Isabelle Brault, RN, PhD, is an Associate Professor and leader of interfaculty IPE courses of Collaboration in health care at the Faculty of Nursing of Université de Montréal. Since June 2014, she is vice president of the Interfaculty Operational Committee for Interprofessional Education on Collaboration and Partnership in Care. Her research focus includes evaluative research on Interprofessional education on collaboration and Partnership in care, nursing administration and clinical governance. She is a researcher from the Quebec Nursing Intervention Network and from the Institut de recherche en santé publique de l’Université de Montréal.
During their careers, nurses in all fields of the health care systems are likely to experience a ... more During their careers, nurses in all fields of the health care systems are likely to experience a period of moral distress at some point during their career. Moral distress has both short and long-terms consequences for the health care system, for the nurses' health as well as for the quality and safety of patient care. The actions to prevent moral distress are still poorly documented. The aim of this article circumscribes the concept of moral distress amongst nurses and proposes interventions that can contribute to its prevention. The psychodynamic of work theoretical framework was chosen to analyze and structure the literature in terms of: the source of suffering at work and the defensives strategies developed by nurses in response to such suffering. Through a review of the literature, this article identifies factors influencing moral distress amongst nurses and the consequences it can have. The interventions identified and interventions proposed represent important recommendations for health organizations and managers seeking to reduce, or even prevent moral distress amongst nurses.
Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined rol... more 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 clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strateg...
Journal of Health Organisation and Management, Jun 15, 2015
Purpose - Introducing change is a difficult issue facing all health care systems. The use of vari... more Purpose - Introducing change is a difficult issue facing all health care systems. The use of various clinical governance levers can facilitate change in health care systems. The purpose of this paper is to define clinical governance levers, and to illustrate their use in a large-scale transformation. Design/methodology/approach - The empirical analysis deals with the in-depth study of a specific case, which is the organizational model for Ontario's cancer sector. The authors used a qualitative research strategy and drew the data from three sources: semi-structured interviews, analysis of documents, and non-participative observations. Findings - From the results, the authors identified three phases and several steps in the reform of cancer services in this province. The authors conclude that a combination of clinical governance levers was used to transform the system. These levers operated at different levels of the system to meet the targeted objectives. Practical implications - To exercise clinical governance, managers need to acquire new competencies. Mobilizing clinical governance levers requires in-depth understanding of the role and scope of clinical governance levers. Originality/value - This study provides a better understanding of clinical governance levers. Clinical governance levers are used to implement an organizational environment that is conducive to developing clinical practice, as well as to act directly on practices to improve quality of care.
Depuis 2011, des centaines d’élèves autochtones et d’étudiants universitaires se sont rencontrés ... more Depuis 2011, des centaines d’élèves autochtones et d’étudiants universitaires se sont rencontrés grâce aux Mini-écoles de la santé initiées par le Dr Stanley Vollant en collaboration avec l’Université de Montréal. Les Mini-écoles consistent en une série d’activités interactives. Dans les classes, des cercles de partage sont dirigés par des étudiants issus des programmes de la santé et visent à encourager la persévérance scolaire et à discuter des saines habitudes de vie. Dans le gymnase, les étudiants organisent des kiosques interactifs d’information sur leur future profession et partagent leur passion avec les élèves. L’utilisation ludique de matériel lié aux métiers de la santé favorise les échanges entre les étudiants universitaires et les élèves. Les Bibliothèques UdeM, en collaboration avec les écoles visitées, préparent et animent un kiosque de livres sur la santé et les sciences. Les livres sont ensuite offerts aux écoles. Chaque année, les communautés de Manawan et de Wemotaci sont visitées. Les étudiants rencontrent les élèves du primaire d’une communauté et ceux du secondaire de l’autre communauté, soit environ 600 élèves. La Mini-école se déplace aussi annuellement sur la Côte-Nord à la rencontre des communautés innues (Ekuanitshit, Nutashkuan et autres). Dans cet atelier, on présentera le projet de la Mini-école et ses retombées
A discussion of an optimal set of indicators that can be used on a priority basis to assess the p... more A discussion of an optimal set of indicators that can be used on a priority basis to assess the performance of nursing care. 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. Organizations now face the challenge of selecting, from this universe, a realistic subset of indicators that can form a balanced and common scorecard. Discussion paper drawing on a systematic assessment of selected performance indicators. Previous works, based on systematic reviews of the literature published between 1990 - 2014, have contributed to the development of the Nursing Care Performance Framework. These works confirmed a robust set of indicators that capture the universe of content currently supported by the scientific literature and cover all major areas of nursing care performance. Building on these previous works, this study consisted in gathering the sp...
