Patient and nurse preferences for implementation of bedside handover: Do they agree? Findings from a discrete choice experiment

Objective: To describe and compare patients' and nurses' preferences for the implementation of bedside handover. Design: Discrete choice experiment describing handover choices using six characteristics: whether the patient is invited to participate; whether a family member/carer/friend is invited; the number of nurses present; the level of patient involvement; the information content; and privacy. Setting: Two Australian hospitals. Participants: Adult patients (n=401) and nurses (n=200) recruited from medical wards. Main outcome measures: Mean importance scores for handover characteristics estimated using mixed multinomial logit regression of the choice data. Results: Both patient and nurse participants preferred handover at the bedside rather than elsewhere (P<.05). Being invited to participate, supporting strong two-way communication, having a family member/carer/friend present and having two nurses rather than the nursing team present were most important for patients. Patients being invited to participate and supporting strong two-way communication were most important for nurses. However, contrary to patient preferences, having a family member/carer/friend present was not considered important by nurses. Further, while patients expressed a weak preference to have sensitive information handed over quietly at the bedside, nurses expressed a relatively strong preference for handover of sensitive information verbally away from the bedside. Conclusions: All participants strongly support handover at the bedside and want patients to participate although patient and nurse preferences for various aspects of bedside handover differ. An understanding of these preferences is expected to support recommendations for improving the patient hospital experience and the consistent implementation of bedside handover as a safety initiative

Prescription opioid and benzodiazepine misuse is associated with suicidal ideation in older adults

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147198/1/gps4999_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/147198/2/gps4999.pd

Successful Community Nutrition Programming:lessons from Kenya,Tanzania,and Uganda

Learning from success is the most effective and efficient way of learning.This report brings together the main findings of a series of assessments of successful community nutrition programming carried out in Kenya, Tanzania, and Uganda between 1999 and 2000. The overall aim of the assessments was to identify key lessons, or the main driving forces behind the successful processes and outcomes in these programs. Such elements of success fundamentally have to do with both what was done and how it was done. Experience with community-based nutrition programming, as documented in various syntheses and reviews during the 1990s, does show that malnutrition can be effectively addressed on a large scale, at reasonable cost, through appropriate programs and strategies, and backed up by sustained political support. In most cases, successful attempts to overcome malnutrition originate with participatory, community-based nutrition programs undertaken in parallel with supportive sectoral actions directed toward nutritionally at-risk groups. Such actions are often enabled and supported by policies aimed at improving access by the poor to adequate social services, improving women’s status and education, and\ud fostering equitable economic growth. Successful community-based programs are not islands of excellence existing in an imperfect world. Rather, part of their success has to do with contextual factors that provide an enabling or supportive environment. Some of these contextual factors are particularly influenced by policy, some less so. Contextual factors may include, for example, high literacy rates, women’s empowerment, community organizational capacity and structures, appropriate legislation. Nutrition program managers cannot normally influence contextual factors, at least in the short term.\ud In addition to favorable contextual factors, certain program factors contribute to successful programs, such as the design, implementation, and/or management of the program or project, which can, of course, be influenced by program managers. Both contextual and program factors, and the way they interact, need to be identified in order to understand the dynamics behind success. In 1998, under the Greater Horn of Africa Initiative (GHAI) supported by the United States Agency for International Development (USAID), nutrition coalitions were formed in Kenya, Tanzania, and Uganda. These nutrition coalitions, comprising individuals representing government, non-governmental organizations (NGOs), donors, academic institutions, and the private sector, seek to advance the nutrition agenda both in policy and programming through coordination and advocacy efforts. One of the first tasks of the nutrition coalitions, under the leadership of the Program for Applied Technologies in Health (PATH) in Kenya, the Tanzania Food and Nutrition Centre (TFNC) in Tanzania, and the African Medical Research Foundation (AMREF) in Uganda, was to prepare an inventory of community nutrition programs in their respective countries and identify of better practices in community nutrition programming. Country teams, supported by USAID/REDSO/ESA and LINKAGES/AED, then selected three successful programs in their respective countries based on preestablished "process" and "outcome" criteria. UNICEF has a long history of promoting and supporting community-based programs in Eastern and Southern Africa and has supported many reviews and evaluations. As part of its continued effort to strengthen community-based programs by learning from new success stories, UNICEF also identified for review a relatively large scale successful program in Tanzania\u

