scholarly journals Narrative Medicine to integrate patients’, caregivers’ and clinicians’ migraine experiences: the DRONE multicentre project

2021 ◽  
Author(s):  
Maria Clara Tonini ◽  
Alessandra Fiorencis ◽  
Rosario Iannacchero ◽  
Mauro Zampolini ◽  
Antonietta Cappuccio ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Social Impact ◽  
Care Pathway ◽  
Narrative Medicine ◽  
Illness Experience ◽  
Caregiving Burden ◽  
Written Narratives ◽  
Pathway Evolution ◽  
Effective Care ◽  
Headache Centres

Abstract Background Although migraine is widespread and disabling, stigmatisation and poor awareness of the condition still represent barriers to effective care; furthermore, research on migraine individual and social impact must be enhanced to unveil neglected issues, such as caregiving burden. The project investigated the migraine illness experience through Narrative Medicine (NM) to understand daily life, needs and personal resources of migraneurs, their caregivers and clinicians, and to provide insights for clinical practice. Methods The project involved 13 Italian headache centres and targeted migraneurs, their caregivers and migraine specialists at these centres. Written narratives, composed by a sociodemographic survey and illness plot or parallel chart, were collected through the project’s webpage. Illness plots and parallel charts employed open words to encourage participants’ expression. Narratives were analysed through Nvivo software, interpretive coding and NM classifications. Results One hundred and seven narratives were collected from patients and 26 from caregivers, as well as 45 parallel charts from clinicians. The analysis revealed migraine perception in social, domestic and work life within the care pathway evolution and a bond between chaos narratives and day loss due to migraine; furthermore, narratives suggested the extent of the caregiving burden and a risk of underestimation of migraine burden in patients’ and caregivers’ life. Conclusion The project represents the first investigation on migraine illness experience through NM simultaneously considering migraneurs’, caregivers’ and clinicians’ perspectives. Comparing narratives and parallel charts allowed to obtain suggestions for clinical practice, while NM emerged as able to foster the pursuing of migraine knowledge and awareness.

Integral Metatheory in the Time of COVID: Implications for Medical and Nursing Teaching and Practice

2021 ◽  
pp. HumanCaring-D-20-00027
Author(s):  
Stephen J. Darcy
Keyword(s):  
Nursing Education ◽  
Clinical Practice ◽  
Patient Care ◽  
Medical Practice ◽  
Potential Application ◽  
Illness Experience ◽  
Comprehensive View ◽  
Practice Of Medicine ◽  
Basic Concepts ◽  
Interpretive Framework

Ken Wilber's integral metatheory is an interpretive framework that can that be applied to the clinical practice of medicine and medical and nursing education. It offers a comprehensive view of the patient illness experience superior to current models of patient care and may provide a valuable guide for nursing and medical practice and teaching. This article seeks to explain some of the basic concepts of integral metatheory and show their potential application to practice and teaching using the current COVID-19 pandemic as an illustrative model.

scholarly journals Planning Implementation Success of Syncope Clinical Practice Guidelines in the Emergency Department Using CFIR Framework

2021 ◽  
Author(s):  
Jing Li ◽  
Susan S. Smyth ◽  
Jessica Miller Clouser ◽  
Colleen A. McMullen ◽  
Vedant Gupta ◽  
...  
Keyword(s):  
Emergency Department ◽  
Clinical Practice ◽  
Family Caregivers ◽  
Implementation Strategy ◽  
Care Pathway ◽  
Implementation Strategies ◽  
Mobile App ◽  
Care Plan ◽  
Local Context ◽  
Successful Implementation

