scholarly journals Development of a Complex Intervention to Support Parents of Chronically Ill Adolescents in Transition From Pediatrics to Adult Care (ParTNer-STEPs)

2021 ◽  
Author(s):  
Ena Lindhart Thomsen ◽  
Bente Appel Esbensen ◽  
Signe Hanghøj ◽  
Helena Hansson ◽  
Kirsten Arntz Boisen
Keyword(s):  
Health Care Professionals ◽  
Participatory Design ◽  
Complex Interventions ◽  
Chronically Ill ◽  
Evidence Base ◽  
Transition Program ◽  
Successful Implementation ◽  
Adult Care ◽  
Mrc Framework ◽  
The Uk

Abstract Background Transfer from pediatric to adult care for chronically ill adolescents is associated with outpatient non-attendance and low treatment adherence in adolescents, and with anxiety and concerns among parents. Recent studies have shown that parent involvement results in better transitions. The aim of this paper was to describe the development, through participatory design, of a brief transition program targeted to parents of chronically ill adolescents.Methods The study was based on the UK Medical Research Council’s (MRC) framework on developing and testing complex interventions. To increase the program’s feasibility and relevance, participatory design was chosen as the overall method. A collaboration group of parents, adolescents and health care professionals (HCP) were actively involved in the development of the program. The program was developed in three development stages, in accordance with the MRC framework: 1) identifying the evidence base, 2) identifying theory, and 3) modelling process and outcomes. Results Together with the collaboration group, we developed a brief transition program targeting parents, by undertaking an iterative process, involving a literature review, individual interviews, workshops, online brainstorms and multiple pilot tests. The program, called ParTNer-STEPs (Parents in Transition – a Nurse-led Support and Transfer Educational Program) comprised three components: 1) an informative website, 2) online educational events for parents, and 3) transfer consultations with providers from both pediatrics and adult care.Conclusions The MRC framework was successfully applied to develop a brief transition program targeting parents of chronically ill adolescents. By incorporating the principles of participatory design in the development phase, we ensured that both parents’ and adolescents’ needs were represented and addressed in the program. Furthermore, the involvement of HCPs ensured the feasibility and relevance of the intervention in clinical practice and will increase the chances of successful implementation.Trial registration ClinicalTrials.gov ID NCT04969328

scholarly journals Exploring Existential Loneliness Among Frail Older People as a Basis for an Intervention: Protocol for the Development Phase of the LONE Study (Preprint)

2019 ◽  
Author(s):  
Anna-Karin Edberg ◽  
Ingrid Bolmsjö
Keyword(s):  
Older People ◽  
Health Care Professionals ◽  
Large Body ◽  
Complex Interventions ◽  
Significant Others ◽  
Evidence Base ◽  
Development Phase ◽  
Frail Older People ◽  
Existential Loneliness ◽  
Intervention Protocol

BACKGROUND International research concerning end-of-life issues emphasizes the importance of health care professionals (HCPs) being prepared to deal with existential aspects, like loneliness, in order to provide adequate care. The last phase of life is often related to losses of different kinds, which might trigger feelings of isolation in general and existential loneliness (EL) in particular. There is a large body of research concerning loneliness among older people in general, but little is known about the phenomenon and concept of EL in old age. OBJECTIVE This study aims to describe the framing, design, and first results of the exploratory phase of an intervention study focusing on EL among older people: the LONE study. This stage of the study corresponds to the development phase, according to the Medical Research Council framework for designing complex interventions. METHODS The LONE study contains both theoretical and empirical studies concerning: (1) identifying the evidence base; (2) identifying and developing theory through individual and focus group interviews with frail older people, significant others, and HCPs; and (3) modeling process and outcomes for the intervention. This project involves sensitive issues that must be carefully reviewed. The topic in itself concerns a sensitive matter and the study group is vulnerable, therefore, an ethical consciousness will be applied throughout the project. RESULTS The results so far show that EL means being disconnected from life and implies a feeling of being fundamentally separated from others and the world, whether or not one has family, friends, or other close acquaintances. Although significant others highlighted things such as lack of activities, not participating in a social environment, and giving up on life as aspects of EL, the older people themselves highlighted a sense of meaningless waiting, a longing for a deeper connectedness, and restricted freedom as their origins of EL. The views of HCPs on the origin of EL, the place of care, and their own role differed between contexts. CONCLUSIONS The studies focusing on identifying the evidence base and developing theory are published. These results will now be used to identify potential intervention components, barriers, and enablers for the implementation of an intervention aimed at supporting HCPs in encountering EL among older people. INTERNATIONAL REGISTERED REPOR RR1-10.2196/13607

