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ABSTRACT: Traumatic brain injury (TBI) is an important public health concern that presents real challenges for health care systems throughout the world. Through an international partnership between Canadian and French researchers, a vast qualitative study aimed to explore the needs of individuals with TBIs and their loved ones throughout the continuum of care and services. The study was first conducted in 3 regions of Quebec (Canada) and subsequently replicated in 3 regions of France. Overall, the data were collected from focus groups with 150 participants: individuals with TBIs, their loved ones, and health care professionals. Despite regional differences, the results demonstrate participants' very similar perceptions regarding the needs such as information, support, and a collaborative relationship with health care professionals experienced by individuals with TBIs and their loved ones. These needs change throughout the stages of care. The fulfillment of these needs play a determining role throughout the adaptation process of individuals with TBIs and their loved ones. Health care professionals must adopt a personalized approach to respond to needs related to the evolution of information, support, and relationships.
Journal of trauma nursing: the official journal of the Society of Trauma Nurses 10/2012; 19(4):197-207.
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ABSTRACT: This study aims to paint a picture of the needs of people close to individuals with a TBI and the services offered to answer these needs, from the point of view of the individuals with a TBI and health professionals.
This study has a qualitative design and a reflexive group was used to collect data. The démarche réflexive d'analyse en partenariat, DRAP (developing reflexive analysis for partnership) was used as a data collection method. The sample comprised Montreal family members (n = 4), Outaouais family members (n = 8), Abitibi family members (n = 7); Montreal care providers (n = 9), Outaouais care providers (n = 11) and Abitibi care providers (n = 9).
The results show that people close to individuals with a TBI need information on the health problem, specifically with regard to the diagnostic, the prognostic, and the factors that influence it, as well as the steps towards rehabilitation, and care and services. The results show that close ones need specific, quality services and continuity of services.
In conclusion, the pertinence of this study lies in the desire of close ones and health professionals to ease the adaptation process imposed by a TBI, and to promote the well-being of informal caregivers.
Brain Injury 05/2012; 26(9):1084-97. · 1.36 Impact Factor
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ABSTRACT: Clients with mild stroke may present subtle deficits that have an impact on complex activities and roles. The purpose of this study was to explore the perceived quality of life of spouses, 3 months after the client with stroke was discharged to go home from acute care. A qalitative design based on a constructivist paradigm was used. Interviews were conducted with family members of the clients with mild stroke, 3 months after discharge. An interview guide was used and the audio content was transcribed, followed by a content analysis. In this study, eight interviews were conducted (mean age 56.9±9.2 years; men=2/8), and six essential themes emerged from the data. According to the participants, clients with mild stroke present sequelae that interfere with complex tasks (patient), increasing the burden on other family members who have to limit their personal activities (daily living). Sometimes, spouses were reported to act like a parent, which caused tensions in the relationship (conjugal relationship). Anxiety is related to the risk of stroke recurrence (relapse) and some family members present physical symptoms and a lack of energy (health). However, family members do not have access to services despite support from their relatives (services). The results of this exploratory study strongly suggest that even a 'mild' stroke has an impact on the daily lives of spouses and affects their quality of life.
International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation 02/2011; 34(3):209-14. · 0.36 Impact Factor
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ABSTRACT: This article presents a study that compared participation by elderly individuals living in the community according to primary transportation mode used, and estimated the association between transportation, personal factors, and environmental factors. Participants included 90 adults aged 65 and older (M=76.3 years; SD=7.7). They were classified according to their primary transportation mode: driver, passenger, public transport user, walk, or adapted transport/taxi user. Participation was measured with the Craig Handicap Assessment and Reporting Technique (CHART) and the Nottingham Leisure Questionnaire (NLQ). Overall, results indicated that drivers, public transport users, and walkers had higher participation levels compared to passengers and adapted transport/taxi users. This study suggests that clinicians should consider older adults' use of transportation in an attempt to encourage and maximize their participation.
Canadian journal on aging = La revue canadienne du vieillissement 12/2010; 29(4):491-502. · 0.92 Impact Factor
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ABSTRACT: Abstract
Background
Regional networks have been recognized as an interesting model to support interdisciplinary and inter-organizational interactions that lead to meaningful care improvements. Existing communities of practice within the a regional network, the Montreal Stroke Network (MSN) offers a compelling structure to better manage the exponential growth of knowledge and to support care providers to better manage the complex cases they must deal with in their practices. This research project proposes to examine internal and external factors that influence individual and organisational readiness to adopt national stroke best practices and to assess the impact of an e-collaborative platform in facilitating knowledge translation activities.
