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- Frykman, M., et al.
(författare)
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Functions of behavior change interventions when implementing multi-professional teamwork at an emergency department : A comparative case study
- 2014
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Ingår i: BMC Health Services Research. - : BioMed Central Ltd.. - 1472-6963. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- While there is strong support for the benefits of working in multi-professional teams in health care, the implementation of multi-professional teamwork is reported to be complex and challenging. Implementation strategies combining multiple behavior change interventions are recommended, but the understanding of how and why the behavior change interventions influence staff behavior is limited. There is a lack of studies focusing on the functions of different behavior change interventions and the mechanisms driving behavior change. In this study, applied behavior analysis is used to analyze the function and impact of different behavior change interventions when implementing multi-professional teamwork. Methods. A comparative case study design was applied. Two sections of an emergency department implemented multi-professional teamwork involving changes in work processes, aimed at increasing inter-professional collaboration. Behavior change interventions and staff behavior change were studied using observations, interviews and document analysis. Using a hybrid thematic analysis, the behavior change interventions were categorized according to the DCOM® model. The functions of the behavior change interventions were then analyzed using applied behavior analysis. Results: The two sections used different behavior change interventions, resulting in a large difference in the degree of staff behavior change. The successful section enabled staff performance of teamwork behaviors with a strategy based on ongoing problem-solving and frequent clarification of directions. Managerial feedback initially played an important role in motivating teamwork behaviors. Gradually, as staff started to experience positive outcomes of the intervention, motivation for teamwork behaviors was replaced by positive task-generated feedback. Conclusions: The functional perspective of applied behavior analysis offers insight into the behavioral mechanisms that describe how and why behavior change interventions influence staff behavior. The analysis demonstrates how enabling behavior change interventions, managerial feedback and task-related feedback interact in their influence on behavior and have complementary functions during different stages of implementation.
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- Khoddam, Homeira, et al.
(författare)
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Knowledge translation in health care : a concept analysis
- 2014
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Ingår i: Medical Journal of the Islamic Republic of Iran. - 1016-1430 .- 2251-6840. ; 28
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Tidskriftsartikel (refereegranskat)abstract
- Background:Although knowledge translation is one of the most widely used concepts in health and medicalliterature, there is a sense of ambiguity and confusion over its definition. The aim of this paper is to clarify thecharacteristics of KT. This will assist the theoretical development of it and shape its implementation into thehealth care systemMethods:Walker and Avant’s framework was used to analyze the concept and the related literature publishedbetween 2000 and 2010 was reviewed. A total of 112 papers were analyzed.Results:Review of the literature showed that "KT is a process" and "implementing refined knowledge into aparticipatory context through a set of challenging activities" are the characteristics of KT. Moreover, to occursuccessfully, KT needssome necessary antecedents like an integrated source of knowledge, a receptive context,and preparedness. The main consequence of successful process is a change in four fields of healthcare, i.e. quali-ty of patient care, professional practice, health system, and community. In addition, this study revealed someempirical referents which are helpful to evaluate the process.Conclusion:By aiming to portray a clear picture of KT, we highlighted its attributes, antecedents, conse-quences and empiricalreferents. Identifying the characteristics of this concept may resolve the existing ambigui-ties in its definition and boundaries thereby facilitate distinction from similar concepts. In addition, these find-ings can be used as a knowledge infrastructure fordeveloping the KT-related models, theories, or tools.
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- Kitson, Alison, et al.
