Aim
This study aims to examine, through the lens of the Job Demands‐Resources model, the influence of caring for COVID‐19 patients on nurse's perception of chronic fatigue, quality of care, ...satisfaction at work and intention to leave their organisation and the profession.
Background
Studies have examined how fear of COVID‐19 contributes to the mental, physical and work adjustment among nurses. To date, few studies have been conducted examining how caring for patients with COVID‐19 contributes to work outcomes among nurses.
Methods
This is a cross‐sectional survey involving 1705 frontline nurses and licensed practical nurses in Quebec, Canada. From these, 782 reported caring for COVID‐19 patients.
Results
High chronic fatigue, poor quality of care, lower work satisfaction and higher intention to leave their organisation were found for nurses caring for COVID‐19 patients. Poorly prepared and overwhelmed nurses showed higher turnover intention than those well prepared and in control.
Conclusions
There is an urgent need to provide support to nurses during the pandemic, with a long‐term strategy to increase their retention.
Implications for Nursing Management
Nurse administrators play an important role in supporting their nurses during a pandemic in the form of education, training and policy development to positively impact quality of care and retention.
Full text
Available for:
BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK, VSZLJ
Context: Optimal management in the diagnosis, treatment and support of cancer patients is increasingly associated with network-based models of care, an approach promoted by experts worldwide and ...pursued as a key objective in many national cancer plans. The Quebec national cancer plan proposed that fragmentation of care should be remedied through creating local cancer networks (LCNs). Objective: To measure to what extent a mandated cancer network, prescribed at the policy level but operationalized at the point-of-care, produce integration. Methods: This research is part of a larger study aiming at analyzing the implementation of a mandated cancer network in Quebec1. Data were collected through a survey of stakeholders from four local cancer networks (LCNs) using the Health System Integration Study questionnaire. The instrument consists of 64 questions ordered to reflect the degree of implementation of integration (functional, normative, clinical and professional). Data were analyzed using descriptive statistics of score aggregation by network (mean, standard deviation (SD), intraclass correlation coefficient (ICC)) Results: Globally, participants-reported (n=83) scores of integration (min=0; max=100) range from 48 (SD=31) to 84 (SD=28). The proportion of participants reporting a positive perception of the integration dimensions varied by network: functional (59 to 78 %), normative (68 to 88 %), clinical (46 to 64 %) and professional (47 to 77 %) ICC by network range from 0.24 to 0. 57. Discussion: Although data only represent preliminary analysis, empirical results suggest that “prescribed” networks at the policy level lead to a partial and widely varied integration. LCNs have simultaneously invested efforts in integration to conform to the Quebec cancer plan. Functional and normative integration appeared more advanced and more internally agreed than clinical and professional dimensions. Results raise questions about agreement from LCNs partners. Conclusions: Additional work is needed to examine how national cancer programs promoting network-based practices reach the point-of-care and ultimately cancer patients. Further analysis of our study data will provide more detailed results of which contextual and individual characteristics facilitate or impede each dimension of integration. Lessons learned: The key lesson learned is that implementation of network-based practices are major experiment operating in a challenging professional bureaucracy. Cancer care providers respond differently to network-based form mandated at the policy level. Policymakers should anticipate variation in local context, and various strategies to dive into the micro dynamics of coordinated care. Limitations: This presentation build upon preliminary analysis, and further work is required to offer more detailed results. Considering the characteristics of our sample and because access to cancer services is universal in Quebec, we feel cautious about generalizing our results to other healthcare systems. Nevertheless, our study contributes to the numerous efforts to demonstrate intermediate outcomes of mandated cancer networks. Future Research: Further analysis will examine in detail the sub-scales of each integration dimensions. Analysis will be performed to determine the association between the activation of governance functions (distal macro level) and the integration in LCNs (local micro level). Reference: 1- Tremblay D et al. Understanding cancer networks better to implement them more effectively: a mixed methods multi-case study. Implementation science : IS 11:39, 2016
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Interdisciplinary teamwork (ITW) is deemed necessary for quality cancer care practices. Nevertheless, variation in ITW intensity among cancer teams is understudied, and quantitative evidence of the ...effect of different ITW intensities among cancer teams on patients' perceived experience of care is limited. This study aims to compare patient-reported experience measures (PREMs) of cancer outpatients followed by teams characterized by high vs. low ITW intensity.
