The role of performance feedback in the self-assessment of competence: A research study with nursing clinicians

Transferring care to enhance access to early-phase cancer clinical trials: Protocol to evaluate a novel program

Involving diverse populations in early-phase (phase I and II) cancer clinical trials is critical to informed therapeutic development. However, given the growing costs and complexities of early-phase trials, trial activation and enrollment barriers may be greatest for these studies at healthcare facilities that provide care to the most diverse patient groups, including those in historically underserved communities (e.g., safety-net healthcare systems). To promote diverse and equitable access to early-phase cancer clinical trials, we are implementing a novel program for the transfer of care to enhance access to early-phase cancer clinical trials. We will then perform a mixed-methods study to determine perceptions and impact of the program. Specifically, we will screen, recruit, and enroll diverse patients from an urban, integrated safety-net healthcare system to open and active early-phase clinical trials being conducted in a university-based cancer center. To evaluate this novel program, we will: (1) determine program impact and efficiency; and (2) determine stakeholder experience with and perceptions of the program. To achieve these goals, we will conduct preliminary cost analyses of the program. We will also conduct surveys and interviews with patients and caregivers to elucidate program impact, challenges, and areas for improvement. We hypothesize that broadening access to early-phase cancer trials conducted at experienced centers may improve equity and diversity. In turn, such efforts may enhance the efficiency and generalizability of cancer clinical research.

Development of a virtual reality-based intervention for community walking post stroke: an integrated knowledge translation approach

PURPOSE

To develop a virtual reality (VR) based intervention targeting community walking requirements.

METHODS

Two focus groups each involving 7 clinicians allowed exploring optimal features, needed support and perceived favorable/unfavorable factors associated with the use of the VR-based intervention from the clinicians' perspective. Three stroke survivors and 2 clinicians further interacted with the intervention and filled questionnaires related to acceptability and favorable/unfavorable perceptions on the VR intervention. Stroke participants additionally rated their perceived effort (NASA Tax Load Index), presence (Slater-Usoh-Steed) and cybersickness (Simulator Sickness Questionnaire).

RESULTS

Results identified optimal features (patient eligibility criteria, task complexity), needed support (training, human assistance), as well as favorable (cognitive stimulation, engagement, representativeness of therapeutic goals) and unfavorable factors (misalignment with a natural walking pattern, client suitability, generalization to real-life) associated with the intervention. Acceptability scores following the interaction with the tool were 28 and 42 (max 56) for clinicians and ranged from 43 to 52 for stroke participants. Stroke participants reported moderate perceptions of effort (range:20-33/max:60), high levels of presence (29-42/42) and minimal cybersickness (0-3/64).

CONCLUSION

Findings collected in the early development phase of the VR intervention will allow addressing favorable/unfavorable factors and incorporating desired optimal features, prior to conducting effectiveness and implementation studies.

Decision making in metoidioplasty and phalloplasty gender-affirming surgery: a mixed methods study

BACKGROUND

Gender-affirming surgical procedures, such as metoidioplasty and phalloplasty for those assigned female at birth, are complex and multistaged and involve risks. Individuals considering these procedures experience greater uncertainty or decisional conflict, compounded by difficulty finding trustworthy information.

AIM

(1) To explore the factors contributing to decisional uncertainty and the needs of individuals considering metoidioplasty and phalloplasty gender-affirming surgery (MaPGAS) and (2) to inform development of a patient-centered decision aid.

METHODS

This cross-sectional study was based on mixed methods. Adult transgender men and nonbinary individuals assigned female at birth at various stages of MaPGAS decision making were recruited from 2 study sites in the United States to participate in semistructured interviews and an online gender health survey, which included measures of gender congruence, decisional conflict, urinary health, and quality of life. Trained qualitative researchers conducted all interviews with questions to explore constructs from the Ottawa decision support framework.

OUTCOMES

Outcomes included goals and priorities for MaPGAS, expectations, knowledge, and decisional needs, as well as variations in decisional conflict by surgical preference, surgical status, and sociodemographic variables.

