Demystifying Content Analysis

Young adult's views on using a poster to learn about fertility: redesigning the fertility education poster

Fertility awareness should be taught to everyone. The International Reproductive Health Education Collaboration (IRHEC) designed a fertility poster in 2019 but did not have a specific target group in mind. Studies have been conducted in Denmark and Sweden to determine how the poster can be redesigned. In this study, we carried out focus groups with young adults in the UK to ask their views of the poster, with the aim of redesigning it. Six focus groups were undertaken with twenty seven, 18-25 year olds. Five questions were asked: 1. What are your thoughts, feelings, and reactions to the poster? 2. Did you learn anything from the poster? 3. How has reading the poster impacted your opinions or thoughts about having children? 4. What are your opinions about using a poster format to inform and start reflections regarding family building? 5. Reading through each point are there any changes to be made? Content analysis was performed. Themes identified revealed the information on the poster gave the participants some anxiety and apprehension, especially regarding the effect of age on fertility, perceptions of IVF, and gaps in knowledge. The fertility education poster is a good resource for education, but other resources should be developed.

The effects of video-based simulation in Collaborative Learning in a Student-led Global Classroom (CLSGC) program on non-technical skills among undergraduate nursing students in three regions: A mixed-methods study

BACKGROUND

Global nursing shortages and increasing cultural diversity in healthcare necessitate the development of culturally sensitive nurses. Intercultural learning and exchange programs have been shown to enhance nursing students' intercultural knowledge, cultural awareness, and sensitivity. However, non-technical skills such as communication, leadership, and teamwork are less emphasized in existing programs, despite their importance in facilitating adaptation to clinical contexts and ensuring patient safety across different ethnic groups.

OBJECTIVE

This study aims to evaluate the effectiveness of a Collaborative Learning in a Student-led Global Classroom (CLSGC) program that employs video-based learning and student-led debriefings to enhance non-technical skills, and to explore the experiences of undergraduate nursing student participants from three different regions.

METHODS

Seventy-eight nursing students from the Hong Kong Polytechnic University, Malmo University, and La Trobe University participated in the program. The program included three webinars on teamwork, communication skills, and leadership, facilitated through student-led discussions and video simulations. Data were collected using the Team Strategies and Tools to Enhance Performance and Patient Safety Teamwork Attitudes Questionnaire, and qualitative methods including focus groups and reflective journals. A paired t-test and manifest content analysis were used to analyze the quantitative and qualitative data, respectively.

RESULTS

The quantitative results indicated significant improvements in the students' attitudes towards teamwork, communication, and leadership. The qualitative data shed light on the students' learning experiences, highlighting the value of cultural exchanges in exploring the importance of non-technical skills in practice, and the effectiveness of the program structure.

CONCLUSIONS

The CLSGC program effectively improved nursing students' non-technical skills and enriched their clinical practice. Integrating simulation-based learning and student-led debriefing sessions to enhance nursing students' knowledge and attitudes towards teamwork, communication, and leadership is recommended in nursing education. Continuous exposure to simulation should be part of nursing education to reinforce the significance of non-technical skills in practice.

"Our Community Comes First": Investigating Recruitment Ads That Represent and Appeal to Black Women for Online, HIV-Related Research Studies

BACKGROUND

Black women are underrepresented in health-related research. Consulting Black women in the creation of recruitment materials may help increase their representation in research studies, but few of these recruitment materials have been evaluated. This manuscript reports on the impact of two ads (one featuring older women and one featuring younger women) created through multiple focus group sessions with Black women. The purpose of the ads were to recruit Black women to participate in an online research study about HIV prevention and pre-exposure prophylaxis, PrEP.

MATERIALS AND METHODS

Questions about the ads were embedded in the eligibility screener for inclusion in the online parent research study. Respondents were asked which ad they saw, what they liked about it, and what about the ad piqued their interest in the study.

RESULTS

In total, 301 Black women completed the eligibility screener for the online study and answered questions pertaining to the two ads. Most participants reported seeing the ad with younger women (260/301, 86.4%). Representation of Black women (n = 70), ad design (n = 64), relevance to Black women and the Black community (n = 60), and comprehensiveness of ad content (n = 38) were the top 4 ad features respondents liked. Relevance to Black women and the Black community (n = 104) as well as ad content (n = 54) (i.e., study purpose, location, duration, images, incentive) were the top two reasons provided about ads that piqued respondent's interest in the online study.

CONCLUSION

Findings showcase how recruitment ads informed by Black women could help increase their interest and participation in research.

Mental health curricula in predoctoral dental school programs: A content analysis

BACKGROUND

Given the prevalence of mental health concerns, dentists have an opportunity to provide mental health screenings to enhance overall patient care. The purpose of this study is to summarize and discuss the characteristics of mental health curricula related to patient care in accredited dental schools.

METHODS

We identified accredited predoctoral dental programs incorporating mental health training related to patient care into their curriculum. We summarized course characteristics and thematically analyzed course descriptions using headings from the National Library of Medicine.

RESULTS

From our review of curricula from 80 dental programs, 27 included a mental health component, and these were found in both didactic and clinical courses. Behavioral science and building clinical competence were the most common themes.

DISCUSSION

While mental health is an important component in overall patient care, a minority of accredited dental programs' curricula address it. Further, the manner and extent of inclusion varies. Including mental health training into dental curricula will better prepare dentists for their patients' comprehensive health needs.

Contribution of Basic Science Education to the Professional Identity Development of Medical Learners: A Critical Scoping Review

PURPOSE

Professional identity development (PID) has become an important focus of medical education. To date, contributions of basic science education to physician PID have not been broadly explored. This review explores the literature surrounding the contribution of basic science education to the PID of medical learners and interprets findings critically in terms of the landscapes of practice (LoP) framework.

METHOD

In this critical scoping review, the authors searched 12 different databases and professional organization websites from January 1988 to October 2022 for references relating to how, if at all, the basic science component of medical education contributes to the PID of medical learners. The LoP learning theory was chosen as a framework for critically interpreting the identified articles.

RESULTS

Of the 6,674 identified references, 257 met the inclusion criteria. After data extraction, content analysis of recorded key findings was used to ensure all findings were incorporated into the synthesis. Findings aligned with and were critically interpreted in relation to the 3 LoP modes of identification: engagement (engaging in the work of a physician), imagination (imagining oneself becoming a "good doctor"), and alignment (aligning with the practices and expectations of a medical community or specialty). Within each mode of identification, it was possible to see how basic science may support, or catalyze, PID and how basic science may serve as a barrier, or an inhibitor, to PID or contribute to the development of negative aspects of identity development.

CONCLUSIONS

The LoP learning theory suggests that the effect of basic science on physicians' PID is most effective if educators view themselves as guides through interfaces between their scientific disciplines and medicine. Learners need opportunities to be engaged, to imagine how their current learning activities and developing skills will be useful as future physicians, and to feel alignment with medical specialties.

A Worked Example of Qualitative Descriptive Design: A Step-by-Step Guide for Novice and Early Career Researchers

AIM

To provide a worked example informed by relevant literature and related studies that novice and early career researchers may use to reflect on, prepare and conduct a thoughtful and rigorous qualitative descriptive study.

DESIGN

Methodological discussion of qualitative descriptive design.

METHODS

Seminal work and recent related literature were reviewed to situate the discussion and identify the concepts and steps to conduct a qualitative descriptive study.

RESULTS

Qualitative descriptive design is widely used in nursing and health science research. This design offers flexible use of qualitative methods, which presents a double-edged sword, posing challenges in preparing a well-developed study and achieving methodological rigour. The design often borrows methods from other qualitative traditions, which may need to be clarified for novice and early career researchers, wherein studies may be conducted using a mix and match of methods without giving justice to the heart of qualitative descriptive design. In this paper, we present a step-by-step guide, using a worked example, to demonstrate how to conduct a qualitative descriptive study.

CONCLUSION

Qualitative descriptive design may be confusing due to its flexibility, which may limit the scope of research and subsequently, the quality and impact of the findings. With the appropriate application of research methods producing high-quality and relevant findings, qualitative descriptive design is a valuable qualitative method in its own right.

IMPLICATIONS FOR THE PROFESSION

Novice and early career researchers may increase the impact of their findings through rigorously conducting their studies. Clarifying steps for thoughtful execution may inform novice and early career researchers, allowing for a rigorous application of the method, which, in turn, may contribute to impactful findings.

IMPACT

A clear presentation of steps, supported by a worked example and related studies, may support novice and early career researchers in conducting a qualitative descriptive study with methodological rigour.

REPORTING METHOD

Not applicable.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

A multi-site mixed-method evaluation of 'Cardiac College for Women' implementation: perspectives of cardiac rehabilitation patients and providers

A Cardiac College for Women curriculum was developed to address the dearth of women-focused cardiac rehabilitation (CR) education. This study investigated: (1) patient utilization of the education; (2) acceptability and applicability of the education; as well as (3) patient and CR providers' experiences implementing it. This was a multi-site, mixed-methods study. After baseline assessments at an academic CR program in two Canadian provinces, the 12 weekly 30 min structured in-person group education sessions were led by staff in the relevant discipline, with supporting online videos and written materials. Women reported their engagement with the education in weekly diaries, and completed a survey post-program. Semi-structured virtual interviews were held with willing participants and staff delivering the intervention. Transcripts were analyzed concurrently by two researchers independently via NVIVO using text condensation, followed by consensus reconciliation and multi-source validation. Forty patients participated in the women-focused education program, with 28 completing weekly diaries and 36 post-intervention surveys. Participants attended 80% of sessions (67%-89%). They spent an average of 30 min/week engaging additionally with the online education, with 83% rating the weekly content applicable (73%-100%). Overall acceptability was rated 4.3 ± 1.7/5. Twelve patients and 5 staff participated in interviews. Four themes were identified: contextual considerations, staffing and implementation issues, valued aspects, and suggestions for improvement. In conclusion, Cardiac College for Women was established as highly acceptable and applicable to patients, supporting their self-management. The women-specific CR education materials were also established as readily implementable by CR staff.

