Experiences Of Providing Care Research Articles

Antenatal care practices for gestational weight gain: a cross sectional survey of antenatal care providers reported provision and barriers to providing recommended care.

Implementation of recommended gestational weight gain (GWG) care by antenatal care providers is poor. It is unclear whether practice implementation and barriers differ between antenatal care provider profession or experience. This study aimed to assesses the provision of and barriers to guideline care for GWG and examine associations with professional discipline and years of experience. A cross sectional survey was conducted with antenatal care providers working in three public maternity services in a regional city in Australia. Data were collected on the provision of and barriers (informed by the Theoretical Domains Framework) to recommended GWG care. Data were summarised using descriptive statistics. Associations between health profession characteristics (professional discipline and years providing antenatal care) and GWG care practices and barrier outcomes were assessed using multivariate logistic regression. 117 antenatal care providers completed the survey (75% participation rate). One quarter (25%) reported that they routinely provided recommended GWG assessment at the first antenatal visit, and 9% at subsequent visits. Only 7% routinely provided recommended advice on GWG, healthy eating and physical activity. Professional discipline or years of experience were not associated with higher odds of GWG practices. Skills, belief about capabilities, belief about consequences and environmental context and resources were barriers to providing care. Medical professionals had higher odds of agreeing that they have been adequately trained to address GWG (OR = 9.14, 95%CI:3.10-26.90) and feel competent in having sensitive conversations with pregnant women about GWG (OR = 8.60, 95%CI:2.29-32.28) than midwives. Midwives had higher odds of agreeing that there are services they can refer pregnant women to for further support (OR = 2.80, 95%CI:1.13-6.91). The provision of antenatal care for GWG was low, inconsistently provided and did not differ by professional discipline or years of experience. Antenatal care providers report numerous barriers including skills, belief about capabilities, belief about consequences, and environmental context and resources. Barriers to GWG care provision differed by professional discipline, but not years of providing care. The findings demonstrate that the type and prioritisation of practice-change implementation strategies may need to be tailored to address the differential barriers faced by professional groups.

Primary care provider beliefs and knowledge of prescribing gender-affirming hormone therapy to transgender and gender diverse patients

BackgroundTransgender patients often cannot access a provider who is knowledgeable about providing gender-affirming hormone therapy (GAHT). This study evaluated primary care provider (PCP) comfort and experience with, opinions about, and knowledge of prescribing GAHT to adults.MethodsAn anonymous Qualtrics survey was distributed to PCPs in San Diego County. Fisher’s exact test assessed any association between age, years in practice, or practice setting and 1) comfort in prescribing GAHT and 2) favorable statements about learning about, providing, and benefitting from training in GAHT. T-tests determined relationship between age, years in practice, or practice type setting with number of correctly answered multiple choice knowledge-based questions out of 4.ResultsOut of 220 responses, median age was 41, 60% had practiced for ≤ 10 years, and 19% had practiced in an academic setting. Forty-two percent did not receive any education about transgender healthcare during medical training. The most commonly reported barrier to providing GAHT was lack of training (74%). PCPs age ≤ 41 (67% vs 49%, p = 0.009), PCPs practicing for ≤ 10 years (65% vs 51%, p = 0.037), and PCPs in non-academic settings (64% vs. 41%, p = 0.013) were more likely to report being comfortable with prescribing GAHT. PCPs age ≤ 41 (89% vs 62%, p < 0.001) and PCPs practicing for ≤ 10 years (86% vs 66%, p < 0.001) were more likely to show interest in learning about GAHT. PCPs age ≤ 41 (74% vs 46%, p < 0.001) and PCPs practicing for ≤ 10 years (70% vs 50%, p = 0.003) were more likely to show interest in prescribing GAHT. Knowledge scores were higher for PCPs age ≥42 (mean 1.7 vs 1.4, p = 0.033) and PCPs working in academic centers (mean 2.0 vs 1.4, p = 0.002).ConclusionYounger (age ≤ 41) and early career (practicing for ≤ 10 years) PCPs reported being more comfortable with prescribing GAHT and had more favorable opinions in learning about, providing, and benefitting from training in GAHT. They are interested in providing GAHT; however, few prescribe GAHT with most reporting lack of training as a major barrier. This was evident with overall low knowledge scores regardless of age, experience, or clinical setting and underscores the need for increased educational efforts in transgender care throughout medical training.

Pandemic Action Plan: Phase 3-Lessons Learned from Implementation. "What Did We Learn?"