The study is designed as an ex post facto quasi-experimental study. Participants (n = 1379) were recruited in nine outpatient oncology clinics characterized by different ITW intensities. ITW intensities were evaluated using the characteristics of structure (team composition and size) and process (interactions among team members), as per West's seminal work on team effectiveness. ITW intensity was dichotomized (high vs. low ITW intensity). PREMs were classified and measured using validated scales corresponding to six dimensions: Prompt access to care, Person-centred response, Quality of patient-professional communication, Quality of the care environment, Continuity of care, and Results of care. Dichotomous variables were created for each dimension (positive vs. less positive experience). Multiple logistic regression analyses were performed to assess the association between ITW intensities and the six PREMs dimensions, while controlling for patient and organizational characteristics. PROC GENMOD was used to fit logistic models for categorical variables.
Outpatients treated by teams characterized by high ITW intensity reported almost four times more positive perceptions of Prompt access to care compared to patients treated by low ITW intensity teams (OR = 3.99; CI = 1.89-8.41). High ITW intensity also positively affected patients' perceptions of Quality of patient-professional communication (OR = 2.37; CI = 1.25-4.51), Person-centred response (OR = 2.11; CI = 1.05-4.24, and Continuity of care (OR = 2.18; CI = 1.07-4.45). No significant association was found between ITW intensity and perceived Results of care (OR = 1.31; CI = 0.68-2.52) or Quality of the care environment (OR = 0.66; CI = 0.31-1.39).
This study provides empirical evidence, from the patient's perspective, that ITW intensity affects some critical aspects of patient-reported quality of care. Future research will allow explaining how and why ITW structure and processes may contribute to positive cancer care experiences.
Full text
Available for:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Contexte : Au Canada, les soins offerts aux survivants du cancer demeurent fragmentés. On sait peu de choses de l’expérience des infirmières canadiennes en oncologie qui interviennent auprès des ...survivants du cancer pendant la transition du traitement actif vers les soins primaires.
Objectifs de l’étude : 1) examiner l’expérience des infirmières en oncologie qui doivent composer avec les soins fragmentés que reçoivent les personnes en transition vers la phase de survivance; 2) comprendre les points de vue des infirmières en oncologie pour savoir ce qui facilite ou entrave la qualité des soins; 3) solliciter leurs suggestions pour améliorer les soins oncologiques.
Devis : La présente étude utilise un devis phénoménologique pour consigner la description que font les infirmières en oncologie de leur expérience auprès des patients atteints de cancer en transition vers la phase de survivance afin de l’examiner en détail. Les données ont été recueillies dans le cadre d’entrevues semi-structurées; une analyse phénoménologique interprétative a ensuite permis d’en faire ressortir les thèmes.
Résultats : Trois infirmières en oncologie ont pris part à l’étude, dont se dégagent les cinq thèmes suivants : 1) transition personnelle : évaluation infirmière, prise en charge des symptômes, enseignement au patient, ressources offertes, refus de l’étiquette de survivants, aide pour s’adapter à une nouvelle normalité et retourner au travail, reconnaissance de la signification de la phase de survivance; 2) transition des soins aux survivants du cancer : aide pour encourager les autosoins, la communication et le rétablissement optimal des fonctions corporelles; 3) expérience positive des infirmières favorisant la prestation de soins oncologiques de qualité : soins apportés aux survivants, expérience et connaissances, défense des intérêts des patients; 4) obstacles nuisant à la prestation des soins oncologiques : faible statut socio-économique (particulièrement le faible revenu), barrières de langues et de cultures, restriction du temps disponible pour les soins infirmiers; 5) suggestions pour améliorer les soins oncologiques : création d’un nouveau poste (infirmière primaire), augmentation du nombre de professionnels de la santé, amélioration des connaissances, des compétences et de l’expérience.