Methods
We will develop an e-collaborative platform that will include various social networking and collaborative tools. We propose to create online brainstorming sessions ('jams') around each best practice recommendation. Jam postings will be analysed to identify emergent themes. Syntheses of these analyses will be provided to members to help them identify priority areas for practice change. Discussions will be moderated by clinical leaders, whose role will be to accelerate crystallizing of ideas around 'how to' implement selected best practices. All clinicians (~200) involved in stroke care among the MSN will be asked to participate. Activities during face-to-face meetings and on the e-collaborative platform will be documented. Content analysis of all activities will be performed using an observation grid that will use as outcome indicators key elements of communities of practice and of the knowledge creation cycle developed by Nonaka. Semi-structured interviews will be conducted among users of the e-collaborative platform to collect information on variables of the knowledge-to-action framework. All participants will be asked to complete three questionnaires: the typology questionnaire, which classifies individuals into one of four mutually exclusive categories of information seeking; the e-health state of readiness, which covers ten domains of the readiness to change; and a community of practice evaluation survey.
Summary
This project is expected to enhance our understanding of collaborative work across disciplines and organisations in accelerating implementation of best practices along the continuum of care, and how e-technologies influence access, sharing, creation, and application of knowledge.
Implementation Science. 01/2010;
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ABSTRACT: This study explores the perceptions of adolescents, their parents and professionals as to the social inclusion of adolescents who have suffered a moderate traumatic brain injury (TBI). Research design: Exploratory descriptive qualitative study.
Semi-structured interviews were conducted with three adolescents who had suffered a moderate TBI and with their parents. In addition, a focus group was conducted with four professionals.
The results show that the perceptions of adolescents, as well as their parents, affect different aspects of their lives, such as the adolescent's personal experiences, the family, friends, the environment and school. A great number of repercussions were indeed noted, which facilitate and sometimes limit the social inclusion of these adolescents. In general, the professionals shared the same perceptions, but added some ideas that did not come up in interviews with the adolescents and their parents.
The results of this study should enable health professionals to better understand the social inclusion experienced by these people. They should also provide professionals with guidelines on how to better support the social inclusion of adolescents with TBIs and help families cope with this difficult situation.
Brain Injury 01/2010; 24(9):1087-97. · 1.36 Impact Factor
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ABSTRACT: Regional networks have been recognized as an interesting model to support interdisciplinary and inter-organizational interactions that lead to meaningful care improvements. Existing communities of practice within the a regional network, the Montreal Stroke Network (MSN) offers a compelling structure to better manage the exponential growth of knowledge and to support care providers to better manage the complex cases they must deal with in their practices. This research project proposes to examine internal and external factors that influence individual and organisational readiness to adopt national stroke best practices and to assess the impact of an e-collaborative platform in facilitating knowledge translation activities.
We will develop an e-collaborative platform that will include various social networking and collaborative tools. We propose to create online brainstorming sessions ('jams') around each best practice recommendation. Jam postings will be analysed to identify emergent themes. Syntheses of these analyses will be provided to members to help them identify priority areas for practice change. Discussions will be moderated by clinical leaders, whose role will be to accelerate crystallizing of ideas around 'how to' implement selected best practices. All clinicians (~200) involved in stroke care among the MSN will be asked to participate. Activities during face-to-face meetings and on the e-collaborative platform will be documented. Content analysis of all activities will be performed using an observation grid that will use as outcome indicators key elements of communities of practice and of the knowledge creation cycle developed by Nonaka. Semi-structured interviews will be conducted among users of the e-collaborative platform to collect information on variables of the knowledge-to-action framework. All participants will be asked to complete three questionnaires: the typology questionnaire, which classifies individuals into one of four mutually exclusive categories of information seeking; the e-health state of readiness, which covers ten domains of the readiness to change; and a community of practice evaluation survey.
This project is expected to enhance our understanding of collaborative work across disciplines and organisations in accelerating implementation of best practices along the continuum of care, and how e-technologies influence access, sharing, creation, and application of knowledge.