The COVID-19 pandemic created critical challenges for hospitals and health care providers. Suddenly clinics were forced to close; elective procedures were delayed; scheduled visits were canceled; emergency rooms were overcrowded; hospital beds, equipment, and personal protective equipment (PPE) were in short supply; and staff were faced with rapidly changing circumstances, care protocols, trauma, and personal risk. To better address challenges of the ongoing COVID-19 pandemic and prepare for future pandemics, the National Telemedicine Technology Assessment Resource Center (TTAC) was asked to develop a Pandemic Response Action Plan that would allow its users to address critical issues with available telemedicine and related technologies. The project was constructed in 3 phases. Phase 1-Develop a Pandemic Response Action Plan and a Pandemic Response Action Plan Policy and Regulatory Summary, which identifies the regulatory challenges as well as policy recommendations. Phase 2-Publish the Action Plan and the Policy and Regulatory Summary. Phase 3-Look at health care providers who used the approaches, tools, and technology in the Pandemic Action Plan and document the results. This document represents Phase 3. This document is Phase 3. In this report we look back at health care providers who used the approaches in the Phase 1 Pandemic Response Action Plan as published in Phase 2. In this document we report on the challenges and results of implementing parts of the Pandemic Action Plan. It records the findings, conclusions, and recommendations resulting from the experience of health care providers and the professional experiences of the team and their organizations in implementing parts or all of the plan. Methods: The same multidisciplinary team that constructed Phase 1 and Phase 2 were engaged to develop this Phase 3 report. The members of the team represent leadership expertise and key stakeholders in health care delivery during a pandemic (administration, infection control, physicians, nurses, public health, contingency planning, disaster response, and information technology) as well as a facilitator. For Phase 3, the group used structured brainstorming to define the findings, issues, and results of their own organizations' digital health response to the pandemic. In addition, eight health care providers (hospitals) identified by the Telemedicine Resource Centers' (TRCs) organizations, who used the Pandemic response Plan (created in Phases 1 and 2), were interviewed. All interviews were conducted by the same facilitator with leaders (CEO, and leaders of the telemedicine programs) in each of the eight programs, using a standard questionnaire created by the team. Current literature references are included in this report to illustrate when findings are known to have broader applicability. Conclusions: The impact of the COVID-19 Pandemic was severe and identified multiple critical challenges and weaknesses. Applying the approaches, tools, and technology outlined in the Pandemic Response Action Plan proved to be effective in addressing critical provider challenges. However, implementing these tools during a crisis was difficult unless the organization had experience with the tools and necessary workflows in advance. Implementing these tools as part of standard workflows and everyday operations increased the capabilities and resilience of these organizations in the provision of care during this and for future pandemics.

Teleneonatal or routine resuscitation in extremely preterm infants: a randomized simulation trial.

Teleneonatology, the use of telemedicine for newborn resuscitation and care, can connect experienced care providers with high-risk deliveries. In a simulated resuscitation, we hypothesized that teleneonatal resuscitation, compared to usual resuscitation, would reduce the no-flow fraction. This was a single-center, randomized simulation trial in which pediatric residents were randomized to teleneonatal or routine resuscitation. The primary outcome was no-flow fraction defined as time without chest compressions divided by the time during which the heart rate was <60. Secondary outcomes included corrective modifications of bag-mask ventilation and times to intubation and epinephrine administration. Fifty-one residents completed the scenario. The no-flow fraction (median [IQR]) was significantly better in the teleneonatal group (0.06[0.05]) compared to the routine resuscitation group (0.07[0.82]); effect (95% CI): -16 (-43 to 0). Participants in the teleneonatal resuscitation group more frequently performed corrective modifications to bag-mask ventilation (60% vs 15%; p < 0.001). Time to intubation (214 s vs 230 s; p = 0.58) and epinephrine (395 s vs 444 s; p = 0.21) were comparable between groups. In this randomized simulation trial of neonatal resuscitation, teleneonatal resuscitation reduced adverse delivery outcomes compared to routine care. Further in hospital evaluation of teleneonatology may substantiate this technology's impact on delivery outcomes. NCT04258722 IMPACT: Whereas telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings, unique challenges include the need for real-time, high-fidelity audio-video communication with a low failure rate. The no-flow fraction, which evaluates the quality of chest compressions when indicated, has been associated with survival in other clinical contexts. We report a reduction in no-flow fraction in neonatal resuscitations supported with telemedicine, in addition to improvements in the quality of neonatal resuscitation. Telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings without direct access to neonatologists.

