Mieux comprendre la capacité fonctionnelle du coeur et mieux intervenir dans la progestion des comportements spécifiques d’autosoins de la personne atteinte d’une maladie coronarienne

Les chercheurs reconnaissent que l’adoption de comportements spécifiques d’autosoins peut freiner, modifier ou retarder la progression de la maladie coronarienne. L’infirmière doit assumer un rôle de facilitatrice de comportements de santé pour aider la personne atteinte d’une maladie coronarienne à adopter de saines habitudes de vie. Pour ce faire, l’infirmière doit comprendre la capacité fonctionnelle du coeur chez la personne atteinte d’une maladie coronarienne afin de la guider vers un niveau d’activités physiques efficace et sécuritaire. Elle a la responsabilité de connaître les différents comportements que la personne doit adopter afin de maintenir ou d’améliorer sa santé cardiaque, par exemple, le non-usage du tabac. L’infirmière observe alors la personne aux prises avec des changements afin de déterminer son évolution à travers les stades comportementaux de manière à mieux adapter ses interventions.Researchers recognize that adopting specific self-care behaviours can halt, change or delay the progress of coronary disease. Nurses must take on the role of facilitator of health behaviours, and encourage people suffering from coronary disease to make healthy lifestyle changes. Nurses must understand the functional capacity of the heart of individuals suffering from coronary disease in order to guide them to a safe and efficient level of physical activity. Nurses are required to know the different behaviours individuals must adopt to maintain or improve their cardiac health, for example, not smoking tobacco. Nurses should therefore observe individuals in the midst of changes to determine their evolution through the various behaviours in order to better tailor their treatment to the individual

Composantes de la capacité d’autosoin de personnes ayant subi un infarctus du myocarde et participant à un programme d’exercices à domicile

L’étude de Robichaud-Ekstrand (1993) démontre une amélioration plus précoce de la capacité globale d’autosoin des participants au programme d’exercices à domicile à la suite d’un récent infarctus du myocarde (IM), comparativement aux sujets qui reçoivent des soins usuels. Cet article présente une analyse secondaire des données pour déterminer la ou les composantes qui engendrent cette amélioration. Tous les participants ont complété l’échelle de la Exercise of Self-Care Agency (ESCA) à l’hôpital, puis aux 8e et 14e semaines suivant leur congé de l’hôpital. L’initiative et la responsabilité est à l’origine des gains plus précoces retrouvés dans la capacité globale d’autosoin chez les participants au programme d’exercices. Celles-ci reflètent une meilleure attitude pour ce qui est de prendre soin de soi-même et un niveau de motivation accru pour adopter des comportements de santé sains à 8 semaines pour les participants. Le concept de soi, les connaissances et la recherche d’information ainsi que l’engagement demeurent similaires avec ou sans programme d’exercices à domicile.Robichaud-Ekstrand’s study (1993) showed earlier improvement in global self-care agency in recent low-risk myocardial infarction individuals participating in a home-based exercise program compared to subjects receiving usual care. This paper presents a secondary data analysis to determine which sub-concept is responsible for the more important improvement in global self-care agency. All participants completed the Exercise of Self-Care Agency (ESCA) scale at hospital pre-discharge, and at 8 and 14 weeks post-discharge. Initiative and responsibility is responsible for the earlier improvement in global self-care agency in exercise program participants (p = .001). These are demonstrated by participants’ better attitude to take care of themselves, and an increased level of motivation to adopt healthy behaviours at 8 weeks for participants.With or without a home-based exercise program, self-concept, knowledge and information seeking, as well as action taking remain similar

Interprofessional Collaboration Competencies of Nursing Students, Nurse Practitioner Students, and Paramedics in a Simulated Palliative Home Care Setting: A Pilot Study

