Primary Healthcare Case Management Nurses and Assistance Provided to Chronic Patients: A Narrative Review.

Population aging is causing increases in the numbers of chronic diseases, with the consequent need for changes in health systems to better assist patients with chronic conditions. A narrative review was conducted in this study with the objective of analysing the scientific evidence on the care and assistance provided by Case Management Nurses (CMNs) to chronic patients in primary healthcare. A total of 15 articles published in English, Spanish, and Portuguese were selected in the following databases: PubMed, Embase, Cochrane Library, Scopus, Dialnet, Cinahl, and Web of Science. In total, 46.6% of the studies showed the assistance provided by CMNs for chronic pathologies. Most of the articles selected (80%) considered that the assistance offered by case management nurses in relation to chronic diseases is effective, enabling cost reductions, which supposes benefits at the economic and political levels. It was concluded that CMNs have proven to be efficient in caring for people with chronic diseases, improving the quality of life of these people and their caregivers; therefore, they have a fundamental role in the PHC.

Impact of training and case manager support for traditional birth attendants in the linkage of care among HIV-positive pregnant women in Southwest Nigeria: a 3-arm cluster randomized control trial.

BACKGROUND: Mother-to-child transmission (MTCT) accounts for 90% of all new paediatric HIV infections in Nigeria and for approximately 30% of the global burden. This study aimed to determine the effectiveness of a training model that incorporated case managers working closely with traditional birth attendants (TBAs) to ensure linkage to care for HIV-positive pregnant women. METHODS: This study was a 3-arm parallel design cluster randomized controlled trial in Ifo and Ado-Odo Ota, Ogun State, Nigeria. The study employed a random sampling technique to allocate three distinct TBA associations as clusters. Cluster 1 received training exclusively; Cluster 2 underwent training in addition to the utilization of case managers, and Cluster 3 served as a control group. In total, 240 TBAs were enrolled in the study, with 80 participants in each of the intervention and control groups. and were followed up for a duration of 6 months. We employed a one-way analysis of variance (ANOVA) statistical test to evaluate the differences between baseline and endline HIV knowledge scores and PMTCT practices. Additionally, bivariate analysis using the chi-square test was used to investigate linkage to care. Furthermore, logistic regression analysis was utilized to identify TBA characteristics associated with various PMTCT interventions, including the receipt of HIV test results and repeat testing at term for HIV-negative pregnant women. The data analysis was performed using Stata version 16.1.877, and we considered results statistically significant when p values were less than 0.05. RESULTS: At the end of this study, there were improvements in the TBAs' HIV and PMTCT-related knowledge within the intervention groups, however, it did not reach statistical significance (p > 0.05). The referral of pregnant clients for HIV testing was highest (93.5%) within cluster 2 TBAs, who received both PMTCT training and case manager support (p ≤ 0.001). The likelihood of HIV-negative pregnant women at term repeating an HIV test was approximately 4.1 times higher when referred by TBAs in cluster 1 (AOR = 4.14; 95% CI [2.82-5.99]) compared to those in the control group and 1.9 times in cluster 2 (AOR = 1.93; 95% CI [1.3-2.89]) compared to the control group. Additionally, older TBAs (OR = 1.62; 95% CI [1.26-2.1]) and TBAs with more years of experience in their practice (OR = 1.45; 95% CI [1.09-1.93]) were more likely to encourage retesting among HIV-negative women at term. CONCLUSIONS: The combination of case managers and PMTCT training was more effective than training alone for TBAs in facilitating the linkage to care of HIV-positive pregnant women, although this effect did not reach statistical significance. Larger-scale studies to further investigate the benefits of case manager support in facilitating the linkage to care for PMTCT of HIV are recommended. TRIAL REGISTRATION: The study was retrospectively registered in the Pan African Clinical Trial Registry, and it was assigned the unique identification number PACTR202206622552114.

Dilemmas and support strategies in dementia care: Experiences of case managers in Taiwan.

