Use, Usability, And Impact of A Tool To Support Conversations About End-of-Life Preferences In Residential Elder Care – A Qualitative Study of Staff Experiences

Abstract Background: If EOL care is to be person-centred and value-concordant, proactive conversations about individual preferences between residents, relatives, and staff are required. Nevertheless, the prevalence of conversations about preferences for EOL care is still low in residential care homes (RCHs), often relating to staff’s perceived lack of skills and confidence. Conversation tools may be useful to support staff in facilitating EOL conversations, but often focus more on documenting treatment priorities than on exploring underlying values and reasoning for preferences. In this study, we use the DöBra cards, the Swedish version of the GoWish cards, to support discussions about EOL care values and preferences in RCHs, and explore staff perspectives on use, usability, and impact. Methods: This qualitative study was based on data generated from two participatory action research processes in which RCH staff tested and evaluated use of DöBra cards in EOL conversations. Data comprise 6 interviews and 8 group meetings with a total of 13 participants from 7 elder care facilities. Qualitative content analysis was performed to identify key concepts in relation to use, usability, and impact of the DöBra cards with residents and/or relatives.Results: Based on participants’ experiences of using the DöBra cards as an EOL conversation tool in RCHs, we identified three main categories in relation to its usefulness. Outcomes of using the cards (1) included the outlining of content of conversations and supporting connection and development of rapport. Perceived impact (2) related to enabling openings for future communication and aligning care goals between stakeholders. Use and usability of the cards (3) were influenced by supporting and limiting factors on the personal and contextual level.Conclusions: This study demonstrates how the DöBra cards was found to be useful by staff for facilitating conversations about EOL values, influencing both the content of discussion and interactions between those present. The tool encouraged reflection and interaction, which staff perceived as potentially helpful in building preparedness for future care-decision making. The combination of providing a shared framework and being adaptable in use appeared to be key features for the DöBra cards usability in the RCH setting.

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Exploring Community-Dwelling Older Adults’ Considerations About Values and Preferences for Future End-of-Life Care: A Study from Sweden

The Gerontologist ◽

10.1093/geront/gnaa012 ◽

2020 ◽

Vol 60 (7) ◽

pp. 1332-1342 ◽

Cited By ~ 1

Author(s):

Malin Eneslätt ◽

Gert Helgesson ◽

Carol Tishelman

Keyword(s):

Older Adults ◽

End Of Life ◽

Community Dwelling ◽

Participatory Action ◽

Action Research Project ◽

Care Needs ◽

Swedish Version ◽

Using Data ◽

Eol Care ◽

Community Dwelling Older Adults

Abstract Background and Objectives There is a substantial body of research on advance care planning (ACP), often originating from English-speaking countries and focused on health care settings. However, studies of content of ACP conversations in community settings remain scarce. We therefore explore community-dwelling, older adults’ reasoning about end-of-life (EoL) values and preferences in ACP conversations. Research Design and Methods In this participatory action research project, planned and conducted in collaboration with national community-based organizations, we interviewed 65 older adults without known EoL care needs, about their values and preferences for future EoL care. Conversations were stimulated by sorting and ranking statements in a Swedish version of GoWish cards, called the DöBra cards, and verbatim transcripts were analyzed inductively. Results While participants shared some common preferences about EoL care, there was great variation among individuals in how they reasoned. Although EoL preferences and prioritizations could be identical, different individuals explained these choices very differently. We exemplify this variation using data from four participants who discussed their respective EoL preferences by focusing on either physical, social, existential, or practical implications. Discussion and Implications A previously undocumented benefit of the GoWish/DöBra cards is how the flexibility of the card statements support substantial discussion of an individual’s EoL preferences and underlying values. Such in-depth descriptions of participants’ reasoning and considerations are important for understanding the very individual nature of prioritizing EoL preferences. We suggest future users of the DöBra/GoWish cards consider the underlying reasoning of individuals’ prioritizations to strengthen person-centeredness in EoL conversations and care provision.