Background and Objectives: Overuse and inappropriate use of testing and hospital admission are common in syncope evaluation and management. Though guidelines are available to optimize syncope care, study suggested that the current clinical guidelines have not significantly impacted resource utilization surrounding emergency department (ED) evaluation of syncope. Matching implementation strategies to barriers and facilitators and tailoring strategies to local context hold significant promise for a successful implementation of clinical practice guideline (CPG). Our team applied implementation science principles to develop a stakeholder-based implementation strategy. Methods and Materials: We partnered with patients, family caregivers, frontline clinicians and staff, and health system administrators at four health systems to conduct quantitative surveys and qualitative interviews for context assessment. The identification of implementation strategies was done by applying the CFIR-ERIC Implementation Strategy Matching Tool and soliciting stakeholders’ inputs. We then co-designed with patients and frontline teams, developed and tested specific strategies. Results: 114 clinicians completed surveys and 32 clinicians and stake-holders participated in interviews. Results from the surveys and interview indicated low awareness of syncope guidelines, and communication challenges with patients, lack of CPG protocol integration into ED workflows, and organizational process to change were recognized as major barriers. Thirty-one patients and their family caregivers participated in interviews and ex-pressed their expectations: clarity regarding their diagnosis, context surrounding care plan and diagnostic testing, and a desire to feel cared about. After identifying change methods to address those barriers, the multilevel, multicomponent implementation strategy, MISSION, included pa-tient educational materials, mentored implementation, academic detailing, Syncope Optimal Care Pathway and corresponding Mobile App, and Lean quality improvement methods. The pilot of MISSION demonstrated feasibility, acceptability and initial success on appropriate testing. Con-clusions: Effect multifaceted implementation strategies that target individuals, teams, and healthcare systems can be employed to plan successful implementation and promote adherence to syncope CPGs.

scholarly journals Development of a Breech-Specific Integrated Care Pathway for Pregnant Women: Protocol for a Mixed Methods Study (Preprint)

2020 ◽  
Author(s):  
Sara Morris ◽  
Sadie Geraghty ◽  
Deborah Sundin
Keyword(s):  
Clinical Practice ◽  
Mixed Methods ◽  
Integrated Care ◽  
Western Australia ◽  
Delphi Study ◽  
Care Pathway ◽  
Breech Presentation ◽  
Mixed Methods Approach ◽  
Breech Birth ◽  
Integrated Care Pathway

BACKGROUND The development of an integrated care pathway with multidisciplinary input to standardize and streamline care for pregnant women experiencing breech presentation at 36 or more weeks of gestation poses several challenges because of the divisive and contentious nature of the phenomenon. Although many clinicians are interested in obtaining the skills required to safely support women desiring a vaginal breech birth, the primary trend in most health care facilities is to recommend a cesarean section. OBJECTIVE This paper aims to discuss the mixed methods approach used in a doctoral study conducted to generate new knowledge regarding women’s experiences of breech birth in Western Australia and professional recommendations regarding the care of women experiencing breech presentation close to or at term. This study was designed to inform the development of an integrated care pathway for women experiencing a breech presentation. This mixed methods approach situated within the pragmatic paradigm was determined to be the optimal way for incorporating multidisciplinary recommendations with current clinical practice guidelines and consumer feedback. METHODS A mixed methods study utilizing semistructured interviews, an electronic Delphi (e-Delphi) study, and clinical practice guideline appraisal was conducted to generate new data. The interviews were designed to provide insights and understanding of the experiences of women in Western Australia who are diagnosed with a breech presentation. The e-Delphi study explored childbirth professionals’ knowledge, opinions, and recommendations for the care of women experiencing breech presentation close to or at term. The clinical practice guideline appraisal will examine the current national and professional breech management and care guidelines. This study has the potential to highlight areas in practice that may need improvement and enable clinicians to better support women through what can be a difficult time. RESULTS Data collection for this study began in November 2018 and concluded in March 2020. Data analysis is currently taking place, and the results will be disseminated through publication when the analysis is complete. CONCLUSIONS The results of this study will guide the development of an integrated care pathway for women experiencing a breech presentation close to or at term, with the hope of moving toward standardized breech care for women in Western Australia. This study protocol has the potential to be used as a research framework for future studies of a similar nature. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/23514

scholarly journals Care Pathway of RPE65-Related Inherited Retinal Disorders from Early Symptoms to Genetic Counseling: A Multicenter Narrative Medicine Project in Italy

