Kimberly D. Fraser

Arts-based methods in health research: A systematic review of the literature

The arts are valued by most societies for a variety of reasons. From a health perspective they have been valued primarily for therapeutic purposes. Subsequently, the benefit of the arts in health research is increasingly evident. Although the arts have been used as a research method in other disciplines, their use in health is much more recent. There is no clear understanding of the kind of arts or the way the arts have been used as a research method. This systematic review of the literature was conducted to fill this knowledge gap. We undertook the review to determine what constitutes arts-based methods in health research and how have these methods been used. We searched eight databases using different combinations of several keywords. We used content and thematic analysis to analyze our results. Thirty studies met our criteria for inclusion. Visual arts were the most common, followed by performance arts, and literary arts. The purposes of using arts in health research were primarily for knowledge production and knowledge translation. Artistic methods are a useful technique for both knowledge production and translation purposes, albeit to a limited degree. We will discuss our findings in terms of trends, methodological issues and theoretical issues. Further research is needed to advance this area of knowledge.

Factors influencing intentions to stay and retention of nurse managers: a systematic review

AIMS This systematic review aimed to explore factors known to influence intentions to stay and retention of nurse managers in their current position. BACKGROUND Retaining staff nurses and recruiting nurses to management positions are well documented; however, there is sparse research examining factors that influence retention of nurse managers. EVALUATIONS Thirteen studies were identified through a systematic search of the literature. Eligibility criteria included both qualitative and quantitative studies that examined factors related to nurse manager intentions to stay and retention. Quality assessments, data extraction and analysis were completed on all studies included. Twenty-one factors were categorized into three major categories: organizational, role and personal. KEY ISSUES Job satisfaction, organizational commitment, organizational culture and values, feelings of being valued and lack of time to complete tasks leading to work/life imbalance, were prominent across all categories. CONCLUSION These findings suggest that intentions to stay and retention of nurse managers are multifactoral. However, lack of robust literature highlights the need for further research to develop strategies to retain nurse managers. ImplICATIONS FOR NURSE MANAGEMENT: Health-care organizations and senior decision-makers should feel a responsibility to support front-line managers in relation to workload and span of control, and in understanding work/life balance issues faced by managers.

Factors that Affect Quality of Life from the Perspective of People with Dementia: A Metasynthesis

To comprehensively and systematically identify, appraise, and synthesize qualitative research findings on factors that affect quality of life from the perspective of people with dementia.

Decision-making and nurse case management: a philosophical perspective.

Decision-making related to resource allocation in home care case management practice is addressed from the unique perspective of nursing. The case management process stipulates the adherence to both client-centered and system-centered goals. Issues that emerge from this process include the ethical dilemma of deciding the equitable and fair distribution of resources related to the provision of appropriate levels of service; economic factors as they relate to limited financial resources; and the variance among case managers in their decision-making. Moderate realism, as compared to critical and feminist theory, provides a philosophical perspective that allows a practical interpretation of these issues.

The Use of Data for Process and Quality Improvement in Long Term Care and Home Care: A Systematic Review of the Literature

BACKGROUND Standardized resident or client assessments, including the Resident Assessment Instrument (RAI), have been available in long term care and home care settings (continuing care sector) in many jurisdictions for a number of years. Although using these data can make quality improvement activities more efficient and less costly, there has not been a review of the literature reporting quality improvement interventions using standardized data. OBJECTIVES To address 2 questions: (1) How have RAI and other standardized data been used in process or quality improvement activities in the continuing care sector? and (2) Has the use of RAI and similar data resulted in improvements to resident or other outcomes? DATA SOURCES Searches using a combination of keyword and controlled vocabulary term searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, and PsychINFO. ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: English language publications from database inception to October 2008 were included. Eligibility criteria included the following: (1) set in continuing care (long-term care facility or home care), (2) involved some form of intervention designed to improve quality or process of care, and (3) used standardized data in the quality or process improvement intervention. STUDY APPRAISAL AND SYNTHESIS METHODS After reviewing the articles, we grouped the studies according to the type of intervention used to initiate process improvement. Four different intervention types were identified. We organized the results and discussion by these 4 intervention types. RESULTS Key word searches identified 713 articles, of which we excluded 639 on abstract review because they did not meet inclusion criteria. A further 50 articles were excluded on full-text review, leaving a total of 24 articles. Of the 24 studies, 10 used a defined process improvement model, 8 used a combination of interventions (multimodal), 5 implemented new guidelines or protocols, and 1 used an education intervention. CONCLUSIONS/IMPLICATIONS The most frequently cited issues contributing to unsuccessful quality improvement interventions were lack of staff, high staff turnover, and limited time available to train staff in ways that would improve client care. Innovative strategies and supporting research are required to determine how to intervene successfully to improve quality in these settings characterized by low staffing levels and predominantly nonprofessional staff. Research on how to effectively enable practitioners to use data to improve quality of care, and ultimately quality of life, needs to be a priority.

