scholarly journals Proactive frailty identification – a good idea? A sequential mixed-methods study of GP views

2021 ◽  
pp. BJGP.2020.0178
Author(s):  
Ebrahim Mulla ◽  
Elizabeth Orton ◽  
Denise Kendrick
Keyword(s):  
Mixed Methods ◽  
Risk Stratification ◽  
Independent Living ◽  
Structured Interview ◽  
Mixed Methods Study ◽  
Framework Analysis ◽  
Online Questionnaire ◽  
East Midlands ◽  
Sequential Mixed Methods ◽  
The Impact

Background: In England, general practitioners (GPs) are independent contractors working to a national contract. Since 2017 the contract requires GPs to use electronic tools to proactively identify moderate and severe frailty in people aged 65 and over and offer interventions to help those identified to stay well and maintain independent living. Little is currently known about GPs’ views of this contractual requirement. Aim: To explore GPs’ views of identifying frailty and offering interventions for those living with moderate or severe frailty. Design and setting: Sequential mixed-methods study of GPs in the East Midlands region of England (Derbyshire, Leicestershire, Lincolnshire, Nottinghamshire, Northamptonshire) between January and May 2019. Methods: Survey of GPs by online questionnaire, followed by semi-structured interview. Based on survey responses GPs with a range of views on identifying frailty, GP and practice characteristics, were selected for interview. Questionnaires were analysed using descriptive statistics. Interview transcripts were analysed using framework analysis. Results: 188 (6.1%) GPs responded to the survey and 18 GPs were interviewed. GPs were broadly supportive of identifying frailty, but felt risk-stratification tools lacked sensitivity and specificity and wanted evidence showing clinical benefit. Frailty identification increased workload and was under-resourced, with limited time for, and access to necessary interventions. GPs felt they lacked knowledge about frailty and more education was required. Conclusion: Proactively identifying and responding to frailty in primary care requires GP education, highly sensitive and specific risk-stratification tools, access to interventions to lessen the impact of frailty and adequate resourcing to achieve its potential clinical impact.

scholarly journals Does de-implementation of low-value care impact the patient-clinician relationship? A mixed methods study

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Michelle S. Rockwell ◽  
Kenan C. Michaels ◽  
John W. Epling
Keyword(s):  
Primary Care ◽  
Vitamin D ◽  
Mixed Methods ◽  
Quality Care ◽  
Structured Interview ◽  
Mixed Methods Study ◽  
Primary Care Clinician ◽  
Minimal Impact ◽  
Broad Concept ◽  
The Impact

Abstract Background The importance of reducing low-value care (LVC) is increasingly recognized, but the impact of de-implementation on the patient-clinician relationship is not well understood. This mixed-methods study explored the impact of LVC de-implementation on the patient-clinician relationship. Methods Adult primary care patients from a large Virginia health system volunteered to participate in a survey (n = 232) or interview (n = 24). Participants completed the Patient-Doctor Relationship Questionnaire (PDRQ-9) after reading a vignette about a clinician declining to provide a low-value service: antibiotics for acute sinusitis (LVC-antibiotics); screening EKG (LVC-EKG); screening vitamin D test (LVC-vitamin D); or an alternate vignette about a high-value service, and imagining that their own primary care clinician had acted in the same manner. A different sample of participants was asked to imagine that their own primary care clinician did not order LVC-antibiotics or LVC-EKG and then respond to semi-structured interview questions. Outcomes data included participant demographics, PDRQ-9 scores (higher score = greater relationship integrity), and content analysis of transcribed interviews. Differences in PDRQ-9 scores were analyzed using one-way ANOVA. Data were integrated for analysis and interpretation. Results Although participants generally agreed with the vignette narrative (not providing LVC), many demonstrated difficulty comprehending the broad concept of LVC and potential harms. The topic triggered memories of negative experiences with healthcare (typically poor-quality care, not necessarily LVC). The most common recommendation for reducing LVC was for patients to take greater responsibility for their own health. Most participants believed that their relationship with their clinician would not be negatively impacted by denial of LVC because they trusted their clinician’s guidance. Participants emphasized that trusted clinicians are those who listen to them, spend time with them, and offer understandable advice. Some felt that not providing LVC would actually increase their trust in their clinician. Similar PDRQ-9 scores were observed for LVC-antibiotics (38.9), LVC-EKG (37.5), and the alternate vignette (36.4), but LVC-vitamin D was associated with a significantly lower score (31.2) (p < 0.05). Conclusions In this vignette-based study, we observed minimal impact of LVC de-implementation on the patient-clinician relationship, although service-specific differences surfaced. Further situation-based research is needed to confirm study findings.