scholarly journals Exploring Existential Loneliness Among Frail Older People as a Basis for an Intervention: Protocol for the Development Phase of the LONE Study

10.2196/13607 ◽  
2019 ◽  
Vol 8 (8) ◽  
pp. e13607 ◽  
Author(s):  
Anna-Karin Edberg ◽  
Ingrid Bolmsjö
Keyword(s):  
Older People ◽  
Health Care Professionals ◽  
Large Body ◽  
Complex Interventions ◽  
Significant Others ◽  
Evidence Base ◽  
Development Phase ◽  
Frail Older People ◽  
Existential Loneliness ◽  
Intervention Protocol

Background International research concerning end-of-life issues emphasizes the importance of health care professionals (HCPs) being prepared to deal with existential aspects, like loneliness, in order to provide adequate care. The last phase of life is often related to losses of different kinds, which might trigger feelings of isolation in general and existential loneliness (EL) in particular. There is a large body of research concerning loneliness among older people in general, but little is known about the phenomenon and concept of EL in old age. Objective This study aims to describe the framing, design, and first results of the exploratory phase of an intervention study focusing on EL among older people: the LONE study. This stage of the study corresponds to the development phase, according to the Medical Research Council framework for designing complex interventions. Methods The LONE study contains both theoretical and empirical studies concerning: (1) identifying the evidence base; (2) identifying and developing theory through individual and focus group interviews with frail older people, significant others, and HCPs; and (3) modeling process and outcomes for the intervention. This project involves sensitive issues that must be carefully reviewed. The topic in itself concerns a sensitive matter and the study group is vulnerable, therefore, an ethical consciousness will be applied throughout the project. Results The results so far show that EL means being disconnected from life and implies a feeling of being fundamentally separated from others and the world, whether or not one has family, friends, or other close acquaintances. Although significant others highlighted things such as lack of activities, not participating in a social environment, and giving up on life as aspects of EL, the older people themselves highlighted a sense of meaningless waiting, a longing for a deeper connectedness, and restricted freedom as their origins of EL. The views of HCPs on the origin of EL, the place of care, and their own role differed between contexts. Conclusions The studies focusing on identifying the evidence base and developing theory are published. These results will now be used to identify potential intervention components, barriers, and enablers for the implementation of an intervention aimed at supporting HCPs in encountering EL among older people. International Registered Report Identifier (IRRID) RR1-10.2196/13607

scholarly journals Perceived barriers and facilitators of the implementation of a combined lifestyle intervention with a financial incentive for chronically ill patients

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
C. C. M. Molema ◽  
G. C. W. Wendel-Vos ◽  
S. ter Schegget ◽  
A. J. Schuit ◽  
L. A. M. van de Goor
Keyword(s):  
Health Care ◽  
Lifestyle Intervention ◽  
Health Care Professionals ◽  
Healthy Lifestyle ◽  
Financial Incentive ◽  
Chronically Ill ◽  
Barriers And Facilitators ◽  
Successful Implementation ◽  
Structured Interviews ◽  
Care Groups

