42 research outputs found
Predictors of psychological distress in mothers and fathers of neonates admitted to the neonatal intensive care unit for surgical correction of a congenital anomaly
No full textPredictors of psychological distress in mothers and fathers of neonates admitted to the neonatal intensive care unit for surgical correction of a congenital anomaly
No full textPredictors of psychological distress in mothers and fathers of neonates admitted to the neonatal intensive care unit for surgical correction of a congenital anomaly
No full textPredictors and outcomes of sustained, intermittent or never achieving remission in patients with recent onset inflammatory polyarthritis:Results from the Norfolk Arthritis Register
No full textObjectives: Early remission is the current treatment strategy for patients with inflammatory polyarthritis (IP) and RA. Our objective was to identify baseline factors associated with achieving remission: sustained (SR), intermittent (IR) or never (NR) over a 5-year period in patients with early IP. Methods: Clinical and demographic data of patients with IP recruited to the Norfolk Arthritis Register (NOAR) were obtained at baseline and years 1, 2, 3 and 5. Remission was defined as no tender or swollen joints (out of 51). Patients were classified as NR or PR, respectively, if they were in remission at: no assessment or ⩾3 consecutive assessments after baseline, and IR otherwise. Ordinal regression and a random effects model, respectively, were used to examine the association between baseline factors, remission group and HAQ scores over time. Results: A total of 868 patients (66% female) were included. Of these, 54%, 34% and 12% achieved NR, IR and SR, respectively. In multivariate analysis, female sex (odds ratio, OR 0.47, 95% CI: 0.35, 0.63), higher tender joint count (OR = 0.94, 95% CI: 0.93, 0.96), higher HAQ (OR = 0.59, 95% CI: 0.48, 0.74), being obese (OR = 0.70, 95% CI: 0.50, 0.99), hypertensive (OR = 0.67, 95% CI: 0.50, 0.90) or depressed (OR = 0.74, 95% CI: 0.55, 1.00) at baseline were independent predictors of being in a lower remission group. IR and SR were associated with lower HAQ scores over time and lower DAS28 at year 5. Conclusion: Women with higher tender joint count and disability at baseline, depression, obesity and hypertension were less likely to achieve remission. This information could help when stratifying patients for more aggressive therapy
Person-Centred Care: Principles and Practice Barriers (oral presentation). In: Enabling Person-Centred Care for Palliative Care Patients and Their Informal Carers: Definitions, Models of Practice and Implementation; invited session (Gunn Grande & Gail Ewing, moderators)
No full textAim: Barriers to the implementation of person-centred care within pal- liative care practice have been identified for patients and family carers. A shared understanding of (i) the principles of person-centred care, and (ii) how to successfully implement person-centred interventions is there- fore required. This paper aims to to define the key principles of person- centred care and identify barriers and enablers to implementation success within palliative care practice. Methods: This paper brings together the international evidence on person-centred care, and reviews the enablers and barriers to imple- mentation within palliative care practice. It will draw on the experi- ences of the development of person-centred care practice and the implementation of the Carer Support Needs Assessment Tool inter- vention, a person-centred process of assessment and support for fam- ily carers. Results: Person-centred care is characterised by practitioners initiat- ing, working through and safeguarding a partnership ‘with’ patients and/or family carers. As such, a change in practice from a practi- tioner-led approach, to one which is led by a patient/family carer is often required. Implementation barriers at the individual level include viewing a person-centred approach as an ‘add-on’ to existing practice, and at the organisational level include a lack of managerial support and protected time. Training is therefore required for the individual practitioner to help them integrate this approach into their everyday practice, and for the organisation to ensure adequate prep- aration, and the establishment of a strategy to support implementa- tion. A team of practitioners within the organisation is needed to drive this implementation planning and ensure organisational readi- ness for change. Conclusions: The evidence presented provides vital lessons learned for implementation of person-centred interventions for patients or family carers within palliative care practice
Facilitating successful implementation of a person-centred approach to carer assessment and support
No full textBackground: The Carer Support Needs Assessment Tool (CSNAT) intervention identifies and addresses family carer support needs towards end of life. This person-centred approach involves a change in practice from a practitioner- to carer-led assessment process. Numerous policies recommend carers’ needs should be addressed yet there is little guidance on how to achieve this within palliative care. To address this gap and assist a change to a carer-led process, an implementation strategy for the CSNAT intervention was developed, of which facilitation is key.Aims: investigate components of facilitation associated with successful implementation of the CSNAT intervention across a range of palliative/end-of-life care services.Methods: Qualitative: Interviews three and six months post-CSNAT implementation with 38 practitioners with the role of CSNAT ‘champion’ (internal facilitation) in 32 services. Researcher field notes collected from teleconference support sessions with ‘champions’ (external facilitation). Results: Successful implementation of the CSNAT intervention was associated with: utilising a teamwork approach to facilitation; the ‘lead champion’ having a leadership role in the service e.g. team manager; presenting a clear rationale why a change in practice was needed; reviewing progress and making changes to overcome identified barriers; ‘champions’ having good communication skills and authority to make changes. Larger services faced more barriers to facilitation e.g. difficulties with providing training to all staff and less frequent opportunities to review progress as a team. Aspects of context which constrained facilitation included the need to establish a new carer record, and organisational changes e.g. budget cuts and a culture focused on the patient. In contrast, support from management was one aspect of context which assisted with facilitation efforts.Conclusions: In addition to managerial support, establishing a team of practitioners to lead facilitation of the CSNAT intervention and regularly review implementation progress, is vital for implementation success.<br/
