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BMC Health Services Research Jun 2017While greater reliance on nurse practitioners in primary healthcare settings can improve service efficiency and accessibility, their integration is not straightforward,...
BACKGROUND
While greater reliance on nurse practitioners in primary healthcare settings can improve service efficiency and accessibility, their integration is not straightforward, challenging existing role definitions of both registered nurses and physicians. Developing adequate support practices is therefore essential in primary healthcare nurse practitioners' integration. This study's main objective is to examine different structures and mechanisms put in place to support the development of primary healthcare nurse practitioner's practice in different healthcare settings, and develop a practical model for identifying and planning adequate support practices.
METHODS
This study is part of a larger multicentre study on primary healthcare nurse practitioners in the province of Quebec, Canada. It focuses on three healthcare settings into which one or more primary healthcare nurse practitioners have been integrated. Case studies have been selected to cover a maximum of variations in terms of location, organizational setting, and stages of primary healthcare nurse practitioner integration. Findings are based on the analysis of available documentation in each primary healthcare setting and on semi-structured interviews with key actors in each clinical team. Data were analyzed following thematic and cross-sectional analysis approaches.
RESULTS
This article identifies three types of support practices: clinical, team, and systemic. This three-level analysis demonstrates that, on the ground, primary healthcare nurse practitioner integration is essentially a team-based, multilevel endeavour. Despite the existence of a provincial implementation plan, the three settings adopted very different implementation structures and practices, and different actors were involved at each of the three levels. The results also indicated that nursing departments played a decisive role at all three levels.
CONCLUSIONS
Based on these findings, we suggest that support practices should be adapted to each organization's environment and experience and be modified as needed throughout the integration process. We also stress the importance of combining this approach with a strong coordination mechanism involving managers who have in-depth understanding of nursing professional roles and scopes of practice. Making primary healthcare nurse practitioner integration frameworks more flexible and clarifying and strengthening the role of senior nursing managers could be the key to successful integration.
Topics: Cross-Sectional Studies; Nurse Administrators; Nurse Practitioners; Nurse's Role; Patient Care Team; Primary Health Care; Quebec; Workforce
PubMed: 28651529
DOI: 10.1186/s12913-017-2363-4 -
Journal of Feline Medicine and Surgery May 2023There has been a growing interest in alternatives to surgery for controlling reproduction in tom cats, and the resultant medical options add to a practitioner's toolbox... (Review)
Review
BACKGROUND
There has been a growing interest in alternatives to surgery for controlling reproduction in tom cats, and the resultant medical options add to a practitioner's toolbox when handling these cases in clinical practice. It is important, however, that when suggesting these drugs, veterinarians have a good understanding of their mode of action, and their correct use and dosage.
CLINICAL RELEVANCE
Breeders increasingly wish to be able to switch on/off the reproductive ability of their tom cats in a controlled manner. In addition, in small animal medicine, there has been concern from some academics, and a growing number of pet cat owners, about potential long-term effects of surgical sterilisation. Further, for some cats surgical castration may not be possible due to health conditions that mean anaesthesia is unsafe. In all of these scenarios, medical alternatives to surgery can prove useful.
EQUIPMENT AND TECHNICAL SKILLS
No special equipment or technical skills are required. A good knowledge of the medical alternatives to surgical sterilisation for controlling reproduction in a tom, and making sure the patient is a suitable candidate, are, however, important for ensuring the cat's health during and after treatment and the owner's satisfaction.
AUDIENCE
This review is aimed principally (but not exclusively) at veterinary practitioners working with cat breeders who seek a temporary arrest in their tom cat's reproduction. It may also help practitioners with clients who would like an alternative to surgery or with cats where anaesthesia for surgical castration is not possible.
EVIDENCE BASE
Advances in reproductive feline medicine have resulted in improved knowledge of medical contraception. This review draws on scientific evidence-based papers that report on the mode of action, length of efficacy and potential side effects of different methods of medical contraception, as well as the authors' own clinical experience.
Topics: Cats; Animals; Libido; Reproduction; Fertility; Contraception; Castration
PubMed: 37158289
DOI: 10.1177/1098612X231171406 -
Chiropractic & Manual Therapies Apr 2023Optimal shaping of contextual factors (CFs) during clinical encounters may be associated with analgesic responses in treatments for musculoskeletal pain. These CFs...
