Framework For Clinical Practice Research Articles

Impact of Gender on Insomnia.

There is a distinct preponderance of female insomniacs when compared to male insomniacs. The aim of this study was to examine possible gender differences in the causes for insomnia, and the phenotypes of insomnia, and to investigate whether gender-specific insomnia diagnosis and treatment could be relevant in clinical practice. Data were collected from 121 insomniac patients by a medical specialist in the framework of normal clinical practice in Germany. The data consist of the patient's medical history and various sleep-related patient questionnaires. Data from both genders were tested for independence using chi-square tests and Mann-Whitney U tests. We found a correlation between the gender of the patient and insomnia phenotypes in several aspects: concomitant lipometabolic disorders, diabetes mellitus, and high BMIs are more common in male insomniacs (p < 0.05). Frequency of insomnia occurrence in certain age groups, insomnia severity, distribution of SOI (sleep onset insomnia), SMI (sleep maintenance insomnia) and combined SOI + SMI, sleep duration, the time needed to seek medical consultation, trying out sleep-inducing drugs/techniques and the trigger, etiology and familial predisposition of the insomniac disorder were independent of the patient's gender. We would like to re-evaluate the results with a larger number of patients in a further study.

Developing a pre-course workbook for advanced practice students in the UK.

British Journal of NursingVol. 32, No. 4 CommentDeveloping a pre-course workbook for advanced practice students in the UKAnna Jones, Colette Henderson, Jonathan Thomas, Angie Banks, Melanie RogersAnna JonesE-mail Address: [email protected]PGT Director for Learning and Teaching, Cardiff University and Deputy Chair Association of Advanced Practice Educators UK (AAPE UK)Search for more papers by this author, Colette HendersonProgramme Lead MSc Advanced Practice, University of Dundee and Chair Scottish Advanced Practice Educators Network (SAPEN)Search for more papers by this author, Jonathan ThomasProgramme Director MSc Advanced Practice, Swansea University and Chair Wales Advanced Practice Educators Network (WAPEN)Search for more papers by this author, Angie BanksProgramme lead MSc Advanced Clinical Practice, Sheffield Hallam UniversitySearch for more papers by this author, Melanie RogersProfessor of Advanced Practice, University of HuddersfieldSearch for more papers by this authorAnna Jones; Colette Henderson; Jonathan Thomas; Angie Banks; Melanie RogersPublished Online:24 Feb 2023https://doi.org/10.12968/bjon.2023.32.4.224AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Department of Health and Social Security. Neighbourhood nursing: a focus for care. Report of the Review of Community Nursing chaired by J Cumberlege. London: HMSO; 10986 Google ScholarDepartment of Health, Social Services and Public Safety. Advanced nursing practice framework. 2016 (revised version of document first published 2014). https://www.health-ni.gov.uk/publications/advanced-nursing-practice-framework (accessed 13 February 2023) Google ScholarGloster A, Leigh J. The knowledge and skills required of advanced level practitioners for accreditation and safe practice. Br J Nurs. 2021;30(3):168-171. https://doi.org/10.12968/bjon.2021.30.3.168 Link, Google ScholarHealth Education England. Multi-professional framework for advanced clinical practice in England. 2017. https://www.hee.nhs.uk/sites/default/files/documents/multi-professionalframeworkforadvancedclinicalpracticeinengland.pdf (accessed 13 February 2023) Google ScholarInternational Council of Nurses. Guidelines on advanced practice nursing. 2020. https://tinyurl.com/5asnjbrx (accessed 14 February 2023) Google ScholarLeary A, MacLaine K, Trevatt P, Radford M, Punshon G. Variation in job titles within the nursing workforce. J Clin Nurs. 2017; 26(23-24): 4945-4950. https://doi.org/10.1111/jocn.13985 Crossref, Medline, Google ScholarNational Leadership and Innovation Agency for Healthcare. Framework for Advanced Nursing, Midwifery and Allied Health Professional Practice in Wales. 2010. https://heiw.nhs.wales/files/weds-introducing-advanced-practice/nliah-advanced-practice-framework/ (accessed 13 February 2023) Google ScholarNHS Education for Scotland. Advanced practice toolkit. 2018. https://www.advancedpractice.scot.nhs.uk (accessed 13 February 2023) Google ScholarPhillips SJ. 30th Annual APRN legislative update: Improving access to healthcare one state at a time. Nurse Pract. 2018;43(1):27-54. doi: https://doi.org/10.1097/01.NPR.0000527569.36428.ed Crossref, Medline, Google ScholarRogers M, Gloster A. Advanced practice nursing in the UK. In: Hassmiller SPulcini J (eds). Advanced practice nursing leadership: a global perspective. Springer; 2020 Crossref, Google ScholarScottish Government. Transforming Nursing Midwifery and Health Professions' (NMaHP) Roles: Paper 2 Advanced Nursing Practice. Chief Nursing Officer Directorate. 2017. https://www.gov.scot/publications/transforming-nursing-midwifery-health-professions-roles-advance-nursing-practice/ (accessed 13 February 2023) Google Scholar FiguresReferencesRelatedDetails 23 February 2023Volume 32Issue 4ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Published online 24 February 2023 Published in print 23 February 2023 Information© MA Healthcare LimitedPDF download

