scholarly journals POS0158-HPR UNDERSTANDING NURSE-LED CARE IN EARLY RA: INTERVIEW STUDY WITH RHEUMATOLOGY NURSE SPECIALISTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 291.2-292
Author(s):  
A. M. T. Sweeney ◽  
J. Robson ◽  
C. Flurey ◽  
P. Richards ◽  
C. Mccabe ◽  
...  
Keyword(s):  
Service Evaluation ◽  
Treat To Target ◽  
Service Improvement ◽  
Evidence Based ◽  
Psychosocial Needs ◽  
Specialist Service ◽  
Complex Needs ◽  
Early Ra ◽  
Disease Impact ◽  
The Individual

Background:Nurse-led care in early RA is not well defined in the literature and the current recommendations.Objectives:This study aimed to develop an understanding of what comprises nurse-led care in early RA from the perspective of rheumatology nurse specialists.Methods:This was a qualitative study using semi-structured telephone interviews with rheumatology nurse specialists in England (Summer 2020). Interviews were audio-recorded, transcribed verbatim and analysed using inductive thematic analysis.[1]Results:Sixteen nurses were recruited and interviews lasted between 30 to 60 minutes. Seven themes were identified.Early disease managementCare was characterised by evidence-based RA management provided by experienced nurse specialists with a high degree of autonomy, in the context of a rheumatology multidisciplinary team. The aims of care were to: start treatment, keep in treatment, educate and support.’So treat to target...escalating treatment as necessary, and addressing any concerns that the patients might have’ (CNS14)Addressing psychosocial needsPatients with early RA experience shock, fear, anger, grief and denial while feeling unwell with pain and fatigue. Nurses use a holistic, person-centred and empathetic approach to address psychosocial needs, building a working relationship, listening and creating trust.’Because it all relates, and if they’re stressed because they’re not coping at work, then their arthritis isn’t going to be so good. So everything relates to one another really’ (CNS06)Monitoring treatment, disease impact and patient outcomesNurses monitor disease activity and disease impact using validated outcome measures and by asking questions during the consultation. Good outcomes are disease control, managing disease impact, medication and side effects, wellbeing and keeping in work.’When you get them stable, when you get them into remission, when they’re happy, when they’re feeling well, I think there’s lots of ways you can measure that’… (CNS13)Coordinating care, referring and signpostingNurses coordinate care, refer to other health professionals and signpost patients to relevant services and charities. Lack of access to psychology expertise was highlighted.‘And whilst most of us have got some degree of understanding of…self management, or psychology…we’re not psychologists’ (CNS02)Providing a ‘lifeline’Nurse-led telephone advice services provide a ‘lifeline’ for patients. If patients struggle, they can call and speak with a specialist who knows them and their RA well.’The advice line has been a lifeline to them, to be able to speak to someone, to be able to get a response quickly to their questions, they feel very well supported, they know that they can always call us’ (CNS16)Service evaluation and auditingThe individual clinics are reviewed regularly. Patients are asked for feedback on their experience of appointments, if their needs were met and about changes to the service....‘It’s really important to ask them initially what they expect to have from the consultation...We’ve always had really good feedback in general’… (CNS02)COVID-19 challenges and opportunitiesThe pandemic caused major disruptions to the services, prohibiting most face-to-face consultations which was an essential aspect of clinical assessments. Despite the challenges imposed by the pandemic, the services adapted fast, using telephone, video clinics and digital solutions, which streamlined procedures and improved documentation and communication.‘I do have to rely on them telling me what’s going on, because I can’t see it at the moment’ (CNS14)’With Covid we’re doing it over the telephone, and we’re getting them to watch the video [injection tutorial] before we have the appointment with them’ (CNS04)Conclusion:Nurse-led care in early arthritis is a specialist service, addressing complex needs of patients, using evidence based and person-centred approaches. Innovation and service improvement are seen as part of the role.References:[1]Braun V, Clarke V. Successful Qualitative Research. First edition. London: SAGE 2013.Disclosure of Interests:None declared

