检索结果-南通市图书馆

Implementation Strategies for Improving the Care of Depressed Elderly Persons—Summary of an International Workshop

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Nursing 2014年第11期4卷 715-723页

作者： Elisabeth Severinsson anne lise holm Centre for Women’s Family and Child Health Faculty of Health Sciences Buskerud & Vestfold University College Kongsberg Norway

The aim of the study was to identify the most important research priorities as well as future strategies for promoting and implementing evidence-based care of depressed elderly persons. An interdisciplinary workshop was organized using a focus group format and the transcript of the discussion was interpreted by means of the qualitative content analysis. The most important research priorities for improving the care of depressed elderly persons, implementation levels, theoretical approaches as well as possible outcomes were analysed on individual consumer, healthcare system, and policy level. A wide range of theories and methods are necessary to identify and explain implementation processes and results. Qualitative and quantitative methodologies in combination with knowledge synthesis were discussed. In addition, the need to summarize the literature in terms of specific issues was emphasized. In conclusion, the implementation strategies for improving the care of depressed elderly persons should be addressed on three levels: individual consumer, healthcare system and policy. Although some aspects of the implementation model may need to be enhanced, the fact that it includes conditions on individual level, i.e. self-management support, is of importance. The expansion and maintenance of evidence-based care generate potential for change in mental healthcare, thus improving outcomes for individual elderly patients. Areas that require further research are organization, cost and leadership. The use of mixed methods could strengthen future studies. Implementation researchers need a broad repertoire in order to plan and perform evidence-based research. To improve practice, implementation strategies should be developed in clinical and community guidelines.

关键词： Implementation Research Depression Elderly Professional Guidelines Workshop

Patients’ Role in Their Own Safety—A Systematic Review of Patient Involvement in Safety

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Nursing 2015年第7期5卷 642-653页

作者： Elisabeth Severinsson anne lise holm Centre for Women’s Family and Child Health Faculty of Health Sciences Buskerud & Vestfold University College Kongsberg Norway Department of Health Science Stord/Haugesund University College Stord Norway

It is necessary to evaluate progress in the area of patient safety. However, although there has been an increase in number of quality and safety related studies have increased, the topics of patient involvement and patient safety are not automatically linked. The aim of this systematic review was to identify and evaluate the evidence contributed by studies of patient involvement in the provision of safe care. Inclusion criteria were studies undertaken to promote involvement in safety, covering patients’ attitudes, unsafe and safe care, risk reduction and handover practices during discharge from hospital to primary care. The results revealed three themes: satisfaction with and need for knowledge about healthcare and the health system, sharing responsibility and accountability for safety and the need to overcome language barriers to prevent harm and error. In conclusion, there is an increased focus on the role of the patient in the provision of safe care. Existing evidence is related to medication rather than patients’ capability and willingness to be involved. It is recommended that patient participation in the provision of safe care should be explored in relation to phenomena such as trust, responsibility, shared decision-making and powerlessness. It is also important to investigate the patient’s role with respect to patient rights.

关键词： Patient Involvement Patient Safety Systematic Review

Understanding and Improving Quality of Care in the Context of Depressed Elderly Persons Living in Norway

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Nursing 2014年第12期4卷 809-817页

作者： Elisabeth Severinsson anne lise holm The Centre for Women’s Family and Child Health Faculty of Health Sciences Buskerud & Vestfold University College Kongsberg Norway

Effective leadership plays an important role in safe patient care. The aim of this paper was to understand and improve the implementation outcomes identified by empirical studies based on Proctors et al.’s key concepts, acceptability appropriateness, feasibility and fidelity, and to propose recommendations for further research. Methods: An interdisciplinary approach using mixed methods. Results: A total of twenty papers based on data from this interdisciplinary study have been published. Overall, our published empirical studies revealed that the CCM intervention had positive results due to staff members’ engagement to improve care, their awareness of the need for collaboration and willingness to assume responsibility for patient care. From the perspective of the depressed elderly persons the results of the research project indicated their need for support to increase self-management. In conclusion, an improved understanding of the implementation outcomes will have an impact on best practice for depressed elderly persons and dissemination purposes. Quality management and highly action-oriented involvement are necessary in implementation research. These will also affect the professional development of interdisciplinary teams as well as constitute a basis for further research on understanding and improving the care of depressed elderly individuals.

