scholarly journals What treatment outcomes matter most? A Q-study of outcome priority profiles among youth with lived experience of depression

2021 ◽  
Author(s):  
Karolin Rose Krause ◽  
Julian Edbrooke-Childs ◽  
Holly Alice Bear ◽  
Ana Calderón ◽  
Miranda Wolpert
Keyword(s):  
Lived Experience ◽  
Q Methodology ◽  
Service Use ◽  
Care Delivery ◽  
Principal Component ◽  
Limited Attention ◽  
Emotional States ◽  
Care Providers ◽  
Structured Interviews ◽  
State Learning

AbstractInterest in youth perspectives on what constitutes an important outcome in the treatment of depression has been growing, but limited attention has been given to heterogeneity in outcome priorities, and minority viewpoints. These are important to consider for person-centred outcome tracking in clinical practice, or when conducting clinical trials targeting specific populations. This study used Q-methodology to identify outcome priority profiles among youth with lived experience of service use for depression. A purposive sample of 28 youth (aged 16–21 years) rank-ordered 35 outcome statements by importance and completed brief semi-structured interviews eliciting their sorting rationales. By-person principal component analysis was used to identify outcome priority profiles based on all Q-sort configurations. Priority profiles were described and interpreted with reference to the qualitative interview data. Four distinct outcome priority profiles were identified: “Relieving distress and experiencing a happier emotional state”; “Learning to cope with cyclical distressing emotional states”; “Understanding and processing distressing emotional states”; and “Reduced interference of ongoing distressing emotional states with daily life”. All four profiles prioritised improvements in mood and the ability to feel pleasure but differed in the level of importance assigned to learning coping skills, processing experiences, and the reduced interference of depression with life and identity. As part of a person-centered approach to care delivery, care providers should routinely engage young people in conversation and shared decision-making about the types of change they would like to prioritise and track during treatment, beyond a common core of consensus outcomes.

scholarly journals What Treatment Outcomes Matter Most? A Q-study of Outcome Priority Profiles Among Youth with Lived Experience of Depression

2020 ◽  
Author(s):  
K. R. Krause ◽  
J. Edbrooke-Childs ◽  
H. A. Bear ◽  
A. Calderón ◽  
M. Wolpert
Keyword(s):  
Lived Experience ◽  
Q Methodology ◽  
Service Use ◽  
Care Delivery ◽  
Principal Component ◽  
Well Being ◽  
Limited Attention ◽  
Care Providers ◽  
Structured Interviews ◽  
Treatment Of Depression

AbstractObjectiveOver the past years, interest in youth perspectives on what constitutes an important outcome in the treatment of depression has been growing, but limited attention has been given to heterogeneity in outcome priorities and minority viewpoints. These are important to consider for person-centered outcome tracking in clinical practice, or when conducting clinical trials targeting specific populations. This study used Q-methodology to identify outcome priority profiles among youth with lived experience of service use for depression.MethodA purposive sample of 28 youth (aged 16–21 years) rank-ordered 35 outcomes by importance and completed brief semi-structured interviews eliciting their sorting rationales. By-person principal component analysis was used to identify outcome priority profiles based on all Q-sort configurations. Priority profiles were described and interpreted with reference to the qualitative interview data.ResultsFour distinct outcome priority profiles were identified: “symptom reduction and enhanced well-being”; “improved coping and self-management”; “better understanding past and present”; and “less interference with daily life”. All four profiles prioritized outcomes related to improved mood and affect over other outcome concepts. Beyond these core outcomes, profiles differed in the level of importance assigned to learning practical coping skills, processing experiences, finding safe ways to articulate emotions, and reduced interference of depression with life and identity.ConclusionAs part of a person-centered approach to care delivery, care providers should routinely engage young people in conversation and shared decision-making about the types of change they would like to prioritize and track during treatment, beyond a common core of consensus outcomes.

The role of nursing leadership in supporting the delivery of compassionate care during NHS mergers and acquisitions

2021 ◽  
Vol 27 (7) ◽  
pp. 186-193
Author(s):  
Helen Rogers
Keyword(s):  
Mergers And Acquisitions ◽  
Lived Experience ◽  
Care Delivery ◽  
Nursing Leadership ◽  
Compassionate Care ◽  
Structured Interviews ◽  
Nurse Leadership ◽  
Role Of Nursing ◽  
The Impact

