scholarly journals Normalisation process theory and the implementation of a new glaucoma clinical pathway in hospital eye services: Perspectives of doctors, nurses and optometrists

PLoS ONE ◽  
2021 ◽  
Vol 16 (8) ◽  
pp. e0255564
Author(s):  
Simon Read ◽  
James Morgan ◽  
David Gillespie ◽  
Claire Nollett ◽  
Marjorie Weiss ◽  
...  
Keyword(s):  
Clinical Pathway ◽  
Process Theory ◽  
Patient Treatment ◽  
Normalisation Process Theory ◽  
Structured Interviews ◽  
Healthcare Settings ◽  
Data Collection And Analysis ◽  
Contextual Integration ◽  
Field Notes ◽  
Theory Framework

Background Normalisation process theory reports the importance of contextual integration in successfully embedding novel interventions, with recent propositions detailing the role that ‘plasticity’ of intervention components and ‘elasticity’ of an intended setting contribute. We report on the introduction of a clinical pathway assessing patient non-responsiveness to treatment for glaucoma and ocular hypertension. The aim of this study was to assess the feasibility of implementing the Cardiff Model of Glaucoma Care into hospital eye services, identifying any issues of acceptability for staff through the filter of normalisation process theory. Methods A prospective observational study was undertaken in four hospital eye services. This incorporated detailed qualitative semi-structured interviews with staff (n = 8) to gather their perceptions on the intervention’s usefulness and practicality. In addition, observational field notes of patient and staff consultations (n = 88) were collected, as well as broader organisational observations from within the research sites (n = 52). Data collection and analysis was informed by the normalisation process theory framework. Results Staff reported the pathway led to beneficial knowledge on managing patient treatment, but the model was sometimes perceived as overly prescriptive. This perception varied significantly based on the composition of clinics in relation to staff experience, staff availability and pre-existing clinical structures. The most commonly recounted barrier came in contextually integrating into sites where wider administrative systems were inflexible to intervention components. Conclusions Flexibility will be the key determinant of whether the clinical pathway can progress to wider implementation. Addressing the complexity and variation associated with practice between clinics required a remodelling of the pathway to maintain its central benefits but enhance its plasticity. Our study therefore helps to confirm propositions developed in relation to normalisation process theory, contextual integration, intervention plasticity, and setting elasticity. This enables the transferability of findings to healthcare settings other than ophthalmology, where any novel intervention is implemented.

scholarly journals Identification and management of frailty in English primary care: a qualitative study of national policy

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711161
Author(s):  
Harm van Marwijk ◽  
Tom Blakeman ◽  
David Reeves ◽  
Khulud Alharbi
Keyword(s):  
Primary Care ◽  
National Policy ◽  
Evidence Base ◽  
System Thinking ◽  
Normalisation Process Theory ◽  
Routine Practice ◽  
Ageing Population ◽  
Structured Interviews ◽  
Data Collection And Analysis ◽  
General Practices

BackgroundPolicymakers are directing attention to addressing the needs of an ageing population. Since 2017, general practices in England have been contractually required to identify and code ‘frailty’ as a new clinical concept and, in doing so, support targeted management for this population with the aim of improving outcomes. However, embedding frailty policies into routine practice is not without challenges and little is currently known about the success or otherwise of the programme.AimTo explore the implementation of a national policy on frailty identification and management in English primary care.MethodSemi-structured interviews were conducted with GPs (n = 10), nurses (n = 6), practice managers (n = 3) and health advisors (n = 3). Normalisation Process Theory (NPT) and System Thinking provided sensitizing frameworks to support data collection and analysis.ResultsPrimary care professionals were starting to use the concept of frailty to structure care both within practices and across organisations, however, there was widespread concern about the challenge of providing expanded care for the identified needs within existing resources. Concerns were also expressed around how best to identify the frail subpopulation and the limitations of current tools for this, and there was a professional reticence to use the term ‘frailty’ with patients.ConclusionFindings suggest that additional focused resources and the development of a stronger evidence base are essential to facilitate professional engagement in policies to improve the targeted coding and management of frailty in primary care.

scholarly journals Acute kidney injury electronic alerts: mixed methods Normalisation Process Theory evaluation of their implementation into secondary care in England

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e032925
Author(s):  
Jason Scott ◽  
Tracy Finch ◽  
Mark Bevan ◽  
Gregory Maniatopoulos ◽  
Chris Gibbins ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Mixed Methods ◽  
Secondary Care ◽  
Qualitative Data ◽  
Kidney Injury ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Electronic Alerts

