BackgroundRecognising demographic changes and importance of the environment in influencing the care experience of patients with dementia, there is a need for developing the knowledge base to improve hospital environments. Involving patients in the development of the hospital environment can be a way to create more responsive services. To date, few studies have involved the direct voice of patients with dementia about their experiences of the hospital environment.Design and methodUsing an action research approach, we worked with patients with dementia and a team of interdisciplinary staff on a medical unit to improve dementia care. The insights provided by patients with dementia in the early phase shaped actions undertaken at the later stage to develop person‐centred care within a medical ward. We used methods including go‐along interviews, video recording and participant observation to enable rich data generation.AimThis study explores the perspectives of patients with dementia about the hospital environment.ResultsThe participants indicated that a supportive hospital environment would need to be a place of enabling independence, a place of safety, a place of supporting social interactions and a place of respect.ConclusionsPatient participants persuasively articulated the supportive and unsupportive elements in the environment that affected their well‐being and care experiences. They provided useful insights and pointed out practical solutions for improvement. Action research offers patients not only opportunities to voice their opinion, but also possibilities to contribute to hospital service development.Implications for practiceThis is the first study that demonstrates the possibility of using go‐along interviews and videoing with patients with dementia staying in a hospital for environmental redesign.Researchers, hospital leaders and designers should further explore strategies to best support the involvement of patients with dementia in design and redesign of hospital environments.
In this action study, researchers worked with a team of interdisciplinary practitioners to co-develop knowledge and practice in a medical unit of a large urban hospital in Canada. An appreciative inquiry approach was utilized to guide the project. This article specifically focuses on examining the research experiences of practitioners and their accounts on how the research influenced their practice development to enact person-centered care. Method: The project took place in the hospital's medical unit. A total of 50 staff participants attended focus groups including nursing staff, allied health practitioners, unit leaders, and physicians. One senior hospital administrator was interviewed individually. In total, 36 focus groups were conducted to bring participants together to co-vision and co-develop person-centered care. Results: Analysis of the data produced three themes: (a) appreciating the power of co-inquiry, (b) building team capacity, and (c) continuous development. Furthermore, 10 key enablers for engaging staff in the research process were developed from the data. A conceptual tool, "team Engagement Action Making" (TEAM) has been created to support others to do similar work in practice development. Conclusion: An appreciative inquiry approach has the potential to address gaps in knowledge by revealing ways to take action. Future research should further investigate how the appreciative inquiry approach may be used to support bridging research and practice.
<p><strong>ABSTRACT</strong><br /><strong></strong></p><p><strong>Background:</strong> Proton pump inhibitors (PPIs) have proven clinical efficacy for a variety of indications. However, there is emerging evidence of adverse events associated with their long-term use. The emergence of these adverse events has reinforced the need to regularly evaluate the appropriateness of continuing PPI therapy, and to use only the lowest effective dose for the minimally indicated duration. <br /><strong>Objectives:</strong> To characterize the appropriateness of PPI orders continued or initiated in the internal medicine and family practice units of Vancouver General Hospital, to detect adverse events associated with PPI use, and to explore the impact of multidisciplinary teaching and provision of educational resources on health care practitioners’ views about PPI use.<br /><strong></strong></p><p><strong>Methods:</strong> A chart review was conducted for patients admitted (for at least 24 hours) between January 1 and December 31, 2015, for whom a hospital formulary PPI was prescribed. An educational initiative, which included interprofessional in-service sessions, a PPI prescribing infographic, a PPI prescribing card, and a patient counselling sheet, was implemented. The impact of these interventions was assessed using a qualitative survey of health care practitioners. <br /><strong></strong></p><p><strong>Results:</strong> Of the 258 patients whose charts were reviewed, 175 had a PPI prescription before hospital admission, and 83 were initiated on PPI therapy during their hospital stay. Overall, 94 (36%) of the patients were receiving PPIs without an appropriate indication. Community-acquired pneumonia and Clostridium difficile infections were the most common adverse events potentially associated with PPI use. In-service sessions and educational resources on PPI prescribing were reported to affect the clinical practice of 24 (52%) of the 46 survey respondents. <br /><strong></strong></p><p><strong>Conclusions:</strong> The results of this study emphasize the need for ongoing re-evaluation of long-term PPI therapy at the time of admission, during the hospital stay, and upon discharge. Implementing multidisciplinary teaching and providing educational resources may encourage more appropriate prescribing.</p><p><strong>RÉSUMÉ</strong><br /><strong>Contexte :</strong> Les inhibiteurs de la pompe à protons (IPP) ont prouvé leur efficacité clinique pour une gamme d’indications. Cependant, de nouvelles données sur leur utilisation à long terme leur imputent des événements indésirables. L’émergence de ces événements indésirables a renforcé l’idée qu’il est nécessaire d’évaluer régulièrement la pertinence d’un traitement prolongé par IPP et d’employer seulement la plus faible dose efficace pendant la durée indiquée la plus courte. <br /><strong></strong></p><p><strong>Objectifs :</strong> Offrir un portrait de la pertinence des ordonnances d’IPP, renouvelées ou nouvelles, dans les services de médecine interne et de médecine familiale de l’Hôpital général de Vancouver, détecter les événements indésirables liés à l’utilisation des IPP et étudier l’effet qu’ont une formation multidisciplinaire et une fourniture de ressources éducatives sur les points de vue des professionnels de la santé à propos des IPP. <br /><strong></strong></p><p><strong>Méthodes :</strong> Une analyse rétrospective de dossiers médicaux a été menée auprès de patients qui ont été admis (pendant au moins 24 heures) entre le 1er janvier et le 31 décembre 2015 et qui se sont vu prescrire un IPP inscrit sur la liste des médicaments de l’hôpital. On a mis en place un programme éducatif comprenant des séances de formation interprofes-sionnelles internes, un document infographique de prescription des IPP, une carte de prescription des IPP et une fiche de conseils aux patients. L’effet de ces interventions a été évalué à l’aide d’une enquête qualitative auprès des professionnels de la santé. <br /><strong></strong></p><p><strong>Résultats :</strong> Parmi les 258 patients dont le dossier a été examiné, 175 avaient une ordonnance d’IPP avant l’admission à l’hôpital et 83 ont amorcé un traitement par IPP pendant leur séjour. Dans l’ensemble, 94 (36 %) des patients recevaient un IPP sans indication pertinente. Les infections à Clostridium difficile et les pneumonies extra-hospitalières représentaient les événements indésirables les plus courants potentielle-ment liés à l’utilisation des IPP. On a signalé que les séances de formation interne et les ressources éducatives sur la prescription des IPP avaient eu un effet sur la pratique clinique de 24 (52 %) des 46 participants à l’enquête.</p><p><strong>Conclusions :</strong> Les résultats de l’étude font ressortir la nécessité d’une réévaluation continuelle des traitements à long terme par IPP au moment de l’admission, pendant le séjour et lors du congé. La mise en place de formation multidisciplinaire et l’offre de ressources éducatives pourraient favoriser des pratiques de prescription plus adéquates. </p><p> </p>
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