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Implementation of integrated services networks in Quebec and nursing practice transformation: convergence or divergence?

Longpré C, Dubois CA - BMC Health Serv Res (2015)

Bottom Line: Only two dimensions out of nine ('quality of care' and 'interprofessional teamwork') were prevalent in all the pathways; two others ('transparent entrepreneurship' and 'performance management') were in none of the pathways, and the remaining five ('patient-family centered care', 'result-focused learning', 'delivery system', 'commitment', 'roles and tasks') were present to varying degrees.These results suggest that particular efforts should be made to bridge the significant gap between the pace of nursing practice transformation and the objectives of service integration.These efforts should focus, among other things, on the deployment of organizational, clinical, human, and material resources to support practice renewal and continuing education for nurses to prepare them for the requirements of integration.

View Article: PubMed Central - PubMed

Affiliation: Centre for Training and Expertise in Nursing Administration Research (FERASI), University of Montreal, Montreal, Quebec, Canada. caroline.longpre@umontreal.ca.

ABSTRACT

Background: 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 involved in services integration.

Methods: This descriptive study was carried out with 107 nurses working an integrated network of healthcare services in Quebec in four different care pathways: chronic obstructive pulmonary disease, autonomy support for the elderly, palliative oncology care, and mental health. Development model for integrated care (DMIC) was used, first, to examine the prevalence in each pathway of integrative activities, grouped into nine practice dimensions, and then to position each pathway in relation to the four phases of development for any integration process, as defined by the DMIC.

Results: Only one pathway had reached Phase 3, which involves expansion and monitoring of integration, whereas the others were still in the preliminary Phases 1 and 2 characterized by initiative and experimentation. Only two dimensions out of nine ('quality of care' and 'interprofessional teamwork') were prevalent in all the pathways; two others ('transparent entrepreneurship' and 'performance management') were in none of the pathways, and the remaining five ('patient-family centered care', 'result-focused learning', 'delivery system', 'commitment', 'roles and tasks') were present to varying degrees.

Conclusions: These results suggest that particular efforts should be made to bridge the significant gap between the pace of nursing practice transformation and the objectives of service integration. These efforts should focus, among other things, on the deployment of organizational, clinical, human, and material resources to support practice renewal and continuing education for nurses to prepare them for the requirements of integration.

No MeSH data available.


Related in: MedlinePlus

Integrated care development model[19].
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
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Fig1: Integrated care development model[19].

Mentions: For this study, we selected as our reference framework the development model for integrated care (DMIC) developed by Minkman and colleagues, because of its conceptual contributions [31]. It is the only model that was specifically designed with a view to operationalizing nursing practices related to the integration process and that differentiates among the development phases of the process according to changes in practice (Figure 1). Unlike models centered on chronic illnesses, it can be applied to all clienteles and care pathways. The validity of the methodological process leading to its development has been demonstrated as has its theoretical validity [19,32,33]. Moreover, it has already been used, mainly in Europe, to evaluate and describe a variety of integration contexts, in such areas as traumatology, cardiology, and neurology services [19]. The present study provided an opportunity to test the model in the North American context and thereby to increase its external validity. In this model adapted to the Quebec context, nursing practice activities that contribute to the development of integrated care are operationalized as 89 integrative activities (elements in the DMIC model), organized into nine broad dimensions (clusters in the DMIC model): ‘client-family centered care’; ‘delivery system’; ‘performance management’; ‘quality of care’; ‘result-focused learning’; ‘interprofessional teamwork’; ‘roles and tasks’; ‘commitment’; and ‘transparent entrepreneurship’ (Table 1) [32]. The activities associated with these dimensions are ranked by complexity, making it possible to identify, using an analysis grid, four phases of development in the integration process: 1) initiative and design; 2) experimentation and execution; 3) expansion and monitoring; and 4) consolidation and transformation of the integration project [34]. The illustration of the model depicts the nine dimensions of integrative practice in interaction, following a narrowing spiral path from Phase 1 to Phase 4 as the complexity of integration mechanisms increases (Figure 1).Figure 1


Implementation of integrated services networks in Quebec and nursing practice transformation: convergence or divergence?