Conclusion : Les connaissances et l’expérience des infirmières en oncologie forment la base de la qualité des soins prodigués aux personnes atteintes de cancer, et contribuent à la santé et au bien-être des survivants.
Mots-clés : infirmières en oncologie, soins du cancer, transition post-traitement
Full text
Available for:
NUK, OILJ, UL, UM, UPUK, VSZLJ
Cancer care for Canadian cancer survivors remains fragmented. Little is known about the experience of Canadian oncology nurses providing cancer care for cancer survivors, as they transition from ...acute treatment to primary care.BackgroundCancer care for Canadian cancer survivors remains fragmented. Little is known about the experience of Canadian oncology nurses providing cancer care for cancer survivors, as they transition from acute treatment to primary care.This study aimed to (1) explore the experience of oncology nurses dealing with fragmented cancer care for cancer survivors in transition to survivorship; (2) identify oncology nurses' perspectives about what promotes or inhibits their delivery of quality cancer care; and (3) obtain their suggestions to improve cancer care.ObjectivesThis study aimed to (1) explore the experience of oncology nurses dealing with fragmented cancer care for cancer survivors in transition to survivorship; (2) identify oncology nurses' perspectives about what promotes or inhibits their delivery of quality cancer care; and (3) obtain their suggestions to improve cancer care.This study used a phenomenological design to explore the experience of oncology nurses in caring for cancer survivors during transition to survivorship and examine how the nurse participants describe their experience. Semi-structured interviews were used to collect data and an interpretative phenomenological analysis approach was used to develop themes from the data.DesignThis study used a phenomenological design to explore the experience of oncology nurses in caring for cancer survivors during transition to survivorship and examine how the nurse participants describe their experience. Semi-structured interviews were used to collect data and an interpretative phenomenological analysis approach was used to develop themes from the data.Three oncology nurses participated in this study. The following five themes emerged: (1) Under personal transition: nursing assessment, symptoms management, patient education, resources offered, refusing label of cancer survivors, promoting adjustment to a new normal life, promoting return to work, and recognizing meaning of survivorship; (2) Under cancer survivor's care transition: promoting self-care management, communication, and maximal recovery of body functions; (3) Under nurse's positive experience promoting delivery of quality cancer care: caring for cancer survivors, experience and knowledge, and advocate for cancer survivors; (4) Under barriers that negatively affected delivery of cancer care: low socioeconomic status (especially low income), cultures and languages barriers, and limited time providing nursing care; and (5) Suggestions to improve cancer care: establishing a new position - primary nurse, increasing the number of healthcare professionals, and improving knowledge, skills, and experience.ResultsThree oncology nurses participated in this study. The following five themes emerged: (1) Under personal transition: nursing assessment, symptoms management, patient education, resources offered, refusing label of cancer survivors, promoting adjustment to a new normal life, promoting return to work, and recognizing meaning of survivorship; (2) Under cancer survivor's care transition: promoting self-care management, communication, and maximal recovery of body functions; (3) Under nurse's positive experience promoting delivery of quality cancer care: caring for cancer survivors, experience and knowledge, and advocate for cancer survivors; (4) Under barriers that negatively affected delivery of cancer care: low socioeconomic status (especially low income), cultures and languages barriers, and limited time providing nursing care; and (5) Suggestions to improve cancer care: establishing a new position - primary nurse, increasing the number of healthcare professionals, and improving knowledge, skills, and experience.Oncology nurses' knowledge and experience provide a good foundation for quality cancer care and contribute to the health and wellbeing of cancer survivors.ConclusionOncology nurses' knowledge and experience provide a good foundation for quality cancer care and contribute to the health and wellbeing of cancer survivors.
