the recordings may provide new insights for practice development in terms of individual and team-based performance in patient consultations. CONCLUSION: Video recordings by healthcaref providers may be a useful source to provide information and learning about patient consultation practice to use in research and supervision, keeping in mind their challenges of implementation into daily clinical practice.


Assuntos
Pessoal de Saúde , Encaminhamento e Consulta , Grupos Focais , Humanos , Pesquisa Qualitativa , Gravação em Vídeo
2.
Clin Interv Aging ; 17: 885-902, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35686030

RESUMO

Purpose: Limited information is available concerning primary care providers' encountered barriers and facilitators when implementing falls prevention and providing interventions in a real-life setting. This study aimed to identify barriers and facilitators when i) implementing a falls risk assessment strategy at GP practices and among community nurses and ii) providing evidence-based falls prevention interventions in a real-life setting to independently living, frail older people. Methods: A researcher's journal was maintained during the implementation of a falls risk assessment strategy, which entailed notes from informal conversations with GPs, practice nurses and community nurses. After implementation, two online focus groups with GPs, practice and community nurses, physio- and exercise therapists were conducted. Data were thematically analyzed. Results: Data were collected from 32 GPs, 13 practice nurses, eight community nurses, nine physiotherapists, and two exercise therapists. The GPs and nurses acknowledged that falls prevention is part of their job, meaningful, and that they have sufficient knowledge and skills to offer falls prevention. Collaboration, a previously implemented care program for older people, resources, reimbursement for interventions, and patients' motivation, awareness and health issues were considered to be important factors for the implementation of falls prevention. Physio- and exercise therapists described collaboration with different disciplines, receiving sufficient referrals, reimbursements, intensity and set-up of the interventions, and patients' motivation, expectations, goals, self-confidence, awareness, and health issues as important factors when providing falls prevention interventions. Conclusion: This study identified care provider-, context-, patient-, and innovation (strategy)-related barriers and facilitators when implementing falls prevention and providing interventions in primary care. Development of a more successful implementation strategy should focus on intensifying collaboration, reimbursement for interventions, availability of resources, and patients' lack of motivation and health issues. Hence, falls prevention may become more structurally applied, reducing a major threat for the quality of life of independently living older people.


Assuntos
Qualidade de Vida , Encaminhamento e Consulta , Idoso , Grupos Focais , Humanos , Atenção Primária à Saúde
3.
Artigo em Inglês | MEDLINE | ID: mdl-35682125

RESUMO

BACKGROUND: Nurses and nursing students experienced an emotional burden while working during the COVID-19 outbreak. During the COVID-19 outbreak three questions for nurses working under these extreme circumstances were formulated: 1. What today's events do you remember? 2. How do you feel (physically and mentally)? 3. Do you have enough support? The purpose of this study was to obtain insight into whether nurses and nursing students perceive that the use of the three-questions-method contributes to effective coping with the emotional burden during the COVID-19 outbreak. METHODS: Focus group interviews were held with hospital nurses (n = 11) and nursing students with internships in mental health care (n = 2), hospital (n = 9), and homecare/nursing home care (n = 3) in September 2020 followed by twenty semi-structured interviews one year later. RESULTS: Almost all nurses and nursing students named factors that contributed to the emotional burden: fear, powerlessness, frustration, lack of knowledge about COVID-19, and pressure to pass the internship. Participants indicated that using the three-questions-method can help to effectively cope with the emotional burden during and after the COVID-19 outbreak. CONCLUSIONS: Using the three-questions-method offers added value in coping with emotional burden and can be used in education as well as in practice.


