Johanne Goudreau

Assessment in the Context of Uncertainty Using the Script Concordance Test: More Meaning for Scores

Background: The Script Concordance Test (SCT) uses authentic, ill-defined clinical cases to compare medical learners’ judgment skills with those of experienced physicians. SCT scores are meant to measure the degree of concordance between the performance of examinees and that of the reference panel. Raw test scores have meaning only if statistics (mean and standard deviation) describing the panel’s performance are concurrently provided. Purpose: The purpose of this study is to suggest a method for reporting scores that standardizes panel mean and standard deviation, allowing examinees to immediately gauge their performance relative to panel members. Methods: Based on a statistical method of standardization, a new method for computing SCT scores is described. According to this method, test raw scores are converted into a scale in which the panel mean is set as the value of reference, and the standard deviation of the panel serves as a yardstick by which examinee performance is measured. Results: The effect of this transformation on four data sets obtained from SCTs in radio-oncology, surgery, neurology, and nursing is discussed. Conclusion: This transformation method proposes a common metric basis for reporting SCT scores and provides examinees with clear, interpretable insights into their performance relative to that of physicians of the field. We recommend reporting SCT scores with the mean and standard deviation of panel scores set at standard scores of 80 and 5, respectively. Beyond SCT, our transformation method may be generalizable to the scoring of other test formats in which the performance of examinees and those of a panel of reference undertaking the same cognitive tasks are compared.

Integrating the Illness Beliefs Model in Clinical Practice: A Family Systems Nursing Knowledge Utilization Model

To promote the integration of Family Systems Nursing (FSN) in clinical practice, we need to better understand how nurses overcome the challenges of FSN knowledge utilization. A qualitative exploratory study was conducted with 32 practicing female nurses from hospital and community settings who had received FSN intervention training and skill development based on the Illness Beliefs Model and the Calgary Family Assessment and Intervention Models. The participants were interviewed about how they utilized FSN knowledge in their nursing practice. From the data analysis, a FSN Knowledge Utilization Model emerged that involves three major components: (a) nurses’ beliefs in FSN and in their FSN skills, (b) nurses’ knowledge utilization strategies to address the challenges of FSN practice, and (c) FSN positive outcomes. The FSN Knowledge Utilization Model describes a circular, incremental, and iterative process used by nurses to integrate FSN in daily nursing practice. Findings point to a need for re-evaluation of educational and management strategies in clinical settings for advancing the practice of FSN.

Priorities for action to improve cardiovascular preventive care of patients with multimorbid conditions in primary care--a participatory action research project.

BACKGROUND Cardiovascular disease (CVD) prevention in patients with multimorbid conditions is not always optimal in primary care (PC). Interactive collaborative processes involving PC community are recommended to develop new models of care and to successfully reshape clinical practices. OBJECTIVE To identify challenges and priorities for action in PC to improve CVD prevention among patients with multimorbid conditions. METHODS Physicians (n = 6), nurses (n = 6), community pharmacists (n = 6), other health professionals (n = 6), patients (n = 6) and family members (n = 6), decision makers (n = 6) and researchers (n = 6) took part in a 1-day workshop. Using the Chronic Care Model (CCM) as a framework, participants in focus groups and nominal groups identified the challenges and priorities for action. RESULTS Providing appropriate support to lifestyle change in patients and implementing collaborative practices are challenging. Priorities for action relate to three CCM domains: (i) improve the clinical information system by providing computerized tools for interprofessional and interinstitutional communication, (ii) improve the organization of health care and delivery system design by enhancing interprofessional collaboration, especially with nurses and pharmacists, and creating care teams that include a case manager and (iii) improve self-management support by giving patients access to nutritionists, to personalized health care plans including lifestyle recommendations and to other resources (community resources, websites). CONCLUSIONS To optimize CVD prevention, PC actors recommend focussing mainly on three CCM domains. Electronic medical records, collaborative practices and self-management support are perceived as pivotal aspects of successful PC prevention programme. Developing and implementing such models are challenging and will require the mobilization of the whole PC community.