Background: Post-secondary institutions do not adequately prepare future professionals to provide quality palliative care. Furthermore, the competencies necessary for interprofessional collaborative practice in home-based palliative care are poorly described in the scientific literature. A palliative care simulation involving standardized patients and paramedics would be a strategy to educate nursing students and nurse practitioner students who have little opportunity to experience interprofessional collaborative palliative care in the home. Objective: Describe the interprofessional competencies of nursing students, nurse practitioner students, and paramedics during a home-based palliative care simulation according to a National Competency Framework. Method: This pilot study is qualitative descriptive. Six nursing students, five nurse practitioner students and three paramedics participated in home palliative care simulations involving standardized patients and completed an interprofessional collaboration competencies rubric. A focus group was held after the simulation. Performances were observed using simulation recording and debriefing and assessed using an interprofessional collaboration competencies rubric. Results: The competencies best mobilized were person-centered care (and family-centered care for the nurse practitioner students and paramedics), as well as interprofessional communication (for the nurse practitioner students). Competencies that need further development are role clarification, teamwork, collaborative leadership (for all three groups), interprofessional conflict resolution (for nurse practitioner students and nursing students), and interprofessional communication (for nursing students and paramedics). Conclusion: This simulation involving standardized patients provides a learning context for mobilizing palliative care interprofessional collaboration competencies at home. Résumé Contexte : Les institutions postsecondaires ne préparent pas adéquatement les futur(e)s professionnel(le)s à fournir des soins palliatifs de qualité. Aussi, les compétences nécessaires à la pratique en collaboration interprofessionnelle en soins palliatifs à domicile sont peu décrites dans la littérature scientifique. Une simulation en soins palliatifs impliquant des patients standardisés et des paramédics serait une stratégie pour former des étudiant(e)s en sciences infirmières et des étudiant(e)s infirmières et infirmiers praticien(ne)s spécialisé(e)s qui ont peu d\u27occasions de pratiquer des soins palliatifs à domicile en collaboration interprofessionnelle. Objectif : Décrire les compétences interprofessionnelles d\u27étudiant(e)s en sciences infirmières, d’étudiant(e)s praticien(ne)s et de paramédicaux lors d\u27une simulation de soins palliatifs à domicile selon le Référentiel national de compétences. Méthode : Cette étude pilote est qualitative descriptive. Six étudiantes en sciences infirmières, cinq étudiantes praticiennes et trois paramédics ont participé à des simulations de soins palliatifs à domicile impliquant des patients standardisés et ont rempli un outil d’autoévaluation des compétences de collaboration interprofessionnel. Un groupe de discussion a eu lieu après la simulation. Les performances ont été observées à l\u27aide de l’enregistrement des simulations et des débriefings et évaluées à l’aide d’un outil des compétences de collaboration interprofessionnelle. Résultats : Les compétences les mieux mobilisées sont les soins centrés sur la personne (et la famille pour les étudiantes infirmières praticiennes et les paramédics), ainsi que la communication interprofessionnelle (pour les étudiantes infirmières praticiennes). Les compétences à développer davantage sont : la clarification des rôles, le travail d’équipe, le leadership collaboratif (pour les trois groupes), la résolution de conflits interprofessionnels (pour les étudiantes praticiennes et les étudiantes en sciences infirmières), ainsi que la communication interprofessionnelle (pour les étudiantes en science infirmière et les paramédics). Conclusion : Cette formation simulée impliquant des patients standardisés offre un contexte d\u27apprentissage permettant la mobilisation des compétences de collaboration interprofessionnelle en matière de soins palliatifs à domicile

Understanding Lived Experiences of Food Insecurity through a Paraliminality Lens

Moraes, C., McEachern, M. G., Gibbons, A. and Scullion, L. (2021). Understanding lived experiences of food poverty through a paraliminality lens. Sociology, 55(6), 1169-1190. https://doi.org/10.1177/00380385211003450. Copyright © [2021] (Copyright Holder). Reprinted by permission of SAGE Publications.This article examines lived experiences of food insecurity in the United Kingdom as a liminal phenomenon. Our research is set within the context of austerity measures, welfare reform and the precarity experienced by increasing numbers of individuals. Drawing on original qualitative data, we highlight diverse food insecurity experiences as transitional, oscillating between phases of everyday food access to requiring supplementary food, which are both empowering and reinforcing of food insecurity. We make three original contributions to existing research on food insecurity. First, we expand the scope of empirical research by conceptualising food insecurity as liminal. Second, we illuminate shared social processes and practices that intersect individual agency and structure, co-constructing people’s experiences of food insecurity. Third, we extend liminality theory by conceptualising paraliminality, a hybrid of liminal and liminoid phenomena that co-generates a persistent liminal state. Finally, we highlight policy implications that go beyond short-term emergency food access measures