Assuntos
COVID-19 , Estudantes de Enfermagem , Adaptação Psicológica , COVID-19/epidemiologia , Emoções , Grupos Focais , Humanos , Estudantes de Enfermagem/psicologia
4.
Artigo em Inglês | MEDLINE | ID: mdl-35682344

RESUMO

EhcoBUTLER is a tablet platform mainly aimed at the elderly with mild cognitive impairment (MCI) to promote their well-being and health. The main objective of this study was to explore the perceptions and feedback level of the ehcoBUTLER potential users and stakeholders to improve its development. Through this exploration, the secondary objective was to contribute to the development of software/apps that promote their integral health. Focus groups were conducted (13 elderly with MCI, 13 with dementia, 12 caregivers, 11 professionals). The content and feedback level were analyzed. Participants liked the appearance of ehcoBUTLER, would like to use it, and were mainly interested in the emotional, healthy lifestyle, cognitive, and ergonomic tools. It is necessary to have prior training, more intuitive/customizable apps, low-price/free, offline/USB content, and add other activities/features. EhcoBUTLER is well-oriented to meet the needs and preferences of potential users. However, improvements in its usability, accessibility, and sustainability are needed. The participants' perspectives provided a comprehensive view to improve ehcoBUTLER, so that in the future, it can benefit the elderly to be active agents in their health; support caregivers in their role and to have a respite; and professionals to have a multi-intervention platform. The present findings can contribute to the development of tablet software/apps that promote the integral well-being of this population.


Assuntos
Disfunção Cognitiva , Demência , Idoso , Cuidadores/psicologia , Disfunção Cognitiva/psicologia , Atenção à Saúde , Demência/psicologia , Grupos Focais , Humanos , Comprimidos
5.
Artigo em Inglês | MEDLINE | ID: mdl-35682355

RESUMO

Collaboration between birth care and Preventive Child Health Care (PCHC) in the Netherlands is so far insufficient. The aim of the Connecting Obstetric; Maternity; Pediatric and PCHC (COMPLETE) study is to: (1) better understand the collaboration between birth care and PCHC and its underlying mechanisms (including barriers and facilitators); (2) investigate whether a new multidisciplinary strategy that is developed as part of the project will result in improved collaboration. To realize the first aim, a mixed-method study composed of a (focus group) interview study, a multiple case study and a survey study will be conducted. To realize the second aim, the new strategy will be piloted in two regions in an iterative process to evaluate and refine it, following the Participatory Action Research (PAR) approach. A prospective study will be conducted to compare outcomes related to child health, patient reported outcomes and experiences and quality of care between three different cohorts (i.e., those that were recruited before, during and after the implementation of the strategy). With our study we wish to contribute to a better understanding of collaboration in care and develop knowledge on how the integration of birth care and PCHC is envisioned by stakeholders, as well as how it can be translated into practice.


Assuntos
Saúde da Criança , Serviços Preventivos de Saúde , Criança , Feminino , Grupos Focais , Humanos , Gravidez , Estudos Prospectivos , Pesquisa Qualitativa
6.
Artigo em Inglês | MEDLINE | ID: mdl-35682366

RESUMO

The development of true evidence-based practice requires that practitioners have the knowledge and skills to research, analyze, and use evidence. These skills must be acquired in pre-graduate training. The objective of the present study was to analyze the contributions of students' participation in knowledge translation projects to clinical practice for evidence-based learning. This was a qualitative, descriptive, and exploratory study that used focus groups. Scripted interviews were administered. The design of the study included five phases and took place in the partnering institutions of the Safety Transition Project, involving fifteen participants. The study was authorized by the Research Ethics Committee. The data were analyzed following the steps encoding the categories, storage and recovery, and (3) interpretation and using computer software (WebQDA®, Ludomédia, Aveiro, Portugal). Four categories were identified: learning evidence; communicating science; evidence-based practice; and developing skills. The successful implementation of evidence-based practice education resulted in students who understand its importance and use it competently. Further research should explore the skills developed by nurses involved in similar projects and their contribution to an EBP culture.


