scholarly journals Mutual trust is a prerequisite for nurses’ sense of safety and work satisfaction – Mobile Integrated Care Model: A qualitative interview study

2021 ◽  
pp. 205715852110621
Author(s):  
Lina Hovlin ◽  
Catharina Gillsjö ◽  
Anna K. Dahl Aslan ◽  
Jenny Hallgren
Keyword(s):  
Health Care ◽  
Integrated Care ◽  
Home Health Care ◽  
Older Persons ◽  
Qualitative Content Analysis ◽  
Work Satisfaction ◽  
Care Model ◽  
Structured Interviews ◽  
Care Needs ◽  
Qualitative Interview Study

An increasing number of older persons have complex health care needs. This, along with the organizational principle of remaining at home, emphasizes the need to develop collaborations among organizations caring for older persons. A health care model developed in Sweden, the Mobile Integrated Care Model aims to promote work in teams across organizations. The aim of the study was to describe nurses’ experiences in working and providing health care in the Mobile Integrated Care Model in the home with home health care physicians. Semi-structured interviews were conducted with 18 nurses and analyzed through qualitative content analysis. The method was compliant with the COREQ checklist. A mutually trusting collaboration with physicians, which formed person-centered care, created work satisfaction for the nurses. Working within the Mobile Integrated Care Model was negatively impacted by being employed by different organizations, lack of time to provide health care, and physicians’ person-centered work abilities.

scholarly journals Health care professionals’ experiences of how an eHealth application can function as a value-creating resource - a qualitative interview study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Catharina Carlqvist ◽  
Heidi Hagerman ◽  
Markus Fellesson ◽  
Mirjam Ekstedt ◽  
Amanda Hellström
Keyword(s):  
Health Care ◽  
Value Creation ◽  
Health Care Professionals ◽  
Qualitative Content Analysis ◽  
Active Role ◽  
Formation Processes ◽  
Structured Interviews ◽  
A Value ◽  
Number Of Patients ◽  
Qualitative Interview Study

Abstract Background The number of patients with one or more chronic conditions is increasing globally. One strategy to achieve more sustainable care for these patients is by implementing use of home-based eHealth applications. Such services support patients to take on a more active role as value-creating co-producers of their own care, in collaboration with health care professionals. Health care professionals have a key role in the value creation process, but little is known about value formation within eHealth interactions, especially from their perspective. Therefore, this study aimed to provide a deeper understanding of how an eHealth application can function as a value-creating resource from the perspective of health care professionals. Methods Semi-structured interviews were conducted with thirteen health care professionals (nurses, physicians and first-line managers). Qualitative content analysis was used to analyze the interviews. Results The findings indicate that value formation processes are strongly influenced by the organizational preconditions and by the usability and functionality of technology. The experiences of the health care professionals indicated that value was conceptualized in dimensions of meaningfulness, building of relationships, building safety and feelings of trust. Although these dimensions were mainly expressed in a positive way, such as perceived improvement of medical care, accessibility and continuity, they also had a negative side that caused value destruction. This was primarily due to patient difficulties in using the application or making measurements. Subsequent efforts at value recovery resulted in value creation, but were often time-consuming for the professionals. Conclusions This study contributes by extending conceptualizations of value to the role of health care professionals and by highlighting technology as sometimes facilitating and sometimes hampering value formation processes. The findings indicate that the eHealth application was a value-creating resource, facilitating proactive communication and supporting patients’ engagement and control over their self-care. However, for the application to become a more valuable resource in practice and counteract inequity in care, it needs to be further developed to be adapted to the needs and preconditions of patients.

Challenges faced by peer support workers during the integration into hospital-based mental health-care teams: Results from a qualitative interview study

2020 ◽  
Vol 66 (3) ◽  
pp. 263-269
Author(s):  
Ina Otte ◽  
Anna Werning ◽  
Alexa Nossek ◽  
Jochen Vollmann ◽  
Georg Juckel ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Care ◽  
Peer Support ◽  
Qualitative Content Analysis ◽  
Psychiatric Hospitals ◽  
Health Care Teams ◽  
Structured Interviews ◽  
Qualitative Interview Study ◽  
Specific Implementation

Background: Being aware of the challenges that may occur during the implementation of peer support work in psychiatry is important to facilitate the integration of peer support workers (PSWs) into multidisciplinary mental health-care teams. Aim: The purpose of this study is to explore the challenges faced by PSWs during their integration into hospital-based mental health-care teams. Methods: Qualitative content analysis of nine open-ended, semi-structured interviews with PSWs is undertaken in five adult psychiatric hospitals in North Rhine-Westphalia, Germany. Results: The analysis of the data revealed three themes: (1) ‘Pioneers and the pressure to succeed’; (2) ‘a colleague, a rival or yet another patient?’ and (3) ‘sharing of information, boundaries and professionalism’. All three themes relate to several concrete challenges on different systemic levels and have the potential to impede the PSWs’ integration process. Conclusion: Specific implementation strategies which address potential barriers on the different systemic levels should be developed and applied prior to the start of the integration of PSWs into multidisciplinary mental health-care teams.

