scholarly journals Implementation of evidence-based guidance for dementia palliative care using participatory action research: examining implementation through the Consolidated Framework for Implementation Research (CFIR)

2021 ◽  
Vol 2 (1) ◽  
Author(s):  
Alice Coffey ◽  
Irene Hartigan ◽  
Suzanne Timmons ◽  
Catherine Buckley ◽  
Elaine Lehane ◽  
...  
Keyword(s):  
Palliative Care ◽  
Action Research ◽  
Participatory Action Research ◽  
Situational Analysis ◽  
Evidence Based ◽  
Guidance Document ◽  
Participatory Action ◽  
Term Care ◽  
Learning Groups ◽  
Inner Setting

Abstract Background The importance of providing evidence-based palliative care for people with dementia is increasingly acknowledged as important for patient outcomes. In Ireland, evidence-based guidance has been developed in order to address key features of dementia palliative care, including the management of pain, medications and hydration and nutrition. The aim of this study was to identify and explore the factors affecting the implementation of evidence-based guidance on dementia palliative care. Methods The Consolidated Framework for Implementation (CFIR) guided a mixed-method pre-post study. One guidance document pertaining to the management of pain, medication or hydration and nutrition was implemented in three long-term care facilities. Participatory action research in the form of work-based learning groups was used to implement the guidance, drawing on a situational analysis (pre-implementation). Staff questionnaires and audits were conducted pre- and post-implementation while champion interviews were also conducted post-implementation. Results Features of the guidance, the inner setting components such as readiness to change, and the process of implementation were most frequently identified as impacting implementation. Components of the outer setting, such as external policy incentives and individual characteristics, featured less commonly. Data from qualitative interviews revealed that the guidance was perceived as advantageous or complimentary to previous care provided. Within the inner setting, leadership and support from other colleagues facilitated implementation. However, limited availability of other healthcare professionals to assist with carrying out guidance actions presented a barrier in some facilities. The external facilitators of the work-based learning groups (WBLGs) were perceived as experienced and encouraged active participation and reflection on practices. Despite the challenge of releasing staff to attend the WBLGs, quantitative data demonstrated reduced staff de-motivation amongst those who did attend was noted post-implementation (pre-Mdn = 19.50 versus post-Mdn = 22.00, U = 497.00, p = 0.07). Conclusions A situational analysis informed by the CFIR framework in conjunction with a participatory action research approach helped to advance the implementation of the guidance. The progress of implementation depended on the extent to which evidence-based care was previously being implemented at each site. Post-implementation analysis using CFIR identified challenges to address in future projects such as staff cover and timing of training to facilitate attendance for staff with different working hours. Facilitators included multidisciplinary engagement with the intervention and champions at each site to support the implementation process.

scholarly journals Implementation of Evidence-based Guidance for Dementia Palliative Care using Participatory Action Research: Examining Implementation through the Consolidated Framework for Implementation Research (CFIR)

2021 ◽  
Author(s):  
Alice Coffey ◽  
Irene Hartigan ◽  
Suzanne Timmons ◽  
Catherine Buckley ◽  
Elaine Lehane ◽  
...  
Keyword(s):  
Palliative Care ◽  
Action Research ◽  
Participatory Action Research ◽  
Situational Analysis ◽  
Evidence Based ◽  
Guidance Document ◽  
Participatory Action ◽  
Term Care ◽  
Learning Groups ◽  
Inner Setting

Abstract Background The importance of providing evidence-based palliative care for people with dementia is increasingly acknowledged. In Ireland, evidence-based guidance has been developed in order to address key features of dementia palliative care, including the management of pain, medications and hydration and nutrition. The aim of this study was to identify and explore the factors affecting the implementation of evidence-based guidance on dementia palliative care. Methods The Consolidated Framework for Implementation (CFIR) guided a mixed-method pre-post study. One guidance document pertaining to the management of pain, medication or hydration and nutrition was implemented in three long-term care facilities. Participatory Action Research in the form of work-based learning groups was used to implement the guidance, drawing on a situational analysis (pre-implementation). Staff questionnaires and audits were conducted pre and post-implementation while champion interviews were also conducted post-implementation. Results Features of the guidance (innovation), the inner setting, and the process of implementation were most frequently identified as impacting implementation. Components of the outer setting and individual characteristics featured less commonly. The guidance was perceived as advantageous or complimentary to previous care provided. Within the inner setting, leadership and support from other colleagues facilitated implementation. However, limited availability of other healthcare professionals to assist with carrying out guidance actions presented a barrier in some facilities. The external facilitators of the work-based learning groups (WBLGs) were perceived as experienced and encouraged active participation and reflection on practices. Despite the challenge of releasing staff to attend the WBLGs, a trend toward reduced staff de-motivation among those who did attend was noted post-implementation. Conclusions A situational analysis informed by the CFIR framework in conjunction with a participatory action research approach helped to advance implementation of the guidance. The progress of implementation depended on the extent to which evidence-based care was previously being implemented at each site. Post-implementation analysis using CFIR, identified challenges to address in future projects such as staff cover on the ward and timing of training to facilitate attendance for staff with different working hours. Facilitators included multidisciplinary engagement with the intervention and champions at each site to support the implementation process.

