The Effects of a Participatory Intervention in Mental Health Units on Nurses’ Perceptions of the Practice Environment: A Mixed Methods Study

2022 ◽  
pp. 107839032110661
Author(s):  
Antonio R. Moreno-Poyato ◽  
Khadija EL Abidi ◽  
Francesca González-Palau ◽  
Diana Tolosa-Merlos ◽  
Óscar Rodríguez-Nogueira ◽  
...  
Keyword(s):  
Mental Health ◽  
Quality Of Care ◽  
Clinical Practice ◽  
Mixed Methods ◽  
Action Research ◽  
Mixed Methods Study ◽  
Practice Environment ◽  
Patient Relationship ◽  
Nurses Perceptions

BACKGROUND: The practice environment influences the quality of care and the nursing outcomes achieved in their workplaces. OBJECTIVE: To examine the perception of the clinical practice environment among nurses working in mental health units in the context of their participation in an action research study aimed at improving the nurse–patient relationship. METHOD: An explanatory sequential mixed methods study was designed. The data were collected in three phases in 18 mental health units ( n = 95 nurses). Quantitative data were collected through the Practice Environment Scale of the Nursing Work Index, and qualitative data were collected through reflective diaries and focus groups in the context of participatory action research. RESULTS: The nurses’ assessment of their practice environment shifted from positive to negative. Nurse manager leadership was the aspect that worsened the most. In addition, the perception of their participation in the affairs of the center and nursing foundations for quality of care decreased. The nurses considered it essential to be able to influence decision-making bodies and that the institution should promote a model of care that upholds the therapeutic relationship in actual clinical practice. CONCLUSIONS: Nurses perceived that they should be involved in organizational decisions and required more presence and understanding from managers. Furthermore, nurses stated that institutions should promote nursing foundations for quality of care. This study contributes to understanding how nurses in mental health units perceive their work environment and how it affects the improvement of the nurse–patient relationship in clinical practice.

Nurses’ Perceptions of a Care Plan Information Technology Solution With Hundreds of Clinical Practice Guidelines in Adult Intensive Care Units: Survey Study (Preprint)

2018 ◽  
Author(s):  
Azizeh Khaled Sowan ◽  
Meghan Leibas ◽  
Albert Tarriela ◽  
Charles Reed
Keyword(s):  
Intensive Care ◽  
Quality Of Care ◽  
Clinical Practice ◽  
Nursing Care ◽  
Clinical Practice Guidelines ◽  
Practice Guidelines ◽  
Care Plan ◽  
System Use ◽  
Nurses Perceptions

BACKGROUND The integration of clinical practice guidelines (CPGs) into the nursing care plan and documentation systems aims to translate evidence into practice, improve safety and quality of care, and standardize care processes. OBJECTIVE This study aimed to evaluate nurses’ perceptions of the usability of a nursing care plan solution that includes 234 CPGs. METHODS A total of 100 nurses from 4 adult intensive care units (ICUs) responded to a survey measuring nurses’ perceptions of system usability. The survey included 37 rated items and 3 open-ended questions. RESULTS Nurses’ perceptions were favorable with more than 60.0% (60/100) in agreement on 12 features of the system and negative to moderate with 20.0% (20/100), to 59.0% (59/100) in agreement on 19 features. The majority of the nurses (80/100, 80.0% to 90/100, 90.0%) agreed on 4 missing safety features within the system. More than half of the nurses believed they would benefit from refresher classes on system use. Overall satisfaction with the system was just above average (54/100, 54.0%). Common positive themes from the narrative data were related to the system serving as a reminder for complete documentation and individualizing patient care. Common negative aspects were related to duplicate charting, difficulty locating CPGs, missing unit-specific CPGs, irrelevancy of information, and lack of perceived system value on patient outcomes. No relationship was found between years of system use or ICU experience and satisfaction with the system (P=.10 to P=.25). CONCLUSIONS Care plan systems in ICUs should be easy to navigate; support efficient documentation; present relevant, unit-specific, and easy-to-find information; endorse interdisciplinary communication; and improve safety and quality of care.

