Interpreting intracorporeal landscapes: how patients visualize pathophysiology and utilize medical images in their understanding of chronic musculoskeletal illness

Medical science and other sources, such as the media, increasingly inform the general public’s understanding of disease. There is often discordance between this understanding and the diagnostic interpretations of health care practitioners (HCPs). In this paper – based on a supra-analysis of qualitative interview data from two studies of joint pain, including osteoarthritis – we investigate how people imagine and make sense of the pathophysiology of their illness, and how these understandings may affect self-management behavior. We then explore how HCPs’ use of medical images and models can inform patients’ understanding. In conceptualizing their illness to make sense of their experience of the disease, individuals often used visualizations of their inner body; these images may arise from their own lay understanding, or may be based on images provided by HCPs. When HCPs used anatomical models or medical images judiciously, patients’ orientation to their illness changed. Including patients in a more collaborative diagnostic event that uses medical images and visual models to support explanations about their condition may help them to achieve a more meaningful understanding of their illness and to manage their condition more effectively.

• Implications for Rehabilitation

• Chronic musculoskeletal pain is a leading cause of pain and years lived with disability, and despite its being common, patients and healthcare professionals often have a different understanding of the underlying disease.

• An individual’s understanding of his or her pathophysiology plays an important role in making sense of painful joint conditions and in decision-making about self-management and care.

• Including patients in a more collaborative diagnostic event using medical images and anatomical models to support explanations about their symptoms may help them to better understand their condition and manage it more effectively.

• Using visually informed explanations and anatomical models may also help to reassure patients about the safety and effectiveness of core treatments such as physical exercise and thereby help restore or improve patients’ activity levels and return to social participation.

     

Psychosocial issues need more attention in COPD self-management education

Abstract

Objective: To find out how regularly the contents of patient education regarded as essential for COPD patients’ self-management are provided by healthcare professionals in specialised healthcare (SHC) and primary healthcare (PHC) in Finland.

Design: A cross-sectional study based on an e-questionnaire with 42 items on the content of self-management education of COPD patients.

Setting: The study sample included all public SHC units with pulmonary outpatient clinics (n?=?29) and nine out of 160 health centres in Finland.

Subjects: 83 doctors and 162 nurses.

Main outcome measures: The respondents’ answers on how regularly they included the contents regarded as essential for COPD patients’ self-management in their education of COPD patients.

Results: COPD patients were educated regularly on medical issues regarding COPD treatment, such as smoking cessation, exercise and pharmacological treatment. However, issues vital for coping with the disease, such as psychological well-being, stress management or fatigue, were often ignored. Patient education in SHC seemed to be more systematic than education in PHC. The education provided by the asthma/COPD nurses (n?=?70) was more systematic than the education provided by the other nurses (n?=?84).

Conclusion: Healthcare professionals’ continuous education should cover not only the medical but also the psychosocial aspects of coping with COPD. The role of doctors and nurses should be considered to ensure that there is no gap in COPD patients’ education. Training asthma/COPD nurses and promoting specialised nurse-led asthma/COPD clinics in primary care could be beneficial while improving practices of patient education that enhance patients’ ability to cope with the disease.

• KEY POINTS

• Issues vital for coping with chronic obstructive pulmonary disease (COPD), such as psychological well-being, stress and fatigue, are irregularly included in self-management education both in primary and specialised healthcare.

• Patient education provided by asthma/COPD nurses is more regular than patient education provided by other nurses.

• The distribution of work between doctors and nurses should be considered to ensure that there is no gap in COPD patients’ education.

     

How can task shifting put patient safety at risk? A qualitative study of experiences among general practitioners in Norway

Abstract

Objective: To describe experiences among general practitioners (GPs) in Norway regarding horizontal task shifting experiences associated with adverse events that potentially put patient safety at risk.

Design and contributors: We conducted a qualitative study with data from a retrospective convenience sample of consecutive, already posted comments in a restricted Facebook group for GPs in Norway. The sample consisted of 43 unique posts from 38 contributors (23 women and 15 men), presenting thick and specific accounts of potentially adverse events in the context of horizontal task shifting. Analysis was conducted with systematic text condensation, a method for thematic cross-case analysis.

