scholarly journals Comparison of simulation debriefs with traditional needs assessment methods: a qualitative exploratory study in a critical care community setting

BMJ Open ◽  
2018 ◽  
Vol 8 (10) ◽  
pp. e020570
Author(s):  
Aimee J Sarti ◽  
Rola Ajjawi ◽  
Stephanie Sutherland ◽  
Angele Landriault ◽  
John Kim ◽  
...  

ObjectiveTo better understand the potential of a needs assessment approach using qualitative data from manikin-based and virtual patient simulation debriefing sessions compared with traditional data collection methods (ie, focus groups and interviews).DesignOriginal data from simulation debrief sessions was compared and contrasted with data from an earlier assessment of critical care needs in a community setting (using focus groups and interviews), thus undertaking secondary analysis of data. Time and cost data were also examined. Debrief sessions were coded using deductive and inductive techniques. Matrices were used to explore the commonalities, differences and emergent findings across the methods.SettingCritical care unit in a community hospital setting.ResultsInterviews and focus groups yielded 684 and 647 min of audio-recordings, respectively. The manikin-based debrief recordings averaged 22 min (total=130 min) and virtual patient debrief recordings averaged 31 min (total=186 min). The approximate cost for the interviews and focus groups was $13 560, for manikin-based simulation debriefs was $4030 and for the virtual patient debriefs was $3475. Fifteen of 20 total themes were common across the simulation debriefs and interview/focus group data. Simulation-specific themes were identified, including fidelity (environment, equipment and psychological) and the multiple roles of the simulation instructor (educative, promoting reflection and assessing needs).ConclusionsGiven current fiscal realities, the dual benefit of being educative and identifying needs is appealing. While simulation is an innovative method to conduct needs assessments, it is important to recognise that there are trade-offs with the selection of methods.

BMC Nursing ◽  
2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Alessandra Schirin Gessl ◽  
Angela Flörl ◽  
Eva Schulc

Abstract Background The number of people with complex nursing and care needs living in their own homes is increasing. The implementation of Case and Care Management has shown to have a positive effect on unmet care needs. Research on and implementation of Case and Care Management in the community setting in Austria is limited. This study aimed to understand the changes and challenges of changing care needs by mobile nurses and to evaluate the need for Case Management in mobile care organizations by investigating the evolution of mobile care nurses‘task profiles and the challenges in working in a dynamic field with changing target groups and complexifying care needs. Methods A qualitative study with reductive-interpretative data analysis consisting of semi-structured focus groups was conducted. Community care nurses, head nurses, and managers of community mobile care units as well as discharge managers of a community hospital (n = 24) participated in nine qualitative, semi-structured focus groups. The recorded focus groups were transcribed and analyzed using qualitative content analysis. Results The analysis revealed three main categories: the complexity of the case, innerinstitutional frameworks, and interinstitutional collaboration, which influence the perception of need for further development in the direction of Case and Care Management. Feelings of overwhelmedness among nurses were predominantly tied to cases that presented with issues beyond healthcare such as legal, financial, or social that necessitated communication and collaboration across multiple care providers. Conclusions Care institutions need to adapt to changing and increasingly complex care needs that necessitate cooperation between organizations within and across the health and social sectors. A key facilitator for care coordination and the adequate service provision for complex care needs are multidisciplinary institutional networks, which often remain informal, leaving nurses in the role of petitioner without equal footing. Embedding Case and Care Management in the community has the potential to fill this gap and facilitate flexible, timely, and coordinated care across multiple care providers.


2020 ◽  
Vol 79 (OCE2) ◽  
Author(s):  
Patricia Domínguez Castro ◽  
Sharon Kennelly ◽  
Celine Murrin ◽  
Catriona Bradley ◽  
Barbara Clyne ◽  
...  