Background/Aims This qualitative study explores the role of nursing leadership in supporting the delivery of compassionate care in a hospital that experienced both an acquisition and merger within 5 years. It aimed to understand the impact that NHS mergers and acquisitions have on a nursing team's capacity to deliver compassionate care to patients and to explore how nursing leadership can support the delivery of compassionate care during these periods. Methods Semi-structured interviews were undertaken with seven members of purposively recruited staff, who had lived experience of working at a hospital during an acquisition by a larger NHS trust, followed by a merger with another large NHS trust 5 years later. Results Staff valued authentic, honest and visible nurse leadership that was understanding of the context in which they were delivering care. Ward managers and matrons acted as ‘shock absorbers’ to protect their teams from the negative aspects of the change process. However, this came at an emotional cost and demonstrates the need for continued support structures. Conclusions This case study shows that staff value being able to deliver compassionate care; it gives meaning to their work, especially the ‘small things’. However, the context of care delivery can affect their ability to do this. There remains a great need for emotional support for staff to sustain their resilience in the face of changing staff, policies, practices and clinical models.

Having a Sibling With Schizophrenia: A Phenomenological Study

2006 ◽  
Vol 20 (3) ◽  
pp. 247-264 ◽  
Author(s):  
Alexia Barnable ◽  
Alice Gaudine ◽  
Lorna Bennett ◽  
Robert Meadus
Keyword(s):  
Health Care ◽  
Lived Experience ◽  
Health Care Providers ◽  
Phenomenological Study ◽  
Hermeneutic Phenomenology ◽  
Limited Attention ◽  
Care Providers ◽  
The Impact

Limited attention has been paid to experiences of individuals with siblings diagnosed with schizophrenia. The purpose of this article is to address this gap by exploring the impact of having a brother or sister with schizophrenia. The lived experience of 6 individuals with a sibling with schizophrenia was explored using van Manen’s (1997) Hermeneutic Phenomenology. Four themes were identified: struggling to understand, struggling with the system, caring for the sibling, and seeing beyond the illness. Health care providers need to re-evaluate current approaches for assisting individuals to cope with having a sibling with schizophrenia. Inclusion in the plan of care and recognition of their struggle is essential for individuals having a sibling with schizophrenia.

scholarly journals Providers' Perceptions of Challenges in Obstetrical Care for Somali Women

2013 ◽  
Vol 2013 ◽  
pp. 1-12 ◽  
Author(s):  
Jalana N. Lazar ◽  
Crista E. Johnson-Agbakwu ◽  
Olga I. Davis ◽  
Michele P.-L. Shipp
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Health Care Services ◽  
Care Delivery ◽  
Clinical Encounter ◽  
Female Genital Cutting ◽  
Care Providers ◽  
Structured Interviews ◽  
Care Services ◽  
Somali Refugee

Background. This pilot study explored health care providers’ perceptions of barriers to providing health care services to Somali refugee women. The specific aim was to obtain information about providers’ experiences, training, practices and attitudes surrounding the prenatal care, delivery, and management of women with Female Genital Cutting (FGC).Methods. Individual semi-structured interviews were conducted with 14 obstetricians/gynecologists and nurse midwives in Columbus, Ohio.Results. While providers did not perceive FGC as a significant barrier in itself, they noted considerable challenges in communicating with their Somali patients and the lack of formal training or protocols guiding the management of circumcised women. Providers expressed frustration with what they perceived as Somali patients' resistance to obstetrical interventions and disappointment with a perception of mistrust from patients and their families.Conclusion. Improving the clinical encounter for both patients and providers entails establishing effective dialogue, enhancing clinical and cultural training of providers, improving health literacy, and developing trust through community engagement.

Complex Psychological Trauma and Self-Dysregulation: A Theory Synthesis for Nursing

2016 ◽  
Vol 30 (1) ◽  
pp. 10-25 ◽  
Author(s):  
Kristen R. Choi
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Care Delivery ◽  
Self Regulation ◽  
Psychological Trauma ◽  
Trauma Survivors ◽  
Limited Attention ◽  
Care Providers ◽  
Nursing Science ◽  
Regulatory Processes

Complex psychological trauma is a phenomenon resulting from severe interpersonal trauma that can negatively affect how individuals experience health care. However, few theories conceptualizing complex trauma exist, and it has received only limited attention in the nursing literature. The purpose of this theory synthesis was to organize two theories of (a) self-regulation and (b) self-dysregulation following complex psychological trauma into a single conceptual framework for use in nursing practice. This article used the theory synthesis approach described by Walker and Avant. The theory has potential to advance nursing science by helping nurses and other health professionals understand how trauma can alter self-regulatory processes and result in unique challenges in care delivery. It also has potential to prevent retraumatization of trauma survivors at the hands of health care providers.

scholarly journals The Lived Experience of Being Diagnosed With COVID-19 Among Black Patients: A Qualitative Study