Water Quality/Use Findings Document

The purpose of this document is to present as much useful information as is available on the water quality and usage of the four ponds to assist in· community decision-making and action. The document also summarizes the concerns and suggestions made at the July 1993 and January 1994 public forums and suggests ways in which people can achieve results. Appendix F offers a list of resource persons and how to contact them. It is hoped that this document will be used by YOU and shared with others so that the communities who use these precious resources will be able to work together for solutions and improvements

What next for Shared Lives? Family-based support as a potential option for older people

With an ageing population and limited resources the challenge for policy makers and practitioners is how best to provide for the care and support needs of older people. This article draws on findings from two studies, a scoping study of the personalisation of care services and another which aimed to generate evidence about the potential use of family-based support schemes (Shared Lives, SL) for certain groups of older people. Forty-three schemes participated in a survey to gather information about services provided and the extent to which this included older people and their carers, and six staffs were interviewed across two schemes about issues for expanding provision for older people in their local areas. It was evident that SL schemes were already supporting a number of older people and there was support for expansion from both schemes and local authorities. Adequate resources, awareness raising, management commitment, and a pool of suitable carers would be needed to support any expansion effort. There is also still a need for SL to be more widely known and understood by care managers if it is to be considered part of mainstream provision for older people

A qualitative exploration of mental health service user and carer perspectives on safety issues in UK mental health services

Background Service user and carer perspectives on safety issues in mental health services are not well known and may be important in preventing and reducing harm. The development of the Yorkshire Contributory Factors Framework—Mental Health (YCFF‐MH) provides a broad structure within which to explore these perspectives. Objective To explore what service users of mental health services and their carers consider to be safety issues. Design, setting and participants Qualitative interviews with 13 service users and 7 carers in the UK. Participants were asked about their experiences and perceptions of safety within mental health services. Perceived safety issues were identified using framework analysis, guided by the YCFF‐MH. Results Service users and carers identified a broad range of safety issues. These were categorized under ‘safety culture’ and included psychological concepts of safety and raising concerns; ‘social environment’ involved threatened violence and sexual abuse; ‘individual service user and staff factors’ dominated by not being listened to; ‘management of staff and staffing levels’ resulting in poor continuity of care; and ‘service process’ typified by difficulty accessing services during a crisis. Several examples of ‘active failures’ were also described. Discussion and conclusions Safety issues appear broader than those recorded and reported by health services and inspectorates. Many safety issues have also been identified in other care settings supporting the notion that there are overlaps between service users and carers’ perspectives of safety in mental health services and those of users in other settings. Areas for further research are suggested

Analysing 'big picture' policy reform mechanisms: The Australian health service safety and quality accreditation scheme

© 2015 John Wiley & Sons Ltd. Background: Agencies promoting national health-care accreditation reform to improve the quality of care and safety of patients are largely working without specific blueprints that can increase the likelihood of success. Objective: This study investigated the development and implementation of the Australian Health Service Safety and Quality Accreditation Scheme and National Safety and Quality Health Service Standards (the Scheme), their expected benefits, and challenges and facilitators to implementation. Methods: A multimethod study was conducted using document analysis, observation and interviews. Data sources were eight government reports, 25 h of observation and 34 interviews with 197 diverse stakeholders. Results: Development of the Scheme was achieved through extensive consultation conducted over a prolonged period, that is, from 2000 onwards. Participants, prior to implementation, believed the Scheme would produce benefits at multiple levels of the health system. The Scheme offered a national framework to promote patient-centred care, allowing organizations to engage and coordinate professionals' quality improvement activities. Significant challenges are apparent, including developing and maintaining stakeholder understanding of the Scheme's requirements. Risks must also be addressed. The standardized application of, and reliable assessment against, the standards must be achieved to maintain credibility with the Scheme. Government employment of effective stakeholder engagement strategies, such as structured consultation processes, was viewed as necessary for successful, sustainable implementation. Conclusion: The Australian experience demonstrates that national accreditation reform can engender widespread stakeholder support, but implementation challenges must be overcome. In particular, the fundamental role of continued stakeholder engagement increases the likelihood that such reforms are taken up and spread across health systems

Social inclusion and valued roles : a supportive framework

The aim of this paper is to examine the concepts of social exclusion, social inclusion and their relevance to health, well-being and valued social roles. The article presents a framework, based on Social Role Valorization (SRV), which was developed initially to support and sustain socially valued roles for those who are, or are at risk of, being devalued within our society. The framework incorporates these principles and can be used by health professionals across a range of practice, as a legitimate starting point from which to support the acquisition of socially valued roles which are integral to inclusio