The influence of context and practitioner attitudes on implementation of person-centred assessment and support for family carers within palliative care
No full textBackground: The Carer Support Needs Assessment Tool (CSNAT) intervention is an evidence-based, person-centred approach to carer assessment and support within palliative care. As such, it requires a change in practice from a practitioner- to a carer-led assessment and support process. A paucity of studies have investigated factors affecting implementation of evidence based interventions within palliative care. Objectives: To examine differences between high and low adopters of the CSNAT intervention in terms of practitioner attitudes to the intervention and organisational context.Methods: Phase IV study of implementation of the CSNAT intervention at scale in 36 UK palliative care services over six months. Survey at baseline and six months of practitioners at implementation sites, informed by the Promoting Action on Research Implementation in Health Services (PARIHS) Framework. Survey tools: (i) questionnaire to assess attitudes to the CSNAT intervention; (ii) Alberta Context Tool (ACT) to assess organisational context. Monthly data on intervention use enabled service classification as ‘high’ or ‘low’ adopters. Results: 157/462 surveys returned at baseline; 69/462 at six months. Compared with ‘low’ adoption services, ‘high’ adopters were more likely to be hospice at home and day services; have a higher ratio of internal facilitators to total staff numbers; and higher scores for ACT ‘informal interactions’ denoting more discussions about care between colleagues. Both had similarly positive attitudes to the CSNAT intervention pre-implementation, but by six months ‘low’ adoption services developed significantly more negative attitudes; while in ‘high’ adoption services attitudes mostly remained the same/improved.Linking evidence to action: Implementation may be more successful for services that offer regular opportunities to use the intervention in practice, have sufficient levels of facilitators, stimulate more staff discussion, and encourage maintenance of positive motivation. Implementation of person-centred interventions needs to plan for such factors. This has informed an implementation toolkit for the CSNAT intervention.<br/
Facilitating successful implementation of the Carer Support Needs Assessment Tool (CSNAT) intervention within palliative care
No full textBackground: The Carer Support Needs Assessment Tool (CSNAT) intervention identifies and addresses family carer support needs towards end of life 1-3. This person-centred approach involves a change in practice from a practitioner- to carer-led assessment process. Numerous policies recommend carers’ needs should be addressed yet there is little guidance on how to achieve this within palliative care. To address this gap and assist a change to a carer-led process, an implementation strategy for the CSNAT intervention was developed, of which facilitation is key.Aims: investigate components of facilitation associated with successful implementation of the CSNAT intervention across 36 palliative care services.Methods: Qualitative: Interviews three and six months post-CSNAT implementation with 38 practitioners acting as CSNAT ‘champion’ (internal facilitation) in 32 services. Researcher field notes collected from teleconference support sessions with ‘champions’ (external facilitation). Results: Successful implementation of the CSNAT intervention was associated with: a teamwork approach to facilitation; the ‘lead champion’ having a leadership role in the service e.g. team manager; presenting a clear rationale why a change in practice was needed; reviewing progress and making changes to overcome identified barriers; ‘champions’ having good communication skills and authority to make changes. Aspects of context which constrained facilitation included the need to establish a new carer record, and organisational changes e.g. budget cuts, and a culture focused on the patient. Management support assisted with facilitation efforts.Conclusions: Establishing a team of practitioners to lead facilitation of the CSNAT intervention and regularly review implementation progress, is recommended to help ensure implementation success.<br/
The influence of organisational context and practitioner attitudes on implementation of the Carer Support Needs Assessment Tool (CSNAT) intervention
No full textBackground: The Carer Support Needs Assessment Tool (CSNAT) intervention identifies and addresses family carer support needs towards end of life 1-3. A paucity of studies have investigated how to successfully implement evidence based interventions within palliative care.Aim: Investigate how staff attitudes and organisational context affect implementation of the CSNAT intervention in palliative care.Methods: 36 UK palliative care services participated. Staff surveys measured attitudes and context prior to, and six months after the implementation began including (i) a questionnaire assessing staff attitudes to the CSNAT; (ii) The Alberta Context Tool (ACT) assessing organisational context. Data on use of the CSNAT intervention were collected over six months; services were classified as ‘high’ or ‘low’ adopters on this basis. Relationships between service characteristics, aggregate data on staff attitudes and organisational context, and level of adoption were analysed. Results: 157/462 surveys were returned at baseline and 69/462 at six months. Level of adoption depended on service type. ‘High’ adopters had a higher ratio of intervention ‘champions’ to total staff numbers and higher scores for ACT ‘informal interactions’ (e.g. more discussions with colleagues about patient care), compared to ‘low’ adopters. Both groups had similarly positive attitudes to the CSNAT intervention pre-implementation. By six months attitudes for ‘low’ adopters were significantly more negative, but remained similar or improved for ‘high’ adopters.Conclusions: Ensuring successful implementation of complex interventions within palliative care requires consideration of the organisational context, service type, strategies for maintaining positive staff attitudes over time, and the use of intervention ‘champions’.<br/
The influence of organisational context on staff attitudes to the implementation of a carer support needs intervention
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