Lise Lamothe

The treatment of the restless legs syndrome with clonazepam: a prospective controlled study

The effect of clonazepam on the restless legs syndrome was studied in a group of 6 patients. Following a drug-free period, 3 patients received clonazepam for 4 weeks followed by placebo for 4 weeks thereafter and 3 patients received the same medication and for the same length of time but in reverse order. The effectiveness of the medication was evaluated by means of a self-rating system in which patients assigned a score daily to the degree of discomfort experienced in the previous 24 hours. Three patients improved on clonazepam but 2 of these also improved on placebo. Clonazepam was not shown to be significantly more effective than placebo in the treatment of RLS.

Boundary work and the introduction of acute care nurse practitioners in healthcare teams

AIM This article is a report of a study of boundary work following the introduction of an acute care nurse practitioner role in healthcare teams. BACKGROUND Acute care nurse practitioners enacting their roles in healthcare teams have faced a number of challenges including a mix of positive and negative views of the acute care nurse practitioner role from healthcare team members and acute care nurse practitioner roles crossing the boundaries between the medical and nursing professions. Understanding the process by which the boundaries between professions changed following the introduction of an acute care nurse practitioner role was important since this could affect scope of practice and the teams ability to give patient care. METHODS The study was conducted in two university-affiliated teaching hospitals in Canada. A descriptive multiple case study design was used. Data were collected from March to May 2009. RESULTS Participants (N = 59) described boundary work as a process that included: (1) creating space; (2) loss of a valued function; (3) trust; (4) interpersonal dynamics; and (5) time. The development of trust among team members was essential. The co-location of team members working on common projects, and medical and nursing leadership facilitated boundary work. CONCLUSION The micro-level processes of boundary work in healthcare teams have important implications for the development of full scope of practice for acute care nurse practitioners, effective inter-professional teamwork and the integration of new roles in healthcare systems. Future research needs to be undertaken in different contexts, and with patients and families.

The dynamics of IT adoption in a major change process in healthcare delivery

The main objective of the study is to comprehend the dynamics of interactions between partners (caregivers, promoters, consultants, patients and managers) involved in the implementation process of an integrated delivery system designed to support the treatment of women with breast cancer. Preliminary findings permit to identify adoption/resistance factors at individual, professional and organizational levels in addition to technological factors. They give insights on the challenges to be faced when redesigning work processes in an interorganizational setting. Significant adoption factors include individual participation to the project and positive assessment of benefits of the system by individuals as well as by professional groups. On the other hand, the absence of a multidisciplinary committee and the complexity of the environment, the tasks and the technology are among the factors identified as troublesome. In terms of the dynamics of the process, our observation reveals that promoters have adopted a contingent and political approach. While this strategy is usually considered appropriate in healthcare organizations, information generated by this study has allowed for a better understanding of important factors and mechanisms to consider and address in the subsequent phases of implementation.

Identity Struggles in Merging Organizations Renegotiating the Sameness–Difference Dialectic

Mergers as a type of organizational change call attention to questions of identity. In this article, the authors ask: How do people collectively reconstitute their group identities for themselves and others, and in particular, how do they renegotiate understandings of sameness and difference called into question by merging? The authors draw on qualitative case data from two different merger contexts within the health care sector to develop rich descriptions and a deeper understanding of the identity struggles of four groups of employees. They identified four patterns of identity work ranging from more proactive forms of positioning as “mavericks” or fighters” to more passive forms as “adapters” or “victims” as each group struggled to navigate an altered, fluid, and emerging landscape of potential resources for self-understanding and affiliation. The authors show how identity regulation and identity work manifest themselves in three domains of language, practices and space, and how identity regulation and identity work mutually interact. Thus, the negotiation of identity in merging is a dialectic process in which managerial identity regulation aimed at enhancing convergence across groups may be undermined both by groups’ attempts to reestablish differences and by a countervailing managerial need to accommodate (and thus sustain) differences in order to enable groups to locate themselves in the emerging entity.

An integrated strategy of knowledge application for optimal e-health implementation: A multi-method study protocol

BackgroundE-health is increasingly valued for supporting: 1) access to quality health care services for all citizens; 2) information flow and exchange; 3) integrated health care services and 4) interprofessional collaboration. Nevertheless, several questions remain on the factors allowing an optimal integration of e-health in health care policies, organisations and practices. An evidence-based integrated strategy would maximise the efficacy and efficiency of e-health implementation. However, decisions regarding e-health applications are usually not evidence-based, which can lead to a sub-optimal use of these technologies. This study aims at understanding factors influencing the application of scientific knowledge for an optimal implementation of e-health in the health care system.MethodsA three-year multi-method study is being conducted in the Province of Quebec (Canada). Decision-making at each decisional level (political, organisational and clinical) are analysed based on specific approaches. At the political level, critical incidents analysis is being used. This method will identify how decisions regarding the implementation of e-health could be influenced or not by scientific knowledge. Then, interviews with key-decision-makers will look at how knowledge was actually used to support their decisions, and what factors influenced its use. At the organisational level, e-health projects are being analysed as case studies in order to explore the use of scientific knowledge to support decision-making during the implementation of the technology. Interviews with promoters, managers and clinicians will be carried out in order to identify factors influencing the production and application of scientific knowledge. At the clinical level, questionnaires are being distributed to clinicians involved in e-health projects in order to analyse factors influencing knowledge application in their decision-making. Finally, a triangulation of the results will be done using mixed methodologies to allow a transversal analysis of the results at each of the decisional levels.ResultsThis study will identify factors influencing the use of scientific evidence and other types of knowledge by decision-makers involved in planning, financing, implementing and evaluating e-health projects.ConclusionThese results will be highly relevant to inform decision-makers who wish to optimise the implementation of e-health in the Quebec health care system. This study is extremely relevant given the context of major transformations in the health care system where e-health becomes a must.