Objective: This study aimed to examine the dilemmas encountered and the countermeasures adopted by case managers, who care for individuals with dementia. The study also aimed to identify the types of support and assistance case managers require.Methods: In this qualitative study, the researchers conducted semi-structured interviews with 10 case managers, six from integrated dementia care centers and four from community-based dementia care centers in Taiwan.Results: The results are as follows: (1) Case managers providing services for individuals with dementia primarily encountered two major dilemmas, including cognitive differences (such as a lack of understanding of dementia, differences in ideas about dementia care, and distrust of the professionalism of case managers) with family members and their own insufficient professional capabilities, which made it difficult to reach a consensus on caregiving with family members and address the diverse conditions of individuals with dementia. (2) In response to these dilemmas, case managers adopted various approaches to enhance families' understanding of dementia and facilitate reaching a consensus on care. They also improved their professional capabilities through team discussions and resource networking. (3) The support and assistance required by case managers are continuous learning, the enhancement of their professional competencies, organizational support, and workload management.Conclusion: The findings of this study contribute to an understanding of the dilemmas faced by case managers in Taiwan's centers for integrated dementia care and community-based dementia care centers during policies implementation, as well as the strategies they adopted and the assistance they required. These results can also offer recommendations for policies, professional training, dementia services, and resources to reduce the disparity between policy and practice.

Homebound oral care for older adults: A qualitative study of professional carers' perspectives in Perth, Western Australia.

OBJECTIVE: To examine professional support workers and case managers' (professional carers) perspectives of what promoted or compromised oral health care in homebound adults aged over 65 years in Perth, Western Australia and identify professional carers' need for support in this context. BACKGROUND: Accessing dental services can be difficult to navigate and unaffordable for homebound older adults. Paid carers often play a substantial role in facilitating access to services yet there is limited qualitative evidence of the perspectives of these stakeholders. METHODS: Given limited evidence in this area, this simple qualitative study was informed by constructivist grounded theory. Participants comprised 15 professional carers of homebound older adults. Transcripts were analysed to identify participant perceptions of key barriers and enablers to providing oral health care. RESULTS: Barriers to clients accessing dental care included participants' uncertainty around navigating the dental system, low priority of oral health care, affordability and confusion around who was responsible to provide oral care. Enablers included participants supporting clients' autonomy around oral care, better integration of oral care into primary health care and education and opportunity for training for professional carers. CONCLUSION: Ensuring oral health is part of primary health plans, clarifying roles and responsibilities around delivering oral health care to homebound older adults and training carers were key findings. Inter-sectoral collaboration between the dental and aged care sectors can benefit dental practitioners and professional carers in shared learning and has likely flow-on effects for homebound older adults.

[Experiences of Transitional Care for Medicaid Case Managers].

PURPOSE: This phenomenological study tried to understand the essence of the transitional care experience of medicaid case managers and its structural meaning. In addition, it was attempted to establish a system of transitional care and seek support measures for medicaid case managers. METHODS: The participants of this study were 7 medicaid case managers who had spent more than 1 year and 6 months in medicaid pilot project. Data were collected with individual in-depth interviews from June to December 2021. The data were analyzed by Giorgi's phenomenological analysis method. RESULTS: The seven constituents derived from the results of this study were 'struggle to establish a living environment', 'dedication to supporting independent living', 'anxiety about safety', 'pressure on care responsibilities', 'distress in building the pilot project', 'pride in role', and 'expectation for improvement'. CONCLUSION: The study results provide a comprehensive understanding of the transition care reality for medicaid case managers. They also shed light on managers' perceptions and attitudes. These findings can serve as fundamental information for establishing support measures for medicaid case managers and transitional care systems.

Advanced practice nurse case managers improve efforts by US hospitals to address patient social needs.