Unpacking an affordance-based model of chronic pain: a video game analogy

AbstractChronic pain is one of the most disabling medical conditions globally, yet, to date, we lack a satisfying theoretical framework for research and clinical practice. Over the prior decades, several frameworks have been presented with biopsychosocial models as the most promising. However, in translation to clinical practice, these models are often applied in an overly reductionist manner, leaving much to be desired. In particular, they often fail to characterize the complexities and dynamics of the lived experience of chronic pain. Recently, an enactive, affordance-based approach has been proposed, opening up new ways to view chronic pain. This model characterizes how the persistence of pain alters a person’s field of affordances: the unfolding set of action possibilities that a person perceives as available to them. The affordance-based model provides a promising perspective on chronic pain as it allows for a systematic investigation of the interactive relation between patients and their environment, including characteristic alterations in the experience of their bodies and the space they inhabit. To help bridge the gap from philosophy to clinical practice, we unpack in this paper the core concepts of an affordance-based approach to chronic pain and their clinical implications, highlighting aspects that have so far received insufficient attention. We do so with an analogy to playing video games, as we consider such comparative illustration a useful tool to convey the complex concepts in an affordance-based model and further explore central aspects of the lived experience of chronic pain.

Exploring valuation practices in diagnosis-as-category: The rising dominance of clinical practice in the categorisation of Sepsis, 1991-2016.

This article contributes to the sociology of diagnosis by exploring how an acute medical condition, sepsis, was categorised over a 25-year period. We focus on publications reporting the outcomes of three consensus conferences that were convened to stabilise definitions of sepsis and on the failure of a controversial drug. We also focus on the category of severe sepsis by exploring why it was considered useful when introduced in 1991 but redundant by 2016. Drawing on insights from the sociology of valuation, our analysis of pivotal events within this period involving actors from clinical practice, biomedical science, regulation and industry identifies numerous and often contesting evaluative frameworks that came to bear on the categorisation of sepsis. Our analysis further reveals that the evaluative framework of clinical practice, mobilised by the professional specialty of intensive and critical care, became dominant in this categorisation, and that this did not reflect a dominance of biomedicine despite concerning an acute medical condition. Our contributions are to posit the ontological purpose of diagnostic categories and the role of valuation practices and strategic agency in diagnosis-as-category.

General practitioners' everyday clinical decision-making on psychosocial problems of children and youth in the Netherlands.