Abstract Background This study aims to describe barriers and facilitators of the implementation of a combined lifestyle intervention (CLI) in primary care for patients with chronic disease. The aim of CLI to help patients to create a healthy lifestyle and to maintain this healthy lifestyle. During a CLI a patient receives advice and counselling to improve health-related behavior such as physical activity and diet. Special attention was given to the influence of adding a health promoting financial incentive (HPFI) for the participants to the CLI. Methods Twenty-four semi-structured interviews within six care groups were performed between July and October 2017. The interviews were transcribed verbatim and coded by two researchers independently. Results Respondents mentioned several preferred characteristics of the CLI such as easy accessibility of the intervention site and the presence of health care professionals during exercise sessions. Moreover, factors that could influence implementation (such as attitude of the health care professionals) and preconditions for a successful implementation of a CLI (such as structural funding and good infrastructure) were identified. Overall, positive HPFIs (e.g. a reward) were preferred over negative HPFIs (e.g. a fine). According to the respondents, HPFIs could positively influence the degree of participation, and break down barriers for participating in and finishing the CLI. Conclusions Multiple barriers and facilitators for successful implementation of a CLI were identified. For successful implementing CLIs, a positive attitude of all stakeholders is essential and specific preconditions should be fulfilled. With regard to adding a HPFI, more research is needed to identify the attitude of specific target groups towards an HPFI.

Best practice for chronic oedema in community settings: what can we learn?

2020 ◽  
Vol 25 (12) ◽  
pp. 610-614
Author(s):  
Garry Cooper-Stanton
Keyword(s):  
Service Provision ◽  
Best Practice ◽  
Evidence Base ◽  
Community Services ◽  
Guidance Document ◽  
Community Settings ◽  
Tissue Viability ◽  
Delivery Of Care ◽  
Specialist Nurses ◽  
The Uk

There are various opportunities and challenges in the delivery of care to those diagnosed with chronic oedema/lymphoedema. Service provision is not consistent within the UK, and non-specialist nurses and other health professionals may be called on to fill the gaps in this area. The latest best practice guidance on chronic oedema is directed at community services that care for people within their own homes in primary care. This guide was developed in order to increase awareness, knowledge and access to an evidence base. Those involved in its creation cross specialist fields (lymphoedema and tissue viability), resulting in the document covering a number of areas, including an explanation of chronic oedema, its assessment and management and the association between chronic oedema and wet legs. The document complements existing frameworks on the condition and its management and also increases the available tools within chronic oedema management in the community. The present article provides an overview of the guidance document and discusses its salient features.

scholarly journals A Delphi Study Investigating Clinicians’ Views on Access to, Delivery of, and Adaptations of MBCT in the UK Clinical Settings

Mindfulness ◽  
2021 ◽  
Author(s):  
Kate Williams ◽  
Samantha Hartley ◽  
Peter Taylor
Keyword(s):  
Delphi Study ◽  
Good Practice ◽  
Evidence Base ◽  
Clinical Settings ◽  
Training Support ◽  
Decision Making Processes ◽  
Complex Decision Making ◽  
Complex Decision ◽  
The Uk ◽  
Clinical Populations

Abstract Objectives Mindfulness-based cognitive therapy (MBCT) is a well-evidenced relapse-prevention intervention for depression with a growing evidence-base for use in other clinical populations. The UK initiatives have outlined plans for increasing access to MBCT in clinical settings, although evidence suggests that access remains limited. Given the increased popularity and access to MBCT, there may be deviations from the evidence-base and potential risks of harm. We aimed to understand what clinicians believe should be best clinical practice regarding access to, delivery of, and adaptations to MBCT. Methods We employed a two-stage Delphi methodology. First, to develop statements around best practices, we consulted five mindfulness-based experts and reviewed the literature. Second, a total of 59 statements were taken forward into three survey rating rounds. Results Twenty-nine clinicians completed round one, with 25 subsequently completing both rounds two and three. Forty-four statements reached consensus; 15 statements did not. Clinicians agreed with statements regarding sufficient preparation for accessing MBCT, adherence to the evidence-base and good practice guidelines, consideration of risks, sufficient access to training, support, and resources within services, and carefully considered adaptations. The consensus was not reached on statements which reflected a lack of evidence-base for specific clinical populations or the complex decision-making processes involved in delivering and making adaptations to MBCT. Conclusions Our findings highlight the delicate balance of maintaining a client-centred and transparent approach whilst adhering to the evidence-base in clinical decisions around access to, delivery of, and adaptations in MBCT and have important wide-reaching implications.

