‘Rapid review’ is an accelerated evidence synthesis approach that has emerged to meet the needs of knowledge users in healthcare settings who require timely input to support evidence-informed policy and practice questions. Although use of rapid reviews continues to expand, there is a paucity of research on this topic. This thesis addresses three identified knowledge gaps: 1) To address the lack of an established definition for rapid reviews, a modified Delphi process was used to pursue expert consensus on the defining characteristics of rapid reviews and an operational definition; 2) To further our understanding of the prevalent opinions and perceptions towards rapid reviews, a Q methodology was used to characterize the viewpoints of research producers and knowledge users; and, 3) To extend our knowledge on the characteristics, conduct and reporting quality of rapid reviews, compliance with currently accepted checklists (AMSTAR, PRISMA) was explored in a sample of recent rapid reviews.

La violence des patients est un problème presque quotidien auprès du personnel infirmier œuvrant en milieu hospitalier psychiatrique. Cette violence vécue dans le milieu de travail entraîne non seulement de nombreuses répercussions sur la victime, mais également sur l’organisation et ultimement les patients. Plusieurs facteurs entrent en ligne de compte lorsqu’on enquête sur les circonstances entourant une agression. Pourtant, la mise en place d’interventions qui permettraient de prévenir cette violence demeure inégale dans les milieux de soins faute de directives claires. Au vu des conséquences, les gestionnaires de soins de santé doivent reconnaitre cette problématique et contribuer à implanter des interventions pour la prévenir. Se basant sur les cinq étapes de Dobbins (2017), une revue rapide a été menée dans le but d’identifier des interventions afin de soutenir les gestionnaires dans la prévention de la violence provenant des patients en milieu hospitalier psychiatrique auprès du personnel. Au total, 147 écrits, dont 37 revues de synthèse et 110 articles empiriques ont été retenus pour l’analyse. Le modèle des causes organisationnelles d’accident de Vincent et al. (1998) permet de structurer les résultats en classant les interventions en fonction des sept types de facteur pouvant être impliqués dans un événement accidentel en contexte médical soit : 1) le contexte institutionnel; 2) les facteurs organisationnels et de gestion; 3) les facteurs liés à l’environnement de travail; 4) les facteurs d’équipe; 5) les facteurs individuels; 6) les facteurs liés aux tâches à effectuer; 7) les facteurs liés aux patients. Parmi les interventions les plus recensées dans les écrits, on retrouve des formations auprès du personnel, des salles sensorielles pour les patients, l’utilisation d’outils d’évaluation du risque de violence et la pharmacothérapie. Ainsi, en collaboration avec les équipes de soins et la haute direction, les gestionnaires sont des acteurs clés dans la mise en place d’interventions permettant une prévention proactive et systémique de la violence des patients auprès du personnel au sein des institutions psychiatriques. Toutefois, la sélection des interventions doit se faire en tenant compte de la clientèle desservie et des besoins du personnel. Les gestionnaires doivent donc être sensibles aux facteurs contraignants et facilitants présents dans leur contexte local. / Patient violence is an almost daily issue for nurses working in psychiatric hospitals. This violence experienced in the workplace has many repercussions on the victim, the organization, and ultimately on the patients. Several factors come into play when analyzing the circumstances surrounding an attack. However, implementing interventions that prevent this violence remains uneven in healthcare settings due to a lack of clear directives. Given the consequences, health care managers must recognize this problem and contribute to implementing interventions to prevent it. Based on the five steps of Dobbins (2017), a rapid review was conducted to identify interventions to support managers in preventing violence from patients toward staff in psychiatric hospital settings. A total of 147 papers, including 37 reviews and 110 empirical articles, were selected for analysis. The organisational accident model by Vincent et al. (1998) enables to structure the results by classifying the interventions according to the seven factors that may be involved in an accidental event in a medical context: 1) institutional context; 2) organisational and management factors; 3) work environment; 4) team factors; 5) individual factors; 6) task factors; 7) patient characteristics. Among the most documented interventions are staff training, patient sensory rooms, use of violence risk assessment tools, and pharmacotherapy. Thus, in collaboration with the care teams and senior management, managers are critical in implementing interventions that allow proactive and systemic prevention of patient violence endured by staff in psychiatric institutions. However, the selection of interventions must consider the targeted clientele and the needs of the personnel. The manager must be sensitive to the constraining and facilitating factors in their local context.