Implementation Science 01/2010; 5:44. · 3.10 Impact Factor
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ABSTRACT: Traumatic brain injury (TBI) has damaging impacts on victims and family members' lives and their long-term social integration constitutes a major challenge.
The objective of the study was to document the repercussions of TBI on victims' long-term social integration (10 years post-trauma) and the contribution made by the services received from the point of view of TBI victims and family caregivers. This article examines the determinants of long-term social integration as well as the impact of TBI on family caregivers.
A qualitative design was used (semi-directed interviews). The sample consisted of 22 individuals who had sustained a moderate or severe TBI and 21 family caregivers.
The results show that TBI is an experience that continues to present difficulties, even 10 years after the accident, and that different barriers contribute to this difficulty: not going back to work, depressive episodes, problems in relationships and sequellae. Family caregivers must help TBI victims confront the barriers in their path.
This study adopts a longitudinal perspective to help professionals determine how to intervene with TBI victims and their families. It validates the importance of having clients and family caregivers describe their reality.
Brain Injury 08/2008; 22(7-8):535-43. · 1.36 Impact Factor
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ABSTRACT: To identify the specific service needs of adolescents with mild traumatic brain injury (MTBI) and those of their parents through the perspective of expert service providers as well as to compare it to the perspective of adolescents and their parents obtained in a prior study.
Qualitative design including a focus group held with experts in the field of adolescent TBI and a validation survey of other professionals.
Eight experts from a variety of disciplines participated in a focus group where important needs of adolescents were discussed. Results were then validated through a questionnaire to 33 professionals.
Experts questioned through both methods are generally in agreement and acknowledge that adolescents are unique, but they often find them challenging. Like adolescents themselves, experts identify the need for information as the most important but are wary of offering too much detail and fear that this could encourage malingering of symptoms and problems. Service providers also recognize the importance of supporting adolescents and parents when returning to activities (school and physical activities).
The notion that teens represent a specific group of consumers of healthcare services is supported by findings in this study. These results provide important information to those involved in the structuring of service provision to adolescents following MTBI.
Brain Injury 08/2008; 22(7-8):581-8. · 1.36 Impact Factor
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ABSTRACT: This preliminary study aimed at documenting the needs of families having a child with a disability concerning information, from the point of view of both parents and professionals involved with them. Three discussion groups were carried out: two with parents of children with Down's syndrome or cerebral palsy, and another group with health professionals involved with them. The results show that the parents are searching for information concerning the initial health problem, the available health care and other resources that might be of help. Sources of information for parents include the health care professionals, other parents within a similar situation, the media and the Internet. The obtained information influences the parents' adjustment over their child's health situation and also impacts the relationships they have with the health care team. Some recommendations regarding intervention are proposed.
Recherche en soins infirmiers 04/2008;
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ABSTRACT: The information conveyed to patients and families dealing with a health problem such as traumatic brain injury or stroke combines with what they already know to form a new pool of knowledge. The aim of this pilot study was to describe the information needs of family caregivers, their sources of information, their strategies for gathering information, and the impact of the information on their adjustment and their relationship with health professionals. Focus groups were held with close relatives of persons who had sustained a traumatic brain injury or a stroke and with health professionals from various disciplines working with theses clienteles. The information needs of relatives concerned the impact of the person's disabilities on their everyday lives. From the professionals' point of view, the information needs of close relatives concerned the person's disabilities, their coping strategies, and their information sources. Life experience was the main source of knowledge. The results form a basis for recommendations regarding interventions in acute care and rehabilitation.
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 04/2008; 40(1):143-60.
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ABSTRACT: This review of the literature considers the use of video as a pedagogic tool (teaching instrument) for the training of new perioperative nurses. The literature review seeks to address the question of which usage of the video medium can be integrated into the education of new OR nurses. Kolb's model of experiential learning, whereby knowledge is acquired by transforming experience into new ways of thinking and behaviours, is the theoretical framework used to analyze the pertinent literature. The selected articles were obtained from the following search engines: CINAHL, ERIC and PSYCH INFO. In addition, articles were obtained from experts in the clinical field. The reviewed literature can be classified into three main categories: the use of video to demonstrate content; the use of video for self-analysis; and the integration of video in to multimedia teaching programs.
Canadian operating room nursing journal 04/2008; 26(1):8-9, 14-5, 17-20.