AIMS: US hospitals are focussing more than ever on meeting important patient social needs. Patients often make multiple trips to hospitals related to nonmedical issues that could likely be averted through the increased integration of case management strategies. Although the percentage of hospitals using advanced practice nurses (APNs) in this role is still relatively low, we explore the idea that employing APN case managers improves hospitals' abilities to alleviate hospital overusage. DESIGN: The study used a cross-sectional design. METHODS: We used the 2021 American Hospital Association data set, which includes 5855 hospitals, of which 4315 were general medical hospitals. RESULTS: Using descriptive statistics and Poisson regression, we discovered that employing APN case managers in US acute care hospitals is associated with an increased likelihood that hospitals will implement strategies addressing patient social needs. CONCLUSIONS: When hospitals screen patients for social needs and formulate and implement internal and external strategies designed to meet patient social needs, many stakeholders stand to benefit. Should more hospitals observe such benefits when utilizing an APN case manager model, it will likely proliferate, and demand for APNs could accelerate further. IMPACT: Following the reduction in unnecessary patient visits and readmissions, hospitals' scarce resources are freed up to offer timely care to patients that are truly medically in need. Furthermore, financial performance improves under this scenario. APNs play a critical role in enabling hospitals to realize such benefits. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. We used archival data in this study.

Pathways by which case managers' match support influences youth mentoring outcomes: Testing the systemic model of youth mentoring.

Keller's systemic model of youth mentoring posits there are multiple pathways through which all stakeholders in the youth mentoring process, including the program staff who support the match (or case managers), influence youth outcomes. This study examines case managers' direct and indirect contributions to match outcomes and tests how transitive interactions facilitate a theorized sequence of mentoring interactions to effect greater closeness and length, specifically in nontargeted mentoring programs. A structural equations model of case manager contributions to match outcomes was tested using data from 758 mentor-mentee matches, supported by 73 case managers across seven mentoring agencies. Results reveal direct effects of mentor-reported match support quality on match length and indirect influences on match length through increasing youth-centeredness, goal-focused orientation, and closeness. The findings confirm the presence of multiple pathways of influence, including indirect effects on outcomes via transitive interactions in match support that scaffold youth-centeredness and goal-focused interactions in the match. Findings also suggest supervisors' evaluations of case managers may provide little information about how match support influences the nature of mentor-mentee interactions.

Should case management be considered a component of obstetrical interventions for pregnancies at risk of preterm birth?

Preterm birth remains the leading cause of morbidity and mortality among nonanomalous neonates in the United States. Unfortunately, preterm birth rates remain high despite current medical interventions such as progestogen supplementation and cerclage placement. Case management, which encompasses coordinated care aimed at providing a more comprehensive and supportive environment, is a key component in improving health and reducing costs in other areas of medicine. However, it has not made its way into the general lexicon and practice of obstetrical care. Case management intended for decreasing prematurity or ameliorating its consequences may include specialty clinics, social services, coordination of specialty services such as nutrition counseling, home visits or frequent phone calls by specially trained personnel, and other elements described herein. It is not currently included in nor is it advocated for as a recommended prematurity prevention approach in the American College of Obstetricians and Gynecologists or Society for Maternal-Fetal Medicine guidelines for medically indicated or spontaneous preterm birth prevention. Our review of existing evidence finds consistent reductions or trends toward reductions in preterm birth with case management, particularly among individuals with high a priori risk of preterm birth across systematic reviews, metaanalyses, and randomized controlled studies. These findings suggest that case management has substantial potential to improve the environmental, behavioral, social, and psychological factors with patients at risk of preterm birth.

Emotional Universe of Nurse Case Managers Regarding Care for Elderly at Risk in Spain: A Hermeneutical Study.

The role of nurse case managers (NCM) involves a rarely visible emotional labor, even more when their role focuses on the care of elders at risk (EAR). Motivated by the lack of qualitative research on the emotional universe of NCM, this study explores the emotional universe (EU) of NCM regarding the care they provide to EAR in primary health care as well as the reasons that generate these emotions. An interpretative-phenomenological approach was implemented in southern Spain, with a purposive sampling that included nurses playing the NCM role for at least three years. Data collection was conducted in two periods (between September 2019 and July 2022). The primary collection tool was the semi-structured individual interview, with starting categories based on Bisquerra's EU taxonomy. The analysis followed Ricoeur's considerations, using the Nvivo software. In the NCM's EU, the recognition of the social phenomena stands out, with an open feeling of empathy regarding the desire of the EAR to continue living at home. However, there was also helplessness, resignation, disappointment, and frustration when EAR rejected their proposals. Furthermore, the system's limitations aroused compassion in the NCM and made them go beyond the limits of their role. This EU requires that their role be valued more, and higher responsiveness must be enforced to improve EAR care.