Le roulement infirmier représente un problème persistant dans le système de santé et il a des effets néfastes sur la satisfaction au travail chez les infirmières, ainsi que sur la qualité et la sécurité des soins. Le roulement est associé au processus par lequel le personnel infirmier quitte l’établissement de santé ou change d’unité de soins, de manière volontaire ou involontaire. Le leadership transformationnel de l’infirmière gestionnaire a démontré un effet positif sur la réduction du roulement infirmier. Plusieurs études ont exploré les conséquences du leadership transformationnel sur les patients, les employés et les organisations de santé. Toutefois, il existe peu de connaissances en lien avec les stratégies découlant du leadership transformationnel mobilisé par les infirmières gestionnaires qui permettent de contribuer à la réduction du roulement des effectifs infirmiers. Ce mémoire, présenté sous forme de revue rapide des écrits scientifiques, vise à mettre en évidence les connaissances actuelles et à émettre des recommandations en lien avec les stratégies contribuant à la réduction du roulement infirmier, qui découlent des pratiques de leadership transformationnel des infirmières gestionnaires. Ces stratégies sont présentées selon les pratiques de leadership transformationnel définies par le modèle conceptuel du développement et maintien du leadership infirmier, proposé par l’AIIAO. La question de recherche est : Quelles stratégies de réduction du roulement infirmier découlent des pratiques de leadership transformationnel des infirmières gestionnaires ? La méthodologie de la revue rapide est basée sur l’approche en cinq étapes de Dobbins. Les résultats mettent en évidence le fait que l’aspect le plus apprécié par les infirmières est lié aux compétences humaines de l’infirmière gestionnaire, au-delà de ses compétences en gestion du personnel et des finances. Dans cette perspective, plusieurs stratégies ont été identifiées en lien avec les trois premières pratiques de leadership transformationnel de l’AIIAO, soit : 1) Bâtir des relations et de la confiance ; 2) Créer un milieu de travail stimulant : 3) Créer une culture qui encourage le développement et l’intégration des connaissances. Les stratégies spécifiques aux dernières pratiques de leadership transformationnel du modèle conceptuel, soit 4) Orienter le changement et en assurer la durabilité et 5) Équilibrer les complexités du système, gérer les valeurs et les priorités concurrentes, sont moins soulignées dans les études retenues. Le forces et les limites de l’étude, ainsi que les implications pour la pratique sont mises en évidence à travers la discussion des résultats. En conclusion, le mémoire a permis de documenter une variété de stratégies de leadership transformationnel des infirmières gestionnaires qui démontrent un impact positif sur le travail et la satisfaction des infirmières, ce qui contribue à la réduction du roulement. / Nurse turnover is a persistent problem in the healthcare system and has a negative impact on nurses' job satisfaction and the quality and safety of care. Nurse turnover refers to the process by which nurses leave the healthcare facility or change care units, voluntarily or involuntarily. Transformational leadership practices of nurse managers have shown a positive effect on reducing nurse turnover. Several studies have explored the impact of transformational leadership on patients, employees, and healthcare organizations. However, little is known about the strategies resulting from the transformational leadership mobilized by nurse managers that can contribute to reducing nurse turnover. The purpose of this thesis, presented in the form of a rapid review of the scientific literature, is to highlight current knowledge and make recommendations regarding strategies that contribute to the reduction of nurse turnover, which stem from the transformational leadership practices of nurse managers. These strategies are presented according to the transformational leadership practices defined by the RNAO's conceptual model of nursing leadership development and maintenance. The research question is: What strategies for reducing nurse turnover result from transformational leadership practices of nurse managers? The methodology of the rapid review is based on Dobbins' five-step approach. The results highlight the fact that the aspect most valued by nurses is related to the human skills of the nurse manager, beyond their skills in personnel and finance management. In this perspective, several strategies have been identified in relation to the first three practices of transformational leadership of the RNAO, namely 1) Building relationships and trust; 2) Create a stimulating work environment: 3) Create a culture that encourages the development and integration of knowledge. The strategies specific to the last two transformational leadership practices of the conceptual model, namely 4) Guiding change and ensuring its sustainability and 5) Balancing the complexities of the system, managing competing values and priorities, are less highlighted in the studies included. The strengths and limitations of the study, as well as the implications for practice are highlighted through the discussion of the results. In conclusion, this thesis has documented a variety of transformational leadership strategies of nurse managers that demonstrate a positive impact on the work and satisfaction of nurses, which contributes to the reduction of turnover.

