scholarly journals The role of trained champions in sustaining and spreading nutrition care improvements in hospital: qualitative interviews following an implementation study

2021 ◽  
pp. e000281
Author(s):  
Celia Laur ◽  
Jack Bell ◽  
Renata Valaitis ◽  
Sumantra Ray ◽  
Heather Keller
Keyword(s):  
Phase 1 ◽  
Qualitative Interviews ◽  
Audit And Feedback ◽  
Routine Practice ◽  
Phase 2 ◽  
Process Measures ◽  
Link Type ◽  
Nutrition Care ◽  
Registration Number

BackgroundMany patients are already malnourished when admitted to hospital. Barriers and facilitators to nutrition care in hospital have been identified and successful interventions developed; however, few studies have explored how to sustain and spread improvements. The More-2-Eat phase 1 study involved five hospitals across Canada implementing nutrition care improvements, while phase 2 implemented a scalable model using trained champions, audit and feedback, a community of practice with external mentorship and an implementation toolkit in 10 hospitals (four continuing from phase 1). Process measures showed that screening and assessment from phase 1 were sustained for at least 4 years. The objective of this study was to help explain how these nutrition care improvements were sustained and spread by understanding the role of the trained champions, and to confirm and expand on themes identified in phase 1.MethodsSemistructured telephone interviews were conducted with champions from each phase 2 hospital and recordings transcribed verbatim. To explore the champion role, transcripts were deductively coded to the 3C model of Concept, Competence and Capacity. Phase 2 transcripts were also deductively coded to themes identified in phase 1 interviews and focus groups.ResultsTen interviews (n=14 champions) were conducted. To sustain and spread nutrition care improvements, champions needed to understand the Concepts of change management, implementation, adaptation, sustainability and spread in order to embed changes into routine practice. Champions also needed the Competence, including the skills to identify, support and empower new champions, thus sharing the responsibility. Capacity, including time, resources and leadership support, was the most important facilitator for staying engaged, and the most challenging. All themes identified in qualitative interviews in phase 1 were applicable 4 years later and were mentioned by new phase 2 hospitals. There was increased emphasis on audit and feedback, and the need for standardisation to support embedding into current practice.ConclusionTrained local champions were required for implementation. By understanding key concepts, with appropriate and evolving competence and capacity, champions supported sustainability and spread of nutrition care improvements. Understanding the role of champions in supporting implementation, spread and sustainability of nutrition care improvements can help other hospitals when planning for and implementing these improvements.Trial registration numberNCT02800304, NCT03391752.

scholarly journals Codeveloping a multibehavioural mobile phone app to enhance social and emotional well-being and reduce health risks among Aboriginal and Torres Strait Islander women during preconception and pregnancy: a three-phased mixed-methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. e052545
Author(s):  
Michelle Kennedy ◽  
Ratika Kumar ◽  
Nicole M Ryan ◽  
Jessica Bennett ◽  
Gina La Hera Fuentes ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Mobile Phone ◽  
Phase 1 ◽  
Qualitative Interviews ◽  
Mixed Methods Study ◽  
Phase 2 ◽  
Community Members ◽  
Phase 3 ◽  
Aboriginal Community ◽  
Aboriginal Women

