Description des caractéristiques présentes lors d'une modification dans le processus de changement de comportement à risque chez les femmes ayant subi une angioplastie coronarienne transluminale percutanée (PTCA)

Contexte : Les maladies cardiovasculaires dont l'angine et l'infarctus sont un fléau grandissant pour les Canadiens. En 2008, les femmes canadiennes sont 16% plus susceptibles de succomber à un infarctus que les hommes. Pour améliorer la qualité de vie des patients souffrant d'angine ou d'infarctus, la perfusion transluminale per cutanée (PTCA) s'avère le traitement de choix. Suite à celle-ci, il est recommandé d'effectuer des modifications d'habitudes de vie. Cependant, les femmes cardiaques devant modifier leurs habitudes de vie ont une perception de la maladie différente des hommes mais les caractéristiques présentes lors de changement d'habitude de vie ne sont pas connues. Le nouveau contexte de la PTCA n'est pas adapté à cette population grandissante. Objectif: Décrire les caractéristiques présentes lors d'un changement dans le processus de modification de comportements à risque des femmes ayant subi une PTCA. Méthodologie : Cette étude descriptive. L'échantillon non probabiliste de convenance est composé de 22 femmes (X= 65.4 ans) ayant subi une PTCA au CHUS-Fleurimont. Toutes les participantes complétaient le même questionnaire à 1- 2 semaines (Tl) et à 4 mois post-PTCA (T2) lors d'une rencontre à leur domicile. Les questions évaluaient les trois habitudes de vie en lien avec l'alimentation, l'activité physique et le tabagisme ainsi que les principales caractéristiques pouvant être présentes lors d'une modification de comportement à risque (soutien des proches, perception de la maladie, fatigue, dépression, stress, optimisme, variables sociodémographiques, facilitants et barrières perçues par les participantes). Des statistiques descriptives ont été réalisées. Des tests non paramétriques (a = 0.05) ont été faits pour comparer les participantes entre le Tl et le T2 (Wilcoxon) puis des sous-groupes de celles-ci en fonction de leur motivation à modifier leurs comportements à risque à T2 (Mann-Withney et Krustall-Wallis). Les données qualitatives ont été regroupées par catégorie à l'aide d'une analyse de contenu. Résultats : Les femmes de l'étude identifient plus de symptômes de la maladie, sont plus fatiguées (p=0.01) et plus stressées (p=0.04) au Tl (p=0.000) qu'au T2. Celles-ci perçoivent leur maladie cardiaque comme chronique (p=0.006) et ont une meilleure compréhension de celle-ci (p=0.007) 4 mois suivant la PTCA. Le soutien des professionnels de la santé ainsi que les programmes de réadaptation cardiaque sont perçus comme des facilitants à la modification de comportement au même titre que celui de la famille et des amis. Les symptômes physiques (douleurs aux jambes, au dos, etc.) et les symptômes dépressifs sont identifiés comme des barrières à la modification de comportement. Conclusion : Cette étude a permis de faire ressortir certaines caractéristiques présentes tant en post-PTCA que lors d'un changement dans le processus de modification de comportement. D'autres études doivent cependant être conduite afin de valider ces caractéristiques auprès d'un plus grand échantillon et ainsi pouvoir proposer des interventions infirmières d'enseignements solides et structurés à partir de solides assises sur les caractéristiques associées aux femmes ayant subi une PTCA

L’évaluation de la performance de stagiaires basée sur des observations rapportées dans les programmes professionnalisants en santé : une étude de portée

