Exploring nurse navigators' contribution to integrated care: a qualitative study

2019 ◽  
Vol 25 (4) ◽  
pp. 339
Author(s):  
Clare Hannan-Jones ◽  
Charlotte Young ◽  
Geoffrey Mitchell ◽  
Allyson Mutch
Keyword(s):  
Qualitative Study ◽  
Integrated Care ◽  
Healthcare Professionals ◽  
Interdisciplinary Collaboration ◽  
Clinical Integration ◽  
Two Phase ◽  
Professional Integration ◽  
Healthcare Settings ◽  
Care Practices ◽  
Depth Interviews

This paper examines nurse navigation as a model of integrated care operating across primary and secondary healthcare settings. A two-phase qualitative study involving a focus group with seven nurse navigators (NNs) to explore their understandings and perceptions of the role, followed by in-depth interviews with three NNs to examine current practice, was undertaken in Queensland, Australia. NNs’ role spanned a continuum of patient and population care, and involved engagement in clinical integration, coordinating patient care and providing education and points-of-contact for healthcare professionals. NNs also engaged in professional integration, fostering interdisciplinary collaboration, education and connections between healthcare professionals, while promoting integrated care across care settings. NNs were enabled through the establishment of relationships, trust and shared communication between stakeholders. NNs’ work transcended traditional clinical boundaries, operating horizontally across silos and specialties, which allowed them to avoid (some) system shortfalls. By contributing to a culture of integration, NNs can potentially support more sustainable integrated care practices that extend relationships between healthcare professionals and beyond individual patients. Increasing our understanding of nurse navigation as a model of integrated care, this study illustrates the complexity, diversity and breadth of the role and its ability to contribute to broader, system-wide integration.

Implementing integrated care pilot projects in hospital settings – an exploration of disruptive practices

2020 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Elizabeth Mansfield ◽  
Jane Sandercock ◽  
Penny Dowedoff ◽  
Sara Martel ◽  
Michelle Marcinow ◽  
...  
Keyword(s):  
Health Services ◽  
Integrated Care ◽  
Healthcare Professionals ◽  
Hospital Setting ◽  
Healthcare Team ◽  
Pilot Projects ◽  
Content Type ◽  
Implementation Phase ◽  
Early Implementation ◽  
Care Practices

PurposeIn Canada, integrated care pilot projects are often implemented as a local reform strategy to improve the quality of patient care and system efficiencies. In the qualitative study reported here, the authors explored the experiences of healthcare professionals when first implementing integrated care pilot projects, bringing together physical and mental health services, in a community hospital setting.Design/methodology/approachEngaging a qualitative descriptive study design, semi-structured interviews were conducted with 24 healthcare professionals who discussed their experiences with implementing three integrated care pilot projects one year following project launch. The thematic analysis captured early implementation issues and was informed by an institutional logics framework.FindingsThree themes highlight disruptions to established logics reported by healthcare professionals during the early implementation phase: (1) integrated care practices increased workload and impacted clinical workflows; (2) integrating mental and physical health services altered patient and healthcare provider relationships; and (3) the introduction of integrated care practices disrupted healthcare team relations.Originality/valueStudy findings highlight the importance of considering existing logics in healthcare settings when planning integrated care initiatives. While integrated care pilot projects can contribute to organizational, team and individual practice changes, the priorities of healthcare stakeholders, relational work required and limited project resources can create significant implementation barriers.

scholarly journals Experiences of Iranian women with prenatal diagnosis of fetal abnormalities: A qualitative study

2020 ◽  
Author(s):  
Fahimeh Ranjbar ◽  
Fatemeh Oskouie ◽  
Shahrzad Hashemi Dizaji ◽  
Maryam Gharacheh
Keyword(s):  
Decision Making ◽  
Prenatal Diagnosis ◽  
Qualitative Study ◽  
Healthcare Professionals ◽  
Fetal Abnormalities ◽  
Economic Problems ◽  
Self Blame ◽  
Emotional Suffering ◽  
Conventional Content Analysis ◽  
Depth Interviews

Abstract Background: Women are more likely to be diagnosed with congenital anomalies. Following prenatal diagnosis of fetal abnormalities, women may be forced to make decisions about whether to continue a pregnancy with fetal abnormalities. This can be a dilemma for the women. The aim of the study was to explore women’s experiences of prenatal diagnosis of fetal abnormalities. Methods: A qualitative study was conducted in a referral women’s hospital in Tehran, Iran in 2018. Participants were a purposeful sample of 15 women with prenatal diagnosis of fetal abnormalities. Data were collected by individual, in-depth interviews. The conventional content analysis approach was used to analyze the data. Results: Two main themes “emotional suffering” and “decision-making challenge” were extracted from the participants’ experiences. Emotional suffering consisted of subthemes “sense of guilt”, “self-blame”, “questioning of God”, “commiseration” and “projection”. Decision making challenge included subthemes “distrust”, “possible cure”, “dark future”, “economic problems”, “stereotypical beliefs”, “coercion” and “lack of support”. Conclusions: The experience of prenatal diagnosis of fetal abnormalities was associated with emotional suffering and challenges in decision-making to continue or terminate the pregnancy. Strategies need to be employed to improve women’s autonomy in decision-making. Healthcare professionals should be trained in communication skills to provide appropriate counseling to support women with diagnosis of fetal anomalies.