Type 2 diabetes is a complex chronic disease that requires ongoing monitoring by an interprofessi... more Type 2 diabetes is a complex chronic disease that requires ongoing monitoring by an interprofessional team to prevent complications. The INMED (INterprofessional Management and Education in Diabetes) care pathway was developed by our team to optimize primary care services for these patients and their families. The objective of this study is to describe the preliminary results of its adoption and implementation. The INMED care pathway is organized into four axes: (a) continuing professional education, (b) self-management support, (c) case management, and (d) ongoing evaluation of the quality of diabetes care and services. A multiple-case study is underway to document its effects on practice change using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Preliminary results on the adoption and implementation revealed some strengths: (a) regular patient follow-up by the case manager, (b) scheduling of physician appointments when required, and (c) regular screening for risk factors. Barriers were also identified: (a) lack of clear understanding of the case manager role, (b) lack of referrals to team members, and (c) lack of use of the motivational interview approach. The INMED care pathway is being adopted by primary care teams but challenges need to be overcome to improve its reach and effectiveness.
To prepare future healthcare professionals to collaborate effectively, many universities have dev... more To prepare future healthcare professionals to collaborate effectively, many universities have developed interprofessional education programs (IPE). Till date, these programs have been mostly courses or clinical simulation experiences. Few attempts have been made to pursue IPE in healthcare clinical settings. This article presents the results of a pilot project in which interprofessional learning activities (ILAs) were implemented during students' professional practicum and discusses the actual and potential use of informatics in the ILA implementation. We conducted a pilot study in four healthcare settings. Our analysis is based on focus group interviews with trainees, clinical supervisors, ILA coordinators, and education managers. Overall, ILAs led to better clarification of roles and understanding of each professional's specific expertise. Informatics was helpful for developing a common language about IPE between trainees and healthcare professionals; opportunities for future application of informatics were noted. Our results support the relevance of ILAs and the value of promoting professional exchanges between students of different professions, both in academia and in the clinical setting. Informatics appears to offer opportunities for networking among students from different professions and for team members' professional development. The use of technology facilitated communication among the participants.
Journal of health organization and management, 2015
Purpose - Introducing change is a difficult issue facing all health care systems. The use of vari... more Purpose - Introducing change is a difficult issue facing all health care systems. The use of various clinical governance levers can facilitate change in health care systems. The purpose of this paper is to define clinical governance levers, and to illustrate their use in a large-scale transformation. Design/methodology/approach - The empirical analysis deals with the in-depth study of a specific case, which is the organizational model for Ontario's cancer sector. The authors used a qualitative research strategy and drew the data from three sources: semi-structured interviews, analysis of documents, and non-participative observations. Findings - From the results, the authors identified three phases and several steps in the reform of cancer services in this province. The authors conclude that a combination of clinical governance levers was used to transform the system. These levers operated at different levels of the system to meet the targeted objectives. Practical implications -...
During their careers, nurses in all fields of the health care systems are likely to experience a ... more During their careers, nurses in all fields of the health care systems are likely to experience a period of moral distress at some point during their career. Moral distress has both short and long-terms consequences for the health care system, for the nurses' health as well as for the quality and safety of patient care. The actions to prevent moral distress are still poorly documented. The aim of this article circumscribes the concept of moral distress amongst nurses and proposes interventions that can contribute to its prevention. The psychodynamic of work theoretical framework was chosen to analyze and structure the literature in terms of: the source of suffering at work and the defensives strategies developed by nurses in response to such suffering. Through a review of the literature, this article identifies factors influencing moral distress amongst nurses and the consequences it can have. The interventions identified and interventions proposed represent important recommendations for health organizations and managers seeking to reduce, or even prevent moral distress amongst nurses.
Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined rol... more 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 clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strateg...
Journal of Health Organisation and Management, Jun 15, 2015
Purpose - Introducing change is a difficult issue facing all health care systems. The use of vari... more Purpose - Introducing change is a difficult issue facing all health care systems. The use of various clinical governance levers can facilitate change in health care systems. The purpose of this paper is to define clinical governance levers, and to illustrate their use in a large-scale transformation. Design/methodology/approach - The empirical analysis deals with the in-depth study of a specific case, which is the organizational model for Ontario's cancer sector. The authors used a qualitative research strategy and drew the data from three sources: semi-structured interviews, analysis of documents, and non-participative observations. Findings - From the results, the authors identified three phases and several steps in the reform of cancer services in this province. The authors conclude that a combination of clinical governance levers was used to transform the system. These levers operated at different levels of the system to meet the targeted objectives. Practical implications - To exercise clinical governance, managers need to acquire new competencies. Mobilizing clinical governance levers requires in-depth understanding of the role and scope of clinical governance levers. Originality/value - This study provides a better understanding of clinical governance levers. Clinical governance levers are used to implement an organizational environment that is conducive to developing clinical practice, as well as to act directly on practices to improve quality of care.
