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To discuss the dyadic and triadic interviewing techniques as distinct approaches to data collection in qualitative research.
Methodological/methodical discussion.
Underpinned by a layered theoretical basis involving interpretivism, social constructivism and symbolic interactionism, dyadic and triadic interviewing approaches represent a tapestry that seeks to illuminate not only what participants think at the individual level, but also how they think together to generate shared, nuanced meanings. Key methodical considerations include participant recruitment and selection to form the dyads or triads, ethical issues, navigating power dynamics, determining saturation at the dyad or triad level and shifting the unit of analysis from the individual level to the dyad or triad level. Notable challenges to using these approaches include logistical complexity, ethical risks and the great need for skilled moderation.
Dyadic and triadic interviewing techniques occupy a vital methodological niche in qualitative studies, particularly within the contexts of health and social care research where relational dynamics and collaborative decision-making are central. By foregrounding co-constructed narratives and real-time interactions, dyadic and triadic interviewing techniques illuminate the interplay of individual agency, power asymmetries and cultural norms, offering insights that transcend the limitations of individual interviews or focus groups.
The increasing complexity of care, treatment pathways, recovery and family-centered decision making warrants engagement beyond individual interviews. Dyadic and triadic interview techniques facilitate this by combining the in-depth benefit of individual interviews and shared interpretations of focus group discussions to capture meanings and experiences.
This methodological/methodical discussion offers clarity to employing dyadic or triadic interviewing approaches to improve their uptake in health and social care research.
Not applicable.
No patient or public contribution.
To explore key stakeholders' experiences and perceptions of end-of-life communication in acute care settings.
A qualitative descriptive study.
Data were collected from 4 May to 31 October 2023. Patients with terminal illness, family caregivers and healthcare providers were recruited from two Chinese hospitals via purposive sampling. Individual interviews were conducted with patients and family caregivers, whereas healthcare providers participated in focus group discussions. Thematic analysis was conducted.
Nineteen patients, 22 family caregivers and 25 healthcare providers participated. Five themes emerged: (1) protective end-of-life communication, characterised by dominant family involvement, truth concealment and restricted end-of-life topics; (2) open end-of-life communication, characterised by dominant patient involvement, truth disclosure and diverse end-of-life topics; (3) patient-related factors, including comfort level in talking about end-of-life, burden and treatment engagement; (4) family-related factors, including comfort, burden, expectations, values and trust in healthcare providers and (5) healthcare provider-related factors, including comfort, time availability and clinical priorities, end-of-life communication awareness and skills and end-of-life care knowledge.
End-of-life communication in Chinese acute care settings oscillates between protective and open approaches, influenced by several individual factors.
Healthcare providers must overcome stereotypes rooted in cultural values and adopt a proactive approach to end-of-life communication. Enhanced training and institutional procedures are needed to improve end-of-life communication in acute care settings.
The study provides nuanced insights into end-of-life communication dynamics in Chinese acute care settings, complementing global evidence. Coexisting protective and open communication approaches highlight the need for context-sensitive approaches to end-of-life communication. Multifocal interventions addressing patient-, family- and healthcare provider-related factors are warranted.
Standards for Reporting Qualitative Research.
No patient or public contribution was involved in the design or conduct of the study.
Hospital falls and associated injuries are a global issue associated with harm and significant costs to individuals and society, especially for older adults. Hospital standards specify the minimum level of care required to optimise patient safety, quality and outcomes. Standards are often used during hospital accreditation. This investigation analysed the content and quality of hospital falls standards across the globe.
Hospital standards were located by searching online databases (PubMed, CINAHL, Google Scholar, MEDLINE), ChatGPT, the grey literature via internet search engines, and websites of accreditation agencies, government agencies, and other relevant organisations. We searched for standards from the 60 largest countries by population plus the 60 countries with the highest gross domestic product (n = 82 after accounting for duplicates). For inclusion, hospital standards had to mention ‘fall/s’. Data were analysed using a deductive framework synthesis and content analysis to identify emergent themes.