Mitigating Alarm Fatigue and Improving the Bedside Experience by Reducing Nonactionable Alarms

To assess whether conditional bedside alarm triggers can reduce the frequency of non-actionable alarms without compromising patient safety and enhance nursing and family satisfaction. Single center, quality improvement initiative in an acute care cardiac unit (ACCU) and pediatric intensive care unit (PICU). Following the 4-week pre-intervention baseline period, bedside monitors were programmed with hierarchical time delay and conditional alarm triggers. Bedside alarms were tallied for 4 weeks each in the immediate post intervention period and 2-year follow-up. The primary outcome was alarms per monitored patient day. Nurses and families were surveyed pre- and post-intervention. A total of 1509 patients contributed to 2034, 1968, and 2043 monitored patient days which were evaluated in the baseline, follow-up, and 2-year follow-up periods, respectively. The median number of alarms per monitored patient day decreased by 75% in the PICU (p<0.001) and 82% in the ACCU (p<0.001) with sustained effect at 2-year follow-up. No increase of rapid response calls, emergent transfers, or code events occurred in either unit. Nursing surveys reported an improved capacity to respond to alarms and fewer perceived non-actionable alarms. Family surveys, however, did not demonstrate improved sleep quality. Implemented changes to bedside monitor alarms decreased total alarm frequency in both the acute care cardiac unit and pediatric intensive care unit, improving the care provider experience without compromising safety.

Impact of En Route Critical Care Provider Experience on Lung Protective Ventilation Compliance During Air Transport of Combat Wounded.

The primary objective of this study was to evaluate the association between the U.S. Air Force Critical Care Air Transport (CCAT) provider operational experience with compliance for lung protective ventilation (LPV) volumes recommended by Acute Respiratory Distress Syndrome Clinical Network guidelines. We performed a retrospective cohort study of CCAT providers transporting combat casualties requiring mechanical ventilation from the Middle East to Germany from 2007 to 2012. We reviewed CCAT medical records from 2007 to 2012 for the total number of patient transports by CCAT physicians and respiratory care practitioners (RCPs). Center for Sustainment of Trauma and Readiness Skills Cincinnati process improvement questionnaire data described provider demographics and clinical backgrounds. We linked these data to patient demographics and in-flight ventilation management from a prior CCAT cohort study. Patient inclusion criteria included transport by CCAT from the Middle East to Germany for traumatic injury requiring mechanical ventilation between 2007 and 2012. We excluded patients with no documented height or tidal volume. LPV compliance was defined as tidal volumes ≤8 mL/kg of predicted body weight during en route critical care transport. We performed a logistic regression analysis. This study was reviewed and approved by the 59th Medical Wing institutional review board (IRB). We analyzed 491 patient transports conducted by 71 (RCPs and 84 physicians. Patients had a median age of 25 years (IQR 22-30), 98% were male, median injury severity score was 24 (IQR 17-34), and median preflight PaO2/FiO2 was 285 (IQR 220-365). Median experience was 26 missions (IQR 13-40) for RCPs and 23 missions (IQR 12-38) for physicians. All in-flight tidal volumes were LPV compliant in 58.3% of missions. Unadjusted analysis showed higher LPV compliance for RCPs with in-garrison critical care experience. Multivariate models did not find an association between missions flown and LPV compliance but did demonstrate a positive association with physician specialty of medical intensivist (OR 3.0, 95% CI 1.6-5.7) and a negative association with flights in 2008 (OR 0.4, 95% CI 0.2-0.7) for LPV compliance. No association was found between number of missions flown by CCAT providers and lung protective tidal volume compliance. Linkage of multiple data sources enabled investigation of clinical and operational currency associations with a care quality metric compliance in the combat en route care environment. Future studies should evaluate the impact of ongoing CCAT training and quality improvement interventions on LPV compliance.

Written communication and the ICU team experience (WRITE): A pre-post intervention study

ObjectiveFamilies of critically ill patients may benefit from receiving a written update of patient care each day. Our objective was to develop a system to facilitate care provider creation of written updates and to determine the effect of implementing this process on the care provider experience. DesignThe experiences of ICU care providers (nurses, advanced practice providers, and physicians) were measured monthly during a 3-month pre-intervention and a 3-month intervention period. During the intervention period, written updates were sent to families each day and posted in the electronic medical record. Study investigators assisted by editing and distributing the written communication to families. SettingAn urban academic medical center in the United States. Main outcome measuresNurse-Physician Collaboration Scale (NPCS) and Maslach Burnout Inventory (MBI). ResultsOver the 3-month intervention period, care providers created written communication for families of 152 patients (average 5 ICU days per family). NPCS scores among the 65 participating care providers were significantly lower, indicating greater collaboration during the intervention vs. pre-intervention period: 49.9 (95 % CI 46.4–53.6) vs. 55.4 (95 % CI 51.5–59.3), p = 0.002. MBI scores were similar during the intervention vs. pre-intervention periods. A subset of care providers participated in individual interviews. Care providers reported that the process of creating written communication was acceptable and had clear benefits for both families and the medical team. ConclusionsUse of written communication as a supplement to verbal communication improves collaboration among ICU care providers without affecting symptoms of burnout. Implications for practiceWe created a system to facilitate written communication with ICU families that was acceptable to care providers and improved aspects of their experience. In the future, use of written communication can be enhanced with refinements to the process that reduce the time spent creating written updates while highlighting the benefits to families and care providers.