RESULTS

We interviewed 26 participants and collected survey data from 39 (24 interviewees, 92%) at various stages of MaPGAS decision making. In surveys and interviews, affirmation of gender identity, standing to urinate, sensation, and the ability to "pass" as male emerged as highly important factors for deciding to undergo MaPGAS. A third of survey respondents reported decisional conflict. Triangulation of data from all sources revealed that conflict emerged most when trying to balance the strong desire to resolve gender dysphoria through surgical transition against the risks and unknowns in urinary and sexual function, appearance, and preservation of sensation post-MaPGAS. Insurance coverage, age, access to surgeons, and health concerns further influenced surgery preferences and timing.

CLINICAL IMPLICATIONS

The findings add to the understanding of decisional needs and priorities of those considering MaPGAS while revealing new complexities among knowledge, personal factors, and decisional uncertainty.

STRENGTHS AND LIMITATIONS

This mixed methods study was codeveloped by members of the transgender and nonbinary community and yielded important guidance for providers and individuals considering MaPGAS. The results provide rich qualitative insights for MaPGAS decision making in US contexts. Limitations include low diversity and sample size; both are being addressed in work underway.

CONCLUSIONS

This study increases understanding of the factors important to MaPGAS decision making, and results are being used to guide development of a patient-centered surgical decision aid and informed survey revision for national distribution.

Enhancing access to and diversity in cancer clinical trials through a financial reimbursement program: Protocol to evaluate a novel program

As clinical trials have become more complex, with increasing numbers of required procedures and clinic visits, gaining access to promising new treatments has become even more challenging for many individuals. To address these barriers, we implemented a financial reimbursement and outreach program designed to increase the number and diversity of participants in cancer clinical trials at centers in Dallas, Houston, and Philadelphia. As endorsed by U.S. Food and Drug Administration (FDA) and the Texas and Pennsylvania State Legislatures, the program provides financial reimbursement for non-clinical costs (e.g., travel, lodging) to patients on cancer clinical trials with household income up to 700% the Federal poverty rate. The research study described here, centered at the Dallas site, evaluates program impact by assessing (1) numbers and diversity of patients enrolled to cancer clinical trials before and after program implementation; (2) characteristics of patients offered participation in the program who do versus do not enroll; (3) characteristics of patients enrolled in the program who do versus do not complete the reimbursement process. To evaluate perceived barriers and facilitators of program participation, we will conduct semi-structured interviews and administer the Comprehensive Score for Financial Toxicity Patient Reported Outcome Measure (COST PROM) and the Short Assessment of Health Literacy (SAHL). This program will examine how reimbursement of non-clinical costs can improve access to cancer clinical trials, with the eventual goal of increasing trial enrollment, diversity, representativeness, and generalizability.

Putting risk management into the corporate sustainability context

Purpose

This research investigates what is driving corporate sustainability within South African organisations and to what extent these drivers intersect with risk management. This is important as new and emerging business risks are proving to be directly linked to sustainability issues having implication on long-term organisational performance. This implies that sustainability and risk should not be mutually exclusive.

Design/methodology/approach

By means of semi-structured interviews, sustainability managers of 11 South African organisations were engaged to gain insight relating to the immediate sustainability issues, risk landscape and the possible intersection between these issues within their organisations. Questions posed were around drivers of sustainability, risks to an organisation, changes in risks, relationship between sustainability and risk. By means of thematic analysis key issues emerging from the responses of the sustainability managers could be identified and themes determined based on similarities. This was followed by trend analysis of the frequency of responses to different sustainability and risk themes to interpret the data.

Findings

Results reveal that sustainability and risk management are similar in their intent purpose and output both aligned towards reducing impacts and managing uncertainty. However even though sustainability has increasingly become integral to business its value contribution and linkage with risk management differ significantly amongst organisations. This suggests that sustainability and risk management remain two distinct frameworks for managing uncertainty in business.

Originality/value

Research on integrating a sustainability perspective in risk management is at an early stage. To understand and respond to emerging risks, organisations need to integrate sustainability and risk management into their decision strategies – not only to minimize potential losses but also to exploit new business opportunities arising from the sustainability agenda. Future research should be directed towards advancing systematic methods for identifying and managing sustainability risks such that key sustainability challenges are firmly embedded in the risk management of the business. In this regard, organisations would be in a position to build resilience into their business models and operations.

