Health Service Practice Research Articles

Rehabilitation following shoulder arthroplasty in the United Kingdom National Health Service: A survey of publicly facing information.

The prevalence of shoulder arthroplasty (SA) is rising, but there is limited research evaluating rehabilitation following SA and whether there is an optimal approach remains unknown. The aim of this study was to understand current National Health Service (NHS) practice for rehabilitation following SA as a platform for conducting much needed further research. Two reviewers independently undertook electronic searches for publicly available information sheets (PIS) from websites of NHS Trusts that included detail about rehabilitation following SA, for example, duration of immobilisation. One reviewer extracted data, and a second reviewer verified this. Not required. Forty-three PIS from 40 Trusts were identified. Twenty-four referred to more than one type of arthroplasty (anatomic, reverse and hemiarthroplasty) but did not describe different approaches to rehabilitation based on prosthesis type. Twenty-five PIS provided some instruction regarding movement restrictions, which varied considerably. All PIS referred to postoperative immobilisation, typically with a sling, with median duration of 4 weeks (range 0 to 8). Thirty-four PIS reported commencing passive exercise immediately. Median time to commencing active exercise was 4 weeks (range 1 to 6) and 5 weeks (range 1 to 16) for resisted exercise. Median time expected to return to driving was 6 weeks (range 3 to 12) and general work 12 weeks (range 3 to 26). This study has highlighted significant heterogeneity between rehabilitation approaches following SA, not previously reported in the United Kingdom, with a lack of specific rehabilitation PIS for different prosthesis types. Our results will facilitate evaluation of rehabilitation strategies in future research.

Evidence-based practice in child and adolescent mental health services - The challenge of implementing national guidelines for treatment of depression and anxiety.

Mental health problems are one of the most pressing public health concerns of our time. Sweden has seen a sharp increase in mental disorders among children and youth during the last decade. The evidence base for treatment of psychiatric conditions has developed strongly. Clinical practice guidelines aim to compile such evidence and support healthcare professionals in evidence-based clinical decision-making. In Sweden, the national guidelines for the treatment of depression and anxiety disorders in children and adolescents were launched in 2010. The aim of this study was two folded, (i) to explore to what extent these guidelines were known and adhered to by health professionals in Child and Adolescent Mental Health Services and (ii) to investigate factors influencing implementation of the guidelines informed by the Consolidated Framework for Implementation Research. A qualitative approach was used, and data were collected through interviews with 18 health professionals in Child Mental Health Services in Sweden and a combination of conventional and directed content analyses was used. The Consolidated Framework for Implementation Research guided and structured data collection and analysis. The guidelines were largely unknown by health professionals in Child Mental Health Services in all the clinics investigated. Adherence to guideline recommendations was reported as very low. Barriers to implementation were found in relation to the characteristics of the intervention, outer setting, inner setting and characteristics of the individuals involved. The government initiative to develop and disseminate the guidelines seems to have made very little impact on health professionals' clinical practice. The guidelines were poorly aligned with the health professionals' knowledge and beliefs about effective mental health services for children and youth with depression and anxiety disorders. Suggestions for future efforts to improve the development and implementation of guidelines in Child Mental Health Services settings are given.

Evaluation of Facilitators and Barriers to Implementing Evidence-Based Practice in the Health Services: A Systematic Review.

Background: Evidence-based practice (EBP) is an ambition for health service administrators. We aimed to systematically review the major relevant articles in case of barriers and facilitators to implementing evidence-based practice in health services. Materials and Methods: The type of study was a systematic review. We searched the libraries and online sources such as PubMed, MEDLINE, Wiley, EMBASE, ISI Web of Knowledge, Scopus, Science Direct, Cochrane Library, and Google scholar. We used keywords included "Evidence-Based Practice", "Evidence-Based Management", "Healthcare", "Care Management, Evidence-Based Healthcare Management", "Health Care", Health", "Barrier", "Facilitator", policy and "Evidence-Based Healthcare". Results: In total, 12 studies were included. Several barriers and facilitators were recognized through the included papers, the factors such as organization support and a helpful education system improved skills, knowledge, and confidence to EBP. The outcomes of studies were identified as the employ of the internet as a highest-rated skill for increasing EBP quality. Conclusion: Generally, the results showed health service administrators should first identify barriers of EBP then transferred them to facilitators to the implementation of proper and efficient EBP.

