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Patient advocacy: barriers and facilitators
Reza Negarandeh, Fatemeh Oskouie, Fazlollah Ahmadi, Mansoure Nikravesh, Ingalill Hallberg
BMC Nursing , 2006, DOI: 10.1186/1472-6955-5-3
Abstract: This study was conducted by grounded theory method. Participants were 24 Iranian registered nurses working in a large university hospital in Tehran, Iran. Semi-structured interviews were used for data collection. All interviews were transcribed verbatim and simultaneously Constant comparative analysis was used according to the Strauss and Corbin method.Through data analysis, several main themes emerged to describe the factors that hindered or facilitated patient advocacy. Nurses in this study identified powerlessness, lack of support, law, code of ethics and motivation, limited communication, physicians leading, risk of advocacy, royalty to peers, and insufficient time to interact with patients and families as barriers to advocacy. As for factors that facilitated nurses to act as a patient advocate, it was found that the nature of nurse-patient relationship, recognizing patients' needs, nurses' responsibility, physician as a colleague, and nurses' knowledge and skills could be influential in adopting the advocacy role.Participants believed that in this context taking an advocacy role is difficult for nurses due to the barriers mentioned. Therefore, they make decisions and act as a patient's advocate in any situation concerning patient needs and status of barriers and facilitators. In most cases, they can not act at an optimal level; instead they accept only what they can do, which we called 'limited advocacy' in this study. It is concluded that advocacy is contextually complex, and is a controversial and risky component of the nursing practice. Further research is needed to determine the possibility of a correlation between identified barriers/ facilitators and the use of advocacy.The role of patient advocacy is not new for nurses. Historically, patient advocacy has been a moral obligation for nurses. During recent years, nursing literature has been focused on the advocacy role and nursing professions has adopted the term 'patient advocacy' to denote an ideal of the
Barriers and Facilitators to Community Mobility for Assistive Technology Users  [PDF]
Natasha Layton
Rehabilitation Research and Practice , 2012, DOI: 10.1155/2012/454195
Abstract: Mobility is frequently described in terms of individual body function and structures however contemporary views of disability also recognise the role of environment in creating disability. Aim. To identify consumer perspectives regarding barriers and facilitators to optimal mobility for a heterogeneous population of impaired Victorians who use assistive technology in their daily lives. Method. An accessible survey investigated the impact of supports or facilitators upon actual and desired life outcomes and health-related quality of life, from 100?AT users in Victoria, Australia. This paper reports upon data pertaining to community mobility. Results. A range of barriers and enablers to community mobility were identified including access to AT devices, environmental interventions, public transport, and inclusive community environs. Substantial levels of unmet need result in limited personal mobility and community participation. Outcomes fall short of many principles enshrined in current policy and human rights frameworks. Conclusion. AT devices as well as accessible and inclusive home and community environs are essential to maximizing mobility for many. Given the impact of the environment upon the capacity of individuals to realise community mobility, this raises the question as to whether rehabilitation practitioners, as well as prescribing AT devices, should work to build accessible communities via systemic advocacy. 1. Introduction Getting around at the home and in the community is a core activity, central to much human participation and therefore of key interest to rehabilitation practitioners. Identifying the constraints and supports which consumers perceive as impacting their current and desired life outcomes will both inform the work of rehabilitation practitioners and identify any barriers usually beyond the gaze of rehabilitation practice [1]. 1.1. Mobility Mobility, defined by the Oxford Dictionary of English [2] as the capacity to move, is a core element of human capacity. Independent mobility, preferably without the need for assistive technology (AT), is viewed as a key outcome measure, alongside communication and self-care, in the rehabilitation literature [3]. Health-related quality-of-life measures also regard the capacity to independently mobilize as a key indicator for quality of life [4, 5]. The extent of mobility will depend upon both the capacity of the person and the nature of the environments in which the person operates. A tension exists in considering the relationship between the person and the environment in which mobility takes
Lynch syndrome: barriers to and facilitators of screening and disease management
Kathy E Watkins, Christine Y Way, Jacqueline J Fiander, Robert J Meadus, Mary Esplen, Jane S Green, Valerie C Ludlow, Holly A Etchegary, Patrick S Parfrey
Hereditary Cancer in Clinical Practice , 2011, DOI: 10.1186/1897-4287-9-8