2021 ◽  
Vol Volume 15 ◽  
pp. 4591-4605
Author(s):  
Francesca Simonelli ◽  
Andrea Sodi ◽  
Benedetto Falsini ◽  
Giacomo Bacci ◽  
Giancarlo Iarossi ◽  
...  
Keyword(s):  
Genetic Counseling ◽  
Care Pathway ◽  
Narrative Medicine ◽  
Early Symptoms ◽  
Retinal Disorders ◽  
Inherited Retinal Disorders

scholarly journals Development of a Breech-Specific Integrated Care Pathway for Pregnant Women: Protocol for a Mixed Methods Study

10.2196/23514 ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. e23514 ◽  
Author(s):  
Sara Morris ◽  
Sadie Geraghty ◽  
Deborah Sundin
Keyword(s):  
Clinical Practice ◽  
Mixed Methods ◽  
Integrated Care ◽  
Western Australia ◽  
Delphi Study ◽  
Care Pathway ◽  
Breech Presentation ◽  
Mixed Methods Approach ◽  
Breech Birth ◽  
Integrated Care Pathway

Background The development of an integrated care pathway with multidisciplinary input to standardize and streamline care for pregnant women experiencing breech presentation at 36 or more weeks of gestation poses several challenges because of the divisive and contentious nature of the phenomenon. Although many clinicians are interested in obtaining the skills required to safely support women desiring a vaginal breech birth, the primary trend in most health care facilities is to recommend a cesarean section. Objective This paper aims to discuss the mixed methods approach used in a doctoral study conducted to generate new knowledge regarding women’s experiences of breech birth in Western Australia and professional recommendations regarding the care of women experiencing breech presentation close to or at term. This study was designed to inform the development of an integrated care pathway for women experiencing a breech presentation. This mixed methods approach situated within the pragmatic paradigm was determined to be the optimal way for incorporating multidisciplinary recommendations with current clinical practice guidelines and consumer feedback. Methods A mixed methods study utilizing semistructured interviews, an electronic Delphi (e-Delphi) study, and clinical practice guideline appraisal was conducted to generate new data. The interviews were designed to provide insights and understanding of the experiences of women in Western Australia who are diagnosed with a breech presentation. The e-Delphi study explored childbirth professionals’ knowledge, opinions, and recommendations for the care of women experiencing breech presentation close to or at term. The clinical practice guideline appraisal will examine the current national and professional breech management and care guidelines. This study has the potential to highlight areas in practice that may need improvement and enable clinicians to better support women through what can be a difficult time. Results Data collection for this study began in November 2018 and concluded in March 2020. Data analysis is currently taking place, and the results will be disseminated through publication when the analysis is complete. Conclusions The results of this study will guide the development of an integrated care pathway for women experiencing a breech presentation close to or at term, with the hope of moving toward standardized breech care for women in Western Australia. This study protocol has the potential to be used as a research framework for future studies of a similar nature. International Registered Report Identifier (IRRID) DERR1-10.2196/23514

scholarly journals Bronchiolitis diagnosis, treatment, and prevention in children: an evidence-based clinical practice guideline adapted for the use in Egypt based on the ‘Adapted ADAPTE’ Methodology

2022 ◽  
Vol 70 (1) ◽  
Author(s):  
Ashraf Abdel Baky ◽  
Eman Mahmoud Fouda ◽  
Shahenaz Mahmoud Hussein ◽  
Ahmad Ata Sobeih ◽  
Ahmed Mohamad Abd Al Razek ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Clinical Practice Guideline ◽  
Practice Guideline ◽  
Care Pathway ◽  
National Level ◽  
Clinical Score ◽  
National Committee ◽  
Evidence Based ◽  
Acute Bronchiolitis ◽  
Treatment And Prevention