BACKGROUND
Optimal shaping of contextual factors (CFs) during clinical encounters may be associated with analgesic responses in treatments for musculoskeletal pain. These CFs (i.e., the patient-practitioner relationship, patient's and practitioner's beliefs/characteristics, treatment characteristics, and environment) have not been widely evaluated by musculoskeletal practitioners. Understanding their views has the potential to improve treatment quality and effectiveness. Drawing on a panel of United Kingdom practitioners' expertise, this study aimed to investigate their perceptions of CFs during the management of patients presenting with chronic low back pain (LBP).
METHODS
A modified two-round online Delphi-consensus survey was conducted to measure the extent of panel agreement regarding the perceived acceptability and influence of five main types of CFs during clinical management of patients with chronic LBP. Qualified musculoskeletal practitioners in the United Kingdom providing regular treatment for patients with chronic LBP were invited to take part.
RESULTS
The successive Delphi rounds included 39 and 23 panellists with an average of 19.9 and 21.3 years of clinical experience respectively. The panel demonstrated a high degree of consensus regarding approaches to enhance the patient-practitioner relationship (18/19 statements); leverage their own characteristics/beliefs (10/11 statements); modify the patient's beliefs and consider patient's characteristics (21/25 statements) to influence patient outcomes during chronic LBP rehabilitation. There was a lower degree of consensus regarding the influence and use of approaches related to the treatment characteristics (6/12 statements) and treatment environment (3/7 statements), and these CFs were viewed as the least important. The patient-practitioner relationship was rated as the most important CF, although the panel were not entirely confident in managing a range of patients' cognitive and emotional needs.
CONCLUSION
This Delphi study provides initial insights regarding a panel of musculoskeletal practitioners' attitudes towards CFs during chronic LBP rehabilitation in the United Kingdom. All five CF domains were perceived as capable of influencing patient outcomes, with the patient-practitioner relationship being perceived as the most important CF during routine clinical practice. Musculoskeletal practitioners may require further training to enhance their proficiency and confidence in applying essential psychosocial skills to address the complex needs of patients with chronic LBP.
Topics: Humans; Low Back Pain; Delphi Technique; United Kingdom
PubMed: 37020314
DOI: 10.1186/s12998-023-00482-4 -
Child & Adolescent Social Work Journal... Aug 2022Families globally experience child to parent violence (CPV). Stories of CPV have been considered at an individual and collective level to ascertain themes in parents'...
Families globally experience child to parent violence (CPV). Stories of CPV have been considered at an individual and collective level to ascertain themes in parents' accounts to identify enabling and restraining factors for CPV. However, understanding the societal narratives, defined as discourses, which have a multi-directional and entangled relationship with individual recounts of CPV have yet to be investigated. This research utilizes Narrative Inquiry with participatory approaches to explicate the societal narratives within mothers' recounts of CPV. This analysis, guided by the interactional and discursive view of violence, and response-based practice, identifies societal narratives which set the conditions for what is possible and impossible in relation to CPV. The analysis contributes to understanding the attitudes of minimization and concealment of violence within parents' accounts of CPV. The mothers' recounts were constrained and made possible by the 'good' mother narrative and narratives of adolescence and gender. This research examines the intra-actions mothers' recounts have with the societal narratives, and the performance of their roles as (en)actors of the subject positions 'mother' and 'child'. Implications for practice and research include: consideration to practitioner's views of power and subject positions in a parent and child relationship when working with CPV; and practitioners to be critical of essentialism and gender in working with CPV. This study posits a practical demonstration for using the response-based practice approach in research; and a way of viewing stories which can be incorporated in working with families experiencing CPV.
PubMed: 35992616
DOI: 10.1007/s10560-022-00870-4 -
Aesthetic Surgery Journal. Open Forum 2022Quality assessment comprises 2 distinct forms: technical quality (TQ) and functional quality (FQ). On the one hand, TQ describes accuracy and excellence, the degree to...
BACKGROUND
Quality assessment comprises 2 distinct forms: technical quality (TQ) and functional quality (FQ). On the one hand, TQ describes accuracy and excellence, the degree to which procedures are done "correctly." On the other hand, FQ is the way services are delivered and represents how the customer perceives and experiences the treatment or service.
OBJECTIVES
To determine the relative importance of functional quality factors in the care of cosmetic injectable patients and return patronage.
METHODS
The Cosmetic Injectable Patient Experience Exploratory Study (CIPEES) survey assessed reasons for return patronage to a specific cosmetic injector and the correlation between satisfaction with cosmetic results (patient assessment of TQ) and respondents' trust level in their practitioner, a marker for FQ.
RESULTS
The CIPEES survey collected 1488 responses across 75 countries, with 66% of participants completing all 15 questions. The respondents were 95.6% female and 4.4% male, with ages ranging from 18 years to >65 years old (median 33 years old). The number one ranked reason for returning to a previous cosmetic injector (return patronage) was "Trust in my practitioner's action and ability," closely followed by "Cosmetic result/outcome from the previous treatment/s." Respondents' level of satisfaction with their cosmetic results also correlated highly with trust in their practitioners.