Assuntos
Bacharelado em Enfermagem , Estudantes de Enfermagem , Bacharelado em Enfermagem/métodos , Prática Clínica Baseada em Evidências , Grupos Focais , Humanos , Aprendizagem , Portugal
7.
Artigo em Inglês | MEDLINE | ID: mdl-35682417

RESUMO

BACKGROUND: A scientific consensus on the public health impact of electronic nicotine delivery systems (ENDS) remains elusive. This is partly due to the wide variation in product characteristics often lumped together under one category. Research is needed to better understand what ENDS device type characteristics motivate their use by adults. METHODS: Nine focus groups of 32 current ENDS users who were 18+ years old, had used ENDS in the previous 30 days, and had been using ENDS for more than two months were held either in person or online between February and June 2020. RESULTS: Participants' reasons for their choice of ENDS characteristics included both general, applying to all ENDS products, and specific, relating to particular ENDS devices. Health benefits and the lack of offensive odor were commonly identified as important reasons for using ENDS in general. Flavor and product discreteness were both general and device-specific determinants of ENDS use. Conversely, nicotine delivery, cloud size, battery properties, aesthetics, ease of use, and cost were device-specific drivers of participants' choice. CONCLUSIONS: The reasons that adults choose to use ENDS are complex and sometimes related to both ENDS as a category and as specific ENDS product types. Regulations and public communication campaigns should reflect their ultimate objective and consider both general and specific motivations when attempting to achieve public health objectives.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Vaping , Adolescente , Adulto , Grupos Focais , Humanos , Motivação , Nicotina , Pesquisa Qualitativa
8.
BMC Nephrol ; 23(1): 205, 2022 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-35690713

RESUMO

BACKGROUND: Progression of chronic kidney disease (CKD) may be delayed if patients engage in healthy lifestyle behaviors. However, lifestyle adherence is very difficult and may be influenced by problems in psychosocial functioning. This qualitative study was performed to gain insights into psychosocial barriers and facilitators for lifestyle adherence among patients with CKD not receiving dialysis. METHODS: Eight semi-structured focus groups were conducted with a purposive sample of 24 patients and 23 health care professionals from four Dutch medical centers. Transcripts were analyzed using thematic analysis. Subsequently, the codes from the inductive analysis were deductively mapped onto the Theoretical Domains Framework (TDF). RESULTS: Many psychosocial barriers and facilitators for engagement in a healthy lifestyle were brought forward, such as patients' knowledge and intrinsic motivation, emotional wellbeing and psychological distress, optimism, and disease acceptance. The findings of the inductive analysis matched all fourteen domains of the TDF. The most prominent domains were 'social influences''and 'environmental context and resources', reflecting how patients' environments hinder or support engagement in a healthy lifestyle. CONCLUSIONS: The results indicate a need for tailored behavioral lifestyle interventions to support disease self-management. The TDF domains can guide development of adequate strategies to identify and target individually experienced psychosocial barriers and facilitators.


Assuntos
Diálise Renal , Insuficiência Renal Crônica , Grupos Focais , Estilo de Vida Saudável , Humanos , Pesquisa Qualitativa , Insuficiência Renal Crônica/terapia
9.
BMC Health Serv Res ; 22(1): 730, 2022 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-35650598

RESUMO

OBJECTIVES: The burden and costs of abdominal surgery for chronic conditions are on the rise, but could be reduced through self-management support. However, structured support to prepare for colorectal surgery is not routinely offered to patients in Canada. This study aimed to describe experiences and explore preferences for multimodal prehabilitation among colorectal surgery patients. METHODS: A qualitative descriptive study using three focus groups (FG) was held with 19 patients who had a surgical date for abdominal surgery (April 2017-April 2018) and lived close (≤ 50 km radius) to a tertiary hospital in Western Canada (including a Surgical Lead for the British Columbia Enhanced Recovery After Surgery (ERAS) Collaborative). FGs were audio-taped and verbatim transcribed with coding and pile-and-sort methods performed by two independent reviewers, confirmed by a third reviewer, in NVivo v9 software; followed by thematic analysis and narrative synthesis. RESULTS: Four themes emerged: support, informed decision-making, personalization of care, and mental/emotional health, which patients felt was particularly important but rarely addressed. Patient preferences for prehabilitation programming emphasised regular support from a single professional source, simple health messages, convenient access, and flexibility. CONCLUSIONS: There is an unmet need for structured preoperative support to better prepare patients for colorectal surgery. Future multimodal prehabilitation should be flexible and presented with non-medical information so patients can make informed decisions about their preoperative care and surgical outcomes. Healthcare providers have an important role in encouraging healthy lifestyle changes before colorectal surgery, though clearer communication and accurate advice on self-care, particularly mental health, are needed for improving patient outcomes.