Análise dos incidentes relacionados à assistência à saúde no município de Porto Alegre, Rio Grande do Sul, nos anos de 2016 e 2017

Introduction: Health care incidents represent a serious public health problem since they are associated with increased mortality, length of hospitalization and treatment costs. In this context, the continuous monitoring and surveillance of incident occurrence by the health services are important prevention tools. Objective: To describe and evaluate the quality of the incident notification related to healthcare occurred in the city of Porto Alegre, RS, between 2016 and 2017. Method: A descriptive study that proposes to calculate the prevalence of notified incidents and to analyze their variables from secondary data. Results: A total of 1,059 events occurred among the studied years, most of them in hospitals, with mild damage and during healthcare. The most affected age group was the elderly and the most frequent incidents were produced by falls. The most frequent never event were pressure ulcers and the quality of the notification was generally low. Conclusions: It is important risk monitoring and incident notification to be permanent practices in health services and the notified data to be used as a tool for constant improvement of healthcare processes.

Pediatric Psychology in Emergency Services: a Clinical Practice to Follow in Hospital Context

SiSince the beginning of 2016, the team of the Emergency Service (SU) of the Pediatric Department of the Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte (HSM-CHULN), counts with another valence in its intervention plan. Traditionally specialized in an approach of organic pathology, the service is now composed of a specialized intervention of Pediatric Psychology. This paper has the purpose of review, deepen and disclose (i) the psychological intervention model that is used in the SU, focused on babies, children and adolescents, as well as on direct/indirect support to families, at a Physical and Mental Health levels, (ii) the developed work in stress management of the emergency team and (iii) the performance of psychologists in the emergency context, as a way to update the intervention protocols within this practice according to international guidelines. The intervention carried in this SU, in situations of emergency, urgency or crisis, resort from strategies that mitigate and treat the intense cognitive, behavioral and emotional malaise of the pediatric patient and families/caregivers, in a interprofessional perspective and always as a first line resource. Given the increase and clinical relevance of the psychological variables, the inclusion of this specialized area presents itself as a sustainable and important intervention for a practice that we wish to be implemented transversally, contributing to the reduction of outpatient visits, therapeutic prescriptions, number of consultations and frequency of hospitalizations. A pre- and postgraduate training that privilege this type of knowledge and enables the implementation of these intervention models in a larger number of institutions presents itself as a sustained practice of health services.

Prevalence of complementary and alternative medicine (CAM) use in Brazil

BackgroundThe use of medicinal plants or other alternative practices can be the only therapeutic resources for many communities and ethnic groups, especially in developing countries. In Brazil, the Ministry of Health incorporated Complementary and Alternative Medicine (CAM) as a public health policy since 2006. The aim of this study was to evaluate the prevalence of CAM use in Brazil.MethodsThis was a cross-sectional study performed as an epidemiological survey, with data from the National Health Survey, 2013 that evaluated a sample of adult Brazilians (18+ years old). The outcome was the use of CAM therapies, such as acupuncture, homeopathy, medicinal plants and herbal medicines in the last 12 months. We employed a logistic regression model (CI 95%) to evaluate the chances of CAM use.ResultsThe prevalence of CAM use in Brazil was 4.5%. The subjects with higher chances to use CAM were: women (AOR = 1.42), aged > 40 years (AOR = 1.64), with higher educational levels (AOR = 2.35), and residents at North (AOR = 2.02) and South (AOR = 1.67) regions of Brazil, all with p-value < 0.001. According to the socioeconomic status, subjects from upper classes had higher chances to use acupuncture and homeopathy when compared to the other classes, and individuals from lower classes had higher chances to use medicinal plants and herbal medicines. Almost half of all individuals reporting CAM use did so outside the health care system. The Brazilian Unified Health System (SUS) was the least used funding for CAM when compared to other types of funding.ConclusionsWe recommend that the Ministry of Health invests in capacity building for health professionals who work with CAM, providing structure for those practices in health services, increasing the access of CAM therapies for SUS users, and improving the registering of information about those therapies, encouraging the use of CAM by the Brazilian population.