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ABSTRACT: Various guidelines have been developed to implement coherent and uniform management of persons with a mild traumatic brain injury (mTBI), but those have typically been developed for adults or children and may not address or meet the specific needs of adolescents. The purpose of this study was to explore the specific service needs of adolescents (12-18 years) after a mTBI.
Qualitative phenomenological study.
Individual semi-structured interviews were conducted with 15 adolescents and their parents who had received different levels of care from paediatric trauma centres within the previous 12 months.
All adolescents and parents expressed the need to receive information about the injury, its expected recovery and when to return to activities. Many adolescents reported wanting to be seen rapidly, by professionals who genuinely care about them and who acknowledge that they have specific needs that differ from those of younger children. Parents and, to a lesser degree, adolescents think that enhanced communication between the healthcare and school systems would be beneficial following a mTBI to assist in returning to demanding academic activities.
Professionals involved in the management of adolescents with mTBI should be aware of their needs in order to provide optimal and developmentally appropriate services.
Brain Injury 03/2008; 22(2):161-73. · 1.36 Impact Factor
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ABSTRACT: The information conveyed to patients and families dealing with a health problem such as traumatic brain injury or stroke combines with what they already know to form a new pool of knowledge. The aim of this pilot study was to describe the information needs of family caregivers, their sources of information, their strategies for gathering information, and the impact of the information on their adjustment and their relationship with health professionals. Focus groups were held with close relatives of persons who had sustained a traumatic brain injury or a stroke and with health professionals from various disciplines working with theses clienteles. The information needs of relatives concerned the impact of the person's disabilities on their everyday lives. From the professionals' point of view, the information needs of close relatives concerned the person's disabilities, their coping strategies, and their information sources. Life experience was the main source of knowledge. The results form a basis for recommendations regarding interventions in acute care and rehabilitation.
French
L'information transmise aux patients et aux familles aux prises avec des troubles de santé comme un traumatisme crânien ou un accident vasculaire cérébral (AVC) s'ajoute à ce que ces personnes savent déjà pour former un corpus de connaissances. Cette étude avait pour objectif d'identifier les besoins des aidants naturels en matière d'information, leurs sources d'information, leurs stratégies de cueillette d'information et l'impact de celle-ci sur leur capacité d'adaptation et leur lien avec les professionnels de la santé. Des groupes de discussions auxquels participaient des proches parents de personnes atteintes de traumatisme crânien ou d'un AVC ainsi que des professionnels de la santé de diverses disciplines travaillant avec cette clientèle ont été menés. Les besoins en information des proches parents portaient sur l'impact du handicap de la personne atteinte sur leur vie quotidienne. Selon le point de vue des professionnels, les besoins des proches portaient sur les incapacités de la personne, leurs stratégies d'adaptation et leurs sources d'information. L'expérience de la vie constituait la principale source de connaissances. Des recommandations en matière d'intervention en soins actifs et de réadaptation ont été émises à partir des résultats de l'étude.
The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières 02/2008; 40(1):142-160.
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ABSTRACT: The birth of a child is a transitional situation that triggers stress in the family and each person has to use adjustment strategies allowing them to reposition gradually in relation to themselves and other members of the family, and to make space for the new arrival. When the child has a health problem, the stress on the parents is correspondingly greater. Research shows that fathers and mothers of a child with a health problem experience this ordeal differently. This article reports on the current state of knowledge about the experience of fathers and mothers of a child with a health problem, and suggests new directions for research to provide a fuller understanding of their experience.
Journal of Child Health Care 07/2007; 11(2):112-31. · 0.75 Impact Factor
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ABSTRACT: This paper presents research results regarding disclosure of traumatic brain injury (TBI) diagnosis and resulting deficits of a study aiming to investigate the experiences of individuals who had sustained a TBI, their families, the physicians and health professionals involved, from the critical care episodes and subsequent rehabilitation.
Semi-structured interviews were conducted with individuals who had sustained a TBI (n = 8) and their families (n = 8) as well as with the health professionals (or service providers) (n = 22) and physicians (n = 9) who provided them care.
Results revealed that the quality of the disclosure is strongly influenced by the medical uncertainty surrounding the TBI and the difficulties of healthcare professionals in dealing with the family's emotions.
Delivering bad news is always difficult, but it is possible to make this harrowing experience easier and, in so doing, enhance patient and family resilience.