Background: Educators now use reported observations when assessing trainees’ performance. Unfortunately, they have little information about how to design and implement assessments based on reported observations. Objective: The purpose of this scoping review was to map the literature on the use of reported observations in judging health professions education (HPE) trainees' performances. Methods: Arksey and O'Malley’s (2005) method was used with four databases (sources: ERIC, CINAHL, MEDLINE, PsycINFO). Eligibility criteria for articles were: documents in English or French, including primary data, and initial or professional training; (2) training in an HPE program; (3) workplace-based assessment; and (4) assessment based on reported observations. The inclusion/exclusion, and data extraction steps were performed (agreement rate > 90%). We developed a data extraction grid to chart the data. Descriptive analyses were used to summarize quantitative data, and the authors conducted thematic analysis for qualitative data. Results: Based on 36 papers and 13 consultations, the team identified six steps characterizing trainee performance assessment based on reported observations in HPE: (1) making first contact, (2) observing and documenting the trainee performance, (3) collecting and completing assessment data, (4) aggregating assessment data, (5) inferring the level of competence, and (6) documenting and communicating the decision to the stakeholders. Discussion: The design and implementation of assessment based on reported observations is a first step towards a quality implementation by guiding educators and administrators responsible for graduating competent professionals. Future research might focus on understanding the context beyond assessor cognition to ensure the quality of meta-assessors’ decisions.Contexte : Les éducateurs utilisent désormais les observations rapportées pour évaluer la performance de leurs stagiaires. Malheureusement, ils disposent de peu d'informations sur la manière de concevoir et de mettre en œuvre des évaluations basées sur les observations rapportées. Objectif : L'objectif de cette étude de la portée des écrits était de recenser la littérature sur l'utilisation des observations rapportées lors d'évaluation de la performance de stagiaires dans les programmes professionnalisants en santé (PPS). Méthodes : La méthode d'Arksey et O'Malley (2005) a été utilisée et quatre bases de données ont été interrogées (ERIC, CINAHL, MEDLINE, PsycINFO). Les critères d'admissibilité des articles étaient les suivants : (1) écrit en anglais ou en français ; (2) comprend des données primaires ; (3) traite de la formation initiale ou professionnelle ; (4) se situe en formation d'un PPS ; (5) traite de l’évaluation en stage ;  et (6) traite de l’évaluation basée sur des observations rapportées. Les étapes d'inclusion/exclusion et d'extraction des données ont été réalisées à deux personnes (taux d'accord > 90%). Nous avons extrait les données avec une grille d'extraction des données préétablie et itérative. Des analyses quantitatives ont été menées pour résumer les données numériques et une analyse thématique pour résumer les données qualitatives. Résultats : Sur la base de 36 articles et de 13 consultations, nous avons identifié six étapes caractérisant l'évaluation de la performances de stagiaires basée sur des observations rapportées dans les PPS : (1) établir un premier contact, (2) observer et documenter la performance du stagiaire, (3) recueillir et compléter les données d'évaluation, (4) agréger les données d'évaluation, (5) déduire le niveau de compétence, et (6) documenter et communiquer la décision aux parties prenantes. Discussion : La conception et la mise en œuvre de l'évaluation sur la base d’observations rapportées constituent un premier pas vers la mise en œuvre d’une évaluation de qualité en guidant les éducateurs et les administrateurs responsables de la formation de professionnels compétents. Les recherches futures pourraient se concentrer sur la compréhension du contexte au-delà de la cognition de l'évaluateur afin de garantir la qualité des décisions prises par les métaévaluateurs

La santé psychologique et la conciliation travail-famille des infirmières en soins ambulatoires à l’ère de la COVID-19 : résultats d’une enquête