Forty-one standards used by at least 72 countries were identified from our search. Sixteen were excluded from detailed analysis because they did not mention falls and 3 could not be retrieved. A total of 22 standards were included in the final detailed analysis. Included standards showed wide variations in content and quality. Seven were assessed as high quality, 12 medium quality, and 3 were deemed to be of low quality. Some lacked details on hospital falls screening, assessment, prevention, and management. Consumer engagement in development, implementation, or evaluation was not mentioned in all standards. Procedures for falls data collection and reporting were seldom documented. Hospital standards infrequently referred readers to contemporary research or clinical practice guidelines.
There are variations in the quality and content of standards on hospital falls. International collaboration is recommended to increase the consistency and validity of hospital falls standards across nations, in order to optimise healthcare outcomes.
The findings of this global analysis of hospital falls standards have the potential to impact falls rates and fall-related injuries in hospital patients by providing data to inform the content, evidence base and use of hospital standards to optimise the safety and quality of care delivery. The findings inform the review, design and implementation of hospital accreditation procedures to improve patient outcomes, patient experiences, and service quality.
To explore individual and organisational factors affecting near-miss reporting in healthcare settings.
Systematic review following the PRISMA 2020 guidelines.
Five electronic databases from 2013 to 2024 studies published were searched.
A comprehensive search was conducted across PubMed, Web of Science, MEDLINE, Scopus and OpenAlex, covering English, full-text literature from 2013 to 2024. Inclusion criteria focused on studies investigating factors influencing near-miss reporting in healthcare. The risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions tool. Data were synthesised using the Health Belief Model and the Hospital Patient Safety Culture framework.
A total of 20 studies were included. Key individual barriers to near-miss reporting included a lack of knowledge and negative perceptions. Organisational factors, including hospital safety culture, leadership support, error communication, and non-punitive responses to reporting, significantly impacted reporting behaviours.
Promoting a structured and supportive reporting culture, educational initiatives, and simplified reporting mechanisms can improve near-miss reporting practices.
Improving near-miss reporting practices by addressing identified barriers can lead to safer healthcare environments and better patient outcomes.
This paper addresses a gap in the literature regarding near-miss underreporting. The findings will have an impact on healthcare administrators, healthcare professionals, and ultimately, patients. Implementing strategies such as peer mentoring and constructive feedback, targeted training and simplified reporting systems can encourage consistent near-miss reporting. These efforts will ultimately lead to safer healthcare environments and improved patient outcomes.
The review methodology, including data selection, extraction and synthesis, follows PRISMA standards to ensure clarity, transparency and reproducibility.
This study did not include patient or public involvement in its design, conduct, or reporting.
This systematic review has been registered with the OSF and is publicly available at https://doi.org/10.17605/OSF.IO/EJGY2
Exploring the concept of patient agitation in the intensive care unit.
Patient agitation in the intensive care unit is of widespread concern and linked to negative outcomes for patients, staff, and family members. There is currently no consensus on what constitutes agitation in the intensive care context, hindering effective and tailored prevention and management.
Concept Analysis.
Walker and Avant's eight-step concept analysis approach.
A comprehensive search was carried out in the databases MEDLINE, PsychINFO and CINAHL. A total of 32 papers published between 1992 and 2023 were included, reviewed, and analysed to explore definitions, attributes, antecedents and consequences of patient agitation.
Patient agitation in the intensive care unit is characterised by excessive motor activity, emotional tension, cognitive impairment, and disruption of care, often accompanied by aggression and changes in vital signs. Antecedents encompass critical illness, pharmacological agents and other drugs, physical and emotional discomfort, patient-specific characteristics and uncaring staff behaviours. Consequences of agitation range from treatment interruptions and poor patient outcomes to the psychological impact on patients, families, and staff.
Agitation in the intensive care unit is a complex issue which significantly impacts patient treatment and clinical outcomes. For healthcare professionals, patient agitation can contribute to high workloads and job dissatisfaction. Due to the complex nature of agitation, clinicians must consider multifaceted strategies and not rely on medication alone. Further research is needed to fully understand patient agitation in the ICU. Such understanding will support the development of improved strategies for preventing and managing the behaviours.
