La pratique clinique et le bien-être au travail des infirmières selon un processus d’intégration des soins

Thèse en administration des services-infirmiers subventionnée par "Formation et expertise en recherche administration des services infirmiers" (FERASI)Cette étude a pour but de comprendre les processus de transformation de la pratique clinique chez les infirmières à la faveur des initiatives d’intégration des soins et services et d’examiner l’impact de ces processus sur le bien-être au travail des infirmières. De façon spécifique, l’étude vise: 1) à décrire les pratiques infirmières dans le contexte d’intégration des soins et services au Québec 2) à analyser la relation entre les processus de changement sous-jacents aux efforts d’intégration et le bien-être au travail des infirmières selon leurs perceptions et 3) à identifier les principaux leviers, sur les plans de la gestion et de la clinique, que peuvent mobiliser les organisations afin de soutenir la pratique infirmière dans un contexte d’intégration des soins. L’étude a été organisée en trois volets correspondant respectivement aux trois objectifs précédemment mentionnés. Le cadre de référence développé et utilisé pour cette étude est le « Modèle infirmier du développement de l’intégration des soins » (MIDIS). Il s’appuie sur les prémisses du modèle de Cazale, Touati et Fleury (2007), qui couvrent les interrelations entre les variables contextuelles (organisationnelles et structurelles), l’adoption et l’institutionnalisation des pratiques intégratives, et les effets qui y sont associés pour les infirmières en termes de bien-être au travail. Pour atteindre les objectifs de l’étude, un devis mixte a été utilisé, incluant : un devis quantitatif descriptif (volet 1), un devis quantitatif corrélationnel (volet 2) et un devis qualitatif d’étude de cas unique avec niveaux d’analyse imbriqués (volet 3). La collecte des données a été menée dans le cadre de quatre trajectoires de soins (TdeS) : Soutien à l’autonomie (SoAu), Palliatifs/oncologiques (PaOn), Santé mentale (SaMe) et Maladie pulmonaire obstructive chronique (Mpoc). L’étude a été effectuée auprès d’infirmières, de professionnels autres, et de gestionnaires. Pour les volets un et deux, 107 questionnaires ont été complétés et 37 entrevues semi-dirigées ont été effectuées pour le volet 3. Les résultats du premier volet ont démontré non seulement d’importantes variations dans le développement de l’intégration entre les TdeS mais également un décalage entre l’évolution de la pratique infirmière et l’introduction des changements visant une plus grande intégration des soins. Deux dimensions seulement de la pratique intégrative sur neuf (Qualité des soins et Équipe interprofessionnelle) prévalent dans l’ensemble des TdeS et seule la TdeS PaOn a atteint une étape plus avancée du processus d’intégration. Les résultats du deuxième volet démontrent que plus l’intégration se situe à un niveau avancé de développement, moins elle est associée à une perception de menace chez les infirmières et plus elle est associée à des réactions positives et un bien-être au travail. Le troisième volet a mis en lumière trois types de leviers qui doivent être mobilisés de manière complémentaire dans le but de favoriser l’intégration : les processus organisationnels, les processus cliniques, les investissements dans des ressources clés et dans le renouvellement de certaines structures organisationnelles. Ces résultats apportent des éclairages quant aux défis posés par les processus d’intégration des soins et montrent l’importance d’une pluralité d’interventions qui doivent être conduites à tous les paliers organisationnels afin de faciliter l’institutionnalisation des pratiques intégratives et obtenir les effets escomptés.The aim of this study is to understand processes of transformation of clinical practice among nurses in the context of care and service integration initiatives, and to examine the impact of these processes on nurses’ well-being at work. Specifically, the study’s objectives are to: 1) describe nursing practices that underpin efforts to integrate care and services in Quebec; 2) analyze the relationship between the change processes underpinning integration efforts and nurses’ self-perceived well-being at work; and 3) identify the main levers that organizations can use at management and clinical levels to support nursing practices in an care integration context. The study was set up in three parts, corresponding respectively to the three objectives mentioned above. The reference framework developed for this study, is the Modèle infirmier du développement de l’intégration des soins (MIDIS – Development model for integrated care in nursing). It is based on the premises of the model of Cazale, Touati et Fleury, (2007) that cover the interrelationships between contextual variables (organizational and institutional), the adoption and institutionalization of integrative practices, and the associated effects on professionals with respect to well-being in the workplace. To achieve the study’s objectives, a mixed-method design was used, which included: a descriptive quantitative component (Part 1), a correlational quantitative component (Part 2), and a single case qualitative study with nested levels of analysis (Part 3). Data were collected within four care pathways (CPs): autonomy support for the elderly (ASE); palliative oncology services (POS); mental health services (MHS); and chronic obstructive pulmonary disease (CPOD). Data were collected from nurses, health professionals, and managers. For Parts 1 and 2, 107 questionnaires completed and 37 semi-structured interviews conducted for Part 3. The results of the first part of the study showed not only significant variations across CPs in the development of integration, but also a gap between the evolution of nursing practice and the introduction of changes aimed at greater integration of care. Only two out of nine dimensions of integrative practice (‘quality of care’ and ‘interprofessional teamwork’) were prevalent across all CPs and only one CP (POS) had reached a more advanced stage in the integration process. The results of the second part of the study showed that, as integration became more highly developed, it was associated less with a perception of threat by nurses and more with positive reactions and well-being at work. The third part of the study identified three types of levers that should be used in a complementary way to speed up the progress of integration: organizational processes; clinical-administrative processes; investment in key resources and in renovation of certain organizational structures. These results shed additional light on the challenges posed by the process of integration of care, and show the importance of leading multiple interventions at all organizational levels to facilitate institutionalization of integrative practices and achieve the intended effects