Assuntos
Cirurgia Colorretal , Colúmbia Britânica , Grupos Focais , Humanos , Preferência do Paciente , Pesquisa Qualitativa
10.
Transpl Int ; 35: 10255, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35664427

RESUMO

We aimed to identify, assess, compare and map research priorities of patients and professionals in the Swiss Transplant Cohort Study. The project followed 3 steps. 1) Focus group interviews identified patients' (n = 22) research priorities. 2) A nationwide survey assessed and compared the priorities in 292 patients and 175 professionals. 3) Priorities were mapped to the 4 levels of Bronfenbrenner's ecological framework. The 13 research priorities (financial pressure, medication taking, continuity of care, emotional well-being, return to work, trustful relationships, person-centredness, organization of care, exercise and physical fitness, graft functioning, pregnancy, peer contact and public knowledge of transplantation), addressed all framework levels: patient (n = 7), micro (n = 3), meso (n = 2), and macro (n = 1). Comparing each group's top 10 priorities revealed that continuity of care received highest importance rating from both (92.2% patients, 92.5% professionals), with 3 more agreements between the groups. Otherwise, perspectives were more diverse than congruent: Patients emphasized patient level priorities (emotional well-being, graft functioning, return to work), professionals those on the meso level (continuity of care, organization of care). Patients' research priorities highlighted a need to expand research to the micro, meso and macro level. Discrepancies should be recognized to avoid understudying topics that are more important to professionals than to patients.


Assuntos
Pesquisa , Estudos de Coortes , Feminino , Grupos Focais , Humanos , Gravidez , Pesquisa Qualitativa , Inquéritos e Questionários , Suíça
11.
Rev Esc Enferm USP ; 56: e20210597, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35666983

RESUMO

OBJECTIVE: To identify elements of the Strengths-Based Nursing and Healthcare in the maternity nurses care practice in a perspective of continuity of care. METHOD: Qualitative exploratory-descriptive study. A focus group was used for data collection, seven meetings were held with 18 nurses between August 2019 and January 2020, starting from a priori categories: "problem-based nursing care" and "strengths-based nursing and healthcare". RESULTS: In the first category, nurses' care is centered on problems identified in women; they keep a hierarchical relationship and a prescriptive posture based on a biomedical model. In the second category, care is focused on singularity, empowerment, self-determination, learning, collaborative partnership, and promotion of women's health, based on a holistic nursing model. CONCLUSION: Although nurses use the biomedical model in their care practice, many of them already use the framework elements empirically. Applying this theoretical framework allows nurses to shift the focus of their attention from the disease to the person/family, promoting health and the continuity of care in a holistic way.


Assuntos
Atenção à Saúde , Autonomia Pessoal , Continuidade da Assistência ao Paciente , Feminino , Grupos Focais , Humanos , Gravidez , Pesquisa Qualitativa
12.
BMC Health Serv Res ; 22(1): 751, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35668491