Longpré C, Dubois CA - BMC Health Serv Res (2015)

Integrated care development model[19].
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4359500&req=5

Fig1: Integrated care development model[19].
Mentions: For this study, we selected as our reference framework the development model for integrated care (DMIC) developed by Minkman and colleagues, because of its conceptual contributions [31]. It is the only model that was specifically designed with a view to operationalizing nursing practices related to the integration process and that differentiates among the development phases of the process according to changes in practice (Figure 1). Unlike models centered on chronic illnesses, it can be applied to all clienteles and care pathways. The validity of the methodological process leading to its development has been demonstrated as has its theoretical validity [19,32,33]. Moreover, it has already been used, mainly in Europe, to evaluate and describe a variety of integration contexts, in such areas as traumatology, cardiology, and neurology services [19]. The present study provided an opportunity to test the model in the North American context and thereby to increase its external validity. In this model adapted to the Quebec context, nursing practice activities that contribute to the development of integrated care are operationalized as 89 integrative activities (elements in the DMIC model), organized into nine broad dimensions (clusters in the DMIC model): ‘client-family centered care’; ‘delivery system’; ‘performance management’; ‘quality of care’; ‘result-focused learning’; ‘interprofessional teamwork’; ‘roles and tasks’; ‘commitment’; and ‘transparent entrepreneurship’ (Table 1) [32]. The activities associated with these dimensions are ranked by complexity, making it possible to identify, using an analysis grid, four phases of development in the integration process: 1) initiative and design; 2) experimentation and execution; 3) expansion and monitoring; and 4) consolidation and transformation of the integration project [34]. The illustration of the model depicts the nine dimensions of integrative practice in interaction, following a narrowing spiral path from Phase 1 to Phase 4 as the complexity of integration mechanisms increases (Figure 1).Figure 1

Bottom Line: Only two dimensions out of nine ('quality of care' and 'interprofessional teamwork') were prevalent in all the pathways; two others ('transparent entrepreneurship' and 'performance management') were in none of the pathways, and the remaining five ('patient-family centered care', 'result-focused learning', 'delivery system', 'commitment', 'roles and tasks') were present to varying degrees.These results suggest that particular efforts should be made to bridge the significant gap between the pace of nursing practice transformation and the objectives of service integration.These efforts should focus, among other things, on the deployment of organizational, clinical, human, and material resources to support practice renewal and continuing education for nurses to prepare them for the requirements of integration.

View Article: PubMed Central - PubMed

Affiliation: Centre for Training and Expertise in Nursing Administration Research (FERASI), University of Montreal, Montreal, Quebec, Canada. caroline.longpre@umontreal.ca.

ABSTRACT

Background: 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 involved in services integration.

Methods: This descriptive study was carried out with 107 nurses working an integrated network of healthcare services in Quebec in four different care pathways: chronic obstructive pulmonary disease, autonomy support for the elderly, palliative oncology care, and mental health. Development model for integrated care (DMIC) was used, first, to examine the prevalence in each pathway of integrative activities, grouped into nine practice dimensions, and then to position each pathway in relation to the four phases of development for any integration process, as defined by the DMIC.

Results: Only one pathway had reached Phase 3, which involves expansion and monitoring of integration, whereas the others were still in the preliminary Phases 1 and 2 characterized by initiative and experimentation. Only two dimensions out of nine ('quality of care' and 'interprofessional teamwork') were prevalent in all the pathways; two others ('transparent entrepreneurship' and 'performance management') were in none of the pathways, and the remaining five ('patient-family centered care', 'result-focused learning', 'delivery system', 'commitment', 'roles and tasks') were present to varying degrees.

Conclusions: These results suggest that particular efforts should be made to bridge the significant gap between the pace of nursing practice transformation and the objectives of service integration. These efforts should focus, among other things, on the deployment of organizational, clinical, human, and material resources to support practice renewal and continuing education for nurses to prepare them for the requirements of integration.

No MeSH data available.


Related in: MedlinePlus