A Holistic Client Functioning Profile Comparison of People With Serious Mental Illness

Among a sample of 196 participants, small differences in holistic client functioning, as measured by standardized Adult Needs and Strengths Assessment (Lyons &amp; Walton, 1999) and symptom severity scores, emerged across 3 diagnostic categories of serious mental illness (SMI; i.e., depression, bipolar disorder, and schizophrenia). However, sizable variations in symptom severity were evident across diagnoses of SMI, despite study participants receiving a similar configuration and intensity of recovery‐oriented usual‐care services. These results may evidence previous concerns surrounding the transdiagnosis of SMI, overlapping criteria and symptomatology among disorders in the Diagnostic and Statistical Manual of Mental Disorders, and mental health treatment and service practices in the United States. Implications for counselor practice are discussed.

Family Therapy for Child and Youth Mental Health: A Scoping Literature Review

Early intervention in childhood years is an important part of successful therapies for children and adolescents living with or at risk of mental illness. Family therapy acknowledges the role of family relationships, interactions, and family systems in child and youth mental health. To explore the effectiveness and delivery of family therapy in order to inform current family therapy practice in Australian public mental health services, a scoping literature review mapped key concepts of the past 11 years of family therapy research. Current gaps were noted within the following key concepts: family therapy settings and definitions, the influence of family factors on outcomes, transparency of intervention methods, and the training of family therapists. Further research could be undertaken to address current gaps in the literature, specifically: assessment and intervention processes; typical length of time for a series of family sessions; frequency of sessions; and theoretical foundations linked with most effective outcomes, as identified by clinicians, children, and their families. This research would provide a better understanding of best practice and evidence‐based family therapy practices that work for children and their families to inform family therapy practice in Australia and beyond. This scoping literature review identified that there is a noteworthy variation in the way brief family therapy is provided, both in terms of the duration and frequency of sessions, as well as the theoretical underpinnings employed. Further research is warranted to explore different service contexts and brief versions of family therapy delivery and the outcomes for the children and their families.

File audit to assess sustained fidelity to a recovery and wellbeing oriented mental health service model: an Australian case study

BackgroundOver the past decade there has been increasing attention to implementing recovery-oriented approaches within mental health service practice and enhancing fidelity to such approaches. However, as is often the case with evidence-based practices, less attention has been paid to the sustainability of recovery-oriented approaches over time. This study sought to investigate whether fidelity to a recovery-oriented practice framework – the Collaborative Recovery Model could be sustained over time.MethodThe study setting was an Australian community managed mental health organisation. A file audit of consumer support plans was undertaken using the Goal and Action Plan Instrument for Quality audit tool (GAP-IQ). The audit tool assessed 17 areas for quality. Consumers (n = 116) from a large community managed mental health organisation participated in the study. Sustained fidelity to the Collaborative Recovery Model (CRM) was determined by comparing results from the file audit to a similar audit conducted 3 years earlier.ResultsThe file audit revealed a significant increase in fidelity to CRM practices between 2011 and 2014. Fidelity to individual audit items that comprise the GAP-IQ was also found to significantly increase across 16 of the 17 GAP-IQ audit items, with the exception of the ‘Action Plan Review’ audit item.ConclusionsA comparison of file audit data across different time points within the same setting can provide useful feedback about whether or not a practice is being sustained over time. Although fidelity increased overtime the study design does not allow conclusions that training and coaching practices implemented by the organisation were responsible.