CONCLUSIONS
In order to maximize patient satisfaction and return patronage, healthcare practitioners should focus on improving FQ care and value it at least as high as TQ in the delivery of cosmetic injectable treatments.
PubMed: 35795885
DOI: 10.1093/asjof/ojac044 -
PloS One 2022Long-term athletic development practices have been recommended for the past two decades. However, limited research exists exploring the knowledge and skills required by...
Long-term athletic development practices have been recommended for the past two decades. However, limited research exists exploring the knowledge and skills required by practitioners to optimise long-term athletic development. Therefore, this study aimed to evaluate the knowledge, adherence, practices, and challenges of practitioners responsible for delivering long-term athletic development. A mixed methods survey was completed by 236 practitioners (e.g., sport coaches, physical education teachers) consisting of four parts; 1) demographics, 2) knowledge, 3) adherence, and 4) practices and challenges. Quantitative and qualitative data were analysed by Friedman's analysis of variance and thematic analyses, respectively. Quantitative findings showed practitioners 1) recognised their responsibility for delivering long-term athletic development, 2) have a familiarity with existing developmental models, and 3) had high adherence, focused upon health and wellbeing, to delivering long-term athletic development. However, practices associated with growth and maturity, monitoring and assessment, and the systematic progression and individualisation of training had lower adherence. Qualitative analysis indicated that practitioner's perceived definitions of athleticism and long-term athletic development were inconsistent, especially according to the psychological components (i.e., confidence). Practitioners' descriptions of their long-term athletic development practices identified two higher order themes; 1) goals, in which long-term athletic development "is for life" and the importance of "an individual centered journey" highlighted as sub-themes; and 2) realities of delivering long-term athletic development, whereby variety in programme delivery, monitoring development and practical challenges were noted as key priorities. Eight practical challenges were identified including governance and priorities, resources, education, early specialization, high training volumes, staff communication, parents and youth motivation. This mixed method survey highlighted a multitude of knowledge, adherence, practices and challenges towards long-term athletic development. These novel findings can help inform policy to optimise long-term athletic development and to support the complex problem of developing a healthier, fitter and more physically active youth population.
Topics: Adult; Aged; Athletes; Female; Humans; Male; Middle Aged; Physical Education and Training; Sports
PubMed: 35077515
DOI: 10.1371/journal.pone.0262995 -
Medical Examiner (Philadelphia, Pa.) Apr 1850
PubMed: 38121494
DOI: No ID Found -
BMJ Open Aug 2018As legislation addressing medical treatments continues to evolve, there are several circumstances (eg, abortion, assisted dying) in which health practitioners may choose...
INTRODUCTION
As legislation addressing medical treatments continues to evolve, there are several circumstances (eg, abortion, assisted dying) in which health practitioners may choose to not provide legally available care options. It is not always clear what underlies practitioner choice, as some research has suggested non-participation in care provision is not always due to an ethical abstention but may represent other factors. This results in tension between a practitioner's right to refrain from practices deemed morally objectionable by the practitioner, and the care recipient's right to access legally available treatments. The aim of this systematic scoping review is to identify the current knowledge regarding all the factors influencing practitioner's choices when declining involvement in legally available healthcare options.
METHODS AND ANALYSIS
Arksey and O'Malley's scoping framework in concert with Levac 's enhancements will guide the systematic scoping review methodological processes. English language documents from 1 January 1998 to current will be sought using Medline, CINAHL, JSTOR, EMBASE, ProQuest Dissertations and Theses Global, PsychINFO and Sociological Abstracts. MeSH headings, keywords and synonyms will be adjusted using an iterative search process. Theses and dissertations will be included in the search protocol; however, other grey literature will be accessed only as required. Two research team members will screen the abstracts and full articles against inclusion criteria. Article information will be extracted via a data collection tool and undergo thematic analysis. Descriptive summary (visual summary and study contextual information) and a presentation of analytical themes will align findings back to the research question.
ETHICS AND DISSEMINATION
Ethics approval is not required. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be used to support transparency and guide translation of findings. Findings will be disseminated through professional networks, in peer-reviewed journals and conferences via abstract and presentation.
Topics: Choice Behavior; Conscientious Refusal to Treat; Humans; Physicians; Systematic Reviews as Topic
PubMed: 30121617
DOI: 10.1136/bmjopen-2018-023901 -
BMC Family Practice Jan 2019The attitude of General Practitioner's (GP's) towards dementia and confidence in their clinical abilities impacts on diagnosis rates and management of the condition. The...
