Observe, Coach, Assist, and Report: An Emerging Framework for Integrating Unregulated Healthcare Providers into Interdisciplinary Healthcare Teams

Background: Unregulated healthcare providers known as personal support workers (PSWs) provide the majority of home care services in Ontario, Canada. However, there is little direction to guide their activities as members of interdisciplinary healthcare teams. The purpose of this study was to explore and describe the role of PSWs in interdisciplinary evidence-based stroke care.Methods and Findings: A concurrent triangulation mixed-methods design was used. Data sources included surveys (N = 270), chart audits (N = 234), interviews (N = 28), focus groups (N = 7), textbook review, an advisory committee (N = 14), and knowledge fairs (N = 112). PSWs can participate in team-based stroke care by observing vital information about clients in their homes, coaching clients to follow care plans, assisting to implement recommendations made by other healthcare providers, and reporting client progress, challenges, needs, and preferences to the healthcare team.Conclusions: The Observe, Coach, Assist, and Report (OCAR) themes have the potential to be used as a framework to guide improvements in intra-team communication, information sharing, and awareness of the PSW role, in order to support a more integrated home care experience for clients and families. Next steps include pilot testing the OCAR framework at the point of care in various settings to enhance interdisciplinary collaboration that is inclusive of PSWs

Nurses\u27 Involvement in HIV Policy Formulation in Nigerian Health Care System

Background of study: Nigerian national policy on HIV stresses the need for the adoption of multi-sectoral and multi-disciplinary approach in policy formulation, with the health sector taking the lead. This calls for collaboration among the various stakeholders including nurses in policy development initiatives to ensure that diverse health care needs and disciplinary perspectives are captured in HIV health policies. Purpose: This paper will present the findings of a recent study which examined nurse’s involvement in policy development in the context of mother-to-child transmission (MTCT) of HIV in Nigeria. Methodology: A qualitative case study design under the guiding tenets of critical social and power theories. The research is a single case study of one state with embedded units. Thirty nurse-leaders from the various embedded units were recruited through purposive and snowball sampling technique. Semi-structured in-depth interviews and document reviews were used for data collection. Focus group discussions were used as a form of member-checking and also to generate data. Data was analysed using thematic analysis. Results: This paper focuses on the major themes that emerged from the study as well as highlight specific interplay of power dynamics in the health care system which hinders nurse’s involvement in policy formulation. Conclusion: The paper concludes with some of the lessons learnt in the study and proffer suggestions for effective integration of nurses into policy arena. It suggests the need for a broad-based educational curriculum which will incorporate strategies to build nurses capacity for leadership and policy development in nursing training schools

Observe, Coach, Assist, and Report: An Emerging Framework for Integrating Unregulated Healthcare Providers into Interdisciplinary Healthcare Teams

Background: Unregulated healthcare providers known as personal support workers (PSWs) provide the majority of home care services in Ontario, Canada. However, there is little direction to guide their activities as members of interdisciplinary healthcare teams. The purpose of this study was to explore and describe the role of PSWs in interdisciplinary evidence-based stroke care.Methods and Findings: A concurrent triangulation mixed-methods design was used. Data sources included surveys (N = 270), chart audits (N = 234), interviews (N = 28), focus groups (N = 7), textbook review, an advisory committee (N = 14), and knowledge fairs (N = 112). PSWs can participate in team-based stroke care by observing vital information about clients in their homes, coaching clients to follow care plans, assisting to implement recommendations made by other healthcare providers, and reporting client progress, challenges, needs, and preferences to the healthcare team.Conclusions: The Observe, Coach, Assist, and Report (OCAR) themes have the potential to be used as a framework to guide improvements in intra-team communication, information sharing, and awareness of the PSW role, in order to support a more integrated home care experience for clients and families. Next steps include pilot testing the OCAR framework at the point of care in various settings to enhance interdisciplinary collaboration that is inclusive of PSWs

A community of practice for graduate students in health sciences

Purpose – The aim of this study was to describe the experiences of graduate students who participated in the community of practice (CoP) and identify areas for improvement to support academic success. Design/methodology/approach – In total, 19 graduate students engaged in a CoP to facilitate social interactions, knowledge sharing and learning within a culture of scholarship. A descriptive qualitative research study was conducted using semistructured interviews with eight participants who had attended the CoP meeting. Findings – All participants were from the School of Nursing and perceived the CoP to be beneficial, particularly international students who had challenges in adapting to new academic and social environments. Areas for improvement include creating a group structure that enhances belonging and learning. Originality/value – This is the first CoP that was implemented at the Faculty of Health Sciences at the authors’ university. It has been the authors’ experience that a CoP can benefit graduate students through networking, knowledge sharing, social support and learning. The finding of this research will be used to inform a new CoP to address the needs of graduate students. The authors will be adapting the CoP to the current context that includes a virtual platform during the COVID-19 pandemic and will include content specific for international students

