Barriers and enablers that influence guideline-based care of geriatric fall patients presenting to the emergency department

2019 ◽  
pp. emermed-2018-208260
Author(s):  
Adam Parks ◽  
Debra Eagles ◽  
Yipeng Ge ◽  
Ian G Stiell ◽  
Warren J Cheung
Keyword(s):  
Positive Reinforcement ◽  
Allied Health ◽  
Health Workers ◽  
Guideline Implementation ◽  
Theoretical Domains Framework ◽  
Barriers And Enablers ◽  
Clinical Encounters ◽  
Semistructured Interviews ◽  
Interview Guide ◽  
Health Support

BackgroundGeriatric patients commonly present to the ED after a fall. Recent evidence suggests that ED physicians are poorly adherent to published ED-specific geriatric fall guidelines. This study applied a theoretical domains framework (TDF) approach to systematically investigate barriers and enablers in the provision of guideline-based care to ED geriatric fall patients.MethodsFrom June to September 2017, semistructured interviews of staff ED physicians practising in Ontario, Canada, were conducted and analysed. An interview guide based on the TDF was used to capture 14 domains influencing provision of guideline-based care. Relevant domains were identified based on frequencies of beliefs, existence of conflicting beliefs and evidence of strong beliefs that would influence provision of guideline-based care.ResultsEleven interviews were conducted with practising ED physicians. Thirty belief statements were identified across 13 relevant TDF domains (all except Optimism). Prominent themes included lack of knowledge, paucity of evidence, heterogeneous self-perceived skills, perceived increased time and workload, importance of allied health support, inconsistently available allied health workers, lack of positive reinforcement, emotions negatively impacting these clinical encounters and support for memory aids. Overall, ED physicians were supportive of guideline implementation, and believe it will lead to better outcomes for geriatric fall patients.ConclusionThis study identified important barriers and enablers to provision of guideline-based care in geriatric ED fall patients. Based on these findings, future implementation of guidelines nationally and internationally should focus on improving knowledge and training on guidelines, improving positive reinforcement for guideline-appropriate management, greater allied health support and further research to support guidelines.

scholarly journals LO17: Barriers and enablers that influence guideline-based care of geriatric falls patients presenting to the emergency department

CJEM ◽  
2019 ◽  
Vol 21 (S1) ◽  
pp. S13
Author(s):  
A. Parks ◽  
D. Eagles ◽  
W. Cheung ◽  
Y. Ge ◽  
I. Stiell
Keyword(s):  
Emergency Department ◽  
Allied Health ◽  
Theoretical Domains Framework ◽  
Health Coverage ◽  
Structured Interviews ◽  
Training Interventions ◽  
Barriers And Enablers ◽  
Interview Guide ◽  
Health Support ◽  
Belief Statements

Introduction: Geriatric patients commonly present to the emergency department (ED) after a fall. Unfortunately, recent evidence suggests that ED physicians are poorly adherent to published ED-specific geriatric falls guidelines. This study applied a theoretical domains framework (TDF)-driven approach to systematically investigate barriers and enablers in the provision of guideline-based care to older patients presenting to the ED with a fall. Methods: From June to September 2017, semi-structured interviews of staff ED physicians practicing in Ontario, Canada were conducted and analyzed. An interview guide based on the TDF was used to capture 14 domains that may influence provision of guideline-based care. Interview transcripts were analyzed, and specific beliefs were generated by grouping similar responses. Relevant domains were identified based on frequencies of beliefs, existence of conflicting beliefs, and evidence of strong beliefs that would influence provision of guideline-based care. Results: Eleven interviews were conducted with practicing ED physicians. Thirty specific belief statements across 13 different TDF domains (all except Optimism) were identified as relevant. Overall, Ontario ED physicians are supportive of providing guideline-based care and believe it would lead to better outcomes for geriatric falls patients. Important barriers include knowledge, skills, time and workload constraints, and inconsistent allied health support. Conclusion: This study identified important barriers and enablers to provision of guideline-based care in geriatric ED falls patients. These results will help guide implementation of guidelines nationally and internationally, with a focus on improved knowledge dissemination, implementation of training interventions, and improvements in allied health coverage and supports.