[Establishment of Role and Core Competencies of Geriatric Case Managers in Taiwan].

BACKGROUND: Older adults have unique and complex care needs that are multifaceted, continuous, and integrated and that span prevention and treatment to long-term rehabilitation. Case managers are able to integrate healthcare and social resources to help older adults and their caregivers manage the needs of daily life. Therefore, identifying the role and core competencies of geriatric case managers in Taiwan is crucial. PURPOSE: To develop the role and core competencies of geriatric case managers in Taiwan. METHODS: Based on a review of the literature, a two-round modified Delphi technique was used to evaluate the framework of the geriatric case manager role and core competencies. Experts were invited to join a panel to review and rank the importance of each role and competency within the context of the Delphi technique. RESULTS: Four roles and 36 core competencies of geriatric case managers were identified, and 94.4% consensus was reached in round two. The roles and core competencies included care expert (18 competencies), coordinator (6 competencies), consultant (6 competencies), and evidence-based practitioner (6 competencies). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: Training programs may be developed for geriatric case managers based on the results of this study to further promote the quality of provided geriatric care.

Coproducing care and support delivery in healthcare triads: Dutch case managers for people with dementia at home using strategies to handle conflict in the healthcare triad.

Dutch policy stipulates that people with dementia should remain at home for as long as possible. If they need care, they must preferably appeal to family, friends and neighbours. Professional help and nursing homes are deemed last resorts. Therefore, case managers must coproduce their public services increasingly in healthcare triads with both people with dementia (PWDs) and their informal caregivers. Case managers are professionals who provide and coordinate care and support for PWDs and their informal caregivers during the entire trajectory from (suspected) diagnosis until institutionalisation. The literature on coproduction has focused on the bilateral interactions between service providers and users rather than the multilateral collaborative relationships through which many public services are currently delivered, as is the case in dementia care. Little is known about how frontline workers, case managers in this study, handle conflicts in these healthcare triads. Our study addresses this gap in the coproduction literature and explores the action strategies case managers use to handle conflicts. We interviewed 19 Dutch case managers and observed 10 of their home visits between January and May 2017. We focused on the end stage of dementia at home, just before admission to a nursing home, as we assumed that most conflicts occur in that phase. The findings reveal that the case managers use a variety of action strategies to resolve and intervene in these conflicts. Their initial strategies are in line with the ideals underlying coproduction; however, their successive strategies abandon those ideals and are more focused on production or result from their own lack of power. We also found that current reforms create new dilemmas for case managers. Future research should focus on the boundaries of coproducing public services in triadic relationships and the effects of current welfare reforms aimed at coproducing public services in healthcare triads.

Community case managers' challenges collaborating with primary care when managing complex patients in the community: A qualitative study in Singapore.

Community case managers (CCMs) play a crucial role in the continuity of care for complex patients in the community. However, they are often considered as non-members of the healthcare team and not actively engaged by the primary care team because of the unique landscape of social services in Singapore. Given that these two distinct professional groups had minimal collaboration previously, integrating CCMs as partners of patient care within the primary care team may pose many challenges. The objective of this qualitative study was to understand the challenges encountered by CCMs when collaborating with primary care services. This exploratory qualitative descriptive study used individual in-depth interviews. CCMs were selected using convenience and snowball sampling. The interviews were semi-structured, guided by a topic guide. Fourteen CCMs were interviewed within a period of 12 weeks (October-December 2018). Thematic analysis was used to analyse the transcripts. Two researchers coded each transcript independently, and a coding framework was agreed upon. Potential themes were then independently developed based on the coding framework. Fourteen individual in-depth interviews were conducted. Six themes emerged from the data, i.e., self-identity, patient factor, inter-professional factor, collaborative culture, confidentiality and organisational structure. Challenges that resonated with previous studies were self-identity, inter-professional factors and confidentiality, whereas other challenges such as patient factors, collaborative culture and organisational structure were unique to Singapore's healthcare landscape. Significant challenges were encountered by CCMs when collaborating with primary care services. Understanding these challenges is key to refining intervention in current models of comprehensive community care between medical and non-medical professionals.