ObjectiveDescribe the development and pretest of a prototype multibehavioural change app MAMA-EMPOWER.DesignMixed-methods study reporting three phases: (1) contextual enquiry included stakeholder engagement and qualitative interviews with Aboriginal women, (2) value specification included user-workshop with an Aboriginal researcher, community members and experts, (3) codesign with Aboriginal researchers and community members, followed by a pretest of the app with Aboriginal women, and feedback from qualitative interviews and the user-Mobile Application Rating Scale (U-MARS) survey tool.SettingsAboriginal women and communities in urban and regional New South Wales, Australia.ParticipantsPhase 1: interviews, 8 Aboriginal women. Phase 2: workshop, 6 Aboriginal women. Phase 3: app trial, 16 Aboriginal women. U-MARS, 5 Aboriginal women.ResultsPhase 1 interviews revealed three themes: current app use, desired app characteristics and implementation. Phase 2 workshop provided guidance for the user experience. Phase 3 app trial assessed all content areas. The highest ratings were for information (mean score of 3.80 out of 5, SD=0.77) and aesthetics (mean score of 3.87 with SD of 0.74), while functionality, engagement and subjective quality had lower scores. Qualitative interviews revealed the acceptability of the app, however, functionality was problematic.ConclusionsDeveloping a mobile phone app, particularly in an Aboriginal community setting, requires extensive consultation, negotiation and design work. Using a strong theoretical foundation of behavioural change technique’s coupled with the consultative approach has added rigour to this process. Using phone apps to implement behavioural interventions in Aboriginal community settings remains a new area for investigation. In the next iteration of the app, we aim to find better ways to personalise the content to women’s needs, then ensure full functionality before conducting a larger trial. We predict the process of development will be of interest to other health researchers and practitioners.

scholarly journals Evaluating the specialist palliative care clinical nurse specialist role in an acute hospital setting: a mixed methods sequential explanatory study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Michael Connolly ◽  
Mary Ryder ◽  
Kate Frazer ◽  
Eileen Furlong ◽  
Teresa Plazo Escribano ◽  
...  
Keyword(s):  
Palliative Care ◽  
Phase 1 ◽  
Hospital Setting ◽  
Acute Hospital ◽  
Nurse Specialist ◽  
Phase 2 ◽  
Specialist Palliative Care ◽  
Clinical Nurse ◽  
Acute Hospital Setting

Abstract Background Special palliative care is provided in a range of settings including a patient’s home (their primary place of dwelling), a hospice in-patient unit, or an acute hospital. The aim of the study was to evaluate the role of the specialist in palliative care clinical nurse specialist (SPC CNS) role in an acute hospital setting. Methods This study was conducted using a mixed methods sequential explanatory approach in two phases; phase 1 involved completion of a study questionnaire (n = 121) and phase 2 involved part-taking in a focus group (n = 6) or individual interview (n = 4). Results Phase 1 results indicated that respondents held positive attitudes towards the Specialist Palliative Care Clinical Nurses Specialist (SPC CNS) in relation to clinical care, education and patient advocacy. Phase 2 qualitative findings identified the importance of the role in terms of symptom management, education and support. Conclusions This study provides an evaluation of a SPC CNS role since it was established in an acute hospital setting. The evidence indicates that there is a varied understanding of the role of the SPC CNS. The role was seen as an important one particularly in terms of referrals to and support provided by the SPC CNS, as well as recognition of the importance of the role is providing ongoing education to staff.

scholarly journals A Novel Approach to Practice-Based Learning and Improvement Using a Web-Based Audit and Feedback Module

2014 ◽  
Vol 6 (3) ◽  
pp. 541-546 ◽  
Author(s):  
Joel C. Boggan ◽  
George Cheely ◽  
Bimal R. Shah ◽  
Randy Heffelfinger ◽  
Deanna Springall ◽  
...  
Keyword(s):  
Phase 1 ◽  
Data Entry ◽  
Audit And Feedback ◽  
Phase 2 ◽  
Online Data ◽  
Web Based ◽  
Online Tool ◽  
Novel Approach ◽  
Patients With Diabetes ◽  
Personal Performance