BACKGROUND
The attitude of General Practitioner's (GP's) towards dementia and confidence in their clinical abilities impacts on diagnosis rates and management of the condition. The purpose of the present research is to refine and confirm the reliability and validity of the General Practitioner Attitudes and Confidence Scale for Dementia (GPACS-D) as a tool to measure confidence and attitude.
METHODS
A sample of 194 GP volunteers attending dementia education workshops were recruited to complete the GPACS-D before and after the workshop. Volunteer respondents comprised both GP Registrars and GP Supervisors. Analyses included Confirmatory Factor Analysis (CFA), measures of internal consistency, Pearson correlations, and a comparison of subscale scores between cohorts (T-Test for independent samples).
RESULTS
Findings of the CFA support a 15-item, 3-factor model with four items removed due to poor performance and one item moved between factors. The resultant model exhibited good fit (x = 103.88; p = .105; RMSEA = .032; PCLOSE = .915; CFI = .967; TLI = 960), with acceptable internal consistency. Subscales exhibited clear discriminant validity with no underlying relationships between subscales. Finally, total and subscale scores exhibited good discrimination between groups who would be expected to score differently based on experience and level of exposure to dementia.
CONCLUSION
The 15-item, 3-subscale GPACS-D is a reliable and valid measure of GP confidence and attitudes toward dementia. The subscales clearly distinguish between groups who might be expected to score differently from each other based on their training or professional experiences. The psychometric properties of the GPACS-D support its use as a research tool.
Topics: Adult; Aged; Attitude of Health Personnel; Clinical Competence; Dementia; Factor Analysis, Statistical; Female; General Practitioners; Humans; Male; Middle Aged; Reproducibility of Results
PubMed: 30621599
DOI: 10.1186/s12875-018-0896-1 -
Implementation Research and Practice 2021It has been well-documented that the degree to which interventions are implemented with fidelity in typical service settings has varied. Frequently, interventions are...
A mixed-methods study to understand the impact of practitioner and organizational factors on fidelity of a child maltreatment prevention intervention in community-based settings.
UNLABELLED
It has been well-documented that the degree to which interventions are implemented with fidelity in typical service settings has varied. Frequently, interventions are developed and tested in highly controlled or early adopter settings. Less attention has been given to what implementation looks like in usual care, and which factors promote practitioners' ability to implement with fidelity. Individuals and organizations implementing interventions in the real world receive varying levels of external supports and may apply a new intervention unaided. The purpose of this mixed-methods study was to explore factors that support implementation as intended in local community agencies. In the quantitative phase of this study, 32 case planners implementing Family Connections (FC), a child maltreatment preventive intervention, completed a survey about their perceptions of practitioner and organizational factors related to fidelity. The survey data were connected to case-level fidelity scores to understand the relationship between perceptions and fidelity. The qualitative phase of this study involved further exploration with nine case planner interviews and two separate focus groups with supervisors and agency leadership. The results of this study suggest that supervision is a key contributor to a practitioner's ability to implement an intervention in usual care. The quantitative and qualitative results suggest supervision, including supervisors' perseverance, proactiveness, knowledge, availability, and skill reinforcement are important components of enhancing a practitioners' ability to learn and use FC. The quantitative results suggest that the level of education was positively associated with fidelity and perceptions of the intervention's limitations may be negatively related to implementation. Additional components that influence implementation for future research emerged from the qualitative phase related to system expectations and policies, individual practitioner attributes, and characteristics of the intervention.
PLAIN LANGUAGE ABSTRACT
This mixed-methods study sought to understand the impact of practitioner and organizational factors on fidelity of a child maltreatment prevention intervention in community-based settings. The study first asked case planners about their perceptions of practitioner and organizational factors related to fidelity through an online survey. This survey was connected to case-level fidelity scores to understand the relationship between perceptions and fidelity. The qualitative phase of this study involved further exploration with nine case planner interviews and two separate focus groups with supervisors and agency leadership. The results of this study suggest that supervision is a key contributor to a practitioner's ability to implement a maltreatment prevention intervention. Both methods of the study suggest that various aspects of supervision, including supervisors' perseverance, proactiveness, knowledge, availability, and skill reinforcement are important components of enhancing a practitioner's ability to learn and use the intervention. Additional components that influence the implementation for future research emerged from the qualitative phase related to system expectations and policies, individual practitioner attributes, and characteristics of the intervention.
PubMed: 37089988
DOI: 10.1177/26334895211050864