Introduction: The COVID-19 pandemic impacted nurses’ psychological health and work-family balance, including in ambulatory care settings. The results presented in this article are part of a study aiming to describe and contextualize the psychological health and changes in nurses’ follow-up practices in Quebec (Canada) during the COVID-19 pandemic. Objective: Explore and describe factors that influenced ambulatory care nurses’ psychological health and work-family balance during the first wave of the COVID-19 pandemic. Methods: Exploratory mixed data cross-sectional study using the SurveyMonkey platform. We collected data from July 2020 to September 2020. The target population comprised all practicing nurses in Quebec whose clinical activities included the follow-up of ambulatory patients, 200 of whom completed the survey.  Results: Multiple linear regression models indicated that anxiety (GAD-7 scores) and depressive symptoms (PHQ-9 scores) were associated with younger age, living alone, worries about transmitting COVID-19, and feeling that one’s work was not coherent with one’s values. Work-family balance was considered more difficult than before the pandemic by 54.5 % of participants. Factors perceived as influencing work-family balance were either related to work conditions (e.g., schedule and time at work, access to work from home, redeployment to another work setting), to family-related responsibilities/tasks or were specific to the pandemic. Discussion and conclusion: Apart from age, the feeling that one’s work was not coherent with their values was the only variable correlated with both GAD-7 and PHQ-9 in multivariate models. Further research should investigate the relationships between sense of coherence, psychological health, and work conditions like schedule flexibility and access to work from home.Introduction : La pandémie a eu des répercussions sur la santé psychologique et la conciliation travail-famille des infirmières, y compris dans les milieux de soins ambulatoires. Les résultats présentés dans cet article font partie d’une étude visant à décrire et contextualiser la santé psychologique et l’évolution des pratiques de suivi infirmier au Québec (Canada) lors de la pandémie de COVID-19. Objectif : Explorer et décrire les facteurs qui ont influencé la santé psychologique et la conciliation travail-famille des infirmières en soins ambulatoires pendant la première vague de la pandémie de COVID-19. Méthodes : Enquête exploratoire avec données mixtes par le biais de la plateforme SurveyMonkey. Les données ont été collectées de juillet 2020 à septembre 2020. La population cible était toutes les infirmières du Québec dont les activités cliniques incluaient le suivi de patients ambulatoires ; 200 infirmières ont participé. Résultats : Les modèles de régression ont indiqué que les symptômes anxieux (scores au GAD-7) et dépressifs (scores au PHQ-9) étaient associés à un plus jeune âge, au fait de vivre seul, aux inquiétudes concernant la transmission de la COVID-19 et au sentiment que son travail n’était pas cohérent avec ses valeurs. La conciliation travail-famille était jugée plus difficile qu’avant la pandémie par 54,5 % des participants. Les facteurs perçus comme l’influençant étaient soit liés aux conditions de travail (p. ex., horaire et temps de travail, télétravail, délestage), aux tâches familiales, ou étaient spécifiques à la pandémie. Discussion et conclusion : Outre l’âge, le sentiment que son travail n’était pas cohérent avec ses valeurs était la seule variable corrélée à la fois avec le GAD-7 et le PHQ-9. Les futures recherches devraient s’intéresser à la relation entre le sentiment de cohérence, la santé psychologique et les conditions de travail favorables à la conciliation travail-famille

The impact of funding models on the integration of registered nurses in primary health care teams: protocol for a multi-phase mixed-methods study in Canada.

BACKGROUND: Family practice registered nurses co-managing patient care as healthcare professionals in interdisciplinary primary care teams have been shown to improve access, continuity of care, patient satisfaction, and clinical outcomes for patients with chronic diseases while being cost-effective. Currently, however, it is unclear how different funding models support or hinder the integration of family practice nurses into existing primary health care systems and interdisciplinary practices. This has resulted in the underutilisation of family practice nurses in contributing to high-quality patient care. METHODS: This mixed-methods project is comprised of three studies: (1) a funding model analysis; (2) case studies; and (3) an online survey with family practice nurses. The funding model analysis will employ policy scans to identify, describe, and compare the various funding models used in Canada to integrate family practice nurses in primary care. Case studies involving qualitative interviews with clinic teams (family practice nurses, physicians, and administrators) and family practice nurse activity logs will explore the variation of nursing professional practice, training, skill set, and team functioning in British Columbia, Nova Scotia, Ontario, and Quebec. Interview transcripts will be analysed thematically and comparisons will be made across funding models. Activity log responses will be analysed to represent nurses\u27 time spent on independent, dependent, interdependent, or non-nursing work in each funding model. Finally, a cross-sectional online survey of family practice nurses in Canada will examine the relationships between funding models, nursing professional practice, training, skill set, team functioning, and patient care co-management in primary care. We will employ bivariate tests and multivariable regression to examine these relationships in the survey results. DISCUSSION: This project aims to address a gap in the literature on funding models for family practice nurses. In particular, findings will support provincial and territorial governments in structuring funding models that optimise the roles of family practice nurses while establishing evidence about the benefits of interdisciplinary team-based care. Overall, the findings may contribute to the integration and optimisation of family practice nursing within primary health care, to the benefit of patients, primary healthcare providers, and health care systems nationally