Abstract Background Systematically engaging residents in large programs in quality improvement (QI) is challenging. Objective To coordinate a shared QI project in a large residency program using an online tool. Methods A web-based QI tool guided residents through a 2-phase evaluation of performance of foot examinations in patients with diabetes. In phase 1, residents completed reviews of health records with online data entry. Residents were then presented with personal performance data relative to peers and were prompted to develop improvement plans. In phase 2, residents again reviewed personal performance. Rates of performance were compared at the program and clinic levels for each phase, with data presented for residents. Acceptability was measured by the number of residents completing each phase. Feasibility was measured by estimated faculty, programmer, and administrator time and costs. Results Seventy-nine of 86 eligible residents (92%) completed improvement plans and reviewed 1471 patients in phase 1, whereas 68 residents (79%) reviewed 1054 patient charts in phase 2. Rates of performance of examination increased significantly between phases (from 52% to 73% for complete examination, P < .001). Development of the tool required 130 hours of programmer time. Project analysis and management required 6 hours of administrator and faculty time monthly. Conclusions An online tool developed and implemented for program-wide QI initiatives successfully engaged residents to participate in QI activities. Residents using this tool demonstrated improvement in a selected quality target. This tool could be adapted by other graduate medical education programs or for faculty development.

scholarly journals Bintrafusp alfa, a bifunctional fusion protein targeting TGF-β and PD-L1, in patients with human papillomavirus-associated malignancies

2020 ◽  
Vol 8 (2) ◽  
pp. e001395
Author(s):  
Julius Strauss ◽  
Margaret E Gatti-Mays ◽  
Byoung Chul Cho ◽  
Andrew Hill ◽  
Sébastien Salas ◽  
...  
Keyword(s):  
Human Papillomavirus ◽  
Fusion Protein ◽  
Response Rate ◽  
Checkpoint Inhibitor ◽  
Phase 1 ◽  
Objective Response ◽  
Additional Patient ◽  
Phase 2 ◽  
Link Type ◽  
Bifunctional Fusion Protein

BackgroundBintrafusp alfa is a first-in-class bifunctional fusion protein composed of the extracellular domain of transforming growth factor (TGF)-βRII (a TGF-β ‘trap’) fused to a human IgG1 mAb blocking programmed cell death ligand 1. This is the largest analysis of patients with advanced, pretreated human papillomavirus (HPV)-associated malignancies treated with bintrafusp alfa.MethodsIn these phase 1 (NCT02517398) and phase 2 trials (NCT03427411), 59 patients with advanced, pretreated, checkpoint inhibitor-naive HPV-associated cancers received bintrafusp alfa intravenously every 2 weeks until progressive disease, unacceptable toxicity, or withdrawal. Primary endpoint was best overall response per Response Evaluation Criteria in Solid Tumors (RECIST) V.1.1; other endpoints included safety.ResultsAs of April 17, 2019 (phase 1), and October 4, 2019 (phase 2), the confirmed objective response rate per RECIST V.1.1 in the checkpoint inhibitor-naive, full-analysis population was 30.5% (95% CI, 19.2% to 43.9%; five complete responses); eight patients had stable disease (disease control rate, 44.1% (95% CI, 31.2% to 57.6%)). In addition, three patients experienced a delayed partial response after initial disease progression, for a total clinical response rate of 35.6% (95% CI, 23.6% to 49.1%). An additional patient with vulvar cancer had an unconfirmed response. Forty-nine patients (83.1%) experienced treatment-related adverse events, which were grade 3/4 in 16 patients (27.1%). No treatment-related deaths occurred.ConclusionBintrafusp alfa showed clinical activity and manageable safety and is a promising treatment in HPV-associated cancers. These findings support further investigation of bintrafusp alfa in patients with advanced, pretreated HPV-associated cancers.

scholarly journals The Role of Coping Strategies in Maintaining Well-Being During the COVID-19 Outbreak in South Korea

2021 ◽  
pp. 194855062199059
Author(s):  
Joo Hyun Kim ◽  
Yerin Shim ◽  
Incheol Choi ◽  
Eunsoo Choi
Keyword(s):  
South Korea ◽  
Coping Strategies ◽  
Growth Models ◽  
Phase 1 ◽  
Well Being ◽  
Rate Of Change ◽  
Phase 2 ◽  
Behavioral Strategies ◽  
The Individual