Results: Contributing GPs reported several types of adverse events associated with horizontal task shifting that could put patient safety at risk. They described how spill-over work dispatched to GPs may generate administrative hassle and hazardous delay of necessary examinations. Overdiagnosis, reduced access and endangered accountability occur when time-consuming procedures and pre-investigation before referral are pushed upon GPs. Resource-draining chores beyond GPs’ proficiency is also dispatched without appropriate instruction or equipment. Furthermore, potential malpractice is imposed by hospital colleagues who overrule the GPs’ medical judgement.

Implications: Patient safety is endangered when horizontal task shifting is initiated and performed without a systematic process involving all stakeholders that considers available resources. A risk and vulnerability analysis, securing competent staff, resources, time and equipment before launching such reforms is necessary to protect patient safety. Infrastructure comprised of local coordination groups may facilitate dialogue between health care service levels and negotiate responsibilities and workload.

• Key points

• Task shifting between different levels of health care is a relevant and legitimate strategy for planning and policy.

• GPs in Norway report adverse events related to task shifting from specialist colleagues without proper resource allocation.

• Patient safety may be put at risk by hazardous delay, overdiagnosis, endangered accountability and potential malpractice.

• Planning and implementation of task shifting must involve all system levels and relevant stakeholders to ensure patient safety.

     

Patients’ ideas,concerns, expectations and satisfaction in primary health care – a questionnaire study of patients and health care professionals’ perspectives

Abstract

Objective: Explore the perceptions of patients and health care professionals about patients’ ideas, concerns, expectations (ICE), and satisfaction in consultations with general practitioners (GPs), district nurses (DNs) and physiotherapists (PTs).

Design: Cross-sectional questionnaire study of participants in planned consultations.

Setting: Five primary health care centers and two rehabilitation centers in Stockholm, Sweden.

Subjects: Pairs of patients and GPs (n?=?156), patients and DNs (n?=?73), and patients and PTs (n?=?69).

Main outcome measures: Multiple-choice questions about patients’ ICE and satisfaction.

Results: Approximately 75% of patients and GPs reported that patients’ thoughts and explanations about their symptoms emerged during the consultation. For patient-DN pairs, the figure was 60%, and for patient-PT pairs, 80%. A majority of patients reported not having concerns and anxiety about the investigation/treatment, whereas health care professionals thought patients were more concerned. One-third of patients consulting GPs and PTs expected to receive a reason/explanation for their symptoms. Figures were lower for the DNs. About 70% of patients were satisfied with the consultation.

Conclusions: Most patients expressed their ideas, a minority had concerns, and a minority expected an explanation of their illness. Patients and health care professionals rated patient satisfaction high, but health care professionals tended to believe patients were less satisfied than patients reported they were.

• Key points

• Patient surveys show that important aspects of patient-centeredness remain weak in Swedish primary health care; for example, shared decision-making.

• In this study of planned consultations, few patients expected to receive an explanation of their symptoms, but most were satisfied with the consultation.

• Health care professionals thought patients’ experiences were more negative than they were.

• This discrepancy was observed in responses to questions about patients’ concerns, expectations and satisfaction.

     

Requirements for implementing online information material for patients with low back pain in general practice: an interview study

Objective: To identify general practitioners’ (GPs) barriers and facilitators regarding the use of health information technology (HIT) in the treatment of patients with low back pain (LBP).

Design: A qualitative study employing a participatory design approach, with an inductive analytical thematic approach utilising semi-structured interviews. Empirical data was analysed using the qualitative data analysis software (QDAS) Nvivo.

Setting: General practices in Denmark.

Subjects: Eight interviews were conducted with an average duration of 60?min. The interviewees were GPs from different geographical settings and different organisational structures, varying in age and professional interests.

Main outcome measures: Barriers and facilitators for future use of the HIT application for patients with LBP.

Results: Through the inclusion of healthcare professionals in the design process, this study found that in order for GPs to recommend a HIT application it is essential to target the application towards their patients. Furthermore, GPs required that the HIT application should support patient self-management. Additionally, the content of the HIT application should support the initiated treatment and it should be easy for GPs to recommend the HIT application. Finally, healthcare professionals need to be involved in the design process.