Applying the Panarchy Framework to Examining Post-Pandemic Adaptation in the Undergraduate Medical Education Environment: A Qualitative Study

Phenomenon: The COVID-19 pandemic necessitated an abrupt shift to online medical education, disrupting learning across knowledge, skills, and social connections. Post-pandemic, medical schools must evaluate how these disruptions shaped student experiences to optimize the return to in-person learning. Approach: This cross-sectional qualitative study explored medical students' perceptions of their learning environment during the post-pandemic reintegration period in Oman. Fifty-four preclinical and clinical students participated in six focus group interviews. Content analysis identified key topics characterizing students' perceptions of change and change processes in the post-pandemic learning environment. The panarchy framework, developed to characterize complex adaptive systems in nature, was used to frame the results. Findings: The return to in-person environments presented a mix of renewed connectivity, involving collaborative benefits alongside transitional adjustment strains. Five major topics characterizing student perceptions of change and change processes in their post-pandemic learning environment were identified: learning skills, developing clinical competence, faculty interactions, physical atmosphere, and social connections. Managing academic schedules and cognitive load as the learning environment opened challenged students' learning skills. Learners valued a renewed opportunity for interactive application of knowledge through collaboration, patient contact, and empathy skill-building to feel prepared for future practice. Returning to in-person instruction renewed a sense of community and peer support networks disrupted by pandemic isolation. Some students continued to struggle with study-life imbalance and felt ill-equipped to handle post-pandemic demands. Improved access to student support and wellness services was emphasized to ease transitional stresses. Students defined an ideal learning climate as supportive, active, personalized, relevant, challenging, accessible, and collaborative. Insights: While pandemic disruptions posed challenges, they provide opportunities to strengthen the educational system's resilience moving forward. Our findings highlight an opportunity for medical educators and learners to capitalize on the innovations that emerged during this period, integrating technology with interactive learning activities and reconnecting students with the core values of the medical profession. Applying the panarchy framework to frame this adaptive process could enable the tracking of multi-level interactions within the medical education environment and the evaluation of interventions targeted at identified areas of concern. Further exploration to achieve complete mapping of specific environmental domains onto the panarchical cycles merits future investigation to build integrated resilience frameworks.

Using Politeness Theory to Deconstruct How Preregistrant Pharmacists Approach Disagreement in the Workplace

OBJECTIVE

Using politeness theory, this study investigates how preregistrant pharmacists engage in workplace disputes.

METHODS

Overall, 56 students participated in 2 mock job judgment scenarios. In scenario A (n = 25), the conflict was with a colleague of lower hierarchical status, while in scenario B (n = 32), the conflict was with a colleague of equal hierarchical status. Using politeness theory, responses were coded into 3 tiers: (1) engagement in the face-threatening act (FTA); (2) use of on/off-record approaches; and (3) communicative strategies. For tier 1, reasons for engaging in the FTA were also coded.

RESULTS

89% of the participants indicated they would unequivocally engage in the FTA. For scenario A, the pharmacist's roles and responsibilities (40%) and for scenario B, situational urgency/safety (65%) were the key drivers. Scenario A participants were more likely to use an on-record approach (80%) than those in scenario B (68%). Empathetic approaches (56%) were more common in scenario A, while explanatory approaches (64%) were more frequent in scenario B.

CONCLUSION

This study shows that preregistrant pharmacists are aware of the principles of face-work. While the study only reflects what participants believe they would do, not their actual ability in professional disputes, it supports current research that students need simulated low-stakes opportunities to practice communication skills before entering the workplace, especially where situational urgency is present. Integration of politeness theory in workshop and feedback design could help students to link awareness to actual interaction, although the theory should be expanded to integrate urgency as a factor impacting all levels of interactional decision-making.

Usability Evaluation of the Revised Color Me Healthy Symptom Assessment App: Perspectives of Children and Parents

BACKGROUND

The Color Me Healthy symptom reporting app was co-designed with school-age children with cancer, their parents, and clinicians. Preliminary studies demonstrated its feasibility and acceptability; however, children and parents identified the need for additional refinements.

METHODS

Guided by the Technology Acceptance Model and principles of user-centered design, this study supported refinements to the Color Me Healthy user interface and evaluation of its usability. As the programming team completed builds of the app, school-age children with cancer and their parents participated in cognitive walkthrough usability evaluations and qualitative interviews. Usability logs documented the completion of key tasks related to reporting pain and review of child-reported data. Parents completed the Technology Acceptance Model Perceived Usefulness Scale (TAM-PUS). Interview responses were analyzed using qualitative content analysis.

RESULTS

Fourteen children (median age 8.5 years; range 6-12) and 14 parents (median age 38.5 years; range 34-49) participated in one of three usability evaluation cycles. After the third cycle, children and parents navigated the app and completed key tasks independently. Median TAM-PUS scores were 6 (range 6-8), indicating high perceived usefulness. Qualitative analyses indicated that children regarded the app as easy and fun to use. Parents emphasized the app's developmental relevance for their child and for themselves as the child's caregiver.

CONCLUSIONS

This study demonstrates the perceived usefulness and perceived ease of use of the revised Color Me Healthy app. Optimizing the usability of the Color Me Healthy app with attention to the user needs of children and parents positions the app for wider-scale clinical implementation.

Nurses' Descriptions of Interdisciplinary Interactions in Stroke and Geriatric Rehabilitation Units: A Case Example of the Registered Practical Nurse

AIM

To analyse how nurses describe their interactions with other interdisciplinary team members within stroke and geriatric rehabilitation.

DESIGN

A secondary analysis of cross-sectional ethnographic interview data was conducted using Elo and Kyngäs' (2008) deductive content analysis.

METHODS

Between April 12 and July 25, 2022, semi-structured interviews were conducted with 31 registered practical nurses recruited through convenience sampling from three tertiary hospital sites in Southwestern Ontario. Interview transcripts were reviewed to identify described interactions between nurses and interdisciplinary team members and were coded for: who were the interdisciplinary team member(s) involved; what content was addressed; and where, when, and why the interaction occurred.

RESULTS

Categories representing how nurses describe their interactions with interdisciplinary team members were as follows: (1) arising from the unique roles owned by either the nurse or interdisciplinary team member(s); (2) requiring open communication to achieve patient goals and improve patient care; (3) occurring within what is perceived to be either the therapists' or nurses' physical space; and (4) contributing to supportive team environments that are mutually beneficial.

CONCLUSIONS

While nurses view other interdisciplinary team members as 'owning' certain roles and physical spaces within rehabilitation, they also recognised their 'owned' spaces and roles. Unique contributions of all team members were valued as necessary to provide holistic, person-centred patient care and positive team-based support.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses' descriptions of their interactions with interdisciplinary team members demonstrated their essential contributions to team-based patient care and acknowledged nurse contributions to the rehabilitation process for patients.

IMPACT

Findings elucidate the nature of interprofessional interactions and 'ownership' within the rehabilitation process. Results are beneficial for policymakers, educators, and healthcare organisations aiming to optimise the nursing role within rehabilitation spaces.

REPORTING METHOD

The Consolidated Criteria for Reporting Qualitative Research Checklist (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Physician educators' perceptions of experiences contributing to teaching

INTRODUCTION

Physician educators are essential in training the next generation of physicians. However, physician educators' perspectives about what experiences they find beneficial to their teaching and the prevalence of these experiences remain unknown. Guided by social cognitive career theory (SCCT) and communities of practice (CoP), we explored what experiences physician educators perceive as beneficial in preparing them to teach.

METHODS

In 2019, the Uniformed Services University School of Medicine in the United States surveyed its physician alumni to understand their education experiences during medical school, their current career path and what has contributed to their teaching role. Content analysis was applied to extract themes across the text response. Chi-square analysis was applied to examine if perceived contributing factors vary based on physician educators' gender, specialty and academic ranks.

RESULTS

The five most prevalent contributing factors participants (n = 781) identified are (1) experiences gained during residency and fellowship (29.8%), (2) teaching as faculty member (28.9%) and (3) class experiences and peer interaction during medical school (26%). We organised three themes that reflected major avenues of how physician educators acquire teaching skills: reflection about quality teaching, journey as learners and learning by doing. Gender and clinical specialty were differentially associated with contributing factors such as faculty development and meta-reflection.

CONCLUSION

The results are in line with theories of SCCT and CoP, in which we identified self-directed learning and regulation in shaping physician educators' teaching. The findings also revealed gaps and potential contexts for more formalised teaching practices to develop physician educators.

Credibility, readability and content analysis of treatment recommendations for adolescents with nonspecific back pain published on consumer websites

BACKGROUND

Parents may seek out health information online when their adolescent has nonspecific back pain to better understand treatment options. Such information directed towards consumers has not been previously analysed.

METHODS

A descriptive cross-sectional content analysis was performed to describe the treatments recommended on consumer websites for nonspecific back pain in adolescents. The credibility and readability of the websites were also assessed. Systematic Google searches were completed in five countries, and relevant content from eligible web pages was analysed. An a priori codebook with 34 treatment-related codes was developed. Nine additional codes were inductively created during analysis. Credibility was assessed using the JAMA benchmark. Readability was assessed via the Flesch Kincaid Grade Level.