The COVID-19 pandemic continues to pose an unprecedented challenge for the world as people strive to cope with this significant threat to their well-being. This intensive longitudinal study of the first 94 days of the COVID-19 outbreak in South Korea (Phase 1: initial outbreak, Phase 2: intense social distancing) examined individuals’ changes in well-being, in relation to their use of coping strategies and fear of infection. A sample of 10,464 South Koreans participated in surveys during Phase 1 and Phase 2, resulting in 35,846 observations. Multilevel growth models revealed a decrease in well-being while different coping strategies moderated the individual rate of change in well-being. Although preventive measures were associated with a greater decrease in well-being, cognitive appraisal and behavioral strategies predicted stable well-being during the pandemic. Coping strategies further mediated the association between fear of infection and deterioration of well-being.

Building a Caring-Based Hyperglycemic Crisis Prevention Model for Patients With Diabetes Mellitus, Thailand

2018 ◽  
Vol 22 (2) ◽  
pp. 4-13
Author(s):  
Nongnut Oba ◽  
Charlotte D. Barry ◽  
Shirley C. Gordon ◽  
Rachada Pipatsart ◽  
Viruch Sirigulsatien
Keyword(s):  
Diabetes Mellitus ◽  
Phase 1 ◽  
Qualitative Interviews ◽  
Patient Experiences ◽  
Phase 2 ◽  
Crisis Prevention ◽  
Patients With Diabetes ◽  
Prevention Model ◽  
Seeking Help ◽  
Using Data

The purpose of this study was to understand patient experiences of hyperglycemic crisis (HC) and develop a caring-based, interdisciplinary model for preventing HC in Thailand. A 2-Phase approach was used. In Phase 1, qualitative interviews were conducted with 15 in-patients with diabetes mellitus who had experienced a HC. Four themes emerged: not knowing, depending on others for care, experiencing stress, and seeking help for self-care. In Phase 2, interdisciplinary, participatory team focus groups were conducted using data from Phase 1 to develop a model of hyperglycemic crisis prevention.

Applying User-Centered Design to Develop an Audit and Feedback Intervention for the Home Care Sector

2017 ◽  
Vol 29 (3) ◽  
pp. 148-160 ◽  
Author(s):  
Heather L. Colquhoun ◽  
Deborah Sattler ◽  
Christine Chan ◽  
Taheera Walji ◽  
Rachel Palumbo ◽  
...  
Keyword(s):  
Home Care ◽  
Care Management ◽  
Phase 1 ◽  
Audit And Feedback ◽  
Phase 2 ◽  
User Centered Design ◽  
User Testing ◽  
Home And Community Care ◽  
Semistructured Interviews ◽  
User Centered

The objective of this study was to optimize a planned audit and feedback (A&F) intervention for home and community care through incorporating user-centered design principles. Phase 1 comprised the development of a paper prototype, followed by testing of the prototype using semistructured interviews and focus groups. Phase 2 involved the development of a revised and online prototype based on the results of Phase 1, followed by user testing. A total of 39 participants across Phase 1 ( n = 33) and Phase 2 ( n = 6) provided input into the design of the A&F intervention. Key changes included improving clarity of the variables, reducing cognitive load, and highlighting opportunities for action. Preliminary findings suggest potential usefulness in this approach to optimize home care management.

scholarly journals Influence of Music on Closed Motor Skills: A Controlled Study with Novice Female Dart-Throwers

2020 ◽  
Vol 17 (11) ◽  
pp. 4146 ◽  
Author(s):  
Félix Arbinaga ◽  
Nehemías Romero-Pérez ◽  
Lidia Torres-Rosado ◽  
Eduardo J. Fernández-Ozcorta ◽  
María Isabel Mendoza-Sierra
Keyword(s):  
Motor Skills ◽  
Phase 1 ◽  
Controlled Study ◽  
Group Differences ◽  
Phase 2 ◽  
Factorial Anova ◽  
Dart Throwing ◽  
Two Phases ◽  
Mixed Factorial Anova

