The roles of specialisation and evidence-based practice in inter-professional jurisdictions: A qualitative study of stroke services in England, Sweden and Poland

Baeza, Juan; Boaz, Annette; Fraser, Alec

doi:10.1016/j.socscimed.2016.03.001

Cited by 7 publications

(8 citation statements)

References 35 publications

(24 reference statements)

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“…Several factors relating to personal work experience and other professionals' expertise affected competence and specialisation in stroke care. Prior knowledge of the patient (Johnsen et al, 2016), knowledge of one's own strengths in patient care (Burau et al, 2017; Struwe et al, 2013) and increased ability to validate practise and predict improvement in the patient's condition acquired during work experience (Baeza et al, 2016; Longley et al, 2018; Pattison et al, 2015) were all connected with competence in working with stroke patients. Less experienced professionals considered stroke care very demanding (Luker et al, 2014).…”

Section: Resultsmentioning

confidence: 99%

“…Professionals felt that working with more experienced colleagues and other professionals improved their own competence and ability to specialise in stroke care (Pattison et al, 2015). A perceived lack of specialisation caused by holding a weak professional position was reported to cause feelings of powerlessness and lack of engagement among nurses (Baeza et al, 2016).…”

Section: Resultsmentioning

confidence: 99%

“…Notably, professionals who had undergone training felt that they still lacked competence in areas such as conducting psychological assessments (Harrison et al, 2017), knowledge of dementia and potential residual problems (Longley et al, 2018), and providing high‐quality holistic care (Struwe et al, 2013; Turner et al, 2019). Professionals also felt that their ability to implement evidence‐based practice was limited by a lack of relevant evidence (Baeza et al, 2016; Lam Wai Shun et al, 2017).…”

Section: Resultsmentioning

confidence: 99%

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Healthcare professionals' competence in stroke care pathways: A mixed‐methods systematic review

Jarva

Mikkonen

Tuomikoski

et al. 2021

Journal of Clinical Nursing

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Background The challenges of caring for stroke patients are growing due to population ageing and improved survival rates. Healthcare professionals' competence development in stroke care is a necessity to ensure high‐quality patient care. Objectives To identify and describe the competence areas of healthcare professionals working in the stroke patient care pathway and factors influencing these competences. Design A mixed‐methods systematic review. Methods The review was conducted according to the JBI guidelines and registered in the PROSPERO database (CRD42020204062). PRISMA checklist guided the review process. Relevant original studies were identified by searching four databases—CINAHL (EBSCO), PubMed, Scopus and Medic. After researcher consensus was reached, 32 studies were selected for inclusion and subjected to content analysis and data tabulation. Results Competence in care processes, clinical competence, competence in using self‐management strategies, interaction skills, skills in acknowledging family and competence in integrating the available evidence base into patient care were identified as key competence areas. Organisation of services, specialisation in stroke care, continuous development and education, family and carer and training in oral care and cognitive rehabilitation were identified as factors that influence healthcare professionals' competence. Conclusions Diverse clinical and interaction competencies are needed throughout the stroke care pathway, and various factors affect healthcare professionals' competence. Further research on healthcare professionals' stroke care competence will be needed to respond to changing healthcare demand. Relevance to clinical practice We recommend organisational support and formulation of stroke care patient guidelines in line with healthcare competence requirements. Focus should be added for nursing professions in developing interactive communication competence since nurses spend the majority of the time providing individual patient care. Also, organisations should integrate continuing training in specialised stroke care for healthcare professionals' competence development.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Healthcare professionals' competence in stroke care pathways: A mixed‐methods systematic review

Jarva

Mikkonen

Tuomikoski

et al. 2021

Journal of Clinical Nursing

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“…We also identified tensions between institutional and ‘pan-London’ loyalties for clinical and managerial informants. These contributed to our analysis by encouraging us to consider the different ways in which evidence is mobilised by certain professional groups [51] and also how different actors identify with particular institutions.…”

Section: Methodsmentioning

confidence: 99%

‘Holding the line’: a qualitative study of the role of evidence in early phase decision-making in the reconfiguration of stroke services in London