Facilitating Implementation of Interprofessional Collaborative Practices Into Primary Care: A Trilogy of Driving Forces.

EXECUTIVE SUMMARY Implementing interprofessional collaborative practices in primary care is challenging, and research about its facilitating factors remains scarce. The goal of this participatory action research study was to better understand the driving forces during the early stage of the implementation process of a community‐driven and patient‐focused program in primary care titled “TRANSforming InTerprofessional cardiovascular disease prevention in primary care” (TRANSIT). Eight primary care clinics in Quebec, Canada, agreed to participate by creating and implementing an interprofessional facilitation team (IFT). Sixty‐three participants volunteered to be part of an IFT, and 759 patients agreed to participate. We randomized six clinics into a supported facilitation (“supported”) group, with an external facilitator (EF) and financial incentives for participants. We assigned two clinics to an unsupported facilitation (“unsupported”) group, with no EF or financial incentives. After 3 months, we held one interview for the two EFs. After 6 months, we held eight focus groups with IFT members and another interview with each EF. The analyses revealed three key forces: (1) opportunity for dialogue through the IFT, (2) active role of the EF, and (3) change implementation budgets. Decisionmakers designing implementation plans for interprofessional programs should ensure that these driving forces are activated. Further research should examine how these forces affect interprofessional practices and patient outcomes.

External facilitators and interprofessional facilitation teams: a qualitative study of their roles in supporting practice change

BackgroundFacilitation is a powerful approach to support practice change. The purpose of this study is to better understand the facilitation roles exercised by both external facilitators and interprofessional facilitation teams to foster the implementation of change. Building on Dogherty et al.’s taxonomy of facilitation activities, this study uses an organizational development lens to identify and analyze facilitation roles. It includes a concise definition of what interprofessional facilitation teams actually do, thus expanding our limited knowledge of teams that act as change agents. We also investigate the facilitation dynamics between change actors.MethodsWe carried out a qualitative analysis of a 1-year process of practice change implementation. We studied four family medicine groups, in which we constituted interprofessional facilitation teams. Each team was supported by one external facilitator and included at least one family physician, one case manager nurse, and health professionals located on or off the family medicine group’s site (one pharmacist, plus at least one nutritionist, kinesiologist, or psychologist). We collected our data through focus group interviews with the four teams, individual interviews with the two external facilitators, and case audit documentation. We analyzed both predetermined (as per Dogherty et al., 2012) and emerging facilitation roles, as well as facilitation dynamics.ResultsA non-linear framework of facilitation roles emerged from our data, based on four fields of expertise: change management, project management, meeting management, and group/interpersonal dynamics. We identified 72 facilitation roles, grouped into two categories: “implementation-oriented” and “support-oriented.” Each category was subdivided into themes (n = 6; n = 5) for clearer understanding (e.g., legitimation of change/project, management of effective meetings). Finally, an examination of facilitation dynamics revealed eight relational ties occurring within and/or between groups of actors.ConclusionsFacilitation is an approach used by appointed individuals, which teams can also foster, to build capacity and support practice change. Increased understanding of facilitation roles constitutes an asset in training practitioners such as organizational development experts, consultants, facilitators, and facilitation teams. It also helps decision makers become aware of the multiple roles and dynamics involved and the key competencies needed to recruit facilitators and members of interprofessional facilitation teams.