scholarly journals Does De-Implementation of Low Value Care Impact the Patient-Clinician Relationship? A Mixed Methods Study

2021 ◽  
Author(s):  
Michelle S. Rockwell ◽  
Kenan C. Michaels ◽  
John W. Epling
Keyword(s):  
Primary Care ◽  
Vitamin D ◽  
Mixed Methods ◽  
Quality Care ◽  
Structured Interview ◽  
Mixed Methods Study ◽  
Primary Care Clinician ◽  
Minimal Impact ◽  
Broad Concept ◽  
The Impact

Abstract Background: The importance of reducing low-value care (LVC) is increasingly recognized, but the impact of de-implementation on the patient-clinician relationship is not well understood. This mixed-methods study explored the impact of LVC de-implementation on the patient-clinician relationship. Methods: Adult primary care patients from a large Virginia health system volunteered to participate in a survey (n=232) or interview (n=24). Participants completed the Patient-Doctor Relationship Questionnaire (PDRQ-9) after reading a vignette about a clinician declining to provide a low-value service: antibiotics for acute sinusitis (LVC-antibiotics); screening EKG (LVC-EKG); screening vitamin D test (LVC-vitamin D); or a comparison vignette about a high-value service, and imagining that their own primary care clinician had acted in the same manner. A different sample of participants was asked to imagine that their own primary care clinician did not order LVC-antibiotics or LVC-EKG and then respond to semi-structured interview questions. Outcomes data included participant demographics, PDRQ-9 scores (higher score = greater relationship integrity), and content analysis of transcribed interviews. Differences in PDRQ-9 scores were analyzed using one-way ANOVA. Data were integrated for analysis and interpretation. Results: Although participants generally agreed with the vignette narrative (not providing LVC), many demonstrated difficulty comprehending the broad concept of LVC and potential harms. The topic triggered memories of negative experiences with healthcare (typically poor-quality care, not necessarily LVC). The most common recommendation for reducing LVC was for patients to take greater responsibility for their own health. Most participants believed that their relationship with their clinician would not be negatively impacted by not receiving the described service because they trusted their clinician’s guidance. Participants emphasized that trusted clinicians are those who listen to them, spend time with them, and offer understandable advice. Some felt that not providing LVC would actually increase their trust in their clinician. Similar PDRQ-9 scores were observed for LVC-antibiotics (38.9), LVC-EKG (37.5), and the comparison vignette (36.4), but LVC-vitamin D was associated with a significantly lower score (31.2) (p<0.05). Conclusions: Findings suggest minimal impact of LVC de-implementation on the patient-clinician relationship, although service-specific differences may exist. Further research on enhancing patient trust through LVC de-implementation is needed.

scholarly journals Carers using assistive technology in dementia care: an explanatory sequential mixed methods study

2021 ◽  
Author(s):  
Vimal Sriram ◽  
Crispin Jenkinson ◽  
Michele Peters
Keyword(s):  
Mixed Methods ◽  
Assistive Technology ◽  
Short Form ◽  
Mixed Methods Study ◽  
Sequential Mixed Methods ◽  
Informal Carers ◽  
The Uk ◽  
Person With Dementia ◽  
The Impact ◽  
Component Scores

AbstractINTRODUCTIONInformal carers support persons with dementia to live at home, even with deteriorating physical and cognitive issues. The purpose of this explanatory sequential mixed methods study is to examine the experiences and impact of Assistive Technology (AT) on carers, providing care for a person with dementia.METHODSThe quantitative phase was a survey carried out with carers of persons with dementia in the UK, who used AT. The qualitative phase involved in-depth telephone interviews with a purposive sample of survey respondents. Data was analysed using hermeneutic phenomenology to develop, compare and explain the findings of the survey.RESULTSThe survey included data from 201 carers. Smartphones and tablet computers were the most frequently used AT. Multiple AT were used in the care of persons with dementia predominantly for safety, communication, and reminders. The Short Form-12 questions in the survey showed that carers in the 46-65 age group and carers who were not extremely satisfied with AT had lower mental component scores and carers who lived with the person with dementia and older carers had lower physical component scores. Twenty-three carers participated in the interviews, and 5 themes with 14 sub-themes were identified. The interviews helped confirm data from the survey on the impact of AT on the physical, mental and social wellbeing of the carers. It helped describe reasons for satisfaction with AT; how AT was used in daily life and strengthened caring relationships; and how wider support systems enhanced the care of a person with dementia using AT.CONCLUSIONSThis study describes the use of AT in the real-world context. AT supplements the care provided to a person with dementia in the community. Appropriate use, access to AT and abilities of the carer can enhance the support provided through AT to both carers and the person with dementia.