Learning from clinicians\u2019 views of good quality practice in mental healthcare services in the context of suicide prevention: a qualitative study

BackgroundSuicide and non-fatal self-harm represent key patient safety events in mental healthcare services. However, additional important learning can also be derived by highlighting examples of optimal practice that help to keep patients safe. In this study, we aimed to explore clinicians’ views of what constitutes good practice in mental healthcare services in the context of suicide prevention.MethodsData were extracted from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) database, a consecutive case series study of suicide by people in contact with mental healthcare services. A large national sample of clinicians’ responses was analysed with a hybrid thematic analysis.ResultsResponses (n = 2331) were submitted by clinicians across 62 mental healthcare providers. The following five themes illustrated good practice that helps to: 1) promote safer environments, 2) develop stronger relationships with patients and families, 3) provide timely access to tailored and appropriate care, 4) facilitate seamless transitions, and 5) establish a sufficiently skilled, resourced and supported staff team.ConclusionThis study highlighted clinicians’ views on key elements of good practice in mental health services. Respondents included practice specific to mental health services that focus on enhancing patient safety via prevention of self-harm and suicide. Clinicians possess important understanding of optimal practice but there are few opportunities to share such insight on a broader scale. A further challenge is to implement optimal practice into routine, daily care to improve patient safety and reduce suicide risk.

The actual scope of nursing practice in community health services in remote areas

Nurses can help improve access to health services and the quality of the care, provided that they fully engage in their field of practice. Conducted in Quebec in a remote region far from any major urban centers, this study aims to 1) measure the actual scope of nursing practice (ASCOP) in community health services and 2) determine the individual and work-based characteristics that influence it. This study uses a transversal description of work.Forty-four (44) nurses practicing in different types of community health services were invited to answer an online questionnaire. The results indicate a suboptimal ASCOP. Activities related to improving the quality and safety of care obtained the lowest scores. Activities with the highest scores were the assessment and planning of care, the education of individuals and their families, and updating and using knowledge. While no characteristics influenced the overall ASCOP, significant differences were found for gender, weekly working time, and sub-regions for certain dimensions of the ASCOP. The findings offer some insight into nursing practices in community health services in remote areas. This portrait helps to formulate recommendations adapted to these contexts.

Adesão à higiene das mãos antes e após intervenções educativas do dia mundial para higienização das mãos em um hospital universitário

Objetivo: Analisar os efeitos das ações educativas sobre adesão dos profissionais da saúde à higienização das mãos, em hospital universitário. Métodos: Pesquisa descritiva-documental, a partir de levantamento de dados do Serviço de Controle das Infecções Relacionadas à Assistência à Saúde, sobre a adesão à higiene das mãos de janeiro a agosto de 2018. Resultados: Foram analisadas 1371 oportunidades nas unidades de internação do hospital. Realizada uma comparação dos registros de observação direta da adesão à higiene das mãos, considerando as oportunidades nas quais os profissionais de saúde utilizaram água e sabão ou álcool gel a 70% ou não aderiram à prática de higienização das mãos. A maioria dos profissionais não higienizou as mãos no momento indicado (χ2 = 14,544; p valor = 0,0423). O comportamento dos mesmos não mudou, tendo se mantido o hábito de não higienizar as mãos nos cinco momentos básicos (χ2 = 4,933; p valor = 0,1768). Conclusão: Torna-se imprescindível reforçar a prática de higiene das mãos nos serviços de saúde, na tentativa de mudar a cultura prevalente entre os profissionais de saúde, como também o desenvolvimento de metodologias que possam resultar no aumento da adesão dos profissionais de saúde às práticas de higienização das mãos.

