41 research outputs found
Exploring the intersection of hermeneutics and implementation: a scoping review
No full textAbstract
Background
An enduring challenge remains about how to effectively implement programs, services, or practices. Too often, implementation does not achieve its intended effectiveness, fidelity, and sustainability, even when frameworks or theories determine implementation strategies and actions. A different approach is needed. This scoping review joined two markedly different bodies of literature: implementation and hermeneutics. Implementation is usually depicted as focused, direct, and somewhat linear, while hermeneutics attends to the messiness of everyday experience and human interaction. Both, however, are concerned with practical solutions to real-life problems. The purpose of the scoping review was to summarize existing knowledge on how a hermeneutic approach has informed the process of implementing health programs, services, or practices.
Methods
We completed a scoping review by taking a Gadamerian hermeneutic approach to the JBI scoping review method. Following a pilot search, we searched eight health-related electronic databases using broadly stated terms such as implementation and hermeneutics. A diverse research team that included a patient and healthcare leader, working in pairs, independently screened titles/abstracts and full-text articles. Through the use of inclusion criteria and full-team dialogue, we selected the final articles and identified their characteristics, hermeneutic features, and implementation components.
Results
Electronic searches resulted in 2871 unique studies. After full-text screening, we retained six articles that addressed both hermeneutics and implementing a program, service, or practice. The studies varied widely in location, topic, implementation strategies, and hermeneutic approach. All addressed assumptions underpinning implementation, the human dimensions of implementing, power differentials, and knowledge creation during implementation. All studies addressed issues foundational to implementing such as cross-cultural communication and surfacing and addressing tensions during processes of change. The studies showed how creating conceptual knowledge was a precursor to concrete, instrumental knowledge for action and behavioral change. Finally, each study demonstrated how the hermeneutic process of the fusion of horizons created new understandings needed for implementation.
Conclusions
Hermeneutics and implementation have rarely been combined. The studies reveal important features that can contribute to implementation success. Implementers and implementation research may benefit from understanding, articulating, and communicating hermeneutic approaches that foster the relational and contextual foundations necessary for successful implementation.
Trial registration
The protocol was registered at the Centre for Open Science on September 10, 2019.
MacLeod M, Snadden D, McCaffrey G, Zimmer L, Wilson E, Graham I, et al. A hermeneutic approach to advancing implementation science: a scoping review protocol 2019. Accessed at osf.io/eac37
Addressing uncertainty : contributions of knowing patients and team members to negotiating team-based primary care
No full textThe interprofessional team-based primary care model currently being implemented in northern British Columbia represents a significant shift in primary care delivery. The purpose of this study is to examine how patients feel known in the context of an interprofessional primary care team that is not co-located, and to illuminate how practices of connection between patients, providers, and team members can influence how care is negotiated within the team. Through methods of observation and interviews, data were collected then analyzed interpretively.
The findings of this study highlight practices within patient-provider encounters that contribute to patients feeling known and maintain therapeutic relationship. The way in which primary care providers know patients influences decision-making about which patients need team-based care, and when. The relationship between primary care providers and team members is also influential in deciding who needs team-based care, yet existing relationships can be disrupted by the degree of uncertainty that occurs alongside major shifts in primary care delivery. Team-based primary care is negotiated through practices of connection and genuine conversation. These practices and conversations influence the timing of team involvement, the information that is shared, and the type of care that is provided. Implications of these findings can support efforts to increase relationship-based care for patients and improve understanding about what patients value in receiving team-based care. Engaging in practices of connection and genuine conversation helps relieve uncertainty, whether at a team or patient level, and re-aligns the core attributes of primary care as central to delivering high quality team-based care
Assessment of an ePortfolio : developing a taxonomy to guide the grading and feedback for personal development planning
No full textThis paper describes the rationale for, and the design, implementation and preliminary evaluation of a taxonomy to guide the grading and feedback of ePortfolio assessment of personal development planning (PDP) in a module where PDP is integrated into the curriculum. Conventional higher education assessment methods do not adequately address the requirements of this innovative approach to learning and assessment, and a new assessment tool was felt to be necessary. Drawing on recent theories in the fields of constructive alignment, reflective practice and assessment for learning, a criteria-based taxonomy was designed with the aims of articulating criteria for achievement aligned with the learning outcomes of the module, and of ensuring valid and reliable evaluation of student achievement. Analysis of student and tutor feedback and statistical comparison of marks achieved after the pilot study have produced encouraging results. While this taxonomy was designed to be used in specific circumstances, it is capable of being adapted for use by others who deliver modules or courses where PDP embedded in the curriculum is supported and assessed by means of an ePortfolio
