28 research outputs found
Research utilisation and knowledge mobilisation in the commissioning and joint planning of public health interventions to reduce alcohol-related harms: a qualitative case design using a cocreation approach
Background: Considerable resources are spent on research to establish what works to improve the nationâs health. If the findings from this research are used, better health outcomes can follow, but we know that these findings are not always used. In public health, evidence of what works may not âfitâ everywhere, making it difficult to know what to do locally. Research suggests that evidence use is a social and dynamic process, not a simple application of research findings. It is unclear whether it is easier to get evidence used via a legal contracting process or within unified organisational arrangements with shared responsibilities. Objective: To work in cocreation with research participants to investigate how research is utilised and knowledge mobilised in the commissioning and planning of public health services to reduce alcohol-related harms. Design, setting and participants: Two in-depth, largely qualitative, cross-comparison case studies were undertaken to compare real-time research utilisation in commissioning across a purchaserâprovider split (England) and in joint planning under unified organisational arrangements (Scotland) to reduce alcohol-related harms. Using an overarching realist approach and working in cocreation, case study partners (stakeholders in the process) picked the topic and helped to interpret the findings. In Scotland, the topic picked was licensing; in England, it was reducing maternal alcohol consumption. Methods: Sixty-nine interviews, two focus groups, 14 observations of decision-making meetings, two local feedback workshops (nâ=â23 and nâ=â15) and one national workshop (nâ=â10) were undertaken. A questionnaire (nâ=â73) using a Behaviourally Anchored Rating Scale was issued to test the transferability of the 10 main findings. Given the small numbers, care must be taken in interpreting the findings. Findings: Not all practitioners have the time, skills or interest to work in cocreation, but when there was collaboration, much was learned. Evidence included professional and tacit knowledge, and anecdotes, as well as findings from rigorous research designs. It was difficult to identify evidence in use and decisions were sometimes progressed in informal ways and in places we did not get to see. There are few formal evidence entry points. Evidence (prevalence and trends in public health issues) enters the process and is embedded in strategic documents to set priorities, but local data were collected in both sites to provide actionable messages (sometimes replicating the evidence base). Conclusions: Two mid-range theories explain the findings. If evidence has saliency (relates to âhere and nowâ as opposed to âthere and thenâ) and immediacy (short, presented verbally or visually and with emotional appeal) it is more likely to be used in both settings. A second mid-range theory explains how differing tensions pull and compete as feasible and acceptable local solutions are pursued across stakeholders. Answering what works depends on answering for whom and where simultaneously to find workable (if temporary) âblendsâ. Gaining this agreement across stakeholders appeared more difficult across the purchaserâprovider split, because opportunities to interact were curtailed; however, more research is needed. Funding: This study was funded by the Health Services and Delivery Research programme of the National Institute for Health Research
ĂąInsufficient Evidence of EffectivenessĂą Is Not ĂąEvidence of No Effectiveness:Ăą Evaluating Computer-Based Education for Patients with Severe Mental Illness
Ways of understanding nursing in psychiatric inpatient care â A phenomenographic study
Implementation of a multi-professional standardized care plan in electronic health records for the care of stroke patients
Becoming a good nurse â Socialisation of newly employed nurses into the oncological clinic
Aim and objectives: To explore newly employed nursesâ socialisation in the process of introduction into an oncological clinic from the perspectives of unit managers and newly employed nurses. Background: There are managerial challenges in retaining nurses at workplaces. The way in which nurses are socialised into their work is important for their job satisfaction and retainment. Method: Qualitative, semiâstructured interviews with seven nurses and two unit managers, and written introductory material. Thematic analyses were made, inspired by Goffman's concepts of social interaction, back stage, front stage and roles. SRQR checklist was used. Results: Unit managers created the framework for socialising newly employed nurses through written introductory guidelines and assignments of supervisors as mainstream role models. Newly employed nurses were socialised gradually through mirroring their supervisors in their role as nurse. Front stage, patients often functioned as objects for newly employed nursesâ training. Back stage, patients often functioned as communication objects for all professionals. Newly employed nurses, who also demand roles such as transformer, boss, coordinator, prompter and friend, were socialised into the role of assistant to the doctor. Medical rounds functioned as a socialisator in this process. Conclusion: The allocated supervisors were role models in socialising newly employed nurses into an oncological clinic and its culture. Nurses were socialised into an understanding of care as a biomedical orientation, in which medicine had a higher value than care in the existing knowledge hierarchy at the oncological clinic. This might have implications for who applies for and stays in the job. Relevance to clinical practice: Increased awareness of the importance of socialisation of nurses into the clinic during the introduction process. Reâthinking nursesâ independent functions and patient perspectives in introduction of newly employed nurses to maintain and develop nursing as an independent profession
Childrenâs active participation in decision-making processes during hospitalisation: an observational study
Aims and objectivesThe aim was to explore and describe the child's active participation in daily healthcare practice at children's hospital units in Sweden.Objectives(a) Identify everyday situations in medical and nursing care that illustrate children's active participation in decisionâmaking, (b) identify various ways of active participation, actual and optimal in situations involving decisionâmaking and (c) explore factors in nursing and medical care that influence children's active participation in decisionâmaking.BackgroundDespite active participation being a fundamental right for children, they are not always involved in decisionâmaking processes during their health care. There still remains uncertainty on how to support children to actively participate in decisions concerning their health care.DesignA qualitative study with overt, nonparticipant observations fulfilling the COREQ checklist criteria.MethodsObservations of interactions between children aged 2 and 17 years with both acute and chronic conditions, their parents, and healthcare professionals were conducted at three paediatric hospitals in Sweden. The Scale of Degrees of Self Determination was used to grade identified situations. The scale describes five levels of active participation, with level one being the least and level five being the most active level of participation. Normative judgements were also made.ResultsChildren's active participation was assessed as being generally at levels four and five. Children demonstrated both verbal and nonverbal ways of communication during decisionâmaking. Findings indicated that children's, parents' and healthcare professional's actions influenced children's active participation in decisionâmaking processes involving healthcare.ConclusionsHealthcare professionals specialised in paediatrics need to embrace both a child perspective and a child's perspective, plan care incorporating key elements of a childâcentred care approach, to ensure children's active participation at a level of their choosing.Relevance to clinical practiceThere is a need for awareness creation to help healthcare professionals facilitate children's active participation in their care and decisionâmaking