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How older patients prioritise their multiple health problems: a qualitative study

BMC Geriatrics ◽

10.1186/s12877-019-1373-y ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Ulrike Junius-Walker ◽

Tanja Schleef ◽

Ulrike Vogelsang ◽

Marie-Luise Dierks

Keyword(s):

Qualitative Study ◽

Psychological Adjustment ◽

Social Inclusion ◽

Qualitative Content Analysis ◽

Health Problems ◽

Health Issues ◽

Structured Interviews ◽

General Practices ◽

Negative Feelings ◽

Treatment Priorities

Abstract Background Patients with multimorbidity often receive diverse treatments; they are subjected to polypharmacy and to a high treatment burden. Hence it is advocated that doctors set individual health and treatment priorities with their patients. In order to apply such a concept, doctors will need a good understanding of what causes patients to prioritise some of their problems over others. This qualitative study explores what underlying reasons patients have when they appraise their health problems as more or less important. Methods We undertook semi-structured interviews with a purposive sample of 34 patients (aged 70 years and over) in German general practices. Initially, patients received a comprehensive geriatric assessment, on the basis of which they rated the importance of their uncovered health problems. Subsequently, they were interviewed as to why they considered some of their problems important and others not. Transcripts were analysed using qualitative content analysis. Results Patients considered their health problems important, if they were severe, constant, uncontrolled, risky or if they restricted daily activities, autonomy and social inclusion. Important problems often correlated with negative feelings. Patients considered problems unimportant, if they were related to a bearable degree of suffering, less restrictions in activities, or psychological adjustment to diseases. Altogether different reasons occurred on the subject of preventive health issues. Conclusions Patients assess health problems as important if they interfere with what they want from life (life values and goals). Psychological adjustment, by contrast, facilitates a downgrading of the importance. Asking patients with multimorbidity, which health problems are important, may guide physicians to treatment priorities and health problems in need of empowerment.

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“I’ve Heard of It, Yes, but I Can’t Remember What Exactly It Was”—A Qualitative Study on Awareness, Knowledge, and Use of the UV Index

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18041615 ◽

2021 ◽

Vol 18 (4) ◽

pp. 1615

Author(s):

Katharina Diehl ◽

Tatiana Görig ◽

Charlotte Jansen ◽

Maike Carola Hruby ◽

Annette B. Pfahlberg ◽

...

Keyword(s):

Qualitative Study ◽

Qualitative Content Analysis ◽

Sun Protection ◽

Structured Interviews ◽

Protection Factor ◽

Protection Measures ◽

Uv Index ◽

Correct Definition ◽

Definition Of

Pharmacists and pharmaceutical technicians play an important role in counselling customers regarding sunscreen use and sun protection measures. A potentially helpful tool that can be used during counselling is the ultraviolet index (UVI), which informs individuals when and what sun protection measures are needed at a specific place and time. Our aim in this qualitative study was to explore awareness, knowledge, and use of the UVI during counselling in pharmacies. We used semi-structured interviews with pharmacists and pharmaceutical technicians (n = 20) to answer our research questions. Interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis. During the interviews pharmacists and pharmaceutical technicians revealed a lot of uncertainty and lack of knowledge regarding the UVI. Eight professionals were able to give a correct definition of UVI. Amongst others, the UVI was confused with sun protection factor. Overall, the UVI was hardly used during the counselling of customers. The UVI was developed to provide guidance when which type of sun protection is required to avoid detrimental effects of ultraviolet radiation. For effective implementation, both the general population and health professionals (e.g., pharmacists) have to increase their knowledge about the UVI. This would strengthen its use during professional counselling in pharmacies and may help to reduce the incidence of skin cancer over the long term.