Care Management for Serious Mental Illness: A Systematic Review and Meta-Analysis.

OBJECTIVE: Persons with serious mental illness face adverse psychiatric and medical outcomes, and their care is associated with a large burden of health care costs. Care management, in which assessment, care planning, and care coordination are provided, is a common model of support, yet the evidence supporting its use among psychiatric populations is mixed. A systematic review and a meta-analysis were undertaken to determine the impact of care management on clinical outcomes, acute care utilization, cost, and satisfaction among adults with serious mental illness. METHODS: A multidatabase literature search was performed. Articles were included if they compared standard outpatient care plus care management with standard outpatient care alone for adults with serious mental illness and reported on one or more predefined outcomes. Randomized controlled trials (RCTs) and other study designs were permitted for inclusion in the systematic review. The meta-analysis included only RCTs. RESULTS: For the systematic review, 34 articles representing 28 unique studies were included. Fifteen of these articles, representing 12 unique studies, were included in the meta-analysis, which indicated that care management was associated with small, statistically significant improvements in psychiatric symptoms, overall quality of life (QOL), and mental QOL (Hedges' g range 0.13-0.26). In addition, care management was associated with a small, statistically significant reduction in inpatient psychiatric hospital days (Hedges' g=0.16, p=0.02). CONCLUSIONS: Care management is associated with fewer psychiatric symptoms and greater QOL for persons with serious mental illness. Further work is needed to determine which components of the intervention are associated with effectiveness.

Demystifying Case Management in Aotearoa New Zealand: A Scoping and Mapping Review.

BACKGROUND: Community-based case managers in health have been compared to glue which holds the dynamic needs of clients to a disjointed range of health and social services. However, case manager roles are difficult to understand due to poorly defined roles, confusing terminology, and low visibility in New Zealand. AIM: This review aims to map the landscape of case management work to advance workforce planning by clarifying the jobs, roles, and relationships of case managers in Aotearoa New Zealand (NZ). METHODS: Our scoping and mapping review includes peer-reviewed articles, grey literature sources, and interview data from 15 case managers. Data was charted iteratively until convergent patterns emerged and distinctive roles identified. RESULTS: A rich and diverse body of literature describing and evaluating case management work in NZ (n = 148) is uncovered with at least 38 different job titles recorded. 18 distinctive roles are further analyzed with sufficient data to explore the research question. Social ecology maps highlight diverse interprofessional and intersectoral relationships. CONCLUSIONS: Significant innovation and adaptations are evident in this field, particularly in the last five years. Case managers also known as health navigators, play a pivotal but often undervalued role in NZ health care, through their interprofessional and intersectoral relationships. Their work is often unrecognised which impedes workforce development and the promotion of person-centered and integrated health care.

Caracterización sociodemográfica y clínica de pacientes con enfermedad renal crónica en condición de pluripatología y sus cuidadores / Sociodemographic and clinical characterization of patients with chronic kidney disease with multiple pathologies and caregivers