Conclusion: When designing health IT applications for patients with LBP in general practice it is important to include both patients and GPs in the design process. GPs would be more willing to recommend a HIT application that: applies content in line with frequently used recommendations; targets patients; supports patients’ self-management; and supports the patients’ needs.

• KEY POINTS

• Online information is currently applied in general practice to some patients with low back pain

• Online information cannot replace the GP, but can rather be a bonding tool between the patient and the GP

• It is important to address both GP and patient barriers to applying new technology and to consider the literacy level

• Participatory methods could play a central role in the future development of online information material

     

Ties that bind,and double-bind: visual impairment,help, and the shaping of relationships

Purpose: Scholars agree that effective rehabilitation relies on a bedrock of reciprocity, relational trust, and authenticity. It is therefore essential for practitioners to develop insight into the complex dynamics within helping relationships. This study aims to provide an in-depth understanding of visually impaired students’ experience of informal helping relationships.

Methods: Ten visually impaired students at a South African university participated in one of two semi-structured focus group interviews (six and four in each group, respectively) wherein we explored their experience of informal helping relationships. Interpretive phenomenological analysis was used to make sense of the data.

Results: Help, according to the participants, can militate against visibility and complete acceptance, and has the potential to cause helpers to feel entrapped. By contrast, some students found that help offered benefits to relationships by boosting the helper’s self-esteem and affording disabled students the opportunity to make friends.

Conclusion: Decisions whether to accept help were mediated more by relationship factors than by the need for help. These findings are important for rehabilitation professionals, as deep relationship can come into being during the course of a rehabilitation process. Although this study was conducted in an informal setting, the relational dynamics that we explore are also applicable to clinical relationships between disabled persons and rehabilitation professionals.

• Implications for rehabilitation

• In this paper, we provide an overview of the intricacies involved in care and helping relationships;

• In order for rehabilitation to be successful, these relationships should ideally be real, trusting, and authentic;

• Yet, authenticity and spontaneity often get lost in helping relationships, as help-recipients may deny help when they need it, and accept help when perfectly able to cope without it. These decisions are mediated more by relationship factors than by the need for help;

• In their daily practice, it is essential for health professionals to be mindful of these relational intricacies within care relationships;

• We recommend that professionals remain motivated to continuously reflect on their own actions and on the emotional investment they might have in their role as a helper;

• Our last recommendation is for rehabilitation professionals to spend energy on exploring, through open and transparent discussions with their disabled patients, the relational dynamics in their relationship.

     

Care managers can be useful for patients with depression but their role must be clear: a qualitative study of GPs’ experiences

Abstract

Objective: Explore general practitioners’ (GPs’) views on and experiences of working with care managers for patients treated for depression in primary care settings. Care managers are specially trained health care professionals, often specialist nurses, who coordinate care for patients with chronic diseases.

Design: Qualitative content analysis of five focus-group discussions.

Setting: Primary health care centers in the Region of Västra Götaland and Dalarna County, Sweden.

Subjects: 29 GPs.

Main outcome measures: GPs’ views and experiences of care managers for patients with depression.

Results: GPs expressed a broad variety of views and experiences. Care managers could ensure care quality while freeing GPs from case management by providing support for patients and security and relief for GPs and by coordinating patient care. GPs could also express concern about role overlap; specifically, that GPs are already care managers, that too many caregivers disrupt patient contact, and that the roles of care managers and psychotherapists seem to compete. GPs thought care managers should be assigned to patients who need them the most (e.g. patients with life difficulties or severe mental health problems). They also found that transition to a chronic care model required change, including alterations in the way GPs worked and changes that made depression treatment more like treatment for other chronic diseases.

Conclusion: GPs have varied experiences of care managers. As a complementary part of the primary health care team, care managers can be useful for patients with depression, but team members’ roles must be clear.

• KEY POINTS

• A growing number of primary health care centers are introducing care managers for patients with depression, but knowledge about GPs’ experiences of this kind of collaborative care is limited.

• GPs find that care managers provide support for patients and security and relief for GPs.

• GPs are concerned about potential role overlap and desire greater latitude in deciding which patients can be assigned a care manager.

• GPs think depression can be treated using a chronic care model that includes care managers but that adjusting to the new way of working will take time.