RESUMO

BACKGROUND: Substantial proliferation of eHealth has enabled a move in patient-centred cancer care from the traditional in-person care model to real-time, dynamic, and technology supported on-demand care. However, in general, the uptake of these innovations is low. Studies show that eHealth is helpful in providing patient empowerment through e.g. providing high quality and timely information, enabling self-monitoring and shared decision making, but dropout rates are high and guidance for optimal implementation is lacking. AIM: To explore barriers to and facilitators for nationwide implementation and consolidation of CMyLife, a multi-component, patient-centred, digital care platform, and to construct a comprehensive implementation guide for launching digital care platforms in daily clinical practice. METHODS: The first qualitative case study of a digital care platform like CMyLife was performed including five focus group- and eighteen in-depth interviews with stakeholders. Data were collected using a semi-structured interview guide, based on the frameworks of Grol and Flottorp. Transcripts of the interviews were analysed and barriers and facilitators were identified and categorized according to the frameworks. An iterative process including participation of main stakeholders and using the CFIR-ERIC framework led to creating a comprehensive implementation guide for digital care platforms. RESULTS: In total, 45 barriers and 41 facilitators were identified. Main barriers were lack of connectivity between information technology systems, changing role for both health care providers and patients, insufficient time and resources, doubts about privacy and security of data, and insufficient digital skills of users. Main facilitators mentioned were motivating patients and health care providers by clarifying the added value of use of a digital care platform, clear business case with vision, demonstrating (cost) effectiveness, using an implementation guide, and educating patients and health care providers about how to use CMyLife. Based on these barriers and facilitators a clear and comprehensive implementation guide was developed for digital care platforms. CONCLUSION: Several barriers to and facilitators for implementation were identified, a clear overview was presented, and a unique comprehensive implementation guide was developed for launching future digital care platforms in daily clinical practice. The next step is to validate the implementation guide in other (oncological) diseases.


Assuntos
Telemedicina , Grupos Focais , Pessoal de Saúde , Humanos , Participação do Paciente , Pesquisa Qualitativa
13.
Reprod Health ; 19(1): 131, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35668524

RESUMO

BACKGROUND: In the global debate around transactional sex little attention has concentrated on Brazil, despite ranking fourth globally in absolute number of girls married or co-habiting by the age of 15 years, and evidence showing that these unions often begin as age-disparate transactional sex (ADTS). This article contributes to filling this gap by exploring the personal beliefs and social norms related to ADTS in urban (favela) communities of Rio de Janeiro, Brazil between adult men (> 18 years) and girls and adolescents (G/A) (< 18 years) with a minimum 5-year age disparity. The primary objective of this study was to identify the social norms that promote and prevent ADTS, and the dynamics between individual beliefs and social norms, to provide contextualized recommendations to prevent ADTS in this setting. METHODS: An exploratory, sequential, mixed-methods design was used, starting with a qualitative phase that included semi-structured, in-depth interviews and focus groups, and a subsequent quantitative phase comprising of a community survey. The items for the quantitative questionnaires were developed based on the qualitative results. RESULTS: Mixed methods results indicate that in these communities ADTS is normalised and not considered exploitative. We identified three themes related to the reasons ADTS occurs: girls' responsibility, male desires and benefits of ADTS. Men's role in ADTS was largely minimised because of a general acceptance of a notion of masculinity characterised by hypersexuality and lack of impulse control. Individual beliefs, however, did not tend to align with these social norms. CONCLUSIONS: In this study, personal beliefs and social norms often did not align, suggesting that initiatives working to change personal or attitudes regarding ADTS may not lead to meaningful change in ADTS behaviours, and social norms interventions may be more effective. Our findings reinforce the need to develop programs tailored to local understandings of ADTS, targeting not only girls but also a wide range of actors. Interventions could also consider the structural factors acting in local and global contexts that promote or prevent ADTS.


