Intentional partnering: a grounded theory study on developing effective partnerships among nurse and physician managers as they co-lead in an evolving healthcare system.

AIM: The aim of this study was to describe the process of how nurse and physician managers in formalized dyads work together to address clinical management issues in the surgical division of one hospital setting. BACKGROUND: Nurse and physician managers are uniquely positioned to co-lead and transform healthcare delivery. However, little is known about how this management dyad functions in the healthcare setting. DESIGN: A constructivist grounded theory approach was used to investigate the process of how nurse and physician managers work together in formalized dyads in an urban Canadian university affiliated teaching hospital. METHODS: Data collection occurred from September 2013-August 2014. Data included participant observation (n = 142 hours) and intensive interviews (n = 36) with nurse-physician manager dyads (12 nurses, 9 physicians) collected in a surgical department. Theoretical sampling was used to elaborate on properties of emerging concepts and categories. RESULTS/FINDINGS: A substantive theory on 'intentional partnering' was generated. Nurses' and physicians' professional agendas, which included their interests and purposes for working with each other served as the starting point of 'intentional partnering'. The theory explains how nurse and physician managers align their professional agendas through the processes of 'accepting mutual necessity', 'daring to risk (together)' and 'constructing a shared responsibility'. Being credible, earning trust and safeguarding respect were fundamental to communicating effectively. CONCLUSION: Intentional partnering elucidates the relational components of working together and the strategizing that occurs as each partner deliberates on what he or she is willing to accept, risk and put into place to reap the benefits of collaborating.

[Reflections and recommendations from Quebec mental health university institutes on the working paper of the provincial forum for the 2014-2020 Mental Health Action Plan]. / Réflexions et recommandations des Instituts universitaires en santé mentale du Québec sur le document de consultation du Forum national sur le plan d'action en santé mentale 2014-2020.

GOAL: Quebec's three mental health university institutes (DMHUI, IUSMM and the IUSMQ) and the Centre hospitalier universitaire de Sherbrooke submitted a statement to the provincial consultation forum on the 2014-2020 Mental Health Action Plan (MHAP), which was held in January 2014 and organized by the Ministère de la Santé et des Services sociaux (MSSS). This article presents these institutes' main recommendations. METHOD: Mental health university institutes deliver a wide and diverse range of services. They know about the challenges of organizing mental health services and are aware of national and international trends in the delivery of the best organizational and clinical practices in mental health. It is therefore as key stakeholders in the mental health care network that they commented on each component in the working paper. RESULTS: The proposed orientations are consistent with the 2005-2010 MHAP. The presented themes clearly reflect current issues, although the guidelines must be more explicit regarding the vision of how services will be organized in coming years. These institutes therefore suggest that the following principles be included: the full exercise of citizenship rights, the organization of services within integrated networks, performance, continuous improvement and innovation, as well as a global and integrated vision of health. The complexity of today's problems requires flexibility, complementarity and continuity of services, particularly for youth, aboriginals, and people with concomitant disorders. These institutions therefore stress the importance of prevention, early intervention programs, and increased support for first-line general practitioners and health care professionals. They also emphasized that specialized inpatient and outpatient services should not be neglected. Community services must also be structured around various levels of support, such as ICM and ACT, as well as around specialized programs available in hospital outpatient clinics. The development and transfer of knowledge remain a central issue when it comes to improving the mental health of the general population. The consolidation of ultra-specialized services, teaching and research should be included in the next MHAP. Finally, a global health perspective must go beyond the MSSS framework to become a governmental and interministerial commitment based on a vision of public mental health that incorporates the health status of the general population and accounts for social determinants. CONCLUSION: It is important to have a national plan that promotes a vision. This plan must be part of an interministerial action plan that truly supports the full exercise of citizenship rights and the fight against stigmatization in collaboration with people who use these services and their families.

A pre-post evaluation of the Adler/Sheiner Programme (ASP): a nursing informational programme to support families and nurses in an intensive care unit (ICU).

BACKGROUND: ICU nurses often report that timely informational and supportive resources would ease distress for clients and providers alike. OBJECTIVES: This pilot study was aimed to explore the role of a comprehensive information and support programme in enhancing the work environment, task performance and reducing emotional distress amongst ICU nurses. RESEARCH METHODOLOGY/DESIGN: Through a mixed quantitative and qualitative design, nurses were invited to complete self-report questionnaires (n=25) and to participate in focus groups (n=7) prior to (T1) and 6 weeks after the implementation of the supportive programme (T2). RESULTS: Measures of physical and mental effort were found to be significantly lower (t=2.45, p=0.02) at post test (T2). Statistical trends towards significance were observed for higher performance satisfaction (t=1.70, p=0.10) and lower emotional distress (t=2.00, p=0.06) at T2. Focus group data revealed that nurses felt more supported in their work, had more satisfaction with work tasks accomplished and felt more emotionally supported with the programme being in place. CONCLUSIONS: Preliminary data from this pilot study suggest that a comprehensive information and support programme designed to support nurses in the ICU can enhance well being and workplace related factors. Work is currently underway to document the program's impact on family members in the ICU. Future studies should document further how and when similar programme contribute to enhance the workplace for other ICU staff.