The influence of music heard at different tempos is analyzed during the execution of a dart-throwing task. The sample consisted of 56 female university students (Mean age = 23.38, SD = 6.773). The participants were randomly assigned to GC (group control without music; n = 18), GS (group with slow-paced music at a tempo of 60 BPM; n = 19) and GF (group with fast-paced music at a tempo of 105 BPM; n = 19). All participants performed a dart-throwing task in two phases. Analysis of the scores obtained during Phase 1 and Phase 2 of dart throwing (examining both between-group differences and within-group differences, i.e., changes in scores from Phase 1 to Phase 2 using a mixed factorial ANOVA) revealed no differences in dart-throwing scores. There were, however, differences in execution time, where the participants in GS needed more time to complete the task than those in GF (F(2,55) = 4.426, p = 0.017) with a large effect size (ŋ2p = 0.143), although neither of these groups differed from GC. The results are discussed in terms of the role of music in precision tasks and the synchronization of the task with the pace of the music.

scholarly journals Evaluating the Specialist Palliative Care Clinical Nurse Specialist Role in an Acute Hospital Setting: A Mixed Methods Sequential Explanatory Study.

2021 ◽  
Author(s):  
Michael Connolly ◽  
Mary Ryder ◽  
Kate Frazer ◽  
Eileen Furlong ◽  
Teresa Plano Escribano ◽  
...  
Keyword(s):  
Palliative Care ◽  
Phase 1 ◽  
Hospital Setting ◽  
Acute Hospital ◽  
Nurse Specialist ◽  
Phase 2 ◽  
Specialist Palliative Care ◽  
Clinical Nurse ◽  
Acute Hospital Setting

Abstract Background Special palliative care is provided in a range of settings including a patient’s home (their primary place of dwelling), a hospice in-patient unit, or an acute hospital. The aim of the study was to evaluate the role of the specialist in palliative care clinical nurse specialist (SPC CNS) role in an acute hospital setting. Methods This study was conducted using a mixed methods sequential explanatory approach in two phases; phase 1 involved completion of a study questionnaire and phase 2 involved part-taking in a focus group interview. Results Phase 1 results indicated that respondents held positive attitudes towards the Specialist Palliative Care Clinical Nurses Specialist (SPC CNS) in relation to clinical care, education and patient advocacy. Phase 2 qualitative findings identified the importance of the role in terms of symptom management, education and support Conclusions This study provides an evaluation of a SPC CNS role since it was established in an acute hospital setting. The evidence indicates that there is a varied understanding of the role of the SPC CNS. The role was seen as an important one particularly in terms of referrals to and support provided by the SPC CNS, as well as recognition of the importance of the role is providing ongoing education to staff.

scholarly journals A Small Nudge can make a Difference: Impact of Passive Feedback on Prescription Behavior

2016 ◽  
Vol 4 (1) ◽  
pp. 31-34
Author(s):  
DK Sharma
Keyword(s):  
Error Rate ◽  
Phase 1 ◽  
Audit And Feedback ◽  
Phase 2 ◽  
Phase 3 ◽  
Prescription Errors ◽  
The Impact ◽  
Prescription Behavior

ABSTRACT It is generally believed that big changes can be brought about by big interventions. Sometimes, small interventions also can show spectacular results. This case describes the impact of simple intervention, audit and feedback on change in the behavior of clinicians. In this case, the impact of simple intervention in the form of passive feedback has been documented. All the prescriptions received in pharmacy during the period of study were scrutinized for specific prescription errors. An overall error rate of 0.12% was observed in phase 1 of the study, which was reduced to 0.04% during phase 2 of the study after implementation of the intervention, which further dropped to zero during phase 3. It was concluded that a simple audit and feedback nudged the recipients of the feedback to modify their behavior. How to cite this article Tadia VK, Ahlawat R, Arya SK, Sharma DK. A Small Nudge can make a Difference: Impact of Passive Feedback on Prescription Behavior. Int J Res Foundation Hosp Health Adm 2016;4(1):31-34.

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