Experiences of individuals presenting to the emergency department for mental health reasons: A systematic mixed studies review.

Emergency departments the world over have seen substantial increases in the number of individuals presenting for mental health reasons. However, we have a limited understanding of their experiences of care. The aim of this review was to systematically examine and synthesise literature relating to the experiences of individuals presenting to emergency department for mental health reasons. We followed Pluye and Hong's seven-step approach to conducting a systematic mixed studies review. Studies were included if they investigated adult mental health experiences in emergency department from the users' perspective. Studies describing proxy, carer/family or care provider experiences were excluded. Sixteen studies were included. Thematic synthesis identified three themes and associated subthemes. Theme 1 - ED staff can make-or-break and ED experience - comprised: Feeling understood and heard; Engaging in judgement-free interactions; Receiving therapeutic support; Being actively and passively invalidated for presenting to the ED; and Once a psych patient, always a psych patient. Theme 2 - Being in the ED environment is counter-therapeutic - comprised: Waiting for an 'extremely' long time; and Lacking privacy. Theme 3 was Having nowhere else to go. The experiences described by individuals presenting to emergency department for mental health reasons were mostly poor. The results illustrate a need for increased mental health education and training for all emergency department staff. Employment of specialist and lived experience workers should also be prioritised to support more therapeutic relationships and emergency department environments. In addition, greater investment in mental health systems is required to manage the current crisis and ensure future sustainability.

Apple Tree Maternity: A Qualitative Exploration of the Development of a Rural Collaborative Interprofessional Maternity Care Service

Introduction: There is currently a maternity care crisis in Canada, with many of the obstetricians and family physicians reaching retirement age in the next 10 years. Primary midwifery care services may offer solutions. However, due to the many constraints and difficulties faced by midwives practicing in rural settings, there is an emerging interest in exploring interprofessional collaborative models of maternity care as a possible solution to the crisis. This study documents the process and experiences of care providers in establishing and providing collaborative interprofessional maternity care in rural British Columbia. Methods: Semistructured interviews were conducted with key stakeholders (primary care providers and allied health professionals) working at Apple Tree Maternity. Interviewees spoke to both the process of establishing a new collaborative interprofessional model of care and the experience of working and providing care within the model. Findings: Four main themes emerged through the dialogue with the stakeholders: motivation for collaboration; challenges and barriers to collaborative care; attributes and benefits of collaborative care; and core qualities and recommendations for successful interprofessional collaboration. Based on their experience of establishing and working within a new model of collaborative, interprofessional, rural maternity care, the study participants identified core qualities and recommendations for successful interprofessional collaboration in a rural community to be mutual trust and respect; common philosophy of care, mutual commitment, and genuine desire to collaborate; clear and effective communication; ensuring the collaborative model is responsive to the unique needs of specific communities; community support; supportive institutional culture; and alternative payment plans and billing structures. Conclusion and implications for practice: This study revealed a number of attributes to collaboration that mirror those identified by others. In addition, study participants identified particular challenges unique to the rural context. Further research documenting the care provider experiences of interprofessional collaboration in other rural settings is warranted. In addition, there is also a need to explore and document the experiences of collaborative practice, in both rural and urban settings, from the client perspective. It is only when this is achieved that significant policy change suggestions should be made that will facilitate both collaborative practice and an improvement in care to women in rural settings. The need for this research is vital given the maternity care crisis in British Columbia and the need for supporting sustainable rural maternity care models. This article has been peer reviewed.