Evidence-based management of behavioural and psychological symptoms of dementia

2017 ◽  
pp. 1015-1020
Author(s):  
Anne Corbett ◽  
Clive Ballard ◽  
Byron Creese
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Psychological Symptoms ◽  
Evidence Based ◽  
Pharmacological Treatments ◽  
Complex Needs ◽  
Clinical Guidance ◽  
Prevention And Treatment ◽  
Behavioural And Psychological Symptoms ◽  
The Individual

Behavioural and psychological symptoms of dementia (BPSD) are common in people with Alzheimer’s disease (AD). They include agitation, aggression, psychosis and depression, and can cause great distress for the individual and their caregivers. Dementia represents a considerable challenge for treatment and care due to the complex needs of people with the condition. Management of BPSD is particularly challenging due to the lack of effective pharmacological treatments, and current clinical guidance is complex. This chapter outlines the causes and impacts of BPSD in people with AD. In particular, it explores the evidence supporting the use of both pharmacological and non-pharmacological treatments and the role they play in the prevention and treatment of BPSD.

Evidence-based Practice regarding knowledge, attitude and perceived barriers of Mangalore Physical Therapists: A Survey

2020 ◽  
Vol 11 (4) ◽  
pp. 7056-7063
Author(s):  
Vineel P ◽  
Gopala Krishna Alaparthi ◽  
Kalyana Chakravarthy Bairapareddy ◽  
Sampath Kumar Amaravadi
Keyword(s):  
Response Rate ◽  
Evidence Based Practice ◽  
Physical Therapists ◽  
Medical Profession ◽  
Demographic Data ◽  
Perceived Barriers ◽  
Hard Copy ◽  
Evidence Based ◽  
Research Committee ◽  
The Individual

  Evidence-based Practice is defined as usage of current best evidence which is conscientious, explicit and judicious in deciding on the care of the individual. It is one of the vital decision-making processes in the medical profession. Though India is renowned as a center for medical education, there is scarcity regarding the literature on evidence-based practice. The survey aims to identify the prevalence of evidence-based practice among the physical therapists of Mangalore. The study protocol submitted to scientific research committee and Ethical institutional committee, K.M.C. Mangalore Manipal University. On approval, the questionnaire had been distributed among the physical therapists of Mangalore through mails and in the written form. The questionnaire consists of questions divided into eight sections: 1) consent form 2) current practice status; 3) demographic data; 4) behavior; 5) previous knowledge of E.B.P. resources; 6) skills and available resources; 7) Opinions regarding E.B.P.; 8)Perceived barriers regarding E.B.P. The emails were sent through Google forms to all the physical therapists, and hard copies were distributed among the selected physical therapists. The response rate for the emails was 13.1%. The response collected through hard copies was 178, whereas total hard copies distributed was 320, the participants rejected some due to lack of interest. In total, including emails and hard copy questionnaire 205 was the response rate in which all were practicing physical therapy as their primary profession. The findings of the study will pave the way to identify the status of evidence-based practice as well as help in designing promotional programmers for evidence-based practice.

Moving an Evidence-Based Policy Agenda Forward: Leadership Tips From the Field

2018 ◽  
Vol 33 (3) ◽  
pp. 158-159 ◽  
Author(s):  
Teresa Garrett
Keyword(s):  
Change Process ◽  
Nursing Profession ◽  
Evidence Based ◽  
Policy Agenda ◽  
Policy Changes ◽  
The Public ◽  
Leverage Point ◽  
Evidence Based Policy ◽  
The Individual ◽  
Improve Health

Advancing evidence-based policy change is a leadership challenge that nurses should embrace. Key tips to ensure that evidence-based policy changes are successful at the individual, community, and population levels are offered to help nurses through the change process. The public trust in the nursing profession is a leverage point that should be used to advance the use of evidence, expedite change, and improve health for students and across communities.