The Psychological Health and Work-Family Balance of Ambulatory Care Nurses in the COVID-19 era: a Cross-Sectional Survey

Introduction: The COVID-19 pandemic impacted nurses’ psychological health and work-family balance, including in ambulatory care settings. The results presented in this article are part of a study aiming to describe and contextualize the psychological health and changes in nurses’ follow-up practices in Quebec (Canada) during the COVID-19 pandemic. Objective: Explore and describe factors that influenced ambulatory care nurses’ psychological health and work-family balance during the first wave of the COVID-19 pandemic. Methods: Exploratory mixed data cross-sectional study using the SurveyMonkey platform. We collected data from July 2020 to September 2020. The target population comprised all practicing nurses in Quebec whose clinical activities included the follow-up of ambulatory patients, 200 of whom completed the survey.  Results: Multiple linear regression models indicated that anxiety (GAD-7 scores) and depressive symptoms (PHQ-9 scores) were associated with younger age, living alone, worries about transmitting COVID-19, and feeling that one’s work was not coherent with one’s values. Work-family balance was considered more difficult than before the pandemic by 54.5 % of participants. Factors perceived as influencing work-family balance were either related to work conditions (e.g., schedule and time at work, access to work from home, redeployment to another work setting), to family-related responsibilities/tasks or were specific to the pandemic. Discussion and conclusion: Apart from age, the feeling that one’s work was not coherent with their values was the only variable correlated with both GAD-7 and PHQ-9 in multivariate models. Further research should investigate the relationships between sense of coherence, psychological health, and work conditions like schedule flexibility and access to work from home

Becoming a research participant : decision-making needs of individuals with neuromuscular diseases

BACKGROUND: Research has shown that some people with neuromuscular diseases may have a lower level of education due to lower socioeconomic status and possibly compromised health literacy. In view of these data, it appears important to document their decision-making needs to ensure better support when faced with the decision to participate or not in research projects. OBJECTIVES: 1) To document the decision-making needs of individuals with neuromuscular diseases to participate in research; 2) To explore their preferences regarding the format of knowledge translation tools related to research participation. METHODS: This qualitative study is based on the Ottawa Decision Support Framework. A two-step descriptive study was conducted to capture the decision-making needs of people with neuromuscular diseases related to research participation: 1) Individual semi-directed interviews (with people with neuromuscular diseases) and focus groups (with healthcare professionals); 2) Synthesis of the literature. RESULTS: The semi-directed interviews (n = 11), the two focus groups (n = 11) and the literature synthesis (n = 50 articles) identified information needs such as learning about ongoing research projects, scientific advances and research results, the potential benefits and risks associated with different types of research projects, and identified values surrounding research participation: helping other generations, trust, obtaining better clinical follow-up, and socialization. CONCLUSION: This paper provides useful recommendations to support researchers and clinicians in developing material to inform individuals with neuromuscular diseases about research participation

Chronic disease patients’ experience with telehealth interventions and self-care strategies during the first wave of the COVID-19 pandemic