2021 ◽  
Vol 8 ◽  
pp. 237437352199696
Author(s):  
Sainfer Aliyu ◽  
Jasmine L Travers ◽  
Allison A Norful ◽  
Michael Clarke ◽  
Krista Schroeder
Keyword(s):  
Lived Experience ◽  
Health Care Providers ◽  
Care Delivery ◽  
Clinical Care ◽  
Improve Patient Care ◽  
Spiritual Needs ◽  
Care Providers ◽  
Black Patients ◽  
Increased Risk ◽  
Patient Care Delivery

Diagnosis and hospitalization for COVID-19 are disproportionately higher among black persons. The purpose of this study was to explore the lived experience of being diagnosed with COVID-19 among black patients. Semistructured one-on-one interviews with black patients diagnosed with COVID-19 were conducted. Data were analyzed using conventional content analysis and a directed content approach. Fifteen patients participated and 3 themes were identified: Panic amidst a COVID-19 diagnosis, Feeling the repercussion of the diagnosis, and Personal assessment of risks within one’s individual environment. Fear of dying, inadequate health benefits, financial issues, and worries about spreading the virus to loved ones were acknowledged by the patients as critical areas of concerns. Majority of the patients looked to God as the ultimate way of surviving COVID-19. However, none of the patients reported receiving support for spiritual needs from health care providers. This is the first study to investigate the lived experience of being diagnosed with COVID-19 among black patients. Our results highlight several factors that put this group at increased risk for COVID-19 and where additional strategies are needed to address these inadequacies. Integrating public health interventions to reduce socioeconomic barriers and integrating spirituality into clinical care could improve patient care delivery.

scholarly journals Hospice care providers experiences of grappling with medical assistance in dying in a hospice setting: a qualitative descriptive study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Shannon Freeman ◽  
Davina Banner ◽  
Valerie Ward
Keyword(s):  
Care Provider ◽  
Hospice Care ◽  
Care Delivery ◽  
Patient Choice ◽  
Care Providers ◽  
Medical Assistance ◽  
Structured Interviews ◽  
Patient Centered ◽  
Medical Assistance In Dying ◽  
Qualitative Descriptive

Abstract Background Rapid implementation of Medical Assistance in Dying (MAiD) across care settings has challenged providers and organizations, including hospices, to develop and implement new modes of practice. The aim of this study was to examine the effects that legalization of MAiD has had on hospice care provider roles within the non-provider context. Methods Eight in-depth semi-structured interviews were conducted and a qualitative descriptive approach used to examine hospice care providers experiences in a small western Canadian city. In the study context, patients who choose MAiD are cared for until immediately prior to the procedure when they are transferred off-site to undergo MAiD. Inductive and thematic analyses were undertaken. Results Participants experienced practical, philosophical, and professional challenges. Despite the overwhelming desire to support patient autonomy and decision-making, some interpreted patient choice for MAiD as rejection of the natural death experience at the hospice. Patient choice for MAiD initiated a new and different pathway of end-of-life care. While participants felt uncertain how best to support patients undergoing MAiD, they shared mixed optimism on how their care provider roles were evolving as their level of experience broadened. While implementation of MAiD was rapid, the introduction of practical and professional supports has remained slow to materialize, leaving many providers to navigate their own personal and professional positions and practices. Conclusion Care providers require a multi-faceted range of clinical, legal, and logistical supports at the practice, organizational, and health system levels, to facilitate care delivery to those requesting and undergoing MAiD and to promote coordinated and holistic patient-centered care. The different pathway for those who chose MAiD may lead care providers to struggle with relational challenges and interpersonal unease. Further research may address how to support those undergoing MAiD within the hospice context.

scholarly journals Examining Health Care Providers’ and Middle-level Managers’ Readiness for Change:A Qualitative Study

2019 ◽  
Author(s):  
Tujuanna Austin ◽  
Samia Chreim ◽  
Agnes Grudniewicz
Keyword(s):  
Health Care Providers ◽  
Middle Managers ◽  
Care Program ◽  
Readiness For Change ◽  
Middle Level ◽  
Middle Manager ◽  
Limited Attention ◽  
Care Providers ◽  
Structured Interviews ◽  
Trust In Management