scholarly journals Integrated Management of Childhood Illnesses (IMCI): a mixed-methods study on implementation, knowledge and resource availability in Malawi

2021 ◽  
Vol 5 (1) ◽  
pp. e001044
Author(s):  
Kim Kilov ◽  
Helena Hildenwall ◽  
Albert Dube ◽  
Beatiwel Zadutsa ◽  
Lumbani Banda ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Mixed Methods ◽  
Resource Availability ◽  
Quantitative Data ◽  
Integrated Management ◽  
Knowledge Score ◽  
Holistic Approach ◽  
Mixed Methods Study ◽  
Childhood Illnesses

BackgroundThe introduction of the WHO’s Integrated Management of Childhood Illnesses (IMCI) guidelines in the mid-1990s contributed to global reductions in under-five mortality. However, issues in quality of care have been reported. We aimed to determine resource availability and healthcare worker knowledge of IMCI guidelines in two districts in Malawi.MethodsWe conducted a mixed-methods study, including health facility audits to record availability and functionality of essential IMCI equipment and availability of IMCI drugs, healthcare provider survey and focus group discussions (FGDs) with facility staff. The study was conducted between January and April 2019 in Mchinji (central region) and Zomba (southern region) districts. Quantitative data were described using proportions and χ2 tests; linear regression was conducted to explore factors associated with IMCI knowledge. Qualitative data were analysed using a pragmatic framework approach. Qualitative and quantitative data were analysed and presented separately.ResultsForty-seven health facilities and 531 healthcare workers were included. Lumefantrine-Artemether and cotrimoxazole were the most available drugs (98% and 96%); while amoxicillin tablets and salbutamol nebuliser solution were the least available (28% and 36%). Respiratory rate timers were the least available piece of equipment, with only 8 (17%) facilities having a functional device. The mean IMCI knowledge score was 3.96 out of 10, and there was a statistically significant association between knowledge and having received refresher training (coeff: 0.42; 95% CI 0.01 to 0.82). Four themes were identified in the FGDs: IMCI implementation and practice, barriers to IMCI, benefits of IMCI and sustainability.ConclusionWe found key gaps in IMCI implementation; however, these were not homogenous across facilities, suggesting opportunities to learn from locally adapted IMCI best practices. Improving on-going mentorship, training and supervision should be explored to improve quality of care, and programming which moves away from vertical financing with short-term support, to a more holistic approach with embedded sustainability may address the balance of resources for different conditions.

A Mixed-Methods Study of the Quality of Care Provided to Patients Boarding in the Emergency Department

2012 ◽  
Vol 69 (6) ◽  
pp. 679-698 ◽  
Author(s):  
Shan W. Liu ◽  
Yuchiao Chang ◽  
Carlos A. Camargo ◽  
Joel S. Weissman ◽  
Kathleen Walsh ◽  
...  
Keyword(s):  
Emergency Department ◽  
Quality Of Care ◽  
Mixed Methods ◽  
Mixed Methods Study

scholarly journals Clinical mentoring to improve quality of care provided at three NIM-ART facilities: A mixed methods study

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Chris A. Visser ◽  
Jacqueline E. Wolvaardt ◽  
David Cameron ◽  
Gert J.O. Marincowitz
Keyword(s):  
Quality Of Care ◽  
Mixed Methods ◽  
Health Workers ◽  
High Standard ◽  
Standard Of Care ◽  
Undetectable Viral Load ◽  
Mixed Methods Study ◽  
High Level ◽  
Clinical Records

