Cécile Michaud

Impact of the Implementation of the Critical-care Pain Observation Tool (cpot) on Pain Management and Clinical Outcomes in Mechanically Ventilated Trauma Intensive Care Unit Patients: A Pilot Study

This pilot study was aimed to explore the impact of the implementation of the Critical-Care Pain Observation Tool on pain management and clinical outcomes in mechanically ventilated trauma intensive care unit patients. Thirty medical files were reviewed in this preexperimental before-and-after study design. Pain assessments and identification of pain episodes were more frequent postimplementation of the tool. Although fewer analgesics were administered during the postimplementation phase, these interventions were found to be more efficient than those of the preimplementation phase. Moreover, during the postimplementation phase, a lower number of complications were observed.

Feasibility and acceptability of hand massage therapy for pain management of postoperative cardiac surgery patients in the intensive care unit

OBJECTIVE The purpose was to evaluate the acceptability and feasibility of hand massage therapy in the intensive care unit (ICU). BACKGROUND Clinical guidelines suggest the use of non-pharmacological interventions for pain management in ICU adults. The results presented are secondary to a pilot RCT evaluating the preliminary effectiveness of hand massage on pain after cardiac surgery. METHODS A qualitative descriptive design was used. Acceptability was evaluated using individual interviews with participants in both groups i.e., experimental and control (n = 40). Feasibility was examined using field notes and video recordings. RESULTS While participants receiving the massage perceived it as appropriate, the control group suggested different dosages of the treatment and body areas targeted. Results also suggest that barriers (e.g. noise, numerous clinical activities) need to be overcome. CONCLUSIONS Increasing staff acceptance, reducing the rest period, involving families, and repeating the treatment are avenues to consider. Building evidence for non-pharmacological pain management in the critical care setting is necessary.

Predictive Validity and Psychiatric Nursing Staff's Perception of the Clinical Usefulness of the French Version of the Dynamic Appraisal of Situational Aggression

This study seeks to evaluate the predictive validity of the French version of the Dynamic Appraisal of Situational Aggression (DASAfr) and psychiatric nurses’ perceptions of the clinical usefulness of the scale. The study was conducted in a 12-bed psychiatric intensive care unit in a large adult general psychiatric hospital. We found that the total score on the DASAfr has acceptable predictive accuracy for aggression against others and against staff and for seclusion with restraints; predictive accuracy was poorer for aggression against objects. Moreover, the nurses though the scale would be useful to their practice; and, indeed, the team still uses the DASAfr.

Evaluation of the Preliminary Effectiveness of Hand Massage Therapy on Postoperative Pain of Adults in the Intensive Care Unit after Cardiac Surgery: A Pilot Randomized Controlled Trial

Although many intensive care unit patients experience significant pain, very few studies explored massage to maximize their pain relief. This study aimed to evaluate the preliminary effects of hand massage on pain after cardiac surgery in the adult intensive care unit. A pilot randomized controlled trial was used for this study. The study was conducted in a Canadian medical-surgical intensive care unit. Forty adults who were admitted to the intensive care unit after undergoing elective cardiac surgery in the previous 24 hours participated in the study. They were randomly assigned to the experimental (n = 21) or control (n = 19) group. The experimental group received a 15-minute hand massage, and the control group received a 15-minute hand-holding without massage. In both groups the intervention was followed by a 30-minute rest period. The interventions were offered on 2-3 occasions within 24 hours after surgery. Pain, muscle tension, and vital signs were assessed. Pain intensity and behavioral scores were decreased for the experimental group. Although hand massage decreased muscle tension, fluctuations in vital signs were not significant. This study supports potential benefits of hand massage for intensive care unit postoperative pain management. Although larger randomized controlled trials are necessary, this low-cost nonpharmacologic intervention can be safely administered.

Evaluation of the effectiveness of arsenic screening promotion in private wells: a quasi-experimental study

The Eastern Townships (ETR) is a region in Québec (Canada) where the soil is naturally rich in arsenic (As). About a third of the people in the ETR obtain their water from a private well. A quasi-experimental design was used to compare two campaigns designed to promote As screening in well water: a mass-media campaign (MMC) followed or not by a community-based intervention (CBI). The MMC is based on a press release issued for the ETR, along with a leaflet on As made available on the Internet, and in strategic places. The CBI, formulated according to the factors of the Precede-Proceed model, was aimed at mobilizing local authorities and small media. It targets only one municipality; the intervention community (IC). Using a separate pre-post samples design, two population-based cross-sectional (pre-CBI and post-CBI) surveys were conducted by phone at 6-month intervals, by means of random samples. The samples counted, for the IC and the ETR, respectively, 87 and 156 well owners in pre-CBI, and 106 and 190 in post-CBI. The results in post-CBI showed that the proportion of well owners who had their water test increased by four times in the IC after (16% p = 0.004). When adjusting for age and gender among all the post-CBI respondents, As screening is related with intervention status (exposed to MMC and CBI; p ≤ 0.001) and on previous microbiological water analysis behavior (p ≤ 0.05), but is not related to knowledge. This study demonstrates the superiority of a community-based campaign over a MMC when environmental health is concerned.