ObjectiveAround one in five emergency hospital admissions are affected by acute kidney injury (AKI). To address poor quality of care in relation to AKI, electronic alerts (e-alerts) are mandated across primary and secondary care in England and Wales. Evidence of the benefit of AKI e-alerts remains conflicting, with at least some uncertainty explained by poor or unclear implementation. The objective of this study was to identify factors relating to implementation, using Normalisation Process Theory (NPT), which promote or inhibit use of AKI e-alerts in secondary care.DesignMixed methods combining qualitative (observations, semi-structured interviews) and quantitative (survey) methods.Setting and participantsThree secondary care hospitals in North East England, representing two distinct AKI e-alerting systems. Observations (>44 hours) were conducted in Emergency Assessment Units (EAUs). Semi-structured interviews were conducted with clinicians (n=29) from EAUs, vascular or general surgery or care of the elderly. Qualitative data were supplemented by Normalization MeAsure Development (NoMAD) surveys (n=101).AnalysisQualitative data were analysed using the NPT framework, with quantitative data analysed descriptively and using χ2 and Wilcoxon signed-rank test for differences in current and future normalisation.ResultsParticipants reported familiarity with the AKI e-alerts but that the e-alerts would become more normalised in the future (p<0.001). No single NPT mechanism led to current (un)successful implementation of the e-alerts, but analysis of the underlying subconstructs identified several mechanisms indicative of successful normalisation (internalisation, legitimation) or unsuccessful normalisation (initiation, differentiation, skill set workability, systematisation).ConclusionsClinicians recognised the value and importance of AKI e-alerts in their practice, although this was not sufficient for the e-alerts to be routinely engaged with by clinicians. To further normalise the use of AKI e-alerts, there is a need for tailored training on use of the e-alerts and routine feedback to clinicians on the impact that e-alerts have on patient outcomes.

scholarly journals Facilitators and barriers to safer care in Scottish general practice: a qualitative study of the implementation of the trigger review method using normalisation process theory

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029914
Author(s):  
Carl de Wet ◽  
Paul Bowie ◽  
Catherine A O'Donnell
Keyword(s):  
General Practice ◽  
Qualitative Study ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Science Literature ◽  
Leadership Roles ◽  
Structured Interviews ◽  
Theoretical Frameworks ◽  
Practice Nurses ◽  
Healthcare Interventions

ObjectivesPatient safety is a key concern of modern health systems, with numerous approaches to support safety. One, the trigger review method (TRM), is promoted nationally in Scotland as an approach to improve the safety of care in general medical practice. However, it remains unclear which factors are facilitating or hindering its implementation. The aim of this study was to identify the important factors that facilitate or hinder the implementation of the TRM in this setting.DesignQualitative study employing semi-structured interviews. Data analysis was theoretically informed using normalisation process theory (NPT).SettingScottish general practice.ParticipantsWe conducted 28 semistructured interviews with general practitioners (n=12), practice nurses (n=11) and practice managers (n=5) in Scotland.ResultsWe identified four important factors that facilitated or hindered implementation: (1) the amount of time and allocated resources; (2) integration of the TRM into existing initiatives and frameworks facilitated implementation and justified participants’ involvement; (3) the characteristics of the reviewers—implementation was facilitated by experienced, reflective clinicians with leadership roles in their teams; (4) the degree to which participants perceived the TRM as acceptable, feasible and useful.ConclusionsThis study is the first known attempt to investigate how the TRM is implemented and perceived by general practice clinicians and staff. The four main factors that facilitated TRM implementation are comparable with the wider implementation science literature, suggesting that a small number of specific factors determine the success of most, if not all, complex healthcare interventions. These factors can be identified, described and understood through theoretical frameworks such as NPT and are amenable to intervention. Researchers and policymakers should proactively identify and address these factors.

scholarly journals Implementing online patient feedback in a ‘special measures’ acute hospital: A case study using Normalisation Process Theory

2021 ◽  
Vol 7 ◽  
pp. 205520762110059
Author(s):  
Rebecca Baines ◽  
Frazer Underwood ◽  
Kim O’Keeffe ◽  
Jessica Saunders ◽  
Ray B Jones
Keyword(s):  
Opportunity To Learn ◽  
Analytical Framework ◽  
Acute Hospital ◽  
Process Theory ◽  
Normalisation Process Theory ◽  
Regulatory Body ◽  
Structured Interviews ◽  
Staff Members ◽  
Patient Feedback ◽  
Online Feedback

