scholarly journals Perspectives of health professionals towards deprescribing practice in Asian nursing homes: a qualitative interview study

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e030106 ◽  
Author(s):  
Chong-Han Kua ◽  
Vivienne SL Mak ◽  
Shaun Wen Huey Lee

ObjectiveTo examine the determinants of deprescribing among health professionals in nursing homes, focusing on knowledge, practice and attitude.DesignThis was a qualitative study comprising semi-structured face-to-face interviews guided by 10 open-ended questions. Interviews were conducted until data saturation was achieved and no new ideas were formed. The interviews were audio-recorded, transcribed verbatim and analysed for themes. To derive themes, we employed directed content analysis of transcript data. Coding was completed using a combination of open, axial and selective coding.SettingFour nursing homes in Singapore.ParticipantsThe study involved 17 participants (comprising 4 doctors, 4 pharmacists and 9 nurses).ResultsTwo key themes were identified, enablers and challenges. These were enablers and challenges faced by doctors, pharmacists and nurses towards deprescribing. The identified subthemes for enablers of deprescribing were: (1) awareness of medications that are unnecessary or could be targeted for deprescribing; (2) improving quality of life for patients with limited life expectancy; (3) improving communication between doctors, pharmacists and nurses; (4) systematic deprescribing practice and educational tools and (5) acknowledgement of possible benefits of deprescribing. The identified subthemes for challenges of deprescribing were: (1) symptoms not acknowledged as possibly drug-related; (2) lack of knowledge in patient’s and family members’ preferences; (3) lack of coordination between health professionals in hospitals and nursing homes and (4) limited tools for deprescribing. The development of a local guideline, mentoring nurses, case discussions, better shared decision-making and improving multidisciplinary communication, may help to support the process of deprescribing.ConclusionIn conclusion, this study highlighted that deprescribing in the nursing homes is perceived by health professionals to be challenging and future research could assess how routine case studies, mentoring and better multidisciplinary communication could improve deprescribing knowledge and process in the nursing homes.

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Julian Hirt ◽  
Melanie Karrer ◽  
Laura Adlbrecht ◽  
Susi Saxer ◽  
Adelheid Zeller

Abstract Background To support the implementation of nurse-led interventions in long-term dementia care, in-depth knowledge of specific supporting factors and barriers is required. Conditions and structures of caring for people with dementia differ widely, depending on the country and the care context. Our study aimed to describe the experiences and opinions of nursing experts and managers with regard to facilitators and barriers to the implementation of nurse-led interventions in long-term dementia care. Methods We conducted a qualitative descriptive study using individual interviews based on qualitative vignettes as a useful stimulus to generate narrations allowing to study peoples’ perceptions and beliefs. The study took place in nursing homes in the German-speaking part of Switzerland and in the Principality of Liechtenstein using purposive sampling. We intended to conduct the interviews face-to-face in a quiet room according to the participant’s choice. However, due to the lockdown of nursing homes during the COVID-19 pandemic in spring 2020, we performed interviews face-to-face and by video. We analysed data thematically following Braun and Clarke to achieve a detailed, nuanced description. To verify our interpretation and to ensure congruence with participants’ perspectives, we conducted member checks. The Standards for Reporting Qualitative Research (SRQR) served to structure our manuscript. Results Six dyads of nursing home managers and nursing experts from six nursing homes took part in our study (n = 12). Our thematic analysis yielded seven themes reflecting facilitators and barriers to implementing nurse-led interventions in long-term dementia care: «A common attitude and cohesion within the organization», «Commitment on several levels», «A needs-oriented implementation», «The effect and the public perception of the intervention», «A structured and guided implementation process», «Supporting knowledge and competencies», as well as «Resources for implementing the intervention». Conclusions To support the implementation of nurse-led interventions in long-term dementia care, active commitment-building seems essential. It is necessary that the value of the intervention is perceptible.Commitment-building is the precondition to reach the persons involved, such as nursing home managers, nursing staff, residents and relatives. Furthermore, nurses should precisely inform about the intervention. It is necessary that the value of the intervention is perceptible. In addition, nurses should adjust the interventions to the situational needs of people with dementia, thus. Therefore, it is important to support dementia-specific competencies in long-term care. Findings indicate that the barrier is determined by the intervention and its implementation – and not by the behaviour of the person with dementia.