Full text
Available for:
NUK, OILJ, UL, UM, UPUK, VSZLJ
Risk-stratified pathways of survivorship care seek to optimize coordination between cancer specialists and primary care physicians based on the whole person needs of the individual. While the ...principle is supported by leading cancer institutions, translating knowledge to practice confronts a lack of clarity about the meaning of risk stratification, uncertainties around the expectations the model holds for different actors, and health system structures that impede communication and coordination across the care continuum. These barriers must be better understood and addressed to pave the way for future implementation. Recognizing that an innovation is more likely to be adopted when user experience is incorporated into the planning process, a deliberative consultation was held as a preliminary step to developing a pilot project of risk-stratified pathways for patients transitioning from specialized oncology teams to primary care providers. This article presents findings from the deliberative consultation that sought to understand the perspectives of cancer specialists, primary care physicians, oncology nurses, allied professionals, cancer survivors and researchers regarding the following questions: what does a risk stratified model of cancer survivorship care mean to care providers and users? What are the prerequisites for translating risk stratification into practice? What challenges are involved in establishing these prerequisites? The multi-stakeholder consultation provides empirical data to guide actions that support the development of risk-stratified pathways to coordinate survivorship care.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK, VSZLJ
ObjectivesTo clarify the definition of vignette-based methodology in qualitative research and to identify key elements underpinning its development and utilisation in qualitative empirical studies ...involving healthcare professionals.DesignScoping review according to the Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines.Data sourcesElectronic databases: Academic Search Complete, CINAHL Plus, MEDLINE, PsycINFO and SocINDEX (January 2000–December 2020).Eligibility criteriaEmpirical studies in English or French with a qualitative design including an explicit methodological description of the development and/or use of vignettes to collect qualitative data from healthcare professionals. Titles and abstracts were screened, and full text was reviewed by pairs of researchers according to inclusion/exclusion criteria.Data extraction and synthesisData extraction included study characteristics, definition, development and utilisation of a vignette, as well as strengths, limitations and recommendations from authors of the included articles. Systematic qualitative thematic analysis was performed, followed by data matrices to display the findings according to the scoping review questions.ResultsTen articles were included. An explicit definition of vignettes was provided in only half the studies. Variations of the development process (steps, expert consultation and pretesting), data collection and analysis demonstrate opportunities for improvement in rigour and transparency of the whole research process. Most studies failed to address quality criteria of the wider qualitative design and to discuss study limitations.ConclusionsVignette-based studies in qualitative research appear promising to deepen our understanding of sensitive and challenging situations lived by healthcare professionals. However, vignettes require conceptual clarification and robust methodological guidance so that researchers can systematically plan their study. Focusing on quality criteria of qualitative design can produce stronger evidence around measures that may help healthcare professionals reflect on and learn to cope with adversity.
Introduction: This study empirically explores how dimensions of proximity that support integrated care emerge from deliberate actions within a cancer network in Quebec (Canada).Methods:We conduct a ...supplementary analysis of qualitative data from a primary multi-case study focused on collaborative governance and cancer care integration. Data from semi-structured interviews, documents and observation are analysed to find out how relationships take shape through actions that create different dimensions of proximity, and how these contribute to integrated practices.Results: Deliberate actions at different levels within the network create dimensions of proximity. The creation of committees and communities of practice at national and local level establish geographic proximity. Relational proximity among actors emerges to different degrees in these venues. Cognitive proximity is generated by consistent promotion of the national cancer plan and person-centred care. The priority of cancer care at policy level and prescription of common standards enhance organizational proximity. Synergy between dimensions of proximity appears essential to the emergence of integrated practices. Insufficient efforts to create technological and institutional proximity contribute to inconsistent clinical and professional integration.Conclusion:The concept of proximity appears a promising complement to existing models of integration, especially in complex contexts such as cancer networks.Highlights* Deliberate actions at different levels within the cancer network create a number of dimensions of proximity* Geographic proximity, be it objective or subjective, facilitates relational, cognitive and institutional proximity* A national cancer plan sustained by shared leadership enhances organizational proximity, facilitating integrated practices* Activation of different dimensions of proximity among network actors likely underpins and sustains functional, normative and organizational integration* Insufficient efforts to create technological and institutional proximity contribute to inconsistent clinical and professional integrationThe multiple dimensions of proximity appear a promising complement to existing models of integration, especially in complex contexts such as cancer networks.