Depuis 2011, des centaines d’élèves autochtones et d’étudiants universitaires se sont rencontrés ... more Depuis 2011, des centaines d’élèves autochtones et d’étudiants universitaires se sont rencontrés grâce aux Mini-écoles de la santé initiées par le Dr Stanley Vollant en collaboration avec l’Université de Montréal. Les Mini-écoles consistent en une série d’activités interactives. Dans les classes, des cercles de partage sont dirigés par des étudiants issus des programmes de la santé et visent à encourager la persévérance scolaire et à discuter des saines habitudes de vie. Dans le gymnase, les étudiants organisent des kiosques interactifs d’information sur leur future profession et partagent leur passion avec les élèves. L’utilisation ludique de matériel lié aux métiers de la santé favorise les échanges entre les étudiants universitaires et les élèves. Les Bibliothèques UdeM, en collaboration avec les écoles visitées, préparent et animent un kiosque de livres sur la santé et les sciences. Les livres sont ensuite offerts aux écoles. Chaque année, les communautés de Manawan et de Wemotaci sont visitées. Les étudiants rencontrent les élèves du primaire d’une communauté et ceux du secondaire de l’autre communauté, soit environ 600 élèves. La Mini-école se déplace aussi annuellement sur la Côte-Nord à la rencontre des communautés innues (Ekuanitshit, Nutashkuan et autres). Dans cet atelier, on présentera le projet de la Mini-école et ses retombées
A discussion of an optimal set of indicators that can be used on a priority basis to assess the p... more A discussion of an optimal set of indicators that can be used on a priority basis to assess the performance of nursing care. 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. Organizations now face the challenge of selecting, from this universe, a realistic subset of indicators that can form a balanced and common scorecard. Discussion paper drawing on a systematic assessment of selected performance indicators. Previous works, based on systematic reviews of the literature published between 1990 - 2014, have contributed to the development of the Nursing Care Performance Framework. These works confirmed a robust set of indicators that capture the universe of content currently supported by the scientific literature and cover all major areas of nursing care performance. Building on these previous works, this study consisted in gathering the sp...
Type 2 diabetes is a complex chronic disease that requires ongoing monitoring by an interprofessi... more Type 2 diabetes is a complex chronic disease that requires ongoing monitoring by an interprofessional team to prevent complications. The INMED (INterprofessional Management and Education in Diabetes) care pathway was developed by our team to optimize primary care services for these patients and their families. The objective of this study is to describe the preliminary results of its adoption and implementation. The INMED care pathway is organized into four axes: (a) continuing professional education, (b) self-management support, (c) case management, and (d) ongoing evaluation of the quality of diabetes care and services. A multiple-case study is underway to document its effects on practice change using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Preliminary results on the adoption and implementation revealed some strengths: (a) regular patient follow-up by the case manager, (b) scheduling of physician appointments when required, and (c) regular screening for risk factors. Barriers were also identified: (a) lack of clear understanding of the case manager role, (b) lack of referrals to team members, and (c) lack of use of the motivational interview approach. The INMED care pathway is being adopted by primary care teams but challenges need to be overcome to improve its reach and effectiveness.
To prepare future healthcare professionals to collaborate effectively, many universities have dev... more To prepare future healthcare professionals to collaborate effectively, many universities have developed interprofessional education programs (IPE). Till date, these programs have been mostly courses or clinical simulation experiences. Few attempts have been made to pursue IPE in healthcare clinical settings. This article presents the results of a pilot project in which interprofessional learning activities (ILAs) were implemented during students' professional practicum and discusses the actual and potential use of informatics in the ILA implementation. We conducted a pilot study in four healthcare settings. Our analysis is based on focus group interviews with trainees, clinical supervisors, ILA coordinators, and education managers. Overall, ILAs led to better clarification of roles and understanding of each professional's specific expertise. Informatics was helpful for developing a common language about IPE between trainees and healthcare professionals; opportunities for future application of informatics were noted. Our results support the relevance of ILAs and the value of promoting professional exchanges between students of different professions, both in academia and in the clinical setting. Informatics appears to offer opportunities for networking among students from different professions and for team members' professional development. The use of technology facilitated communication among the participants.
Journal of health organization and management, 2015
Purpose - Introducing change is a difficult issue facing all health care systems. The use of vari... more Purpose - Introducing change is a difficult issue facing all health care systems. The use of various clinical governance levers can facilitate change in health care systems. The purpose of this paper is to define clinical governance levers, and to illustrate their use in a large-scale transformation. Design/methodology/approach - The empirical analysis deals with the in-depth study of a specific case, which is the organizational model for Ontario's cancer sector. The authors used a qualitative research strategy and drew the data from three sources: semi-structured interviews, analysis of documents, and non-participative observations. Findings - From the results, the authors identified three phases and several steps in the reform of cancer services in this province. The authors conclude that a combination of clinical governance levers was used to transform the system. These levers operated at different levels of the system to meet the targeted objectives. Practical implications -...
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