Abstract Background: Readiness is a critical precursor of successful change; it denotes whether those involved in the change are motivated and empowered to participate in the change. Research on readiness tends to focus on frontline providers or individuals in non-managerial positions and offers limited attention to individuals in middle management positions who are expected to lead frontline providers in change implementation. Yet middle-level managers are also recipients of changes that are planned and decreed by those in higher positions. This study sought to examine both frontline provider and middle manager readiness for change in the context of primary care program integration. Methods: Using a qualitative case study approach, we examined how frontline providers and middle managers experienced six readiness factors: discrepancy, appropriateness, valence, efficacy, fairness and trust in management. Data were collected through documents, meeting observation and semi-structured interviews with frontline providers and middle managers involved in the change. Results: The findings highlighted similarities and differences in readiness experiences of frontline providers and middle managers. Across both types of participants, we found that the notion of valence should be expanded to consider individuals’ evaluation of benefits to patients and the health system; efficacy applies to both content and process of change; fairness and trust in management findings require further exploration to determine their appropriateness to be incorporated in models of readiness for change; and trust in management (or lack of trust) has a cascading influence across the levels in the organization. Conclusions: Our study makes a contribution by nuancing and extending conceptualizations of individual readiness factors, and by highlighting the central role of middle manager readiness for change. Implications of the study include the need to consider readiness factors prior to the implementation of change and the importance of fostering readiness throughout all levels of the organization.

scholarly journals Health literacy of Samoan mothers and their experiences with health professionals

2020 ◽  
Vol 12 (1) ◽  
pp. 57 ◽  
Author(s):  
Fofoa H. Pio ◽  
Vili Nosa
Keyword(s):  
Health Care ◽  
Health Literacy ◽  
General Practitioners ◽  
Health Care Providers ◽  
Health Professionals ◽  
Care Delivery ◽  
Shared Responsibility ◽  
Care Providers ◽  
Structured Interviews ◽  
Open Communication

ABSTRACT INTRODUCTIONPatient and health professional engagement is a crucial factor for the effectiveness of service delivery and the management of care. Low health literacy amongst Pacific peoples is likely to affect their engagement with health professionals. AIMTo explore the health literacy of Samoan mothers and their experiences with health professionals in primary care. METHODSTwenty Samoan mothers and caregivers living in Auckland were interviewed about their experiences when engaging with health professionals. Semi-structured interviews guided by open-ended questions were conducted with individual participants in either Samoan or English. The interviews were recorded, transcribed and analysed. RESULTSA key finding was the significance of the health professionals’ role, in particular general practitioners, in providing resources and information to participants. Many participants recognised their general practitioner as their primary source of information. The findings revealed the negative experiences participants faced while engaging with general practitioners and shared how this affected their ability to manage care. Themes about enablers of open communication with health professionals included mothers understanding their rights as patients and being acknowledged as an expert on their child’s health. Themes about barriers to open communication with health professionals included limited consultation time, language barriers, medical jargon, closed answers, power relations and the shame associated with not fully understanding. DISCUSSIONThis research can inform health care engagement practices with patients. This study is relevant to health-care providers, development of health resources, health researchers evaluating health-care communications between providers and patients, to inform culturally appropriate and effective health-care delivery. The importance of shared responsibility in addressing issues of health literacy is noted, shifting the focus to everyone involved in providing and receiving information and in making decisions and managing care.

scholarly journals The gender perspective in the opinions and discourse of women about caregiving

2018 ◽  
Vol 52 (0) ◽  
Author(s):  
Inmaculada Lancharro Tavero ◽  
Eugenia Gil García ◽  
Juana Macías Seda ◽  
Rocío Romero Serrano ◽  
Isabel María Calvo Cabrera ◽  
...  
Keyword(s):  
Labor Market ◽  
Health Care Providers ◽  
Women Caregivers ◽  
Emotional States ◽  
Care Providers ◽  
Social Dimensions ◽  
Structured Interviews ◽  
Care Needs ◽  
Work History ◽  
Gender Perspective

ABSTRACT Objective: To investigate the meanings given by women caregivers to their care practices and to analyze the relationship between such practices and their work history. Method: This was a phenomenological qualitative cohort study conducted in Seville, Spain, with family caregivers. Data were collected using semi-structured interviews and submitted to content analysis, using Atlas-ti GmbH software version 5.0®. The following categories emerged: caregiving history and work history, and the meaning of care in their lives. Results: Twenty caregivers participated in the study. Women caregivers told stories of wide-ranging care, including several individuals in their family at different moments. They performed different forms of care, encompassing physical and social dimensions. Their discourse expressed the contradiction between their caregiving role and entering and/or maintaining their place in the labor market. Conclusion: The women expressed a concept of comprehensive care that includes responsibility, availability, and companionship, as well as emotional states, which greatly impact health. They tailored their participation in the labor market according to their family’s care needs. Thus, the gender perspective must be incorporated by health care providers who work with the health of caregivers.

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