Portfolio-Based Performance Appraisal for Doctors: A Case of Paperwork Compliance
No full textThis paper discusses the findings of research exploring the conduct of portfolio-based performance appraisal within medicine. Portfolios are now used throughout medical school and junior doctor training, in later specialist training, as well as to support the implementation of annual NHS appraisal of doctors as part of their employment contract. They will also play a role in the new medical governance quality assurance process known as revalidation, when it is implemented in 2010. The paper discusses how the growth of portfolio-based performance appraisal within medicine is bound up with the growth of managerial systems of surveillance and control within western health care systems. Theoretically, it draws upon a Governmentality perspective to analyse doctor\'s accounts of the appraisal process. This views appraisal as an information panopticon that to better enable social control seeks to construct appraisees as calculable and administrable subjects. However, the paper highlights how the doctors interviewed used the tacit dimensions of their expertise to engage in creative game-playing toward appraisal, adopting a stance of paperwork compliance toward it. Paperwork compliance leaves a paper trail that makes it appear doctors have complied with the technical requirements of performance appraisal when in fact they have not. The paper concludes that current reforms to medical governance introduced to ensure the general public is protected from medical error and malpractice, provide sociologists with an invaluable opportunity to undertake a dedicated research program into the performance management of medical work.Annual Appraisal, Audit Society,, Governmentality, Medical Autonomy, Medical Regulation, Paperwork Compliance, Performance Appraisal, Revalidation
Long journeys: Healthcare providers' perspectives about promoting equity and community-based palliative care for rural, remote, and indigenous communities in northern British Columbia
No full textInequitable access to palliative care in Canada is a pressing issue. People with life-limiting illnesses in rural and remote northern and Indigenous geographies in British Columbia (BC) face ethically problematic barriers to receiving palliative care. Palliative approaches that are equity-oriented and community-based bring significant improvements to the healthcare system and to people's quality of life. The purpose of this qualitative study was to find ways to promote health equity and community-based palliative care. This research is informed by action-oriented, anti-colonial, and critical Indigenous methodologies. As perspectives of frontline healthcare workers offer transformative insights, palliative care providers working in northern BC were interviewed, and, from their interviews, three main themes emerged. These were (1) Support Primary Palliative Care, (2) earlier and inclusive Integration of Palliative care, and (3) Culturally Safe Palliative Care. The implications of these findings are situated at the intersection of cultural safety, public health, and health promotion
The West of Scotland Cohort of Mitochondrial Individuals with the m.3243A>G Variant: Variations in Phenotypes and Predictors of Disease Severity
No full textBACKGROUND: The m.3243A>G variant is the commonest mitochondrial (mt) DNA pathogenic variant and a frequent cause of mitochondrial disease. Individuals present with a variety of clinical manifestations from diabetes to neurological events resembling strokes. Due to this, patients are commonly cared for by a multidisciplinary team. OBJECTIVES: This project aimed to identify patients with confirmed mt.3243A>G-related mitochondrial disease attending the Muscle Clinic at Queen Elizabeth University Hospital in Glasgow. We explored potential correlates between clinical phenotypes and mtDNA heteroplasmy levels, HbA1c levels, body mass index, and specific clinical manifestations. We investigated if there were discrepancies between non-neurological speciality labelling in clinical records and individuals\u27 phenotypes. METHODS: Data were gathered from the West of Scotland electronic records. Phenotypes were ascertained by a clinician with expertise in mitochondrial disorders. Statistical analyses were applied to study relationships between tissue heteroplasmy, HbA1c and clinical phenotypes including body mass index (BMI). RESULTS: Forty-six individuals were identified from 31 unrelated pedigrees. Maternally inherited diabetes and deafness was the prominent syndromic phenotype (48%). A significant association was found between overall number of symptoms and bowel dysmotility (p < 0.01). HbA1c was investigated as a predictor of severity with potential association seen. Although used widely as a prognosticator, neither corrected blood nor urine mtDNA heteroplasmy levels were associated with increased number of symptoms. In 74.1% of records, syndromic phenotypes were incorrectly used by non-neurological specialities. CONCLUSIONS: This m.3243 A > G patient cohort present with marked clinical heterogeneity. Urine and blood heteroplasmy levels are not reliable predictors of disease severity. HbA1c may be a novel predictor of disease severity with further research required to investigate this association. We infer that prognosis may be worse in patients with low BMIs and in those with bowel dysmotility. These results underscore a multidisciplinary approach and highlight a problem with inaccurate use of the existing nomenclature