RESULTS

Of 245 web pages, 48 were deemed eligible and analysed. Of 43 treatment codes, 37 were present in at least one web page. The five most frequently identified codes were See the doctor/get a diagnosis (found on 85% of web pages), Ergonomics/posture/biomechanics (52%), Reassurance (48%), Physiotherapy (48%) and Non-prescription pharmaceuticals/supplements (46%). Only 21% of the web pages met all four JAMA benchmark criteria, and 15% cited at least one recent or high-quality source. The median Flesch Kincaid Grade Level score was 9.0 (range 3.5-12.9).

CONCLUSIONS

Parents of adolescents with nonspecific back pain may find that treatment recommendations published online are numerous and varied, with visits to the doctor encouraged. The credibility scores of these web pages are generally low, while the median reading level may be too high for the general population.

SIGNIFICANCE STATEMENT

This analysis reveals that public-facing websites with recommendations for treating adolescent nonspecific back pain do not cite the most recent, high-quality research. Although web pages correctly encourage physical activity and exercise over surgery and prescription medications, they do not reflect the psychologically informed or interdisciplinary care emphasized in recently published treatment recommendations. Clinicians must be aware that caregivers of their adolescent patients with nonspecific back pain may be exposed to online messages that encourage them to keep seeking a diagnosis.

A mixed-methods analysis of similarities and differences in animal shelter staff, dog behavior professionals, and the public in determining kenneled dog welfare

The ability of animal shelter employees to identify poor welfare states in kenneled dogs is crucial for the mitigation of suffering. Animal shelter employees (n = 28), animal behavior professional (n = 49), and the general public (n = 41) watched 10 videos of kenneled dogs then rated the welfare of the dogs, stated the rationale for their score, indicated how they would improve the welfare, and rated the feasibility of improvements. Professionals gave slightly lower (poorer) welfare scores compared to the public (z = -1.998, p = 0.046). Shelter employees (z = -5.976, p < 0.001) and professionals (z = 9.047, p < 0.001) used body language and behavior to explain their welfare scores more than the public. All three populations mentioned the addition of enrichment to improve the welfare, however, shelter employees (z = -5.748, p < 0.001) and professionals (z = 6.046, p < 0.001) mentioned it significantly more. There were no significant differences in the perceived feasibility of changes. Future research should explore possible reasons for the lack of welfare improvements within animal shelters.

Using retrospective reports to develop profiles of harmful versus playful teasing experiences

INTRODUCTION

The current investigation's central goal was to elucidate the complex features of peer teasing episodes that individuals use to interpret teasing as harmful versus playful.

METHOD

In 2022-2023, we used semistructured interviews to gather retrospective reports of K-12 peer teasing experiences from a sample of 27 students from a university in southern Ontario, Canada (18-25 years old, 63% female, 78% White).

RESULTS

Content analysis revealed the multifaceted nature of teasing, with participants defining teasing as harmful, playful, or including elements of both harm and pleasure. Harmful teasing experiences often included content that was sensitive to the target, occurred between both friends and nonfriends, and often included a power differential with the teasing perpetrator having more power than the target. Targets recalled negative emotional responses, with behavioral responses to mitigate the situation and reduce further teasing. In contrast, playful teasing often occurred between friends or close friends, was often motivated by positive interpersonal motives (e.g., for encouragement), and had positive impacts on the relationship between perpetrator and target. However, despite benign intent, some playful teasing was marked by negative emotional responses and feelings of harm.

CONCLUSIONS

Results have implications for uncovering the nuanced and complex nature of teasing, and provide a preliminary profile of harmful versus playful teasing interactions.

A mixed methods study on poisoning and injury-related emergency department visits associated with opioids in Canada, 2011 to 2022: from the Canadian hospitals injury reporting and prevention program

BACKGROUND

The opioid crisis is a serious public health issue in Canada. There have been many surveillance programs and research studies on opioid-related emergency department (ED) visits at a national, provincial, regional or municipal level. However, no published studies have investigated the in-depth contexts surrounding opioid-related ED visits. In addition, few studies have examined injuries other than poisonings in those visits. The objective of this study is to investigate the contextual factors and co-occurrence of poisonings and injuries among the opioid-related ED visits in a Canadian sentinel surveillance system on injuries and poisonings from 2011 to 2022.

METHODS

This study used a mixed methods design. The data source was the Canadian Hospitals Injury Reporting and Prevention Program. We first selected all opioid-related ED visits during our study period and then identified the contextual factors through a content analysis of the combination of the narrative description and other variables in the patients' records. The contextual factors were organized into themes as opioid use context, social resource utilization, bystander involvement, and prior naloxone use. The opioid use context was used as a co-variable to examine the other themes and ED presentations (poisonings and other injuries). Quantitative descriptive approach was used to analyze all the contexts and ED presentations.

RESULTS

The most common opioid use context was non-prescribed opioid use without intention to cause harm, followed by self-poisoning, children's exposure, and medication error. Various rare contexts occurred. Paramedics participated in 27.9% of visits. Police and security guards were involved in 5.1% and 2.3% of visits, respectively. Child welfare or social workers were involved in 0.4% of visits. Bystanders initiated 18.9% of the ED visits. Naloxone use before arriving at the ED occurred in 23.4% of the visits with a variety of administrators. The majority of patients presented with poisoning effects, either with poisoning effects only or with other injuries or conditions.

CONCLUSIONS

Our study has provided an in-depth analysis of contextual factors and co-occurrence of poisonings and injuries among opioid-related ED visits in Canada. This information is important for ED programming and opioid-related poisoning and injury intervention and prevention.

Discharge from secondary care services to primary care for adults with serious mental illness: a scoping review

BACKGROUND

Effective transitions of patients from Secondary Care Services (SCSs) to primary care are necessary for optimization of resources and care. Factors that enable or restrict smooth transitions of individuals with Serious Mental Illness (SMI) to primary care from SCSs have not been comprehensively synthesized.

METHODS

A scoping review was conducted to answer the questions (1) "What are the barriers and facilitators to discharge from SCSs to primary care for adults with SMI?" and (2) "What programs have been developed to support these transitions?".

RESULTS

Barriers and facilitators of discharge included patient-, primary care capacity-, and transition Process/Support-related factors. Patient-related barriers and facilitators were most frequently reported. 11 discharge programs were reported across the evidence sources. The most frequently reported program components were the provision of additional mental health supports for the transition and development of care plans with relapse signatures and intervention plans.

CONCLUSIONS

Established discharge programs should be comprehensively evaluated to determine their relative benefits. Furthermore, research should be expanded to evaluate barriers and facilitators to discharge and discharge programs in different national contexts and models of care.

TRIAL REGISTRATION

The protocol for this scoping review is registered with the Open Science Framework ( https://doi.org/10.17605/OSF.IO/NBTMZ ).

Insights From Important Event Recounts Told by People With Traumatic Brain Injury

PURPOSE

Communication can be chronically impacted by severe traumatic brain injury (TBI), yet there is a critical lack of research investigating communication recovery beyond 12 months postinjury with discourse measures. This longitudinal study aimed to investigate quantitative and qualitative changes in important event recounts produced by a group of people with severe TBI up to 2 years postinjury.

METHOD

A prospective observational design with an inception cohort was adopted. Thirty-four participants with severe TBI were asked to produce an important event recount at 6, 12, and 24 months postinjury. A mixed-methods approach comprised a quantitative analysis of microlinguistic and macrostructural measures, using the automated discourse command EVAL in Computerized Language Analysis (CLAN) and the CLAN Collaborative Commentary tool, respectively. Statistical analysis included a repeated-measures analysis of variance and the Friedman test. An independent qualitative content analysis was also conducted.

RESULTS

The measures revealed significant differences between 6 and 24 months, indicating a protracted recovery trajectory. The microlinguistic analysis showed increased use of revision and repetition over time. The macrostructural analysis indicated changes with orientation to recount characters, evaluative comments, and the number of events or complexity of the recount. The content analysis revealed categories of (a) childhood events, (b) family and relationships, (c) career and education, and (d) grief and loss. Topics at 6 months focused on childhood events and holidays, whereas career and education predominated at 24 months.

CONCLUSIONS

This is the first study to explore important event recounts told by people with severe TBI as they recovered. Participants showed discourse recovery beyond 12 months, highlighting the need for equivalent timing of service provision. The important event recount shows good potential as an ecologically valid assessment tool to evaluate communication recovery that can also be integrated with advances in computerized analysis. Analyses additionally provided insights into potential therapy targets and content categories for chronic discourse impairments.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.26499271.

School-Based Occupational Therapists' Roles Supporting Transitions Into and Throughout Kindergarten to Grade 12: A Scoping Review

IMPORTANCE

Large educational transitions occur when students enter and exit school or move between grades or divisions within the kindergarten to Grade 12 (K-12) school system. For students with disabilities, the quality of large educational transitions affects academic and postschool outcomes, which is germane to school-based occupational therapists.

OBJECTIVE

To explore the school-based occupational therapy literature to describe the roles of occupational therapists in supporting large educational transitions and to identify relevant terminology.

DATA SOURCES

We searched six databases (CINAHL, EMCare, Embase, ERIC, MEDLINE, and PsycINFO) for peer-reviewed publications in English with no date limitations.

STUDY SELECTION AND DATA COLLECTION

We included articles focused on children and youth with disabilities and school-based occupational therapy services supporting large transitions within K to 12 education. Using directed content analysis, we reported on publication characteristics, occupational therapy roles, and terminology.

FINDINGS

We included 46 publications spanning 37 yr that addressed transitions into school (n = 3), within K to 12 grades or divisions (n = 10), or to exit secondary education (n = 33). Occupational therapists assumed many roles in supporting large transitions, some much more frequently than others; 125 transition terms were used across included articles with few terms explicitly defined.