Abstract: The study used a grounded theory approach to data collection and analysis as part of a multiphase project examining the psychosocial and behavioral impact of predictive DNA testing for Lynch syndrome. Individual and small group interviews were conducted with individuals from 10 families with the MSH2 intron 5 splice site mutation or exon 8 deletion. The data from confirmed carriers (n = 23) were subjected to re-analysis to identify key barriers to and/or facilitators of screening and disease management.Thematic analysis identified personal, health care provider and health care system factors as dominant barriers to and/or facilitators of managing Lynch syndrome. Person-centered factors reflect risk perceptions and decision-making, and enduring screening/disease management. The perceived knowledge and clinical management skills of health care providers also influenced participation in recommended protocols. The health care system barriers/facilitators are defined in terms of continuity of care and coordination of services among providers.Individuals with Lynch syndrome often encounter multiple barriers to and facilitators of disease management that go beyond the individual to the provider and health care system levels. The current organization and implementation of health care services are inadequate. A coordinated system of local services capable of providing integrated, efficient health care and follow-up, populated by providers with knowledge of hereditary cancer, is necessary to maintain optimal health.The increased use of predictive DNA testing to determine the hereditary basis of familial cancer has important implications for cognitive, affective and behavioral outcomes of high risk individuals. Investigations into the impact of genetic testing have focused more on cognitive and affective responses and less on factors facilitating optimal disease management. Our understanding of behavioral responses is a significant gap in the research literature.The most commo
Facilitators and barriers in the humanization of childbirth practice in Japan
Roxana Behruzi, Marie Hatem, William Fraser, Lise Goulet, Masako Ii, Chizuru Misago
BMC Pregnancy and Childbirth , 2010, DOI: 10.1186/1471-2393-10-25
Abstract: A qualitative field research design was used in this study. Forty four individuals and nine institutions were recruited. Data was collected through observation, field notes, focus groups, informal and semi-structured interviews. A qualitative content analysis was performed.All the settings had implemented strategies aimed at reducing caesarean sections, and keeping childbirth as natural as possible. The barriers and facilitators encountered in the practice of humanized birth were categorized into four main groups: rules and strategies, physical structure, contingency factors, and individual factors. The most important barriers identified in humanized birth care were the institutional rules and strategies that restricted the presence of a birth companion. The main facilitators were women's own cultural values and beliefs in a natural birth, and institutional strategies designed to prevent unnecessary medical interventions.The Japanese birthing institutions which have identified as part of their mission to instate humanized birth have, as a whole, been successful in improving care. However, barriers remain to achieving the ultimate goal. Importantly, the cultural values and beliefs of Japanese women regarding natural birth is an important factor promoting the humanization of childbirth in Japan.Childbirth is regarded as one of the most important events in a women's life, and it can, in turn, affect the rest of their life, both physically, and emotionally [1].During the past decades, giving birth has been increasingly medicalized procedures in most of countries [2,3]. Pregnancy and birth were conceptualized as pathological processes that require intensive monitoring by a physician. Medical interventions in childbirth such as use of electronic fetal monitoring (EFM), epidural analgesia, amniotomy, induced labour, episiotomy, and elective caesarean section deliveries increased especially in the North America in the last decade and continue to increase [4-6]. These proced
Facilitators and barriers to implementing clinical care pathways
Sara Evans-Lacko, Manuela Jarrett, Paul McCrone, Graham Thornicroft
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-182
Abstract: Care pathways can provide patients with clear expectations of their care, provide a means of measuring patient's progress, promote teamwork on a multi-disciplinary team, facilitate the use of guidelines, and may act as a basis for a payment system. In order to achieve adequate implementation, however, facilitators and barriers must be considered, planned for, and incorporated directly into the pathway with full engagement among clinical and management staff. Barriers and/or facilitators may be present at each stage of development, implementation and evaluation; and, barriers at any stage can impede successful implementation. Important considerations to be made are ensuring the inclusion of all types of staff, plans for evaluating and incorporating continuous improvements, allowing for organisational adaptations and promoting