Browsing by Author "Yost, Jennifer"
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- ItemOpen AccessA Systematic Review of the Cost-Effectiveness of Nurse Practitioners and Clinical Nurse Specialists: What Is the Quality of the Evidence?(2014-09-01) Donald, Faith; Kilpatrick, Kelley; Reid, Kim; Carter, Nancy; Martin-Misener, Ruth; Bryant-Lukosius, Denise; Harbman, Patricia; Kaasalainen, Sharon; Marshall, Deborah A.; Charbonneau-Smith, Renee; Donald, Erin E.; Lloyd, Monique; Wickson-Griffiths, Abigail; Yost, Jennifer; Baxter, Pamela; Sangster-Gormley, Esther; Hubley, Pamela; Laflamme, Célyne; Campbell–Yeo, Marsha; Price, Sheri; Boyko, Jennifer; DiCenso, AlbaBackground. Improved quality of care and control of healthcare costs are important factors influencing decisions to implement nurse practitioner (NP) and clinical nurse specialist (CNS) roles. Objective. To assess the quality of randomized controlled trials (RCTs) evaluating NP and CNS cost-effectiveness (defined broadly to also include studies measuring health resource utilization). Design. Systematic review of RCTs of NP and CNS cost-effectiveness reported between 1980 and July 2012. Results. 4,397 unique records were reviewed. We included 43 RCTs in six groupings, NP-outpatient (), NP-transition (), NP-inpatient (), CNS-outpatient (), CNS-transition (), and CNS-inpatient (). Internal validity was assessed using the Cochrane risk of bias tool; 18 (42%) studies were at low, 17 (39%) were at moderate, and eight (19%) at high risk of bias. Few studies included detailed descriptions of the education, experience, or role of the NPs or CNSs, affecting external validity. Conclusions. We identified 43 RCTs evaluating the cost-effectiveness of NPs and CNSs using criteria that meet current definitions of the roles. Almost half the RCTs were at low risk of bias. Incomplete reporting of study methods and lack of details about NP or CNS education, experience, and role create challenges in consolidating the evidence of the cost-effectiveness of these roles.
- ItemOpen AccessImpact of an organization-wide knowledge translation strategy to support evidence-informed public health decision making(2018-12-29) Dobbins, Maureen; Traynor, Robyn L; Workentine, Stephanie; Yousefi-Nooraie, Reza; Yost, JenniferAbstract Background The public health sector is moving toward adopting evidence-informed decision making into practice, but effort is still required to effectively develop capacity and promote contextual factors that advance and sustain it. This paper describes the impact of an organization-wide knowledge translation intervention delivered by knowledge brokers on evidence-informed decision making knowledge, skills and behaviour. Methods A case study design was implemented with the intervention and data collection tailored to the unique needs of each case (health department). A knowledge broker provided training workshops and mentored small groups through a seven step process of evidence-informed decision making. The intervention was delivered over 22 months; data related to evidence-informed decision making knowledge, skills and behaviour were collected at baseline and follow-up. Mixed effects regression models were developed to assess the impact of involvement in the intervention on the evidence-informed decision making outcomes. Results Data from a total of 606 health department staff were collected during baseline: 207 (33%) staff from Case A, 304 (28%) from Case B, and 95 (47%) from Case C. There were a total of 804 participants at follow-up: 258 (42%) from Case A, 391 from Case B (37%), and 155 (50%) from Case C. Statistically significant increases in knowledge and skills were observed overall, and in all three health departments. An increase in evidence-informed decision making behaviour was observed among those intensively involved in the intervention from all cases (statistically significant in Case A). The organizational characteristics of strategic priority, leadership, readiness, and choice of staff emerged as important factors in the change process. Conclusions Knowledge brokering is a promising organizational knowledge translation intervention to support evidence-informed decision making. The intervention appeared to have the greatest impact on those who became actively engaged with the knowledge broker in the intervention. Active participation in face-to-face training activities with a knowledge broker, focused specifically on evidence-informed decision making skill development, led to the greatest impact on associated behaviours, knowledge, and skills. Several organizational factors emerged as integral to success of the knowledge translation intervention.
- ItemOpen AccessPerceptions of diabetes distress during pregnancy in women with type 1 and type 2 diabetes: a qualitative interpretive description study(2024-04-03) Tschirhart, Holly; Landeen, Janet; Yost, Jennifer; Nerenberg, Kara A.; Sherifali, DianaAbstract Background Diabetes distress is commonly seen in adults with pre-existing diabetes and is associated with worsened glycemic management and self-management practices. While a majority of women report increased stress during pregnancy, it is unknown how women with type 1 or type 2 diabetes experience diabetes distress during this unique and transitional time. Purpose This study aimed to understand the experiences and perceptions of diabetes distress in women with pre-existing diabetes during pregnancy. Methods A qualitative study using an interpretive description approach was conducted. In-depth, one to one interviewing was used to capture rich descriptions of the pregnancy experience. Nested, stratified, and theoretical sampling was used to recruit 18 participants with type 1 and type 2 diabetes from the quantitative strand of this mixed methods study. Constant comparative analysis was used to inductively analyze the data and develop themes. Findings Four themes, each with several subthemes, emerged under the main finding of “Diabetes Distress”: 1) Worry for Baby’s Health – “What’s this going to do to the baby?”’ 2) Feeling Overwhelmed with Diabetes Management—“It just seemed unattainable”; 3) Living with Diabetes – “There’s no way out” and 4) Cycle of Diabetes Distress. Conclusions The findings from this study identify the sources and experiences of diabetes distress during pregnancy in women with pre-existing diabetes. Diabetes distress often presents as cyclical and multifaceted during pregnancy, with elements of fear for the unborn baby, difficulties with diabetes management, and having negative lived experiences of diabetes. Further work is needed to develop appropriate screening tools for pregnancy and interventions to mitigate diabetes distress. Diabetes educators are well-positioned provide emotional support and person-centred self-management education to individuals with diabetes.