Patients' expectations and solutions for improving primary diabetes care.

Purpose The purpose of this paper is to document health care needs expressed by people living with diabetes, describe the solutions they envisaged for improving the quality of primary care (PC) services and empower them to make better use of PC services. Design/methodology/approach A participatory research approach was used. Six workshops were organised to provide diabetes patients with knowledge on available services and to engage them in sharing their experience. Group discussions were recorded. Data were analysed using the thematic analysis method. Findings In total, 79 persons living with diabetes for a mean of 13 years participated. Needs expressed were grouped under seven themes: assurance of satisfactory follow-up by a family physician, continuous access to services adapted to evolving needs, motivation to adopt and maintain healthy behaviours, maintenance of knowledge about diabetes, psychological support, financial constraints, and collaboration with secondary-level services. Patients proposed solutions for improving services that were grouped under five themes: facilitating access to services, disseminating information about available services, centralising diabetes information on the internet, offering personalised services and improving interprofessional collaboration. Practical implications Needs expressed by diabetic patients concern different aspects of care such as accessibility, organisation, coordination, and better dissemination and visibility of services. The solutions proposed by patients focussed on better access to information and interprofessional services. Originality/value The workshop format used in this study offers an original and interesting approach and tool for actively engaging patients in quality improvement of services.

[Interprofessional Collaboration as a Modality to Resolve Therapeutic Impasses in Child Psychiatry: A Review]. / La collaboration interprofessionnelle comme modalité pour résoudre les impasses thérapeutiques en pédopsychiatrie : une revue de littérature.

Child and adolescent intervention in child psychiatric clinics generates a high risk of therapeutic impasses for clinicians. Among the factors that contribute to this situation are the increasing severity of the problems of young people who are referred to psychiatric clinics and the obligation for professionals to collaborate with various actors surrounding the patient. This literature review explores the possibility that an intervention targeting indicators of interprofessional collaboration can help resolved the therapeutic impasses encountered by professionals working in child psychiatry. The article begins with a description of the impasse in therapeutic clinical child psychiatry. It then introduces a broad look at research about interprofessional collaboration and its effects on mental health service delivery. Finally, it examines the structuring model of the interprofessional collaboration process of D'Amour et al. in order to highlight the indicators that may be related to the resolution of clinical therapeutic impasses in child psychiatry. This review examines the possible interventions that could be done when targeting indicators of D'Amour et al.'s interprofessional collaboration model in order to improve therapeutic impasses resolution. A promising direction for future research which could contribute to therapeutic impasses resolution in child psychiatry is proposed.

[Evaluation and intervention of psychological work climate among nursing staff : a review of the literature]. / Évaluation et intervention en matière de climat psychologique de travail chez le personnel infirmier : une revue de la littérature.

This review of literature focuses on the influence of psychological work climate and job satisfaction on nurses' turnover intentions. More specifically, this review aims to explain the influence of the primary dimensions of psychological work climate - job characteristics, role characteristics, leadership characteristics, teamwork characteristics and organizational characteristics - on nurses' organizational and occupational turnover intentions. Furthermore, this review aims to explain the role of job satisfaction as a potential mediator in the relationship between psychological work climate dimensions and both organizational and occupational turnover intentions among nurses. More specifically, the mechanism by which an individual goes from having negative perceptions of psychological work climate to having turnover intentions is introduced. The review concludes by revealing evaluation and intervention practices that may facilitate the implementation of continuous improvement processes aimed to enhance nurses' perceptions of the psychological work climate and job satisfaction.

Effectiveness of past and current critical incident analysis on reflective learning and practice change.

OBJECTIVES: Critical incident analysis (CIA) is one of the strategies frequently used to facilitate reflective learning. It involves the thorough description and analysis of an authentic and experienced event within its specific context. However, CIA has also been described as having the potential to expose vulnerabilities, threaten learners' coping mechanisms and increase rather than reduce their anxiety levels. The aim of this study was to compare the analysis of current critical incidents with that of past critical incidents, and to further explore why and how the former is more conducive to reflective learning and practice change than the latter. METHODS: A collaborative research study was conducted. Eight occupational therapists were recruited to participate in a reflective learning group that convened for 12 meetings held over a 15-month period. The group facilitator planned and adapted the learning strategies to be used to promote reflective learning and guided the group process. Critical incident analysis represented the main activity carried out in the group discussions. The data collected were analysed using the grounded theory method. RESULTS: Three phenomena were found to differentiate between the learning contexts created by the analysis of, respectively, past and current critical incidents: attitudinal disposition; legitimacy of purpose, and the availability of opportunities for experimentation. Analysis of current clinical events was found to improve participants' motivation to self-evaluate, to increase their self-efficacy, and to help them transfer learning into action and to progressively self-regulate. CONCLUSIONS: The results of this collaborative research study suggest that the analysis of current clinical events in order to promote reflection offers a safer and more constructive learning environment than does the analysis of incidents that have occurred in the past. This learning strategy is directly grounded in health professional practice. The remaining challenge for continuing education providers is that of creating conditions conducive to its use.