CONCLUSIONS AND RELEVANCE

School-based occupational therapists' involvement in educational transitions is extensive, with potential for expansion. Consistency in terminology would support future research and practice. Plain-Language Summary: A large educational transition occurs when students move between a school, grade, or division as part of their K to 12 education. For students with disabilities, the quality of a large educational transition affects their academic and postschool outcomes. This review provides an understanding of how school-based occupational therapists support educational transitions for youth with disabilities. The review found that occupational therapists took on many roles, with the potential for expanding their roles. The review also identified 125 transition terms that were used across the literature review and found that few terms were explicitly defined. Consistency in terminology would support future research and expanded occupational therapy practice in this area.

Workplace Reintegration Programs, Policies, and Procedures for Nurses Experiencing Operational Stress Injury: A Scoping Literature Review

BACKGROUND

Nurses experience elevated rates of operational stress injuries (OSIs). This can necessitate taking leave from work and subsequently engaging in a workplace reintegration process. An unsuccessful process can have long term impacts on a nurse's career, affecting the individual, their family, and broader community, while contributing to nursing shortages. A knowledge gap regarding the workplace reintegration of nurses experiencing mental health challenges, impedes the development and implementation of initiatives that might increase the success of nurses reintegrating into the workplace. This scoping review explored the existing literature concerning workplace reintegration for nurses experiencing OSIs.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) reporting guidelines were utilized. Three key search terms across six databases were employed followed by a qualitative content analysis of the resulting literature.

RESULTS

Eight documents were included. The literature exhibited high heterogeneity in objectives, content, and article types. The content analysis revealed five themes: (1) recognizing stigma, (2) elements of successful workplace reintegration, (3) considerations for military nurses, (4) considerations for nurses with substance use disorders, and (5) gaps in the existing literature.

CONCLUSION

A paucity of programs, policies, procedures, and research exists regarding workplace reintegration for nurses facing mental health challenges. It is imperative to recognize that nurses may experience OSIs, necessitating mental health support, time off work, and operationally/culturally-specific assistance in returning to work. Innovative and evidence-based approaches to workplace reintegration are needed to enhance the retention of a skilled, experienced, compassionate, and healthy nursing workforce.

Development of a palliative paramedicine framework to standardise best practice: A Delphi study

BACKGROUND

Growing global demand for palliative care services has prompted generalist clinicians to provide adjunct support to specialist teams. Paramedics are uniquely placed to respond to these patients in the community. However, embedding palliative care principles into their core business will require multifactorial interventions at structural, healthcare service and individual clinician and consumer levels.

AIM

To develop a palliative paramedicine framework suitable for national implementation, to standardise best practice in Australia.

DESIGN

Delphi study utilising questionnaire completion; each round informed the need for, and content of, the next round. Free text comments were also sought in Round 1. Two rounds of Delphi were undertaken.

SETTING/PARTICIPANTS

Sixty-eight participants took part in Round 1, representing six countries, and 66 in Round 2. Participants included paramedics, palliative care doctors and nurses, general practitioners, researchers and carers with lived experience and expertise in palliative paramedicine.

RESULTS

Seventeen of the original 24 components gained consensus; 6 components were modified; and 9 new components arose from Round 1. All modified and new components gained consensus in Round 2. Only one original component did not gain consensus across both rounds and was excluded from the final 32-component framework.

CONCLUSION

This study has developed a comprehensive national framework addressing the macro-, meso- and micro-level interventions required to standardise palliative paramedicine across Australia. Future research ought to engage a multidisciplinary team to create an implementation strategy, addressing any perceived barriers, facilitators and challenges for applying the framework into policy and practice.

Perspectives on Self-Management and Meditation: A Qualitative Study of Adolescents With Type 1 Diabetes Mellitus and Their Parents

BACKGROUND

One in three adolescents with type 1 diabetes mellitus (T1DM) experiences diabetes distress, which predicts poor self-management and glycemic control. Mindfulness-based interventions such as meditation have been associated with reduced psychological distress and health outcomes in different populations. This study explores the psychosocial barriers and facilitators of diabetes self-management and beliefs about meditation practices.

METHODS

Eight adolescents aged 15-19 who had been diagnosed with T1DM for more than a year were invited to participate in a 40-60-minute semi-structured one-on-one interview. Their parents were also invited to participate in the study. Three of the eight parents invited were able to participate in the study. Participants were asked about perceived psychosocial barriers and facilitators of diabetes self-management and their beliefs about meditation as a tool for addressing some of the psychosocial barriers to self-management. Data were analyzed using NVivo 10 (QSR International, Melbourne, Australia). Conventional content analysis was conducted based on an inductive coding approach.

RESULTS

Adolescents with T1DM had similar psychosocial challenges with managing T1DM, including high levels of diabetes distress and forgetfulness due to competing demands on their time. They also noted similar facilitators to effective self-management, such as the presence of family and peer support. Acceptance of T1DM diagnosis and personal commitment to self-management were also indicated as common facilitators of self-management. Adolescents with T1DM and parents of adolescents with T1DM believe that meditation can play a positive role in T1DM self-management by reducing diabetes distress and improving mental health and overall well-being.

CONCLUSION

Results suggest that adolescents with T1DM and parents of adolescents with T1DM believe peer and family support is crucial to diabetes self-management. They also noted that diabetes distress and forgetfulness are primary barriers to self-management. Participants also see a potential for meditation to help manage general stress and diabetes distress, thereby aiding self-management. Further research is needed to explore meditation-based interventions to reduce diabetes distress in adolescents diagnosed with T1DM. The findings from this study can inform the development and implementation of meditation-based interventions that integrate family and peer support to reduce diabetes distress and enhance self-management in adolescents with T1DM.

Retention and turnover among migrant nurses: A scoping review

AIM

To map and explore primary research about factors related to retention, turnover and turnover intention among migrant nurses.

BACKGROUND

Understanding retention and turnover among migrant nurses is essential, especially in the context of nursing shortage. There is a range of factors motivating nurses to emigrate; however, factors related to retention and turnover among migrant nurses in the host country are unclear.

METHODS

This review utilised Arksey and O'Malley's methodological framework for scoping reviews, and is reported with the PRISMA-ScR checklist. Four electronic databases were searched-CINAHL, PsycINFO, ProQuest and PubMed-to identify primary research published between January 2000 and May 2022. Titles and abstracts were reviewed against the inclusion and exclusion criteria, and then full-text versions were reviewed. Data extracted were summarised, and results synthesised.

RESULTS

Fifteen studies were included, with studies mainly from the Middle East, the United Kingdom and the United States. Personal, organisational, financial, political and environmental factors were found to influence retention and turnover among migrant nurses.

CONCLUSION

Retention and turnover rates among migrant nurses vary among host countries. The factors identified are related to each other; hence, retention and turnover among migrant nurses are best understood in the context of their source country, host country and individual circumstances. IMPLICATIONS FOR NURSING POLICY, SOCIAL POLICY, AND HEALTH POLICY: Host countries must promote strategies that foster retention, such as reviewing immigration policies to support long-term immigration and family unity. Organisations employing migrant nurses need to consider the presence of a social network to facilitate adaptation and integration. It is also recommended that source countries address the reasons for emigration and initiate policies encouraging return migration, including providing merit to overseas experience. International nursing organisations should call for an examination of the conditions of migrant nurses to ensure equality across all source countries.

What nutrition advice is freely available for gymnasts, coaches and parents on their member National Governing Body webpages?

The purpose of this content analysis was to ascertain what nutrition advice or information is freely available on a global scale through each National Governing Body (NGB) webpage. In total, 52 NGBs and the International Federation of Gymnastics (FIG) were identified based on the FIG November 2022 world rankings for both male and female athletes in all disciplines. Concluding observations were that publicly available nutrition advice is limited across the global gymnastics platforms. Conflicting advice was also identified within some organisations surrounding the weighing of gymnasts for hydration purposes and some macronutrient discrepancies thus, potentially impacting the clarity of the message for the reader. Based on this content analysis recommendations for future practice include providing clarity and provision of tools to measure hydration, dietary recommendations should be clear and specific, and a more centralised approach to standardise advice and publicly available information.

Development and initial validation of a hospital stress questionnaire

Background

Hospitalisation can be a traumatic experience, where inpatients are exposed to an abundance of physical and psychological stressors. Evidence suggests that these hospital-related stressors negatively impact health: a phenomenon known as post-hospital syndrome. The current study aimed to identify hospital-related stressors, and to develop and provide initial validation for a new measure of in-hospital stress.

Methods

Measure development occurred in three stages: (i) semi-structured interviews, (ii) item generation, and (iii) pilot testing. Twenty-one patients were interviewed regarding their recent hospital experiences, and a list of hospital-related stressors was produced. These stressors were compiled into a questionnaire and piloted on 200 recent inpatients to provide initial evidence of internal consistency and construct validity.

Results

Stressors identified from the interviews captured all relevant questions from three previous hospital stress measures, plus 12 more. The most reported stressor was 'poor sleep'. These hospital-related stressors were developed into 67 questions, forming the Hospital Stress Questionnaire (HSQ). The HSQ showed excellent internal consistency and construct validity, and correlated with feelings of vulnerability and being unprepared to go home.

Conclusion

The HSQ is a promising self-report tool for measuring in-hospital stress. Future research ought to investigate its psychometric properties further in larger and more diverse samples. The measure has potential to be used to monitor patient risk of post-hospital syndrome.

