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Article
Publication date: 31 July 2023

Mélanie Lefèvre, Jens Detollenaere, Renate Zeevaert and Carine Van de Voorde

Many countries have developed hospital-at-home (HAH) models to bring hospital services closer to home. Although some countries already have a long tradition of HAH for adults…

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Abstract

Purpose

Many countries have developed hospital-at-home (HAH) models to bring hospital services closer to home. Although some countries already have a long tradition of HAH for adults, paediatric HAH has been developed more recently. Specificities of paediatric care make it difficult to directly extend an adult HAH model to the paediatric population. The objective of this study is to compare the organisation of paediatric HAH in four countries: France, Australia (states of Victoria and New South Wales), the Netherlands and Belgium. Ultimately, lessons can be drawn for further development in the countries analysed and/or for implementation in other countries.

Design/methodology/approach

Legal documents and other grey literature were analysed to describe the legal context for the provision of paediatric HAH in the selected countries. In addition, semi-structured in-depth interviews were conducted with key informants from paediatric HAH organisations in these countries, addressing the following topics: historical background, legal framework, functioning of HAH models, workforce, number of services, profile of children, type of care activities, funding, coordination with other providers and quality of care. Results were reviewed by a content expert from the respective country.

Findings

Organisational differences were highlighted in terms of coordinating actor (hospital or home nursing care services), decision-making process, range of clinical conditions treated, territorial organisation, qualifications and expertise of the team members, medical expertise, financing, responsibilities, etc.

Originality/value

There is no single preferred model for the provision of HAH care for children. There is a large variety in almost all aspects of organisation. There are, however, also some common characteristics across the different models. Notably, paediatric expertise of nurses within the HAH team was considered indispensable in all programmes.

Details

Journal of Integrated Care, vol. 31 no. 3
Type: Research Article
ISSN: 1476-9018

Keywords

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Book part
Publication date: 16 June 2022

Katrina Kimport

Purpose: Miscarriage is commonly understood as an involuntary, grieve-able pregnancy outcome. Abortion is commonly understood as a voluntary, if stigmatized, pregnancy outcome

Abstract

Purpose: Miscarriage is commonly understood as an involuntary, grieve-able pregnancy outcome. Abortion is commonly understood as a voluntary, if stigmatized, pregnancy outcome that people do not typically grieve. This chapter examines a nexus of the involuntary and voluntary: how people who chose abortion following observation of a serious fetal health issue make sense of their experience and process associated emotions.

Design: The author draws on semi-structured interviews with cisgender women who had an observed serious fetal health issue and chose to terminate their pregnancy.

Findings: Findings highlight an initial prioritization of medical knowledge in pregnancy decision-making giving way, in the face of the inherent limits of medical knowability, to a focus on personal and familial values. Abortion represented a way to lessen the prospective suffering of their fetus, for many, and felt like an explicitly moral decision. Respondents felt relief after the abortion as well as a sense of loss. They processed their post-abortion emotions, including grief, in multiple ways, including through viewing – or intentionally not viewing – the remains, community rituals, private actions, and no formalized activity. Throughout respondents’ experiences, the stigmatization of abortion negatively affected their ability to obtain the care they desired and, for some, to emotionally process the overall experience.

Originality/Value: This chapter offers insight into the understudied experience of how people make sense of a serious fetal health issue and illustrates an additional facet of the stigmatization of abortion, namely how stigmatization may complicate people’s pregnancy decision-making process and their post-abortion processing.

Details

Facing Death: Familial Responses to Illness and Death
Type: Book
ISBN: 978-1-80382-264-8

Keywords

Available. Open Access. Open Access
Article
Publication date: 28 June 2019

Sabina Abou Malham, Mélanie-Ann Smithman, Nassera Touati, Astrid Brousselle, Christine Loignon, Carl-Ardy Dubois, Kareen Nour, Antoine Boivin and Mylaine Breton

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…

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Abstract

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 outcomes of implementation by analyzing the characteristics of CWLs and contextual factors that influence their implementation.

Design/methodology/approach

A multiple qualitative case study was conducted. Four contrasting CWLs were purposefully selected: two relatively high-performing and two relatively low-performing cases with regard to process indicators. Data collected between 2015 and 2016 drew on three sources: 26 semi-structured interviews with key stakeholders, 22 documents and field notes. The Consolidated Framework for Implementation Research was used to identify, through a cross-case comparison of ratings, constructs that distinguish high from low-performing cases.

Findings

Five constructs distinguished high from low-performing cases: three related to the inner setting: network and communications; leadership engagement; available resources; one from innovation characteristics: adaptability with regard to registration, evaluation of priority and attachment to a family physician; and, one associated with process domain: engaging. Other constructs exerted influence on implementation (e.g. outer setting, individual characteristics), but did not distinguish high and low-performing cases.

Originality/value

This is the first in-depth analysis of CWL implementation. Results suggest important factors that might be useful in efforts to continuously improve implementation performance of CWLs and similar innovations.

Details

Journal of Health Organization and Management, vol. 33 no. 5
Type: Research Article
ISSN: 1477-7266

Keywords

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