Against evidence-based oppression: Marginalized youth and the politics of risk-based assessment and intervention

2016 ◽  
Vol 21 (2) ◽  
pp. 151-167 ◽  
Author(s):  
Tim Goddard ◽  
Randolph R Myers
Keyword(s):  
Lived Experience ◽  
Evidence Based ◽  
Marginalized Youth ◽  
Youth Justice ◽  
Policy And Practice ◽  
Individual Level ◽  
Needs Assessments ◽  
Actuarial Risk ◽  
The Individual ◽  
Causes Of Crime

Actuarial risk/needs assessments exert a formidable influence over the policy and practice of youth offender intervention. Risk-prediction instruments and the programming they inspire are thought not only to link scholarship to practice, but are deemed evidence-based. However, risk-based assessments and programs display a number of troubling characteristics: they reduce the lived experience of racialized inequality into an elevated risk score; they prioritize a very limited set of hyper-individualistic interventions, at the expense of others; and they privilege narrow individual-level outcomes as proof of overall success. As currently practiced, actuarial youth justice replicates earlier interventions that ask young people to navigate structural causes of crime at the individual level, while laundering various racialized inequalities at the root of violence and criminalization. This iteration of actuarial youth justice is not inevitable, and we discuss alternatives to actuarial youth justice as currently practiced.

Positive psychology: resilience and its role within mental health nursing

2021 ◽  
Vol 10 (1) ◽  
pp. 1-14
Author(s):  
Jan Macfarlane
Keyword(s):  
Mental Health ◽  
Positive Psychology ◽  
Psychological Interventions ◽  
Evidence Based ◽  
Mental Health Nursing ◽  
Mental Health Workforce ◽  
Positive Psychological Interventions ◽  
Health Nursing ◽  
The Individual ◽  
User Friendly

This is the ninth article in a series that explores the meaning of positive psychology and the importance it has on the wellbeing of the mental health workforce. It will focus on positive psychology interventions that help to develop resilience and to consider how the uplifting effect of resilience through contemporary use in the field of mental health nursing can be experienced. This article will explain what the term resilience means and how it is embedded in the practice of positive psychological interventions. Finally, it will emphasise how the application of positive psychological interventions can benefit the individual and the organisation. The practical tasks provided in the boxes throughout the article will help the reader identify what resilience means for them and understand how to further develop its transferability through evidence-based, user-friendly exercises.

scholarly journals Evidence-Based Medicine in judicial decisions concerning right to healthcare

2016 ◽  
Vol 14 (1) ◽  
pp. 1-5 ◽  
Author(s):  
Eduardo Rocha Dias ◽  
Geraldo Bezerra da Silva Junior
Keyword(s):  
Health Insurance ◽  
Evidence Based Medicine ◽  
Private Health Insurance ◽  
Scientific Evidence ◽  
Federal Court ◽  
Public Healthcare ◽  
Evidence Based ◽  
Unified Health System ◽  
The Individual ◽  
Based Medicine

ABSTRACT Objective To analyze, from the examination of decisions issued by Brazilian courts, how Evidence-Based Medicine was applied and if it led to well-founded decisions, searching the best scientific knowledge. Methods The decisions made by the Federal Courts were searched, with no time limits, at the website of the Federal Court Council, using the expression “Evidence-Based Medicine”. With regard to decisions issued by the court of the State of São Paulo, the search was done at the webpage and applying the same terms and criterion as to time. Next, a qualitative analysis of the decisions was conducted for each action, to verify if the patient/plaintiff’s situation, as well as the efficacy or inefficacy of treatments or drugs addressed in existing protocols were considered before the court granted the provision claimed by the plaintiff. Results In less than one-third of the decisions there was an appropriate discussion about efficacy of the procedure sought in court, in comparison to other procedures available in clinical guidelines adopted by the Brazilian Unified Health System (Sistema Único de Saúde) or by private health insurance plans, considering the individual situation. The majority of the decisions involved private health insurance plans (n=13, 68%). Conclusion The number of decisions that did consider scientific evidence and the peculiarities of each patient was a concern. Further discussion on Evidence-Based Medicine in judgments involving public healthcare are required.

scholarly journals Addiction service changes due to COVID-19

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S349-S349
Author(s):  
Shumaila Shahbaz ◽  
Zeeshan Hashmani ◽  
Soraya Mayet
Keyword(s):  
Opioid Dependence ◽  
Data Retrieval ◽  
Service Evaluation ◽  
Individual Risk ◽  
Attendance Rates ◽  
Opioid Substitution Treatment ◽  
Face To Face ◽  
Addiction Service ◽  
The Individual ◽  
Opioid Substitution