关键词： Depression Effective Leadership Elderly Implementation

Evaluating Improvement in the Care of Depressed Elderly Patients: An Empirical Approach to the WHO Patient Safety Model

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Nursing 2015年第5期5卷 397-406页

Depression among the elderly is a public health issue. This paper demonstrates the value of patient safety research for future strategies in this area. The aim of the present study was to analyse the relationship between the World Health Organization (WHO) Patient Safety (PS) Model and empirical research on depressed elderly patients’ experiences of quality and safe care. The research question was: Which patients’ experiences could be linked to quality and safe care as recommended by the WHO? We adopted an implementation approach as the starting point for this interdisciplinary project. A total of 29 individual narrative-based, in-depth interviews were performed to explore patients’ experiences and two healthcare teams participated in the focus group interviews. Interpretation of the results revealed that the 23 components of the PS model were linked to elderly patients’ experiences of quality and that safe care was not achieved. There was evidence of low quality and lack of safe care due to psychological distress, stress and fatigue, the absence of involvement in decision-making, misdiagnosis, sleep problems as a result of harm from medical error and a poor physical state. Patients’ experiences of loneliness gave rise to suicidal thoughts. In conclusion, quality improvement is necessary in all components of the WHO PS model. We recommend structural, process and outcome improvements, more specifically: active involvement, shared decision-making and increased self-management.

关键词： Chronic Care Management Implementation Patient Safety Model WHO

Mapping Psychosocial Risk and Protective Factors in Suicidal Older Persons—A Systematic Review

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Nursing 2015年第3期5卷 260-275页

作者： anne lise holm Elisabeth Severinsson Department of Health Science Stord/Haugesund University College Haugesund Norway Centre for Women’s Family and Child Health Faculty of Health Sciences Buskerud and Vestfold University College Drammen Norway

Social disconnectedness in combination with depression, somatic disease, stigma, social exclusion and functional impairment has been described as a major risk factor for suicide in old age. However, protective factors have not been focused on in the same way. The aim was to identify psychosocial risk and protective factors in suicidal older persons. A systematic review was performed in Academic Search Premier (34), Ovid Medline (0), PsycInfo (0), PubMed (66), CINAHL (3) and ProQuest (1078) for the period May - September, 2014. Results: Twelve studies were included in the final analysis. Psychosocial risk factors were categorized under four themes: Being a burden to others increases depression and hopelessness, the struggle due to poor social integration, the strain of physical illness and old age and Negative aspects of religious activity. A total of four protective factors emerged: a sense of belonging, maintaining social dignity, satisfaction with relationships and feeling useful and positive aspects of religious activity. In conclusion, the context of a suicidal older person in a home healthcare service may create a “vulnerable psychosocial state” in which she/he is confronted by stressful psychosocial life events including physical illness and social network changes. The fact that protective factors are solely related to social factors needs to be taken into account in future prevention studies.

关键词： Older Protective Factors Psychosocial Risk Factors Suicide

Managing the Needs of Older Patients with Multimorbidity—A Systematic Review of the Challenges Faced by the Healthcare Services

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Nursing 2016年第10期6卷 881-901页

作者： anne lise holm Astrid Karin Berland Elisabeth Severinsson Department of Health Science Stord/Haugesund University College Stord Norway Centre for Women’s Family and Child Health Faculty of Health Sciences University College of Southeast Norway Kongsberg Norway

Research fails to provide an overview of the challenges involved in caring for older patients with multimorbidity. Multimorbidity is defined as the presence of two or more chronic conditions in the same person, leading to a high risk of care dependency. The aim of this review was to illuminate the challenges faced by the healthcare services in managing the needs of older patients with multimorbidity. A systematic review was performed, a total of 1,965 abstracts were read and nine quantitative studies included. Data were analysed by thematic synthesis, revealing six themes: A frequent problem in older female patients;High healthcare expenditure and costs, Medication management problems, Social inequities, Complex healthcare and consultation needs and High mortality. The study highlights that healthcare professionals struggle to obtain suitable guidelines for the care of patients with multimorbidity while trying to respond to their needs. Patient-centred integration across settings and coordination in clinical practice are necessary. The healthcare system today does not seem to focus on patient safety and preventing harm. Older patients should be reviewed by a healthcare professional responsible for coordinating their care. To ensure safe and effective care for elderly persons with multimorbidity, the healthcare services should abandon the current focus on managing innumerable individual diseases and conditions.