     

Point-of-care ultrasound for general practitioners: a systematic needs assessment

Abstract

Objective: The aim of the study was to achieve consensus among a group of ultrasound proficient general practitioners (GPs) from Denmark, Norway, Sweden and Finland on which ultrasound scanning modalities and ultrasound-guided procedures are essential to GPs in their daily work for the purpose of including them in a basic ultrasound curriculum.

Design: The Delphi methodology was used to obtain consensus.

Subjects: Sixty Scandinavian GPs with more than two years of point-of-care ultrasound (POCUS) experience were invited to join the Delphi expert panel.

Main outcome measures: In the first Delphi round each member of the panel was asked to produce a list of scanning modalities and procedures which they found relevant to include in a basic ultrasound curriculum. In Delphi round two, these suggestions were presented to the entire panel who assessed whether they found them essential in their daily work. Items not reaching consensus in round two, were presented to the panel in a third and final round. Items reaching more than 67% agreement were included.

Results: Forty-five GPs were included in the study and 41 GPs completed all rounds. Agreement was obtained on 30 scanning modalities and procedures primarily within the musculoskeletal (8), abdominal (5), obstetric (5) and soft tissue (3) diagnostic areas. Four ultrasound-guided procedures were also agreed upon.

Conclusion: A prioritized list of 30 scanning modalities and procedures was agreed upon by a group of ultrasound proficient GPs. This list could serve as a guideline when planning future POCUS educational activities for GPs.

• Key points

• Point-of-care ultrasound (POCUS) is increasingly being used by general practitioners (GPs), but little is known about which ultrasound applications are most used.

• We performed a systematic needs assessment among a group of ultrasound proficient GPs using the Delphi methodology for the purpose of establishing a basic POCUS curriculum.

• The process resulted in a prioritized list of 30 scanning modalities and ultrasound guided procedures.

• Our study provides the basis for an evidence-based basic POCUS curriculum for GPs.

     

Patient and provider perspectives on reducing risk of harm in primary health care: a qualitative questionnaire study in Sweden

Abstract

Objective: To explore how patients, that had experienced harm in primary care, and how primary providers and practice managers understood reasons for harm and possibilities to reduce risk of harm.

Design: Inductive qualitative analysis of structured questionnaires with free text answers.

Setting: Primary health care in Sweden.

Patients/subjects: Patients (n?=?22) who had experienced preventable harm in primary health care, and primary care providers and practice managers, including 15 physicians, 20 nurses and 24 practice managers.

Main outcome measures: Categories and overarching themes from the qualitative analysis.

Results: The three categories identified as important for safety were continuity of care, communication and competence. With flaws in these, risks were thought to be greater and if these were strengthened the risks could be reduced. The overarching theme for the patient was the experience of being neglected, like not having been properly examined. The overarching theme for primary care providers and practice managers was lack of continuity of care.

Conclusion: Primary care providers, practice managers and patients understood the risks and how to reduce the risks of patient safety problems as related to three main categories: continuity of care, communication and competence. Future work towards a safer primary health care could therefore benefit from focusing on these areas.

• Key points

• Current awareness:

• ??Patients and primary care providers are rather untapped sources of knowledge regarding patient safety in primary health care.

• Main statements:

• ??Patients understood the risk of harm as stemming from that they were not properly examined.

• ??Primary care providers understood the risk of harm to a great extent as stemming from poor continuity of care.

• ??Patients, primary care providers and practice managers believed continuity, communication and competence play an important role in reducing risks.

     

Patients’ needs during a surgical intervention process for Dupuytren’s disease

Purpose: To explore and describe clients’ needs during a surgical intervention process for Dupuytren’s disease.

Materials and methods: Design: Interview study with 21 men undergoing surgical intervention for Dupuytren’s disease. Qualitative content analysis was performed with the model of Patient Evaluation Process as a theoretical framework.

Results: The primary reason for seeking medical care was to receive an intervention to improve hand function. The need for knowledge was evident during the care process, and was connected to involvement in decision-making. During surgery and rehabilitation, participants needed support with pain relief, a sense of security, support for self-care, or sick leave. There was also a need for participation in the evaluation and improvement of care. Clients’ life situations contributed to the occurrence of needs or were a resource for handling them. Depending on patient character, clients handled their perceived needs differently.