Epidemiological Study of Tuberculosis in Northern Iran

Background &amp; Purpose: One of the most important united nation Millennium Development Goals is to control Tuberculosis (TB). This study aimed to identify the high-risk areas of TB and other related factors of it in an epidemiological study.&#x0D; Materials &amp; Methods: In this retrospective study, the records of 1566 TB infected patients in healthcare centers of 17 cities of Mazandaran University of Medical Sciences were investigated during 2009-2013 years. Information of patients was gathered using a check list. The collected data was then analyzed using chi-square.&#x0D; Results: The mean age of the patients was 46.17± 20.6 years. The 5-year incidence rate was 12.14 in 100,000 populations. Cities in the east of Province (Sari, Behshahr, and Neka) had highest incidence rate (about 16 cases in 100,000 population). The incidence rate was different based on gender as, 15.3 % of the men and 10.2 % of the women were infected. The median delay time in the diagnosis was 34 days.&#x0D; Conclusions: The incidence rate of TB in Mazandaran was found to be almost similar to the previous reported rate in Iran. High incidence rate in east of province may be due to bordering to the Golestan Province as the immigrant province. The short delay time of TB diagnosis during this period indicated the well health services practices in this province. More attention should be paid to high risk areas for identification and giving education to those patients.

Law Enforcement to Transcendental Based of Paramedic Doctoroid Practices in Health Service

Purpose of the study: This article aims to discuss the paramedic doctoroid practices in primary health care in Community Health Center conducted by paramedic doctors.Methodology: This research is socio-legal research; research on law application, viewing law acting as law in action, which involves the interrelation between law and social institutions.Main Findings: Delegation of duty policies under the roof of paramedic doctoroid practices in health services in Community Health Center. This research is a socio-legal aimed at uncovering the phenomenon of paramedic doctoroid practices.Applications of the study: The current study provides criticism for the government in creating inconsistent policies, poor supervision, and law enforcement behind doctoroid practice persistence.Novelty/Originality of the study: the concept of law enforcement is based on the philosophy of the first principle of Pancasila as the Indonesian ideology, transcendental-based law enforcement.

Exploring interprofessional education and collaborative practice in Australian rural health services

ABSTRACTThis article explores how work-based interprofessional education (IPE) influences collaborative practice in rural health services in Australia. Using a qualitative case study design, three rural hospitals were the focal point of the project. Marginal participant observations (98 hours) and semistructured interviews (n = 59) were undertaken. Participants were medical practitioners, nursing and midwifery professionals, physiotherapists, paramedics, social workers and administrative staff, who provided services in relation to each hospital. Data in the form of audio recordings and field notes, including researcher reflections were recorded over a three-year period. Whilst this study comprised of three phases, this article explores the extent to which collaborative practice was present or not before and after IPE. An inductive content analysis resulted in the following themes: Conceptualizing Collaborative Practice, Profession-Driven Education, and Professional Structures and Socialization. Community of practice theory is used to explore the barriers created through profession-based communities of practice.

Obesity prevention and the role of hospital and community-based health services: a scoping review

BackgroundControl of obesity is an important priority to reduce the burden of chronic disease. Clinical guidelines focus on the role of primary healthcare in obesity prevention. The purpose of this scoping review is to examine what the published literature indicates about the role of hospital and community based health services in adult obesity prevention in order to map the evidence and identify gaps in existing research.MethodsDatabases were searched for articles published in English between 2006 and 2016 and screened against inclusion and exclusion criteria. Further papers were highlighted through a manual search of the reference lists. Included papers evaluated interventions aimed at preventing overweight and obesity in adults that were implemented within and/or by hospital and community health services; were an empirical description of obesity prevention within a health setting or reported health staff perceptions of obesity and obesity prevention.ResultsThe evidence supports screening for obesity of all healthcare patients, combined with referral to appropriate intervention services but indicates that health professionals do not typically adopt this practice. As well as practical issues such as time and resourcing, implementation is impacted by health professionals’ views about the causes of obesity and doubts about the benefits of the health sector intervening once someone is already obese. As well as lacking confidence or knowledge about how to integrate prevention into clinical care, health professional judgements about who might benefit from prevention and negative views about effectiveness of prevention hinder the implementation of practice guidelines. This is compounded by an often prevailing view that preventing obesity is a matter of personal responsibility and choice.ConclusionsThis review highlights that whilst a population health approach is important to address the complexity of obesity, it is important that the remit of health services is extended beyond medical treatment to incorporate obesity prevention through screening and referral. Further research into the role of health services in obesity prevention should take a systems approach to examine how health service structures, policy and practice interrelationships, and service delivery boundaries, processes and perspectives impact on changing models of care.