Purpose. During COVID-19 pandemic, Québec (Canada) Public Health Agency asked Family Medicine Group (FMG) to change their practice such as recommending the use of telehealth interventions. However, it is unknown if telehealth meets patients' needs in terms of self-care, especially those suffered from physical and mental chronic condition (PCDs). This study aimed to explore, from a PCD's perspective, the response of FMG about their self-care needs during COVID-19 pandemic. Methods. We conducted an exploratory qualitative descriptive study using semi-structured interviews to reach 40 PCDs from three regions of Québec. We explored FMGs' responses, PCDs needs, coping strategies regarding the COVID-19 and the changes in primary care services. We used the transactional theory of stress and coping to inform the data collection and analysis and the COREQ appraisal grid to report this study. Results. PCDs appreciated telehealth and perceived that the accessibility was increased. Moreover, family physicians from FMG conducted the majority of the follow-ups although interdisciplinary teams were available. The coping strategies raised by the PCDs were primarily aimed at maintaining their health status, while some of them aimed to reduce stress levels. Conclusions. PCDs seem to appreciate telehealth but believe it requires improvements, and it is not adequate for all types of follow-ups. PCDs adopt coping strategies to face the pandemic that were not always optimal for their health. We call for a better understanding of PCDs' needs in times of a pandemic in order to offer them the appropriate services an interdisciplinary team can provide.http://deepblue.lib.umich.edu/bitstream/2027.42/167663/1/Article patients-covid copingVF_PP.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/167663/3/Article patients-covid coping VF_V2.pdfDescription of Article patients-covid copingVF_PP.pdf : Main ArticleSEL

Effectiveness of registered nurses on patient outcomes in primary care: a systematic review

Background Globally, registered nurses (RNs) are increasingly working in primary care interdisciplinary teams. Although existing literature provides some information about the contributions of RNs towards outcomes of care, further evidence on RN workforce contributions, specifically towards patient-level outcomes, is needed. This study synthesized evidence regarding the effectiveness of RNs on patient outcomes in primary care. Methods A systematic review was conducted in accordance with Joanna Briggs Institute methodology. A comprehensive search of databases (CINAHL, MEDLINE Complete, PsycINFO, Embase) was performed using applicable subject headings and keywords. Additional literature was identified through grey literature searches (ProQuest Dissertations and Theses, MedNar, Google Scholar, websites, reference lists of included articles). Quantitative studies measuring the effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN) that reported related outcomes were included. Articles were screened independently by two researchers and assessed for bias using the Integrated Quality Criteria for Review of Multiple Study Designs tool. A narrative synthesis was undertaken due to the heterogeneity in study designs, RN-led interventions, and outcome measures across included studies. Results Forty-six patient outcomes were identified across 23 studies. Outcomes were categorized in accordance with the PaRIS Conceptual Framework (patient-reported experience measures, patient-reported outcome measures, health behaviours) and an additional category added by the research team (biomarkers). Primary care RN-led interventions resulted in improvements within each outcome category, specifically with respect to weight loss, pelvic floor muscle strength and endurance, blood pressure and glycemic control, exercise self-efficacy, social activity, improved diet and physical activity levels, and reduced tobacco use. Patients reported high levels of satisfaction with RN-led care. Conclusions This review provides evidence regarding the effectiveness of RNs on patient outcomes in primary care, specifically with respect to satisfaction, enablement, quality of life, self-efficacy, and improvements in health behaviours. Ongoing evaluation that accounts for primary care RNs’ unique scope of practice and emphasizes the patient experience is necessary to optimize the delivery of patient-centered primary care. Protocol registration ID PROSPERO: International Prospective Register of Systematic Reviews. 2018. ID=CRD42 018090767

Effectiveness of registered nurses on system outcomes in primary care: a systematic review