AbstractProtein-energy malnutrition, or undernutrition, arising from a deficiency of energy and protein intake, can occur in developed countries both in hospitalised patients and in the primary care/community setting. Oral nutritional supplements (ONS) are an effective method of managing malnutrition if prescribed for patients who are malnourished or at risk of malnutrition. Pooled data of older adults at risk of malnutrition indicate that ONS combined with dietary counselling is the most effective intervention. Previous Irish research has demonstrated that management of patients ‘at risk’ of malnutrition in the primary care/community setting is sub-optimal, with low awareness of the condition and its management among non-dietetic health care professionals. Therefore, the aim of this qualitative study is to explore community nurses’ and dietitians’ experiences and opinions on the management of malnutrition and the prescription of ONS in the primary care/community setting in Ireland. Three focus groups were conducted with primary care dietitians (n = 17) and one focus group with community nurses (n = 5), one of the nurses had prescribing rights. The focus groups explored the following domains; the term malnutrition and patient population presenting as malnourished or at risk of malnutrition, barriers and facilitators in the management of malnutrition, ONS prescribing in the primary care/community setting, and future directions in the management of malnutrition and ONS prescribing. Recorded focus groups were transcribed and analysed using inductive thematic analysis. Both professional groups showed similar perspectives, and three preliminary main themes were identified; i) Malnutrition is a misunderstood term, ii) Delayed treatment of malnutrition, iii) Challenges with ONS prescription in the primary care/community setting. Both dietitians and community nurses agreed that the term malnutrition had negative connotations for patients and preferred not to use it with them. Dietitians identified the need for a multidisciplinary approach to manage patients at risk of malnutrition in the community, and community nurses agreed on their pivotal role identifying the risk of malnutrition and providing first line advice to clients. However, community nurses expressed the urgent need for training to provide first line advice to patients to improve their nutritional status to prevent malnutrition. Both groups also agreed on the need for access to more dietitians in the community, and suggested that giving dietitians prescribing rights would improve appropriate ONS prescribing. Community nurses identified a gap in their knowledge of the different ONS products, and the need to receive independent generic education on nutritional supplements.


BJGP Open ◽  
2018 ◽  
Vol 2 (4) ◽  
pp. bjgpopen18X101610 ◽  
Author(s):  
Rosa Vissenberg ◽  
Ozgul Uysal ◽  
Miriam Goudsmit ◽  
Jos van Campen ◽  
Bianca Buurman-van Es

BackgroundDementia rates are growing rapidly in all regions of the world. In the Netherlands, the incidence of dementia among older immigrants will increase twice as fast compared with the native older population. It, therefore, needs special attention.AimTo describe the barriers for providing primary care to immigrant patients (Turkish, Moroccan and Surinamese) with dementia from the perspectives of GPs.Design & settingA mixed-method study, consisting of an online survey and focus groups.MethodAn online survey was performed among 76 GPs working in the four biggest cities of the Netherlands. The barriers to providing primary care for immigrants with dementia were identified. Subsequently, three focus groups were carried out among 17 primary care physicians to discuss this topic further, and identify possible solutions and recommendations to improve dementia care.ResultsGPs experience many obstacles in the care for the immigrant patient with dementia, namely in the diagnostic process, early detection, and assessment of care needs. Strong collaboration between primary care, community care organisations, specialised memory clinics, and municipalities is needed to optimise healthcare information provision, the availability of culturally sensitive facilities, and the enhancement of healthcare professionals' training and education.ConclusionImportant barriers were identified and recommendations were formulated for future healthcare policy. To be prepared and guarantee optimal care for the rising number of immigrant patients with dementia, recommendations should be implemented and effectiveness should be evaluated as soon as possible.


Author(s):  
Jonathan Penm ◽  
Neil J MacKinnon ◽  
Derek Jorgenson ◽  
Jun Ying ◽  
Jennifer Smith