Children’s mental health strategies and practices in Addis Ababa Ethiopia

In recent years, children’s well-being has become a hot research topic that has been increasingly gaining attention in the field of psychiatry, social work, psychology, and public health research. The present study was meant to explore the existing children’s mental health service strategies and practices in Addis Ababa, Ethiopia. The data have been carefully collected through open-ended interviews and focus group discussions, by capturing the participants’ experiences. This study counted with the participation of managers of child-serving organizations, mental health workers (psychologists, psychiatric nurses, social workers, and psychiatrists), orphans, and vulnerable children, including their guardians. The findings indicated limited access to specialized treatment, inadequate skilled human resources, lack of mental health education, and depicted that the local community preferred traditional medicine and religious healing practices in order to cure mental illnesses. Children’s mental health services are at a disadvantage and the most neglected health program, needing urgent involvement of the local government, non-governmental organizations, researchers, and policymakers, amongst several other stakeholders.

\u2018Thinking outside the box\u2019: advanced geriatric nursing in primary health care in Scandinavia

BackgroundOlder people are frequent users of primary health care (PHC) services. PHC services have been critiqued, mainly regarding limited accessibility and continuity of care. In many countries, investment in nurse practitioners (NPs) has been one strategy to improve PHC services. In the North of Europe, the NP role is still in its infancy. The aim of this study was to explore the feasibility of introducing geriatric nurse practitioners (GNPs) in PHC in Scandinavia, from multiprofessional and older persons’ perspectives.MethodsThe study had a qualitative design, including 25 semi-structured interviews with nurses, nurse leaders, physicians, politicians and older persons from several communities in Scandinavia. The material was analysed by means of qualitative content analysis.ResultsThe results highlight current challenges in health services for the older population, i.e. comorbid older patients with complex care needs aging in place, lack of competent staff, and organisational challenges. The results present an envisioned GNP scope of practice in health services for the older population, including bringing advanced competence closer to the patient, an autonomous role including task-shifting, and a linking role. The results also present factors influencing implementation of the GNP role, i.e. GNP competence level, unclear role and scope of practice, and openness to reorganisation.ConclusionsThe results indicate that it is feasible to implement the GNP role in primary health care in Scandinavia. Notwithstanding, there are factors influencing implementation of the GNP role that should be considered.

The Interdisciplinary Research Group on Nursing Issues: Advancing Health Services Research, Policy, Regulation, and Practice

The Interdisciplinary Research Group on Nursing Issues: Advancing Health Services Research, Policy, Regulation, and Practice

What we can learn from families experiences of family therapy in an adolescent mental health day program setting?

ABSTRACTObjective: Over the past 50 years Family Therapy has become a widely used treatment approach for emotional and behavioural problems in children and within families [Sargent, 1997. Family therapy in child and adolescent psychiatry. Child and Adolescent Psychiatric Clinics of North America, 152–171]. Within Child and Adolescent Psychiatry, Family Therapy is recognised as a cornerstone of holistic treatment with meta-analysis showing the general effectiveness of such treatments [Hoagwood, Burns, Kiser, Ringeisen, & Schoenwald, 2001. Evidence-based practice in child and adolescent mental health services. Psychiatric Services, 52, 1179–1189]. However, there is a general paucity of literature about Adolescent Mental Health Day Programs and no recorded evidence of the use of Family Therapy within these settings in child and adolescent psychiatry. This study draws upon the experience of two families to explore the use of Family Therapy within Adolescent Mental Health Day Programs.Method: A mixed methodology was employed using the SCORE-15 and semi-structured interviews.Results: The families considered that participating in Family Therapy contributed positively to individual and family outcomes. The case studies highlight the needs and issues in engaging other family members, the importance of both the Family Therapist and mental health clinicians being involved, and that the family approach was seen overall as a positive satisfying experience for families.Discussion: This study provides limited but valuable support for the application of Family Therapy within an Adolescent Mental Health Day Program setting. The study highlights the value of documenting lived experience, as well as indicating further areas for research, including the clinicians experience of this approach.