Fostering development of nursing practices to support integrated care when implementing integrated care pathways: what levers to use?

Abstract Background Care integration has been the focus of recent health system reforms. Given their functions at all levels of the care continuum, nurses have a substantial and primordial role to play in such integration processes. The aim of this study was to identify levers and strategies that organizations can use to support the development of a nursing practice aligned with the requirements of care integration in a health and social services centre (HSSC) in Quebec. Methods The research design was a cross-sectional descriptive qualitative study based on a single case study with nested levels of analysis. The case was a public, multi-disciplinary HSSC in a semi-urban region of Quebec. Semi-structured interviews with 37 persons (nurses, professionals, managers, administrators) allowed for data saturation and ensured theoretical representation by covering four care pathways constituting different care integration contexts. Analysis involved four steps: preparing a predetermined list of codes based on the reference framework developed by Minkman (2011); coding transcript content; developing general and summary matrices to group observations for each care pathway; and creating a general model showing the overall results for the four pathways. Results The organization’s capacity for response with regard to developing an integrated system of services resulted in two types of complementary interventions. The first involved investing in key resources and renewing organizational structures; the second involved deploying a series of organizational and clinical-administrative processes. In resource terms, integration efforts resulted in setting up new strategic services, re-arranging physical infrastructures, and deploying new technological resources. Organizational and clinical-administrative processes to promote integration involved renewing governance, improving the flow of care pathways, fostering continuous quality improvement, developing new roles, promoting clinician collaboration, and strengthening care providers’ capacities. However, progress in these areas was offset by persistent constraints. Conclusions The results highlight key levers organizations can use to foster the implementation and institutionalization of integrative nursing practices. They show that progress in this area requires a combination of strategies using multiple complementary levers. They also suggest that such progress calls for rethinking not only the deployment of certain organizational resources and structures, but also a series of organizational and clinical processes

Standardized and validated training to support the charge nurse: Research protocol

Abstract Aim To develop a standardized training for charge nurses. Design A developmental research design divided into three parts will be undertaken. Methods (1) A scoping review will be used to develop standardized training focusing on charge nurse skills and sub‐skills; (2) a Delphi review with nurses, managers and researchers will validate the content of the training; content validity will be assessed over sufficient rounds of review to obtain a content validity index of over 0.7 and (3) a cross‐sectional study will pilot test the training with 30 charge nurses. Results This study will describe the development of updated and empirically validated training to be systematically implemented in healthcare institutions and offered to charge nurses when they begin

Training sector 2.

Traduction de: Horticulture et jardinerie. Programme d'études professionnelles, 5288"Training sector 2 : agriculture and fisheries