Encouraging patients and families to influence change on a palliative care unit: value of patient satisfaction surveys.

This article describes how a series of patient satisfaction surveys on a palliative care unit were used to help influence the care provided to patients and their families. Innovative interventions aimed at addressing areas of lower satisfaction identified in the initial survey are described. The results from a follow-up survey provided the opportunity to evaluate whether our interventions were effective in improving patient satisfaction and highlight new areas of concern needing to be addressed.

Seeking patient feedback: an important dimension of quality in cancer care.

A patient satisfaction survey was conducted with ambulatory cancer patients to identify areas that they consider priorities for change. Wait times and telephone contact with healthcare providers were the 2 areas of lowest satisfaction. Despite previous interventions to improve wait times, it is consistently the lowest ranked item for patient satisfaction. A subset of patients who were followed by a nurse navigator was more satisfied with wait times than those who were not followed by a nurse navigator.

Supporting families in the ICU: a descriptive correlational study of informational support, anxiety, and satisfaction with care.

BACKGROUND: Informational support to family members of ICU patients has significant potential for reducing their psychological distress, enabling them to better cope and support the patient. OBJECTIVES: To describe family member perception of informational support, anxiety, satisfaction with care, and their interrelationships, to guide further refinement of a local informational support initiative and its eventual evaluation. METHODOLOGY/DESIGN: This cross-sectional descriptive correlational pilot study collected data from a convenience sample of 29 family members using self-report questionnaires. SETTING: 22-bed medical-surgical intensive care unit of a 659-bed university affiliated teaching hospital in Montreal, Quebec, Canada. RESULTS: Mean informational support, assessed with a modified version of the CCFNI (Molter and Leske, 1983), was 55.41(SD=13.28; theoretical range of 20-80). Mean anxiety, assessed with the State Anxiety Scale (Spielberger et al., 1983) was 45.41 (SD=15.27; theoretical range of 20-80). Mean satisfaction with care, assessed using Androfact (Version 4.0, 2001), was 83.09 (SD=15.49; theoretical range of 24-96). A significant positive correlation was found between informational support and satisfaction with care (r=0.741, p<.001). No significant relationships were noted between informational support and anxiety nor between satisfaction with care and anxiety. CONCLUSION: Findings are related to the ultimate objectives of refining a local informational support initiative and its eventual evaluation, and in so doing, are of more widespread interest to others striving to make evidence based improvements to the care of similar populations.

A quality end of life from a palliative care patient's perspective.

This qualitative study explored the meaning of quality of life (QOL) from the perspective of palliative care patients by examining their lived experiences and their perceptions of what contributes to their QOL. Ten in-patients--five women and five men--took part in in-depth, semi-structured interviews. When asked about their QOL, they spoke about three distinct aspects: the meaning of a quality life at this stage in their illness trajectory, the experience of living with the illness, and factors that contributed to their QOL. Patients' approach to life, illness life, and ideal quality life were found to create a sphere of influence that shaped their end-of-life experience. At the heart of living a quality end of life for these patients was their ability to "do the things that I usually do," "be helpful to others," and "live in a caring environment," The findings highlight the importance of understanding each of these factors: patients' approach to life, illness life, and ideal quality of life, and what they mean to patients in order to tailor interventions to enhance their QOL.

Surveying patients as a start to quality improvement in the surgical suites holding area.

The holding area, as the patient's first introduction to the surgical suites, has the potential to set the tone for the entire surgical experience. To identify targets for improvement efforts in the holding area, a convenience sample of 51 surgical patients completed a 12-item patient satisfaction survey developed using Androfact before discharge from hospital. Results reveal 5 aspects that fall below the desired benchmark satisfaction rate of 80%: staff holding personal conversations in the patients' presence, being offered distraction materials while waiting, pleasantness of the physical environment, reassurance that family members would be kept up-to-date during the surgical procedure, and comfort to provide personal information without worrying that others were listening. Discussion of findings indicates priorities for improvement efforts in the holding area.

Patients' satisfaction and importance ratings of quality in an outpatient oncology center.

Oncology patients requiring outpatient services have expectations that must be addressed to ensure continuous and improved quality of care. A convenience sample of 96 patients recruited from an oncology outpatient center completed a 26-item patient satisfaction questionnaire (SEQUS). Overall satisfaction ratings indicate that patients are satisfied with their care. Patients' perception of waiting time and lack of questioning regarding their medications by the pharmacist were identified as two areas needing improvement. Findings suggest that by identifying what is most important to patients, nurses can readily modify the care environment to enhance patient satisfaction and quality of care.

Patient satisfaction and nurses' perceptions of quality in an inpatient cardiology population.

Cardiology patients have important learning needs. A 21-item patient satisfaction questionnaire was mailed to 384 cardiology patients 1 week after discharge. Satisfaction ratings indicated that the 161 respondents were satisfied with their care: however, they wanted more information regarding the management of their symptoms and activity level at home. Nurses' interviews revealed that they assessed the availability of follow-up care upon discharge. The results suggest that patients are not satisfied with the information they receive before discharge. Also, nurses and patients have different perceptions about the information patients need. These differences need to be taken into consideration when designing discharge teaching interventions.