The Governance of Traffic Noise Impacting Pedestrian Amenities in Melbourne Australia: A Critical Policy Review

By identifying a unified aim of Federal, State, and Local government authorities to deliver healthier, more liveable urban spaces and enable walkable neighbourhoods in Melbourne, Australia, questions emerge regarding noise data collection methods and the policies that aim to protect pedestrian areas from potential increases in urban traffic noise. It highlights a missed opportunity to develop strategies that provide explicit guidance for designing more compact urban forms without diminishing pedestrian amenities. This study investigates the governance of traffic-induced noise pollution and its impact on pedestrian amenities in Melbourne, Australia. It aims to identify the government bodies best positioned to protect pedestrians from noise pollution and evaluate the strategic justification for reducing traffic noise to enhance urban walkability. This research employs a semi-systematic policy selection method and a hybrid critique and review method to evaluate the multidisciplinary governance frameworks engaged in the management and mitigation of traffic noise in Melbourne. Key findings reveal that while traffic noise poses significant health risks, current policies overlook its impact on pedestrian amenities in urban areas. This study emphasises the benefits of qualitative and subjective noise data collection to inform policy-makers of the pedestrian aural experience and impacts. Discussion points include noise management strategies and the value of implementing metropolitan-scale noise-mapping to illustrate the impact of noise rather than quantities of sound. The conclusions demonstrate that there is strategic justification for managing traffic-induced noise pollution to protect pedestrian areas within international, federal, and state government policies and implicit rationale at a local level.

Resources to Support Canadian Nurses to Deliver Virtual Care: Environmental Scan

BACKGROUND

Regulatory and professional nursing associations have an important role in ensuring that nurses provide safe, competent, and ethical care and are capable of adapting to emerging phenomena that influence society and population health needs. Telehealth and more recently virtual care are 2 digital health modalities that have gained momentum during the COVID-19 pandemic. Telehealth refers to telecommunications and digital communication technologies used to deliver health care, support health care provider and patient education, and facilitate self-care. Virtual care facilitates the delivery of health care services via any remote communication between patients and health care providers and among health care providers, either synchronously or asynchronously, through information and communication technologies. Despite nurses' adaptability to delivering virtual care, many have also reported challenges.

OBJECTIVE

This study aims to describe resources about virtual care, digital health, and nursing informatics (ie, practice guidelines and fact sheets) available to Canadian nurses through their regulatory and professional associations.

METHODS

An environmental scan was conducted between March and July 2023. The websites of nursing regulatory bodies across 13 Canadian provinces and territories and relevant nursing and a few nonnursing professional associations were searched. Data were extracted from the websites of these organizations to map out educational materials, training opportunities, and guidelines made available for nurses to learn and adapt to the ongoing digitalization of the health care system. Information from each source was summarized and analyzed using an inductive content analysis approach to identify categories and themes. The Virtual Health Competency Framework was applied to support the analysis process.

RESULTS

Seven themes were identified: (1) types of resources available about virtual care, (2) terminologies used in virtual care resources, (3) currency of virtual care resources identified, (4) requirements for providing virtual care between provinces, (5) resources through professional nursing associations and other relevant organizations, (6) regulatory guidance versus competency in virtual care, and (7) resources about digital health and nursing informatics. Results also revealed that practice guidance for delivering telehealth existed before the COVID-19 pandemic, but it was further expanded during the pandemic. Differences were noted across available resources with respect to terms used (eg, telenursing, telehealth, or virtual care), types of documents (eg, guideline vs fact sheet), and the depth of information shared. Only 2 associations provided comprehensive telenursing practice guidelines. Resources relative to digital health and nursing informatics exist, but variations between provinces were also noted.

CONCLUSIONS

The use of telehealth and virtual care services is becoming mainstream in Canadian health care. Despite variations across jurisdictions, the existing nursing practice guidance resources for delivering telehealth and virtual care are substantial and can serve as a beginning step for developing a standardized set of practice requirements or competencies to inform nursing practice and the education of future nurses.

Pharmacist perceptions of continuing professional development and goal development in a community health-system

INTRODUCTION

The Accreditation Council for Pharmacy Education (ACPE) defines continuing professional development (CPD) as a self-directed, ongoing, systematic, and outcomes-focused approach to lifelong learning that is applied into practice. Hospitals and health systems can use the ACPE CPD framework for performance evaluation and to support staff in developing learning goals.

METHODS

This was an exploratory study using cross-sectional surveys and pharmacist self-reported CPD data at a community health system in the Southeastern USA. Surveys evaluating perceived value and use of CPD were administered to pharmacists with descriptive statistics calculated for quantitative survey responses qualitative data from open-ended responses analyzed using content analysis. CPD goals within pharmacist CPD records were reviewed and categorized based on relevance to the pharmacist's current practice setting. Survey results and CPD data were compared using an integrative narrative discussion.

RESULTS

Overall, fifty-seven (33.1%) pharmacists and twelve (85.7%) pharmacy managers and directors responded to surveys. A total of 13 (22.8%) respondents strongly agreed and 21 (36.8%) respondents agreed that using CPD goals to advance their practice increased job enjoyment and 13 (22.8%) respondents strongly agreed and 30 (52.6%) respondents agreed that achievement of CPD goals resulted in improved patient care. A total of 3 (23.1%) managers or directors strongly agreed and 6 (46.2%) agreed that pharmacists are more engaged employees when they use a CPD framework to plan and achieve goals. Additionally, 3 (23.1%) strongly agreed and 7 (53.8%) agreed that using a CPD process for staff development contributed to retention. A total of 1353 CPD goals were documented by 148 pharmacists with 86.3% of goals rated as relevant to practice and 204 (15.1%) containing all specific, measurable, attainable, relevant, and time-bound (SMART) goal components.

CONCLUSIONS

The CPD framework may be a useful approach to support pharmacist development in hospital and health system settings and facilitate performance reviews.

Variability in Care Pathways for Hip Fracture Patients in The Netherlands

Background/Objectives: Integrated orthogeriatric care has demonstrated benefits in hip fracture management for older patients. Comprehensive care pathways are essential for effective integrated care delivery, yet local variability in care pathways persists. We assessed the current hip fracture care pathways in the Netherlands, focusing on the variability between these care pathways and the degree of implementation of orthogeriatric care. Methods: A nationwide inventory study was conducted. A survey was sent to all hospitals in the Netherlands to collect the care pathways or local protocols for hip fracture care. All care elements reported in the care pathways and protocols were systematically analyzed by two independent researchers. Furthermore, an assessment was performed to determine which model of orthogeriatric care was applied. Results: All 71 Dutch hospitals were contacted, and 56 hospitals responded (79%), of which 46 (82%) provided a care pathway or protocol. Forty-one care elements were identified in total. In the care pathways and protocols, the variability in the description of these individual care elements ranged from 7% to 87%. Twenty-one hospitals had an integrated care model with shared responsibility, while an equal number followed an orthopedic trauma surgeon-led care model. Conclusions: These findings provide a detailed description of the hip fracture care pathways in the Netherlands. Variations were observed concerning the care elements described in the care pathways, the structure of the care pathway, and the specification of several elements. The implementation of integrated care with shared responsibilities, as recommended by the international literature, has not been achieved nationwide. The clinical implications of the variability between care pathways, such as the influence on the quality of care, need to be further investigated.

Towards a common definition of surgical prehabilitation: a scoping review of randomised trials

BACKGROUND

There is no universally accepted definition for surgical prehabilitation. The objectives of this scoping review were to (1) identify how surgical prehabilitation is defined across randomised controlled trials and (2) propose a common definition.

METHODS

The final search was conducted in February 2023 using MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, and Cochrane. We included randomised controlled trials (RCTs) of unimodal or multimodal prehabilitation interventions (nutrition, exercise, and psychological support) lasting at least 7 days in adults undergoing elective surgery. Qualitative data were analysed using summative content analysis.

RESULTS

We identified 76 prehabilitation trials of patients undergoing abdominal (n=26, 34%), orthopaedic (n=20, 26%), thoracic (n=14, 18%), cardiac (n=7, 9%), spinal (n=4, 5%), and other (n=5, 7%) surgeries. Surgical prehabilitation was explicitly defined in more than half of these RCTs (n=42, 55%). Our findings consolidated the following definition: 'Prehabilitation is a process from diagnosis to surgery, consisting of one or more preoperative interventions of exercise, nutrition, psychological strategies and respiratory training, that aims to enhance functional capacity and physiological reserve to allow patients to withstand surgical stressors, improve postoperative outcomes, and facilitate recovery.'

CONCLUSIONS

A common definition is the first step towards standardisation, which is needed to guide future high-quality research and advance the field of prehabilitation. The proposed definition should be further evaluated by international stakeholders to ensure that it is comprehensive and globally accepted.

"Breaking through the Brokenness": An Arts-Based Qualitative Exploration of Pregnant Women's Experience of Intimate Partner Violence while Receiving Trauma- and Violence-Informed Antenatal Care

Intimate partner violence (IPV) is a pervasive, worldwide public health concern. Risk of IPV may elevate during the perinatal period, increasing maternal and fetal health risks. Trauma- and violence-informed care shows promise among interventions addressing associated mental health sequelae. As a secondary analysis, the purpose of this study was to employ a qualitative arts-based exploration to better understand pregnant women's experiences of trauma and violence-informed perinatal care in the context of IPV. Using an arts-based qualitative methodology, different art forms were used to analyze, interpret, and report data, resulting in a layered exploration to represent phenomena. From this, four themes were reflected in four poetic pieces: Black Deep Corners, Triggering my Thoughts, Breaking through the Brokenness, and Now Perfectly Imperfect. Nine pieces of visual art were created reflecting these themes, creating a layered, embodied, artistic way to empathically explore and translate phenomena.