Psychosocial problems in children and youth are common and may negatively impact their lives and the lives of their families. Since general practitioners (GPs) play a crucial role in detecting and intervening in such problems, it is clinically necessary to improve our insight into their clinical decision-making (CDM). The objective of this study was to explore which mechanisms underlie GPs' everyday CDM and their options for management or referral. This was a mixed methods study in which qualitative (interview substudy) and quantitative (online survey substudy) data were collected from GPs. Using a question framework and vignettes representative of clinical practice, GPs' CDM was explored. GPs were selected by means of an academic research network and purposive sampling. Data collection continued in constant comparison between both substudies. Using grounded theory, data from both substudies were triangulated into a flowchart consisting of mechanisms and management/referral options. CDM-mechanisms were divided into three groups. GP-related mechanisms were GPs' primary approach of the problem (somatically or psychosocially) and their self-assessed competence to solve the problem based on interest in and knowledge about youth mental health care. Mechanisms related to the child and its social context included GPs' assessment whether there was psychiatric (co)morbidity, their sense of self-limitedness of the problem and assessed complexity of the problem. Whether GPs' had existing collaboration agreements with youth care providers and how they experienced their collaboration were collaboration-related mechanisms. The current study contributes to a relatively unexplored research area by revealing GP's in-depth thought processes regarding their CDM. However, existing research in this area supports the identified CDM mechanisms. Future initiatives should focus on validating CDM mechanisms in a larger population. If confirmed, mechanisms could be integrated into GP training and may offer guidelines for regulating proper access to mental health care services.

Evidence of expert clinical practice among nuclear medicine non-medical staff: a scoping review.

This scoping review concerns expertclinical practice (ECP) by nuclear medicine practitioners (NMP), encompassing radiographers, technologists and nurses. ECP is typically demonstrated by clinical skills with higher levels of autonomy and responsibility traditionally fulfilled by physicians. The Advanced Clinical Practice (ACP) framework by Health Education England (2017) specifies ECP as one aspect of advanced role progression. This scoping review aims to identify and categorise the extent and type of the existing NMP ECP evidence to support the establishment of Nuclear Medicine ACP. PubMed, Cumulative Index to Nursing and Allied Health Literature, and Ovid Medline were searched for peer-reviewed literature published between 2001 and 2021 using extended and advanced practice as key terms alongside nuclear medicine and each NMP profession. Due to the sparsity of results, conference abstracts from prominent international societies were also searched. Studies were independently reviewed and graded for inclusion by four NMP. Of the 36 studies that met the inclusion criteria, 80.6% were conference abstracts and 66.7% were single-centres studies. Commonly reported NM ECP activities included image interpretation, cardiac stressing and therapies. Less reported activities include ordering complementary diagnostic procedures, invasive procedures and physical examinations. The United Kingdom presented itself at the forefront of NMP ECP publications. This study demonstrates evidence of NMP ECP across a variety of clinical roles. The dominance of conference abstracts highlights NMP ECP as an emerging area of role extension and a potential preference for information dissemination by NMP. Greater research into specific NMP ECP activities is required particularly studies of greater sample size and robusticity.

The effect of mind wandering on cognitive flexibility is mediated by boredom

Cognitive theory of boredom presumes that boredom, an important potential indicator for self-dysregulation, represents to be the result of attention failure. And lapses of attention have been shown to act as a key signal in mind wandering (especially spontaneous mind wandering), which has been found to be positively associated with boredom. If both mind wandering and boredom concurrently occupy individuals' on-task processing resources, it would definitely influence their cognitive flexibility, which is an essential component for self-regulation. Until now, however, there has been little discussion about mind wandering, boredom, and cognitive flexibility at the same time. The present study investigated the hypothesis that boredom can mediate the effect of mind wandering on cognitive flexibility at trait-level by adopting a cross-sectional exploratory study design and anonymous structured questionnaires in three studies (N = 449,182 and 190 for Studies 1, 2 and 3, respectively). Correlation analysis demonstrated that mind wandering (especially spontaneous mind wandering) was positively related to boredom, and that cognitive flexibility was negatively related to mind wandering and boredom, respectively. Mediation analysis revealed an indirect effect of mind wandering (especially spontaneous mind wandering) on cognitive flexibility through boredom. In conclusion, these findings are useful to build a theoretical framework for future clinical practice. An implication of these findings is the possibility that efficacious strategies targeting at reducing boredom are needed to decrease the detriment effect of spontaneous mind wandering on cognitive flexibility.

Perceived barriers and facilitators to physical activity in childhood cancer survivors and their parents: A large-scale interview study from the International PACCS Study.

