Carl-Ardy Dubois's research while affiliated with Polytechnique Montréal and other places
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Publications (62)
Background Feedback on clinical performance aims to provide teams in health care settings with structured results about their performance in order to improve these results. Two systematic reviews that included 147 randomized studies showed unresolved variability in professional compliance with desired clinical practices. Conventional recommendation...
Background
Care quality varies between organizations and even units within an organization. Inadequate care can have harmful financial and social consequences, e.g. nosocomial infection, lengthened hospital stays or death. Experts recommend the implementation of nursing performance improvement systems to assess team performance and monitor patient...
Introduction: The operationalization of nursing-sensitive performance measures has been highly variable. It results in measures that are sometimes suboptimal and difficult for managers and nurses to access. The objective is to propose a rigorous method for operationalizing nurse-sensitive performance measures based on routine data. Source of Inform...
Aims
To describe the organization of nursing services (staffing, scope of practice, teamwork) and its association with medication errors and falls, in rehabilitation units.
Background
The healthcare system is greatly impacted by the ageing population and the complexity of care associated with chronic diseases. It is therefore necessary to have eno...
Background: Nosocomial infections (NIs) are among the main preventable healthcare adverse events. Like all countries, Canada and its provinces are affected by NIs. In 2004, Ministry of Health and Social Services (MSSS) of Quebec instituted a mandatory surveillance NI program for the prevention and control (NIPC) in the hospitals of the province. On...
Background
Nurse practitioners (NPs) have been added to primary healthcare teams to improve access to care. Team processes, including communication and decision-making, explicate how patients and families view team functioning. Yet, important gaps exist in our understanding of patient-reported experience and outcomes at the level of the healthcare...
Background
Providing care to cancer patients is associated with a substantial psychological and emotional load on oncology workers. The purpose of this project is to co-construct, implement and assess multidimensional intervention continuums that contribute to developing the resilience of interdisciplinary cancer care teams and thereby reduce the b...
Introduction : Le rôle de l’infirmière praticienne spécialisée en soins de première ligne (IPSPL) est relativement récent au Québec. Il y a peu de données sur le déploiement de ce rôle. Objectif : Cette étude vise à décrire le temps passé dans les activités de soins selon les différentes dimensions cliniques et non-cliniques du rôle des IPSPL. Méth...
Aim
Describe brief (less than half a day) interventions aimed at improving healthcare team functioning.
Methods
A systematic review on brief team interventions aimed at role clarification and team functioning (PROSPERO Registration Number: CRD42018088922). Experimental or quasi-experimental studies were included. Database searches included CINAHL,...
Purpose – Centralized waiting lists (CWLs) for patient attachment to a primary care provider have been implemented across Canada, including Quebec. Little is known about the implementation of CWLs and the factors that influence implementation outcomes of such primary care innovations. The purpose of this paper is to explain variations in the outcom...
Background:
E-learning is rapidly growing as an alternative way of delivering education in nursing. Two contexts regarding the use of e-learning in nursing are discussed in the literature: (1) education among nursing students and (2) nurses' continuing education within a life-long learning perspective. A systematic review of systematic reviews on...
Background:
Nursing care quality varies between hospitals, and even between departments within the same institution. Suboptimal care can have deleterious consequences for patients such as lengthened hospital stay, nosocomial infection, pressure ulcers or death. Experts recommend the implementation of nursing performance improvement systems to asse...
Purpose
Centralized waiting lists (CWLs) for patient attachment to a primary care provider have been implemented across Canada, including Quebec. Little is known about the implementation of CWLs and the factors that influence implementation outcomes of such primary care innovations. The purpose of this paper is to explain variations in the outcome...
BACKGROUND
e-Learning is rapidly growing as an alternative way of delivering education in nursing. Two contexts regarding the use of e-learning in nursing are discussed in the literature: 1) education among nursing students and 2) nurses’ continuing education in a life-long learning perspective. A previous systematic review of systematic reviews on...
Aims:
To identify nurse staffing groups in acute care facilities.
Design:
This retrospective descriptive study used a configurational approach.