Using reflective learning to improve the impact of continuing education in the context of work rehabilitation.

Reflective learning has been described as a promising approach for ameliorating the impact of continuing education (CE) programs. However, there are still very few studies that have investigated how occupational therapists use reflection to improve the integration of CE program content in their decision-making processes. The study objectives were to describe how these professionals, working in the sector of work rehabilitation, used reflective learning to integrate research evidence into their clinical decision-making process and to identify the factors that influenced the reflective learning process. A collaborative research study was conducted. Eight occupational therapists were recruited to participate to the group that was convened for 12 meetings and held during a 15-month period. The strategies used were critical analysis of ill-structured and authentic clinical situations, peer support, reflective journal writing and complementary reading. The group facilitator acted as a research evidence mentor and guided the group process. The data collected was analyzed using the grounded theory method. The reflective learning process, used by the participants, enabled them to change their perspective at six different stages in their decision-making process. The participants developed their ability to use different types of reflective thinking: introspection, concept attainment, self-attribution, problem solving, action planning and reorganization. The factors that most influenced learning were: ease in sharing experience, normative beliefs, coping with negative emotions, perceived self-efficacy, social support and risk taking. Results led to the development of the Model of Research Utilization Grounded in Critical Reflection.

Empowerment interventions, knowledge translation and exchange: perspectives of home care professionals, clients and caregivers.

BACKGROUND: Few studies have examined empowerment interventions as they actually unfold in home care in the context of chronic health problems. This study aims to document the empowerment process as it plays out in interventions with adults receiving home care services. METHODS/DESIGN: The qualitative design chosen is a fourth generation evaluation combined with case studies. A home care team of a health and social services center situated in the Eastern Townships (Québec, Canada) will be involved at every step in the study. A sample will be formed of 15 health care professionals and 30 of their home care clients and caregiver. Semi-structured interviews, observations of home care interventions and socio-demographic questionnaires will be used to collect the data. Nine instruments used by the team in prior studies will be adapted and reviewed. A personal log will document the observers' perspectives in order to foster objectivity and the focus on the intervention. The in-depth qualitative analysis of the data will illustrate profiles of enabling interventions and individual empowerment. DISCUSSION: The ongoing process to transform the health care and social services network creates a growing need to examine intervention practices of health care professionals working with clients receiving home care services. This study will provide the opportunity to examine how the intervention process plays out in real-life situations and how health care professionals, clients and caregivers experience it. The intervention process and individual empowerment examined in this study will enhance the growing body of knowledge about empowerment.

Empowering occupational therapists to become evidence-based work rehabilitation practitioners.

OBJECTIVE: Occupational therapists (OTs) engage in continuing education to integrate best available knowledge and skills into their practice. However, many barriers influence the degree to which they are currently able to integrate research evidence into their clinical decision making process. The specific objectives were to explore the clinical decision-making processes they used, and to describe the empowerment process they developed to become evidence-based practitioners. PARTICIPANTS: Eight OTs, who had attended a four-day workshop on evidence-based work rehabilitation, were recruited to participate to a reflective practice group. METHODS: A collaborative research methodology was used. The group was convened for 12 meetings and held during a 15-month period. The data collected was analyzed using the grounded theory method. RESULTS: The results revealed the different decision-making modes used by OTs: defensive, repressed, cautious, autonomous intuitive and autonomous thoughtful. These modes influenced utilization of evidence and determined the stances taken toward practice change. Reflective learning facilitated their utilization of an evidence-based practice model through a three-level empowerment process: deliberateness, client-centeredness and system mindedness. CONCLUSIONS: During the course of this study, participants learned to become evidence-based practitioners. This process had an impact on how they viewed their clients, their practice and the work rehabilitation system.