Physical activity (PA) may reduce risks of late effects in childhood cancer survivors, yet many have low activity levels. Using the WHO's International Classification of Functioning, Disability, and Health for Children and Youths (ICF-CY) as a conceptual framework, we aimed to identify perceived barriers and facilitators to PA in young survivors and their parents. We conducted individual, semi-structured interviews with 63 survivors, aged 9-18years, ≥1-year off treatment, and 68 parents, recruited from three pediatric oncology departments in Norway and Denmark. Interviews were analyzed inductively using thematic analysis to identify barriers and facilitators to PA, which were mapped onto the ICF-CY model components; body function/structures, activities, participation, and environmental and personal factors. Two-thirds of the survivors described how treatment-related impairments of bodily functions (e.g., fatigue, physical weakness, reduced lung capacity) caused physical limitations, reducing opportunities to participate in PA, especially team sports and school physical education. This resulted in a perceived ability gap between survivors and peers, reducing motivation for PA. These PA barriers were moderated by environmental factors that facilitated or further hindered PA participation (family, peer, and school support). Similarily, personal factors also facilitated (acceptance, motivation, goal setting) or hindered (anxiety, low motivation, and lack of trust) PA participation. Treatment-related long-term or late effects represented significant barriers to PA as their functional consequences reduced survivors' capacities and capabilities to be active. Environmental and personal factors acting as facilitators or further barriers to PA were identified. Applying the ICF-CY framework in clinical practice could help to enable PA participation.

The relationship between subthreshold psychiatric symptoms and Internet Addiction in an Italian population

BackgroundInternet addiction (IA) is an emerging psychopathological entity, often comorbid with a variety of psychiatric disorders. Subthreshold psychopathology has recently emerged as a new field of research, with solid evidence highlighting its role in causing psychological distress. AimsThe study aimed to evaluate the presence of subthreshold psychopathological symptoms and IA in Italian adults recruited from the general population, searching for possible correlations between specific subclinical psychiatric disorders and internet abuse. MethodsThe study was conducted by an online survey released through social networks, web advertising, institutional and professional mailing lists, and messaging services. The General 5-Spectrum Measure (GSM-V) and the Internet Addiction Test (IAT) were chosen to assess subthreshold symptoms, and IA, respectively. ResultsSignificant positive correlations between the total score of the IAT total scores and the multiple domains of GSM-5 (p <0.0001), except for the "Mania" dimension (p = 0.717). ConclusionsIA is very common in subjects unaffected by major psychiatric disorders and it is associated with subthreshold psychopathological dimensions. Further studies on larger samples and the inclusion of a dimensional framework in research settings and clinical practice are needed to better understand the nature and the reciprocal relationships between IA and subthreshold psychopathology.

How to improve aseptic technique to reduce bloodstream infection during vascular access procedures.

Bloodstream infections associated with vascular access procedures pose a serious risk to patients that can be reduced by better standards of aseptic technique. The objectives of this roundtable of experts were to achieve a consensus on how to improve skin antisepsis in hospital, improve training, competency, compliance and consistency in skin antisepsis, review the role of devices in improving skin antisepsis, identify methods to improve skin antisepsis integrated with the Aseptic Non Touch Technique (ANTT®) approach, and identify challenges to the implementation of the panel's recommendations. Recommendations include using MHRA-licensed 2% chlorhexidine gluconate in 70% isopropyl alcohol solution with bidirectional strokes for up to 30 seconds, then leaving the skin to air dry for 30 seconds; using the ANTT Clinical Practice Framework and terminology as the standard for skin antisepsis training and practice; standardised ANTT and skin antisepsis education with 3-yearly competency assessments for all UK health professionals; and more research to address the evidence gap on transmission of infection after skin antisepsis.

Experiences with continuous quality improvement work based on the Occupational Therapy Intervention Process Model

Background Sustainability is an important issue in implementation processes in health care, and more knowledge is needed to facilitate improvement work in occupational therapy practice. Aim The aim of this study was to explore how occupational therapists experienced continuous quality improvement work based on the Occupational Therapy Intervention Process Model after 17 years. Method Two focus group interviews were conducted with a total of 12 occupational therapists. The data were analysed using qualitative content analysis. Results The analysis resulted in three themes with related subthemes describing the occupational therapists’ experiences of their model-based long-term improvement work. The themes were labelled as follows: ‘sharing a safe and well-known professional reasoning’, ‘reaching normality and empowerment’ and ‘questioning and reshaping the too safe and too well-known normality’. The model functioned as a sustainable framework both for ordinary clinical practice and for continuous improvement work. Conclusion By using the model, the occupational therapists had established a safe and well-known professional reasoning in which continual quality improvement work had become sustainable.

