49 research outputs found
Lâadaptation des services de santĂ© Ă lâĂ©gard de personnes migrantes : cas des services infirmiers en premiĂšre ligne
Comment sâadaptent des organisations lorsquâelles font face Ă des changements qui les dĂ©passent? De cette question a Ă©mergĂ© une recherche voulant comprendre comment et pourquoi des organisations de santĂ© dĂ©cident dâadapter (ou non) leurs services aux besoins et aux caractĂ©ristiques des populations migrantes accueillies sur leur territoire.
Pour y rĂ©pondre, cette thĂšse sâest intĂ©ressĂ©e Ă la gouvernance multiniveaux appliquĂ©e aux organisations de santĂ© fournissant des services Ă des populations migrantes.
Dans un contexte de rĂ©gionalisation de lâimmigration, la dynamique du processus migratoire est de mieux en mieux documentĂ©e, mais les capacitĂ©s organisationnelles dâadaptation le sont beaucoup moins.
Nous avons rĂ©alisĂ© une Ă©tude de cas multiples Ă lâaide dâentrevues semi-directives auprĂšs dâacteurs provenant de deux CSSS montĂ©regiens (rĂ©gion au sud de MontrĂ©al, QuĂ©bec) et des paliers locaux, rĂ©gionaux et nationaux.
Les rĂ©sultats de cette Ă©tude ont permis (1) de mettre en Ă©vidence les diffĂ©rents acteurs impliquĂ©s dans ce processus dâadaptation, dont des acteurs de connectivitĂ©; (2) de cerner huit leviers dâaction, divisĂ©s en trois catĂ©gories de leviers : administratif, Ă©mergent et dâhabilitation. La possible imbrication de ces trois catĂ©gories de leviers facilite lâapparition de structures de connectivitĂ©, lĂ©gitimant ainsi lâadaptation de lâorganisation; et (3) de montrer lâambigĂŒitĂ© de lâadaptation Ă travers des facteurs dâinfluence qui favorisent ou entravent le processus dâadaptation Ă plusieurs niveaux de la gouvernance.
Cette thĂšse est construite autour de quatre articles. Le premier, de nature conceptuelle, permet de circonscrire les concepts dâadaptation et de gouvernance multiniveaux Ă travers la lentille des thĂ©ories de la complexitĂ©. Nous campons ainsi notre sujet dans une problĂ©matique liĂ©e Ă la vulnĂ©rabilitĂ© et la migration tout en apprĂ©hendant lâadaptation du systĂšme et son opĂ©rationnalisation au niveau local. Il en ressort un cadre conceptuel avec six propositions de recherches.
Le second article permet quant Ă lui de comprendre les jeux des acteurs au sein dâune organisation de santĂ© et Ă travers son Environnement. Le rĂŽle spĂ©cifique dâacteurs de connectivitĂ© y est rĂ©vĂ©lĂ©.
Câest dans un troisiĂšme article que nous nous intĂ©ressons davantage aux diffĂ©rents leviers dâaction, analysĂ©s selon trois catĂ©gories : administrative, Ă©mergente et dâhabilitation. Les acteurs peuvent les solliciter afin de dâadapter leurs pratiques au contexte particulier de la prise en charge de patients migrants. Un passage des acteurs aux structures de connectivitĂ© est alors rendu possible via un espace : la gouvernance multiniveaux.
Enfin, le quatriĂšme et dernier article sâarticule autour de lâanalyse des diffĂ©rents facteurs pouvant influencer lâadaptation dâune organisation de santĂ©, en lien avec son Environnement. Il en ressort principalement que les facteurs identifiĂ©s sont pour beaucoup des leviers dâaction (cf. article3) qui Ă travers le temps, et par rĂ©cursivitĂ©, deviennent des facteurs dâinfluence. De plus, le type dâinterdĂ©pendance dĂ©veloppĂ© par les acteurs a tendance soit Ă façonner un Environnement « stable », laissant reposer les besoins dâadaptation sur les acteurs opĂ©rationnels; soit Ă façonner un Environnement plus « accidentĂ© », reposant davantage sur des interactions diversifiĂ©es entre les acteurs dâune gouvernance multiniveaux. De cette adĂ©quation avec lâEnvironnement Ă façonner dĂ©coule lâambigĂŒitĂ© de sâadapter ou non pour une organisation.How do organizations adapt when faced with changes that exceed their current capacities? More specifically how and why do healthcare organizations choose to adapt- or not- their services to the needs and characteristics of new and established migrant populations? In this thesis, we attempt to answer these questions using a conceptual model of multilevel governance, applicable to healthcare organizations that provide primary care to migrant population.