Conclusions: Clients’ needs during a surgical intervention process include needs for improvement of hand function, knowledge, and support during treatment, and participation in evaluation. Clients’ needs change during the care process and can be influenced by their life situation or their character. The identified needs ought to be included in quality assessments from the carers’ perspective, to ensure that important needs of the clients are met by the surgical intervention process. Communication and interaction between client and health care provider is a key aspect of fulfilling clients’ needs.

• Implications for rehabilitation

• Patients have need for knowledge throughout the care process: about the disease, risk factors, treatment options, practical and medical information related to the treatment and recovery, and about the care process as a whole.

• Need for knowledge is closely connected to patients’ experience of being involved in decision making.

• Patients need support with both general human and specific medical issues during surgery and rehabilitation.

• Patients’ needs change during the care process and can be influenced by the patient’s life situation or character.

• From the carers’ perspective, the identified needs ought to be included in quality assessments to ensure that important needs of the clients are met by the surgical intervention process.

     

Burn care and rehabilitation in Australia: health professionals’ perspectives

Objective: To understand health professionals’ perspectives of burn care and rehabilitation.

Design: Qualitative and semi-structured interviews.

Setting: Australian burn and rehabilitation units.

Participants: Twenty-two clinicians working in burns units across disciplines and healthcare settings.

Results: The data portrayed the health professionals’ perspectives of burn care and rehabilitation in Australia. Three themes were identified: (1) interprofessional collaboration; (2) integrated community care, and (3) empowering patients to self-care.

Conclusion: Burn care and rehabilitation remains a complex and a challenging area of care with limited access to burn services especially in rural and remote areas. Interprofessional training and education of health professionals involved with the complex care of burn injury remains a key element to support and sustain the long-term rehabilitation requirements for patients and their families. Empowering patients to develop independence early in their rehabilitation is fundamental to their ongoing recovery. A burns model of care that embraces a multidisciplinary collaboration and integrated care across the continuum has the potential to positively impact recovery and improve health outcomes.

• Implications for rehabilitation

• Burn care and rehabilitation remains a complex and challenging area of care.

• Managing the rehabilitation phase after burn injury can be as complex as managing the acute phase.

• Interprofessional collaboration, integrated community care, and empowering patients to self-care are key elements for sustaining the rehabilitation of adults with burn injuries.

     

Return-to-work success despite conflicts: an exploration of decision-making during a work rehabilitation program*

Abstract

Purpose: Collective decision-making by stakeholders appears important to return-to-work success, yet few studies have explored the processes involved. This study aims to explore the influence of decision-making on return-to-work for workers with musculoskeletal or common mental disorders.

Method: This study is a secondary analysis using data from three earlier multiple-case studies that documented decision-making during similar and comparable work rehabilitation programs. Individual interviews were conducted at the end of the program with stakeholders, namely, the disabled workers and representatives of health care professionals, employers, unions and insurers. Verbatims were analysed inductively.

Results: The 28 decision-making processes (cases) led to 115 different decisions-making instances and included the following components: subjects of the decisions, stakeholders’ concerns and powers, and types of decision-making. No differences were found in decision-making processes relative to the workers’ diagnoses or return-to-work status. However, overall analysis of decision-making revealed that stakeholder agreement on a return-to-work goal and acceptance of an intervention plan in which the task demands aligned with the worker’s capacities were essential for return-to-work success.

Conclusion: These results support the possibility of return-to-work success despite conflictual decision-making processes. In addition to facilitating consensual decisions, future studies should be aimed at facilitating negotiated decisions.

• Implications for rehabilitation

• Facilitating decision-making, with the aim of obtaining agreement from all stakeholders on a return-to-work goal and their acceptance of an intervention plan that respects the worker’s capacities, is important for return-to-work success.

• Rehabilitation professionals should constantly be on the lookout for potential conflicts, which may either complicate the reach of an agreement between the stakeholders or constrain return-to-work possibilities.

• Rehabilitation professionals should also be constantly watching for workers’ and employers’ return-to-work concerns, as they may change during work rehabilitation, potentially challenging a reached agreement.

     

Health professionals’ perspectives of next of kin in the context of reablement

Aim: To describe health professionals’ perspectives of next of kin in the context of reablement.