The meaning in grandiose delusions: measure development and cohort studies in clinical psychosis and non-clinical general population groups in the UK and Ireland

The content of grandiose delusions-inaccurate beliefs that one has special powers, wealth, mission, or identity-is likely to be highly meaningful. The meaning, for example providing a sense of purpose, could prove to be a key factor in the delusion taking hold. We aimed to empirically define and develop measures of the experience of meaning in grandiose delusions and the sources of this meaning, and to test whether severity of grandiosity in clinical and non-clinical populations is associated with level of meaning. We did a cross-sectional self-report questionnaire study in two cohorts: non-clinical participants aged 18 years and older, with UK or Irish nationality or residence; and patients with affective or non-affective psychosis diagnoses, aged 16 years and older, and accessing secondary care mental health services in 39 National Health Service providers in England and Wales. Participants with high grandiosity completed two large item pools: one assessing the experience of meaning in grandiose delusions (Grandiosity Meaning Measure [termed gram]) and one assessing the sources of meaning (Grandiosity Meaning Measure-Sources [termed grams]). The Grandiosity Meaning Measure and Grandiosity Meaning Measure-Sources were developed using exploratory factor analysis and confirmatory factor analysis. Structural equation modelling was used to test the associations of meaning with the severity of grandiosity. The primary outcome measure for grandiosity was the Specific Psychotic Experiences Questionnaire (grandiosity subscale) and associations were tested with the Grandiosity Meaning Measure and the Grandiosity Meaning Measure-Sources. From Aug 30, 2019, to Nov 21, 2020, 13 323 non-clinical participants were enrolled. 2821 (21%) were men and 10 134 (76%) were women, 11 974 (90%) were White, and the mean age was 39·5 years (SD 18·6 [range 18-93]). From March 22, 2021, to March 3, 2022, 798 patients with psychosis were enrolled. 475 (60%) were men and 313 (39%) were women, 614 (77%) were White, and the mean age was 43·4 years (SD 13·8 [range 16-81]). The experience of meaning in relation to grandiose delusions had three components: coherence, purpose, and significance. The sources of meaning had seven components: positive social perceptions, spirituality, overcoming adversity, confidence in self among others, greater good, supporting loved ones, and happiness. The measurement of meaning was invariant across clinical and non-clinical populations. In the clinical population, each person typically endorsed multiple meanings and sources of meaning for the grandiose delusion. Meaning in grandiose delusions was strongly associated with severity of grandiosity, explaining 53·5% of variance, and with grandiose delusion conviction explaining 27·4% of variance. Grandiosity was especially associated with sense of purpose, and grandiose delusion conviction with coherence. Similar findings were found for the non-clinical population. Meaning is inherently tied to grandiose delusions. This study provides a framework for research and clinical practice to understand the different types of meaning of grandiosity. The framework is likely to have clinical use in psychological therapy to help guide patients to find sources of equivalent meaning from other areas of their lives and thereby reduce the extent to which the grandiose delusion is needed. Health Education England and National Institute for Health and Care Research.

Competency Gradients in Advanced Practice Nurses, Specialist Nurses, and Registered Nurses: A Multicentre Cross-Sectional Study.

(1) Background: Identifying differences in the competencies of different areas of nursing is a crucial aspect for determining the scope of practice. This would facilitate the creation of a formal structure for clinical practice in advanced and specialised services. The aims of this study are to analyse the distribution of advanced competencies in registered, specialist and advanced practice nurses in Spain, and to determine the level of complexity of the patients attended by these nurses. (2) Methods: A cross-sectional study was developed on registered, specialist and advanced practice nurses, all of whom completed an online survey on their perceived level of advanced competencies and their professional characteristics. (3) Results: In total, 1270 nurses completed the survey. Advanced practice nurses recorded the highest self-perceived level of competency, especially for the dimensions of evidence-based practice, autonomy, leadership and care management. (4) Conclusions: Among registered, specialist and advanced practice nurses, there are significant differences in the level of self-perceived competencies. Patients attended by advanced practice nurses presented the highest levels of complexity. Understanding these differences could facilitate the creation of a regulatory framework for clinical practice in advanced and specialized services.