Do students' self-reflections of performance align with their graded performance in objective structured clinical exams?

INTRODUCTION

Self-awareness of strengths and weaknesses through self-reflection are important for life-long learning and development. The aim of this study was to assess the alignment in third-year undergraduate pharmacy students' self-reflections of their objective structured clinical exam (OSCE) performance to their actual OSCE scores and explore the most common aspects students reflected on as markers of perceived performance.

METHODS

Students completed a three-station OSCE and a written self-reflection about their performance. These reflections were coded using a latent pattern content analysis, with categories defined as "doing well (≥ 50% on exam)" and "not doing well (< 50% on exam)" and compared to their actual OSCE exam scores, to determine the degree of alignment.

RESULTS

Two hundred sixty-nine students completed the OSCE and reflection. Students had a low degree of alignment between their self-reflections and actual OSCE performance. Low alignment was overwhelmingly prevalent and significant in high-achieving students with OSCE scores of ≥90%. Most common aspects students reflected on as indicators of performance were finishing on time and communicating effectively. High-achieving students reflected on aspects such as empathy, systematic questioning, and patient teach-back as aspects of their performance.

CONCLUSIONS

Student reflections on exam performance do not align with their actual performance, particularly amongst the high-achieving students. High-achieving students were more aware of the different aspects that affected their performance. To ensure that high-achieving students are aware of their strengths, educators should provide more targeted feedback mechanisms and positive reassurances to help these students become more confident in their decision-making skills.

Preliminary clinical evaluation: Where are we? An international scoping review

BACKGROUND

The College of Radiographers' vision was that diagnostic radiographers in the UK would be writing preliminary clinical evaluations (PCE) on images. Their 2013 policy supporting the use of PCE has not been updated in a decade and it might be suggested PCE practices in the UK have not really moved on, though elsewhere it appears to have gained traction. The aim of this scoping review was to establish the current global status of the use of PCE.

METHOD

The Arksey and O'Malley scoping review framework and PRISMA-ScR guidelines were used to develop a protocol to identify studies between January 2013 to January 2024 using six databases. Collated literature was analysed using content analysis to identify themes.

RESULTS

52 relevant studies were identified for inclusion. Studies focused predominantly on evaluating accuracy, education, perceptions, and new initiatives. Themes identified a developing role in the use of PCE internationally, perhaps more than in the UK, and in a range of modalities and clinical settings though projectional radiography remains the mainstay. Barriers and drivers to the use of PCE were identified in addition to some quality mechanisms used to support PCE implementation, though impact of implementation was not well explored.

CONCLUSION

Considering PCE has been an aspiration for more than a decade, it remains relatively infrequently researched. There is growing scope internationally, particularly in Australia, yet there is no real evaluation of the impact and role that PCE may have.

IMPLICATIONS FOR PRACTICE

Until further research into the potential impact of PCE and barriers to its implementation, it is likely practices may not evolve with the risk AI technologies may supersede necessity for the practice.

Attachment as a mechanism influencing end-of-life communication: An analogue investigation

Talking about dying when faced with end-of-life may be important for achieving optimal outcomes for young people and their families. Given the lack of research on young people's communication around end-of-life and death, this analogue study examined the role of attachment theory in conversations about dying. Experiment 1 assessed attachment security of 80 healthy young adults and randomised them to receive either an induction that raised awareness of one's attachment figures or a neutral induction, and then primed them with an imagined scenario where they were diagnosed with an incurable illness. Participants then completed a self-report measure of their willingness to discuss end-of-life topics with family, friends, or a psychologist. The experimental attachment induction did not increase willingness to talk about end-of-life concepts. Experiment 2 extended this design and asked participants to describe these conversations and assessed the content of their imagined end-of-life conversations. Experiment 2 replicated the finding that enhancing individuals' awareness of key attachment figures did not increase participants' willingness to engage in end-of-life conversations. However, heightened attachment awareness led participants to talk more about their relationship with the person they were hypothetically talking with. Across both experiments, avoidant attachment tendencies reduced the likelihood that participants receiving the attachment prime would want to engage in end-of-life conversation. Overall, it seems there are important differences between individuals on willingness to talk about death, and this may be influenced by one's attachment style. These results raise implications for the importance of attachment in the therapeutic relationship for healthcare professionals working with young people with life-limiting illnesses, such as cancer. Further research may shed light on how an individually tailored approach, taking into account attachment security, achieves the best outcomes for individuals who require end-of-life conversations.

ChatGPT for Automated Qualitative Research: Content Analysis

BACKGROUND

Data analysis approaches such as qualitative content analysis are notoriously time and labor intensive because of the time to detect, assess, and code a large amount of data. Tools such as ChatGPT may have tremendous potential in automating at least some of the analysis.

OBJECTIVE

The aim of this study was to explore the utility of ChatGPT in conducting qualitative content analysis through the analysis of forum posts from people sharing their experiences on reducing their sugar consumption.

METHODS

Inductive and deductive content analysis were performed on 537 forum posts to detect mechanisms of behavior change. Thorough prompt engineering provided appropriate instructions for ChatGPT to execute data analysis tasks. Data identification involved extracting change mechanisms from a subset of forum posts. The precision of the extracted data was assessed through comparison with human coding. On the basis of the identified change mechanisms, coding schemes were developed with ChatGPT using data-driven (inductive) and theory-driven (deductive) content analysis approaches. The deductive approach was informed by the Theoretical Domains Framework using both an unconstrained coding scheme and a structured coding matrix. In total, 10 coding schemes were created from a subset of data and then applied to the full data set in 10 new conversations, resulting in 100 conversations each for inductive and unconstrained deductive analysis. A total of 10 further conversations coded the full data set into the structured coding matrix. Intercoder agreement was evaluated across and within coding schemes. ChatGPT output was also evaluated by the researchers to assess whether it reflected prompt instructions.

RESULTS

The precision of detecting change mechanisms in the data subset ranged from 66% to 88%. Overall κ scores for intercoder agreement ranged from 0.72 to 0.82 across inductive coding schemes and from 0.58 to 0.73 across unconstrained coding schemes and structured coding matrix. Coding into the best-performing coding scheme resulted in category-specific κ scores ranging from 0.67 to 0.95 for the inductive approach and from 0.13 to 0.87 for the deductive approaches. ChatGPT largely followed prompt instructions in producing a description of each coding scheme, although the wording for the inductively developed coding schemes was lengthier than specified.

CONCLUSIONS

ChatGPT appears fairly reliable in assisting with qualitative analysis. ChatGPT performed better in developing an inductive coding scheme that emerged from the data than adapting an existing framework into an unconstrained coding scheme or coding directly into a structured matrix. The potential for ChatGPT to act as a second coder also appears promising, with almost perfect agreement in at least 1 coding scheme. The findings suggest that ChatGPT could prove useful as a tool to assist in each phase of qualitative content analysis, but multiple iterations are required to determine the reliability of each stage of analysis.

Knowledge, attitude, and practice regarding malnutrition amongst patients with chronic kidney disease in China: A qualitative study

BACKGROUND

Chronic kidney disease (CKD) can be complicated by malnutrition, which has adverse implications on patients' health outcomes and quality of life. CKD patients from different sociocultural contexts may have varying perceptions of knowledge, attitudes, and practices of malnutrition. However, information on the perception of malnutrition in patients with CKD is limited. This study aimed to explore and describe the knowledge, attitude, and practice of patients with CKD disease regarding malnutrition.

MATERIALS AND METHODS

A qualitative-descriptive design was used. Thirteen participants were selected through a purposive sampling technique among malnourished CKD patients from a hospital in Xi'an Provincial Hospital of Traditional Chinese Medicine between November 2022 and January 2023. Data were collected through face-to-face semistructured interviews until data saturation. All participants were informed about the study. Data obtained were analyzed by content analysis.

RESULTS

Three main categories and seven subcategories were extracted from the data analysis: 1) knowledge (basic knowledge acquisition and understanding, knowledge misconceptions, and confusion, nutrition knowledge, and culture collision); 2) attitude (negative attitudes and adverse situations, positive attitude and self-awareness); 3) practice (disadvantageous and passive practice, favorable practice).

CONCLUSION

This study provided insight into the knowledge, attitude, and practice of malnutrition in patients with CKD. Our findings can serve as important baseline data for the development of future interventions that can help reduce the risk of malnutrition, slow disease progression, and improve the quality of life in patients with CKD.

Harnessing policy to promote inclusive medical product evidence: development of a reference standard and structured audit of clinical trial diversity policies

ABSTRACT

Objective

To develop a reference standard based on US Food and Drug Administration and stakeholder guidance for pharmaceutical companies' policies on diversity in clinical trials and to assess these policies.

Design

Development of a reference standard and structured audit for clinical trial diversity policies.

Setting

50 pharmaceutical companies selected from the top 500 by their market capitalizations in 2021 (the 25 largest companies and 25 non-large companies, randomly selected from the remaining 475 companies).

Population

Data from pharmaceutical company websites and annual reports. Policy guidance from the Pharmaceutical Research and Manufacturers of America, International Federation of Pharmaceutical Manufacturers and Associations, Biotechnology Industry Organization, International Committee of Medical Journal Editors, the US Food and Drug Administration, European Medicines Agency, and World Health Organization, up to 15 May 2023.

Main outcome measures

Multicomponent measure based on distinct themes derived from FDA and stakeholder guidance.

