Lessons Learned and Implications of Function Focused Care based Programs of Various Nursing Care Settings: A Thematic Synthesis

2021 ◽  
Vol 6 (2) ◽  
Author(s):  
Vluggen S ◽  
◽  
Heinen M ◽  
Metzelthin S ◽  
Huisman-de Waal G ◽  
...  
Keyword(s):  
Behavior Change ◽  
Focus Groups ◽  
Goal Setting ◽  
Lessons Learned ◽  
Thematic Synthesis ◽  
Clinical Nursing ◽  
Setting Process ◽  
Facilitators And Barriers ◽  
The Impact ◽  
Educational Component

Background and Objective: Function-Focused Care (FFC) aims to optimize daily functioning of older people by changing clinical nursing practice of care professionals. Recently, three multicomponent FFC-programs were implemented in the Dutch home, nursing home, and hospital care setting. Process evaluations were conducted including eight focus groups with 45 care professionals and one focus group with 8 involved researchers. The objective was to synthesize findings and provide lessons learned and implications to optimize future programs. Methods: A thematic synthesis was conducted of nine focus groups using the COREQ checklist. Deductive coding analysis was applied using Nvivo Software. Results: Six themes emerged from the focus groups: four related to those components to be preserved in future programs (policy and environment, education, goal setting, and coaching), and two related to the impact of FFCprograms, and its facilitators and barriers in practice. FFC-related policy and a facilitating environment were considered prerequisites to successfully implement FFC. Education sessions could be improved by being more interactive, containing sufficient behavior change components, and tailoring its content to participants’ needs. Goal setting was poorly delivered and should receive more attention in practice. Coaching was considered pivotal to consolidate FFC in practice. Conclusions and relevance to clinical practice: We suggest to develop an advanced FFC-program for various care settings, which allows for tailoring to setting-specific elements and requirements of participants. Lessons learned include addressing all FFC-components jointly, including a comprehensive interactive educational component that primarily focusses on behavior change in care professionals. Managers should support FFC in practice by ensuring sufficient time and staff resources.

scholarly journals An Evaluation of a Scottish Higher Education ‘Student Transitions’ Enhancement Theme: Stakeholders’ Perceptions and Recommendations for Future Activities

2017 ◽  
Vol 5 (2) ◽  
Author(s):  
Ashley Dennis ◽  
Lisi Gordon ◽  
Stella Howden ◽  
Divya Jindal-Snape
Keyword(s):  
Higher Education ◽  
Academic Staff ◽  
Learning Experience ◽  
Phase 1 ◽  
Lessons Learned ◽  
Education Student ◽  
Quality Assurance Agency ◽  
Facilitators And Barriers ◽  
The Impact ◽  
Student Transitions

The Quality Assurance Agency Enhancement Themes identify specific development themes to enhance the student learning experience in Scottish higher education (HE). This evaluation explored the second year of the ‘Student Transitions’ theme through the questions: How do stakeholders perceive the impact of the ‘Student Transitions’ work and, what are the facilitators and barriers to the successful development of projects? Data were collected during two overlapping phases. In Phase 1, 30 individuals, with national or institutional leadership roles associated with the current Enhancement Theme participated in semi-structured telephone interviews. In Phase 2, 43 online questionnaires were completed by institutionally nominated individuals. Professional, support and academic staff, and student representatives from all 19 Scottish Universities participated. Data were analysed using a thematic framework approach and descriptive statistics. Themes developed were: perceived impact; facilitators and barriers, such as support, engagement and sustainability. These themes were explored across institutions and sector wide. Participants felt ‘Student Transitions’ work was fundamental for Universities. Participants considered that Theme work had enhanced reflection on, and engagement with transition issues. Capturing direct impact was challenging for participants and it was proposed that it may take several years to evidence the outcomes of the work at the level of student experience. Broadly, participants reported that the sector was supportive and collaborative where ideas and resources for the ‘Student Transitions’ work had been openly shared. Challenges to advancing Enhancement Theme activities include limited time and other agendas competing for limited resources e.g. the Teaching Excellence Framework (TEF). The findings highlight the complexity of integrating the Theme within institutions and broadly across the sector. Key recommendations and lessons learned surround 1) defining and measuring impact; 2) enhancing engagement; 3) and Theme integration.