Made available in DSpace on 2014-07-29T15:25:16Z (GMT). No. of bitstreams: 1 Suelene Brito do Nascimento.pdf: 777082 bytes, checksum: f9660425f3055477271c6efbe8608c9e (MD5) Previous issue date: 2011-09-29 / False-negative rates constitute a common problem in the daily routine of cytopathology laboratories. Among the various internal quality control methods, 10% random review is the least effective in detecting false-negative results in routine screening. On the other hand, good results have been found with 100% rapid review and with rapid prescreening. Nevertheless, no studies comparing these two methods have been reported. Objective: To compare the performance of rapid prescreening and 100% rapid review as internal quality control methods in cervical cytopathology. Methods: Over 27 months, 12,208 cervical cytology smears collected from Units of Primary Health Care of Goiânia were submitted to rapid prescreening and routine screening at Rômulo Rocha Center for Clinical Analyses at the School of Pharmacy, Federal University of Goiás, Goiânia, Goiás, Brazil. The 100% rapid review method was performed on all smears classified as negative at routine screening. Conflicting results obtained with either method were reviewed in detail to define final diagnosis, which was considered the gold-standard for evaluating the performance of rapid prescreening and 100% rapid review. In cases with abnormal cytology were evaluated the results of colposcopy, histopathology and of the new cytopathology. The sensitivity and specificity of internal quality control methods were estimated when compared to the final diagnosis, and to follow-up colposcopy, histopathology and at new cytopathology. Results: Compared to the final diagnosis, the sensitivity of routine screening and rapid prescreening was 72.9% (IC 95%: 70,0%-75,8%) and 75.6% (IC 95%: 72,8%-78,4%), respectively. Taking into account only those smears classified as negative at routine screening, the sensitivity of rapid prescreening and RR-100% was 90.2% (IC 95%: 86,4-93,9) and 57.0% (50,8%-63,2%), respectively. Rapid prescreening identified 220 (1.8%), while RR-100% identified 140 (1.15%) of the 244 (2.0%) cases with false-negative results at routine screening. The sensitivity of rapid prescreening in detect abnormal cases at follow-up colposcopy, histopathology and at new cytopathology was 87.5% (CI95%; 74.3%-100.7%) 82,4% (CI95%: 64.2%-100.,5%), 95.7% (CI95%:89.8%-101.5%), respectively, the sensitivity of 100% rapid review was 54.2% (CI95%: 34.2%-74.1%), 52.9% (CI95%: 29.2%-76.7%), 47.8% (CI95%: 33.4%-62.3%) respectively and the sensibility of routine screening was 83.2% (CI95%: 77.1%-89.3%), 85.7% (CI95%: 79.4%-92.0%), 73.3% (CI95%: 66.6%-79.9%), respectively. Conclusions: Rapid prescreening was more effective than 100% rapid review for the detection of false-negative results at routine screening, with a better performance when compared to final diagnosis, to follow-up colposcopy and at new cytopathology. The methods showed similar performance when compared at follow-up histopathology. Therefore, according to the results of this study, rapid prescreening provides subsidies to improve the performance of cervical cytopathology tests, whose the principal function of which is to detect cervical cancer precursor lesions. / As