This article explores the personal beliefs and social norms related to the exchange of sexual favours or relationships for material favours, gifts and/or support in some form, between adult men (> 18 years) and girls and adolescents (< 18 years) with a minimum 5-year age difference. We used interviews, focus groups and questionnaires to understand the factors that promote and prevent these sexual relationships between men and girls. Motivators for these relationships were often related to girls' responsibilities, male desires and the benefits of these relationships. Men's responsibility for their participation in these relationships with girls were often minimised due to a general acceptance of men as overly sexual and lacking impulse control. In this study, personal beliefs and social norms were often not aligned, suggesting that interventions focused on changing personal beliefs or attitudes about these sexual relationships may not be enough to change social norms. The findings highlight the need to develop solutions that consider a wider range of actors, instead of interventions focused only on girls. The study findings also support the need to further investigate how communities and shared expectations can influence sexual relationships in exchange for goods between adult men and girls and adolescents.


Assuntos
Comportamento Sexual , Normas Sociais , Adolescente , Adulto , Brasil , Feminino , Grupos Focais , Humanos , Masculino , Casamento
14.
Prog Community Health Partnersh ; 16(2): 169-179, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35662144

RESUMO

BACKGROUND: Dissemination of research findings to participants and communities, particularly among traditionally marginalized groups, is a systemic challenge. In community-based participatory research (CBPR), long-term partnerships may foster a link between recruitment to research studies, dissemination of results, and recruitment to future studies. OBJECTIVES: To analyze the recruitment to dissemination continuum of a CBPR study and its potential impact on partnership processes and future research. METHODS: We conducted a qualitative study with four focus groups with community members and academic partners who participated in the recruitment and the dissemination of research findings from a study of Hispanic and Somali social networks in Rochester, Minnesota. Thematic analysis and coding of focus group transcripts was conducted by investigators. The CBPR conceptual model for this partnership guided the analysis. RESULTS: Trust, relationship building, and capacity building were key features for successful participant recruitment and research dissemination strategies. Strategies, resources, and relationships used or developed during the recruitment phase of research were directly applied to planning a dissemination event. Participants and members of their communities said they were more likely to participate in future research studies as a result of attending a dissemination event. CONCLUSIONS: This study demonstrated the ways in which recruitment of marginalized populations to research studies and dissemination of study results can manifest as a continuum. This continuum is nurtured by trust, longitudinal relationships, and robust partnership dynamics. These factors fit well within an existing CBPR conceptual model.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Relações Comunidade-Instituição , Fortalecimento Institucional , Pesquisa Participativa Baseada na Comunidade/métodos , Grupos Focais , Humanos , Pesquisa Qualitativa
15.
Stud Health Technol Inform ; 290: 839-843, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35673136

RESUMO

Clinical decision support systems (CDSS) have the potential to support guideline implementation and bridge the research translation chasm. However, clinician barriers to uptake remain strongly reported in previous studies. This study aims to utilise a design thinking approach to develop a CDSS for breathlessness in primary care. A low fidelity mockup was developed based on an exploratory focus group to elucidate clinician needs and assess responses to key features. The low fidelity prototype was then developed and tested through two rounds of Think-Aloud testing. Post each Think-Aloud, changes were made and split-run (A/B) testing conducted in the second round in response to user interface concerns raised in the first round. Overall, GPs find the CDSS to be a useful addition to their breathlessness assessment and are open to its use. This study showed that utilising a design thinking and practice-oriented approach with rapid usability testing, it was possible to gain crucial insight in a more rapid and cost effective way.


Assuntos
Sistemas de Apoio a Decisões Clínicas , Dispneia/diagnóstico , Dispneia/terapia , Grupos Focais , Humanos , Atenção Primária à Saúde
16.
Stud Health Technol Inform ; 290: 1096-1097, 2022 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-35673223

RESUMO

We developed an online decision aid, My Contraceptive Choice (MCC), for college women to select the appropriate birth control methods. MCC consists of a short quiz, customized recommendations, and educational resources. Evaluations from a focus group, an online survey, and test cases showed that the tool is accurate, usable, and useful. Future work is required to further improve MCC's compliance with user needs/preferences and to include additional resources to make it more useful.