A typology of family caregiving for older immigrants: perspectives from care receivers and care providers

PurposeAs populations are ageing and the global average life expectancy is rising, the provision of care for older people is an increasingly salient issue. This paper aims to focus on family-provided care for older immigrants, examining how older immigrants and care providers experience and construct family caregiving.Design/methodology/approachBased on interviews with care recipients, family care providers, municipal staff and representatives for migrant organisations in Sweden, this study presents a typology of family caregiving for older immigrants.FindingsThe authors found three caregiving types, namely, solely family-provided care and a combination of family care and public care (predominantly one or the other). The decision to select family-provided or publicly-funded care depends on personal and institutional factors.Originality/valueThe paper makes three empirical contributions to the literature on care provision for older immigrants. Firstly, this study provides insights into the structural and personal factors that shape care-giving arrangements for older immigrants. Secondly, this study examines the perspectives of care recipients and care providers on family-provided care. Care expectations differ between both groups and sometimes result in intergenerational disagreement. Thirdly, in terms of institutional support, this study finds that the Swedish state’s notion of individual needs does not match the needs of immigrant elderly and their caregivers. The paper places the care types in a broader discussion about eldercare provision in the Swedish welfare state, which has experienced a decline in publicly funded care services and an increase in family caregiving in the past 30 years. In addition, it addresses questions of dignified ageing from a minority perspective.

The value equation for specialist palliative care: design and delivery principles.

The value of specialist palliative care (SPC) is multi-faceted. Patients, families, healthcare providers, health systems and payors all benefit in different ways when SPC is included in the care of those with serious illness; they all have a shared interest in the availability and success of SPC. We propose a new value equation for SPC: SPC services must employ optimal design and standardized delivery of SPC to ensure that the payment model, care model, and needs of the patients are all aligned; and suitable payment models are necessary to provide stable, sustainable resources for the interdisciplinary palliative care teams; when these conditions are met, the cascade of beneficial outcomes of SPC can be produced reliably. We propose a set of 10 design and delivery principles describing these inputs and outcomes, applicable to SPC in all settings-hospital, clinic, and home. Amidst shifts in health policy and financing, the SPC field in the US continues to evolve with new innovations, additional evidence, and a clearer vision of what is valuable. An enduring component of the value equation of SPC continues to be the moderation of the total cost of care for payors. This articulation of the value equation for SPC is based on evidence and experience of palliative care providers and payors in the US, but the framework and principles are likely useful to guide and evaluate SPC in other countries as well.

Nurse Champions: Transforming Evidence-Based Practice

Nursing practice in an organization result from the leadership processes developed for the profession. It is reflected in the performance of nurses in interprofessional teams and the quality of care they provide to patients. Evidence-based practice (EBP) refers to decision-making in the development and delivery of health care services according to the best available research evidence, the experience of health care providers, and the values and preferences of patients. The adoption or implementation of EBP by organizations can lead to safer practices, better outcomes for individuals, and lower healthcare costs. In the literature, "champions" have been identified as determinants and agents of change to ensure adoption within institutions.

Implementation of an Interprofessional Diabetes Management Clinic in the Rural Primary Care Setting.

Background: Access to a primary care provider is not guaranteed for many living in rural settings. Notably, rural populations experience a higher degree of burden from chronic diseases compared to urban-dwellers. For example, diabetes can go undiagnosed and undertreated with lack of primary care. To address these care gaps at a large, rural family medicine practice in western North Carolina, a multidisciplinary pharmacist-led diabetes clinic was developed. Objectives: This article describes the implementation, evolution, and impact of the diabetes management clinic and explores future directions for improving the experience of patients and health care providers. Practice Description and Innovation: The diabetes management clinic at Mountain Area Health Education Center (MAHEC) is a pharmacy resident-led interdisciplinary clinic incorporating nutrition and pharmacy learners to provide patient care in both telehealth and in-office settings. Since its inception in 2018, the clinic has facilitated meaningful learning opportunities for students and residents and helped patients manage their diabetes in a multifaceted approach. Evaluation Methods: A retrospective, cross-sectional study evaluated diabetes-related outcomes for 80 patients seen in the diabetes management clinic during twelve months of appointments. The primary outcome measure was change in A1c from baseline. Results: Among patients with a follow-up A1c during the study (n=64), there was a mean reduction in A1c by 0.79% from baseline. Additionally, among those with a second follow-up A1c available (n=32), there was a mean reduction from baseline in A1c of 1.42%. Conclusion: The utilization of pharmacy residents as part of an interdisciplinary diabetes management clinic can extend access to care for underserved patients. The clinic also serves as a structured teaching clinic for interdisciplinary learners, and it has contributed to positive clinical outcomes, strong interprofessional collaboration, and expansion of experiential education opportunities since its inception in 2018.

Development and initial validation of a sexual and gender minority competency-based survey for health service professionals.