Introducción: Los pacientes con Enfermedad Renal Crónica en condición de pluripatología presentan deterioro funcional progresivo, vulnerabilidad clínica, polifarmacia, calidad de vida disminuida, impacto psicosocial y alto costo para la persona y su familia. Enfermería debe conocer las características clínicas y sociodemográficas para identificar las necesidades.Objetivo:Establecer a través de una valoración multidimensional las condiciones sociodemográficas y clínicas de pacientes pluripatológicos con enfermedad renal crónica y sus cuidadores familiares.Material y Método:Estudio descriptivo de corte transversal, participaron 97 personas con enfermedad renal crónica en situación de pluripatología y sus cuidadores familiares, afiliados a dos aseguradoras de Bogotá, Colombia. Se realizó valoración multidimensional al paciente y cuidador con instrumentos validados. Análisis descriptivo, se utilizó STATA versión 13.Resultados:El 52,6% fueron mujeres mayores de 80 años, 48% estaban casados, todos cursaron primaria completa. Adicional a enfermedad renal, el 43,3%. presenta tres enfermedades asociadas. El 36,08% reportó independencia total en Actividades Básicas de la Vida Diaria. El 38% presenta riesgo social medio y problemático, y mayor alteración de calidad de vida. Los principales cuidadores son hijos, seguidos de cónyuges.Conclusión:La mayoría de pacientes con enfermedad renal crónica en condición de pluripatología presentan tres enfermedades crónicas asociadas, EPOC, cardiopatías y enfermedades mentales. Los resultados reflejan complejidad clínica y psicosocial asociada especialmente a niveles de dependencia funcional y riesgo social. Las dimensiones de calidad de vida más afectadas son función física y rol físico. Los cuidadores familiares principalmente son los hijos, la sobrecarga intensa es baja y la adopción del rol cuidador es adecuada. (AU)

Introduction: Comorbid patients with Chronic Kidney Disease present progressive functional deterioration, clinical vulnerability, polypharmacy, diminished quality of life, psychosocial impact and high cost for the person and their family. Nursing must know the clinical and sociodemographic characteristics to identify patient's needs.Objective:To establish through a multidimensional assessment the sociodemographic and clinical conditions of multiple pathological patients with chronic kidney disease and their family caregivers.Material and Method:Descriptive cross-sectional study, involving 97 people with chronic kidney disease in a situation of multiple pathologies and their family caregivers, attending in two centers in Bogotá, Colombia. A multidimensional assessment was performed on the patient and caregiver with validated instruments. For the descriptive analysis, STATA version 13 was used.Results:52.6% were women over 80 years old, 48% were married, all of them completed primary school. In addition to kidney disease, 43.3%. has three associated diseases. 36.08% reported total independence in Basic Activities of Daily Living. 38% present a medium and problematic social risk, and a severe alteration in the quality of life. The main caregivers were children, followed by spouses.Conclusion:Many comorbid patients with chronic kidney disease present three associated chronic diseases, COPD, heart disease and mental illnesses. The results reflect clinical and psychosocial complexity associated especially with levels of functional dependence and social risk. The most affected quality of life dimensions are physical function and physical role. Family caregivers are mainly children, with a low burden is low and the adoption of the caregiver role is adequate. (AU)

Understanding Nurse-led Case Management in Patients with Chronic Illnesses: A Realist Review.

This realist review aims, with evidence from recent studies, to understand both how nurse-led case management interventions are implemented in the management of chronic illnesses, and in what circumstances these interventions are successful. The review followed the realist review methodology. From four electronic databases, twenty empirical and primary nurse-led case management intervention studies published between January 2011 and February 2020 were included. For each study, causality was explored, and findings were integrated. Three contexts, five mechanisms, and three major outcomes were found, and several context-mechanism-outcome strings were identified. Further analysis and synthesis of the studies showed that when duration of intervention, service delivery mode, and types of services are appropriate, as well as number of services with patients considering care is provided, case managment interventions change outcomes for patients with chronic illnesses. Finally, an explanatory conceptual framework based on the review results was developed to guide nurse managers and researchers.

A Toolkit for Community-Based, Medicaid-Funded Case Managers to Introduce Advance Care Planning to Frail, Older Adults: A Pilot Study.