Background: The South African Department of Health implemented the nurse-initiated management of antiretroviral treatment (NIM-ART) programme as a policy to decentralise services. Increasing access to ART through nurse initiation results in significant consequences.Aim: This study evaluated the quality of care provided, the barriers to the effective rollout of antiretroviral services and the role of a clinical mentor.Setting: The study was conducted at three NIM-ART facilities in South Africa. One clinic provided a high standard of care, one had a high defaulter rate, and at the third clinic, treatment failures were missed, and routine bloods were not collected.Methods: A mixed methods study design was used. Data were collected using patient satisfaction surveys, review of clinical records, facility audits, focus group interviews, field notes and a reflection diary.Results: NIM-ART nurses prescribed rationally and followed antiretroviral guidelines.Mortality rates and loss to follow-up rates were lower than those at the surrounding hospitals, and 91.1% of nurse-monitored patients had an undetectable viral load after a year. The quality of care provided was comparable to doctor-monitored care. The facility audits found recurrent shortages of essential drugs. Patients indicated a high level of satisfaction. Salary challenges,excessive workload, a lack of trained nurses and infrastructural barriers were identified as barriers. On-going mentoring and support by a clinical mentor strengthened each of the facilities, facilitated quality improvement and stimulated health workers to address constraints.Conclusion: Clinical mentors are the key to addressing institutional treatment barriers and ensuring quality of patient care.

scholarly journals Assessing the Quality of Care for Pneumonia in Integrated Community Case Management: A Cross-Sectional Mixed Methods Study

PLoS ONE ◽  
2016 ◽  
Vol 11 (3) ◽  
pp. e0152204 ◽  
Author(s):  
Chomba Sinyangwe ◽  
Kirstie Graham ◽  
Sarala Nicholas ◽  
Rebecca King ◽  
Samuel Mukupa ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Mixed Methods ◽  
Case Management ◽  
Mixed Methods Study ◽  
Community Case Management ◽  
Integrated Community Case Management ◽  
Cross Sectional

scholarly journals Ultrasound at labour triage in eastern Uganda: A mixed methods study of patient perceptions of care and providers’ implementation experience

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259770
Author(s):  
Nathan Isabirye ◽  
Rose Kisa ◽  
Nicole Santos ◽  
Sachita Shah ◽  
Jude Mulowooza ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Mixed Methods ◽  
Mixed Methods Study ◽  
System Level ◽  
Multiple Gestation ◽  
Implementation Barriers ◽  
Chi Square ◽  
Eastern Uganda ◽  
Perceptions Of Care

In settings where antenatal ultrasound is not offered routinely, ultrasound use when a woman first presents to the maternity ward for labour (i.e., triage) may be beneficial. This study investigated patients’ perceptions of care and providers’ experience with ultrasound implementation during labour triage at a district referral hospital (DH) and three primary health centers (HC) in eastern Uganda. This was a mixed methods study comprising questionnaires administered to women and key informant interviews among midwives pre- and post-ultrasound introduction. Bivariate analyses were conducted using chi-square tests. Qualitative themes were categorized as (1) workflow integration; (2) impact on clinical processes; (3) patient response to ultrasound; and (4) implementation barriers. A total of 731 and 815 women completed questionnaires from the HCs and DH, respectively. At the HC-level, triage quality of care, satisfaction and recommendation ratings increased with implementation of ultrasound. In contrast, satisfaction and recommendation ratings did not differ upon ultrasound introduction at the DH, whereas perceived triage quality of care increased. Most participants noted a perceived improvement in midwives’ experience and knowledge upon introduction of ultrasound. Women who underwent a scan also reported diverse feelings, such as fear or worry about their delivery, fear of harm due to the ultrasound, or relief after knowing the baby’s condition. For the midwives’ perspective (n = 14), respondents noted that ultrasound led to more accurate diagnoses (e.g., fetal position, heart rate, multiple gestation) and improved decision-making. However, they noted health system barriers to ultrasound implementation, such as increased workload, not enough ultrasound-trained providers, and irregular electricity. While triage ultrasound in this context was seen as beneficial to mothers and useful in providers’ clinical assessments, further investigation around provider-patient communication, system-level challenges, and fears or misconceptions among women are needed.

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