the use of multifaceted interventions.Although there is a dearth of information regarding the successful implementation of care pathways, evidence is available which may be applied when implementing a care pathway. Multifaceted interventions which incorporate all staff and facilitate organisational adaptations must be seriously considered and incorporated alongside care pathways in a continuous manner. In order to better understand the mechanism upon which care pathways are effective, however, more research specifically addressing conditions under which providers become engaged in using care pathways is needed.Care pathways may serve as useful and evidence-based tools to reduce variations in clinical practice and improve quality and outcomes of healthcare interventions. Care pathway implementation is likely to become increasingly emphasised in England given its prominence within the recent Governmental health policy reports of Lord Darzi [1,2]. Care pathways are cited by Darzi as a form of quality improvement to be implemented in the NHS, and indeed pathway development has already begun for selected health conditions in all regions of the countr
Facilitators and barriers to screening for child abuse in the emergency department
Eveline CFM Louwers, Ida J Korfage, Marjo J Affourtit, Harry J De Koning, Henri?tte A Moll
BMC Pediatrics , 2012, DOI: 10.1186/1471-2431-12-167
Abstract: This qualitative study is based on semi-structured interviews with 27 professionals from seven Dutch hospitals (i.e. seven pediatricians, two surgeons, six ED nurses, six ED managers and six hospital Board members). The resulting list of facilitators/barriers was subsequently discussed with five experts in child abuse and one implementation expert. The results are ordered using the Child Abuse Framework of the Dutch Health Care Inspectorate that legally requires screening for child abuse.Lack of knowledge of child abuse, communication with parents in the case of suspected abuse, and lack of time for development of policy and cases are barriers for ED staff to screen for child abuse. For Board members, lack of means and time, and a high turnover of ED staff are impediments to improving their child abuse policy. Screening can be promoted by training ED staff to better recognize child abuse, improving communication skills, appointing an attendant specifically for child abuse, explicit support of the screening policy by management, and by national implementation of an approved protocol and validated screening instrument.ED staff are motivated to work according to the Dutch Health Care Inspectorate requirements but experiences many barriers, particularly communication with parents of children suspected of being abused. Introduction of a national child abuse protocol can improve screening on child abuse at EDs.Early detection of child abuse is a priority of the Dutch Health Care Inspectorate; in the Netherlands, each year 107,200 children are victim of some type of child abuse [1]. Child abuse is an important public health problem: besides the serious consequences for each child and their environment, the estimated costs of child abuse in the Netherlands are 965 million euros per annum [2,3].The Dutch media frequently report the inadequate detection of child abuse in hospital emergency departments (EDs). Since January 2009 all EDs are legally required to fulfil the Inspec
Drug use and barriers to and facilitators of drug treatment for homeless youth
Adeline Nyamathi, Angela Hudson, Malaika Mutere, Ashley Christiani, Jeff Sweat, Kamala Nyamathi, Theresa Broms
Patient Preference and Adherence , 2007, DOI: http://dx.doi.org/10.2147/PPA.S
Abstract: ug use and barriers to and facilitators of drug treatment for homeless youth (3741) Total Article Views Authors: Adeline Nyamathi, Angela Hudson, Malaika Mutere, Ashley Christiani, Jeff Sweat, Kamala Nyamathi, Theresa Broms Published Date October 2007 Volume 2007:1 Pages 1 - 8 DOI: http://dx.doi.org/10.2147/PPA.S Adeline Nyamathi1, Angela Hudson1, Malaika Mutere1, Ashley Christiani2, Jeff Sweat3, Kamala Nyamathi1, Theresa Broms1 1School of Nursing, 2David Geffen School of Medicine, 3Department of Sociology, University of California, Los Angeles, CA, USA Abstract: In the United States, homeless youth are becoming increasingly entrenched in problem substance use, including high prevalence of alcohol abuse and injection use. A total of 54 substance-using homeless youth (18–25 years) participated in focus groups in order to provide their perspectives on barriers to and facilitators of seeking treatment. Participants were recruited from shelters in Hollywood, CA, and from a street-based, drop-in site in Santa Monica, CA. Participants identified personal barriers to treatment, but reported that facilitators of treatment tended to be more systematic. Homeless youth used and abused substances to dim the psychological effects of living on the streets. They appreciated programs that facilitated treatment and rehabilitation such as mentoring, support groups, and alternative choices to substance use. Implications point to the need for further development and research on culturally-appropriate, age-sensitive programs for homeless youth. The experiences of these youth underscore the need for strategic interventions.
