Browsing by Author "Suter, Esther"

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    Advancing team-based primary health care: a comparative analysis of policies in western Canada
    (2017-07-17) Suter, Esther; Mallinson, Sara; Misfeldt, Renee; Boakye, Omenaa; Nasmith, Louise; Wong, Sabrina T
    Abstract Background We analyzed and compared primary health care (PHC) policies in British Columbia, Alberta and Saskatchewan to understand how they inform the design and implementation of team-based primary health care service delivery. The goal was to develop policy imperatives that can advance team-based PHC in Canada. Methods We conducted comparative case studies (n = 3). The policy analysis included: Context review: We reviewed relevant information (2007 to 2014) from databases and websites. Policy review and comparative analysis: We compared and contrasted publically available PHC policies. Key informant interviews: Key informants (n = 30) validated narratives prepared from the comparative analysis by offering contextual information on potential policy imperatives. Advisory group and roundtable: An expert advisory group guided this work and a key stakeholder roundtable event guided prioritization of policy imperatives. Results The concept of team-based PHC varies widely across and within the three provinces. We noted policy gaps related to team configuration, leadership, scope of practice, role clarity and financing of team-based care; few policies speak explicitly to monitoring and evaluation of team-based PHC. We prioritized four policy imperatives: (1) alignment of goals and policies at different system levels; (2) investment of resources for system change; (3) compensation models for all members of the team; and (4) accountability through collaborative practice metrics. Conclusions Policies supporting team-based PHC have been slow to emerge, lacking a systematic and coordinated approach. Greater alignment with specific consideration of financing, reimbursement, implementation mechanisms and performance monitoring could accelerate systemic transformation by removing some well-known barriers to team-based care.
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    Correction to: Family Integrated Care (FICare) in Level II Neonatal Intensive Care Units: study protocol for a cluster randomized controlled trial
    (2020-03-19) Benzies, Karen M; Shah, Vibhuti; Aziz, Khalid; Isaranuwatchai, Wanrudee; Palacio-Derflingher, Luz; Scotland, Jeanne; Larocque, Jill; Mrklas, Kelly; Suter, Esther; Naugler, Christopher; Stelfox, Henry T; Chari, Radha; Lodha, Abhay
    After publication of our article [1], the authors have reported mathematical errors made in the sample size calculation for this cluster randomized controlled trial (cRCT) (Benzies et al. 2017).
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    Exploring the Professional Role of Massage Therapists in Patient Care in Canadian Urban Hospitals – A Mixed Methods Study
    (2014-01-29) Kania-Richmond, Anna; Verhoef, Marja J.; Suter, Esther; Reece, Barbara
    Background: Massage therapy (MT) is becoming established as a recognized health care profession. MT services are being incorporated into various types of health care settings, including hospitals. However, little is known about the delivery of MT services and the role of massage therapists in patient care in hospitals in the Canadian context. Purpose: The purpose of this study was to conduct a comprehensive examination of massage therapy incorporation into Canadian urban hospitals. Methods: A mixed methods study design was used. The quantitative phase (survey) and qualitative phase (semi-structured interviews) were conducted sequentially, with an emphasis on the qualitative phase. The survey was conducted in settings where MT services were organized by hospitals and provided by licensed massage therapists to patients. Semi-structured interviews were conducted with a purposively diverse sample of participants. The quantitative and qualitative approaches were mixed during data collection and analysis. Results: Sixteen urban hospitals across Canada (5%) provided MT to patients by licensed therapists. The majority of hospitals were located in Ontario and ranged from specialized small community hospitals to large multi-site hospitals. Three MT delivery approaches emerged: stand-alone, closed-incorporated, and open-incorporated. In addition to clinical functions as health care providers and team members, components of the massage therapists’ professional role included: program support, educator, promotor, and researcher. Role related experiences suggested the presence of ambiguity regarding the massage therapists’ role, overlap with other health care professionals (HCPs), role overload related to limited availability of time and massage staff, and role conflict. Patterns suggesting variations in the role components and types of role experiences across study sites and in relation to team member status were apparent. However, the small sample size precluded further analysis of these potential differences. Conclusions: While hospital-based MT in Canada is not a new phenomenon, MT is not yet an established health care profession in hospitals. However, there is significant potential for the inclusion of the MT role in Canadian hospitals that should be research-informed for effective implementation.