Methods: A total of 49 health professionals from different organizational levels participated. Their ages, genders, experiences, and professions varied. A total of 10 focus group discussions were held in two municipalities. The data analysis was conducted using a constructivist grounded theory approach.

Results: The core category was identified as negotiating between themselves. Two categories captured the different dimensions of the core category: facing a dilemma with next of kin in reablement and ambiguous motives for collaborating with next of kin.

Conclusion: In collaboration with next of kin, it is important for health professionals to be aware of and manage the possible differences in expectations and opinions concerning reablement. Health professionals need to acknowledge that next of kin can be a source of support for older adults. They also need to take into consideration that next of kin may need support, information, and education associated with their roles as next of kin to older adults.

• Implications for rehabilitation

• Health professionals need to be aware of how they collaborate with next of kin and what they expect of them.

• There is a need for health professionals to find a routine in how next of kin can become partners in reablement without compromising the older adult’s autonomy.

• This study contributes to further awareness of the different roles of health professionals and next of kin regarding expectations of reablement.

• Health professionals may benefit from providing a more family-centred approach by taking into account that next of kin can be a resource in reablement. In addition, they need to take into consideration that next of kin also have their own needs and must be respected.

     

Caregiver perspectives on a smart home-based socially assistive robot for individuals with Alzheimer’s disease and related dementia

Abstract

Purpose: Innovative assistive technology can address aging-in-place and caregiving needs of individuals with Alzheimer’s disease and related dementia (ADRD). The purpose of this study was to beta-test a novel socially assistive robot (SAR) with a cohort of ADRD caregivers and gather their perspectives on its potential integration in the home context.

Methods: The SAR involved a programmable research robot linked with commercially available Internet of things sensors to receive and respond to care recipient’s behaviour. Eight caregivers observed the SAR perform two care protocols concerning the care recipient’s daily routine and home safety, and then participated in a focus group and phone interview. The researchers used grounded theory and the Unified Theory of Acceptance and Use of Technology as a framework to gather and analyse the data.

Results: The caregivers’ asserted the potential of the SAR to relieve care burden and envisioned it as a next-generation technology for caregivers. Adoption of the SAR, as an identified theme, was subject to the SAR’s navigability, care recipient engagement, adaptability, humanoid features, and interface design. In contrast, barriers leading to potential rejection were technological complexity, system failure, exasperation of burden, and failure to address digital divide.

Conclusion: From a broader outlook, success of SARs as a home-health technology for ADRD is reliant on the timing of their integration, commercial viability, funding provisions, and their bonding with the care recipient. Long-term research in the home settings is required to verify the usability and impact of SARs in mediating aging-in-place of individuals with ADRD.

• IMPLICATIONS FOR REHABILITATION

• Socially assistive robots (SARs), an emerging domain of assistive technology, are projected to have a crucial role in supporting aging-in-place of individuals with Alzheimer's disease and related dementia (ADRD).

• Caregivers of individuals with ADRD who observed and interacted with a novel SAR asserted their acceptance of the technology as well as its scope and feasibility for the upcoming generation of caregivers.

• Navigability, care recipient engagement, adaptability, humanoid features, and interface design were stated to be critical factors for SAR's acceptance by caregiver and care recipient dyads.

• In contrast, technological complexity, system failure, exasperation of burden, and failure to address digital divide are detrimental to SAR's adoption.

• Several design and implementation requirements must be considered towards the full-scale development and deployment of the SARs in the home context.

     

Meeting the mental health needs of people with multiple sclerosis: a qualitative study of patients and professionals

Purpose: To explore perspectives and experiences of people with multiple sclerosis (MS) and health care professionals of mental health support for MS in the UK.

Method: 24 people with MS, 13 practice nurses, 12 general practitioners (GPs) and 9?MS specialist nurses were recruited through community groups and primary care practices across North West England. Semi-structured interviews were conducted, and data analyzed thematically using constant comparative analysis within and across the data sets. The theoretical framework of candidacy was used to interrogate data.

Results: Four themes were identified: candidates for care, management choices, defining roles, and permeability and responsiveness.

Discussion: Candidacy for care, and symptom management, depended on the framing of symptoms through a social or medical model of depression. Normalizing symptoms could prevent help-seeking by patients. Reported referral behavior varied by professional group, based on perceived remit, competency and training needs. GPs were perceived by patients and other professionals as central for management of mental health needs in MS, but may not perceive this role themselves, suggesting a need for increased knowledge, training, and improved access to specialist care.