scholarly journals Implementation of Evidence-based Guidance for Dementia Palliative Care using Participatory Action Research: Examining Implementation Through the Consolidated Framework for Implementation Research (CFIR)

2021 ◽  
Author(s):  
Alice Coffey ◽  
Irene Hartigan ◽  
Suzanne Timmons ◽  
Catherine Buckley ◽  
Elaine Lehane ◽  
...  
Keyword(s):  
Palliative Care ◽  
Action Research ◽  
Participatory Action Research ◽  
Situational Analysis ◽  
Evidence Based ◽  
Guidance Document ◽  
Participatory Action ◽  
Term Care ◽  
Learning Groups ◽  
Inner Setting

Abstract Background: The importance of providing evidence-based palliative care for people with dementia is increasingly acknowledged. In Ireland, evidence-based guidance has been developed in order to address key features of dementia palliative care, including the management of pain, medications and hydration and nutrition. The aim of this study was to identify and explore the factors affecting the implementation of evidence-based guidance on dementia palliative care.Methods: The Consolidated Framework for Implementation (CFIR) guided a mixed-method pre-post study. One guidance document pertaining to the management of pain, medication or hydration and nutrition was implemented in three long-term care facilities. Participatory Action Research in the form of work-based learning groups was used to implement the guidance, drawing on a situational analysis (pre-implementation). Staff questionnaires and audits were conducted pre and post-implementation while champion interviews were also conducted post-implementation. Results: Features of the guidance (innovation), the inner setting, and the process of implementation were most frequently identified as impacting implementation. Components of the outer setting and individual characteristics featured less commonly. The guidance was perceived as advantageous or complimentary to previous care provided. Within the inner setting, leadership and support from other colleagues facilitated implementation. However, limited availability of other healthcare professionals to assist with carrying out guidance actions presented a barrier in some facilities. The external facilitators of the work-based learning groups (WBLGs) were perceived as experienced and encouraged active participation and reflection on practices. Despite the challenge of releasing staff to attend the WBLGs, a trend toward reduced staff de-motivation among those who did attend was noted post-implementation. Conclusions: A situational analysis informed by the CFIR framework in conjunction with a participatory action research approach helped to advance implementation of the guidance. The progress of implementation depended on the extent to which evidence-based care was previously being implemented at each site. Post-implementation analysis using CFIR, identified challenges to address in future projects such as staff cover on the ward and timing of training to facilitate attendance for staff with different working hours. Facilitators included multidisciplinary engagement with the intervention and champions at each site to support the implementation process.

scholarly journals Participatory action research to enhance the collective involvement of residents in elderly care: About power, dialogue and understanding

2019 ◽  
Vol 17 (4) ◽  
pp. 528-548 ◽  
Author(s):  
Susan Woelders ◽  
Tineke Abma
Keyword(s):  
Action Research ◽  
Participatory Action Research ◽  
Expert Knowledge ◽  
Elderly Care ◽  
Care Home ◽  
Western Society ◽  
Research Approach ◽  
Participatory Action ◽  
Term Care ◽  
Action Research Approach

The collective involvement of patients and clients in health care organizations is valued in our Western society. In practice, giving form to this involvement seems to be a complex process. In this paper we present our learning experiences with a process of enhancing the involvement of older people in a residential care home in the Netherlands, by using a participatory action research approach, called PARTNER. This approach is inspired by responsive evaluation and developed for the context of long-term care. We use concepts of Habermas’ theory to understand what happens when trying to create communicative spaces through dialogue. Our learning history shows that the involvement of residents is not an easy task, because power issues are at stake. System values seem to dominate the lifeworld and expert knowledge seems to be more valued than expressed emotions and narratives of residents. Researchers who use participatory action research must be aware of these issues of power, often hidden in language and discourse. Dialogue can be a vehicle to enhance mutual understanding, when attention is paid to underlying values, assumptions and meanings of all people. Then, the gap between system and lifeworld can be bridged and communicative spaces can be opened up.

Effectiveness of the implementation of an evidence-based nursing model using participatory action research in oncohematology: research protocol

2010 ◽  
Vol 66 (8) ◽  
pp. 1845-1851 ◽  
Author(s):  
Eva Abad-Corpa ◽  
Cristobal Meseguer-Liza ◽  
José Tomás Martínez-Corbalán ◽  
Lourdes Zárate-Riscal ◽  
Amor Caravaca-Hernández ◽  
...  
Keyword(s):  
Action Research ◽  
Participatory Action Research ◽  
Evidence Based ◽  
Research Protocol ◽  
Participatory Action ◽  
Evidence Based Nursing

scholarly journals Improving Evidence-Based Practice education in healthcare courses: A Participatory Action Research multiple-case study

2019 ◽  
Author(s):  
Kylie Murphy ◽  
Tracey Parnell ◽  
Rodney Pope ◽  
Clarissa Hughes ◽  
Marguerite Bramble ◽  
...  
Keyword(s):  
Action Research ◽  
Participatory Action Research ◽  
Workplace Learning ◽  
Evidence Based Practice ◽  
Education Quality ◽  
Evidence Based ◽  
Participatory Action ◽  
Multiple Case ◽  
Asking Questions