Background: Advance care planning (ACP) among frail, older adults receiving in-home care is low. Leveraging case managers to introduce ACP may increase engagement. Objective: Pilot an ACP-Toolkit for case managers and their clients. Design: Feasibility pilot of an ACP-Toolkit for case managers to introduce ACP and the PREPAREforYourCare.org website and advance directives. Setting/Subjects: Case managers from four local aging service organizations who referred English-speaking clients ≥55 years old. Measurements: Using validated surveys (five-point Likert scales), we assessed changes in case managers' attitudes, confidence, and readiness to facilitate ACP and clients' readiness to engage in ACP from baseline to follow-up (one-week) using Wilcoxon signed-rank tests. Results: We enrolled 9 case managers and 12 clients (median age 69 [standard deviation 8], 75% minority race/ethnicity). At follow-up, case managers' confidence increased (3.2 [0.7] to 4.2 [0.7]; p = 0.02), and clients' readiness increased (2.8 [1.5] to 3.4 [1.4]; p = 0.06). All case managers agreed the Toolkit was easy to use, helped start ACP conversations, and would recommend it to others. All clients found the Toolkit easy to understand and were comfortable with case managers using it. Nearly all clients (92%) would recommend it to others. Suggestions for improvement included offering the Toolkit in other languages and disseminating it in clinical and community settings. Conclusions: The ACP-Toolkit resulted in higher case manager confidence in facilitating ACP and client readiness to engage in ACP, and usability was high. A brief ACP-Toolkit may be a feasible solution to increase ACP engagement among frail, older adults receiving in-home care.

Construction of the instrument for care transition in pediatric units / Construcción del instrumento para transición de cuidados en unidades pediátricas / Construção do instrumento para transição de cuidado em unidades pediátricas

ABSTRACT Objective: to build and semantically validate a safe communication tool to systematize care transition in pediatric clinical and emergency units. Method: a methodological study, based on the Classic Theory of Psychometric Tests and on the Instrument Development Model, proposed by Pasquali, which included seven professionals, five nurses and two physicians, experts in pediatrics and/or patient safety, who followed specific criteria for inclusion. Data collection was carried out between November and December 2016 and took place with the application of a form made available to the experts via the Google Drive/Microsoft® tool in two validation rounds, conducted by the Delphi Technique, being organized into two domains with 19 items. Data analysis was performed by calculating the Content Validity Index. Results: in order to validate the content, it was necessary to reach a Content Validity Index ≥ 0.80; thus, in the first round, five items underwent changes and were adjusted according to the experts' recommendations. These were validated in the second round, maintaining two domains and nineteen items. Conclusion: the construction and content validation of the instrument can enhance and qualify the clinical practice and contribute to minimize failures in pediatric patient safety associated with effective communication.

RESUMEN Objetivo: construir y validar semánticamente una herramienta de comunicación segura para sistematizar la transición de cuidados en las unidades clínicas y de urgencias pediátricas. Método: estudio metodológico, basado en la Teoría Clásica de Pruebas Psicométricas y en el Modelo de Construcción de Instrumentos, propuesto por Pasquali, que incluyó a siete profesionales especialistas en pediatría y / o seguridad del paciente, que siguieron criterios específicos de inclusión, cinco enfermeras y dos médicas. La recolección de datos se realizó entre noviembre y diciembre de 2016 y se dio con la aplicación de un formulario puesto a disposición de los especialistas a través de la herramienta Google Drive/Microsoft® en dos rondas de validación, realizadas por la Técnica Delphi, organizadas en dos dominios con 19 ítems. El análisis de los datos se realizó calculando el Índice de Validez de Contenido. Resultados: para la validación de contenido fue necesario alcanzar un Índice de Validez de Contenido ≥ 0,80, por lo que en la primera ronda se modificaron cinco ítems y se ajustaron según las recomendaciones de los expertos. Estos fueron validados en la segunda ronda, manteniendo dos dominios y diecinueve ítems. Conclusión: la construcción y validación de contenido del instrumento puede incrementar y calificar la práctica clínica y contribuye a minimizar las fallas en la seguridad del paciente pediátrico asociadas a una comunicación efectiva.