Fraser

Baeza

Boaz

2017

Health Res Policy Sys

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BackgroundHealth service reconfigurations are of international interest but remain poorly understood. This article focuses on the use of evidence by senior managerial decision-makers involved in the reconfiguration of stroke services in London 2008–2012. Recent work comparing stroke service reconfiguration in London and Manchester emphasises the ability of senior managerial decision-makers in London to ‘hold the line’ in the crucial early phases of the stroke reconfiguration programme. In this article, we explore in detail how these decision-makers ‘held the line’ and ask what the broader power implications of doing so are for the interaction between evidence, health policy and system redesign.MethodsThe research combined semi-structured interviews (n = 20) and documentary analysis of historically relevant policy papers and contemporary stroke reconfiguration documentation published by NHS London and other interested parties (n = 125). We applied a critical interpretive and reflexive approach to the analysis of the data.ResultsWe identified two forms of power which senior managerial decision-makers drew upon in order to ‘hold the line’. Firstly, discursive power, which through an emphasis on evidence, better patient outcomes, professional support and clinical credibility alongside a tightly managed consultation process, helped to set an agenda that was broadly receptive to the overall decision to change stroke services in the capital in a radical way. Secondly, once the essential parameters of the decision to change services had been agreed, senior managerial decision-makers ‘held the line’ through hierarchical New Public Management style power to minimise the traditional pressures to de-radicalise the reconfiguration through ‘top down’ decision-making.ConclusionsWe problematise the concept of ‘holding the line’ and explore the power implications of such managerial approaches in the early phases of health service reconfiguration. We highlight the importance of evidence for senior managerial decision-makers in agenda setting and the limitations of clinical research findings in guiding politically sensitive policy decisions which impact upon regional healthcare systems.

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“…Evidence-based practice is important for rehabilitation practitioners such as occupational therapists (Baeza, Boaz & Fraser, 2016). One way to strengthen evidencebased practice is through regular use of standardised instruments amongst practitioners (Gustafsson, Molineux & Bennett, 2014;Unsworth, 2011).…”

Section: Introductionmentioning

confidence: 99%

Overview of reviews of standardised occupation‐based instruments for use in occupational therapy practice

Romli

Yunus

Mackenzie

2019

Aus Occup Therapy J

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Introduction:Using standardised instruments is one approach to support evidence-based practice. Referring to systematic reviews is an option to identify suitable instruments. However, with an abundance of systematic reviews available, therapists are challenged to identify an appropriate instrument to use. Therefore, this overview of reviews aimed to summarise relevant systematic review findings about standardised occupation-based instruments relevant for occupational therapy practice. Methods: An overview of reviews was conducted. A systematic search was performed on four databases up to March 2018. Included systematic reviews were analysed for quality using A MeaSurement Tool to Assess systematic Reviews (AMSTAR). Results: A total of 2187 articles were identified after removing duplicates. Ultimately, 58 systematic reviews were identified that yielded 641 instruments. From those, 45 instruments were selected for appraisal as they met the inclusion criteria of being developed mainly by occupational therapists and were recommended in the summarised findings from the systematic reviews. The instruments were classified according to the following occupation domains: (i) multidimensional, (ii) activities of daily living, (iii) productivity, (iv) social, (v) sleep/rest, (vi) sexuality and (vii) spirituality. No systematic review was identified that specifically focussed on occupations related to school/education, leisure and play. Discussion: Certain occupation domains such as activities of daily living, social and sleep/rest received high attention amongst researchers. There is a need for systematic reviews of instruments to measure education/school, play and leisure. Limited numbers of instruments were developed by occupational therapists outside the occupation domain of activities of daily living, and in areas of practice other than children and older people. Nevertheless, this overview can give some guidance for occupational therapists in selecting a suitable occupational therapy instrument for practice.

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The roles of specialisation and evidence-based practice in inter-professional jurisdictions: A qualitative study of stroke services in England, Sweden and Poland

Cited by 7 publications

References 35 publications

Healthcare professionals' competence in stroke care pathways: A mixed‐methods systematic review

Healthcare professionals' competence in stroke care pathways: A mixed‐methods systematic review

‘Holding the line’: a qualitative study of the role of evidence in early phase decision-making in the reconfiguration of stroke services in London

Overview of reviews of standardised occupation‐based instruments for use in occupational therapy practice

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