Using person-centred key performance indicators to improve paediatric services: an international venture

Nurses are a critical part of the healthcare workforce and provide a significant proportion of care. There is a recognised gap in the evidence base regarding how to measure the impact of care and its contributions to the quality of the patient and family experience. This paper focuses on a set of eight key performance indicators (KPIs), developed from primary research led by a team at Ulster University to reflect core aspects of person-centred practice. The KPIs, having already been tested across a range of practice settings, are currently being implemented and further tested through an international study in the area of paediatrics. This study set out to explore their utility in supporting the development of person-centred practice across a range of services provided to sick children. The study involves children\u27s wards/hospitals in Australia (six sites across three states) and Europe (seven sites across four countries). Its purpose is twofold: To describe the person-centred KPIs and how they link to the person-centred nursing framework 2. To describe how these KPIs are being further tested internationally across children\u27s services,and the benefits and challenges of this international approac

Good enough evaluation

A significant obligation still rests with practitioners and researchers to help spread an understanding - and ultimately a valuing - of person-centred practice among stakeholders at various levels, through systematic and meaningful evaluation of their efforts. While there is a range of frameworks (for example, Praxis and Fourth Generation Evaluation) that help guide the evaluation process, there is still the tendency to feel overwhelmed by choices when selecting the right tools or measures for the right people at the right time. In addition, a burden may be created by the amount and range of data produced and how this is analysed and used, which may result in incomplete, inadequate or incongruous evaluations. If we are unable to provide evidence of the effectiveness of our evaluations then stakeholders may assume practice development does not make much difference to the development of an effective person-centred culture. This paper focuses on the importance of evaluation in practice development work and outlines a new framework that incorporates the principles of person-centred practice. This framework will assist practitioners and researchers to undertake effective evaluations and produce strong, reliable evidence for key stakeholders. A case example will be outlined to illustrate the key principles of the framework and how it can be used in practice

The T-box family

Transcription factors of the T-box family are required both for early cell-fate decisions, such as those necessary for formation of the basic vertebrate body plan, and for differentiation and organogenesis. When mutated, T-box genes give dramatic phenotypes in mouse and zebrafish, and they have been implicated both in fundamentals of limb patterning and in a number of human congenital malformations such as Holt-Oram, ulnar-mammary and DiGeorge syndromes, as well as being amplified in a subset of cancers. Genes encoding members of the T-box family have recently been shown to comprise approximately 0.1% of genomes as diverse as those of nematodes and humans and have been identified in a wide variety of animals from ctenophores (comb jellies) to mammals; they are, however, completely absent from genomes from other organisms (such as the model plant Arabidopsis thaliana)

Using data from mHealth apps to inform person-centred practice: A discussion paper

Background mHealth applications(apps) are tools that can enhance research by efficiently collecting and storing large amounts of data. However, data collection alone does not lead to change. Innovation and practice change occur through utilisation of evidence. The volume of data collected raises questions regarding utilisation of data by nurses and midwives, and how data from mHealth apps can be used to improve person-centred practice. There is limited empirical evidence and a lack of direction from global health authorities to guide nurses and midwives in this area.Aim To describe strategies for nurses and midwives that could enhance the effective use of data generated by mHealth apps to inform person-centred practice. The purpose of this paper is to stimulate reflection and generate actions for data utilisation when using mHealth apps in nursing research and practice.Methods This discussion paper has been informed by current evidence, the integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework, and research experience as part of doctoral study. Findings Before engaging in data collection using mHealth apps, nurses and midwives would benefit from considering the nature of the evidence collected, available technological infrastructure, and staff skill levels. When collecting data and interpreting results, use of a team approach supported by engaged leadership and external facilitation is invaluable. This provides support to operate apps, and more importantly use the data collected to inform person-centred practice.Conclusions This paper addresses the limited available evidence to guide nurses and midwives when using mHealth apps to collect and use data to inform practice change. It highlights the need for appropriate technology, external facilitative support, engaged leadership, and a team approach to collect meaningful evidence using mHealth apps. Clinicians, leaders, and researchers can apply the strategies provided to enhance the use of mHealth apps and ensure translation of evidence into practice.<br/

The Use of Data Collected from mHealth apps to inform Evidence-based Quality Improvement: An Integrative Review:Using data from mHealth apps to inform Evidence-based Quality Improvement