altas taxas de resultados falso-negativos são problemas enfrentados na rotina dos laboratórios de citopatologia. Dentre os métodos de controle interno da qualidade, a revisão de 10% é a menos eficiente para detectar os resultados falso-negativos do escrutínio de rotina. No entanto, há evidências de que a revisão rápida de 100% e o pré-escrutínio rápido apresentam bons resultados na sua detecção. Porém, não existem estudos que compararam estes dois métodos. Objetivo: Comparar o desempenho do pré-escrutínio rápido e da revisão rápida de 100% como métodos de controle interno da qualidade dos exames citológicos do colo do útero. Métodos: Durante 27 meses 12.208 esfregaços citológicos cervicais provenientes das Unidades de Atenção Básica à Saúde do município de Goiânia foram submetidos ao pré-escrutínio rápido e ao escrutínio de rotina no Centro de Análises Clínicas Rômulo Rocha da Faculdade de Farmácia da Universidade Federal de Goiás-Goiânia-GO-Brasil. A revisão rápida de 100% foi realizada nos esfregaços negativos no escrutínio de rotina. Os resultados discordantes por qualquer dos métodos foram revisados detalhadamente para definição do diagnóstico citológico final, considerado padrão ouro para avaliar o desempenho do pré-escrutínio rápido e da revisão rápida de 100%. Nos casos com anormalidades citológicas foi avaliado o resultado dos exames colposcópicos, histológicos e da nova citologia. Foram estimadas a sensibilidade e a especificidade dos métodos de controle interno da qualidade quando comparados ao diagnóstico citológico final, ao exame colposcópico, histológico e ao novo exame citológico. Resultados: Comparado ao diagnóstico citológico final a sensibilidade do escrutínio de rotina e do pré-escrutínio rápido foi de 72,9% (IC 95%: 70,0%-75,8%) e 75,6% (IC 95%: 72,8%-78,4%), respectivamente. A sensibilidade do pré-escrutínio rápido e da revisão rápida de 100%, levando em conta os esfregaços negativos no escrutínio de rotina foi 90,2% (IC 95%: 86,4-93,9) e 57,0% (50,8%-63,2%), respectivamente. O pré-escrutínio rápido identificou 220 (1,8%) e a revisão rápida de 100% 140 (1,15%) dos 244 (2,0%) falso-negativos do escrutínio de rotina. A sensibilidade do pré-escrutínio rápido na detecção de anormalidades colposcópicas, histoológicas e no novo exame citológico foi de 87,5% (IC95%: 74,3%-100,7%), 82,4% (IC95%: 64,2%-100,5%), 95,7% (IC95%: 89,8%-101,5%), respectivamente, a sensibilidade da revisão rápida de 100% foi de 54,2% (IC95%: 34,2%-74,1%), 52,9% (IC95%: 29,2%-76,7%), 47,8% (IC95%: 33,4%-62,3%), respectivamente e a sensibilidade do escrutínio de rotina foi de 83,2% (IC95%: 77,1%-89,3%), 85,7% (IC95%: 79,4%-92,0%), 73,3% (IC95%: 66,6%-79,9%), respectivamente. Conclusões: O pré-escrutínio rápido foi mais eficiente que a revisão rápida de 100% para detectar resultados falso-negativos do escrutínio de rotina obtendo melhor desempenho quando comparado ao diagnóstico citológico final, ao resultado do exame colposcópico e ao novo exame citológico. Os métodos apresentaram desempenho semelhante quando comparado ao resultado do exame histológico. Portanto, de acordo com os resultados desse estudo, o pré-escrutínio rápido fornece subsídios para melhorar o desempenho dos exames citológicos, cuja principal função é detectar as lesões precursoras do câncer do colo do útero.