scholarly journals Engaging Stakeholders in a Pragmatic Trial of Home-Delivered Meals for Persons with Dementia

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 919-919
Author(s):  
Jill Harrison ◽  
Kathleen McAuliff ◽  
Kali Thomas
Keyword(s):  
Pragmatic Trial ◽  
Lessons Learned ◽  
Advisory Panel ◽  
Age In Place ◽  
Meals On Wheels ◽  
Potential Benefits ◽  
Facilitators And Barriers ◽  
Home Placement ◽  
The Impact ◽  
Research Team Member

Abstract Gathering stakeholder feedback is essential to designing and implementing relevant and actionable research. Additionally, stakeholders, particularly those directly impacted by an intervention, bring unique insights and experiences. This paper presents the process and findings of a research endeavor to co-design a pragmatic clinical trial with a Stakeholder Advisory Panel (SAP) in an effort to understand facilitators and barriers to conducting the research and implementing study findings. The proposed trial compares the impact of frozen, drop-shipped meals versus daily home-delivered meals provided by Meals on Wheels (MOW) programs on the ability of individuals living with dementia to age in place. We recruited nine SAP members, who were compensated for their time. The SAP is composed of a) MOW clients with dementia, b) family members of MOW clients with dementia, c) paid or volunteer MOW drivers, and d) MOW staff. A research team member facilitated two 90-minute meetings with the SAP members via Zoom. The topics of the meetings included potential benefits and challenges with each mode of meal delivery, the importance of the primary outcome (time to nursing home placement), topics of interest to include in interviews with clients and caregivers, and how participants would explain the study to a friend. Audio of the Zoom meetings was transcribed, and meeting summaries were shared with the SAP. Benefits of forming and engaging a SAP, as well as key lessons learned from SAP members and how recommendations were reflected in changes to the study protocol will be discussed.

scholarly journals Evaluating the Impact of Goal Setting on Improving Diet Quality in Chronic Kidney Disease

2021 ◽  
Vol 8 ◽  
Author(s):  
Chi H. Chan ◽  
Marguerite Conley ◽  
Marina M. Reeves ◽  
Katrina L. Campbell ◽  
Jaimon T. Kelly
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Behavior Change ◽  
Goal Setting ◽  
Diet Quality ◽  
Healthy Eating Index ◽  
Text Messages ◽  
Fiber Intake ◽  
Patient Centered ◽  
The Impact

Background: Improving diet quality in chronic kidney disease (CKD) is challenging due to a myriad of competing recommendations. Patient-centered goal setting can facilitate dietary behavior change; however, its role in improving diet quality in CKD has not been investigated.Aim: The aim of the study is to evaluate the effects of goal setting on improving diet quality in stages 3–4 CKD.Methods: Forty-one participants completed a 6-month dietitian-led telehealth (combined coaching calls and text messages) intervention as part of a larger RCT. Participants set one to two diet-related SMART goals and received weekly goal tracking text messages. Dietary intake was assessed using the Australian Eating Survey at baseline, 3, and 6 months, with diet quality determined using the Alternate Healthy Eating Index (AHEI).Results: Significant improvements in AHEI (+6.9 points; 95% CI 1.2–12.7), vegetable (+1.1 serves; 95% CI 0.0–2.3) and fiber intake (+4.2 g; 95% CI 0.2–8.2) were observed at 3 months in participants setting a fruit and/or vegetable goal, compared with those who did not. However, no significant or meaningful changes were observed at 6 months. No other goal setting strategy appeared in effect on diet intake behavior or clinical outcomes in this group of CKD participants.Conclusions: Patient-centered goal setting, particularly in relation to fruit and vegetable intake, as part of a telehealth coaching program, significantly improved diet quality (AHEI), vegetable and fiber intake over 3 months. More support may be required to achieve longer-term behavior change in stages 3–4 CKD patients.

scholarly journals Implementation of a behavioral medicine approach in physiotherapy: a process evaluation of facilitation methods

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Johanna Fritz ◽  
Lars Wallin ◽  
Anne Söderlund ◽  
Lena Almqvist ◽  
Maria Sandborgh
Keyword(s):  
Behavior Change ◽  
Behavioral Medicine ◽  
Goal Setting ◽  
Behavioral Change ◽  
Time Management ◽  
Educational Materials ◽  
Clinical Behavior ◽  
Quasi Experimental ◽  
The Impact ◽  
Outreach Visits