Assuntos
Anticoncepção , Anticoncepcionais , Anticoncepção/métodos , Feminino , Grupos Focais , Humanos , Inquéritos e Questionários , Universidades
17.
BMC Health Serv Res ; 22(1): 749, 2022 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-35659660

RESUMO

BACKGROUND: Adequate care support from home health care nurses is needed to meet the needs of an increasing number of home-dwelling persons with dementia and those who resist care. The decisions nurses make in home health care when encountering resistance from persons with dementia have an extensive impact on the quality of care and access to care. There is little research on what influences nurse's encounters with resistance to care from home-dwelling persons with dementia. RESEARCH AIM: To get insight into how nurses experience resistance to care from home-dwelling persons with dementia. METHODS: A qualitative research design using a thematic analysis was conducted following the six steps by Braun and Clarke. Data was gathered from three focus group and three individual interviews, and a total of 18 nurses from home health care participated. The interviews took place over a period of 5 months, from December 2020 to April 2021. ETHICAL CONSIDERATIONS: Approved by the Norwegian Centre for Research, reference number 515138 and by the research advisers and home care managers in each section of the municipality. RESULTS: Two main themes were identified: 1) Challenged by complex and inadequate care structures and 2) Adapting care according to circumstances. There were three subthemes within the first main theme: lack of systematic collaboration and understanding, insufficient flexibility to care, and the challenge of privacy. In the second main theme, there were three subthemes: avoid forced treatment and care to protect autonomy, gray-areas of coercive care and reduced care. The two main themes seemed to be interdependent, as challenges and changes in organizational structures influenced how nurses could conduct their care practices. CONCLUSION: Our findings indicate that nurses' responsibility to decide how to conduct care is downplayed when facing resistance. Further, their professional judgement is influenced by contextual factors and characterized by a strong commitment to avoid forced treatment and care. A continuous challenge is to safeguard shared decision-making at the same time as it is balanced against risks of severe health damage in home-dwelling persons with dementia. A fundamental question to ask is whether autonomy does conquer all, even when severe health damage is at stake.


Assuntos
Demência , Serviços de Assistência Domiciliar , Enfermeiras e Enfermeiros , Demência/terapia , Grupos Focais , Humanos , Autonomia Profissional , Pesquisa Qualitativa
18.
J Aging Stud ; 61: 101021, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-35654547

RESUMO

Across the world, the experiences of women in later life vary enormously, not only along intersectional lines, but also due to cumulative (dis)advantages over an individual's life course. The current study explores how early-life structural (dis)advantages experienced by older African women (particularly experiences related to economic adversity and the social disadvantages that often accompany it) shape their later life experiences and agency. The life stories used in this paper emerged from a larger qualitative study of aging and gender identities in Tanzania based on fifteen (15) in-depth interviews and ten (10) focus group discussions with women 60 to 82 years old. Analyzing the data from an intersectional perspective and life course approach demonstrated that older women's situations area result of the complex interaction of various structural and individual factors, and that timing is crucial for exercising agency. The findings also revealed that as a result of gender norms, the majority of older Tanzanian women were vulnerable to discrimination, poverty, and violence. The norms that promote gender discrimination also limit women's agency and social functioning subject to the constraints imposed. To help protect older women against discrimination and violence, gender-sensitive policies, social programs and legal reforms are critical for speed up the pace of change and foster permanent shifts in harmful gender norms so that aging experiences are no longer all about being a woman.


Assuntos
Identidade de Gênero , Pobreza , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Humanos , Pesquisa Qualitativa , Tanzânia
19.
BMC Prim Care ; 23(1): 139, 2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35655143