Le Québec a connu de multiples réformes au système de santé au cours des dernières années. Face à cette restructuration et réorganisation de soins, à la pénurie du personnel infirmier et aux demandes grandissantes des soins liées au vieillissement de la population et aux maladies chroniques, les infirmières gestionnaires sont interpellées à trouver des solutions novatrices et concrètes pour répondre de manière efficace et efficiente aux besoins de la population tout en offrant des soins et de services sécuritaires et de qualité optimale. À cet effet, plusieurs écrits sont d’avis que l’optimisation de l’étendue de pratique infirmière (ÉPI) et du champ d’exercice infirmier sont un levier essentiel pour répondre de façon efficace et efficiente aux besoins de la population en vue d’atteindre la performance du système de santé. Certes, les études réalisées au Québec ont démontré que l’ÉPI est déployée de manière insuffisante en raison des facteurs individuels et organisationnels qui l’influencent. Considérant que les infirmières gestionnaires exercent un rôle crucial pour soutenir le déploiement de l’ÉPI et qu’une sous-utilisation de l’éventail des activités professionnelles des infirmières constitue à la fois des enjeux professionnels, organisationnels et systémiques, il est opportun d’examiner et d’identifier les interventions favorables qui permettent à ces infirmières gestionnaires de contribuer à actualiser l’ÉPI optimalement. Suivant ces constats et dans une perspective de l’administration des soins infirmiers, ce projet d’étude avait pour but de d’identifier et de décrire les interventions émises aux infirmières gestionnaires afin de soutenir le déploiement optimal de l’ÉPI. Pour répondre à ce but, un rapid review selon les cinq principales étapes de Dobbins (2017) a été utilisé. Cette méthode a permis d’obtenir une synthèse des connaissances issues des écrits scientifiques et de la littérature grise systématiquement recueillie, évaluée et analysée afin de recommander des interventions prometteuses aux infirmières gestionnaires. Le modèle d’utilisation des ressources infirmières (MURI) de Dubois et al. (2012) a servi comme trame de fond tout au long de ce processus méthodologique. Au terme de cette étude, six recommandations et 38 pistes d’interventions prometteuses pour optimiser l’ÉPI ont été identifiées selon le type d’infirmières gestionnaires afin de répondre aux enjeux d’ordre professionnels, organisationnels et systémiques reliés à une sous-utilisation de l’ÉPI et du champ d’exercice infirmier constatés au sein du système de santé au Québec. Ces recommandations et ces pistes d’interventions à caractère systémique, organisationnel et individuel qui sont proposées aux infirmières gestionnaires permettraient d’optimiser l’ÉPI et en conséquence, d’améliorer la sécurité, la qualité des soins et les services à la population ainsi que de valoriser l’expertise infirmière. / Quebec has undergone multiple reforms to the health care system in recent years. Faced with this restructuring and reorganization of care, the shortage of nursing staff and the growing demands for care related to the aging of the population and chronic diseases, nurse managers are challenged to find innovative and concrete solutions to respond effectively and efficiently to the needs of the population while providing safe and optimal quality care and services. To this end, several writings are of the opinion that the optimization of the scope of nursing practice (SNP) and the field of nursing practice are an essential lever to respond effectively and efficiently to the needs of the population in order to achieve the performance of the health system. Some studies conducted in Quebec have shown that SNP is deployed insufficiently because of the individual and organizational factors that influence it. Considering that nurse managers play a crucial role in supporting the deployment of SNP and that an underutilization of the range of nurses' professional activities constitutes both professional, organizational and systemic issues, it is appropriate to examine and identify the favorable interventions that allow these nurse managers to contribute to the optimal updating of SNP. Based on these findings and from a nursing administration perspective, this study project aimed to identify and describe interventions addressed to nurse managers to support the optimal deployment of SNP. To meet this goal, a rapid review according to the five main steps of Dobbins (2017) was used. This method provided a synthesis of knowledge from scientific literature and grey literature systematically collected, evaluated and analyzed to recommend promising interventions to nurse managers. The Nursing Resource Utilization Model (MURI) by Dubois and al. (2012) had served throughout this methodological process. At the end of this study, six recommendations and 38 promising interventions to optimize SNP were identified according to the type of nurse managers in order to respond to professional, organizational and systemic issues related to an under-use of the SNP and the field of nursing practice observed within the health system in Quebec. These recommendations and these systemic, organizational and individual interventions that are addressed to nurse managers would make it possible to optimize SNP and consequently, to improve safety, quality of care and services to the population as well as to enhance nursing expertise.