RESUMO Objetivo: construir e validar semanticamente um instrumento de comunicação segura para sistematizar a transição de cuidado em unidades clínicas e de emergência pediátricas. Método: estudo metodológico, fundamentado na Teoria Clássica dos Testes da Psicometria e no Modelo de Construção de Instrumentos, proposto por Pasquali, o qual incluiu sete profissionais experts em pediatria e/ou segurança do paciente, que seguiram critérios específicos para inclusão, sendo cinco enfermeiras e duas médicas. A coleta de dados foi realizada entre novembro e dezembro de 2016 e ocorreu com a aplicação de formulário disponibilizado às experts via ferramenta Google Drive/Microsoft® em duas rodadas de validação, conduzida pela Técnica Delphi, sendo organizados em dois domínios com 19 itens. A análise dos dados ocorreu pelo cálculo do Índice de Validade de Conteúdo. Resultados: para a validação do conteúdo foi necessário atingir um Índice de Validade de Conteúdo ≥ 0,80, assim na primeira rodada cinco itens sofreram alterações e foram ajustados de acordo com as recomendações das experts. Sendo estes validados na segunda rodada, mantendo dois domínios e dezenove itens. Conclusão: a construção e validação de conteúdo do instrumento pode incrementar e qualificar a prática clínica e contribuir para minimizar as falhas na segurança do paciente pediátrico associado a comunicação eficaz.

"And Then He Got into the Wrong Group": A Qualitative Study Exploring the Effects of Randomization in Recruitment to a Randomized Controlled Trial.

BACKGROUND: Randomized controlled trials (RCTs) are regarded as the most internally valid means of estimating the effectiveness of complex public health interventions, but the recruitment of participants can be difficult. The aim of this study was to explore factors that may have affected the recruitment of employees with musculoskeletal disorders (MSDs) to a multicenter worksite health promotion program from the perspective of recruiting case managers. METHODS: Factors in recruitment to the RCT were explored using three focus group discussions with case managers. Data were processed using MAXQDA and analyzed with a combination of content and sequence analysis. RESULTS: Findings showed that randomization is a major challenge for recruitment. Case managers adapted their communication with, and approaches to possible participants because of the randomization design and employed coping strategies to compensate for allocation into the control arm of the study. Perceptions of the superiority of the intervention group over the control group, perceptions of the (mis)match of participants to one of the groups, as well as the understanding of the necessity of randomization for effectiveness evaluations, further affected recruitment. Perceived expectations of possible participants and their (emotional) reactions to the randomization allocation also complicated recruitment. CONCLUSION: We were able to gain insight into the challenges of randomization for the recruitment of participants to a multicenter RCT. This study assisted the development of strategies to overcome barriers in the ongoing implementation process of the trial (i.e., the adaption of best practice information sheets and newsletters). There remains a need to develop effective interventions to help those recruiting to trials.

Integrating Evidence-Supported Psychotherapy Principles in Mental Health Case Management: A Capacity-Building Pilot.

OBJECTIVES: Mental health case managers comprise a large workforce who help patients who struggle with complex mental illnesses and unmet needs with respect to the social determinants of health. This mixed-methods capacity-building pilot examined the feasibility, experiences, and outcomes of training community-based mental health case managers to integrate evidence-based psychotherapy principles into their case conceptualization and management practices. METHODS: Case-based, once-weekly, group consultations and training in applied therapeutic principles from mentalizing, interpersonal psychotherapy, motivational interviewing, and other evidence-based psychotherapies were provided to case managers over 8 months. A trauma-informed and culturally sensitive approach was emphasized to improve therapeutic alliances and to foster adaptive expertise and an appreciation of individual patient differences. RESULTS: Qualitative analyses of focus groups and individualized interviews identified a shift toward being more reflective rather than reactive, with improved empathy, patient engagement, morale, and confidence resulting from the training (N = 16). Self-reported pre-post counseling self-efficacy changes revealed significant improvements overall, driven by improved microskills and an ability to deal with challenging client behaviors (N = 10; P < 0.05). CONCLUSIONS: This pilot demonstrated that case-based consultations and training of mental health case managers within a community-of-practice in trauma-informed, culturally sensitive application of evidence-supported psychotherapy principles were feasible and acceptable with scalable potential to improve case managers' counseling self-efficacy, reflective capacity, empathy, and morale. Further research in this area is needed with a larger sample, and patient and health systems outcomes.