Development of undergraduate nursing entrustable professional activities through using a participatory design approach

BACKGROUND

Competencies represent sets of general abilities and attributes that graduating nurses must acquire. Most nursing programs adopt competency based assessment and training approaches to prepare their students to enter the clinical environment. However, some concern has been raised regarding their interpretation and implementation in everyday clinical training. To operationalize competencies for better use in clinical practice, the Entrustable Professional Activities framework (EPAs) was introduced in 2005 by ten Cate.

AIM

The aim of this study is to develop a framework of EPAs for an Undergraduate Nursing Program.

METHOD

Through using a participatory action design approach, the participants developed a set of EPAs linked with competencies for an Undergraduate Nursing Program. Thematic analysis was performed, and EPAs framework validity was constructed.

RESULT

A total of eight core EPAs were developed and each one was operationalized by a brief description and nested within the related core competency domains. Supervision levels and entrustment decisions were determined.

CONCLUSION

The development of EPAs specific to undergraduate nursing programs may offer the opportunity to have standardized language to evaluate students' progress toward competency in nursing. It is recommended to conduct further research to improve the developed EPAs.

Nursing Staff Needs in Providing Palliative Care for Persons With Dementia at Home or in Nursing Homes: A Survey

PURPOSE

This study aimed to evaluate what types and forms of support nursing staff need in providing palliative care for persons with dementia. Another aim was to compare the needs of nursing staff with different educational levels and working in home care or in nursing homes.

DESIGN

A cross-sectional, descriptive survey design was used.

METHODS

A questionnaire was administered to a convenience sample of Dutch nursing staff working in the home care or nursing home setting. Data were collected from July through October 2018. Quantitative survey data were analyzed using descriptive statistics. Data from two open-ended survey questions were investigated using content analysis.

FINDINGS

The sample comprised 416 respondents. Nursing staff with different educational levels and working in different settings indicated largely similar needs. The highest-ranking needs for support were in dealing with family disagreement in end-of-life decision making (58%), dealing with challenging behaviors (41%), and recognizing and managing pain (38%). The highest-ranking form of support was peer-to-peer learning (51%). If respondents would have more time to do their work, devoting personal attention would be a priority.

CONCLUSIONS

Nursing staff with different educational levels and working in home care or in nursing homes endorsed similar needs in providing palliative care for persons with dementia and their loved ones.

CLINICAL RELEVANCE

It is critical to understand the specific needs of nursing staff in order to develop tailored strategies. Interventions aimed at increasing the competence of nursing staff in providing palliative care for persons with dementia may target similar areas to support a heterogeneous group of nurses and nurse assistants, working in home care or in a nursing home.

Qualitative Study on the Impact of Child Sexual Abuse: Perspectives of Children, Caregivers, and Professionals in Indian Context

With an alarming increase in reported cases of Child Sexual Abuse (CSA) in India, the present study was conceived in an attempt to unearth the impact of CSA from the perspective of children, their caregivers, and the professionals dealing with them using qualitative research methodology. The secondary objective of the study was to discuss the clinical implications of the obtained findings for conducting culturally sensitive psychological assessment and intervention for CSA in India. Thus, in-depth interviews with 11 children and 7 Focused Group Discussions (FGDs) with 21 caregivers and 27 professionals were conducted. A total of 59 sample participants were recruited, and a thematic analysis was done. Six broad themes were identified from 223 generated codes-impact on behavioral, emotional, cognitive functioning and academics, psychopathology, biological, and social functioning. Four essential recommendations were concluded from the study, i.e., multidimensional impact assessment as a mandatory clinical practice, developing and utilizing culturally sensitive assessment & intervention protocols, incorporation of family-focused approach and multidisciplinary treatment team approach to ensure the holistic well-being of each chilsd in India.