A clearer understanding of patient agitation supports the development of tailored interventions that improve patient care, guide ICU training, and inform future research.
This concept analysis was developed with input from a patient representative.
To explore the conceptualisation of social frailty and discuss its role in shaping the disease trajectory of heart failure. Based on the discussion, recommendations on how to prevent and manage social frailty in this clinical cohort are delineated.
A discursive paper.
This paper searched two databases, PubMed and Google Scholar, for a narrative review of the literature related to social frailty and heart failure from 2008 to 2024.
By integrating the conceptualisation of social frailty from different theoretical paradigms, social frailty is a multi-domain construct that relies on a balance between the availability of environmental resources, social interactions and an individual's ability to maintain and acquire these resources to enhance their well-being. Substantial evidence showed the prognostic impact of social frailty on patient-reported, functional and clinical outcomes of patients with heart failure. The underlying mechanism is still under-investigated, but heart failure-related self-care may mediate its impact. Based on this evidence, improving social frailty may rely on a diagnostic protocol to enhance the person-centred care planning on ways to optimise the social resources to support complex self-care.
Social frailty poses a greater risk to health outcomes in patients with heart failure. Further research is needed to explore determinants and interventions for social frailty in this population.
This paper increases the awareness of social frailty in heart failure patients and provides important insights on how to combat this social determinant of poor health outcomes among this clinical cohort. A dual-purpose approach of improving social resources and self-care behaviours may have great promise in reducing their social frailty, and this postulation will need to be investigated in future research.
There is no involvement of patients or the public in the design or writing of this discursive paper.
To explore determinants impacting an Electronic Health Record-based information system implementation and their association with implementation fidelity based on the Theoretical Domains Framework (TDF) from nurses' perspectives.
Exploratory sequential mixed-method design.
In stage one, semi-structured interviews with 53 purposively selected nurses informed the exploration of TDF domains influencing the implementation of the information system with directed content analysis. In stage two, a cross-sectional survey, informed by the qualitative findings, was conducted among 482 nurses to identify the most relevant and relatively important TDF domains by running generalised linear regression models.
The qualitative interviews generated 13 TDF domains that were identified as major influencing factors, including technology characteristics, knowledge, attitudes, role agreement, self-efficacy, goal-setting, information circulation, and communication among nurses. Quantitative findings showed that 70% of nurses used and printed the written form through the information system, and only 34% offered verbal education consistently. Regression analysis identified nine domains that were relevant and important factors for implementation fidelity, including knowledge, skills, role identity, beliefs in consequences, beliefs in capabilities, intentions, goals, memory and decision processes, and environmental context.
Our findings confirmed previous evidence on determinants of implementing digital health technologies, including knowledge, competencies, perceived effectiveness, role agreement, intentions, decision processes, and environmental context. Additionally, we highlighted the importance of goal-setting for successful implementation.
This study investigated the relatively important associated factors that can impact the successful implementation of the nurse-led information system for post-acute care based on nurses' perspectives. These results can guide nurse practitioners in implementing similar initiatives and support evidence-based decision-making. Researchers can also further investigate the relationships between the identified determinants.
Journal Article Reporting Standards for Mixed Methods Research.
No patient or public contribution.
Despite extensive research on doctoral education, reliable tools to measure how writers' development relates to participation in social interventions such as writing groups are lacking. To address this, we conducted a study to create and evaluate a measurement tool for assessing the impact of writing group interventions on writers' development.
This methodology paper reports on the design, content validity, and evaluation of a new survey tool: the Doctoral and Academic Writing in Nursing, Midwifery, and Allied Health Professional writing questionnaire (DAWNMAHP).
We created a pool of 39 items based on empirical articles from SCOPUS, ERIC, BEI, ZETOC, CINAHL, EBHOST, and PsycINFO, our experience, and stakeholder consultations. After a content validity assessment by writing experts, we revised the pool to 44 items in five domains. Finally, we tested it on doctoral writing workshop attendees using factor analysis, Pearson correlations, and Cronbach's Alpha evaluation.