2019 ◽  
Vol 73 (1) ◽  
pp. 3-34 ◽  
Author(s):  
Christina Breuer ◽  
Joachim Hüffmeier ◽  
Frederike Hibben ◽  
Guido Hertel

Do we really need personal meetings to develop trust within teams? Which factors impact trust emergence within face-to-face and virtual teams? How do high-trust teams interact compared with teams with low team trust? Trust is seen as an important predictor of behavior in teams. However, the psychological mechanisms linking team trust to both its antecedents and its behavioral consequences are not well understood. The present study introduces a new taxonomy of team trust mechanisms by integrating results from a qualitative interview study with prior theoretical and empirical research on team trust. We conducted exploratory interviews based on the critical incident technique with 55 professionals who had substantial teamwork experience. Altogether, 776 behavioral items were collected stemming from 127 team events that were perceived as critical for the emergence of trust in teams. A content analysis revealed five main categories of perceived trustworthiness factors in teams as antecedents of team trust and three main categories of risk-taking behaviors as behavioral consequences in teams. The findings contribute to a better understanding of team trust emergence and related behaviors in teams. Future research should validate the derived taxonomy of team trust with quantitative data.


2019 ◽  
Vol 28 (11) ◽  
pp. 738-756
Author(s):  
Christine J. Moffatt ◽  
Susie Murray ◽  
Aimee Aubeeluck ◽  
Isabelle Quere

Objective: The purpose of this study was to explore the challenges of communication between patients and health professionals, and patient adherence to treatment for hard-to-heal wounds when using negative wound pressure therapy (NPWT). Methods: Face-to-face, semi-structured interviews were conducted with patients undergoing NPWT. Specific features of the NPWT device were the priority for discussion although other factors central to communication and adherence were also explored. Results: A total of 24 patients took part in the study. Data saturation was achieved during the analysis. Patients required ongoing support to understand complex and often protracted treatment and this was particularly important when specialist technology was used. A distinction was highlighted between those who decided not to adhere with therapy and those who did so unintentionally. Participants faced difficulties in their communications with health professionals and in ensuring their needs were listened to and addressed. Conclusion: Further research is needed to achieve a better understanding of this distinction and to evaluate interventions which can sustain adherence behaviours. Further exploration of how to establish concordant patient/health professional communications is warranted.


Author(s):  
Jonathan D’Angelo ◽  
Anne-Lise D'Angelo

This chapter reviews the research and theory related to advice in health contexts. The focus is on interpersonal advice offered face-to-face or by phone from health professionals to laypeople. The first part of the chapter discusses who gives advice to whom and who seeks advice. Next, three elements that impact advice efficacy and utilization are considered: source factors, message factors, and receiver factors. The chapter then discusses the development and application of theories of advice in health contexts and identifies areas for future research. Finally, the chapter offers guidelines for those professionals in a position to provide health advice.


Author(s):  
Marise Pinheiro ◽  
Katy Campbell ◽  
Sandra Hirst ◽  
Eugene Krupa

In this study, the experiences of seven female health professionals learning online are examined and, in this context, the implications for online course designs and future research are discussed. The instruments of data collection include individual telephone interviews, journals written by the participants during online courses, and e-mails exchanged by the participants and researcher. The principles of qualitative research are integrated into the process of collecting and analyzing the data. Participants identified lack of face-to-face interaction and overload of work as major challenges to learning online. Increase in confidence and the opportunity to belong to a community of learners were cited as rewards of learning online. In addition, the participants identified preferences for contextual and experiential learning, and for learning environments that foster collaboration. Participants agree that interacting with other classmates, building local support, and developing a mentoring relationship with instructors are key aspects of a successful learning experience.