(författare)
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Anything but basic : Nursing’s challenge in meeting patients' fundamental care needs
- 2014
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Ingår i: Journal of Nursing Scholarship. - : Wiley. - 1527-6546 .- 1547-5069. ; 46:5, s. 331-339
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Tidskriftsartikel (refereegranskat)abstract
- PurposeNursing has not explored the fundamental aspects of patient care in a systematic, conceptually coherent, scientific way, and this has created a number of ongoing challenges.Organizing ConstructEach challenge is identified and addressed in the form of a proposition, with evidence provided to support the arguments put forward and defend the proposed actions.FindingsThe challenges include: the need for an integrated way of thinking about the fundamentals of care from a conceptual, methodological, and practical perspective; the ongoing and unresolved tension in nursing practice between a depersonalized and mechanistic approach (termed a “task and time” driven culture) and the need for consistency around understanding and managing the dynamics of the nurse–patient relationship or encounter (termed a “thinking and linking” approach); and the need for a systematic approach to the fundamentals or basics of care that combines the physical, psychosocial, and relational dimensions of the care encounter within the wider context of the care environment. Pragmatic and practical frameworks are needed to ensure that the basic physical and psychosocial needs of patients are embedded not only in the practice but also in the thinking, reflection, and assessment processes of the nurse.ConclusionsNursing's challenge to meet patients’ basic or fundamental needs is complex. Developing a knowledge base will include identifying researchable questions, using rigorous methodologies, ensuring the relational dimensions are not lost, and ensuring the new knowledge is applied in practice. This requires collaboration on an international scale to achieve improvements in care.Clinical RelevanceTo work collaboratively to generate, test, and implement meaningful ways of capturing nursing practice around basic or fundamental care in order to ensure more integrated, holistic patient care nursing practices.
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- Kitson, Alison, et al.
(författare)
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Development and preliminary testing of a framework to evaluate patients' experiences of the fundamentals of care : a secondary analysis of three stroke survivor narratives.
- 2013
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Ingår i: Nursing Research and Practice. - : Hindawi Limited. - 2090-1429 .- 2090-1437. ; 2013, s. 572437-
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Tidskriftsartikel (refereegranskat)abstract
- Aim. To develop and test a framework describing the interrelationship of three key dimensions (physical, psychosocial, and relational) in the provision of the fundamentals of care to patients. Background. There are few conceptual frameworks to help healthcare staff, particularly nurses, know how to provide direct care around fundamental needs such as eating, drinking, and going to the toilet. Design. Deductive development of a conceptual framework and qualitative analysis of secondary interview data. Method. Framework development followed by a secondary in-depth analysis of primary narrative interview data from three stroke survivors. Results. Using the physical, psychosocial and relational dimensions to develop a conceptual framework, it was possible to identify a number of "archetypes" or scenarios that could explain stroke survivors' positive experiences of their care. Factors contributing to suboptimal care were also identified. Conclusions. This way of thinking about how the fundamentals of care are experienced by patients may help to elucidate the complex processes involved around providing high quality fundamentals of care. This analysis illustrates the multiple dimensions at play. However, more systematic investigation is required with further refining and testing with wider healthcare user groups. The framework has potential to be used as a predictive, evaluative, and explanatory tool.
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- Kitson, Alison, et al.
(författare)
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Stroke survivors’ experiences of the fundamentals of care : A qualitative analysis
- 2013
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Ingår i: International Journal of Nursing Studies. - : Elsevier BV. - 0020-7489 .- 1873-491X. ; 50:3, s. 392-403
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundManaging the fundamentals of care (e.g. elimination, personal hygiene, eating,) needs to be more explicitly addressed within the patient-centred care discourse. It is not possible to investigate issues of patient dignity and respect without acknowledging these basic physical needs. While the literature on caring for people with a stroke is extensive, no studies to date have described stroke survivors’ experiences of all of these fundamentals during the in-hospital phase of their care.DesignSecondary analysis of qualitative data grounded in interpretative phenomenology Participants and settings: Fifteen stroke survivors with in-hospital experiences from multiple healthcare settings and healthcare professionals across the United Kingdom were included.MethodA secondary thematic analysis of primary narrative interview data from stroke survivors.ResultsSurvivors of strokes have vivid and often distressing recollections of their experiences of the fundamentals of care. For every description of a physical need (elimination, eating and drinking, personal hygiene) there where lucid accounts of the psychosocial and emotional impact (humiliation, distress, lack of dignity, recovery, confidence). Linked to the somatic and emotional dimensions were narratives around the relationship between the patient and the carer (nurse, doctor, allied health professional). Positive recollections of the fundamentals of care were less evident than more distressing experiences. Consistent features of positive experiences included: stroke survivors describing how the physical, psychosocial and relational dimensions of care were integrated and coordinated around their particular need. They reported feeling involved in setting achievable targets to regain control of their bodily functions and regain a sense of personal integrity and sense of self. Sociological constructs such as biographical disruption and loss of self were found to be relevant to stroke survivors’ experiences. Indeed, such constructs may be more linked to the disruption of such fundamental activities rather than the experience of the illness itself.ConclusionsWe recommend more practical and integrated approaches be taken around understanding and meeting the physical, psychosocial and relational needs of patients in hospital which could lead to more patient-centred care experiences. These three dimensions need to co-exist in every care episode. More exploration is required to identify the common fundamentals of care needs of patients regardless of illness experience.