<p><strong>ABSTRACT</strong></p><p><strong>Background: </strong>The Blueprint for Pharmacy was a collaborative initiative involving all of the major pharmacy associations in Canada. It aimed to coordinate, facilitate, and be a catalyst for changes required to align pharmacy practice with the health care needs of Canadians. In partial fulfilment of this mandate, a needs assessment for specialist certification for pharmacists was conducted.</p><p><strong>Objective: </strong>To conduct a secondary analysis of data from the needs assessment to determine the perceptions of hospital pharmacists regarding a formal certification process for pharmacist specialties in Canada.</p><p><strong>Methods: </strong>A survey was developed in consultation with the Blueprint for Pharmacy Specialization Project Advisory Group and other key stakeholders. It was distributed electronically, in English and French, to Canadian pharmacists identified through national and provincial pharmacy organizations (survey period January 15 to February 12, 2015). Data for hospital pharmacists were extracted for this secondary analysis. Multivariable logistic regression analyses were conducted to characterize those respondents who supported the certification process and those intending to become certified if a Canadian process were introduced.</p><p><strong>Results: </strong>A total of 640 responses were received from hospital pharmacists. Nearly 85% of the respondents (543/640 [84.8%]) supported a formal certification process for pharmacist specialization, and more than 70% (249/349 [71.3%]) indicated their intention to obtain specialty certification if a Canadian process were introduced. Respondents believed that the main barriers to developing such a system were lack of reimbursement models, the time required, and lack of public awareness of pharmacist specialties. They felt that the most important factors for an optimal certification process were a consistent definition of pharmacist specialty practice and consistent recognition of pharmacist specialty practice across Canada. Multiple regression analysis showed that female respondents were more likely to support a formal certification process (odds ratio [OR] 2.6, 95% confidence interval [CI] 1.2–5.7). Also, those who already specialized in pharmacotherapy were more likely to support mandatory certification (OR 2.6, 95% CI 1.1–6.1).</p><p><strong>Conclusions: </strong>Hospital pharmacists who responded to this survey overwhelmingly supported certification for pharmacist specialization in Canada. Questions remain about the feasibility of establishing a pharmacist specialization system in Canada.</p><p><strong>RÉSUMÉ</strong></p><p><strong>Contexte : </strong>Le Plan directeur pour la pharmacie était un projet collaboratif auquel participaient les plus importantes associations canadiennes de pharmacie. Il cherchait à coordonner, faciliter et catalyser les changements nécessaires pour harmoniser la pratique de la profession avec les besoins en soins de santé des Canadiens. Une évaluation des besoins pour un système de certification des pharmaciens spécialistes a été menée dans le cadre de ce projet.</p><p><strong>Objectif : </strong>Réaliser une analyse secondaire des données recueillies lors de l’évaluation des besoins afin de cerner les opinions des pharmaciens d’hôpitaux en ce qui touche au mécanisme formel de certification pour les spécialités en pharmacie au Canada.</p><p><strong>Méthodes :</strong>Un sondage a été mis au point en consultation avec le Groupe consultatif sur le projet de spécialisation en pharmacie, sous l’égide du Plan directeur pour la pharmacie, et d’autres parties prenantes clés. Le sondage a été transmis par voie électronique, en anglais et en français, aux pharmaciens canadiens grâce aux organismes de pharmacie provinciaux et nationaux (l’enquête a eu lieu du 15 janvier au 12 février 2015). Cette analyse secondaire a porté sur le sous-ensemble des données relatives aux pharmaciens d’hôpitaux. Des analyses de régression logistique multivaria - ble ont été réalisées afin d’offrir un portrait des répondants qui sont partisans d’un mécanisme de certification et de ceux qui ont signalé leur intention d’obtenir la certification si un processus canadien était mis en place.</p><p><strong>Résultats : </strong>Au total, on a obtenu 640 réponses de pharmaciens d’hôpitaux. Près de 85 % des répondants (543/640 [84,8 %]) appuyaient un mécanisme formel de certification pour la spécialisation en pharmacie et plus de 70 % (249/349 [71,3 %]) ont indiqué leur intention d’obtenir une certification de spécialiste si un processus canadien était mis en place. Les répondants croyaient que les principaux obstacles au développement d’un tel système étaient l’absence de modèles de remboursement, le temps nécessaire et l’ignorance du public en matière de spécialités en pharmacie. Selon eux, un processus de certification optimal reposerait principalement sur une définition uniforme de la pratique spécialisée pour les pharmaciens et une reconnaissance systématique de la pratique spécialisée pour les pharmaciens partout au Canada. Une régression multiple a montré que les répondantes étaient plus enclines à appuyer un processus formel de certification (risque relatif approché [RRA] de 2,6, intervalle de confiance [IC] à 95 % de 1,2–5,7). De plus, les répondants déjà spécialisés en pharmacothérapie étaient plus susceptibles d’être partisans d’une certification obligatoire (RRA de 2,6, IC à 95 % de 1,1–6,1).</p><p><strong>Conclusions : </strong>Les pharmaciens d’hôpitaux ayant répondu à ce sondage appuyaient presque tous un mécanisme de certification pour la spécialisation en pharmacie au Canada. Par contre, certaines questions demeurent à propos de la viabilité d’un système de spécialisation en pharmacie au Canada.</p>