Urban poverty and the role of UK food aid organisations in enabling segregating and transitioning spaces of food access

This research examines the role of food aid providers, including their spatial engagement, in seeking to alleviate urban food poverty. Current levels of urban poverty across the UK have resulted in an unprecedented demand for food aid. Yet, urban poverty responsibility increasingly shifts away from policymakers to the third sector. Building on Castilhos and Dolbec’s (2018) notion of segregating space and original qualitative research with food aid organisations, we show how social supermarkets emerge as offering a type of transitional space between the segregating spaces of foodbanks and the market spaces of mainstream food retailers. This research contributes to existing literature by establishing the concept of transitional space, an additional type of space that facilitates movement between types of spaces and particularly transitions from the segregating spaces of emergency food aid to more secure spaces of food access. In so doing, this research extends Castilhos and Dolbec’s (2018) typology of spaces, enabling a more nuanced depiction of the spatiality of urban food poverty

The Long-Term Conditions Questionnaire (LTCQ): Conceptual framework and item development

Purpose: To identify the main issues of importance when living with long-term conditions to refine a conceptual framework for informing the item development of a patient-reported outcome measure for long-term conditions. Methods: Semi-structured qualitative interviews (n=48) were conducted with people living with at least one long-term condition. Participants were recruited through primary care. The interviews were transcribed verbatim and analysed by thematic analysis. The analysis served to refine the conceptual framework, based on reviews of the literature and stakeholder consultations, for developing candidate items for a new measure for long-term conditions. Results: Three main organising concepts were identified ‘Impact of long-term conditions’, ‘Experience of services and support’ and ‘Self-care’. The findings helped to refine a conceptual framework leading to the development of 23 items that represent issues of importance in long-term conditions. The 23 candidate items formed the first draft of the measure, currently named the Long-Term Conditions Questionnaire (LTCQ). Conclusions: The aim of this study was to refine the conceptual framework and develop items for a patient-reported outcome measure for long-term conditions, including single and multiple morbidities, and physical and mental health conditions. Qualitative interviews identified the key themes for assessing outcomes in long-term conditions and these underpinned the development of the initial draft of the measure. These initial items will undergo cognitive testing to refine the items prior to further validation in a survey

How does the use of digital consulting change the meaning of being a patient and/or a health professional? Lessons from the Long-term Conditions Young People Networked Communication study

Background: While studies have examined the impact of digital communication technology on healthcare, there is little exploration of how new models of digital care change the roles and identities of the health professional and patient. The purpose of the current study is to generate multidisciplinary reflections and questions around the use of digital consulting and the way it changes the meaning of being a patient and/or a health professional. Method: We used a large pre-existing qualitative dataset from the Long-term Conditions Young People Networked Communication (LYNC) study which involved interviews with healthcare professionals and a group of 16–24 years patients with long-term physical and mental health conditions. We conducted a three-stage mixed methods analysis. First, using a small sample of interview data from the LYNC study, we identified three key themes to explore in the data and relevant academic literature. Second, in small groups we conducted secondary analysis of samples of patient and health professional LYNC interview data. Third, we ran a series of rapid evidence reviews. Findings: We identified three key themes: workload/flow, impact of increased access to healthcare and vulnerabilities. Both health professionals and patients were 'on duty' in their role more often. Increased access to healthcare introduced more responsibilities to both patients and health professionals. Traditional concepts in medical ethics, confidentiality, empathy, empowerment/power, efficiency and mutual responsibilities are reframed in the context of digital consulting. Conclusions: Our collaboration identified conflicts and constraints in the construction of digital patients and digital clinicians. There is evidence that digital technologies change the nature of a medical consultation and with it the identities and the roles of clinicians and patients which, in turn, calls for a redefinition of traditional concepts of medical ethics. Overall, digital consulting has the potential to significantly reduce costs while maintaining or improving patient care and clinical outcomes. Timely study of digital engagement in the National Health Service is a matter of critical importance