Methods:
Data from a two-month target period from January-March 2016 were collected for 40 facilities in four different hospitals in one of the largest regions of Quebec. Multiple factorial analysis an...
Objective:
To estimate national and geography-based variations in blood pressure and burden of hypertension in Cameroon, generally called 'miniature Africa'.
Methods:
PubMed, Medline, EMBASE, CINHAL, Web of Science, Popline, Scopus and BDSP were searched through November 2018, for hypertension studies among Cameroonians aged at least 18 years. H...
Background
Nurses play a significant role in healthcare systems. Their workplace experience can have an impact not only on nurses themselves, but also on patients and organizations, particularly in terms of quality of care and performance. Despite the importance of this experience, it remains an ambiguous concept with varying interpretations. Curre...
Background
Access to primary healthcare is an important social determinant of health and having a regular general practitioner (GP) has been shown to improve access. In Canada, socio-economically disadvantaged patients are more likely to be unattached (i.e. not have a regular GP). In the province of Quebec, where over 30% of the population is unatt...
Purpose:
In response to more than 15% of Canadians not having a family physician, 7 provinces have implemented centralized waiting lists for unattached patients. The aim of this study is to analyze the association between family physicians' characteristics and their participation in centralized waiting lists.
Methods:
Cross-sectional observation...
Background:
Prenatal education is a core component of perinatal care and services provided by health institutions. Whereas group prenatal education is the most common educational model, some health institutions have opted to implement online prenatal education to address accessibility issues as well as the evolving needs of future parents. Various...
Background
Care integration has been the focus of recent health system reforms. Given their functions at all levels of the care continuum, nurses have a substantial and primordial role to play in such integration processes. The aim of this study was to identify levers and strategies that organizations can use to support the development of a nursing...
Introduction
Continuing education (CE) is imperative to the future of professional nursing. The use of e-learning by registered nurses for CE is spreading. A review of systematic reviews will be conducted to develop a broad picture of the effects of e-learning in a CE context on nursing care.
Methods and analysis
Systematic qualitative, quantitati...
Aims:
A discussion of an optimal set of indicators that can be used on a priority basis to assess the performance of nursing care.
Background:
Recent advances in conceptualization of nursing care performance, exemplified by the Nursing Care Performance Framework, have revealed a broad universe of potentially nursing-sensitive indicators. Organiz...
Background
Hypertension holds a unique place in population health and health care because it is the leading cause of cardiovascular disease and the most common noncommunicable condition seen in primary care worldwide. Without effective prevention and control, raised blood pressure significantly increases the risk of stroke, myocardial infarction, c...
Background
Information and communication technologies (ICTs) are becoming an impetus for quality health care delivery by nurses. The use of ICTs by nurses can impact their practice, modifying the ways in which they plan, provide, document, and review clinical care.
Objective
An overview of systematic reviews was conducted to develop a broad pictur...
Aims:
To assess the economic burden of nurse-sensitive adverse events (NSAEs) in 22 acute care units in Quebec by estimating excess hospital-related costs and calculating resulting additional hospital days.
Background:
Recent changes in the worldwide economic and financial contexts have made the cost of patient safety a topical issue. Yet our kn...
Background
With 4.6 million patients who do not have a regular family physician, Canada performs poorly compared to other OECD countries in terms of attachment to a family physician. To address this issue, several provinces have implemented centralized waiting lists to coordinate supply and demand for attachment to a family physician. Although sign...
A strong and effective primary care capacity has been demonstrated to be crucial for controlling costs, improving outcomes, and ultimately enhancing the performance and sustainability of healthcare systems. However, current challenges are such that the future of primary care is unlikely to be an extension of the current dominant model. Profound env...
Despite the well-known advantages of information and communication technologies (ICTs), their overall impact on nursing care has not been synthesized. The objective of this overview of systematic reviews is to summarize the best evidence regarding the effects of ICTs on nursing care. We considered quantitative, qualitative and mixed-method reviews...
Introduction:
The overall aim of this project is to help develop knowledge about primary care delivery models likely to improve the accessibility, quality and efficiency of care. Operationally, this objective will be achieved through supporting and evaluating 8 primary care team pilot sites that rely on an expanded nursing role within a more inten...