关键词： Healthcare Services Multimorbidity Older Patients Systematic Review Thematic Synthesis

Older Patients’ Involvement in Shared Decision-Making—A Systematic Review

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Nursing 2016年第3期6卷 170-185页

Shared decision-making has been described as allowing patients to gain more control over their life situation and feel less helpless. The aim of this systematic review was to describe the involvement of older patients in shared decision-making in community settings. In accordance with the systematic review method, a total of 2468 abstracts were read, after which nine quantitative studies were included. A qualitative thematic analysis was performed and two themes emerged;increased understanding of self-management and a desire to strengthen one’s position in relationship with professionals, both of which were essential for empowering older patients to participate in shared decision-making. Older patients’ shared decision-making was seen as a struggle to maintain their autonomy in different areas of everyday life. Emotional and psychological problems made their position more difficult. In order to empower them in relationships with healthcare professionals, older patients require more knowledge (self-efficacy) and information about their illness, which could strengthen their position in the decision-making process. They also need a greater awareness of decisional conflicts that may arise. Age, gender and health status influence older patients’ chance of being respected and taken seriously in relationship with professionals.

关键词： Involvement Patient Shared Decision-Making Systematic Review

Shared Decision-Making after Implementation of the Chronic Care Model (CCM)—An Evaluative Approach

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Nursing 2014年第12期4卷 824-835页

作者： anne lise holm anne Lyberg Ingela Berggren Elisabeth Severinsson The Centre for Women’s Family and Child Health Faculty of Health Sciences Buskerud & Vestfold University College Kongsberg Norway The Department of Nursing Health and Culture University West Trollh&#228ttan Sweden

Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis of best available evidence. Methods: Data were collected from two teams that took part in a focus group interview, and the transcript was analysed by means of qualitative thematic analysis. Results: One overall theme emerged—Preventing the violation of human dignity based on three themes, namely, Changing understanding and attitudes, Increasing depressed elderly persons’ autonomy and Clarifying the mental healthcare team coordinator’s role and responsibility. The results of this study reveal that until recently, paternalism has been the dominant decision-making model within healthcare, without any apparent consideration of the patient perspective. Community mental healthcare can be improved by shared decision-making in which team members initiate a dialogue focusing on patient participation to prevent the violation of human dignity. However, in order to determine how best to empower the patient, team members need expert knowledge and intuition.

关键词： Chronic Care Model Decision-Making Depressive Ill Health Focus Group Interviews Participation Team

Depressed Older Patients’ Need for and Expectations of Improved Health Services—An Evaluative Approach to the Chronic Care Model

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Nursing 2015年第4期5卷 376-386页

作者： anne Lyberg Ingela Berggren anne lise holm Elisabeth Severinsson Centre for Women’s Family and Child Health Faculty of Health Sciences Buskerud and Vestfold University College Kongsberg Norway Department of Nursing Health and Culture University West Trollh&aumlttan Sweden Department of Health Science Stord/Haugesund University College Stord Norway

Depression in later life is an underrepresented yet important research area. The aim of the study was to explore depressed older persons’ need for and expectations of improved health services one year after implementation of the Chronic Care Model (CCM). A qualitative evaluative design was used. Data were collected through individual interviews with older persons living in Norway. The qualitative content analysis revealed two themes: The need to be safeguarded and Expectation of being considered valuable and capable. Evaluation of the improvement in care with focus on the CCM components showed that the most important components for improving the depressed older person’s daily life were: delivery system re-design, self-management support, productive interaction and a well-informed active patient. The findings highlight the need for a health services designed for persons suffering from chronic ill-health, where the CCM could serve as a framework for policy change and support the redesign of the existing healthcare system. We conclude that older persons with depression need attention, especially those who have been suffering for many years. The identified components may have implications for health professionals in the promotion of mental healthcare.

关键词： Chronic Care Model Depression Expectations Health Services Needs Older Persons