Homelessness is a social condition increasing in frequency and severity across Canada. Interventions to end and prevent homelessness include effective case management in addition to an affordable housing provision. Little standardization exists for service providers to guide their decision making in developing and maintaining effective case management programs. The purpose of this 2-part article is to articulate dimensions of promising practice for case managers working in a "Housing First" context. Part 1 discusses research processes and findings and Part 2 articulates the 6 dimensions of quality.
Practice settings include community-based organizations that employ and support case managers whose primary role is moving people from homelessness into permanent supportive housing.
Six dimensions of promising practice are critically important to reducing barriers, improving sector collaboration, and ensuring that case managers have appropriate and effective training and support. Dimensions of promising practice are (1) collaboration and cooperation-a true team approach; (2) right matching of services-person-centered; (3) contextual case management-culture and flexibility; (4) the right kind of engagement-relationships and advocacy; (5) coordinated and well-managed system-ethics and communication; and (6) evaluation for success-support and training.
Effective, coordinated case management, in addition to permanent affordable housing has the potential to reduce a person's or family's homelessness permanently. Organizations and professionals working in this context have the opportunity to improve processes, reduce burnout, collaborate and standardize, and, most importantly, efficiently and permanently end someone's homelessness with the help of dimensions of quality for case management.
The winner of the "Best Original Research Paper in Cancer Nursing" Award for 2013 is "Effects of an Internet Support System to Assist Cancer Patients in Reducing Symptom Distress: A Randomized Controlled Trial" by Cornelia M. Ruland, PhD.
The Alumni Program is a novel approach to the continuing care and preventive treatment of clients with "chronic" mental illness. This approach demands a different conceptualization of outpatient psychiatric intervention. The infectious disease model has been deliberately replaced with a chronic illness model that more accurately reflects the course and natural history of psychiatric illness. The Alumni Program is similar to the approach employed with other chronic medical conditions like arthritis, asthma, or diabetes. The program has complementary roles for both specialty psychiatric clinicians and family practitioners. In addition, the program empowers clients and their families to play a key role in their own ongoing adaptation and adjustment to chronic illness while striving for optimal wellness.
Many dietetic researchers have recommended the use of a client-centered approach to counseling, but little has been written about what that means from the perspective of the practicing dietitian. The purpose of this study was to explore dietitians' understanding of the client-centered approach to nutrition counseling. In-depth qualitative interviews were conducted with 25 Canadian dietitians from a variety of practice areas. Interview transcripts were analyzed using a form of inductive, thematic analysis. Results suggest that although participants believe that practicing in a client-centered manner is important, they were struggling in their attempt to balance their practice values and beliefs with the realities of their work environments. Meeting clients' needs and wants was seen as critical to the client-centered approach, but there was some indecision around who determines these needs and what the difference is between needs and wants. Recognizing the expertise that clients can bring to the counseling relationship was also an issue for participants. Additional research to explore the way that dietitians learn how to counsel can lead to a better understanding of how to develop effective therapeutic relationships with our clients within the confines of current workplace environments.
Cardiac self-efficacy is a person's belief in his/her ability to manage the challenges posed by a coronary disease, and its role has been evaluated in several coronary populations using the Cardiac Self-Efficacy Scale (CSE Scale). Self-efficacy has an important role in person-centred care, however there is a lack of appropriate instruments that evaluate person-centred interventions.
The purpose of this study was to validate the CSE Scale by examining its psychometric properties as a first step in evaluating a person-centred care intervention in persons with acute coronary syndrome (ACS).
The study sample consisted of 288 persons (72 women, 216 men) who completed the Swedish version of the CSE Scale two months after hospitalisation for an ACS event. Construct validity was psychometrically evaluated using confirmatory factor analysis. Additionally, convergent and discriminant validity were tested using correlation analyses.
The results revealed that the CSE Scale was represented by three dimensions (control symptoms, control illness and maintain functioning). The analyses also showed that the CSE Scale is suitable for providing a total summary score that represents a global cardiac self-efficacy dimension. Evaluation of convergent and discriminant validity showed the expected correlations.
The CSE Scale is a valid and reliable measure when evaluating self-efficacy in patients with ACS. It also seems to be a useful tool to promote person-centred care in clinical practice since it may offer useful guidance in the dialogue with the patient in the common creation of a personal health plan.