Objective Online patient feedback is becoming increasingly prevalent on an international scale. However, limited research has explored how healthcare organisations implement such feedback. This research sought to explore how an acute hospital, recently placed into ‘special measures’ by a regulatory body implemented online feedback to support its improvement journey. Methods Semi-structured interviews were conducted with eleven key stakeholders involved in the implementation and/or use of online patient feedback. Data was analysed using deductive thematic analysis with Normalisation Process Theory used as the analytical framework. Research findings are translated into the Engage, Support and Promote (ESP) model, a model of rapid feedback adoption. Results Participants viewed the implementation of online feedback as an opportunity to learn, change and improve. Factors found to facilitate implementation were often linked to engagement, support and promotion. Although less frequently described, barriers to implementation included staff anxieties about time pressures, moderation processes and responding responsibilities. Such anxieties were often addressed by activities including the provision of evidence based responder training. Overall, staff were overwhelmingly positive about the value of online feedback with 24 impacts identified at an individual and organisational level, including the ability to boost staff morale, resilience and pride. Conclusions The rapid implementation of online patient feedback can be achieved in a ‘special measures’ organisation. However, the difficulties of implementing such feedback should not be underestimated. In order to embed online feedback, staff members need to be engaged and feel supported, with opportunities to provide, respond and invite patient feedback frequently promoted to both patients and staff members.

scholarly journals The psychosocial response to a terrorist attack at Manchester Arena, 2017: a process evaluation

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Daniel Hind ◽  
Kate Allsopp ◽  
Prathiba Chitsabesan ◽  
Paul French
Keyword(s):  
Young People ◽  
Process Evaluation ◽  
Terrorist Attack ◽  
Health Sector ◽  
Routine Data ◽  
Recovery Phase ◽  
Normalisation Process Theory ◽  
Structured Interviews ◽  
Framework Analysis ◽  
Response Phase

Abstract Background A 2017 terrorist attack in Manchester, UK, affected large numbers of adults and young people. During the response phase (first seven weeks), a multi-sector collaborative co-ordinated a decentralised response. In the subsequent recovery phase they implemented a centralised assertive outreach programme, ‘The Resilience Hub’, to screen and refer those affected. We present a process evaluation conducted after 1 year. Methods Case study, involving a logic modelling approach, aggregate routine data, and semi-structured interviews topic guides based on the Inter-Agency Collaboration Framework and May’s Normalisation Process Theory. Leaders from health, education and voluntary sectors (n = 21) and frontline Resilience Hub workers (n = 6) were sampled for maximum variation or theoretically, then consented and interviewed. Framework analysis of transcripts was undertaken by two researchers. Results Devolved government, a collaborative culture, and existing clinical networks meant that, in the response phase, a collaboration was quickly established between health and education. All but one leader evaluated the response positively, although they were not involved in pre-disaster statutory planning. However, despite overwhelming positive feedback there were clear difficulties. (1) Some voluntary sector colleagues felt that it took some time for them to be involved. (2) Other VCSE organisations were accused of inappropriate, harmful use of early intervention. (3) The health sector were accused of overlooking those below the threshold for clinical treatment. (4) There was a perception that there were barriers to information sharing across organisations, which was particularly evident in relation to attempts to outreach to first responders and other professionals who may have been affected by the incident. (5) Hub workers encountered barriers to referring people who live outside of Greater Manchester. After 1 year of the recovery phase, 877 children and young people and 2375 adults had completed screening via the Resilience Hub, 79% of whom lived outside Greater Manchester. Conclusions The psychosocial response to terrorist attacks and other contingencies should be planned and practiced before the event, including reviews of communications, protocols, data sharing procedures and workforce capacity. Further research is needed to understand how the health and voluntary sectors can best collaborate in the wake of future incidents.

scholarly journals Exploring the experiences related to postpartum changes: perspectives of mothers and healthcare providers in Iran

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mahboobeh Asadi ◽  
Mahnaz Noroozi ◽  
Mousa Alavi
Keyword(s):  
Postpartum Period ◽  
Qualitative Content Analysis ◽  
Healthcare Providers ◽  
Educational Interventions ◽  
Psychological State ◽  
Structured Interviews ◽  
Childbearing Age ◽  
New Period ◽  
Women's Lives ◽  
Field Notes