Taking the learning beyond the individual:how reflection informs change in practice
No full textObjectivesThe purpose of this research was to explore the value of reflection and its application to practice through the implementation of educational modules within a new Diabetes Care and Education Master Degree Programme in Kuwait, and to realise how this teaching intervention informs changes in practice.MethodsA small exploratory case study was conducted within the Dasman Diabetes Institute, Kuwait. A qualitative approach using focus group interviews was carried out with seventeen participants all of whom are studying on the Diabetes Care and Education Master Degree Programme in Kuwait. An inductive approach to thematic analysis, which focused on examining themes within data, was performed.ResultsThe results indicate that participants value the opportunity to study through organised, structured and assessed reflection. The learning provides useful infor-mation and support to the participant by highlighting the role which reflection plays to enhance personal and professional development, the value of educational theory, continuing professional development, collaboration and enhancing patient education and practice.ConclusionsThe significance of reflection is often seen in the literature as an important aspect of professional competence. This research has highlighted the value of reflection as a key component within a new educational programme
Exploring the use of emergency health services for stroke: what is known about when to seek emergency help and how transport decisions impact in-hospital emergency care
No full textTransport practices for seeking emergency stroke care remain largely underresearched and poorly understood, particularly for individuals living in small urban, rural, and remote regions. This multi-method study aims to address this knowledge gap and explores the impact of mode of transport on in-hospital stroke care and the decision-making process of seeking emergency medical attention for patients and their caregivers. Data from the Discharge Abstract Database provide information on stroke-related use of emergency health services across British Columbia. Data from the Canadian Institutes for Health Information Special Project 340 provide information on if calling emergency health services impacts the delivery of care, including the completion of neuroimaging, the administration of acute thrombolysis, and the prescription of antithrombotics upon discharge across a northern health region. Focused, semi-structured interviews provide contextual insight into the decision-making processes for seeking emergency stroke care among patient and caregiver participants in a northern health region. Stroke-related emergency health service use across British Columbia from January 2015 to March 2018 was 67.9% (N=19,849), ranging from 58.8% in Northern Health to 70.2% in Fraser Health. In Northern Health (N=784), there were differences between health service delivery areas for stroke-related emergency health service use ranging from 53.7% in the Northwest to 64.8% in the Northern Interior from January 2015 to March 2018. Similar differences in thrombolytic therapy administration and the prescription of antithrombotics were noted. The odds of emergency health service use were greater for those 65 years of age and older than those younger than 65 and lower for those in the Northwest health service delivery area than those in the Northern Interior health service delivery area. Differences were found for the completion of neuroimaging between males and females. Interviews for patient (n=12) and caregiver (n=7) participants provide complementary contextual insights and yielded three key themes, including the decision-making process following a stroke, experiences of care, and perceived gaps and areas in need of further support. This integrated knowledge translation-informed and practice-driven research addresses health services and policy priorities. Findings are anticipated to help inform the development and refinement of emergency health services in British Columbia by highlighting differences in emergency health services use across geographies and identifying factors that inform patient decisionmaking when seeking emergency medical attention
An optically guided atomic fountain
No full textThis thesis describes the development of a laser-cooling experiment aimed at efficient transfer of cold atoms over a short distance, for loading into a conservative atom trap. We detail the construction of a 3D magneto-optical trap (MOT) and perform characterisation measurements to optimise the number and temperature of the cold atoms. The atoms are launched vertically in a fountain from the MOT using a 'moving molasses' technique and a red-detuned far-off-resonant laser beam is used to guide them into an UHV chamber. Loading into the guiding beam is optimised with respect to the beam and MOT parameters. We demonstrate a maximum loading of 20% and guiding over a distance of more than 10 cm without loss of atoms. The atoms are delivered to the UHV chamber in a cloud with a transverse dimension of order 200 µm. We discuss the extension to continuous operation of the guided atomic fountain. The 3D MOT is replaced by a funnel with 2D trapping and 3D cooling which continuously extracts the cold atoms using moving molasses. A comparison between the flux of guided atoms obtained in a pulsed fashion from the 3D MOT and continuously from the funnel indicate that the pulsed case is a factor of ten more efficient. The difference is due to inferior loading from the funnel. The optically guided fountain is used to load an optical dipole trap in the UHV chamber, using an 'optical trap door'. No additional cooling is required. The dynamics of the atoms in the optical dipole trap are studied. We discuss multiple loading of a conservative trap with the view of accumulating more atoms than can be obtained in a MOT