Letter to the Editor

PEDIATRICS ◽  
1972 ◽  
Vol 49 (6) ◽  
pp. 926-927
Author(s):  
Ralph I. Fried
Keyword(s):  
Quality Of Care ◽  
Child Behavior ◽  
Private Practice ◽  
Allied Health ◽  
Health Workers ◽  
Emotional Problems ◽  
Routine Care ◽  
Parental Concerns ◽  
Life Saving

I gratefully accept your invitation to comment on the letter by Dr. Pick on allied health workers in the private practice of pediatrics. I support Dr. Pick in his statement that this would constitute a regression in the quality of care offered to our children. Dr. Charles A. Janeway remarked in 1957 that during his career the practice of pediatrics had reversed itself from 80% life-saving and 20% routine care, to the opposite figures, so that pediatricians have had to deal increasingly with parental concerns about child behavior and emotional problems.

scholarly journals Barriers and enablers to monitoring and deprescribing opioid analgesics for chronic non-cancer pain: protocol for a qualitative evidence synthesis using the Theoretical Domains Framework

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e034039
Author(s):  
Amanda J Cross ◽  
Rachelle Buchbinder ◽  
Allison Bourne ◽  
Christopher Maher ◽  
Stephanie Mathieson ◽  
...  
Keyword(s):  
Qualitative Research ◽  
Cancer Pain ◽  
Assessment Tool ◽  
Data Extraction ◽  
Evidence Synthesis ◽  
Theoretical Domains Framework ◽  
Opioid Analgesics ◽  
Qualitative Evidence Synthesis ◽  
Barriers And Enablers ◽  
Qualitative Evidence

IntroductionThe over-prescription and overuse of opioid analgesics for chronic non-cancer pain (CNCP) is a growing issue. Synthesis of evidence about the barriers and enablers to reducing long-term opioid prescribing and use will enable the development of tailored interventions to address both problems.ObjectiveTo synthesise the barriers and enablers to monitoring the ongoing appropriateness of opioid treatment and deprescribing opioids for CNCP from the clinician, patient and general public point of view, and to map the findings to the Theoretical Domains Framework (TDF).Methods and analysisWe will perform a qualitative evidence synthesis using the TDF. We will include qualitative research that has explored clinician, patient and the general public’s perceptions regarding barriers and enablers to monitoring and deprescribing opioids for CNCP. Studies will be identified via searches in MEDLINE, EMBASE, CINAHL, AMED and PsycINFO. Databases will be searched from inception to July 2019, and the studies must be published in English. Article selection and data extraction will be completed independently by two review authors. Methodological quality of included studies will be independently assessed by two review authors using the Critical Appraisal Skills Programme quality assessment tool. We will conduct thematic synthesis and then map identified themes and sub-themes to TDF domains. Confidence in synthesis findings will be evaluated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in the Evidence from Reviews of Qualitative Research tool.Ethics and disseminationEthical approval is not required to conduct this review. We will publish the results in a peer-reviewed journal.PROSPERO registration numberCRD42019140784

scholarly journals PERSIAPAN ASI EKSKLUSIF IBU HAMIL DI RB EVA CANDI SIDOARJO

2016 ◽  
Vol 1 (2) ◽  
pp. 125
Author(s):  
Evi Rinata ◽  
Hafmi Putri Syahilda Hamdi
Keyword(s):  
Exclusive Breastfeeding ◽  
Information Search ◽  
Health Workers ◽  
Data Retrieval ◽  
Structured Interview ◽  
Maternity Hospital ◽  
Pregnant Mother ◽  
Interview Guide ◽  
Breast Care ◽  
Survey Approach

Preparation of exclusive breastfeeding for pregnant mother is an effort made by pregnant mother to facilitate breastfeeding exclusively, includes information search, breast care, nutritional preparation for breastfeeding, and psychological preparation for breastfeeding. Based on introduction study for pregnant in 3rd trimester, there were 62,5% haven’t prepared exclusive breastfeeding who could impact to the success of exclusive breastfeeding program. The purpose of this research was to know the description the preparation of exclusive breastfeeding at Eva’s Maternity Hospital, Candi, Sidoarjo. The type of research was used descriptive study with survey approach. The data retrieval was conducted in July to August 2015 primarily using a structured interview guide to thirty pregnant mothers in 3rd trimester. The collected data were presented in distribution table and analyzed descriptively without statistical test. The result showed almost a half, there were 46,7% of less prepare exclusive breastfeeding during pregnancy respondents, 36,7% had done enough preparation, and only 16,7% had been prepared well. This was because 30 of respondents had not tried to find information about exclusive breastfeeding, 20% had not done breast-care yet during pregnancy, 50% had not prepared the nutritions for breastfeeding, and 50% had not prepared psychologically for breastfeeding. The research was concluded there were still less preparation of exclusive breastfeeding to pregnant mother. The suggestion for health workers that they have to improve the preparation of exclusive breastfeeding to pregnant mother so that mothers can prepare for feeding and increase the success of exclusive breasfeeding program.