Abstract Background The presented evidence-based clinical practice guideline (CPG) is proposed as a National CPG using an evidence-based and formal CPG adaptation methodology. The purpose of this study was to adapt the international CPGs’ recommendations for children with bronchiolitis to suit the healthcare system in the Egyptian context. This CPG, ‘diagnosis, treatment, and prevention of Bronchiolitis’, applies to children from 1 through 23 months of age. Other exclusions are noted. The quality of evidence, benefit-harm relationship, and strength of recommendations are indicated. This study is part of a larger collaborative initiative with the faculty staff of pediatric departments of 15 Egyptian universities and a national research center to formulate a national Committee (EPG) that aims to define the topics of, assign authors to, and assist in the adaptation of pediatric evidence-based CPGs according to a national strategic plan. The committee is guided by a formal CPG adaptation methodology: the ‘Adapted ADAPTE’. Results The Bronchiolitis Guideline Adaptation Group (BGAG) reviewed the results of the AGREE II assessment and decided to adapt mainly the Australasian (PREDICT) CPG and for the questions not answered in PREDICT we adapted the relevant recommendations from the American Academy of Pediatrics (AAP) CPG. Seven implementation tools were included: a care pathway for assessment of severity, a clinical algorithm for treatment of acute bronchiolitis in the emergency room, a separate flowchart for assessing babies with bronchiolitis, a power point slide presentation lecture for treatment of acute bronchiolitis, patient information in Arabic, a clinical score (Modified Tal Score) for prediction of bronchiolitis severity, and the criteria for admission and discharge in the hospital. A comprehensive set of multifaceted CPG implementation strategies was provided for the clinicians, patients, nurses, and other relevant stakeholders contextualized to the national settings Conclusion Our experience with this adaptation methodology provides useful insight into its utilization on a national level in Egypt. The BGAG recommended the next review of this adapted CPG to be after 3 years from its publication (i.e., 2022) after checking for updates in the original CPG.

Accounts of Self: Exploring Relationality Through Literature

2016 ◽  
Author(s):  
Maura Spiegel ◽  
Danielle Spencer
Keyword(s):  
Clinical Practice ◽  
Narrative Therapy ◽  
Narrative Medicine ◽  
Critical Perspectives

Literature offers the opportunity to study relationality in many different forms and contexts. This chapter discusses relationality in creative works—Colm Toíbín’s “One Minus One”, Dostoevsky’s Notes from Underground, Alison Bechdel’s Fun Home, and Kazuo Ishiguro’s Never Let Me Go—in combination with selected criticism and theory, exemplifying one approach to the narrative medicine classroom. In these texts characters offer an account of self in contrasting ways—from the vexed, distrustful address of Dostoevsky’s Underground Man to the richly inviting tapestry of Bechdel’s graphic memoir—provoking different readerly experiences. Critical perspectives such as Bakhtin’s analysis of the dialogic nature of the Underground Man’s apparent soliloquy, Rita Felski’s conception of readerly recognition, Michael White’s description of Narrative Therapy, and Judith Butler’s discussion of the ethics of giving an account of self—all enrich our experience of these works and deepen our understanding of relationality, particularly as it relates to clinical practice.

scholarly journals The Role of Reflection in Narrative Medicine

2018 ◽  
Vol 5 ◽  
pp. 238212051878530 ◽  
Author(s):  
John W Murphy ◽  
Berkeley A Franz ◽  
Christian Schlaerth
Keyword(s):  
Health Care ◽  
Clinical Practice ◽  
Patient Care ◽  
Potential Role ◽  
Patient Empowerment ◽  
Narrative Medicine ◽  
Medical Encounter ◽  
Medical Practitioners ◽  
Vital Part

Reflection has become an important tool for physicians and other medical practitioners. However, many forms of reflection exist in the health care literature, with each having particular implications for successful clinical practice. Very little attention has been given to whether reflection is a vital part of narrative medicine and which forms of reflection might be compatible with this approach to patient care. In this article, the most common types of reflection are compared and discussed, specifically regarding their potential role in narrative medicine. Reflection that encourages practitioners to focus on the various perspectives shared within a medical encounter is both in line with the tenets of narrative medicine and has important consequences for patient empowerment.

Narrative Medicine and Emerging Clinical Practice

2009 ◽  
Vol 27 (2) ◽  
pp. 248-271
Author(s):  
Julie Reichert ◽  
Brian Solan ◽  
Craig Timm ◽  
Summers Kalishman
Keyword(s):  
Clinical Practice ◽  
Narrative Medicine
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