The impact of organizational characteristics on telehealth adoption by hospitals

Human and organizational factors are central to the adoption of various telehealth technologies and influence their diffusion into integrated networks. The aim of this paper is twofold. Firstly, a conceptual framework for assessing organizational factors that condition telehealth adoption by hospitals is proposed. Secondly, the results of an exploratory study conducted among the 32 hospitals involved in the Provincial Extended Telehealth Network of Quebec (Canada) are presented and discussed. Relevant concepts from different theoretical frameworks were combined to propose a comprehensive framework of potential factors affecting telehealth adoption by hospitals. A questionnaire was administered via telephone interviews to the DSP (Director of Medicine) of each of the 32 hospitals. Level of telehealth adoption was assessed by computing the number of transmissions performed since the hospitals adhesion to the network. Then, contingency analyses were performed to determine which organizational factors were significantly associated with telehealth adoption. Finally, the paper discusses some of the implications pertaining to the organizational dimensions affecting telehealth adoption by hospitals and proposes avenues to facilitate the diffusion of this technology.

Advanced practice nursing, health care teams, and perceptions of team effectiveness.

This article summarizes the results of an extensive review of the organizational and health care literature of advanced practice nursing (APN) roles, health care teams, and perceptions of team effectiveness. Teams have a long history in health care. Managers play an important role in mobilizing resources, guiding expectations of APN roles in teams and within organizations, and facilitating team process. Researchers have identified a number of advantages to the addition of APN roles in health care teams. The process within health care teams are dynamic and responsive to their surrounding environment. It appears that teams and perceptions of team effectiveness need to be understood in the broader context in which the teams are situated. Key team process are identified for team members to perceive their team as effective. The concepts of teamwork, perceptions of team effectiveness, and the introduction of APN roles in teams have been studied disparately. An exploration of the links between these concepts may further our understanding the health care teams perceptions of team effectiveness when APN roles are introduced. Such knowledge could contribute to the effective deployment of APN roles in health care teams and improve the delivery of health care services to patients and families.

Key enhancing factors for integrating services for patients with mental and substance use disorders

Background: Over the past decade, practice standards have recommended that people experiencing both mental and substance use disorders receive integrated treatment. Yet few institutions offer integrated services, and patients are too often turned away from psychiatric and rehabilitation services. Aim: To identify key enhancing elements for integrating services for patients with co-occurring disorders. Methods: A process evaluation was conducted, using case study research methodology, with the aim of identifying factors that enhance or impede service integration. First, we elaborated a sound conceptual framework of service integration. In-depth case studies analysis using socio-anthropological methods (interviews with managers and professionals, focus groups with patients, non-participant observation, document analysis) were then conducted. Two contrasted forms of services integration, a joint venture and a strategic alliance, were analysed separately, and then compared. Results: Although the forms of inte...

Integrating scientific evidence to support telehomecare development in a remote region.

This study aimed to understand how different types of knowledge have influenced the decision making process regarding the implementation of telehomecare in the organization of regional healthcare services in the Province of Quebec (Canada). A case study was conducted in order to explore how scientific evidence was integrated in the decision-making processes regarding the implementation of a telehomecare system in the Gaspésie-Magdalene Islands Health Region. A total of 14 semistructured interviews were completed with key organizational decision makers (regional managers, organization managers, healthcare professionals, and technological managers). Two researchers independently carried out data analysis, encouraging iterations and validation with study participants. The Gaspésie-Magdalene Islands Telehomecare Project is based on a technological solution named Intelligent Distance Patient Monitoring and constitutes a relevant example of the evolution of an e-health solution. Indeed, the first reports of the experiment influenced decision makers to continue the deployment of the solution. Decision makers from all groups agreed on the importance of using past experience to avoid pitfalls and ensure an optimal decision-making process. They highlighted the importance of knowledge translation between sites as well as within sites. Knowledge translation played an important part in the success of the project. Efficient strategies to transfer evidence to organizational decision making have been identified such as an endusers forum, where researchers provide support by sharing evidence with end-users and actively participate in knowledge translation.

How do general practitioners contribute to preventing long-term work disability of their patients suffering from depressive disorders? A qualitative study.

BackgroundDepression is a major cause of work absenteeism that general practitioners (GPs) face directly since they are responsible for sickness certification and for supervising the return to work (RTW). These activities give GPs a key role in preventing long-term work disability, yet their practices in this regard remain poorly documented. The objectives of this study were therefore to describe GPs’ practices with people experiencing work disability due to depressive disorders and explore how GPs’ work context may impact on their practices.MethodsWe conducted semi-structured individual interviews with 13 GPs and six mental healthcare professionals in two sub-regions of Quebec. The sub-regions differed in terms of availability of specialized resources offering public mental health services. Data were anonymized and transcribed verbatim. Thematic analysis was performed to identify patterns in the GPs’ practices and highlight impacting factors in their work context.ResultsOur results identified a set of practices common to all the GPs and other practices that differentiated them. Two profiles were defined on the basis of the various practices documented. The first is characterized by the integration of the RTW goal into the treatment goal right from sickness certification and by interventions that include the workplace, albeit indirectly. The second is characterized by a lack of early RTW-oriented action and by interventions that include little workplace involvement. Regardless of the practice profile, actions intended to improve collaboration with key stakeholders remain the exception. However, two characteristics of the work context appear to have an impact: the availability of a dedicated mental health nurse and the regular provision of clinical information by psychotherapists. These conditions are rarely present but tend to make a significant difference for the GPs.ConclusionsOur results highlight the significant role of GPs in the prevention of long-term work disability and their need for support through the organization of mental health services at the primary care level.