Sexual and gender minority (SGM) individuals endure a number of health disparities, such as higher rates of violence, mental health conditions, and medical concerns. These disparities are exacerbated by the fact that SGM individuals face stigmatizing health care provider and system-related experiences. The primary purpose of this study was to quantify health service providers' SGM health competency by developing a measure, namely the Health Care Competency Assessment Form-Sexual and Gender Minority Patients (HCAF-SGM). Further, we examined correlates of SGM health competency based on leading theories of prejudice, primarily the dual process model of prejudice and social identity theory. The study comprised two phases: item development and pilot testing, followed by a primary online survey administration with several health care professionals and training organizations (N = 155). Study findings supported a one-factor HCAF-SGM score, suggesting that health care providers view their competency regarding SGM individuals in a holistic manner, without differentiating between knowledge, attitude, and skill. The measure was found to be negatively associated with right-wing authoritarianism and positively correlated with specific social identities most salient to the topic of SGM health (i.e., health care professional and SGM). The HCAF-SGM shows promise as a reliable and valid assessment of perceived provider health care competency. Implications for SGM health-related measurement, clinical supervision, and training are discussed. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Understanding and Managing Fragmented Transitions in Care: Learning from and Guided by Patient, Family, Health Care Provider and System-Level Experiences Before, During and Follow-up to COVID-19

One ongoing challenge in health care is ensuring patients/families and also health care providers have clear direction and implementation guidance around transitions in care across all care and community settings that includes integration, continuity and coordination. Clearly understanding patient, family, care provider and system-level experiences including what works and where improvements are needed with care transitions across acute and community settings has been an ongoing challenge for most health care systems before and during COVID-19. However, although efforts to identify and use experience measures were complicated and impacted during COVID-19 because of rapidly enforced restrictions and emergent safety protocols, learning to adapt to change was also essential.&#x0D; Our study explored the experiences of patients/clients, families, care providers and system leaders regarding their care transitions between acute and community-based care settings prior to and during COVID-19, along with changes in care outcomes, practices, policies and services became the focus of a two-year pilot study in one Canadian provincial health system. We co-designed relevant acute to community care transition process and outcome/impact experience indicators/measures with patients/clients, families and care providers; and explored the feasibility for transferring measures and lessons learned for practice, policy and service changes as part of follow-up and post COVID new ‘norm’ transformation of care transitions. &#x0D; The study involved the Provincial Seniors and Continuing Care Advisory Council, Continuing Care Quality Committee, Transition Services, primary care and eight pilot care settings involving patients/clients transitioning from acute to community settings. Each care setting involved patient/family advisors co-designing and implementing the initiative with care providers and transition leaders. This included survey development, and gathering, analyzing and interpreting client/patient and care provider experiences. Findings in each and across settings included identifying common core patient/family and care provider experience indicators/measures regarding acute to community care transitions, before and during COVID. System-level factors and experiences were also gathered. Themes for what makes transitions in care successful before, during and follow-up to COVID were also confirmed – e.g. clear communication, navigation and information/direction for all stakeholders. The aggregated findings targeted health outcomes and guided changes in transition practices from across acute points of care as well as Emergency, to various community-based care settings including Home Care, Long-term or other interim programs utilized while patients waited for final transition decisions – e.g. CHOICE programs.&#x0D; Essential learnings include having a clear understanding of the experiences of patients/clients, families, care providers and system-level regarding care transitions, and how well integrated, coordinated and continuity-aligned this care is. This includes understanding what works well and where there are gaps in the system. Managing the gaps helps mitigate failed or unsatisfactory patient transitions across care settings. Such findings also guide or inform quality and safety improvement. &#x0D; Identified transition core measures continue to be studied beyond the pilots for transferability across acute, emergency, primary and community care settings. As well, COVID-19 impacts on practice, policy and service changes involving coordinated and integrated transitions need to be monitored for how well care settings adapt to “new norms” and meet patient/client needs. This work continues.

What is in a space? Exploring experiences providing or receiving patient care in unique spaces for patients waiting to transition to their next point of care in Ontario, Canada