In a context of regionalized immigration, the dynamics of the migration process are well documented, however organizations abilities to adapt are less so. We conducted a multiple case study, collecting data from semi-structured interviews with providers from two healthcare organizations from Montéregie region (South shore of Montréal, Québec) as well as stakeholders from local, regional and national scale.
The data collected has allowed us, (1) to identify the most significant stakeholders in adaptation process and to highlight the connectivity between them; (2) to reveal eight action levers that we divided in three categories: administrative, emerging and enabling. The possible imbrications of these three categories facilitate the creation of connectivity structures that legitimate the organizationâs adaptation; and (3) to show the ambiguity of adaptation through the influence of facilitating or hindering factors at several levels of governance.
This thesis is structured on four articles. The first article is conceptual: adaptation and multilevel governance are therein defined through the framework of complexity theory. We anchor our subject in the vulnerability and migration schemata, while apprehending the systemâs adaptation at the local scale. The result is a conceptual framework with six research propositions.
The second article elaborates on the dynamics among stakeholders within healthcare organizations, its networks and the Environment. The specific role of the connectivity between stakeholders is highlighted.
In the third article, we focus on the different action levers, which are analysed in three categories: administrative, emerging and enabling. The stakeholders seek to adapt their practices to the particular context of providing timely and appropriate care to migrant patients. A transition from connectivity between actors and structures is then made possible through multilevel governance.
Finally, the fourth article is an analysis of the different factors that influence a healthcare organizationâs adaptation with regards to the Environment. The results show that many identified factors are firstly action levers (see article 3), and become through time and recursively of influence factors.
In addition, the type of interdependence developed between the stakeholders tends to shape either âstableâ Environment which transfers the responsibility of the adaptation to the operational stakeholders or âruggedâ Environment based on diverse and decentralized interactions between stakeholders through multilevel of governance. From this constant adjustment with the Environment appears the ambiguity of the adaptation for a healthcare organization
Changing nursing practice within primary health care innovations: the case of advanced access model
Background: The advanced access (AA) model has attracted much interest across Canada and worldwide as a
means of ensuring timely access to health care. While nurses contribute significantly to improving access in primary
healthcare, little is known about the practice changes involved in this innovative model. This study explores the
experience of nurse practitioners and registered nurses with implementation of the AA model, and identifies factors
that facilitate or impede change.
Methods: We used a longitudinal qualitative approach, nested within a multiple case study conducted in four
university family medicine groups in Quebec that were early adopters of AA. We conducted semi-structured interviews with two types of purposively selected nurses: nurse practitioners (NPs) (n = 6) and registered nurses (RNs) (n = 5). Each nurse was interviewed twice over a 14-month period. One NP was replaced by another during the second interviews. Data were analyzed using thematic analysis based on two principles of AA and the Niezen & Mathijssen Network Model 2014).
Results: Over time, RNs were not able to review the appointment system according to the AA philosophy. Half of
NPs managed to operate according to AA. Regarding collaborative practice, RNs were still struggling to participate in team-based care. NPs were providing independent and collaborative patient care in both consultative and joint practice, and were assuming leadership in managing patients with acute and chronic diseases. Thematic analysis revealed influential factors at the institutional, organizational, professional, individual and patient level, which acted mainly as facilitators for NPs and barriers for RNs. These factors were: 1) policy and legislation; 2) organizational policy support (leadership and strategies to support nursesâ practice change); facility and employment arrangements(supply and availability of human resources); Inter-professional collegiality; 3) professional boundaries; 4) knowledgeand capabilities; and 5) patient perceptions.