Abstract Background In a quasi-experimental study, facilitation was used to support implementation of the behavioral medicine approach in physiotherapy. The facilitation consisted of an individually tailored multifaceted intervention including outreach visits, peer coaching, educational materials, individual goal-setting, video feedback, self-monitoring in a diary, manager support, and information leaflets to patients. A behavioral medicine approach implies a focus on health related behavior change. Clinical behavioral change was initiated but not maintained among the participating physiotherapists. To explain these findings, a deeper understanding of the implementation process is necessary. The aim was therefore to explore the impact mechanisms in the implementation of a behavioral medicine approach in physiotherapy by examining dose, reach, and participant experiences. Methods An explorative mixed-methods design was used as a part of a quasi-experimental trial. Twenty four physiotherapists working in primary health care were included in the quasi-experimental trial, and all physiotherapists in the experimental group (n = 15) were included in the current study. A facilitation intervention based mainly on social cognitive theory was tested during a 6-month period. Data were collected during and after the implementation period by self-reports of time allocation regarding participation in different implementation methods, documentation of individual goals, ranking of the most important implementation methods, and semi-structured interviews. Descriptive statistical methods and inductive content analysis were used. Results The physiotherapists participated most frequently in the following implementation methods: outreach visits, peer coaching, educational materials, and individual goal-setting. They also considered these methods to be the most important for implementation, contributing to support for learning, practice, memory, emotions, self-management, and time management. However, time management support from the manager was lacking. Conclusions The findings indicate that different mechanisms govern the initiation and maintenance of clinical behavior change. The impact mechanisms for initiation of clinical behavior change refers to the use of externally initiated multiple methods, such as feedback on practice, time management, and extrinsic motivation. The lack of self-regulation capability, intrinsic motivation, and continued support after the implementation intervention period were interpreted as possible mechanisms for the failure of maintaining the behavioral change over time.

scholarly journals Setting goals with patients living with multimorbidity: qualitative analysis of general practice consultations

2019 ◽  
Vol 69 (684) ◽  
pp. e479-e488 ◽  
Author(s):  
Charlotte Salter ◽  
Alice Shiner ◽  
Elizabeth Lenaghan ◽  
Jamie Murdoch ◽  
John A Ford ◽  
...  
Keyword(s):  
General Practice ◽  
Qualitative Analysis ◽  
Focus Groups ◽  
Goal Setting ◽  
Action Planning ◽  
Feasibility Trial ◽  
Patient Goals ◽  
Setting Process ◽  
The Individual ◽  
Time And Energy

BackgroundEstablishing patient goals is widely recommended as a way to deliver care that matters to the individual patient with multimorbidity, who may not be well served by single-disease guidelines. Though multimorbidity is now normal in general practice, little is known about how doctors and patients should set goals together.AimTo determine the key components of the goal-setting process in general practice.Design and settingIn-depth qualitative analysis of goal-setting consultations in three UK general practices, as part of a larger feasibility trial. Focus groups with participating GPs and patients. The study took place between November 2016 and July 2018.MethodActivity analysis was applied to 10 hours of video-recorded doctor–patient interactions to explore key themes relating to how goal setting was attempted and achieved. Core challenges were identified and focus groups were analysed using thematic analysis.ResultsA total of 22 patients and five GPs participated. Four main themes emerged around the goal-setting process: patient preparedness and engagement; eliciting and legitimising goals; collaborative action planning; and GP engagement. GPs were unanimously positive about their experience of goal setting and viewed it as a collaborative process. Patients liked having time to talk about what was most important to them. Challenges included eliciting goals from unprepared patients, and GPs taking control of the goal rather than working through it with the patient.ConclusionGoal setting required time and energy from both parties. GPs had an important role in listening and bearing witness to their patients’ goals. Goal setting worked best when both GP and patient were prepared in advance.