scholarly journals The Impact of Ambassador Animal Facilitated Programs on Visitor Curiosity and Connections: A Mixed-Methods Study

2021 ◽  
Vol 8 (4) ◽  
pp. 558-575
Author(s):  
Shelley J. Rank ◽  
Su-Jen Roberts ◽  
Katherine Manion
Keyword(s):  
Mixed Methods ◽  
Mixed Methods Research ◽  
Research Study ◽  
Mixed Methods Study ◽  
Affective Outcomes ◽  
Close Encounters ◽  
Sequential Mixed Methods ◽  
The Impact ◽  
Broad Interest

Many zoos and aquariums offer opportunities for visitors to have up-close encounters with ambassador animals; however, the impacts of these experiences on visitors’ connections to animals are not well documented. We used observations and family interviews in a sequential mixed-methods research study to explore how animal ambassador programs impact participants. We found that the type of ambassador animal did not affect the number of questions or comments made by participants during programs, suggesting broad interest in animals. Programs in which facilitators prompted participants with questions were especially successful at eliciting questions and guiding the topics of those questions, fueling deeper curiosity. Interviewees described themselves as “animal people” and self-reported practicing conservation behaviors, suggesting that their animal affiliative and pro-environmental identities could be leveraged to discuss conservation issues and encourage solutions-based behaviors. Lastly, opportunities to meet ambassador animals increased participants’ feelings of connecting to animals, building on previous research and corroborating findings. Programs should consider how to further build on these positive learning and affective outcomes by capitalizing on opportunities to provide deep insights into conservation issues and actions related to the ambassador animals.

scholarly journals Exploring the Dynamic Interplay Between Foreign Language Enjoyment and Learner Engagement With Regard to EFL Achievement and Absenteeism: A Sequential Mixed Methods Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Yunxian Guo
Keyword(s):  
Mixed Methods ◽  
Second Language Acquisition ◽  
Foreign Language ◽  
Language Learners ◽  
Well Being ◽  
Structured Interview ◽  
Mixed Methods Study ◽  
Future Research ◽  
Learner Engagement ◽  
Sequential Mixed Methods

Scholarly attention to the feeling of enjoyment experienced in second language acquisition (SLA) has sharply increased in the past 5 years owing to its positive effect on facilitating academic outcomes as well as promoting language learners' well-being. This sequential mixed methods study aims to examine the interplay between Foreign language enjoyment (FLE) and learner engagement (LE) as well as their combined effects on participants' EFL achievement and absenteeism. To this end, we administrated a questionnaire containing the adapted FLE Scale and the four-aspect engagement inventory among 707 Chinese university students and a semi-structured interview among 28 of them. Statistical analysis revealed that FLE was highly and positively correlated with LE, and the causal relationship between the two constructs was reciprocal. Furthermore, both FLE and LE had low correlations with participants' academic achievements, but no significant correlation was found between FLE or LE and absenteeism. However, a higher level of FLE-social was associated with a lower level of absenteeism. Finally, no gender differences were found either in the level FLE or in that of LE. The thematic analysis indicated that FLE was subject substantially to teacher-related variables and the second most significant attractor of FLE was FLE-self. Analysis of the trends of LE indicated that Chinese EFL learners preferred to engage themselves in their English study more emotionally, behaviorally, and cognitively than agentically. Pedagogical implications of the findings for EFL practitioners are also discussed, and suggestions for future research are offered.

scholarly journals Nurses’ educational needs when dealing with aggression from patients and their families: a mixed-methods study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e041711
Author(s):  
Kana Sato ◽  
Yoshimi Kodama
Keyword(s):  
Mixed Methods ◽  
Nursing Students ◽  
Phase I ◽  
Phase Ii ◽  
Mixed Methods Study ◽  
Self Awareness ◽  
Two Phase ◽  
Sequential Mixed Methods ◽  
Nursing Professionals ◽  
Educational Contents