Analysis of a Resident Competence Self-Assessment Survey

ABSTRACT Introduction Orthotic and prosthetic clinicians need to self-assess their performance and make decisions about practice limitations and continuing education throughout their careers. The objectives of this study were to evaluate the internal consistency of a self-assessment survey, examine the latent common factors and responsiveness of the survey, and use the results of the analysis to develop a shortened self-assessment survey. Methods Residents completed a self-assessment 29-item survey based on the six domains of the American Board for Certification in Orthotics, Prosthetics, and Pedorthics (ABC) Practice Analysis of Certified Practitioners in the Disciplines of Orthotics and Prosthetics at multiple times during the clinical residency. Internal consistency was examined through Cronbach α. Confirmatory and exploratory factor analysis were used to examine latent common factors and inform item reduction. Responsiveness was examined through repeated-measures analysis of variance (ANOVA). Results Analysis revealed a Cronbach α of 0.927. Confirmatory factor analysis indicated a poor fit of the six-factor model. The final and best-fitting model suggested four latent common factors: patient centeredness, regulatory awareness, device evaluation, and professional responsibility. Review and revision of the items resulted in a 14-item instrument. The instrument was responsive to changes over time. Conclusions The results indicate a need to reexamine current clinical practice framework in orthotics and prosthetics, particularly as it relates to clinical competence. Future research should evaluate the performance of the shortened self-assessment survey and consider implications for educational standards. Clinical Relevance The use of validated educational tools can strengthen the efficacy of assessments in clinical education and residency. Improved clinical education assessments may result in standardization of competency and improved graduate preparedness.

Research as part of the advanced clinical practitioner role

British Journal of NursingVol. 31, No. 7 Advanced Clinical PracticeResearch as part of the advanced clinical practitioner roleCatherine Fielding, Jennifer Riley, Clare Sutherland, Karen Swift, Adam GordonCatherine FieldingE-mail Address: [email protected]Clinical Academic Trainee Advanced Clinical Practitioner and Health Education England (HEE) and National Institute for Health Research (NIHR) Integrated Clinical Academic (ICA) Clinical Doctoral Research Fellow, University Hospitals of Derby and Burton NHS Foundation Trust, DerbySearch for more papers by this author, Jennifer RileyAssociate Director for Advanced Practice, University Hospitals of Derby and Burton NHS Foundation Trust, DerbySearch for more papers by this author, Clare SutherlandAssociate Director for Advanced Practice, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, Associate Dean Interprofessional Learning, Health Education England East Midlands and Senior Professional Advisor ACP, Health Education England National TeamSearch for more papers by this author, Karen SwiftACP Teaching Fellow, University Hospitals of Derby and Burton NHS Foundation Trust, DerbySearch for more papers by this author, Adam GordonConsultant Geriatrician, University Hospitals of Derby and Burton NHS Foundation Trust, and Professor of the Care of Older People, University of NottinghamSearch for more papers by this authorCatherine Fielding; Jennifer Riley; Clare Sutherland; Karen Swift; Adam GordonPublished Online:11 Apr 2022https://doi.org/10.12968/bjon.2022.31.7.372AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Baltruks D., Callaghan P; Council of Deans of Health. Nursing, midwifery and allied health clinical academic research careers in the UK. 2018. https://tinyurl.com/3acx56vh (accessed 21 March 2022) Google ScholarBauer MS, Damschroder L, Hagedorn H, Smith J, Kilbourne AM. An introduction to implementation science for the non-specialist. BMC Psychol. 2015;3(1):32. https://doi.org/10.1186/s40359-015-0089-9 Crossref, Medline, Google ScholarCarrick-Sen D, Richardson A, Moore A, Dolan S; Association of UK University Hospitals. Transforming healthcare through clinical academic roles in nursing, midwifery and allied health professions: a practical resource for healthcare provider organisations. 2016. https://tinyurl.com/4af5p6h7 (accessed 21 March 2022) Google ScholarCooper J, Mitchell K, Richardson A, Bramley L. Developing the role of the clinical academic nurse, midwife and allied health professional in healthcare organisations. 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Building clinical academic leadership capacity: sustainability through partnership. J Res Nurs. 2018;23(4):346-357. https://doi.org/10.1177/1744987117748348 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 7 April 2022Volume 31Issue 7ISSN (print): 0966-0461ISSN (online): 2052-2819 Metrics History Accepted 1 March 2022 Published online 11 April 2022 Published in print 7 April 2022 Information© MA Healthcare LimitedKeywordsAdvanced clinical practiceAdvanced clinical practitionersClinical academicsResearchAcknowledgements:the authors would like to acknowledge Professor Nicholas Selby and Professor Maarten Taal from the University of Nottingham for their support of Catherine's research and development as a clinical academic. And Dr Louise Bramley for her mentorship in developing clinical academic careers. Thank you to the NIHR who has funded Catherine Fielding (ICA-CDRF-2018-04-5T2-003)PDF download