Clinical interventions, implementation interventions, and the potential greyness in between -a discussion paper

Background: There is increasing awareness that regardless of the proven value of clinical interventions, the use of effective strategies to implement such interventions into clinical practice is necessary to ensure that patients receive the benefits. However, there is often confusion between what is the clinical intervention and what is the implementation intervention. This may be caused by a lack of conceptual clarity between \u27intervention\u27 and \u27implementation\u27, yet at other times by ambiguity in application. We suggest that both the scientific and the clinical communities would benefit from greater clarity; therefore, in this paper, we address the concepts of intervention and implementation, primarily as in clinical interventions and implementation interventions, and explore the grey area in between. Discussion: To begin, we consider the similarities, differences and potential greyness between clinical interventions and implementation interventions through an overview of concepts. This is illustrated with reference to two examples of clinical interventions and implementation intervention studies, including the potential ambiguity in between. We then discuss strategies to explore the hybridity of clinical-implementation intervention studies, including the role of theories, frameworks, models, and reporting guidelines that can be applied to help clarify the clinical and implementation intervention, respectively. Conclusion: Semantics provide opportunities for improved precision in depicting what is \u27intervention\u27 and what is \u27implementation\u27 in health care research. Further, attention to study design, the use of theory, and adoption of reporting guidelines can assist in distinguishing between the clinical intervention and the implementation intervention. However, certain aspects may remain unclear in analyses of hybrid studies of clinical and implementation interventions. Recognizing this potential greyness can inform further discourse

Developing Leadership in Managers to Facilitate the Implementation of National Guideline Recommendations: A Process Evaluation of Feasibility and Usefulness

Background: Previous research supports the claim that managers are vital players in the implementation of clinical practice guidelines (CPGs), yet little is known about interventions aiming to develop managers’ leadership in facilitating implementation. In this pilot study, process evaluation was employed to study the feasibility and usefulness of a leadership intervention by exploring the intervention’s potential to support managers in the implementation of national guideline recommendations for stroke care in outpatient rehabilitation. Methods: Eleven senior and frontline managers from five outpatient stroke rehabilitation centers participated in a fourmonth leadership intervention that included workshops, seminars, and teleconferences. The focus was on developing knowledge and skills to enhance the implementation of CPG recommendations, with a particular focus on leadership behaviors. Each dyad of managers was assigned to develop a leadership plan with specific goals and leadership behaviors for implementing three rehabilitation recommendations. Feasibility and usefulness were explored through observations and interviews with the managers and staff members prior to the intervention, and then one month and one year after the intervention. Results: Managers considered the intervention beneficial, particularly the participation of both senior and frontline managers and the focus on leadership knowledge and skills for implementing CPG recommendations. All the managers developed a leadership plan, but only two units identified goals specific to implementing the three stroke rehabilitation recommendations. Of these, only one identified leadership behaviors that support implementation. Conclusion: Managers found that the intervention was delivered in a feasible way and appreciated the focus on leadership to facilitate implementation. However, the intervention appeared to have limited impact on managers’ behaviors or clinical practice at the units. Future interventions directed towards managers should have a stronger focus on developing leadership skills and behaviors to tailor implementation plans and support implementation of CPG recommendations

From mood to movement: English nationalism, the European Union and taking back control

This article considers whether the 2016 EU referendum can be perceived as an English nationalist movement. Specifically, attention is given to examining how memories of the former British Empire were nostalgically enveloped in anxieties regarding England’s location within the devolved UK state. The comments and work of Enoch Powell and George Orwell are used to help explore the link between nostalgia and anxiety in accounts of English nationalism. Despite their opposing political orientations, when considered together, it is argued that both men provide a unique cross-political perspective on Englishness, empire and nostalgia. By way of exploring these themes in relation to the EU referendum, Aughey’s assertion that English nationalism can be perceived as both a ‘mood’ and ‘movement’ is used to highlight how a sense of English anxiety regarding its lack of national sovereignty (mood), as well as a desire to reclaim this sovereignty by renegotiating trade relations with the ‘Anglo-sphere’ (movement), were conjoined in the popular referendum slogan, ‘take back control’. In conclusion, it is argued that the contextualization of the referendum can be predicated upon an orientation to empire that steers away from glorifying pro-imperial images of England/Britain, towards a more positive and progressive appropriation of the EU referendum as a statement of national change and belonging