ObjectivesTo explore the type of education needed for nurses when dealing with aggression from patients and their families.DesignA two-phase sequential mixed-methods study.SettingThis study was conducted in Japan, with phase I from March to November 2016 and phase II in November 2018.Main outcome measuresThe challenges faced by nurses when dealing with incidents of aggression from the neutral perspective of neither nurse nor patient/family and perceptions of the educational contents developed in this study. Descriptive analyses were used to examine the data retrieved from both phases.ParticipantsPhase I entailed semistructured interviews among 11 neutral-party participants who observed aggressive incidents between nurses and patients/families. Phase II consisted of a web survey conducted among 102 nursing students and 308 nursing professionals.ResultsPhase I resulted in the identification of the following five main educational components: understanding the mechanisms of anger and aggression, maintaining self-awareness, observant listening, managing the self-impression, and communicating based on specific disease characteristics. Each component was related to improved communication through self-awareness. The results of phase II indicated that participants positively perceived these educational contents as likely to be effective for dealing with aggression from patients/families.ConclusionsThis study clarified the type of education needed for nurses when dealing with aggression based on multiple viewpoints. Specifically, neutral-party interviews revealed that communication should be improved through self-awareness. A subsequent survey among nurses and nursing students showed that the identified educational contents were positively received.

scholarly journals Acute care nurses’ perceptions of leadership, teamwork, turnover intention and patient safety – a mixed methods study

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Shahram Zaheer ◽  
Liane Ginsburg ◽  
Hannah J. Wong ◽  
Kelly Thomson ◽  
Lorna Bain ◽  
...  
Keyword(s):  
Patient Safety ◽  
Mixed Methods ◽  
Turnover Intention ◽  
Interactive Effect ◽  
Mixed Methods Study ◽  
Senior Leadership ◽  
Healthcare Organizations ◽  
Staff Perceptions ◽  
Leadership Support ◽  
The Impact

Abstract Background This study contributes to a small but growing body of literature on how context influences perceptions of patient safety in healthcare settings. We examine the impact of senior leadership support for safety, supervisory leadership support for safety, teamwork, and turnover intention on overall patient safety grade. Interaction effects of predictors on perceptions of patient safety are also examined. Methods In this mixed methods study, cross-sectional survey data (N = 185) were collected from nurses and non-physician healthcare professionals. Semi-structured interview data (N = 15) were collected from nurses. The study participants worked in intensive care, general medicine, mental health, or the emergency department of a large community hospital in Southern Ontario. Results Hierarchical regression analyses showed that staff perceptions of senior leadership (p < 0.001), teamwork (p < 0.01), and turnover intention (p < 0.01) were significantly associated with overall patient safety grade. The interactive effect of teamwork and turnover intention on overall patient safety grade was also found to be significant (p < 0.05). The qualitative findings corroborated the survey results but also helped expand the characteristics of the study’s key concepts (e.g., teamwork within and across professional boundaries) and why certain statistical relationships were found to be non-significant (e.g., nurse interviewees perceived the safety specific responsibilities of frontline supervisors much more broadly compared to the narrower conceptualization of the construct in the survey). Conclusions The results of the current study suggest that senior leadership, teamwork, and turnover intention significantly impact nursing staff perceptions of patient safety. Leadership is a modifiable contextual factor and resources should be dedicated to strengthen relational competencies of healthcare leaders. Healthcare organizations must also proactively foster inter and intra-professional collaboration by providing teamwork educational workshops or other on-site learning opportunities (e.g., simulation training). Healthcare organizations would benefit by considering the interactive effect of contextual factors as another lever for patient safety improvement, e.g., lowering staff turnover intentions would maximize the positive impact of teamwork improvement initiatives on patient safety.

How the environment is conceptualised and represented globally in social work codes of ethics

2021 ◽  
pp. 002087282110200
Author(s):  
Kang Liu ◽  
Catherine A Flynn
Keyword(s):  
Human Rights ◽  
Social Justice ◽  
Social Work ◽  
Mixed Methods ◽  
Physical Environment ◽  
Codes Of Ethics ◽  
Mixed Methods Study ◽  
Sequential Mixed Methods ◽  
The Social ◽  
Holistic Understanding

While the environment is fundamental to humankind’s wellbeing, to date, social work has been largely focused on the social, rather than the physical, environment. To map how the broader environment is captured in the profession’s foundational documents, an exploratory sequential mixed methods study (QUAL → quan) analysed data from 64 social work codes of ethics. Findings indicate that although the environment is mentioned in the majority of these, there is a continued focus on the social, overlooking to some degree the physical, predominantly the built, environment. A more holistic understanding of the environment would enable social work to better fulfil its commitment to human rights and social justice.

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