Thirty-six participants completed the DAWNMAHP survey tool: 22 doctoral students, seven early-career researchers, and seven participants on a designated pre-doctoral pathway. Cronbach's Alpha evaluation demonstrated good reliability (α > 0.70) for all five factors. This sample was deemed moderately sufficient (KMO = 0.579), and the items were loaded onto the five factors with all items' factor loadings > 0.5 through principal component analysis.
DAWNMAHP is a novel, reliable tool that measures the impact of writing group interventions on an individual writer's development concerning time management, the writing process, identity, social domains, and relational agency.
Conducting pre- and post-writing group intervention tests and recruiting larger sample sizes is essential to further developing DAWNMAHP. It is a rigorous tool for researching the benefits of writing group interventions. Furthermore, DAWNMAHP is an effective assessment and measurement tool, making a novel contribution to research into doctoral education.
No patient or public involvement was necessary at the validation stage of the DAWNMAHP tool.
To identify and understand the different approaches to local consensus discussions that have been used to implement perioperative pathways for common elective surgeries.
Systematic review.
Five databases (MEDLINE, CINAHL, EMBASE, Web of Science and the Cochrane Library) were searched electronically for literature published between 1 January 2000 and 6 April 2023.
Two reviewers independently screened studies for inclusion and assessed quality. Data were extracted using a structured extraction tool. A narrative synthesis was undertaken to identify and categorise the core elements of local consensus discussions reported. Data were synthesised into process models for undertaking local consensus discussions.
The initial search returned 1159 articles after duplicates were removed. Following title and abstract screening, 135 articles underwent full-text review. A total of 63 articles met the inclusion criteria. Reporting of local consensus discussions varied substantially across the included studies. Four elements were consistently reported, which together define a structured process for undertaking local consensus discussions.
Local consensus discussions are a common implementation strategy used to reduce unwarranted clinical variation in surgical care. Several models for undertaking local consensus discussions and their implementation are presented.
Advancing our understanding of consensus building processes in perioperative pathway development could be significantly improved by refining reporting standards to include criteria for achieving consensus and assessing implementation fidelity, alongside advocating for a systematic approach to employing consensus discussions in hospitals.
These findings contribute to recognised gaps in the literature, including how decisions are commonly made in the design and implementation of perioperative pathways, furthering our understanding of the meaning of consensus processes that can be used by clinicians undertaking improvement initiatives.
This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines.
No patient or public contribution.
Trial Registration: CRD42023413817
To examine the personal characteristics, promoting factors and organisational barriers to the professional realisation of diabetes nurse practitioners in Israel.
A descriptive study using quantitative and qualitative data.
The participants self-completed an electronic questionnaire, which included questions on demographic and professional characteristics and a self-realisation questionnaire constructed by the authors. Researcher-led focus groups were conducted, guided by a semi-structured guide. The discussions were recorded, transcribed and analysed by qualitative methods.
Forty-one diabetes nurse practitioners (median age 50 years, 98% females) participated in the study. On average, the participants reported a relatively high self-realisation of their professional role, especially those who have been working in this role for many years. While some of them work independently and are supported by their organisation, their managers and other healthcare team members, specifically physicians, many feel that there are barriers to the full implementation of the role and achieving professional realisation. These include multitasking challenges and insufficient remuneration. Self-realisation was viewed by the participants as an opportunity to provide excellent care to patients as well as being professional beyond caring for patients. They wanted to expand their knowledge as well as guide and teach. Furthermore, they also associated self-realisation with the autonomy to carry out procedures and make decisions independently of physicians. Internal motivation was perceived as an important factor for personal self-realisation, which stems from personal creativity, aspiration for excellence, a subjective sense of freedom, self-guidance, desire for self-development and aspiration for personal growth at the highest levels.
Recognition and fostering of diabetes nurse practitioners' role contribute to nurses' self-realisation and professional growth.
Personal and organisational factors should be aligned to support diabetes nurse practitioners in delivering high-quality care to patients with diabetes.
COREQ (COnsolidated criteria for REporting Qualitative research).
No patient or public contribution.
FreshRSS 