scholarly journals Registered nurses’ experiences of information technology use in home health care - from a sustainable development perspective

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Vicki Koltsida ◽  
Lise-Lotte Jonasson
Keyword(s):  
Health Care ◽  
Information Technology ◽  
Sustainable Development ◽  
Registered Nurses ◽  
Home Health Care ◽  
Technology Use ◽  
Qualitative Content Analysis ◽  
Well Being ◽  
Home Health ◽  
It Use

Abstract Background The work of registered nurses in home health care is complicated and extensive, and information technology (IT) is used in everyday activities. Coordination between care and resource efficiency is important. There is a wealth of information that supports the notion of sustainable development, but what sustainable development means from the perspective of the registered nurse in home health care when using IT is limited. The term “sustainable development” is not clearly defined and is poorly researched in nursing. Sustainable development in this study includes the ecological, economic, social, technical and ethical dimensions. The aim of this study was to describe registered nurses’ experience of IT use in home health care through a sustainable development model. Methods This study was conducted using ten semi-structured lifeworld interviews with registered nurses. The method employed was a qualitative content analysis with a deductive approach. The deductive approach consisted of a model of sustainable development. Results Analysis of the interviews and the model of sustainable development provided categories: using IT from an ecological dimension, the registered nurses experienced reduced consumption and damage to the environment; using IT in the economical dimension, saving of time and resources was experienced; the use of IT affected social aspects such as the work environment and patient safety, and positive consequences, such as accessibility, were also mentioned; using IT from a technical dimension was characterized by the nurse’s attitude towards it – the registered nurses felt it improved the quality of care and gave users an overview of the organization; and from an ethical dimension, the registered nurses expressed the need for IT to be adaptable to the patient’s well-being and indicated that more awareness of risks in the care meeting may be needed. Conclusion The findings are discussed based on the synergies and conflicts that arise between the different dimensions of sustainable development. IT intertwines and overlaps with, and within, the environment, economy, society, technology and ethics. Registered nurses in home health care want to conduct good and safe care, while using IT could benefit patients.

A randomized clinical trial of home telemonitoring in patients with advanced heart and lung diseases.

2021 ◽  
pp. 1357633X2110597
Author(s):  
Carlos Hernandez-Quiles ◽  
Máximo Bernabeu-Wittel ◽  
Bosco Barón-Franco ◽  
Alfonso Aguirre Palacios ◽  
M Rocio Garcia-Serrano ◽  
...  
Keyword(s):  
Health Care ◽  
Clinical Trial ◽  
Functional Status ◽  
Integrated Care ◽  
Lung Diseases ◽  
Care Model ◽  
Emergency Admissions ◽  
Perceived Satisfaction ◽  
Lung Failure ◽  
Functional Features

Brief Summary The addition of home monitoring to an integrated care model in patients with advanced chronic heart/lung diseases decreases mortality, hospital and emergency admissions, improves functional status, HRQoL, and is cost-effective. Background Telemonitoring is a promising implement for medicine, but its efficacy is unknown in patients with advanced heart and lung failure (AHLF). Objective To determine the efficacy of a telemonitoring system added to coordinated clinical care in patients with AHLF. Design Randomized phase 3 multicenter clinical trial with parallel groups in adult patients. Participants Five spanish centers including patients with AHLF at discharge or in out-patient clinics. Intervention Patients were randomly assigned to receive a remote bio-parameters telemonitoring system (TELECARE) or best usual care (UCARE). TELECARE patients were provided with devices that collected symptoms and bio-parameters, and transferred them synchronously to a call-center, with a real-time health-care response. Main Measures Primary end point was the need of admissions/emergency room visits at 45, 90, 180 days. Secondary end points included health care requirements, mortality, functional assessment, health related quality of life (HRQoL), perceived satisfaction, and cost-efficacy. Results 510 patients were included (54.5% women, median age 76.5 years; 63.1% suffered heart failure, 13.9% lung failure, and 22.9% both conditions). Clinical and functional features were comparable in both arms. TELECARE globally needed less admissions with respect UCARE after 45 days of inclusion (35.4% vs. 46.9%, p < 0.05). This tendency was maintained in the subgroups of patients with multimorbidity (34.2% vs. 46.9%, p < 0.05), intermediate risk of mortality (36.5% vs. 51.1%, p < 0.05), and those included after hospital discharge (34.9% vs. 50.5%, p < 0.01). HRQoL significantly improved (TELECARE/UCARE EuroQol baseline of 56.2 ± 18.2/55.1 ± 19.7, p = 0.054, and 64 ± 19.9/56.3 ± 21.6; p < 0.01 at the end), and perceived satisfaction was also higher (6.77 ± 0.52 vs. 6.62 ± 0.81, p < 0.001; highest possible score = 7). A trend to mortality decrease was also observed (12.9% vs. 19.3%, p = 0.13). TELECARE was cost-efficacious (TELECARE/UCARE QALY 3.94 Euros/0.81Euros). Conclusions The addition of a telemonitoring system to an integrated care model in patients with AHLF decreases hospital and emergency admissions, improves functional status as well as HRQoL, and is cost-efficacious.