Full text
Available for:
IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Abstract
Background
Patient participation in decision-making has become a hallmark of responsive healthcare systems. Cancer networks in many countries have committed to involving people living with ...and beyond cancer (PLC) at multiple levels. However, PLC participation in network governance remains highly variable for reasons that are poorly understood. This study aims to share lessons learned regarding mechanisms that enable PLC participation in cancer network governance.
Methods
This multiple case study, using a qualitative approach in a natural setting, was conducted over six years in three local cancer networks within the larger national cancer network in Quebec (Canada), where PLC participation is prescribed by the Cancer Directorate. Data were collected from multiple sources, including individual and focus group interviews (
n
= 89) with policymakers, managers, clinicians and PLC involved in national and local cancer governance committees. These data were triangulated and iteratively analysed according to a framework based on functions of collaborative governance in the network context.
Results
We identify three main mechanisms that enable PLC participation in cancer network governance: (1) consistent emphasis on patient-centred care as a network objective; (2) flexibility, time and support to translate mandated PLC representation into meaningful participation; and (3) recognition of the distinct knowledge of PLC in decision-making. The shared vision of person-centred care facilitates PLC participation. The quality of participation improves through changes in how committee meetings are conducted, and through the establishment of a national committee where PLC can pool their experience, develop skills and establish a common voice on priority issues. PLC knowledge is especially valued around particular challenges such as designing integrated care trajectories and overcoming barriers to accessing care. These three mechanisms interact to enable PLC participation in governance and are activated to varying extents in each local network.
Conclusions
This study reveals that mandating PLC representation on governance structures is a powerful context element enabling participation, but that it also delineates which governance functions are open to influence from PLC participation. While the activation of mechanisms is context dependent, the insights from this study in Quebec are transferable to cancer networks in other jurisdictions seeking to embed PLC participation in decision-making.
Full text
Available for:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Teams caring for people living with cancer face many difficult clinical situations that are compounded by the pandemic and can have serious consequences on professional and personal life. This study ...aims to better understand how a multi-component intervention builds resilience in oncology teams. The intervention is based on a salutogenic approach, theories and empirical research on team resilience at work. This intervention research involves partnership between researchers and stakeholders in defining situations of adversity and solutions appropriate to context.
The principles of realist evaluation are used to develop context-mechanism-outcome configurations of a multi-component intervention developed by researchers and field partners concerned with the resilience of oncology teams. The multiple case study involves oncology teams in natural contexts in four healthcare establishments in Québec (Canada). Qualitative and quantitative methods are employed. Qualitative data from individual interviews, group interviews and observation are analyzed using thematic content analysis. Quantitative data are collected through validated questionnaires measuring team resilience at work and its effect on teaming processes and cost-effectiveness. Integration of these data enables the elucidation of associations between intervention, context, mechanism and outcome.
The study will provide original data on contextual factors and mechanisms that promote team resilience in oncology settings. It suggests courses of action to better manage difficult situations that arise in a specialized care sector, minimize their negative effects and learn from them, during and after the waves of the pandemic. The mechanisms for problem resolution and arriving at realistic solutions to professional workforce and team effectiveness challenges can help improve practices in other settings.
Full text
Available for:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
PDF