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Identifying ethical and legal issues in elder care

Nursing Ethics ◽

10.1177/0969733020981761 ◽

2021 ◽

pp. 096973302098176

Author(s):

Nertila Podgorica ◽

Emiljano Pjetri ◽

Andreas W Müller ◽

Daniela Deufert

Keyword(s):

Elder Care ◽

Qualitative Content Analysis ◽

Wide Spectrum ◽

Legal Education ◽

European Union Member State ◽

Patient Rights ◽

Legal Issues ◽

Structured Interviews ◽

Ethical Conflicts ◽

Ethical And Legal Issues

Background: As a non–European Union member state, Albania is increasingly orienting itself on Western models regarding human rights, patient rights, and legal regulations for healthcare. Due to its limited fiscal and legal power, enforcing legal and ethical regulations poses a major problem. Aim: The aim of this study is to investigate nurse’s knowledge and experiences regarding ethical and legal issues in Albanian elder care in state-funded and privately run institutions. Research design: The study was conducted using an inductive and qualitative design, utilizing a focused ethnographic approach, based on Roper and Shapira’s framework. Method: Data were collected between June 2017 and September 2018 using participant observation, field notes, and semi-structured interviews with 15 nurses in seven different elder care institutions. In total, 100 h of observation and 15 interviews were performed. Data analysis was based on Mayring’s qualitative content analysis. Ethical consideration: The approval for the study was obtained from UMIT—The Health and Life Sciences University, Austria. Findings: The findings of the study fell into the following main categories: “Everyday care issues,” “End-of-life issues,” “Legal issues,” and “Ethical-legal education and conflicts.” Discussion: The participants reported many ethical and legal issues when describing their everyday challenges and displayed a strong lack of ethical and legal education. Despite a wide spectrum in the quality of care between private and state-funded nursing homes, older people mostly do not know their own diagnosis. Conclusion: This study indicates that further ethical and legal education is needed. Furthermore, nurses need to be better prepared for ethical conflicts with families, as strengthening patient rights could come into conflict with traditional rights of the Albanian family.

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From the Frontlines: A Qualitative Study of Staff Experiences With Clinical Event Debriefing

Hospital Pediatrics ◽

10.1542/hpeds.2021-006088 ◽

2021 ◽

Author(s):

Meghan M. Galligan ◽

Mary Haggerty ◽

Heather A. Wolfe ◽

Dawn Debrocco ◽

Katherine Kellom ◽

...

Keyword(s):

Qualitative Study ◽

Inductive Reasoning ◽

Improve Patient Care ◽

Barriers And Facilitators ◽

Clinical Event ◽

Frontline Staff ◽

Factors Affecting ◽

Participant Engagement ◽

Practice Recommendations ◽

Staff Experiences

OBJECTIVES Clinical event debriefing (CED) can improve patient care and outcomes, but little is known about CED across inpatient settings, and participant experiences have not been well described. In this qualitative study, we sought to characterize and compare staff experiences with CED in 2 hospital units, with a goal of generating recommendations for a hospital-wide debriefing program. METHODS We conducted 32 semistructured interviews with clinical staff who attended a CED in the previous week. We explored experiences with CED, with a focus on barriers and facilitators. We used content analysis with constant comparative coding to understand priorities identified by participants. We used inductive reasoning to develop a set of CED practice recommendations to match participant priorities. RESULTS Three primary themes emerged related to CED barriers and facilitators. (1) Factors affecting attendance: most respondents voiced a need for frontline staff inclusion in CED, but they also cited competing clinical duties and scheduling conflicts as barriers. (2) Factors affecting participant engagement: respondents described factors that influence participant engagement in reflective discussion. They described that the CED leader must cultivate a psychologically safe environment in which participants feel empowered to speak up, free from judgment. (3) Factors affecting learning and systems improvement: respondents emphasized that the CED group should generate a plan for improvement with accountable stakeholders. Collectively, these priorities propose several recommendations for CED practice, including frontline staff inclusion. CONCLUSIONS In this study, we propose recommendations for CED that are derived from first-hand participant experiences. Future study will explore implementation of CED practice recommendations.