2020 ◽  
Author(s):  
Christina Cassady ◽  
William Ben Mortenson ◽  
Andrea F Townson ◽  
Shannon Sproule ◽  
Janice Jennifer Eng

BACKGROUND Access to quality health information is essential for self-management after serious injuries such as spinal cord injury (SCI). OBJECTIVE The goal of this study was to evaluate the role of a consumer website in addressing the information needs of persons and families with SCI, as well as its impact on their knowledge and behaviour. METHODS Persons with SCI and family members were recruited from 3 settings: an acute hospital, a rehabilitation hospital, and an SCI community organization to acquire perspectives from early after injury to the chronic stage. Participants were introduced to the Spinal Cord Injury Research Evidence (SCIRE) Community website, which was an internet site developed to provide evidence-informed health information about SCI in everyday language. After using the SCIRE Community website for 4 weeks, semi-structured individual interviews were conducted to explore purposes of use, user experience, and impact on knowledge and behaviour. Interview transcripts were analyzed using qualitative thematic analysis. RESULTS The participants were 24 individuals (18 persons with SCI and 6 family members). Thirteen participants completed the study in a hospital setting and 11 participants in a community setting. We identified 3 main themes in the data: (1) ‘An internet tool to support and empower persons and families’ described the empowering nature of access to an independent information source which enabled persons and families with SCI to take a more active role in their care; (2) ‘an accessible source of credible information’ described how users valued easy to access content with oversight by experts (i.e., perceived to be trustworthy); and (3) ‘Opportunities to increase impact’ outlined suggestions on creating opportunities to engage with content through active learning strategies and community connections. CONCLUSIONS Persons and families with SCI valued having access to an independent online health information website, especially early after injury, as it helped to empower autonomy and facilitated better communication between persons and families and healthcare providers. Our study provides support for the value of internet-based health information as a supplementary tool for therapeutic education for persons and families with serious health conditions such as SCI.


2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Anne M. Finucane ◽  
Connie Swenson ◽  
John I. MacArtney ◽  
Rachel Perry ◽  
Hazel Lamberton ◽  
...  

Abstract Background Specialist palliative care (SPC) providers tend to use the term ‘complex’ to refer to the needs of patients who require SPC. However, little is known about complex needs on first referral to a SPC service. We examined which needs are present and sought the perspectives of healthcare professionals on the complexity of need on referral to a hospice service. Methods Multi-site sequential explanatory mixed method study consisting of a case-note review and focus groups with healthcare professionals in four UK hospices. Results Documentation relating to 239 new patient referrals to hospice was reviewed; and focus groups involving 22 healthcare professionals conducted. Most patients had two or more needs documented on referral (96%); and needs were recorded across two or more domains for 62%. Physical needs were recorded for 91% of patients; psychological needs were recorded for 59%. Spiritual needs were rarely documented. Referral forms were considered limited for capturing complex needs. Referrals were perceived to be influenced by the experience and confidence of the referrer and the local resource available to meet palliative care needs directly. Conclusions Complexity was hard to detail or to objectively define on referral documentation alone. It appeared to be a term used to describe patients whom primary or secondary care providers felt needed SPC knowledge or support to meet their needs. Hospices need to provide greater clarity regarding who should be referred, when and for what purpose. Education and training in palliative care for primary care nurses and doctors and hospital clinicians could reduce the need for referral and help ensure that hospices are available to those most in need of SPC input.


2020 ◽  
Vol 41 (S1) ◽  
pp. s66-s67
Author(s):  
Gabrielle M. Gussin ◽  
Ken Kleinman ◽  
Raveena D. Singh ◽  
Raheeb Saavedra ◽  
Lauren Heim ◽  
...  

Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.Funding: NoneDisclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.


2016 ◽  
Vol 32 ◽  
pp. 3-8 ◽  
Author(s):  
Roland Faigle ◽  
Elisabeth B. Marsh ◽  
Rafael H. Llinas ◽  
Victor C. Urrutia ◽  
Rebecca F. Gottesman

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