Brain Injury 07/2006; 20(7):711-8. · 1.36 Impact Factor
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ABSTRACT: This is a study of medical care when road accident incidents result in traumatic brain injury (TBI). We investigated the personal perceptions of those involved in acute care episodes and subsequent rehabilitation. We conducted simultaneous semi-structured interviews with individuals who had sustained a TBI (8) and their families (8). We then conducted semi-structured individual interviews with the professionals (22) and physicians (9) who attended them. Results reveal the difficulties encountered by the different people involved, from the standpoint of the rehabilitation of both the person who with the TBI and their families, the relationships among the various actors, and the continuity of care. The results disclose the importance of including the family and the TBI casualty in the care process by endorsing their participation and by setting up suitable structures that prioritize a meaningful partnership among the individuals, families, physicians, professionals and health care organizations and in which each person can play a role as an agent in the care of the person with the TBI. An important element, which came out again in our results, is that the shortage of information provided to the families can jeopardize establishing a relationship of trust among the actors. Furthermore, many of the family members were upset that the health intervention was entirely focussed on the TBI casualty: none of the professionals were concerned with what the families were going through, either during the acute care or rehabilitation. Another major problem is lack of communication, not just amongst the professionals, but also between institutions which seem to function in isolation. Lack of resources, the limited availability of those that are offered, and social policies are also detrimental to the reintegration of the TBI individual into the community. Finally, many of the professionals reported that they had not been trained to assist families in this situation.
Recherche en soins infirmiers 10/2004;
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ABSTRACT: This qualitative study used focus groups to identify the differences and similarities in the experiences of parents of children with a disability. Two main themes emerged, showing the ways in which the mothers and fathers are alike or different. One concerns roles, actual and expected, in the various subsystems of family life. The other concerns the normalization and stigmatization that arise because of the child's problem. Mothers tend to score better in terms of interpersonal and group communications. It would seem that the fathers' expectations are harder to fulfil than the mothers'. The fathers' expectations are attuned to the outer world; the actual day-to-day tasks related to the child's care are not their priority. The mothers are less demanding and their expectations are more self-focused. Interestingly, these families are similar to families of children without a disability; however, the difficulties they experience are accentuated by the presence of a child with a problem.
Journal of Child Health Care 01/2004; 7(4):231-47. · 0.75 Impact Factor
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ABSTRACT: The aim of this study is to estimate parents' satisfaction following a surgical procedure on their child. This includes support as well as additional information and documentation for the individual parent (cognitive and emotional), conjugal, parental and other family members. The majority of parents are satisfied with the treatment program, realizing that the treatment enables them to adapt to their new situation, that is, as parents of a newborn child suffering from health problems. This support allows them to recognize and talk about their own fears and emotions as well as those of their partner, to be reassured when facing their child's treatment, and to better understand the available resources. The results of the study show that there are significant differences in regards to the sex of the parent, the diagnosis of the child and the level of income. Mothers of children inflicted with Down's syndrome are more emotionally satisfied with the treatment than fathers, and lower income families are more satisfied with the treatment as well as with the sub-system of family health-care than middle and upper-income families. Parents of children with a labial and/or palatine cleft are more satisfied with the treatment in regards to the family plan than parents of children with Down's syndrome. These results raise several questions that, with more profound deliberation on the adequacy of early medical procedures with regards to the parents of children with health problems, shall not be overlooked. Let us highlight the heuristic qualities of this evaluative approach which possess the same relevance as the questionnaires developed in order to assess the families' satisfaction. After modifications, these questionnaires could eventually be used on different clientele as well.
Recherche en soins infirmiers 07/2002;
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ABSTRACT: The Program of Interdisciplinary Family Surgical Procedures (PIFSP), is oriented towards the development of partnerships between families and nurses in order to respond to the specific needs of families with children suffering from health problems. It was implemented by the accumulation of information and expertise respective of the other and in regards to their relevance. A retrospective qualitative study on apprenticeships conducted with parents and nurses during a proposal by PIFSP shows at what point parents' and nurses' educational conduits are linked to faith, thought patterns, perception and behaviour, which corresponds to a specific conception of educational medical procedures in nursing science. This is part of the paradigm structure in educational and nursing science.
Recherche en soins infirmiers 07/2002;