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Different forms of informal coercion in psychiatry – a qualitative study

10.21203/rs.2.17476/v1 ◽

2019 ◽

Author(s):

Veikko Pelto-Piri ◽

Lars Kjellin ◽

Ulrika Hylén ◽

Emanuele Valenti ◽

Stefan Priebe

Keyword(s):

Mental Health ◽

Content Analysis ◽

Focus Group ◽

Qualitative Study ◽

Mental Health Professionals ◽

Health Professionals ◽

Qualitative Content Analysis ◽

Focus Group Interviews ◽

Informal Coercion ◽

Group Interviews

Abstract Objectives The objective of the study was to investigate how mental health professionals describe and reflect upon different forms of informal coercion. Results In a deductive qualitative content analysis of focus group interviews, several examples of persuasion, interpersonal leverage, inducements, and threats were found. Persuasion was sometimes described as being more like a negotiation. Some participants worried about that the use of interpersonal leverage and inducements risked to pass into blackmail in some situations. In a following inductive analysis, three more categories of informal coercion was found: cheating, using a disciplinary style and referring to rules and routines. Participants also described situations of coercion from other stakeholders: relatives and other authorities than psychiatry. The results indicate that informal coercion includes forms that are not obviously arranged in a hierarchy, and that its use is complex with a variety of pathways between different forms before treatment is accepted by the patient or compulsion is imposed.

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Parental experience of the neuromotor development of children with congenital heart disease: an exploratory qualitative study

BMC Pediatrics ◽

10.1186/s12887-021-02808-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Elena Mitteregger ◽

Martina Wehrli ◽

Manuela Theiler ◽

Jana Logoteta ◽

Irina Nast ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Qualitative Study ◽

Motor Development ◽

Congenital Heart ◽

Healthcare Professionals ◽

Qualitative Content Analysis ◽

First Year ◽

First Year Of Life ◽

Neuromotor Development

Abstract Background Children with severe congenital heart disease (CHD) are a group of children at risk for neurodevelopmental impairments. Motor development is the first domain to show a delay during the first year of life and may significantly contribute to parental concerns, stress, and difficulties in early child-parent attachment. Thus, the aim of the study was to better understand the wishes and concerns of parents of children with CHD and explore their experience of their children’s neuromotor development in the first year of life. Methods In this qualitative study, fourteen families were recruited. Their children were aged 1–3 years and had undergone open heart surgery within the first 6 months of life. Semi-structured interviews were audio-recorded and transcribed. The data was explored within an expert group, and a qualitative content analysis was conducted using VERBI MAXQDA software 2020. The study was conducted in accordance with the COREQ checklist. Results Parents of children with CHD reported several burdens and needs. Parental burdens concerned the child’s motor development, their own physical and psychological strain, and difficulties in communication with healthcare professionals. The needs, parents reported included supporting their child’s motor development, a medical coordinator, and better communication between healthcare professionals and parents. During the first phase of their children’s illness, parents underwent a dynamic transitional phase and expressed the need to rely on themselves, to trust their children’s abilities, and to regain self-determination in order to strengthen their self-confidence. Conclusions It is essential to involve parents of children with CHD at an early stage of decision-making. Parents are experts in their children and appreciate medical information provided by healthcare professionals. Interprofessional teamwork, partnering with parents, and continuous support are crucial to providing the best possible care for children and their families. Family-centred early motor intervention for CHD children might counteract the effect of parental overprotection and improve children’s motor development and thus strengthen child-parent interaction. In future work, we aim to evaluate a family-centred early motor intervention for children with CHD developed on the basis of this qualitative study. Trial registration Not applicable.