scholarly journals Perspectives of nurses’ role in interprofessional pharmaceutical care across 14 European countries: A qualitative study in pharmacists, physicians and nurses

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0251982
Author(s):  
Elyne De Baetselier ◽  
Tinne Dilles ◽  
Luis M. Batalha ◽  
Nienke E. Dijkstra ◽  
Maria I. Fernandes ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Pharmaceutical Care ◽  
Healthcare Professionals ◽  
Active Role ◽  
Care Quality ◽  
European Countries ◽  
Face To Face ◽  
Healthcare Settings ◽  
Nurses Role ◽  
Legal Frameworks

Objectives To understand healthcare professionals’ experiences and perceptions of nurses’ potential or ideal roles in pharmaceutical care (PC). Design Qualitative study conducted through semi-structured in-depth interviews. Setting Between December 2018 and October 2019, interviews were conducted with healthcare professionals of 14 European countries in four healthcare settings: hospitals, community care, mental health and long-term residential care. Participants In each country, pharmacists, physicians and nurses in each of the four settings were interviewed. Participants were selected on the basis that they were key informants with broad knowledge and experience of PC. Data collection and analysis All interviews were conducted face to face. Each country conducted an initial thematic analysis. Consensus was reached through a face-to-face discussion of all 14 national leads. Results 340 interviews were completed. Several tasks were described within four potential nursing responsibilities, that came up as the analysis themes, being: 1) monitoring therapeutic/adverse effects of medicines, 2) monitoring medicines adherence, 3) decision making on medicines, including prescribing 4) providing patient education/information. Nurses’ autonomy varied across Europe, from none to limited to a few tasks and emergencies to a broad range of tasks and responsibilities. Intended level of autonomy depended on medicine types and level of education. Some changes are needed before nursing roles can be optimised and implemented in practice. Lack of time, shortage of nurses, absence of legal frameworks and limited education and knowledge are main threats to European nurses actualising their ideal role in PC. Conclusions European nurses have an active role in PC. Respondents reported positive impacts on care quality and patient outcomes when nurses assumed PC responsibilities. Healthcare professionals expect nurses to report observations and assessments. This key patient information should be shared and addressed by the interprofessional team. The study evidences the need of a unique and consensus-based PC framework across Europe.

scholarly journals “Very busy”: daily reorganization of mothers to care of children with Congenital Zika Syndrome

2020 ◽  
Vol 41 ◽  
Author(s):  
Paulo Roberto Lima Falcão do Vale ◽  
Deisyane Vitória Alves ◽  
Evanilda Souza de Santana Carvalho
Keyword(s):  
Content Analysis ◽  
Qualitative Study ◽  
Health Professionals ◽  
Family Members ◽  
Social Representation ◽  
Thematic Content Analysis ◽  
The Social ◽  
Congenital Zika Syndrome ◽  
Care Practices ◽  
Depth Interviews

ABSTRACT Objective: To understand the experiences and care practices of mothers of children with congenital Zika syndrome. Methods: A qualitative study with collection held in Feira de Santana - Bahia, between September and November 2017, from in-depth interviews and Story-Drawing with 11 family members of children, using thematic content analysis. Results: Mothers take care from experiences with health professionals and groups of mothers. They reorganize themselves in order to optimize time, streamline domestic activities, teach family members, and navigate care spaces. They experience the routine organizing the home, taking care of the children and, specifically, the child with syndrome, referring to: bedtime; giving a shower; changing diapers; feeding; playing; and, stimulating, actions mediated by intense crying and environmental preparation. Conclusion: The experiences are unique and exceptional, conforming the social representation of the mothers as a group, the “mothers of micro”, an aspect that differs from other experiences.

scholarly journals Patient, carer and healthcare professional experiences of complex care quality in multidisciplinary primary healthcare centres: qualitative study with face-to-face, in-depth interviews and focus groups in five French multidisciplinary primary healthcare centres

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e050165
Author(s):  
Jérémy Derriennic ◽  
Marie Barais ◽  
Delphine Le Goff ◽  
Guillaume Fernandez ◽  
Françoise Le Borne ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Focus Groups ◽  
Primary Healthcare ◽  
Healthcare Professionals ◽  
Care Quality ◽  
Face To Face ◽  
Quality Of Primary Care ◽  
Depth Interviews