![Nursing Care Performance Framework (NCPF) developed by Dubois et al. [15].](publication/281274898/figure/fig1/AS:1088572144791577@1636547232397/Nursing-Care-Performance-Framework-NCPF-developed-by-Dubois-et-al-15_Q320.jpg)
The quality and safety of nursing care vary from one service to another. We have only very limited information on the quality and safety of nursing care in outpatient settings, an expanding area of practice. Our aim in this study was to make available, from the scientific literature, indicators potentially sensitive to nursing that can be used to e...
![Figure 1: Integrated care development model [ 19 ] .](publication/274733183/figure/fig1/AS:272550731186188@1441992566288/Integrated-care-development-model-19_Q320.jpg)
Even though nurses are expected to play a key role in implementing integrated services networks, up to now their practice in this regard has received very little research attention. The aim of this study is to describe the extent to which the evolution of nursing practice in Quebec in recent years has converged with the requirements and efforts inv...
Background: Integrating Nurse Practitioners into primary care teams is a process that involves significant
challenges. To be successful, nurse practitioner integration into primary care teams requires, among other things, a redefinition of professional boundaries, in particular those of medicine and nursing, a coherent model of inter- and intra- pr...
Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into...
To respond better to population needs, in recent years Quebec has invested in improving the integration of services and care pathways. Nurses are on the front lines of these transformation processes, which require them to adopt new clinical practices. This updating of practices can be a source of both satisfaction and stress. The aim of this study...
Background
Most national and provincial commissions on healthcare services in Canada over the past decade have recommended that primary care services be strengthened in order to guarantee each citizen access to a family physician. Despite these recommendations, finding a family physician continues to be problematic. The issue of enrolment with a fa...
Organizational climate in healthcare settings influences patient outcomes, but its effect on nursing care delivery remains poorly understood. In this mixed-methods study, nurse surveys (N = 292) were combined with a qualitative case study of 15 direct-care registered nurses (RNs), nursing personnel, and managers. Organizational climate explained 11...
In recent years, successive work reorganization initiatives have been implemented in many healthcare settings. The failure of many of these change efforts has often been attributed in the prominent management discourse to change resistance. Few studies have paid attention to the temporal process of workers' resource depletion/accumulation over time...
Ensuring the safety of hospitalized patients remains a major challenge for healthcare systems, and nursing services are at the center of hospital care. Yet our knowledge about safety of nursing care is quite limited. In fact, most earlier studies examined one, or at most two, indicators, thus presenting an incomplete picture of safety at an institu...
Despite the critical role of nursing care in determining high-performing healthcare delivery, performance science in this area is still at an early stage of development and nursing's contribution most often remains invisible to policy-makers and managers. The objectives of this study were: 1) to develop a theoretically based framework to conceptual...
Objective:
To examine the associations of four distinct nursing care organizational models with patient safety outcomes.
Design:
Cross-sectional correlational study. Using a standardized protocol, patients' records were screened retrospectively to detect occurrences of patient safety-related events. Binary logistic regression was used to assess...
Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the d...
: This project describes the development and testing of the actual scope of nursing practice questionnaire.
: Underutilization of the skill sets of registered nurses (RNs) is a widespread concern. Cost-effective, safe, and efficient care requires support by management to facilitate the implementation of nursing practice at the full scope.
: Literat...
Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focu...
Drawing on a longitudinal study from the early years of implementation of health-care networks in Quebec, this article describes how public-sector managers deal with complex challenges when both organizational structures and organizational strategies are radically transformed simultaneously. The new organizations studied had to completely re-shuffl...
The main objective of the Regional Training Centres (RTCs) is to produce well qualified personnel within the fields of health services and nursing research. Through their collaborative efforts, each of the RTCs has created opportunities for conceptual and methodological competency, knowledge synthesis and knowledge translation and exchange for grad...
Les résultats de l'évaluation de l'implantation du programme d'intéressement au titre d'infirmière praticienne spécialisée (IPS) montrent une grande valorisation du rôle de l'IPS et une perception généralisée de la contribution significative de celle-ci au système de santé québécois. L'introduction de ce nouveau rôle a nécessité un engagement impor...