scholarly journals Patient factors driving overuse of cardiac catheterisation: a qualitative study with 25 participants from two German teaching practices

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e024600 ◽  
Author(s):  
Anna Herwig ◽  
Dorothea Dehnen ◽  
Birgitta Weltermann
Keyword(s):  
Teaching Practices ◽  
Qualitative Content Analysis ◽  
Stable Coronary Artery Disease ◽  
Cardiac Catheterisation ◽  
Structured Interviews ◽  
Patient Factors ◽  
Qualitative Interview Study ◽  
Patient’S Experience ◽  
Artery Disease ◽  
Physician Adherence

ObjectivesPercutaneous coronary interventions do not provide a benefit over medical therapy for stable patients. However, an overuse of cardiac catheterisation (CC) for stable coronary artery disease (CAD) is documented in Germany and other countries. In this study, we aim to understand patient factors that foster this overuse.DesignOur study is an exploratory qualitative interview study with narrative, structured interviews. The interviews were analysed using qualitative content analysis by Mayring.SettingThe interviews were conducted in two German teaching practices.Participants24 interviews with 25 patients were conducted; 17 (68%) patients were male, the average age was 73.9 years (range 53–88 years). All patients suffered from CAD and had undergone at least one CC. Patients with known anxiety disorders were excluded from the study.ResultsThe analysis identified six patient factors which contributed to or prevented the overuse of CC: (1) unquestioned acceptance of prescheduled appointments for procedures/convenience; (2) disinterest in and/or lack of disease-specific knowledge; (3) helplessness in situations with varying opinions on the required care; (4) fear of another cardiac event, (5) patient–physician relationship and (6) the patient’s experience that repeat interventions did not result in a change of health status or care.ConclusionsConducted in a country with documented overuse of CC, we showed that most patients trusted their physicians’ recommendations for repeat coronary angiographies even if they were asymptomatic. Strategies to align physician adherence with guidelines and corresponding patient information are needed to prevent overuse.

scholarly journals Towards enhanced emotional interactions with older persons. Findings from a nursing intervention in home health care.

2016 ◽  
Vol 6 (3) ◽  
pp. 191-199
Author(s):  
Charlotte Veenvliet ◽  
Hilde Eide ◽  
Martijn de Lange ◽  
Sandra van Dulmen
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Older Persons ◽  
Nursing Intervention ◽  
Home Health ◽  
Post Intervention ◽  
Audio Feedback ◽  
Feedback Intervention ◽  
Before And After ◽  
Post Test

Background. Living at home with a physical condition that requires assistance places high emotional burden on older persons that needs to be attended to by nurses. However, nurses in home health care have previously been found to communicate primarily in an instrumental way. This increases the risk that emotional concerns are being overlooked or not responded to in an appropriate way.Aims and Objectives. To enhance emotional interactions with older clients in home health care, an individual feedback intervention was developed for these nurses. The first experiences and results are presented in this paper.Design and Methods. Ten nurses/nurse assistants participated in this exploratory pre-post test study. They were asked to audiotape visits with older persons (65+) before and after an audio-feedback intervention. Older clients’ implicit and explicit expressions of emotional concerns as well as nurses’ responses to these expressions were rated with the Verona Coding Definition of Emotional Sequences (VR-CoDES). The nurses were given feedback based on the audio-recordings and the observations and were asked to reflect on the audio-feedback intervention.Results. The nurses valued the audio-feedback. Overall, 201 cues and 35 concerns were expressed during 58 recorded visits. At post-intervention, 29% of identified cues and concerns were nurse-initiated, at pre-intervention 18.8% (NS). Nurses provided space in 73.7% of their responses. During shorter visits nurses tended to provide less space (p=.06). After the intervention, 20.9% of the cues and concerns were ignored, before the intervention this was 25% (NS).Conclusions. Receiving feedback was taken in very well by the nurses working in home health care and the feedback intervention seems to enhance emotional interactions in home health care with older persons. Although, due to the low power of the study, the differences between pre-and post-intervention measurements were not significant. Studies with larger samples are needed to replicate these findings.