scholarly journals Pelayanan Kesehatan Ibu, Anak, dan Keluarga Berencana di Puskesmas Cirimekar, Bogor

2020 ◽  
Vol 11 (2) ◽  
pp. 31-36
Author(s):  
Winnie Tunggal Mutika ◽  
Magda Doria ◽  
Mita Meliani Putri ◽  
Ninda Sari ◽  
Yohana Anggriani ◽  
...  
Keyword(s):  
Family Planning ◽  
Health Services ◽  
Functional Organization ◽  
Health Workers ◽  
Descriptive Analysis ◽  
Active Role ◽  
Service Evaluation ◽  
Narrative Form ◽  
Interview Guide ◽  
The Government

Pusat Kesehatan Masyarakat (Puskesmas) adalah organisasi fungsional yang menyelenggarakan upaya kesehatan yang bersifat menyeluruh, terpadu, merata, dapat diterima, terjangkau oleh masyarakat, dengan peran serta aktif masyarakat dan menggunakan hasil pengembangan ilmu pengetahuan dan teknologi tepat guna, dengan biaya yang dapat dipikul oleh pemerintah dan masyarakat. Salah satu tugas dan fungsi puskesmas adalah melaksanakan enam upaya kesehatan wajib diantaranya adalah upaya pelayanan kesehatan ibu, anak, dan keluarga berencana. Penelitian dengan menggunakan pendekatan deskriptif (explanatory research). Pengumpulan data dilakukan melalui observasi serta wawancara kepada tenaga kesehatan dan pasien khususnya yang menerima pelayanan kesehatan ibu, anak, dan keluarga berencana di Puskesmas Cirimekar. Instrumen yang digunakan adalah panduan wawancara evaluasi pelayanan dari tim praktik klinik Program Studi Kebidanan Universitas Gunadarma. Hasil wawancara dan observasi dibuat dalam bentuk narasi sehingga dapat diberikan ke lahan praktik untuk meningkatkan pelayanan Puskesmas Cirimekar. Hasil pelayanan kesehatan ibu, anak, dan keluarga berencana menunjukkan prosedur pelayanan, waktu pelayanan, sarana dan prasarana yang terdapat di puskesmas sudah cukup baik.Keterbatasan sumber daya manusia yaitu petugas kesehatan yang ada di Puskesmas Cirimekar menyebabkan waktu tunggu lebih lama yang ditunjukkan adanya antrian pasien KIA dan KB sehingga pelayanan yang diberikan dirasa kurang optimal.    Public health center (Puskesmas) is a functional organization who held comprehensive, integrated, and acceptable health efforts to society with active role from society and using  science and technology, with cost comes from the government and society. Puskesmas duty is doing six health efforts obligatory in society, one of the obligatory is mother, child, and family planning health services. This research is using explanatory research. Data was collected through observation and interviews with health workers and patients, especially those who received maternal, child and family planning health services in Puskesmas Cirimekar. The instrument used was service evaluation interview guide from the clinical practice team of the Program Study of Universitas Gunadarma. The results of interviews and observations were made in narrative form so that they could be given to practice fields to improve Puskesmas Cirimekar services.Result from interview and observation processed using descriptive analysis. The result shows that health service for mother, child and family planning health services in Puskesmas Cirimekar is pretty good based on procedure, time and facilities. But, the limited of human resources (health workers) in Puskesmas Cirimekar sometimes make a long queue for services at mother health, child health and also family planning, and it makes the services not optimal.