Application of a Risk Management Framework to Parent Sleep During Skin-to-Skin Care in the NICU

As NICU staff work to increase the frequency, duration, and comfort of skin-to-skin care (SSC) sessions, barriers to implementation are frequently encountered. Safety concerns are often raised when parents fall asleep during SSC intentionally or unintentionally. We present a risk management framework that we use in clinical practice to address risk related to parent sleep during SSC. Our approach is based on the steps of the Risk Management Life Cycle, which include the following: establish context, identify risk, analyze risk, respond to risk, and monitor and adapt response to risk. Clinicians may use this framework in clinical practice to manage risks related to prolonged SSC, specifically when parents relax and fall asleep during SSC.

Toward Successful Implementation of Artificial Intelligence in Health Care Practice: Protocol for a Research Program.

BackgroundThe uptake of artificial intelligence (AI) in health care is at an early stage. Recent studies have shown a lack of AI-specific implementation theories, models, or frameworks that could provide guidance for how to translate the potential of AI into daily health care practices. This protocol provides an outline for the first 5 years of a research program seeking to address this knowledge-practice gap through collaboration and co-design between researchers, health care professionals, patients, and industry stakeholders.ObjectiveThe first part of the program focuses on two specific objectives. The first objective is to develop a theoretically informed framework for AI implementation in health care that can be applied to facilitate such implementation in routine health care practice. The second objective is to carry out empirical AI implementation studies, guided by the framework for AI implementation, and to generate learning for enhanced knowledge and operational insights to guide further refinement of the framework. The second part of the program addresses a third objective, which is to apply the developed framework in clinical practice in order to develop regional capacity to provide the practical resources, competencies, and organizational structure required for AI implementation; however, this objective is beyond the scope of this protocol.MethodsThis research program will use a logic model to structure the development of a methodological framework for planning and evaluating implementation of AI systems in health care and to support capacity building for its use in practice. The logic model is divided into time-separated stages, with a focus on theory-driven and coproduced framework development. The activities are based on both knowledge development, using existing theory and literature reviews, and method development by means of co-design and empirical investigations. The activities will involve researchers, health care professionals, and other stakeholders to create a multi-perspective understanding.ResultsThe project started on July 1, 2021, with the Stage 1 activities, including model overview, literature reviews, stakeholder mapping, and impact cases; we will then proceed with Stage 2 activities. Stage 1 and 2 activities will continue until June 30, 2026.ConclusionsThere is a need to advance theory and empirical evidence on the implementation requirements of AI systems in health care, as well as an opportunity to bring together insights from research on the development, introduction, and evaluation of AI systems and existing knowledge from implementation research literature. Therefore, with this research program, we intend to build an understanding, using both theoretical and empirical approaches, of how the implementation of AI systems should be approached in order to increase the likelihood of successful and widespread application in clinical practice.International Registered Report Identifier (IRRID)PRR1-10.2196/34920

Le dévoiement de l’interaction thérapeutique dans l’emprise sectaire. Éléments pour la formation à la prévention