Introduction: Delayed discharge is a key challenge for health systems globally. Pandemic-related capacity pressures on hospitals have increasingly led to patients being moved to unique spaces (overflow units, hotels) while they wait to transition to their next point of care. However, it is unclear how patient care is managed and coordinated in these spaces or how patients and caregivers experience care in these environments.&#x0D; Rationale/Objective: Our study aimed to understand how to optimize care experiences and outcomes for patients with a delayed discharge, their families and care providers. The purpose of our study was to learn about people’s experiences in unique spaces, including what works well and what needs to improve. &#x0D; Methods: Using a qualitative descriptive design, we conducted in-depth, semi-structured interviews with patients/caregivers (n=9) and care providers (n=20; e.g., nurses, rehabilitation therapists, physicians, discharge planners) who had experience with receiving or providing care in a unique space. We interviewed participants from three different unique spaces associated with a hospital across rural and urban health regions in Ontario, Canada: a hotel previously used for patient and caregiver accommodations while receiving care away from home (beside hospital), a structured, heated tent (hospital parking lot) and a clinical building (1 hour away from hospital). Interviews were transcribed and a codebook was developed and applied to all transcripts. Thematic analysis was used to analyze the transcripts, specifically focusing on key challenges and opportunities.&#x0D; Results: Patient, caregiver and care provider experiences in these unique spaces included positive aspects, such as care teams focused on facilitating integrated care transitions, the opportunity to develop a collaborative team culture from the ground up and having increased interdisciplinary patient assessments. Areas of improvement were also described across interviews, such as the need for adequate space and infrastructure for optimal patient care and safety, more integration of information sharing about patient care and journeys between and across providers, patients and caregivers, more resources and support from the associated hospital and clear patient eligibility criteria for care provider referrals.&#x0D; Lessons learned: Unique spaces have the potential to be alternate care settings when hospitals are managing capacity pressures now and in the future; however, hospitals considering moving patients with delayed discharge to these spaces should consider both the opportunities and benefits of providing care within these environments compared to traditional hospital units. It is also important for hospitals to understand the challenges associated with providing care in these settings and develop plans to mitigate these challenges. &#x0D; Next steps: These findings provide learnings to inform a co-design initiative with patients, caregivers and care providers to identify best practices and resources for providing or receiving care in unique spaces that responds to patient needs as the health system continues to look to alternate care settings to ease pressures. This work will have implications on how integrated health care services are implemented in unique spaces so that patients experience a continuum of care both while they wait and as they transition to new points of care.&#x0D;

Technology-Enabled Collaborative Care for Diabetes and Mental Health (TECC-D): Feasibility and Satisfaction of a Co-Re-Designed Integrated Virtual Care Model

Objective: For individuals living with Type-2 Diabetes (T2D), mental health issues such as distress, anxiety, and depression are common. However, current models of care require those living with T2D and mental health issues to navigate a fragmented healthcare system to receive physical and mental health services. This is especially true in rural areas where there are additional barriers at the individual and provider level. To address these gaps, we co-re-designed a person-centred Technology-Enabled Collaborative Care for Diabetes and Mental Health (TECC-D) model through iterative input. &#x0D; Co-Re-Design: To meet the complex needs of those living with T2D and mental health issues, a co-re-design process was utilized. This involved building on existing assets, including a previously co-designed collaborative care model that was re-designed for this population with input from three people with lived experience of diabetes, diabetes and mental health care providers, and community stakeholders. This team supported the design and implementation of the model throughout the study duration.&#x0D; Methods: In this explanatory sequential feasibility trial, the TECC-D model leveraged existing assets including widely available technology (telephone, web-conferencing) to integrate T2D and mental health support through weekly, virtual health coaching sessions with a Certified Diabetes Educator, supported by a multidisciplinary virtual care team for 8 weeks. Primary outcomes included the feasibility and acceptability of the TECC-D model with exploratory outcomes including changes in mental health, substance use, and physical health behaviours collected at baseline, 4, 8, and 12 weeks. Provider and partner experience and satisfaction were also explored through a qualitative descriptive study.&#x0D; Results: 31 participants were recruited and completed the program between June 2021 and June 2022. Study findings demonstrate that the TECC-D model is a feasible and scalable care solution that empowers individuals living with T2D and mental health issues to take an active role in improving their physical and mental health. Participants and providers described program components (e.g., health coaching, virtual care team) and program delivery (e.g., frequency and duration of the program) positively. This included: 1) seeing virtual care as practical and effective for managing routine care needs; 2) feeling that having an expert care coach supported by a virtual care team was “over and above” the care that participants had previously experienced; 3) building expertise and capacity within the care team specific to diabetes and mental health; and 4) recognizing that integrated care is “missing from diabetes care” and that in offering clinical integration, participants felt “much more than just the sum of my parts”. &#x0D; Conclusions: Utilizing widely available technology in the current health system and engaging existing primary and community-based care assets, this model of care was found to be both feasible and acceptable by participants, providers, and patient partners and may improve the lives of individuals living with T2D and mental health issues.