Instructional strategies and course design for teaching statistics online: perspectives from online students

BACKGROUND

Teaching online is a different experience from that of teaching in a face-to-face setting. Knowledge and skills developed for teaching face-to-face classes are not adequate preparation for teaching online. It is even more challenging to teach science, technology, engineering and math (STEM) courses completely online because these courses usually require more hands-on activities and live demonstrations. Although the demand for online STEM courses has never been higher, little has been done to develop effective instructional and online course design strategies for teaching STEM courses online. This paper reports the effectiveness of the instructional strategies adopted and the online course design features in a fully online statistics course from the students' perspectives. The online statistics course was an introductory, quantitative research course that covered common statistical concepts and focused on the application of educational research concepts for graduate students in educational technology. In terms of the statistics concepts covered, the course was similar to an introductory statistics class for students majoring in science, technology, math and engineering (STEM). The participants were mostly K-20 (meaning from kindergarten to college) instructors who had knowledge of instructional strategies.

RESULTS

Data collected from participants' reflections and course evaluations revealed that a range of instructional strategies and course design features were effective and helped students learn statistics in an online environment. Specifically, case studies, video demonstrations, instructor's notes, mini projects, and an online discussion forum were most effective. For online course design features, consistent structure, various resources and learning activities, and the application focused course content were found to be effective.

CONCLUSIONS

The implications of this study include effective instructional strategies and online course design for application-oriented STEM courses such as physics and engineering. The study results can be used to guide online teaching and learning as well as online course design for instructors, course designers, and students in STEM fields.

Creativity and Bipolar Disorder: Igniting a Dialogue

Bipolar disorder (BD) has been related to heightened creativity, yet core questions remain unaddressed about this association. We used qualitative methods to investigate how highly creative individuals with BD understand the role of symptoms and treatment in their creativity, and possible mechanisms underpinning this link. Twenty-two individuals self-identified as highly creative and living with BD took part in focus groups and completed quantitative measures of symptoms, quality of life (QoL), and creativity. Using thematic analysis, five themes emerged: the pros and cons of mania for creativity, benefits of altered thinking, the relationship between creativity and medication, creativity as central to one's identity, and creativity's importance in stigma reduction and treatment. Despite reliance on a small sample who self-identified as having BD, findings shed light on previously mixed results regarding the influence of mania and treatment and suggest new directions for the study of mechanisms driving the creative advantage in BD.

Perceptions of Technology and Its Use for Therapeutic Application for Individuals With Hemiparesis: Findings From Adult and Pediatric Focus Groups

BACKGROUND

Digital technology is becoming an increasingly popular means of delivering meaningful therapy to individuals with neurological impairments. An understanding of clients' technology use and their perspectives on incorporating technology into rehabilitation can provide researchers and designers with valuable information to inform development of technologies and technology-based rehabilitation programs.

OBJECTIVE

This study was designed to establish the current use and perceptions of gaming, social media, and robotics technologies for rehabilitative purposes from the perspective of adults and children with upper limb impairments to identify barriers and enablers to their adoption and use.

METHODS

We conducted three focus groups consisting of pediatric (n=7, mean age 11.0 years) and adult (n=8, mean age 60.8 years) participants with hemiparesis affecting their upper limb. We applied thematic analysis methods to the resulting data.

RESULTS

We identified three key themes: (1) clients' use of technology in everyday life and rehabilitation, (2) barriers to use, and (3) enablers to therapy. Participants had limited exposure to technology for therapeutic purposes, but all acknowledged the potential benefits in providing motivation and interest for the performance of repetitive task practice. Adult participants requested efficacious, simple, and easy-to-use technology for rehabilitation with programs that could be individualized for them and expressed that they wanted these programs to provide a motivating means of repeated practice of therapeutic movements. In contrast, pediatric participants emphasized a desire for technology for rehabilitation that offered opportunities for social interaction and interactive games involving their whole body and not only their affected limb. Perceived safety and privacy were concerns for both groups.

CONCLUSIONS

Our findings highlight that all participants were open to the integration of technology into rehabilitation. Adult participants were more pragmatically motivated by potential recovery gains, whereas pediatric participants were more intrinsically motivated by access to games.