2021 ◽  
Author(s):  
Julian Hirt ◽  
Melanie Karrer ◽  
Laura Adlbrecht ◽  
Susi Saxer ◽  
Adelheid Zeller

Abstract Background: To support the implementation of nurse-led interventions in long-term dementia care, in-depth knowledge of specific supporting factors and barriers is required. Conditions and structures of caring for people with dementia differ widely, depending on the country and the care context. Our study aimed to describe the experiences and opinions of nursing experts and managers with regard to facilitators and barriers to the implementation of nurse-led interventions in Swiss long-term dementia care.Methods: We conducted a qualitative descriptive study using individual interviews based on qualitative vignettes as a useful stimulus to generate narrations allowing to study peoples’ perceptions and beliefs. The study took place in nursing homes in the German-speaking part of Switzerland and in the Principality of Liechtenstein using purposive sampling. We intended to conduct the interviews face-to-face in a quiet room according to the participant’s choice. However, due to the lockdown of nursing homes during the COVID-19 pandemic in spring 2020, we performed interviews face-to-face and by video. We analysed data thematically following Braun and Clarke to achieve a detailed, nuanced description. To verify our interpretation and to ensure congruence with participants’ perspectives, we conducted member checks. The Standards for Reporting Qualitative Research (SRQR) served to structure our manuscript.Results: Six dyads of nursing home managers and nursing experts from six nursing homes took part in our study (n=12). Our thematic analysis yielded seven themes reflecting facilitators and barriers to implementing nurse-led interventions in Swiss long-term dementia care: «A common attitude and cohesion within the organization», «Commitment on several levels», «A needs-oriented implementation», «The effect and the public perception of the intervention», «A structured and guided implementation process», «Supporting knowledge and competencies», as well as «Resources for implementing the intervention».Conclusions: Successful implementation of nurse-led interventions in dementia care is highly challenging due to the complex nature of interventions. Therefore, it is important to know the facilitators and barriers to optimally design implementation strategies. Our results might support researchers and other key persons involved in implementing nurse-led interventions in Swiss long-term dementia care.


Author(s):  
Wei Chern Ang ◽  
Jurisma Che Lah ◽  
Nursyafiqah Zulkepli ◽  
Nursyamimi Sukri ◽  
Amalina Rosedi

Introduction: Home Medications Review (HMR) is a continuation of patient care from health facilities to their home to assess patients’ pharmacotherapy by a multidisciplinary team. Bedridden patients were the main group who received this service. To improve the provision of HMR, we need to understand carers’ viewpoints of the current service.Objectives: To explore the carers’ perspectives of HMR conducted by the medical outreach team (MOT) of Hospital Tuanku Fauziah. Methods: This is a qualitative study conducted among carers who were involved in the HMR programme for more than six months. Subjects were recruited by purposive sampling from August 2019 to December 2019. In-depth interviews were audio-recorded at patients’ homes until data saturation and transcribed verbatim. The transcripts then underwent thematic data analysis.Results: Nine carers were interviewed. All participants had a limited understanding of HMR since they were not properly counselled prior to admission to the programme. The convenience of not having to go to the hospital was perceived as the major benefit of the programme. Healthcare providers were welcomed during each visit. Recognising allied health professionals in the MOT possesses a problem for some carers. There was a concern about having to collect newly add-on medications from the hospital. Some participants suggested increasing the frequency of visits and hope for more financial aids.Conclusion: This study proved that carers’ understanding of HMR was generally poor. All carers were satisfied with the current HMR programme provided by the MOT. However, several aspects of our HMR need to be improved. Despite the COVID-19 situation that puts HMR onhold and telemedicine have been adapted, HMR is here to stay in the post-COVID-19 era. This is supported by studies conducted in the pre-COVID-19 era that HMR is more beneficial than telemedicine due to the personal touch of face-to-face encounters.International Journal of Human and Health Sciences Supplementary Issue: 2021 Page: S24