Collaboration with Indigenous communities in an integrated care learning health system in Ontario, Canada: a case study of the Frontenac, Lennox &amp;amp; Addington Ontario Health Team

Context: Health systems in the province of Ontario in Canada have been restructured into Ontario Health Teams (OHTs). OHTs seek to provide integrated care through improving patient experience, improving care provider experience, improving population health outcomes, reducing costs, and addressing health equity - per the Quintuple Aim framework. The Frontenac, Lennox &amp; Addington (FLA) OHT was created in bringing together numerous clinical and community partners, including local Indigenous health groups. Indigenous peoples face health inequities driven by colonization and systematic racism; improving accessibility, cultural appropriateness, and cultural safety of health systems are essential. To ensure that unique needs of Indigenous peoples are met, there should be a collaborative, participatory approach to planning and executing Indigenous-specific evaluation activities, with Indigenous-specific performance indicators.&#x0D; Objectives: 1) To co-design, implement, and evaluate a governance process for collaboration with Indigenous communities, for Indigenous-focussed evaluation of FLA OHT activities. 2) To nest the above into a case study of the FLA OHT, examining processes for centering Indigenous perspectives and priorities in systems evaluation. &#x0D; Study Design: Case study method involving community-based participatory research (CBPR), and using principles of Ownership, Control, Access, Possession (OCAP) in ethical Indigenous health research. The research team involves Indigenous members of FLA OHT working groups and tables, other partners and stakeholders from the broader Indigenous communities of the region, Queen’s University (Kingston, Ontario) researchers on the FLA OHT’s evaluation support structure, and other FLA OHT team members. Data used for the case study include focus groups and interviews with Indigenous members, analysis of meeting minutes and other relevant organizational documents, and surveys on team function and Indigenous-specific evaluation activities. Indigenous-specific indicators have been identified through rapid literature reviews and are being incorporated into logic models for evaluation of FLA OHT projects.&#x0D; Expected Outcomes: 1) A framework to operationalize collaboration between Indigenous stakeholders and mainstream health systems, in the co-design and co-execution of health system evaluation approaches that reflect Indigenous perspectives and priorities. 2) Incorporation of Indigenous-specific evaluation activities for FLA OHT projects.&#x0D; Results: Work in progress at time of abstract submission.&#x0D; Conclusions: The framework produced will serve as a practical, operationalized guide to other mainstream health systems and Indigenous groups seeking to collaborate together. The Indigenous-specific evaluation activities will enable thoughtful and rigorous consideration of whether the needs of Indigenous patients and communities are met, and allow for modification of programs and services – per the “learning health system” goal of iterative knowledge production and action to drive continuous improvement. Additionally, this project will strengthen relationships between the region’s mainstream service organizations, policymakers, Queen’s University academic researchers, and local Indigenous peoples. Strengthened relationships will facilitate current and future collaborative work to improve systems, as a step towards addressing health inequities facing Indigenous peoples.

A qualitative study of the comfort care experience from the perceptions of health care providers providing care for terminally ill infants in neonatal intensive care unit at the end of life

PurposeThe purpose of this study was to describe the comfort care experiences of health care providers at the NICU at end of life. Designand Method: The study used a qualitative phenomenological approach, to collect data from 20 health care providers (nurses and physicians) who were selected purposively from the NICUs settings in three Jordanian hospitals utilizing semi-structured interviews. The data was recorded and analyzed thematically. ResultsFour distinct themes captured the comfort care experiences of health care providers: (1) Reality vs. Hope, (2) Beliefs and Emotions, (3) Provision of Comfort Care, (4) Passion of Attachment. ConclusionThe finding of the study indicated that the experience of the health care providers was very stressful and challenging. There was a lack of prior education on comfort care and a lack of comfort care policies to provide quality comfort care. This study supports need for adjustments in staffing to meet the complex needs of terminally ill infants at the NICU.

CARE PROVIDERS IN THERAPEUTIC RESIDENTIAL SERVICE AND THEIR EXPERIENCES: Analysis of scientific production

Therapeutic Residential Service targets patients discharged after long-term hospitalization through the mediation of the care providers. The aim of this research was to identify the scientific production of the last ten years on the subject. A search on the Biblioteca Virtual em Saúde - Psicologia Brasil (BVS-Psi), Scielo, and CAPES Periódicos database was conducted using the following terms in Portuguese: “cuidador” and “residência terapêutica”. A total of 15 texts were analyzed considering its year of publication, category, type of study, instruments and materials, results, and gaps. The results show a higher prevalence of studies in 2011 a lower in 2010, 2015 and 2017. Most of the papers (81,25%) are empirical studies and used semi-structured interviews (45,45%). It was observed that being a care provider brings the experience of ambiguous feelings with moments of satisfaction and dissatisfaction. Physical and emotional overwhelming, and lack of support, supervision, training and continued education permeate the care providers experience. As for the gaps, it is noticeable the recommendation and justification of more studies on these professionals and the promotion of hearing and caring to their benefit. It is expected that this research contributes to stress the importance of considering the processes of mental health of the care providers, valuing the roles performed by them.