For the Love of the Game: An Exploration of the Experiences and Psychosocial Development of Women 70 Years of Age and Older Who Play Volleyball

2021 ◽  
pp. 1-10
Author(s):  
Jessica Brooke Kirby ◽  
Mary Ann Kluge
Keyword(s):  
Lived Experience ◽  
Psychosocial Development ◽  
Positive Reinforcement ◽  
Sport Participation ◽  
Later Life ◽  
Physical Competence ◽  
Semistructured Interviews ◽  
Skill Mastery ◽  
Personal Assets ◽  
Inductive Analysis

There is much to learn about the lived experience of sport participation in later life for older women. This qualitative study explored the experiences of 18 women volleyball players, ages 70 years and older. Four themes emerged from an inductive analysis of in-depth, semistructured interviews: (a) seeking and enjoying optimal challenge, (b) demonstrating physical competence through skill mastery, (c) commitment to continue playing while navigating declining competence, and (d) connection with teammates and positive reinforcement. Following the inductive analysis, the themes were analyzed using personal assets frameworks as lenses through which to further understand how these women’s psychosocial development through sport compared with youth and Masters sport. Challenge, competence, connection, and commitment to continue were salient personal assets identified for these women. Researchers should continue to explore how positive sport development across the lifespan can be both universal and nuanced for diverse cohorts of athletes.

REPORT OF THE A.A.P.-A.N.A. CONFERENCE ON UTILIZATION OF ALLIED HEALTH WORKERS IN MEETING THE MANPOWER CRISIS

PEDIATRICS ◽  
1971 ◽  
Vol 47 (6) ◽  
pp. 1080-1084
Author(s):  
Abraham B. Bergman ◽  
La Verne Fakkema ◽  
John P. Connelly
Keyword(s):  
American Academy ◽  
San Francisco ◽  
Nurse Practitioners ◽  
Allied Health ◽  
Health Workers ◽  
Pediatric Nurse ◽  
American Academy Of Pediatrics ◽  
Nursing Organizations ◽  
The University ◽  
Pediatric Nurse Practitioner

On October 22, 1970 a portion of the annual meeting of the American Academy of Pediatrics in San Francisco was devoted to a conference on the utilization of allied health workers in meeting the manpower crisis. It was jointly sponsored by the American Academy of Pediatrics and the American Nurses' Association and was the third and most successful of similar meetings. The first one, held at the Academy's Chicago meeting in October, 1969, provided an introduction to the concept of pediatric nurse practitioners. The second, held at the Washington meeting of the Academy in April, 1970, resulted in a frank exchange of views of the official nursing organizations and academy representatives and pointed to the need for open discussion and collaboration on the subject. The San Francisco meeting got down to the business of a more objective analysis of issues, and though there was much heated discussion most of it was constructive. An attempt was made by the planning committee to include on the program different models of allied health workers in pediatrics. The program highlighted discussion about discharged medical corpsmen, laboratory technologists, pediatric assistants, as well as the more familiar pediatric nurse practitioner. Of the 418 persons in attendance, 294 were nurses, 43 physicians, and 81 were other interested persons. When one of the nurses criticized the fact that there were so few physicians in attendance, Donald Frank of Cincinnati, a member of the Academy's Manpower Committee, pointed out that there was a fivefold improvement in physician attendance since the first conference. The opening keynote address was given by Philip R. Lee, M.D., former HEW official, now Chancellor of the University of California at San Francisco, who refreshingly offered no simple solutions.

The interface of health support workers with the allied health professions

2020 ◽  
pp. 101-124
Author(s):  
Susan Nancarrow
Keyword(s):  
United Kingdom ◽  
Health Workforce ◽  
Allied Health ◽  
Health Professions ◽  
Allied Health Professions ◽  
The United Kingdom ◽  
Different Types ◽  
Challenges And Opportunities ◽  
Health Support ◽  
Professional Project

The chapter begins by describing the allied health workforce, before exploring from a neo-Weberian perspective the development of the support workforce associated with the allied health professions with a focus on the United Kingdom and Australia – not least by considering the reasons for introducing a support workforce, the contexts in which it is used, the negotiation of its boundaries, and the challenges and opportunities for allied health professions and its support workforce. In particular, this chapter claims that the heterogeneous allied health support workforce has evolved through two models, with different types of workers. The first is the profession-led model, which supports the neo-Weberian idea of the professional project, in which allied health professions developed support roles to expand and maintain their market monopoly and autonomy in niche areas. The second is the managerial model, which instead privileges the ‘patient-centred’ goals of increasing role flexibility by recognising and rewarding individuals’ skills and competencies and working across traditional professional and organisational boundaries. The chapter finally outlines some of the key challenges to allied health support workforce going forward.

Sign in / Sign up

Export Citation Format

Share Document