2018 ◽  
Vol 2 (1) ◽  
pp. 35
Author(s):  
Jacquie Kidd

These three poems re-present the findings from a research project that took place in 2013 (Kidd et al. 2018, Kidd et al. 2014). The research explored what health literacy meant for Māori patients and whānau when they accessed palliative care. Through face-to-face interviews and focus groups we engaged with 81 people including patients, whānau, bereaved loved ones, support workers and health professionals. The poems are composite, written to bring some of our themes to life. The first poem is titled Aue. This is a Māori lament that aligns to English words such as ‘oh no’, or ‘arrgh’, or ‘awww’. Each stanza of the poem re-presents some of the stories we heard throughout the research. The second poem is called Tikanga. This is a Māori concept that encompasses customs, traditions and protocols. There are tikanga rituals and processes that guide all aspects of life, death, and relationships. This poem was inspired by an elderly man who explained that he would avoid seeking help from a hospice because ‘they leave tikanga at the door at those places’. His choice was to bear his pain bravely, with pride, within his cultural identity. The third poem is called ‘People Like Me’. This is an autoethnographical reflection of what I experienced as a researcher which draws on the work of scholars such as bell hooks (1984), Laurel Richardson (1997) and Ruth Behar (1996). These and many other authors encourage researchers to use frustration and anger to inform our writing; to use our tears to fuel our need to publish our research.


Author(s):  
Mariek Vanden Abeele

Recent empirical work suggests that phubbing, a term used to describe the practice of snubbing someone with a phone during a face-to-face social interaction, harms the quality of social relationships. Based on a comprehensive literature review, this chapter presents a framework that integrates three concurrent mechanisms that explain the relational impact of phubbing: expectancy violations, ostracism, and attentional conflict. Based on this framework, theoretically grounded propositions are formulated that may serve as guidelines for future research on these mechanisms, the conditions under which they operate, and a number of potential issues that need to be considered to further validate and extend the framework.


2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Daisuke Uritani ◽  
Hitoshi Koda ◽  
Sho Sugita

Abstract Background Enhancing self-efficacy to manage symptoms and functions is an important aspect of self-management for patients with knee osteoarthritis (OA). Many reports have investigated the effects of self-management education programmes for arthritis patients. However, a study that exclusively focuses on patients with OA in the same joints is required to clarify the effects of self-management programmes because individuals with knee OA experience physical and psychological difficulties different from those experienced by individuals with other arthritis diseases. Furthermore, previous studies have reported a wide range of delivery styles of self-management education programmes. This systematic review aimed to evaluate the effects of group-based and face-to-face self-management education programmes conducted by health professionals targeting self-efficacy for knee OA exclusively. Methods The MEDLINE, CENTRAL, EMBASE, CINAHL, Web of Science, and PEDro databases were searched to identify quantitative measures used in randomised controlled trials (RCTs) to assess the effects of self-management education programmes targeting self-efficacy in patients with knee OA. We included studies in which medical professional-delivered self-management education programmes were conducted in a group-based and face-to-face manner in community or outpatient settings. Results Seven RCTs from five countries were included in this review. Our retrieved studies included various types of self-management education programmes such as cognitive behavioural counselling, pain management education, physical education, weight management education, and arthritis self-efficacy management education, and control arms. They assessed various aspects of self-efficacy, including pain, physical function, arthritis symptoms excluding pain, weight management, mobility, and self-regulation. The total score of the Arthritis Self-Efficacy Scale was also measured. Some studies have reported beneficial effects of group-based and face-to-face self-management education programmes on self-efficacy for management of pain and other symptoms and for self-regulatory, knee OA. However, the results of the included studies were varied and inconsistent. Conclusions The current review only included seven studies, and there was a wide range of clinical heterogeneity among these studies. Thus, the effects of group-based and face-to-face self-management education programmes conducted by health professionals on self-efficacy for knee OA exclusively are inconclusive to date. Therefore, high-quality studies are required to provide significant information on clinicians, patients, and healthcare professionals in the future.


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