Is untargeted educational outreach visiting delivered by pharmaceutical advisers effective in primary care? A pragmatic randomized controlled trial
Martin P Eccles, Ian N Steen, Paula M Whitty, Lesley Hall
Implementation Science , 2007, DOI: 10.1186/1748-5908-2-23
Abstract: Within a pragmatic randomized controlled trial, involving all general practices in two primary care trusts (PCTs), routine methods were used to distribute guidelines for the choice of antidepressants for the management of depression. Intervention practices were offered two visits (most accepted only one) by their PCT pharmaceutical adviser who had been trained in the techniques of outreach visiting. Intervention practices were visited regardless of whether they had prior problems with prescribing ('untargeted' visits). The intervention was evaluated using level three prescribing analysis and cost (PACT) data for antidepressant drugs for the six months during which the intervention was delivered and the subsequent twelve months.Across the 72 study practices there was no significant impact of the intervention on usage of any group of antidepressant drugs.The routine use of untargeted educational outreach visiting delivered by existing pharmaceutical advisers may not be a worthwhile strategy.ClinicalTrials.gov NCT00393536There is increasing evidence that clinical guidelines can lead to improvements in both the process and outcome of care [1]. They figure prominently within the UK, particularly since the inception of the Scottish Intercollegiate Guidelines Network (SIGN) and the National Institute for Health and Clinical Excellence (NICE). However, clinical guidelines are not self-implementing, and there is a growing body of research that demonstrates the effectiveness of various implementation strategies [1]. This has suggested that while the commonly used strategy of the postal distribution of educational materials alone may change clinicians' behaviour, it is unlikely to lead to large changes in practice. Educational outreach visits, using a trained person to meet face-to-face with a health care professional to provide information, may improve practice, especially prescribing behaviour [1,2].Estimating the effectiveness of educational outreach is complicated by the f
Barriers and facilitators of research utilization among nurses working in teaching hospitals in Tabriz
Vali Zadeh,L. (M.Sc),Zaman Zadeh,V. (M.Sc)
Hayat Journal of Faculty of Nursing & Midwifery , 2002,
Abstract: This research is a descriptive study in order to assess barriers and facilitators of research utilization among nurses working in teaching hospitals in Tabriz, year 2001. The aim is to identify causes of low extent of utilization and also to assess barriers and facilitators of researches. This study was conducted upon 304 nurses working in 12 teaching hospitals of Tabriz, which were selected by random sampling. Instrument used for study was questionnaire. Data were analyzed using SPSS (10). The results of this study showed that three major barriers for research utilization included: 1) inadequate facilities for implementation, 2) Physicians will not cooperate with implementation and 3) the nurses do not have sufficient time to read researches. Facilitators which nurses suggested, emphasized on the role of education in enhancing their knowledge and skills of research evaluation.
Barriers to and Facilitators of Research Utilization: A Survey of Registered Nurses in China  [PDF]
Li-Ping Wang, Xiao-Lian Jiang, Lei Wang, Guo-Rong Wang, Yang-Jing Bai
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0081908
Abstract: Aims This survey aims to describe the perception of barriers to and facilitators of research utilization by registered nurses in Sichuan province, China, and to explore the factors influencing the perceptions of the barriers to and facilitators of research utilization. Methods A cross sectional survey design and a double cluster sampling method were adopted. A total of 590 registered nurses from 3 tertiary level hospitals in Sichuan province, China, were recruited in a period from September 2006 to January 2007. A modified BARRUERS Scale and a Facilitators Scale were used. Data were analyzed with descriptive statistics, rank transformation test, and multiple linear regression. Results Barriers related to the setting subscale were more influential than barriers related to other subscales. The lack of authority was ranked as the top greatest barrier (15.7%), followed by the lack of time (13.4%) and language barrier (15.0%). Additional barriers identified were the reluctance of patients to research utilization, the lack of funding, and the lack of legal protection. The top three greatest facilitators were enhancing managerial support (36.9%), advancing education to increase knowledge base (21.1%), and increasing time for reviewing and implementing (17.5%), while cooperation of patients to research utilization, establishing a panel to evaluate researches, and funding were listed as additional facilitators. Hospital, educational background, research experience, and knowledge on evidence-based nursing were the factors influencing perceptions of the barriers and facilitators. Conclusions Nurses in China are facing a number of significant barriers in research utilization. Enhancing managerial support might be the most promising facilitator, given Chinese traditional culture and existing health care system. Hospital, educational background, research experience and knowledge on evidence-based nursing should be taken into account to promote research utilization. The BARRIERS Scale should consider funding and involvement of patients in research utilization.
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