Abstract Background Numerous changes occur in different aspects of women’s lives in the postpartum period. Women’s adjusting with problems and taking advantage of this opportunity can develop their personality. In this regard, accurate knowledge of their experiences and feelings is necessary to help them to benefit from this period. Therefore, the present study aimed to explore the experiences related to postpartum changes in women. Methods In the present qualitative study, 23 participants, including women of childbearing age who gave birth and healthcare providers (midwives and obstetricians) in Isfahan, Iran were selected using purposive sampling with a maximum variation strategy. Data were collected through in-depth semi structured interviews, field notes, and daily notes, and simultaneously analyzed using the conventional qualitative content analysis. Results The data analysis results led to the extraction of three main categories including “feeling of decreased female attractiveness” (with two sub-categories of “ feeling of decreased beauty” and “feeling of decreased sexual function”), “feeling of insolvency and helplessness” (with two sub-categories of “physical burnout”, and “mental preoccupations”) and “beginning a new period in life” (with three sub-categories of “changing the meaning of life”, “feeling of maturity” and “deepening the communication”). Conclusions Findings of this study can provide a good context for designing interventions to improve the women’s quality of life by explaining and highlighting their experiences in the postpartum period. In this regard, providing sufficient empathy, social and psychological support from family members (especially husband), performing appropriate educational interventions and also regular assessment of women’s psychological state by healthcare providers in postpartum period can reduce their concerns and help to improve their health.

scholarly journals Loneliness Among the Elderly in Rural Contexts: A Mixed-Method Study Protocol

2021 ◽  
Vol 20 ◽  
pp. 160940692199686
Author(s):  
Borja Rivero Jiménez ◽  
David Conde-Caballero ◽  
Lorenzo Mariano Juárez
Keyword(s):  
Data Collection ◽  
Mixed Method ◽  
Rural Areas ◽  
Population Group ◽  
The Elderly ◽  
Interaction Patterns ◽  
Structured Interviews ◽  
Strict Adherence ◽  
Data Collection And Analysis ◽  
Technological Tools

Loneliness among the elderly has become a pressing issue in Western societies. In the Spanish context, the problem of the so-called “empty” Spain disproportionately affects this population group—elderly individuals living in rural areas with low population density, and therefore at higher risk of social exclusion and isolation. We introduce here a mixed-method, quantitative-qualitative research protocol, triangulated with technological tools, designed to improve both data acquisition and subsequent data analysis and interpretation. This study will take place in a rural locality in the Extremadura region (Spain), chosen according to a particular socio-demographic profile. The De Jong Gierveld Loneliness Scale will be used on a cohort of 80 people over 65 years old. Within this cohort, a smaller sample of 20–30 individuals will be selected for semi-structured interviews about their beliefs and experiences of loneliness. Finally, data gathered from technological tools (smartbands, Bluetooth sensors) will allow us to monitor social interactions and to map daily loneliness/interaction patterns. Data will be triangulated by analyzing and comparing the empirical material gathered through these different methods and tools. Strict adherence to ethical standards for data protection and handling will be essential through data collection and analysis. As well as providing insights into the phenomenon of loneliness in old age, the use of different methods and tools for data collection will provide the basis for an epistemological reflection on the scope and limits of each one of these methods.

scholarly journals Students’ perceptions of visibility in physical education

2021 ◽  
pp. 1356336X2110258
Author(s):  
Eli-Karin S Åsebø ◽  
Helga S Løvoll ◽  
Rune J Krumsvik
Keyword(s):  
Physical Education ◽  
Structured Interviews ◽  
Study Approach ◽  
Transaction Model ◽  
Lesson Content ◽  
Field Notes ◽  
Group Interviews ◽  
Ninth Grade Students ◽  
Past Experiences ◽  
And Coping

The purpose of this study is to explore students’ perceptions of visibility in physical education (PE) using a single cumulative case study approach. Data were generated from the descriptive field notes of seven participant observations ( n = 77), individual semi-structured interviews ( n = 13) and five focus group interviews ( n = 18) with ninth-grade students (ages 14–15 years) from three classes in a public lower secondary school in Norway. The findings show that students perceive visibility differently depending on the context; some students like being visible in PE, while others dread it. Perceptions change rapidly and are situation-specific, influenced by the lesson content, the way the teacher facilitates the lessons, self-perception shaped by past experiences, the presence, actions, and attitudes of fellow students, body pressure and societal body ideals. The findings actualise the relevance of the transaction model of stress and coping ( Lazarus and Folkman, 1984 ) in determining when visibility in PE is and is not perceived as stressful. Consequently, the organization of the PE environment benefits from these insights.

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