• Implications for Rehabilitation

• Anxiety and depression are common in people with MS.

• Management of mental health needs in people with MS relies on complex decisions made by both people with MS and health care professionals.

• General practitioners may play a key role in the ongoing management of mental health needs of people with MS.

     

‘We have no crystal ball’ - advance care planning at nursing homes from the perspective of nurses and physicians

Objective: To investigate clinicians’ perspectives on the factors that shape the process of advance care planning in a nursing home context.

Design: Interviews. Latent qualitative content analysis.

Setting: Nine nursing homes in Sweden.

Subjects: 14 physicians and 11 nurses working at nursing homes.

Main outcome measures: Participants’ views on advance care planning (ACP) at nursing homes.

Results: The analysis of the interviews resulted in four manifest categories: Exploration of preferences and views, e.g. exploring patient wishes regarding end-of-life issues and restrictions in care at an early stage, and sensitivity to patient’s readiness to discuss end-of-life issues; Integration of preferences and views, e.g. integration of patient’s preferences and staff’s and family member’s views; Decision & documentation of the ACP, e.g. clear documentation in patient’s medical records that are up-to-date and available for staff caring for the patient, and Implementation & re-evaluation of the ACP, e.g. nurse following up after ACP-appointment to confirm the content of the documented ACP. The latent theme, Establishing beneficence – defending oneself against tacit accusations of maleficence, emerged as a deeper meaning of all the four (manifest) parts of the ACP-process

Conclusion: This study stresses the importance of involving patients, family members, and the team in the work with advance care planning in nursing homes. In addition, clear medical record documentation and proficiency in end-of-life communication related to advance care planning for physicians as well as nurses may also be factors that significantly shape advance care planning in a nursing home context.

• Key Points

• Advance care planning can help patients to receive care in line with their preferences and can positively impact quality of end-of-life care.

• Our results describe a process consisting of four manifest categories and one latent theme constituting the process of advance care planning, that may be considered in education in advance care planning.

• The significance of nurses and physicians perceiving beneficence as well as fear of accusations of maleficence are important factors to contemplate.

• The study has implications for healthcare staff caring for patients near the end of their lives, in particular patients in nursing homes.

     

A condensed wheelchair skills training ‘bootcamp’ improves students’ self-efficacy for assessing,training, spotting,and documenting manual and power wheelchair skills

Abstract

Objectives: To determine the influence of a bootcamp training approach on students’ self-efficacy for assessing, training, spotting, documenting, and performing manual and power wheelchair skills.

Methods: In a pre-post design, students in their final year of an entry-to-practice master of occupational therapy program completed a two-day manual (6.5?h) and power (6.5?h) wheelchair skills bootcamp. Outcomes for self-efficacy (in assessing, training, spotting and documenting manual and power wheelchair skills; primary) and capacity (manual and power wheelchair skills; secondary) were collected at baseline and immediately after the bootcamp.

Results: Participants (n?=?44) were 27.3?±?4.3?years of age (41 female). Most students (81.8%) reported little previous experience using manual and power wheelchairs at baseline. Students’ self-efficacy for assessing, training, spotting, and documenting manual and power wheelchair skills improved by between 28.4% and 35.3%, representing a change from ‘somewhat confident’ to ‘fairly confident’. Students’ manual and power wheelchair skills capacity increased by 47.2% and 37.1% respectively.

Conclusions: Wheelchair skills training bootcamps may help prepare occupational therapy students to assess, train, spot, and document manual and power wheelchair skills of future clients, while improving students’ wheelchair skills capacity; thus may provide an option for integrating wheelchair skills training into the curriculum of time-intensive programs.

• Implications for rehabiliation

• A two-day condensed wheelchair skills training workshop improves occupational therapy

• students’ self-efficacy for assessing, training, spotting and documenting power and

• manual wheelchair skills.

• A two-day condensed wheelchair skills training workshop improves occupational

• therapy students’ power and manual wheelchair skills.

• Self-efficacy is an indicator of future behaviours. Therefore, improving students’ selfefficacy

• for assessing training and documenting wheelchair skills may influence their future practice.