Justice in the goal-setting process

2003 ◽  
Author(s):  
Andrew Li ◽  
Adam B. Butler
Keyword(s):  
Goal Setting ◽  
Setting Process

59. General medicine residents' perception of the mini-CEXs

2007 ◽  
Vol 30 (4) ◽  
pp. 61
Author(s):  
S. Malhotra ◽  
R. Hatala ◽  
C.-A. Courneya
Keyword(s):  
Internal Medicine ◽  
Medical Education ◽  
Focus Group ◽  
Qualitative Study ◽  
Focus Groups ◽  
General Medicine ◽  
Clinical History ◽  
Phenomenological Approach ◽  
Medical Teacher ◽  
The Impact

The mini-CEX is a 30 minute observed clinical encounter. It can be done in the outpatient, inpatient or emergency room setting. It strives to look at several parameters including a clinical history, physical, professionalism and overall clinical competence. Trainees are rated using a 9-point scoring system: 1-3 unsatisfactory, 4-6 satisfactory and 7-9 superior. Eight months after the introduction of the mini-CEX to the core University of British Columbia Internal Medicine Residents, a one hour semi-structured focus group for residents in each of the three years took place. The focus groups were conducted by an independent moderator, audio-recorded and transcribed. Using a phenomenological approach the comments made by the focus groups participants were read independently by three authors, organized into major themes. In doing so, several intriguing common patterns were revealed on how General Medicine Residents perceive their experience in completing a mini-CEX. The themes include Education, Assessment and Preparation for the Royal College of Physicians and Surgeons Internal Medicine exam. Resident learners perceived that the mini-CEX process provided insight into their clinical strengths and weaknesses. Focus group participants favored that the mini-CEX experience will benefit them in preparation, and successful completion of their licensing exam. Daelmans HE, Overmeer RM, van der Hem-Stockroos HH, Scherpbier AJ, Stehouwer CD, van der Vleuten CP. In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation. Medical Education 2006; 40(1):51-8. De Lima AA, Henquin R, Thierer J, Paulin J, Lamari S, Belcastro F, Van der Vleuten CPM. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher January 2005; 27(1):46-52. DiCicco-Bloom B, Crabtree BF. The Qualitative Research Interview. Medical Education 2006; 40:314-32.

Characteristics of Physician Relocation Following Hurricane Katrina

2009 ◽  
Vol 95 (1) ◽  
pp. 6-12
Author(s):  
Kusuma Madamala ◽  
Claudia R. Campbell ◽  
Edbert B. Hsu ◽  
Yu-Hsiang Hsieh ◽  
James James
Keyword(s):  
Hurricane Katrina ◽  
Gulf Coast ◽  
General Medicine ◽  
The United States ◽  
Lessons Learned ◽  
Bivariate Analysis ◽  
Fisher Exact Test ◽  
Exact Test ◽  
Factors Associated ◽  
The Impact

ABSTRACT Introduction: On Aug. 29, 2005, Hurricane Katrina made landfall along the Gulf Coast of the United States, resulting in the evacuation of more than 1.5 million people, including nearly 6000 physicians. This article examines the relocation patterns of physicians following the storm, determines the impact that the disaster had on their lives and practices, and identifies lessons learned. Methods: An Internet-based survey was conducted among licensed physicians reporting addresses within Federal Emergency Management Agency-designated disaster zones in Louisiana and Mississippi. Descriptive data analysis was used to describe respondent characteristics. Multivariate logistic regression was performed to identify the factors associated with physician nonreturn to original practice. For those remaining relocated out of state, bivariate analysis with x2 or Fisher exact test was used to determine factors associated with plans to return to original practice. Results: A total of 312 eligible responses were collected. Among disaster zone respondents, 85.6 percent lived in Louisiana and 14.4 percent resided in Mississippi before the hurricane struck. By spring 2006, 75.6 percent (n = 236) of the respondents had returned to their original homes, whereas 24.4 percent (n = 76) remained displaced. Factors associated with nonreturn to original employment included family or general medicine practice (OR 0.42, 95 percent CI 0.17–1.04; P = .059) and severe or complete damage to the workplace (OR 0.24, 95 percent CI 0.13–0.42; P < .001). Conclusions: A sizeable proportion of physicians remain displaced after Hurricane Katrina, along with a lasting decrease in the number of physicians serving in the areas affected by the disaster. Programs designed to address identified physician needs in the aftermath of the storm may give confidence to displaced physicians to return.

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