RESUMO

BACKGROUND: Healthcare providers frequently struggle to provide effective care to patients with chronic Lyme-associated symptoms (chronic Lyme disease, CLD), potentially causing these patients to feel misunderstood or neglected by the healthcare system. This study is the first to use a combined medical and communication science approach, and aims to assess patients' experiences with CLD & CLD-related care, identify themes and repertories in these patients' narrations, and provide potential ways to improve communication with them. METHODS: Informed by the principles of 'clean language', we conducted focus groups with self-identified CLD patients (N = 15). We asked participants about their experiences with CLD and CLD-related healthcare. We performed thematic analyses using a bottom-up approach based in discourse analysis. We also sought to identify specific types of verbalizations (repertoires) across themes. RESULTS: Participants thematised a heterogeneous set of CLD-associated symptoms, which they frequently labelled as 'invisible' to others. Their illness significantly affected their daily lives, impacting their work, social activities, relationships with loved ones, hobbies and other means of participating in society. Negative experiences with healthcare providers were near-universal, also in patients with short-lived CLD-associated symptoms. Verbalizations were notable for frequent use of communicative modes that implicitly create common ground between participants and that give a certain validity to personal experiences (impersonal 'you' and other forms of presupposition). CONCLUSION: Central themes found in CLD patients' communication are 1. the experience of significant symptoms, 2. for which adequate relief is only rarely found from conventional medical practitioners, and 3. that are largely invisible to the outside world. Verbalizing these themes, patients use various repertoires for their shared experiences, such as a feeling of abandonment or not being heard by the medical system, feelings of loss with respect to their previous health, and the idea that they might have been better off had they been diagnosed sooner. Working with these repertoires will enable healthcare providers to establish a shared perspective with their CLD patients, thus engaging in more fruitful doctor-patient communication. We hypothesize that these findings are not unique to CLD, but may also be applicable to other conditions with an uncertain aetiology, such as Long COVID.


Assuntos
COVID-19 , Síndrome Pós-Lyme , COVID-19/complicações , Grupos Focais , Humanos , Avaliação de Resultados da Assistência ao Paciente
20.
BMC Health Serv Res ; 22(1): 801, 2022 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-35725608

RESUMO

BACKGROUND: The primary healthcare sector comprises various health services, including disease prevention at local level. Research shows that targeted primary healthcare services can prevent the development of acute complications and ultimately reduce the risk of hospitalisations. While interdisciplinary collaboration has been suggested as a means to improve the quality and responsiveness of personal care needs in preventive services, effective implementation remains a challenge. To improve the quality and responsiveness of primary healthcare and to develop initiatives to support the interdisciplinary collaboration in preventive services, there is a need to investigate the views of primary healthcare providers. The aim of this study was to investigate perceptions of preventive care among primary healthcare providers by examining their views on what constitutes a need for hospitalisation, and which strategies are found useful to prevent hospitalisation. Further, to explain how interdisciplinary collaboration can be supported with a view to providing person-centred care. METHODS: Five focus group interviews were conducted with 27 healthcare providers, including general practitioners, social and healthcare assistants, occupational therapists, physiotherapists, home care nurses, specialist nurses and acute care nurses. Interviews were transcribed, and analysed with qualitative content analysis. RESULTS: Three categories emerged from the analysis: 1) Mental and social conditions influence physical functioning and hospitalisation need, 2) Well-established primary healthcare services are important to provide person-centred care through interdisciplinary collaboration and 3) Interdisciplinary collaboration in primary healthcare services is predominantly focussed on handling acute physical conditions. These describe that the healthcare providers are attentive towards the influence of mental, social and physical conditions on the risk of hospitalisation, entailing a focus on person-centred care. Nevertheless, in the preventive services, interdisciplinary collaboration focusses primarily on handling acute physical conditions, which constitutes a barrier for interdisciplinary collaboration. CONCLUSIONS: By focusing on the whole person, it could be possible to provide more person-centred care through interdisciplinary collaboration and ultimately to prevent some hospitalisations. Stakeholders at all levels should be informed about the relevance of considering mental, social and physical conditions to improve the quality and responsiveness of primary healthcare services and to develop initiatives to support interdisciplinary collaboration.


Assuntos
Pessoal de Saúde , Assistência Centrada no Paciente , Grupos Focais , Hospitalização , Humanos , Pesquisa Qualitativa
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