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Task shifting of intravitreal injections from physicians to nurses: a qualitative study

BMC Health Services Research ◽

10.1186/s12913-021-07203-8 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stine Bolme ◽

Dordi Austeng ◽

Kari Hanne Gjeilo

Keyword(s):

Qualitative Study ◽

Training Program ◽

Qualitative Content Analysis ◽

High Volume ◽

Tertiary Hospital ◽

Intravitreal Injections ◽

Vascular Endothelial ◽

Quality Patient Care ◽

Endothelial Growth Factor ◽

Training Efficiency

Abstract Background Intravitreal injections of anti-vascular endothelial growth factor are high-volume procedures and represent a considerable workload on ophthalmology departments. Several departments have tried to meet this increase by shifting the task to nurses. To maintain high-quality patient care, we developed a training program for nurses that certifies them to administer injections. This qualitative study aimed to evaluate whether the nurses were confident and in control after participating in the training program and whether they were satisfied with the training and the new task. Methods Between 2014 and 2018, 12 registered nurses were trained in a tertiary hospital in central Norway. All the nurses were interviewed, either individually (n = 7) or in a group (n = 5). We analysed the interviews using Graneheim and Lundman’s qualitative content analysis. Results Eight subthemes were clustered within four main themes: 1) procedure and challenges, 2) motivation, 3) cooperation and confidence, and 4) evaluation. The nurses felt confident and in control when administering injections but experienced moments of insecurity. The new task gave the nurses a sense of achievement, and they highlighted improvement of patients’ lives as positive. A greater level of responsibility gave the nurses pride in their profession. They had suggestions that could improve training efficiency but were overall satisfied with the training program. Conclusions Our study showed that the nurses were satisfied with the training and that learning a new task led to higher self-esteem and increased respect from patients and colleagues. Suggestions to improve the training were identified; these should be considered before implementation by other departments.

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Getting Performance Metrics Right: A Qualitative Study of Staff Experiences Implementing and Measuring Practice Transformation

Journal of General Internal Medicine ◽

10.1007/s11606-013-2764-y ◽

2014 ◽

Vol 29 (S2) ◽

pp. 607-613 ◽

Cited By ~ 15

Author(s):

Devan Kansagara ◽

Anaïs Tuepker ◽

Sandy Joos ◽

Christina Nicolaidis ◽

Eleni Skaperdas ◽

...

Keyword(s):

Qualitative Study ◽

Performance Metrics ◽

Staff Experiences

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Factors Affecting Nurses’ Perceived Organizational Commitment: A Qualitative Study

Bangladesh Journal of Medical Science ◽

10.3329/bjms.v18i2.40701 ◽

2019 ◽

Vol 18 (2) ◽

pp. 303-311 ◽

Cited By ~ 1

Author(s):

Faribah Sepahvand ◽

Foorozan Atashzadeh Shoorideh ◽

Soroor Parvizy ◽

Mansoureh Zagheri Tafreshi

Keyword(s):

Content Analysis ◽

Organizational Commitment ◽

Qualitative Study ◽

Nurse Managers ◽

Qualitative Content Analysis ◽

Medical Science ◽

Organizational Factors ◽

Structured Interviews ◽

Factors Affecting ◽

Clinical Nurses

Objective: Nurses’ organizational commitment is one of the most important factors that facilitates their professional evolution and influences the method of care provision, quality of care, and patients’ satisfaction. The aim of this study was identified the factors that affect nurses’ perceived organizational commitment. Material and Methods: This qualitative study, conducted on 16 clinical nurses employed in Social Security Hospital of Khorramabad, Iran, during five months from May to September 2015, used deep semi-structured interviews. Purposive sampling method was used for the selection of nurses and the data were analyzed using conventional qualitative content analysis. Lincoln & Guba’s criteria were used to secure data accuracy and stability. Results: Sixteen subcategories, five categories, and three themes were distilled during content analysis process. The abstracted themes included “organizational factors”, “occupational challenges”, and “contributory management”. Conclusion: Our findings showed that numerous factors present in nurses’ profession and work environment may influence the rate of nurses’ interest and commitment in the hospital and the related organization. Hence, nurse managers can foster the promotion of nurses’ organizational commitment through creating the required suitable conditions. Bangladesh Journal of Medical Science Vol.18(2) 2019 p.303-311

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