Conclusions: Our findings suggest that healthcare decision-makers and organizations need to redefine the boundaries of each category of nursing practice within AA, and create an optimal professional and organizational context that supports practice transformation. They highlight the need to structure teamwork efficiently, and integrate and maximize nursesâ capacities within the team throughout AA implementation in order to reduce waiting times
Les consĂ©quences de la pandĂ©mie sur la santĂ© globale des populations universitaires. Que connait-on de lâĂ©tat de santĂ© mentale des rĂ©pondants ? Faits saillants â Phase 1 â Feuillet No 2
Les consĂ©quences de la pandĂ©mie sur la santĂ© globale des populations universitaires. Qui sont les participants ? Faits saillants â Phase 1 â Feuillet No 1
Les consĂ©quences de la pandĂ©mie sur la santĂ© globale des populations universitaires. Stress, adaptation et soutien social. Faits saillants â Phase 1 â Feuillet No 5
Les consĂ©quences de la pandĂ©mie sur la santĂ© globale des populations universitaires. Quelles sont les rĂ©percussions Ă©conomiques et professionnelles de la pandĂ©mie sur les rĂ©pondants? Faits saillants â Phase 1 â Feuillet No 6
Les consĂ©quences de la pandĂ©mie sur la santĂ© globale des populations universitaires. De quelles maniĂšres les participants perçoivent-ils leurs milieux universitaires? Faits saillants â Phase 1 â Feuillet No 7
COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study
Background:
The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms.
Methods:
International, prospective observational study of 60â109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms.
Results:
âTypicalâ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (â€â18 years: 69, 48, 23; 85%), older adults (â„â70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each Pâ<â0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country.
Interpretation:
This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men
AMĂLIORER LES SERVICES DâĂVALUATION PSYCHOSOCIALE OFFERTS AUX PERSONNES RĂFUGIĂES Ă LEUR ARRIVĂE AU QUĂBEC
Cet article porte sur la pertinence des services dâĂ©valuation psychosociale offerts dans le cadre du programme Passerelle aux personnes rĂ©fugiĂ©es, dĂšs leur arrivĂ©e au QuĂ©bec. Selon un devis de recherche qualitatif, 28 participants originaires dâAfghanistan et dâAfrique subsaharienne, et deux travailleuses sociales, ont Ă©tĂ© rencontrĂ©s lors dâentretiens en groupe ou en individuel. Des recommandations proposĂ©es par les participants pour amĂ©liorer lâĂ©valuation psychosociale sont prĂ©sentĂ©es et discutĂ©es Ă la lumiĂšre de celles faites par des chercheurs. LâexhaustivitĂ© de lâĂ©valuation et les courts dĂ©lais de temps prĂ©vus pour lâeffectuer sont notamment questionnĂ©s, ainsi que lâefficacitĂ© de cette mesure pour pallier les iniquitĂ©s dâaccĂšs aux services de santĂ© et psychosociaux.This article concerns the relevance of psychosocial assessment services offered to refugees as part of the program Passerelle upon their arrival in Quebec. Using a qualitative research design, 28 participants coming from Afghanistan and sub-Saharan Africa, and two social workers, were interviewed through focus group or individual interviews. Recommendations proposed by the participants in order to improve the psychosocial assessment are presented. These recommendations are discussed based on recommendations drawn from scientific literature. Among others, the completeness of the assessment and the short timeframe available to conduct it are questioned, as well as the efficiency of this measure to tackle the inequities of access to health and psychosocial services
The challenges of implementing advanced access for residents in family medicine in Quebec. Do promising strategies exist?
Background: The advanced access (AA) model is a highly recommended innovation to improve timely access to primary healthcare. Despite that many studies have shown positive impacts for healthcare professionals, and for patients, implementing this model in clinics with a teaching mission for family medicine residents poses specific challenges. Objective: To identify these challenges within these clinics, as well as potential strategies to address them. Design: The authors adopted a qualitative multiple case study design, collected data in 2016 using semi-structured interviews (NÂ =Â 40) with healthcare professionals and clerical staff in four family medicine units in Quebec, and performed a thematic analysis. They validated results through a discussion workshop, involving many family physicians and residents practicing in different regions Results: Five challenges emerged from the data: 1) choosing, organizing residentsâ patient; 2) managing and balancing residentsâ appointment schedules; 3) balancing timely access with relational continuity; 4) understanding the AA model; 5) establishing collaborative practices with other health professionals. Several promising strategies were suggested to address these challenges, including clearly defining residentsâ patient panels; adopting a team-based care approach; incorporating the model into academic curriculum and clinical training; proactive and ongoing education of health professionals, residents, and patients; involving residents in the change process and in adjustment strategies. Conclusions: To meet the challenges of implementing AA, decision-makers should consider exposing residents to AA during academic training and clinical internships, involving them in team work on arrival, engaging them as key actors in the implementation and in intra- and inter-professional collaborative models