The prevention and management of chronic disease in primary care: recommendations from a knowledge translation meeting

BackgroundSeven chronic disease prevention and management programs were implemented across Quebec with funding support from a provincial-private industry funding initiative. Given the complexity of implementing integrated primary care chronic disease management programs, a knowledge transfer meeting was held to share experiences across programs and synthesize common challenges and success factors for implementation.MethodsThe knowledge translation meeting was held in February 2014 in Montreal, Canada. Seventy-five participants consisting of 15 clinicians, 14 researchers, 31 knowledge users, and 15 representatives from the funding agencies were broken up into groups of 10 or 11 and conducted a strengths, weaknesses, opportunities, and threats analysis on either the implementation or the evaluation of these chronic disease management programs. Results were reported back to the larger group during a plenary and recorded. Audiotapes were transcribed and summarized using pragmatic thematic analysis.Results and discussionStrengths to leverage for the implementation of the seven programs include: (1) synergy between clinical and research teams; (2) stakeholders working together; (3) motivation of clinicians; and (4) the fact that the programs are evidence-based. Weaknesses to address include: (1) insufficient resources; (2) organizational change within the clinical sites; (3) lack of referrals from primary care physicians; and (4) lack of access to programs. Strengths to leverage for the evaluation of these programs include: (1) engagement of stakeholders and (2) sharing of knowledge between clinical sites. Weaknesses to address include: (1) lack of referrals; (2) difficulties with data collection; and (3) difficulties in identifying indicators and control groups. Opportunities for both themes include: (1) fostering new and existing partnerships and stakeholder relations; (2) seizing funding opportunities; (3) knowledge transfer; (4) supporting the transformation of professional roles; (5) expand the use of health information technology; and (6) conduct cost evaluations. Fifteen recommendations related to mobilisation of primary care physicians, support for the transformation of professional roles, and strategies aimed at facilitating the implementation and evaluation of chronic disease management programs were formulated based on the discussions at this knowledge translation event.ConclusionThe results from this knowledge translation day will help inform the sustainability of these seven chronic disease management programs in Quebec and the implementation and evaluation of similar programs elsewhere.

An Action Research to Optimize the Well-Being of Older People in Nursing Homes: Challenges and Strategies for Implementing a Complex Intervention:

Few studies have been conducted on strategies to promote the implementation of complex interventions in nursing homes (NHs). This article presents a pilot study intended to assess the strategies that would enable the optimal implementation of a complex intervention approach in NHs based on the meanings of screams of older people living with Alzheimer’s disease. An action research approach was used with 19 formal and family caregivers from five NHs. Focus groups and individual interviews were held to assess different implementation strategies. A number of challenges were identified, as were strategies to overcome them. These latter included interactive training, intervention design, and external support. This study shows the feasibility of implementing a complex intervention to optimize older people’s well-being. The article shares strategies that may promote the implementation of these types of interventions in NHs.

Translation and Validation of the Toronto Pain Management Index, French–Canadian Version:

Background To provide effective pain management, nurses must have sufficient knowledge and adequate beliefs about pain management. In Quebec, however, nurses seem to be generally uninvolved in pain management, and there is little significant evidence shedding light on nurses’ pain management knowledge and beliefs in postoperative settings. To perform such studies, a valid questionnaire in French to assess nurses’ knowledge and beliefs is required. Some valid questionnaires are available in English, but none are available in French. Purpose This article describes the process of translation, adaptation, and preliminary validation of the Toronto Pain Management Index into French. Results For temporal stability of the Toronto Pain Management Index, French–Canadian version, the result of intraclass correlation coefficient for the total score of this questionnaire is 0.59 (CI: 0.44–0.72). Conclusion Following this process, the French version of this questionnaire has suitable face and content validity and can be used to evaluate nurses’ knowledge and beliefs about pain management in postoperative settings.

Retombées des ordonnances collectives dans le suivi diabétique conjoint en soins primaires : une étude de cas

Le fardeau des maladies chroniques commande de repenser l’organisation des services et la prestation des soins. Des amenagements parfois organisationnels, parfois legislatifs permettent aux non-medecins d’etre plus actifs dans le suivi des maladies chroniques. Au Quebec, depuis 2003, une nouvelle structure organisationnelle, les groupes de medecine de famille, et une nouvelle modalite d’ordonnance medicale, les ordonnances collectives (OC), se deploient progressivement. Un cas-type a ete retenu parmi 52 participants a une enquete provinciale afin d’explorer les retombees des OC sur les pratiques professionnelles, les interactions medecin-infirmiere-patient et l’autogestion dans le contexte du suivi diabetique. Quinze heures d’observation, 200 documents et des entrevues individuelles aupres de dix patients, trois infirmieres et huit medecins ont ete analyses. Unanimement, les participants reconnaissent que l’autogestion est stimulee par le suivi conjoint. Bien que des conditions liees aux professionnels et aux patients modulent leurs interactions, la triade s’orchestre efficacement selon un mouvement de convergence. Pour les professionnels, les OC permettent une meilleure concordance entre leur emploi du temps, leurs competences et le sens qu’ils accordent a leur pratique. Pour les patients, la progression de leurs competences a l’autogestion et l’acces aise aux soins sont rassurants. Des moyens concrets comme les OC modifient la prestation des soins en misant sur la collaboration professionnelle et facilitent la mobilisation des patients, en accord avec le Chronic Care Model (CCM) [1].

What is the best way to organize vaccination services for the children of Quebec, Canada?

Background Recently in Quebec, Canada, several contextual elements (e.g. physician disengagement, delayed appointments and late vaccines) justified a review of how child vaccination services are offered. A 5-year study begun in 2010-2011 aims to identify the optimal organizational model(s) for vaccination services for children aged 0-5 years. The first three year process and progress are reported.