ObjectivesTo explore care experiences in multidisciplinary primary healthcare centres from the patients, carers and healthcare professionals perspectives.DesignThis qualitative study used face-to-face, in-depth interviews and focus groups. Patients with multimorbidity monitored by a General Practitioner (GP) and another professional from the health centre were recruited through purposive sampling and included with their carer. They were interviewed together while professionals were interviewed separately. Verbatims were coded with subsequent blind analysis, using an inductive approach, to find aspects and features. The constant comparative method highlighted data consistencies and variations.ParticipantsTwenty-six patients, 23 family carers and 57 healthcare professionals.SettingFive multidisciplinary primary healthcare centres, in France, between March 2017 and December 2018.ResultsThis unique study grouped perspectives into nine core quality of primary care aspects: having accessible, available, and varied care; feeling welcome and enjoying comfortable, well-equipped, and clean premises; having quality medicotechnical care (medical knowledge and technical skills); having a reliable GP; receiving appropriate care from healthcare professionals other than the GP; maintaining an efficient relationship with healthcare professionals; benefiting from organised and coordinated care; being an informed, supported and involved patient; having an informed, supported and involved carer. New areas of interest include the multidisciplinary nature of the centres, appreciation of other professionals within the centre, medicotechnical dimensions of care and the carer’s role in maintaining patient autonomy.ConclusionsThis is the first study to interview patients and carers alongside healthcare professionals. This enhanced knowledge improves understanding of these aspects and can guide implementation of evaluation tools that truly reflect patient and carer needs and enable an efficient experience in terms of quality. To address deficiencies in existing questionnaires, the new perspectives found will be added to former aspects to create a comprehensive quality of primary care evaluation tool.Trial registration numberNCT02934711, Results.

scholarly journals Daily life participation in childhood chronic disease: a qualitative study on the child’s and parent’s perspective

2021 ◽  
Vol 5 (1) ◽  
pp. e001057
Author(s):  
Merel M Nap-van der Vlist ◽  
Emma E Berkelbach van der Sprenkel ◽  
Linde N Nijhof ◽  
Martha A Grootenhuis ◽  
Cornelis K van der Ent ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Qualitative Study ◽  
Healthcare Professionals ◽  
Daily Life ◽  
Well Being ◽  
Parents And Children ◽  
Proactive Study ◽  
Parental Strategies ◽  
Depth Interviews ◽  
Level Of Agreement

ObjectiveTo understand how a child with a stable chronic disease and his/her parents shape his/her daily life participation, we assessed: (1) the parents’ goals regarding the child’s daily life participation, (2) parental strategies regarding the child’s participation and () how children and their parents interrelate when their goals regarding participation are not aligned.MethodsThis was a qualitative study design using a general inductive approach. Families of children 8–19 years with a stable chronic disease (cystic fibrosis, autoimmune disease or postcancer treatment) were recruited from the PROactive study. Simultaneous in-depth interviews were conducted separately with the child and parent(s). Analyses included constant comparison, coding and categorisation.ResultsThirty-one of the 57 invited families (54%) participated. We found that parents predominantly focus on securing their child’s well-being, using participation as a means to achieve well-being. Moreover, parents used different strategies to either support participation consistent with the child’s healthy peers or support participation with a focus on physical well-being. The degree of friction between parents and their child was based on the level of agreement on who takes the lead regarding the child’s participation.ConclusionsInterestingly, parents described participation as primarily a means to achieve the child’s well-being, whereas children described participation as more of a goal in itself. Understanding the child’s and parent’s perspective can help children, parents and healthcare professionals start a dialogue on participation and establish mutual goals. This may help parents and children find ways to interrelate while allowing the child to develop his/her autonomy.

An Exploration of Aftercare Services for Female Drug Users

2018 ◽  
Vol 30 (2) ◽  
Author(s):  
Talent Mhangwa ◽  
Madhu Kasiram ◽  
Sibonsile Zibane
Keyword(s):  
South Africa ◽  
Qualitative Study ◽  
Drug Users ◽  
Service Providers ◽  
Service Users ◽  
Rehabilitation Centre ◽  
Aftercare Services ◽  
Data Source ◽  
Female Drug Users ◽  
Depth Interviews

The number of female drug users has been on the rise in South Africa, with statistics reflecting a rise in the number of women who attend treatment centres annually. This article presents empirical data from a broader qualitative study which aimed to explore perceptions concerning the effectiveness of aftercare programmes for female recovering drug users. The main data source was transcripts of in-depth interviews and focus groups with both service users and service providers from a designated rehabilitation centre in Gauteng, South Africa. Framed within a biopsychosocial-spiritual model, this article explores the perceptions and meanings which the female recovering drug users and the service providers attach to aftercare programmes. The findings of the research outlined the range of factors promoting recovery, alongside noteworthy suggestions for improvement in aftercare services. While acknowledging multiple influences on behaviour, this article highlights the significance of these findings in planning and implementing holistic aftercare programmes.

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