A systematic process for creating and appraising clinical vignettes to illustrate interprofessional shared decision making

Abstract Vignettes and written case simulations have been widely used by educators and health services researchers to illustrate plausible situations and measure processes in a wide range of practice settings. We devised a systematic process to create and appraise theory-based vignettes for illustrating an interprofessional approach to shared decision making (IP-SDM) for health professionals. A vignette was developed in six stages: (1) determine IP-SDM content elements; (2) choose true-to-life clinical scenario; (3) draft script; (4) appraise IP-SDM concepts illustrated using two evaluation instruments and an interprofessional concept grid; (5) peer review script for content validity; and (6) retrospective pre-/post-test evaluation of video vignette by health professionals. The vignette contained six scenes demonstrating the asynchronous involvement of five health professionals with an elderly woman and her daughter facing a decision about location of care. The script scored highly on both evaluation scales. Twenty-nine health professionals working in home care watched the vignette during IP-SDM workshops in English or French and rated it as excellent (n = 6), good (n = 20), fair (n = 0) or weak (n = 3). Participants reported higher knowledge of IP-SDM after the workshops compared to before (p < 0.0001). Our video vignette development process resulted in a product that was true-to-life and as part of a multifaceted workshop it appears to improve knowledge among health professionals. This could be used to create and appraise vignettes targeting IP-SDM in other contexts.

Factors that influence case managers' resource allocation decisions in pediatric home care: an ethnographic study.

BACKGROUND Case managers make decisions that directly affect the amount and type of services home care clients receive and subsequently affect the overall available health care resources of home care programs. A recent systematic review of the literature identified significant knowledge gaps with respect to resource allocation decision-making in home care. METHODS Using Spradleys methodology, we designed an ethnographic study of a childrens home care program in Western Canada. The sample included 11 case managers and program leaders. Data sources included interviews, card sorts, and participant observation over a 5-month period. Data analyses included open coding, domain, taxonomic, and componential analysis. RESULTS One of the key findings was a taxonomy of factors that influence case manager resource allocation decisions. The factors were grouped into one of four main categories: system-related, home care program-related, family related, or client-related. Family related factors have not been previously reported as influencing case manager resource allocation decision-making and nor has the teams role been reported as an influencing factor. CONCLUSION The findings of this study are examined in light of Daniels and Sabins Accountability for Reasonableness framework, which may be useful for future knowledge development about micro-level resource allocation theory.

Are home care programs cost-effective? A systematic review of the literature.

The cost-effectiveness of home care programs and services is an important area of health care research given the recent growth and continuing trend in home health care, the current state of health care reform in Canada, and changing demographics in Canada. Home care programs often proceed with little evidence-based decision-making. Increased demand for evidence-based decision-making is apparent in not only clinical settings, but also in policy environments thus creating a need for more research in this area. There are presently very few rigorous studies on the cost-effectiveness of home care programs. This systematic literature review addresses the research question, “What is the relationship between cost-consequence evidence and policy implications within the home care context?” The findings are not surprising. They include mixed results and indicate that cost-effectiveness of home care programs is an important area to study in spite of the many challenges. The challenges presented must be acknowledged and addressed in order to produce better research designs in future studies.

The relational nature of case manager resource allocation decision making: an illustrated case.

We used ethnographic methods in the tradition of Spradley (1979) and constant comparative analysis to explore case manager resource allocation decision making. We interviewed, observed, and shadowed 11 case managers within a children’s home care program in a regional health authority in western Canada as they went about their daily work over a 5-month period. Our findings provide knowledge about the little-understood set of processes at the micro level of resource allocation. Although the case manager considers many factors, reported elsewhere (Fraser, Estabrooks, Allen, & Strang, 2009), they balance and weigh these factors within a relational context. The purpose of this article is to use Jenna’s story as a case example to illustrate how the case manager balances and weighs the factors that influence their resource allocation decisions within this context. Jenna’s story demonstrates the complex and multidimensional processes that are embedded in the relational nature of resource allocation decisions. We discuss home care case manager resource allocation decisions as viewed through the lens of relational ethics.

Does the quality of life construct as illustrated in quantitative measurement tools reflect the perspective of people with dementia

AIMS A discussion of the extent to which people with dementias perspectives on quality of life have been included in quantitative research. BACKGROUND Capturing the perspective of people with dementia may improve understanding of their quality of life. Quantitative tools to assess quality of life exist, but the extent to which these reflect the perspective of people with dementia has not been evaluated. DESIGN A discussion paper. DATA SOURCES Ten tools (designed between 1992-2012) to measure quality of life from the perspective of people with dementia were located from existing reviews. DISCUSSION Each tool was rated according to the extent to which the developers included the perspectives of people with dementia at three different points of quality of life conceptualization: during quality of life assessment, to identify quality of life domains and to define an overall conceptual framework. This analysis demonstrates that tool developers were inconsistent in their approach to including the perspectives of people with dementia to understand quality of life. The perspective of people with dementia was included primarily to assess, but not to select domains or define overall quality of life. IMPLICATIONS FOR NURSING Nurses should consider not only who assesses quality of life, but also whose understanding of quality of life is being assessed. CONCLUSION It is unclear whether the quantitative quality of life literature reflects the perspective of people with dementia. Debate is needed regarding the impact of this issue on the lives of people with dementia.