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    Family Integrated Care (FICare) in Level II Neonatal Intensive Care Units: study protocol for a cluster randomized controlled trial
    (2017-10-10) Benzies, Karen M; Shah, Vibhuti; Aziz, Khalid; Isaranuwatchai, Wanrudee; Palacio-Derflingher, Luz; Scotland, Jeanne; Larocque, Jill; Mrklas, Kelly; Suter, Esther; Naugler, Christopher; Stelfox, Henry T; Chari, Radha; Lodha, Abhay
    Abstract Background Every year, about 15 million of the world’s infants are born preterm (before 37 weeks gestation). In Alberta, the preterm birth rate was 8.7% in 2015, the second highest among Canadian provinces. Approximately 20% of preterm infants are born before 32 weeks gestation (early preterm), and require care in a Level III neonatal intensive care unit (NICU); 80% are born moderate (32 weeks and zero days [320/7] to 336/7 weeks) and late preterm (340/7 to 366/7 weeks), and require care in a Level II NICU. Preterm birth and experiences in the NICU disrupt early parent-infant relationships and induce parental psychosocial distress. Family Integrated Care (FICare) shows promise as a model of care in Level III NICUs. The purpose of this study is to evaluate length of stay, infant and maternal clinical outcomes, and costs following adaptation and implementation of FICare in Level II NICUs. Methods We will conduct a pragmatic, cluster randomized controlled trial (cRCT) in ten Alberta Level II NICUs allocated to one of two groups: FICare or standard care. The FICare Alberta model involves three theoretically-based, standardized components: information sharing, parenting education, and family support. Our sample size of 181 mother-infant dyads per group is based on the primary outcome of NICU length of stay, 80% participation, and 80% retention at follow-up. Secondary outcomes (e.g., infant clinical outcomes and maternal psychosocial distress) will be assessed shortly after admission to NICU, at discharge and 2 months corrected age. We will conduct economic analysis from two perspectives: the public healthcare payer and society. To understand the utility, acceptability, and impact of FICare, qualitative interviews will be conducted with a subset of mothers at the 2-month follow-up, and with hospital administrators and healthcare providers near the end of the study. Discussion Results of this pragmatic cRCT of FICare in Alberta Level II NICUs will inform policy decisions by providing evidence about the clinical effectiveness and costs of FICare. Trial registration ClinicalTrials.gov, ID: NCT02879799 . Registered on 27 May 2016. Protocol version: 9 June 2016; version 2.
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    Nurse Managers and Interprofessional Collaboration: A Grounded Theory Study
    (2017) Kirkpatrick, Megan; Carr, Eloise; Laing, Catherine; Suter, Esther; Deutschlander, Siegrid
    Effective nurse-physician collaboration is an essential component of providing safe patient care. Nurse managers are in a unique position to witness, experience, and lead collaborative practice. The purpose of this study is to gain a better understanding of the social process of nurse-physician collaboration through the lens of nurse managers, as well as how the system supports or impedes collaboration. Seven nurse managers from surgical inpatient units from three major hospitals in western Canada were interviewed following the constructivist grounded theory methodology. Findings revealed five categories in the process of nurse-physician collaboration: (1) communicating expectations and accountability, (2) creating intentional interactions, (3) building trust and earning respect, (4) building relationships, and (5) enculturating collaboration. Nurse-physician collaboration is a multi-faceted, on-going process with the relationship at the centre. Gaining an understanding of the process of nurse-physician collaboration will facilitate improvements to collaborative practice and the delivery of safe health care.
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    The Social Organization of the Staffing Work of Nurse Managers: A Critique of Contemporary Nursing Workload Technologies
    (2016-01-21) Fast, Olive Marlene; Rankin, Janet; Raffin Bouchal, Shelley; Zurawski, Cheryl; Suter, Esther; Hamilton, Patti; Kawalilak, Colleen
    The multifaceted work of providing hospital services on a patient care unit requires people with the ability to coordinate, monitor, and report on the work done by nurses, unit clerks, and health care aides. Nurse managers (NMs) in hospitals are responsible for doing this work. NMs devote significant time and energy to ensure enough staff are available to care for patients; however, this “staffing work” is a source of tension. Motivated by my own experience of nursing management, in this dissertation I empirically describe and analyze NMs’ activities and the tensions they experience. I applied institutional ethnography (IE) to develop an account of how NMs’ work of staffing is socially organized. IE, a method of inquiry, offers an alternate analysis to the authorized knowledge of health care, making possible a critical empirical description of what it is like to be an NM doing staffing work in contemporary Canadian hospitals. Insights into how NMs’ thinking is influenced by economic imperatives, supporting them to act in ways that undermine nurses’ ability to provide patient care, are revealed. An evidentiary trail is built of how documents and technologies (such as the workload management system) are used to plan and administer nurse staffing. This study offers a caution against the increasing reliance on knowledge produced by workload management systems and the relations of ruling into which NMs are pulled when they use such systems. My argument is that NMs’ material knowledge of how to organize safe staffing is being subordinated by knowledge produced in and by contemporary nursing workforce technologies. The loss of this material knowledge and abstracted knowledge that replaces it jeopardize how NMs can be relied on to provide adequate nursing resources to keep patients safe.