Background Internationally, policy-makers and health administrators are seeking evidence to inform further integration and optimal utilization of registered nurses (RNs) within primary care teams. Although existing literature provides some information regarding RN contributions, further evidence on the impact of RNs towards quality and cost of care is necessary to demonstrate the contribution of this role on health system outcomes. In this study we synthesize international evidence on the effectiveness of RNs on care delivery and system-level outcomes in primary care. Methods A systematic review was conducted in accordance with Joanna Briggs Institute methodology. Searches were conducted in CINAHL, MEDLINE Complete, PsycINFO, and Embase for published literature and ProQuest Dissertations and Theses and MedNar for unpublished literature between 2019 and 2022 using relevant subject headings and keywords. Additional literature was identified through Google Scholar, websites, and reference lists of included articles. Studies were included if they measured effectiveness of a RN-led intervention (i.e., any care/activity performed by a primary care RN within the context of an independent or interdependent role) and reported outcomes of these interventions. Included studies were published in English; no date or location restrictions were applied. Risk of bias was assessed using the Integrated Quality Criteria for Review of Multiple Study Designs tool. Due to the heterogeneity of included studies, a narrative synthesis was undertaken. Results Seventeen articles were eligible for inclusion, with 11 examining system outcomes (e.g., cost, workload) and 15 reporting on outcomes related to care delivery (e.g., illness management, quality of smoking cessation support). The studies suggest that RN-led care may have an impact on outcomes, specifically in relation to the provision of medication management, patient triage, chronic disease management, sexual health, routine preventative care, health promotion/education, and self-management interventions (e.g. smoking cessation support). Conclusions The findings suggest that primary care RNs impact the delivery of quality primary care, and that RN-led care may complement and potentially enhance primary care delivered by other primary care providers. Ongoing evaluation in this area is important to further refine nursing scope of practice policy, determine the impact of RN-led care on outcomes, and inform improvements to primary care infrastructure and systems management to meet care needs. Protocol registration ID PROSPERO: International prospective register of systematic reviews. 2018. ID= CRD42018090767

Validation of the disease burden morbidity assessment by self-report in a French-speaking population

<p>Abstract</p> <p>Background</p> <p>The Disease Burden Morbidity Assessment (DBMA) is a self-report questionnaire used to estimate the disease burden experienced by patients. The aim of this study was to test and to measure the properties of the French translation of the DBMA (DBMA-Fv).</p> <p>Methods</p> <p>The original version of the DBMA was translated into French (Canadian) and first assessed during cognitive interviews. In the validation study, patients recruited during consecutive consultation periods completed the DBMA-Fv questionnaire while they were in the waiting room of a primary care setting (T1). Participants completed the same questionnaire mailed to their home two weeks later (T2). Concomitant validity of the DBMA-Fv was assessed using the Cumulative Illness Rating Scale (CIRS). Patient medical records were reviewed to verify chronic diseases and past medical history.</p> <p>Results</p> <p>Ninety-seven patients were recruited and 85 (88%) returned the mailed questionnaires; 5 (5.9%) were incomplete. DBMA-Fv scores of the 80 participants with a complete questionnaire at T2 ranged from 0 to 30 (median 5.5, mean 7.7, SD = 7.0). Test-retest reliability of the DBMA-Fv was high (ICC: 0.86, 95% CI: 0.79-0.92). The DBMA-Fv and the CIRS correlated moderately at T1 (r = 0.46, 95% CI: 0.26 - 0.62, <it>p </it>< 0.01) and T2 (r = 0.56, 95% CI: 0.38 - 0.70, <it>p </it>< 0.01). The mean (SD) sensitivity of patient reports of a condition in relation to chart review at T2 was 73.9 (8.4) (range 62.5% to 90%). The overall mean (SD) specificity was 92.2 (6.7) (range 77.6% to 98.6%).</p> <p>Conclusions</p> <p>The DBMA-Fv's properties are similar to its English counterpart as to its median sensitivity and specificity compared to chart reviews. It correlated moderately with an established index of multimorbidity. A high percentage of patients were able to complete the test correctly as a mail questionnaire and it showed high test-retest reliability.</p