© 2019 Sigma Theta Tau International Background: The global acceptance and use of technology in health care has resulted in an abundance of mobile health (mHealth) applications (apps) available for use in the delivery and improvement of care. With so many apps available to patients and clinicians, it is important to understand how data from apps are being used to inform quality improvement in practice. Aim: The aim of this integrative review is to establish current knowledge of how mHealth apps are used to produce data to inform quality improvement in health care. Methods: Scopus, Web of Science, CINAHL, and Medline Plus Full Text databases were searched for peer-reviewed papers written in English. The inclusion criteria comprised of full-text, empirical research studies relating to mobile health application use (not development) in clinical care. Results: Nineteen studies met inclusion criteria. The functions of the apps outlined in the studies can be summarized into four different categories: communication, illness management, clinical management, and education/information. The types of data collected by the apps included numerical, textual, photographic, and graphical with several apps able to collect a variety of data types. Analysis of the studies showed that although data collection is rarely outlined as the explicit purpose of mHealth apps, data collected through such technology are and can be used to inform practice change both in real time and retrospectively. Linking Evidence to Action: This review highlights while this is an emerging area, data obtained from mHealth apps can and are being used to inform quality improvement in health care. Further research is required in this area to adequately understand how data from mHealth apps can be used to produce quality improvement, specifically in relation to nursing. This review also highlights a need for the development of apps that aim to capture data to inform quality improvement, particularly from the patient perspective

Evaluation of the accuracy of serum MMP-9 as a test for colorectal cancer in a primary care population

Background Bowel cancer is common and is a major cause of death. Meta-analysis of randomised controlled trials estimates that screening for colorectal cancer using faecal occult blood (FOB) test reduces mortality from colorectal cancer by 16%. However, FOB testing has a low positive predictive value, with associated unnecessary cost, risk and anxiety from subsequent investigation, and is unacceptable to a proportion of the target population. Increased levels of an enzyme called matrix metalloproteinase 9 (MMP-9) have been found to be associated with colorectal cancer, and this can be measured from a blood sample. Serum MMP-9 is potentially an accurate, low risk and cost-effective population screening tool. This study aims to evaluate the accuracy of serum MMP-9 as a test for colorectal cancer in a primary care population. Methods/Design People aged 50 to 69 years, who registered in participating general practices in the West Midlands Region, will be asked to complete a questionnaire that asks about symptoms. Respondents who describe any colorectal symptoms (except only abdominal bloating and/or anal symptoms) and are prepared to provide a blood sample for MMP9 estimation and undergo a colonoscopy (current gold standard investigation) will be recruited at GP based clinics by a research nurse. Those unfit for colonoscopy will be excluded. Colonoscopies will be undertaken in dedicated research clinics. The accuracy of MMP-9 will be assessed by comparing the MMP-9 level with the colonoscopy findings, and the combination of factors (e.g. symptoms and MMP-9 level) that best predict a diagnosis of malignancy (invasive disease or polyps) will be determined. Discussion Colorectal cancer is a major cause of morbidity and mortality. Most colorectal cancers arise from adenomas and there is a period for early detection by screening, but available tests have risks, are unacceptable to many, have high false positive rates or are expensive. This study will establish the potential of serum MMP-9 as a screening test for colorectal cancer. If it is confirmed as accurate and acceptable, this serum marker has the potential to assist with reducing the morbidity and mortality from colorectal cancer

Supporting novice designers design of digital touch

Digitally mediated touch is an emerging and significant area for technology and therefore for design and design education. However, the design of digital touch is a challenge, especially for novice designers, compounded by low awareness and understanding of the sociality of touch and the complexity of communicating felt sensations. This paper presents a qualitative study of a two-part educational intervention on the design of digital touch using a design-based research methodology. Findings are presented and discussed on the design challenges faced by novice designers in relation to touch and digital touch (the focus of part one of the intervention) and the development and piloting of the Designing Digital Touch (DDT) toolkit (the outcome of part two). The paper discusses how the toolkit can be used to foster and support novice designers to respond to the future facing complexity of digital touch design

Exploring safety culture within inpatient mental health units:The results from participant observation across three mental health services

In Australia, acute inpatient units within public mental health services have become the last resort for mental health care. This research explored barriers and facilitators to safe, person-centred, recovery-oriented mental health care in these settings. It utilised participant observations conducted by mental health nurses in acute inpatient units. These units were located in three distinct facilities, each serving different areas: a large metropolitan suburban area in a State capital, a mid-sized regional city, and a small city with a large rural catchment area. Our findings highlighted that, in the three inpatient settings, nurses tended to avoid common areas they shared with consumers, except for brief, task-related visits. The prioritisation of administrative tasks seemed to arise in a situation where nurses lacked awareness of alternative practices and activities. Consumers spent prolonged periods of the day sitting in communal areas, where the main distraction was watching television. Boredom was a common issue across these environments. The nursing team structure in the inpatient units provided a mechanism for promoting a sense of psychological safety for staff and were a key element in how safety culture was sustained.</p