In this article we discuss the findings from a series of focus groups conducted as part of a 3-year, mixed-method evaluation of clinical programs in a large mental health and substance use treatment facility in Canada. We examined the perceptions of clinical personnel on the physical design of new treatment units and the impact on service delivery and the work environment. The new physical design appeared to support client recovery and reduce stigma; however, it brought certain challenges. Participants reported a compromised ability to monitor clients, a lack of designated therapeutic spaces, and insufficient workspace for staff. They also thought that physical design positively facilitated communication and therapeutic relationships among clinicians and clients, and increased team cohesion. We suggest that, from these findings, new avenues for research on achieving the important balance between client and staff needs in health facility design can be explored.
We investigated the perceived usefulness by 65 nurses and 12 physicians who had used CHOICE, a support system designed to improve patient-centred symptom management for cancer patients at the point of care. Two questionnaires addressed the following aspects: clinicians' usage patterns; ease of use; system ability to improve care planning, understanding of patients' perspectives, and patient-provider communication; attitudes towards patients' involvement in decision making about patient care; and perceived usefulness, defined as a system's ability to enhance work performance. The overall survey response rate was 78%. Clinicians reported that they had used information outputs provided by the CHOICE system on average 50% of the time, but nurses used them significantly more than physicians. The system received high ratings on all aspects of usefulness by both groups, but again, nurses provided consistently higher usefulness ratings than physicians did. There was a strong, significant correlation between patterns of use and perceived usefulness. There were no correlations between perceived usefulness and respondents' age, gender and clinical experience. Results confirm that the CHOICE system can successfully assist nurses and physicians to improve patient care for cancer patients in ongoing practice.
To discover some of the means by which nurses let older people know that they sense their suffering and are willing to try to relieve or at least reduce it.
A purposive sample of seven nurses employed in long-term care in Canada was recruited by network sampling. Data from unstructured interviews and participant observations were analysed and themes identified.
The overarching theme identified was attention to the essential ordinary, with two sub-themes being 'attention to the little things' and 'keeping the promise to never abandon'.
Paying attention to the little things, and the resulting patient-centred approach that this care provided, seemed to send a message to patients that they had value. When nurses were able to enhance the esteem needs of patients in this way they also found meaning in their work and a sense of professional fulfilment.
The study describes how relationships are created with persons with moderate to severe dementia. The material comprises 24 video sequences of Relational Time (RT) sessions, 24 interviews with persons with dementia and eight interviews with professional caregivers. The study method was Constructivist Grounded Theory. The categories of 'Assigning time', 'Establishing security and trust' and 'Communicating equality' were strategies for arriving at the core category, 'Opening up', which was the process that led to creating relationships. Both parties had to contribute to create a relationship; the professional caregiver controlled the process, but the person with dementia permitted the caregiver's overtures and opened up, thus making the relationship possible. Interpersonal relationships are significant to enhancing the well-being of persons with dementia. Small measures like RT that do not require major resources can open paths to creating relationships.
For most critically ill patients requiring mechanical ventilation in the intensive care unit (ICU) weaning is uncomplicated. For the remainder, weaning is a challenge and may result in further complications and increased risk of mortality. Critical care nurses (CCNs) require substantial knowledge and experience to manage patients experiencing prolonged weaning.
The aim of this study was to explore CCNs approach for management of patients experiencing prolonged weaning in the ICU.
A descriptive qualitative design.
Semi-structured interviews with 19 experienced CCNs were conducted. Data were analysed using content analysis.
Participants used various strategies for weaning that were grouped into four categories: individualized planning for the weaning process, assessing patient's capacity, managing the process and team interaction. The overall theme that emerged was: CCNs drive the weaning process using both a patient centred and targeted approach.
CCNs in these ICUs performed weaning using a patient centred approach to plan, initiate, assess and establish a holistic weaning process. Team collaboration among all health care practitioners was important. CCNs have a key role in prioritizing weaning and driving the process forward.
Closeness to the patient and a key role in management of the mechanical ventilated patient in ICU gives the CCN unique potential to develop and create models and tools for prolonged weaning. These tools, specially designed for patients undergoing prolonged weaning, would give focus on continuous planning, collaborating, managing and evaluation in the process of liberating patients from mechanical ventilation.