This paper synthesises the results of three participatory action research (PAR) studies undertaken to improve the integration of evidence-based practice (EBP) education in three undergraduate health courses at one Australian university: Bachelor of Nursing, Bachelor of Occupational Therapy, and Bachelor of Physiotherapy. The PAR process with interested academics uncovered a range of EBP education strengths and weaknesses in the three courses. Common themes were evident, which are likely to be applicable in other similar courses. Identified weaknesses included a lack of explicit teaching about the meaning, principles, steps, and importance of EBP, partly stemming from a lack of shared understanding. A relative lack of emphasis on certain EBP steps was also noted, particularly the first step of ‘asking’ questions. A lack of communication with workplace learning (WPL) supervisors about how to facilitate EBP was also noted, raising concerns about variable EBP-education quality across WPL settings.  Opportunities for improvement were identified by academics in each course, across multiple subjects and year levels. In our experience, PAR has been a highly constructive approach to EBP curriculum improvement. We encourage consideration of a PAR approach for addressing similarly complex curriculum challenges.

Enabling sense-making for patients receiving outpatient palliative treatment: A participatory action research driven model for person-centered communication

2015 ◽  
Vol 14 (3) ◽  
pp. 212-224 ◽  
Author(s):  
J. Öhlén ◽  
G. Carlsson ◽  
A. Jepsen ◽  
I. Lindberg ◽  
F. Friberg
Keyword(s):  
Palliative Care ◽  
Action Research ◽  
Participatory Action Research ◽  
Cancer Care ◽  
Information Provision ◽  
Sense Making ◽  
Health Providers ◽  
Participatory Action ◽  
Professional Health ◽  
Over Time

ABSTRACTObjectives:In clinical palliative cancer care, the diversity of patient concerns over time makes information provision a critical issue, the demands of information-seeking patients presenting a challenge to both the communicative and organizational skills of the health provider. This study puts forward a practice model for communication between patients, their family members, and professional health providers during ongoing palliative chemotherapy; a model which supports the providers in enabling person-centered communication.Method:A constant comparative analysis adapted to participatory action research was applied. The model was developed step-wise in three interrelated cycles, with results from previous studies from palliative cancer care processed in relation to professional health providers' experience-based clinical knowledge. In doing this, focus group discussions were carried out with providers and patients to develop and revise the model.Results:The Enabling Sense Making model for person-centered communication gave rise to three domains (which are also the major communicative actors in palliative care): the patient, the family, and the provider. These actors were placed in the context of a communicative arena. The three respective domains were built up in different layers discriminating between significant aspects of person-centered communication, from the manifest that is most usually explicated in dialogues, to the latent that tends to be implicitly mediated.Significance of results:The model intends to facilitate timely reorientation of care from curative treatment or rehabilitation to palliation, as well as the introduction of appropriate palliative interventions over time during palliative phases. In this way the model is to be regarded a frame for directing the awareness of the professionals, which focuses on how to communicate and how to consider the patient’s way of reasoning. The model could be used as a complement to other strategic initiatives for the advancement of palliative care communication. It needs to be further evaluated in regard to practice evidence.

scholarly journals Palliative care integration for patients with advanced chronic obstructive pulmonary disease (COPD): Identifying essential components using participatory action research

2021 ◽  
pp. 026921632110289
Author(s):  
Tanja Fusi-Schmidhauser ◽  
Katherine Froggatt ◽  
Nancy Preston
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Palliative Care ◽  
Action Research ◽  
Participatory Action Research ◽  
Pulmonary Disease ◽  
Healthcare Professionals ◽  
Chronic Obstructive ◽  
Care Model ◽  
Participatory Action ◽  
Obstructive Pulmonary Disease

Background: Chronic obstructive pulmonary disease (COPD) is a life-limiting condition with palliative care needs. Despite increasing awareness about the role palliative care can play in care provision for patients with advanced COPD, integration in standard care remains underdeveloped. The unpredictability of the disease progression and misconceptions about palliative care being equivalent to end-of-life care often prevent a timely integrated approach in advanced COPD. Aim: To identify practices designed to increase integration of palliative care in the management of patients with advanced COPD in a respiratory service in Southern Switzerland. Design: A participatory action research approach was chosen and key stakeholders were involved to develop new knowledge and practices, supported by a Theory of Change framework. Data from each cycle and retrospective analysis at the end of the whole research were analysed using thematic analysis. Setting/participants: Five action research cycles with seven healthcare professionals working in palliative or respiratory care settings were conducted. Results: Three elements of integrated palliative care in advanced COPD were identified: multidimensional assessment, healthcare professionals’ education and interdisciplinary team meetings, which are the pillars of a new integrated palliative care model for patients with advanced COPD. Conclusions: The new integrated palliative care model in advanced COPD includes essential elements with a focus on patients, healthcare professionals and care delivery. Further research on testing this model in clinical practice, service development, implementation processes and possible outcomes, including evaluation of the financial impact of integrated palliative care is necessary to foster this care approach across all possible settings.

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