Results

Reviewing FDA and stakeholder guidance identified 14 distinct themes recommended for improving diversity in clinical trials, which were built into a reference standard: (1) enrollment targets that reflect the prevalence of targeted conditions in populations, (2) broad eligibility criteria for trials, (3) diversity in the workforce, (4) identification and remedy of barriers to trial recruitment and retention, (5) incorporation of patient input into trial design, (6) health literacy, (7) multidimensional approaches to diversity, (8) sites with diverse providers and patient populations, (9) data collection after product approval, (10) diverse enrollment in every country where trials are conducted, (11) diverse enrollment should be a focus for all phases of clinical trials, not just later stage or pivotal trials, (12) varied trial design, (13) expanded access, and (14) public reporting of the personal characteristics of participants in trials. Applying this reference standard, 48% (24/50) of companies had no public policy on diversity in clinical trials; among those with policies, content varied widely. Large companies were more likely to have a public policy than non-large companies (21/25, 84% v 5/25, 20%, P<0.001). Large companies most frequently committed to using epidemiological based trial enrollment targets representing the prevalence of indicated conditions in various populations (n=15, 71%), dealing with barriers to trial recruitment (n=15, 71%), and improving patient awareness of trial opportunities (n=14, 67%). The location of the company was not associated with having a public diversity policy (P=0.17). The average company policy had five of the 14 commitments (36%, range 0-8) recommended in FDA and stakeholder guidance.

Conclusions

The findings of the study showed that many pharmaceutical companies did not have public policies on diversity in clinical trials, although policies were more common in large than non-large companies. Policies that were publicly available varied widely and lacked important commitments recommended by stakeholder guidance. The results of the study suggest that corporate policies can be better leveraged to promote representation and fair inclusion in research, and implementation of FDA and stakeholder guidance.

Designing a core data set for benign hysterectomy registration system and its implementation in a referral teaching hospital in Northwest Iran

BACKGROUND AND AIMS

Although minimally invasive hysterectomy offers advantages, abdominal hysterectomy remains the predominant surgical method. Creating a standardized dataset and establishing a hysterectomy registry system present opportunities for early interventions in reducing volume and selecting benign hysterectomy methods. This research aims to develop a dataset for designing benign hysterectomy registration system.

METHODS

Between April and September 2020, a qualitative study was carried out to create a data set for enrolling patients who were candidate for hysterectomy. At this stage, the research team conducted an information needs assessment, relevant data element identification, registry software development, and field testing; Subsequently, a web-based application was designed. In June 2023the registry software was evaluated using data extracted from medical records of patients admitted at Al-Zahra Hospital in Tabriz, Iran.

RESULTS

During two months, 40 patients with benign hysterectomy were successfully registered. The final dataset for the hysterectomy patient registry comprise 11 main groups, 27 subclasses, and a total of 91 Data elements. Mandatory data and essential reports were defined. Furthermore, a web-based registry system designed and evaluated based on data set and various scenarios.

CONCLUSION

Creating a hysterectomy registration system is the initial stride toward identifying and registering hysterectomy candidate patients. this system capture information about the procedure techniques, and associated complications. In Iran, this registry can serve as a valuable resource for assessing the quality of care delivered and the distribution of clinical measures.

Examining the Intersection of Strategic Thinking and Continuous Process Improvement Through the Lens of Military Medical Education to Build a Novel Model

In 2020, the U.S. Air Force School of Aerospace Medicine hired its first civilian dean since its founding in 1918, tasked with building the school's first strategic plan to modernize and improve the institution. Using a combination of military continuous process improvement and academic strategic thinking, the dean produced a highly successful strategic plan. However, its resource-heavy and time-consuming methodology made it difficult to replicate. This study aimed to create a novel and streamlined strategic planning model that combined best practices from continuous process improvement and strategic thinking without redundancy. A qualitative descriptive case study was used to analyze the detailed efforts through content analysis of 150 pages of documentation. A hybrid approach to coding uncovered 44 deductive codes and 5 inductive codes from 10 strategic tools. Results indicated a converging relationship between all strategic processes tested-strategic planning, strategic thinking, and continuous process improvement and their associated tools. A five-step model called the Triple "O" OODA Loop was created, combining best practice tools from strategic planning (purpose trident and SWOT analysis or strengths, weaknesses, opportunities, and threats), strategic thinking (Hot Spots scale and GOST framework or goals, objectives, strategies, and tactics) and continuous process improvement (phases 6-8).

Resisting invisibility in healthcare responses to gender-based violence: a content analysis

Women and girls with disabilities are located at the intersections of patriarchal, ableist, and other structures of oppression that produce specific and heightened vulnerabilities to gender-based violence (GBV). Public health practitioners widely recognise the role of the healthcare sector in addressing GBV, however the role of the healthcare sector in addressing GBV must be questioned given ongoing barriers to healthcare access for people with disabilities. Grounded in an intersectional framework, I conducted a summative content analysis of GBV healthcare interventions to examine whether and how disability and intersectionality are mobilised in public health understanding of, and strategies to, address GBV. By bringing visibility to the ways in which silences construct and sustain the invisibility of women with disabilities and other social structures, I argue that GBV healthcare responses not only fail to provide care for women with disabilities across social locations, but they also risk reproducing understandings that devalue their lives.

Being yourself is a defect: analysis of documented rights violations related to sexual orientation, gender identity and HIV in 2022 using the REAct system in six eastern European, Caucasus and Central Asian countries

INTRODUCTION

Removing legal barriers to HIV services is crucial for the global 2030 goal of ending the HIV and AIDS epidemic, particularly in eastern Europe, the Caucasus and central Asia. Despite state commitments to uphold human rights, gay, bisexual and other men who have sex with men (gbMSM), along with transgender people (TP) still face stigma and discrimination. This article presents an analysis of rights violations based on sexual orientation and gender identity (SOGI) and HIV reported in 2022 across six countries, highlighting features and their links to legislation and law enforcement practices.

METHODS

We examined documented cases of rights violations among gbMSM and TP in Armenia, Kazakhstan, Kyrgyzstan, Tajikistan, Uzbekistan and Ukraine in 2022 using the REAct system, a tool for documenting and responding to rights violations against key populations. Initially, we employed directed content analysis based on Yogyakarta Principles to analyse narratives of violations. A codebook was developed through contextual, manifest and latent coding, with themes, categories and codes converted into quantitative variables for statistical analysis. Descriptive statistics were used to identify the characteristics of violations.

RESULTS

A total of 456 cases of rights violations related to SOGI and HIV were documented, ranging from 22 cases in Tajikistan to 217 in Ukraine. Most violations concerned gbMSM (76.5%), with one-fifth involving TP, predominantly transgender women. Complex violations with multiple perpetrators or infringements were documented in Armenia and central Asia. Privacy rights were commonly violated, often through outing. Cases of violations of the right to the highest attainable standard of health (13.6%) and protection from medical abuses (2.6%) were also documented. Other rights violations were sporadic, with each country exhibiting distinct patterns of violated rights and types of violations. In Ukraine, the full-scale war in 2022 influenced the nature of documented cases, reflecting the challenges faced by gbMSM and TP.

CONCLUSIONS

Monitoring rights violations proved effective for assessing the situation of gbMSM and TP, particularly in the insufficiently studied and diverse eastern Europe, Caucasus and central Asia regions. As rights violations are linked to both legislation and law enforcement practices, comprehensive interventions to minimize structural and interpersonal stigma are essential.

Understanding the Roles, Responsibilities, and Factors for Success of Health Equity Officers in Health Care Settings: A Qualitative Study

CONTEXT

Recent national guidelines aimed at addressing equity in health care settings have contributed to an increase in equity officer positions, yet little is known about their roles, responsibilities, or strategies for engaging in health equity work.

OBJECTIVE

To understand the roles and responsibilities of equity officers, as well as facilitators and barriers to their success.

DESIGN

In-depth semi-structured interviews with selected respondents from the Equity Officer National Study.

SETTING

Hospitals and health care systems across the United States.

PARTICIPANTS

Twenty-six equity officers who had responded to the Equity Officer National Study survey.

MAIN OUTCOME MEASURES

The interview guide explored strategies, facilitators, and barriers for engaging in health equity work in hospitals/health systems and communities.

RESULTS

The job roles described by participants fell into 4 categories: community benefits/relations, population/community health, workforce, and health equity. Equity officers described key areas to support success at the individual equity officer level: knowledge and expertise, professional skills, and interpersonal skills; at the hospital level: leadership, workforce, infrastructure and resources, and policies and processes; at the community level: leadership and partnerships; and at the system level: requirements and regulations, investment and resources, and sociocultural and political characteristics of the community. These key areas have been organized to create a Framework for Equity Officer Success.

CONCLUSIONS

The Framework for Equity Officer Success should be incorporated into hospital board, community stakeholder, and policymaker discussions about how to support health equity work in hospitals and health care systems.

Facilitating Access to Mental Health Services: A Stakeholder-Driven Improvement of the Children and Young People (CYP) as One Referral Platform

(1) Background: Pre-pandemic, child and adolescent mental health service (CAMHS) referrals were paper based in Liverpool and Sefton (England, United Kingdom), causing delays in waiting times. The "CYP as One" online mental health referral platform was co-created to overcome these challenges. (2) Methods: This study aims to improve "CYP as One" accessibility and usability and, subsequently, support CAMHS to improve waiting times. The current study utilised the Living Lab approach. We conducted content analysis on completed online referrals extracted from the "CYP as One" platform. These findings were supplemented by seven online focus groups, with 16-19-year-old young people, parents of children under 16, and health service providers. Thematic analysis was conducted on all data. (3) Results: The thematic analysis returned seven themes, namely (i) "CYP as One" vs. Traditional Referrals, (ii) Gender and Language Dynamics, (iii) Digital Empathy in Action, (iv) the Influence of the Provider Perspective, (v) Age and Social Sensitivity, (vi) Enhancing Access to Information, and (vii) Boosting Admin and Clinical Efficiency. (4) Conclusions: Digital content that seeks to replace in-person referrals can provide adequate support to children and young people who have faced difficulties accessing mental health services.