scholarly journals An interview study to determine the experiences of cellulitis diagnosis amongst health care professionals in the UK

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e034692
Author(s):  
Mitesh Patel ◽  
Siang Ing Lee ◽  
Nick J Levell ◽  
Peter Smart ◽  
Joe Kai ◽  
...  
Keyword(s):  
Clinical Features ◽  
Clinical Experience ◽  
Lower Limb ◽  
Health Care Professionals ◽  
Secondary Outcome ◽  
Snowball Sampling ◽  
Acute Medicine ◽  
Common Diagnosis ◽  
The Uk ◽  
National Networks

ObjectivesTo explore healthcare professionals (HCPs) experiences and challenges in diagnosing suspected lower limb cellulitis.SettingUK nationwide.Participants20 qualified HCPs, who had a minimum of 2 years clinical experience as an HCP in the national health service and had managed a clinical case of suspected cellulitis of the lower limb in the UK. HCPs were recruited from departments of dermatology (including a specialist cellulitis clinic), general practice, tissue viability, lymphoedema services, general surgery, emergency care and acute medicine. Purposive sampling was employed to ensure that participants included consultant doctors, trainee doctors and nurses across the specialties listed above. Participants were recruited through national networks, HCPs who contributed to the cellulitis priority setting partnership, UK Dermatology Clinical Trials Network, snowball sampling where participants helped recruit other participants and personal networks of the authors.Primary and secondary outcomesPrimary outcome was to describe the key clinical features which inform the diagnosis of lower limb cellulitis. Secondary outcome was to explore the difficulties in making a diagnosis of lower limb cellulitis.ResultsThe presentation of lower limb cellulitis changes as the episode runs its course. Therefore, different specialties see clinical features at varying stages of cellulitis. Clinical experience is essential to being confident in making a diagnosis, but even among experienced HCPs, there were differences in the clinical rationale of diagnosis. A group of core clinical features were suggested, many of which overlapped with alternative diagnoses. This emphasises how the diagnosis is challenging, with objective aids and a greater understanding of the mimics of cellulitis required.ConclusionCellulitis is a complex diagnosis and has a variable clinical presentation at different stages. Although cellulitis is a common diagnosis to make, HCPs need to be mindful of alternative diagnoses.

scholarly journals The individualized, accompanied transition program “TraiN” for adolescent kidney patients – a local initiative

2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Paula Collette ◽  
Luisa C. Klein ◽  
Lisa M. Körner ◽  
Gundula Ernst ◽  
Sandra Brengmann ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Disease Management ◽  
Health Risks ◽  
Pediatric Nephrology ◽  
Young Patients ◽  
Transition Program ◽  
University Hospital ◽  
Adult Care ◽  
Local Initiative

Abstract Since the transition from pediatric and adolescent to adult care often proceeds unaccompanied and unplanned, young patients with chronic kidney disease may experience health risks and non-adherence after the transfer. The psychosocial team at the Department of Pediatric Nephrology at the University Hospital of Cologne has therefore developed its local transition program “TraiN” for patients with chronic kidney disease aged 13 years and older. It combines structure and flexibility through predefined content modules that can be individually adapted to the patients, offering continuity and sustainability through a transition contact person. In addition, the family members are offered regular psychological consultations. The timing of the transfer is chosen individually depending on the level of psychosocial and medical transition readiness. The aim of “TraiN” is to strengthen the patients’ transition competence and the responsibility for their disease management and to provide them and their families the best possible support during the transition in order to prevent possible health risks. In the near future, a scientific evaluation will be conducted aiming to determine whether “TraiN” can support young people in their independence and self-reliant disease management.

scholarly journals EXPRESS: Unlearning and Consent in the UK Fire and Rescue Service

2021 ◽  
pp. 001872672110311
Author(s):  
James Brooks ◽  
Irena Grugulis ◽  
Hugh Cook
Keyword(s):  
Qualitative Study ◽  
Social Aspects ◽  
Successful Implementation ◽  
Human System ◽  
Rescue Service ◽  
Rescue Services ◽  
The People ◽  
The Social ◽  
New Knowledge ◽  
The Uk