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- Kitson, Alison, et al.
(författare)
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What’s my line? : A narrative review and synthesis of the literature on Registered Nurses' communication behaviours between shifts
- 2014
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Ingår i: Journal of Advanced Nursing. - : Wiley. - 0309-2402 .- 1365-2648. ; 70:6, s. 1228-1242
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Forskningsöversikt (refereegranskat)abstract
- AimTo describe, appraise and synthesize the seminal and empirical literature around Registered Nurses' communication behaviours between shifts in acute hospital settings.BackgroundEffective communication between shifts (at nursing handover) is acknowledged as a prerequisite to safe and high-quality patient-centred care. However, gaps and inconsistencies continue to prevail.DesignNarrative review and synthesis.Data sourcesThe electronic databases PubMED, CINAHL and Scopus were used.Review methodsEnglish language, peer-reviewed papers published between 1970–April 2012 were considered for review. Criteria included Registered Nurses' communication during handovers in adult hospital settings.ResultsTwenty-nine papers were reviewed. The research lacks a clear conceptual framework to define the core purposes of Nurses' communication behaviours between shifts. Seven themes were identified: overall purpose; report givers and receivers; seeing the whole picture; teaching and education; language; patient-centred care; and social cohesion. Two main communication processes are required – one articulating the whole picture and the other detailing information about patients.ConclusionThis area of research is challenged by lack of consistency in terminology and methodological rigour. While recent research has confirmed the findings from the seminal work, it has not been able to elaborate on some of the key challenges to refine the knowledge base. A more integrated approach is required to understand the complex process of improving nursing communication behaviours, particularly around the nursing handover. A neglected area of study is the role of the unit lead in determining the communication standards of the whole nursing team.
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- Muntlin Athlin, Åsa, et al.
(författare)
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Effects of multidisciplinary teamwork on lead times and patient flow in the emergency department : a longitudinal interventional cohort study
- 2013
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Ingår i: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. - : Springer Science and Business Media LLC. - 1757-7241. ; 21, s. 76-
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Tidskriftsartikel (refereegranskat)abstract
- Background: Long waiting times for emergency care are claimed to be caused by overcrowded emergency departments and non-effective working routines. Teamwork has been suggested as a promising solution to these issues. The aim of the present study was to investigate the effects of teamwork in a Swedish emergency department on lead times and patient flow. Methods: The study was set in an emergency department of a university hospital where teamwork, a multi-professional team responsible for the whole care process for a group of patients, was introduced. The study has a longitudinal non-randomized intervention study design. Data were collected for five two-week periods during a period of 1.5 years. The first part of the data collection used an ABAB design whereby standard procedure (A) was altered weekly with teamwork (B). Then, three follow-ups were conducted. At last follow-up, teamwork was permanently implemented. The outcome measures were: number of patients handled within teamwork time, time to physician, total visit time and number of patients handled within the 4-hour target. Results: A total of 1,838 patient visits were studied. The effect on lead times was only evident at the last follow-up. Findings showed that the number of patients handled within teamwork time was almost equal between the different study periods. At the last follow-up, the median time to physician was significantly decreased by 11 minutes (p = 0.0005) compared to the control phase and the total visit time was significantly shorter at last follow-up compared to control phase (p = <0.0001; 39 minutes shorter on average). Finally, the 4-hour target was met in 71% in the last follow-up compared to 59% in the control phase (p = 0.0005). Conclusions: Teamwork seems to contribute to the quality improvement of emergency care in terms of small but significant decreases in lead times. However, although efficient work processes such as teamwork are necessary to ensure safe patient care, it is likely not sufficient for bringing about larger decreases in lead times or for meeting the 4-hour target in the emergency department.
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