Citations
... Feedback on clinical team performance is based on an unpredictable and complex interdependent sociotechnical system. As described previously [12], the current state of research on feedback limits the ability to understand (1) the occurrence and evolution of social interactions during feedback on clinical team performance, within their context; (2) the evolution of sociotechnical interactions, within particular contexts; and (3) the transformations generated by such a complex system of sociotechnical interactions. We postulated that a critical realist qualitative multiple case study would provide answers to these three limits. ...
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... O sistema de saúde é muito afetado pelo envelhecimento da população e pela complexidade dos cuidados associados às doenças crónicas (3) , exigindo que os profissionais de saúde trabalhem em estreita colaboração. O problema surge porque, apesar do reconhecimento de que as práticas em equipa melhoram a atenção à saúde dos Idosos, não há consenso sobre o modo como otimizar a interação entre os profissionais. ...
... It appears important to expand on this area of research to examine team functioning in other areas such as long-term care and home care, and include the perspective of patients and families. Additional research to understand the impact of specific factors such as role clarity, team processes (e.g., communication, care coordination) and role implementation also needs to be undertaken to make a clearer link between role implementation, scope of practice, team functioning and outcomes [15]. PHCNPs practice in a wide range of setting and with diverse patient populations, including vulnerable populations [72]. ...
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... Second, as with social support, managers may be unaware that team care is occurring, but inadvertently (or even intentionally) "take credit" for the performance of a compassionately well-regulating team, which might lead to bitterness or cynicism on the part of team members. Hence, to foster and nurture team care, managers must be cognizant of team members' reciprocal compassion and provide environments that facilitate the team's engagement in compassionate communication (Dubois et al., 2020). ...
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... Typically, NPs can provide patient care that includes follow up and monitoring of minor acute conditions and chronic illness. NPs are integrated into primary care to improve organizational efficiency and quality of care (Heale et al., 2018) by improving patient access while controlling costs (Landry et al., 2020) and compensating for physician shortages (Cody et al., 2020). ...
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... For the included papers, all data were extracted by one coder and reviewed by a second coder. A structured tool was developed for the study and pilot-tested by the investigators [25]. The extracted data included the aim of the review; review characteristics (e.g., year); number of databases searched; countries; number of studies, date range and designs; population characteristics, intervention, comparator, and synthesis method. ...
... Previous research suggests that centralized waiting lists are effective to increase attachment [44]. However, a number of challenges remain, including large regional variations [45], long wait times (over 500 days on average), physicians' preference for attaching healthy patients [44,46], and inequities in attachment for patients from disadvantaged areas or with complex needs [44,[47][48][49]. Finally, how attachment through centralized waiting lists influences access to and continuity of primary care has not been evaluated. ...
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... They showed that the educational intervention could increase the disaster-related knowledge, attitudes and preparations of nurses in the intervention group compared with the control group [35]. However, a review study reported that the effect size of online training could be different depending on the skills trained, the training outcome and the educational approach used, and nurses needed continuous practical exercises, maneuvers and simulated situations for specialized skills, such as disaster management competencies because they experienced them in special and limited situations [36]. ...
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... Interestingly, although nursing staff perceived their input as being disregarded or unwanted by medical staff, medical staff reported the input of nursing staff as invaluable in their decision-making process. This highlights the importance of feedback amongst clinicians to facilitate and allow clinicians to feel heard [64] . Similarly, another study found that physicians were disinterested in EOLC and often left the nursing staff to manage all aspects of care, with physicians only then providing input with symptom management and confirmation of death [54] . ...
... AINs were implemented into the nursing model to assist and support registered nursing staff to care for complex and heavy workloads. Healthcare settings are moving away from the higher-risk substitution model, where the AIN replaces a registered nurse in the staffing mix (Duffield et al., 2018, Griffiths et al., 2019, Thériault, Dubois, Borgès da Silva, & Prud'homme, 2019. However, healthcare settings still need to recognise that even in this 'complementary' model where the AIN is present as an additional staff member to assist the registered nurse, patient outcomes need to be consistently captured and examined to understand if the aims of 'support' are being achieved. ...