Does voluntary assisted dying impact quality palliative care? A retrospective mixed-method study

OBJECTIVES

We aimed to explore the relationship between the pursuit of voluntary assisted dying (VAD) and the delivery of quality palliative care in an Australian state where VAD was newly available METHODS: We adopted a retrospective convergent mixed-methods design to gather and interpret data from records of 141 patients who expressed an interest in and did or did not pursue VAD over 2 years. Findings were correlated against quality domains.

RESULTS

The mean patient age was 72.4 years, with the majority male, married/partnered, with a cancer diagnosis and identifying with no religion. One-third had depression, anxiety or such symptoms, half were in the deteriorating phase, two-thirds required help with self-care and 83.7% reported moderate/severe symptoms. Patients sought VAD because of a desire for autonomy (68.1%), actual suffering (57.4%), fear of future suffering (51.1%) and social concerns (22.0%). VAD enquiries impacted multiple quality domains, both enhancing or impeding whole person care, family caregiving and the palliative care team. Open communication promoted adherence to therapeutic options and whole person care and allowed for timely access to palliative care. Patients sought VAD over palliative care as a solution to suffering, with the withholding of information impacting relationships.

SIGNIFICANCE OF RESULTS

As legislation is expanded across jurisdictions, palliative care is challenged to accompany patients on their chosen path. Studies are necessary to explore how to ensure the quality of palliative care remains enhanced in those who pursue VAD and support continues for caregivers and staff in their accompaniment of patients.

A Look at Traumatic Brain Injury Community Programs in British Columbia: Barriers and facilitators of implementation

RESEARCH OBJECTIVES

1) Characterize the delivery of programs that support acceptance and resiliency for people with brain injury in the healthcare sector; 2) Understand the barriers and facilitators in implementation of programs to support self-acceptance and resiliency for people with brain injury.

DESIGN

Participatory focus groups were used to explore experiences of conducting brain injury programs and knowledge of the barriers and facilitators to their implementation. Focus group data were analyzed with manifest content analysis to minimally deviate from broad and structural information provided by participants.

SETTING

Four focus group sessions were conducted online through a video calling platform.

PARTICIPANTS

22 individuals from community associations conducting programs for people with brain injury. Participants were recruited from a public brain injury organization database.

RESULTS

Systemic challenges such as access to and allocation of funding require navigation support. Resource consistency and availability, including stable program leaders and a welcoming atmosphere, are important for program implementation and sustainability. Shared experiences promote connection with the community and personal development.

CONCLUSIONS

This study informs individual- and community-level approaches to promote meaningful life after brain injury. Findings highlight existing resources and support future programming for people with brain injury.

A taxing problem: The impacts of research payment practices on participants and inclusive research

Empirical data regarding payments to participants in research is limited. This lack of information constrains our understanding of the effectiveness of payments to achieve scientific goals with respect to recruitment, retention, and inclusion. We conducted a content analysis of consent forms and protocols available on clinicaltrials.gov to determine what information researchers provide regarding payment. We extracted data from HIV (n = 101) and NIMH-funded studies (n = 65) listed on clinicaltrials.gov that had publicly posted a consent form. Using a manifest content analysis approach, we then coded the language regarding payment from the consent document and, where available, protocol for purpose and method of the payment. Although not part of our original planned analysis, the tax-related information that emerged from our content analysis of the consent form language provided additional insights into researcher payment practices. Accordingly, we also recorded whether the payment section mentioned social security numbers (or other tax identification number) in connection with payments and whether it made any statements regarding the Internal Revenue Service or the tax status of payments. We found studies commonly offered payment, but did not distinguish between the purposes for which payment may be offered (i.e., compensation, reimbursement, incentive, or appreciation). We also found studies that excluded some participants from receiving payment or treated them differently from other participants in the study. Differential treatment was typically linked to US tax laws and other legal requirements. A number of US studies also discussed the need to collect Social Security numbers and income reporting based on US tax laws. Collectively, these practices disadvantage some participants and may interfere with efforts to conduct more inclusive research.

The Swedish Stroke Self-Efficacy Questionnaire: translation and cross-cultural adaptation

OBJECTIVE

To translate and cross-culturally adapt the Stroke Self-Efficacy Questionnaire (SSEQ) from English to Swedish and to evaluate psychometric properties of the questionnaire.

METHODS

A cross-sectional study design, where the translation followed a process including initial translation, synthesis, backward translation, expert committee, and pretest. Content validity was assessed using Content validity index (CVI). Psychometric assessments included floor-ceiling effects and internal consistency.

RESULTS

Language and cultural congruence were achieved, and content validity index scores were high (0.923-1). The psychometric evaluations provided acceptable outcomes concerning internal consistency, with Cronbach's alpha scores for the total scale (0.902), the activities subscale (0.861) and the self-management subscale (0.818) respectively. Ceiling effects were evident, but no floor effects.

CONCLUSION

This study found the Swedish version of the SSEQ promising as a tool for assessment of self-efficacy in a Swedish stroke care setting, although further psychometric assessments are recommended in future studies.

Unintended consequences of methadone regulation for opioid use disorder treatment among hospitalized patients

BACKGROUND

In the United States, there are no federal restrictions on the use of methadone to manage opioid withdrawal symptoms when patients are hospitalized with a medical or surgical condition other than addiction. In contrast, in an outpatient setting, methadone for opioid use disorder (OUD) is highly regulated by federal and state governments and can only be dispensed from an opioid treatment program (OTP). Discrepancies in regulatory requirements across these settings may lead to barriers in care for patients with OUD.

OBJECTIVE

Identify how methadone regulation impacts the care of patients with OUD during hospitalization, care transitions, and in the OTP setting.

METHODS

We completed 26 interviews with clinicians and social workers working on hospital-based addiction consultation services across the United States. Study findings are the result of a secondary content analysis of interviews to identifying the word "methadone" and construct themes resulting from the data.

RESULTS

We identified three major themes related to "methadone" for OUD treatment, all of which impacted patient care: (1) limited OTP hours leads to tenuous or delayed hospital discharges; (2) inadequate information-sharing between hospitals and OTPs leads to delays in care; and (3) methadone regulations create treatment barriers for the most vulnerable patients.

CONCLUSION

Strict methadone regulations have resulted in unintended consequences for patients with OUD in the hospital setting, during care transitions, and in the OTP setting. Recent and ongoing federal efforts to reform methadone provision may improve some of the reported challenges, but significant hurdles remain in providing safe, equitable care to hospitalized patients with OUD.

Preventable deaths involving sepsis in England and Wales, 2013-2022: a systematic case series of coroners' reports

PURPOSE

Coroners' Prevention of Future Death (PFDs) reports are an under-utilized resource to learn about preventable deaths in England and Wales. We aimed to identify sepsis-related PFDs and explore the causes and concerns in this subset of preventable sepsis deaths.

METHODS

Four thousand three hundred five reports were acquired from the Courts and Tribunals Judiciary website between July 2013 and November 2022, which were screened for sepsis. Demographic information, coroners concerns and responses to these reports were extracted and analyzed, including a detailed paediatric subgroup analysis.

RESULTS

Two hundred sixty-five reports (6% of total PFDs) involved sepsis-related deaths. The most common cause of death in these reports was "sepsis without septic shock" (42%) and the most common site of infection was the respiratory system (18%) followed by gastrointestinal (16%) and skin (13%) infections. Specific pathogens were named in few reports (27%). Many deaths involved multimorbid patients (49%) or those with recent surgery (26%). Coroners named 773 individual concerns, the most frequent were: a failure to keep accurate records or notes (28%), failure in communication or handover (27%) or failure to recognize risk factors or comorbidities (20%). Paediatric cases frequently reported issues with sepsis screening tools (26%). Sepsis PFDs resulted in 421 individual reports being sent, of which 45% received no response. Most organisations who did respond acknowledged concerns and initiated a new change (74%).

CONCLUSION

Sepsis-related PFDs provide valuable insights into preventable causes of sepsis and identify important sources of improvement in sepsis care. Wider dissemination of findings is vital to learn from these reports.

Examining the Motivational Climate and Student Effort in Professional Competency Courses: Suggestions for Improvement

The attainment of professional competencies leads to essential skills for successful and employable veterinarians. However, the inclusion of professional competencies in veterinary curricula is often underdeveloped, and it is sometimes less appreciated by students than the science/technical skill curricula. The aim of this study was to better understand students' motivation within professional competency courses (PC courses) by (a) comparing students' motivational perceptions in PC courses to those in science/technical skill courses (ST courses), (b) determining the extent to which students' motivational perceptions predict their course effort, and (c) identifying teaching strategies that could be used to improve PC courses. Participants included students from eight courses enrolled in their first or second year of a veterinary college at a large land-grant university in the United States. A partially mixed concurrent dominant status research design was used to collect quantitative and qualitative data. Students completed closed- and open-ended survey items regarding their effort and the motivational climate in their courses. Compared to ST courses, students put forth less effort in PC courses; rated PC courses lower on empowerment, usefulness, and interest; and had higher success expectancies in PC courses. Although students' perceptions of empowerment, usefulness, interest, and caring were significantly correlated with their effort, interest was the most significant predictor of effort in both PC and ST courses. Based on students' responses to the open-ended questions, specific motivational strategies are recommended to increase students' effort in PC courses, such as intentionally implementing strategies to increase students' interest and perceptions of usefulness and empowerment.