After a reminder of the historical and current framework of clinical practice, and before concluding with a discussion of training in the diagnosis and prevention of sectarian aberrations, it is desirable to emphasize and explain what the contribution of the social psychology of interactions can be to the question. More precisely, it will focus on the pathological interaction, which, under the guise of care, enslaves the patient to a person, a group and an illusory theory. Psychologism, i.e. the tendency to misinterpret phenomena, by alleging psychological discipline, is not outside the scope of this field of sectarian influence. Any training in the prevention of sects for health professionals must examine this problem from the point of view of the pathogenic interactions at the origin of these aberrations.

Is ANTT Achievable in the Home Healthcare Setting?

At the heart of infection prevention in the home care setting is aseptic technique, a generic term for the clinical competency of ensuring asepsis during invasive clinical procedures and the maintenance of invasive medical devices. Variable terminology has resulted in confused education and clinical practice. Ambiguity has played out in all care environments, but especially in the home, where the challenge of providing effective aseptic technique is complicated by unique environmental and logistical factors. This has led some to conclude that aseptic technique is not possible in the home, or that it is not required at all in certain situations. This article challenges these assumptions and outlines the Aseptic Non Touch Technique (ANTT®) Clinical Practice Framework, that is used widely internationally. Through a thematic analysis of focus group discussions with home care nurses (n = 107) in the United Kingdom and the United States, opinions about aseptic practice in the home care setting were examined. Three main polarizing themes were identified and used to discuss theory and practice applications of aseptic technique for home healthcare nurses. Specific challenges in performing aseptic technique in home-based settings are exacerbated by ambiguity between what constitutes "clean," "aseptic," or so-called "sterile" technique, and are perpetuated by a lack of competency-based training that doesn't reflect the critical importance of aseptic technique to patient safety. Rather than continuing an endless debate about the definition of aseptic technique, ANTT has redefined aseptic technique education and clinical practice, with a comprehensive clinical practice framework and associated clinical governance better supporting patient safety.

A real-time integrated framework to support clinical decision making for covid-19 patients

BackgroundThe COVID-19 pandemic affected healthcare systems worldwide. Predictive models developed by Artificial Intelligence (AI) and based on timely, centralized and standardized real world patient data could improve management of COVID-19 to achieve better clinical outcomes. The objectives of this manuscript are to describe the structure and technologies used to construct a COVID-19 Data Mart architecture and to present how a large hospital has tackled the challenge of supporting daily management of COVID-19 pandemic emergency, by creating a strong retrospective knowledge base, a real time environment and integrated information dashboard for daily practice and early identification of critical condition at patient level. This framework is also used as an informative, continuously enriched data lake, which is a base for several on-going predictive studies. MethodsThe information technology framework for clinical practice and research was described. It was developed using SAS Institute software analytics tool and SAS® Vyia® environment and Open-Source environment R ® and Python ® for fast prototyping and modeling. The included variables and the source extraction procedures were presented. ResultsThe Data Mart covers a retrospective cohort of 5528 patients with SARS-CoV-2 infection. People who died were older, had more comorbidities, reported more frequently dyspnea at onset, had higher d-dimer, C-reactive protein and urea nitrogen. The dashboard was developed to support the management of COVID-19 patients at three levels: hospital, single ward and individual care level. InterpretationThe COVID-19 Data Mart based on integration of a large collection of clinical data and an AI-based integrated framework has been developed, based on a set of automated procedures for data mining and retrieval, transformation and integration, and has been embedded in the clinical practice to help managing daily care. Benefits from the availability of a Data Mart include the opportunity to build predictive models with a machine learning approach to identify undescribed clinical phenotypes and to foster hospital networks. A real-time updated dashboard built from the Data Mart may represent a valid tool for a better knowledge of epidemiological and clinical features of COVID-19, especially when multiple waves are observed, as well as for epidemic and pandemic events of the same nature (e. g. with critical clinical conditions leading to severe pulmonary inflammation). Therefore, we believe the approach presented in this paper may find several applications in comparable situations even at region or state levels. Finally, models predicting the course of future waves or new pandemics could largely benefit from network of DataMarts.