AimsAddictions services had to respond rapidly to reduce COVID-19 transmission to protect patients and staff. Patients with opioid dependence are particularly vulnerable, with high risks. Our community addiction service changed practice in line with COVID-19 guidelines. For patients with opioid dependence; face-to-face contacts were initially reduce and mainly for new starts, restarts and non-attenders. Prescribing changes were completed on an individually risk assessed basis to reduce attendance at the chemist, specifically to reduce transmission, keep patients in treatment and to ensure chemists could continue to function. We document some of the service changes during the COVID-19 lockdown.MethodService evaluation had approval from Humber Teaching NHS Foundation Trust. Data retrieved on one Hub of a community addictions service in North England, UK. Patients prescribed opioid substitution treatment for opioid dependence were assessed, with data retrieval through electronic healthcare records. Data were analysed by Microsoft Excel anonymously.ResultIn lockdown (March 2020 to June 2020), we identified 112 patients with opioid dependence prescribed opioid substitution (OST) with methadone or buprenorphine at the Hub. All white British, mean 42 years, most male (75%) and prescribed methadone (78%). Ten were new starts and 8 restarts to OST. Attendance rates did not change: 91% before and 92% during lockdown. Appointment format changed from predominantly face-to-face (92%) to telephone (99%). Most patients (91%;n = 88) were offered take-home naloxone and overdose prevention training of which 14 refused. Supervision days at the chemist for OST reduced significantly from 75% collecting daily at the chemist, reducing to 20% during lockdown. Five patients were shielding and 7 had covid-related symptoms. There was one death during lockdown which was not attributed to covid or overdose.ConclusionThe addictions service continued to be open and work proactively throughout lockdown, seeing new patients and continuing treatment interventions safely. Major changes were made in line with COVID-19 guidelines, to respond to the threat of transmission. Our service was flexible and able to adapt quickly to remote working. We maintained excellent attendance rates despite changes to the format of consultations. There were no related incidents e.g. overdoses linked to prescribed medications, despite a reduction in supervision, and therefore patients having extra medications. This important finding may be related to the individual risk assessments that we conducted before making changing to prescribing. This was supported by most patients were receiving naloxone to prevent overdoses. Some of the changes, such as telephone consultations, may be beneficial to continue post COVID-19.

scholarly journals The Myth of Teacher Shortage in India

2021 ◽  
Author(s):  
Sandip Datta ◽  
Geeta Gandhi Kingdon
Keyword(s):  
Public Schools ◽  
Education Policy ◽  
Teacher Shortage ◽  
Allocation Rule ◽  
Evidence Based ◽  
National Education ◽  
Public Elementary Schools ◽  
Median Size ◽  
National Education Policy ◽  
The Individual

This paper examines the widespread perception in India that the country has an acute teacher shortage of about one million teachers in public elementary schools, a view repeated in India’s National Education Policy 2020. Using official DISE data, we show that there is hardly any net teacher deficit in the country since there is roughly the same number of surplus teachers as the number of teacher vacancies. Secondly, we show that measuring teacher requirements after removing the estimated fake students from enrolment data greatly reduces the required number of teachers and increases the number of surplus teachers, yielding an estimated net surplus of about 342,000 teachers. Thirdly, we show that if we both remove fake enrolment and also make a suggested hypothetical change to the teacher allocation rule to adjust for the phenomenon of emptying public schools (which has slashed the national median size of public schools to a mere 64 students, and rendered many schools ‘tiny’), the estimated net teacher surplus is about 764,000 teachers. Fourthly, we highlight that if government does fresh recruitment to fill the supposed nearly one-million vacancies as promised in the National Education Policy 2020, the already modest national mean pupil-teacher-ratio of 22.8 would fall to 15.9, at a permanent fiscal cost of nearly Rupees 480 billion (USD 6.6 billion) per year in 2017-18 prices, which is higher than the individual GDPs of 56 countries in that year. The paper highlights the major economic efficiencies that can result from an evidence-based approach to teacher recruitment and deployment policies.

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