General Practitioners’ Roles in Disaster Health Management: Perspectives of Disaster Managers

2021 ◽  
pp. 1-8
Author(s):  
Penelope L. Burns ◽  
Gerard J. FitzGerald ◽  
Wendy C. Hu ◽  
Peter Aitken ◽  
Kirsty A. Douglas
Keyword(s):  
Health Care ◽  
New Zealand ◽  
General Practitioners ◽  
Health Management ◽  
Health Care Systems ◽  
Health Resources ◽  
Local Health ◽  
Structured Interviews ◽  
Care Needs ◽  
Study Objective

Abstract Introduction: General Practitioners (GPs) are inevitably involved when disaster strikes their communities. Evidence of health care needs in disasters increasingly suggests benefits from greater involvement of GPs, and recent research has clarified key roles. Despite this, GPs continue to be disconnected from disaster health management (DHM) in most countries. Study Objective: The aim of this study was to explore the perspectives of disaster management professionals in two countries, across a range of all-hazard disasters, regarding the roles and contributions of GPs to DHM, and to identify barriers to, and benefits of, more active engagement of GPs in disaster health care systems. Methods: A qualitative research methodology using semi-structured interviews was conducted with a purposive sample of Disaster Managers (DMs) to explore their perspectives arising from experiences and observations of GPs during disasters from 2009 through 2016 in Australia or New Zealand. These involved all-hazard disasters including natural, man-made, and pandemic disasters. Responses were analyzed using thematic analysis. Results: These findings document support from DM participants for greater integration of GPs into DHM with New Zealand DMs reporting GPs as already a valuable integrated contributor. In contrast, Australian DMs reported barriers to inclusion that needed to be addressed before sustained integration could occur. The two most strongly expressed barriers were universally expressed by Australian DMs: (1) limited understanding of the work GPs undertake, restricting DMs’ ability to facilitate GP integration; and (2) DMs’ difficulty engaging with GPs as a single group. Other considerations included GPs’ limited DHM knowledge, limited preparedness, and their heightened vulnerability. Strategies identified to facilitate greater integration of GPs into DHM where it is lacking, such as Australia, included enhanced communication, awareness, and understanding between GPs and DMs. Conclusion: Experience from New Zealand shows systematic, sustained integration of GPs into DHM systems is achievable and valuable. Findings suggest key factors are collaboration between DMs and GPs at local, state, and national levels of DHM in planning and preparedness for the next disaster. A resilient health care system that maximizes capacity of all available local health resources in disasters and sustains them into the recovery should include General Practice.

scholarly journals THE HEALTH-CARE NEEDS AMONG OLDER PERSONS IN AN INDONESIAN URBAN SETTING

2017 ◽  
Vol 10 (7) ◽  
pp. 233
Author(s):  
Setiawan E ◽  
Poedjibudojo J K ◽  
Tondok Ms
Keyword(s):  
Health Care ◽  
Older Persons ◽  
Health Care Services ◽  
Capital City ◽  
Urban Setting ◽  
Health Care Needs ◽  
Care Needs ◽  
Care Services ◽  
Unmet Health Care Needs ◽  
The Government

Objective: The unmet health-care needs among older persons population should be identified and anticipated due to hideous potential impacts. Ironically, no published study regarding this phenomenon was found in Indonesia. Derived from the Indonesian population and civil data, this study was conducted to identify the health-care needs of urban older people living on Java Island, the most populated island in Indonesia.Methods: A qualitative study was conducted in 3 subdistricts in Surabaya, the capital city of East Java, namely, Rungkut, Kenjeran, and Tenggilis. There were 9 focus group discussions (FGDs) conducted during March-August 2015. Participants in this study were recruited purposively, i.e., person in charge of “Karang Werda,” and the discussion explored thematically various topics in the area of unmet health needs phenomena related to: (1) Availability, (2) accessibility, and (3) acceptability. A FGD guide was developed to ensure in-depth discussion.Results: There were 90 older persons serving as volunteers who participated in this study. The unmet health-care needs addressed by participants in this study were (1) Integrated and specialized health-care services for older persons and (2) skillful yet age-friendly health-care personnel were needed by participants. Our findings pointed out that the unmet health-care needs in Indonesian urban settings were classified as primarily availability, accessibility, and acceptability issues.Conclusion: The government needs to take actions to solve the challenges related to the fulfillment of health-care needs among older persons in Indonesia. Further study of the health care personnel’s beliefs and attitudes in providing care among older persons needs to be conducted to provide a more holistic picture of the phenomena before making any strategy for the future Indonesia’s health-care system.

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