Development of an interprofessional program for cardiovascular prevention in primary care: A participatory research approach:

Background: The chronic care model provides a framework for improving the management of chronic diseases. Participatory research could be useful in developing a chronic care model–based program of interventions, but no one has as yet offered a description of precisely how to apply the approach. Objectives: An innovative, structured, multi-step participatory process was applied to select and develop (1) chronic care model–based interventions program to improve cardiovascular disease prevention that can be adapted to a particular regional context and (2) a set of indicators to monitor its implementation. Methods: Primary care clinicians (n = 16), administrative staff (n = 2), patients and family members (n = 4), decision makers (n = 5), researchers, and a research coordinator (n = 7) took part in the process. Additional primary care actors (n = 26) validated the program. Results: The program targets multimorbid patients at high or moderate risk of cardiovascular disease with uncontrolled hypertension, dyslipidemia or diabetes. It comprises interprofessional follow-up coordinated by case-management nurses, in which motivated patients are referred in a timely fashion to appropriate clinical and community resources. The program is supported by clinical tools and includes training in motivational interviewing. A set of 89 process and clinical indicators were defined. Conclusion: Through a participatory process, a contextualized interventions program to optimize cardiovascular disease prevention and a set of quality indicators to monitor its implementation were developed. Similar approach might be used to develop other health programs in primary care if program developers are open to building on community strengths and priorities.

Scientific rigour and innovations in participatory action research investigating workplace learning in continuing interprofessional education

Abstract The persistent theory-practice gap shows how challenging it can be for healthcare professionals to keep updating their practices. The continuing education challenges are partly explained by the tremendous stream of new discoveries in health and the epidemic of multi-morbid conditions. Participatory action research (PAR) is used in healthcare as a research approach that capitalizes on people’s resources to better understand and enhance their professional practices. PAR thus can consolidate our knowledge on workplace learning in continuing interprofessional education while directly improving quality of care. However, PAR lacks clear scientific criteria to ensure the consistency between the investigators’ methodology and philosophy, which jeopardize its credibility. This paper outlines the principles of rigour in PAR and describes the additions of a preliminary planning phase to Kemmis and McTaggart’s PAR description as well as the use of the professional co-development group, an action-oriented data collection method. We believe that this will help PAR co-participants achieve improved scientific rigour and encourage more investigators to collaborate through this research approach contributing to the advancement of knowledge on workplace learning in continuing interprofessional education.

From student to emergency nurse: a qualitative study of an educational support seminar.

The purpose of this qualitative study was to document the transition experience of new nursing graduates who participated in an educational support seminar during their first year of emergency room (ER) practice. Study participants reported that the seminar provided learning and nurturing that facilitated their integration into the ER team, influenced their decision to stay in the ER, and grounded the process of their professionalization. Important considerations regarding education, professionalization, and leadership emerged.

Humanizing Nursing Care: An Analysis of Caring Theories Through the Lens of Humanism

Abstract Humanisms tenets are rarely described in regard to the theories of our discipline. In this article, we outline the historical origins of the humanism movements along with its etymology in order to analyze the assumptions that were brought up by selected North American nursing scholars related to human caring. We then detail each perspective while linking their premises with the roots of humanism. While discussing humanistic caring theories in nursing, we clarify relational concepts such as mutuality, reciprocity, authenticity, and human potential. We finally conclude with a summary of the main tenets of humanism and its implications for nursing practice.

Une approche éducative socioconstructiviste et humaniste pour la formation continue des infirmières soignant des personnes ayant des besoins complexes

In order to care for persons with complex needs, such as those living with a chronic illness and at risk for complications when hospitalized, nurses must possess multiple sorts of knowledge and skills. After a description of the prevalent schools of thought in pedagogy, the case is made for the use of narrative pedagogy - an educational approach based on nursing science research and congruent with the socio-constructivist and humanist schools of thought?in continuing professional development for nurses. Through the sharing of lived experiences from nurses, care recipients and their families, this educational approach fosters active listening, interpretation, questioning, and perspectival openness. It was tested with nurses caring for hospitalized older persons at risk of presenting signs of acute confusional state and found to be promising. Consequently, it is hoped that educators responsible for the continuing education of nurses in clinical settings will explore this novel educational option in order to adjust their teaching to the knowledge and experience of nurses and to the changing needs of care recipients.