Why does so much literature on unlearning ignore the people who do the unlearning? What would we understand differently if we focused on those people? Much of the existing literature argues that unlearning can only be achieved, and new knowledge acquired, if old knowledge is discarded: the clean slate approach. This might be a reasonable way of organising stock in a warehouse, where room needs to be created for new deliveries, but it is not an accurate description of a human system. This article draws on a detailed qualitative study of learning in the UK Fire and Rescue Services to challenge the clean slate approach and demonstrate that, not only did firefighters retain their old knowledge, they used it as a benchmark to assess new routines and practices. This meant that firefighters’ trust in, and consent to, innovation was key to successful implementation. In order to understand the social aspects of unlearning, this research focuses on the people involved as active agents, rather than passive recipients or discarders of knowledge.

scholarly journals Listening to student voice-understanding student and faculty experience at two UK graduate entry programmes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
M. Abdulhadi Alagha ◽  
Linda Jones
Keyword(s):  
Sense Of Self ◽  
Field Analysis ◽  
Small Scale ◽  
Successful Implementation ◽  
Graduate Entry ◽  
Self Regulated Learning ◽  
Point Of Entry ◽  
Shortage Of Physicians ◽  
Elite Interviews ◽  
The Uk

Abstract Context Shortage of physicians in the UK has been a long-standing issue. Graduate entry medicine (GEM) may offer a second point of entry for potential doctors. However, the challenges of developing and implementing these programmes are still unrecognised. This small-scale study aimed to briefly explore the opportunities and challenges facing students at two UK GEM programmes. Methods Two case studies were conducted at Imperial College and Scotland’s GEM (ScotGEM) and used a triangulated qualitative approach via semi-structured and elite interviews. Data analysis, informed by grounded theory, applied thematic and force-field analysis in an empirical approach to generate evidence and instrumental interpretations for Higher Education Institutions. Results Although GEM forms an opportunity for graduates to enter medicine, the different drivers of each programme were key in determining entry requirements and challenges experienced by postgraduates. Three key dilemmas seem to influence the experiences of learners in GEM programmes: (a) postgraduate identity and the everchanging sense-of-self; (b)self-directed and self-regulated learning skills, and (c) servicescape, management and marketing concepts. Conclusions Graduate entry programmes may support policy makers and faculty to fill the workforce gap of healthcare professionals. However, their successful implementation requires careful considerations to the needs of graduates to harness their creativity, resilience and professional development as future healthcare workers.

Parental conceptions of the rotavirus vaccine during implementation in Stockholm: A phenomenographic study

2017 ◽  
Vol 21 (4) ◽  
pp. 476-487 ◽  
Author(s):  
Eva Sjögren ◽  
Lina Schollin Ask ◽  
Åke Örtqvist ◽  
Margareta Asp
Keyword(s):  
Health Care Professionals ◽  
Successful Implementation ◽  
Child Health Care ◽  
Rotavirus Vaccine ◽  
Stockholm County ◽  
Immunization Program ◽  
Rotavirus Infection ◽  
Phenomenographic Study ◽  
Depth Interviews ◽  
Child Immunization Program

In 2014, Stockholm became the first Swedish county to introduce the rotavirus vaccine, which is given from as early as six weeks of age. The aim of this study was to describe parental conceptions of rotavirus infection and vaccination during its implementation as part of the child immunization program, as their support is vital for any new vaccine. The study followed a descriptive, qualitative design with a phenomenographic approach. Ten in-depth interviews with parents were conducted in Stockholm County, transcribed and analyzed to describe qualitatively different conceptions of rotavirus infection and vaccination. Four main categories were identified: to vaccinate without doubt, hesitant to vaccinate, risky to vaccinate, and unnecessary to vaccinate. All the parents had in common the desire to protect their children from suffering, either by vaccinating their child in order to avoid rotavirus infection or by not vaccinating their child because of concerns about the side effects. It is important that child health-care professionals understand the variations of conceptions that influence the parents’ decisions and that these conceptions may differ considerably. Individualized parental information about rotavirus infection and vaccination would help to achieve a successful implementation of the vaccination program.

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