Utilising feedback from patients and their families as a learning strategy in a Foundation Degree in palliative and supportive care: a qualitative study

BACKGROUND

In the UK, support workers provide much of the care that palliative care patients receive, and a novel Foundation Degree was developed to enhance their skills. Feedback on performance is a recognised educational tool that reinforces good practice, and gives insight into areas of weakness, but its use with this workforce has not been described.

AIM

The aim of this qualitative study is to explore tutor and support workers' experiences of seeking and receiving feedback from patients and their families; focusing on its values and challenges.

METHODS

Support workers enrolled onto the Foundation Degree in Palliative and Supportive Care, were asked to seek feedback from patients and/or their families about the care that they provided using a 'My Experience' questionnaire. Forms were returned anonymously to the course tutor who discussed results with the student as a formative education strategy. The students' experience of this was explored in focus group interviews at three time points. Two tutors' experiences were similarly explored. Results were analysed thematically.

RESULTS

Students enjoyed receiving feedback. Positive feedback helped to increase confidence, and negative feedback allowed students to look critically at their practice and identify areas of weakness. Some experienced challenges in approaching patients/families due to having a small number of suitable patients/families; a reluctance to burden patients; high patient turnover and brevity of care relationships. The tutors enjoyed delivering feedback, recognising its benefits as an educational strategy. Some concern was expressed about how to balance delivering negative feedback while continuing to provide tutorial support throughout the Foundation Degree.

CONCLUSIONS

User feedback is considered a key formative educational strategy. Its use in health and social support workers is not established. The experiences of students and tutors in this Foundation Degree demonstrate some of the benefits and challenges of this as an educational strategy.

A cross-national cross-sectional survey of the attitudes and perceived competence of final-year medicine, nursing and pharmacy students in relation to end-of-life care in dementia

BACKGROUND

Little is known about the attitudes of healthcare professional students' perceived competence and confidence in treating those with dementia who are at the end of life.

AIM

To explore the attitudes of final year medical, nursing and pharmacy students towards people with dementia and to evaluate their perceived competence and confidence dealing with biomedical and psychosocial issues within the context of palliative care provision to patients with dementia.

DESIGN

Cross-sectional survey using a questionnaire.

SETTING/PARTICIPANTS

Final-year students in each profession from Queen's University Belfast (Northern Ireland) and the University of Iowa (USA) were recruited.

METHOD

Three versions of an online questionnaire (containing the Attitudes to Dementia Questionnaire and a series of questions on end-of-life care in dementia) were distributed.

RESULTS

A total of 368 responses were received (response rate 42.3%). All respondents reported positive attitudes towards people with dementia. US nursing students reported significantly more positive attitudes than the medical students of United States and Northern Ireland. Medical students were more likely to report low confidence in discussing non-medical aspects of dying, whereas nursing students were most likely to feel prepared and confident to do this. Medical and nursing students reported low confidence with aspects of medication-related care; however, data from the pharmacy samples of Northern Ireland and United States suggested that these students felt confident in advising other healthcare professionals on medication-related issues.

CONCLUSIONS

While healthcare students hold positive attitudes towards people with dementia, some clinical tasks remain challenging and further basic training may be of benefit.

Comparison of the clinical competence of nurses working in two university hospitals in Iran

Hospitals are integrated with medical universities in Iran and are categorized into three types with respect to educational and health services quality. This cross-sectional study aimed to determine and compare the level of clinical competence of nurses who were working in type 1 and type 2 university hospitals. The clinical competence of all 266 nurses in the two hospitals was assessed by using the self-assessment method. The Nurse Competence Scale, a questionnaire consisting of 73 items, was used to assess the level of clinical competence and the frequency of using skills. The nurses who were working in the type 1 university hospital viewed themselves as more competent than those who were working in the type 2 university hospital. Also, only 70% of the clinical skills were used frequently by the nurses who were working in the type 2 university hospital, in comparison to > 83% for the nurses who were working in the type 1 university hospital. The results can be used for the educational needs assessment of nurses and for modifying the quality of care in hospitals.

Developing a valid and reliable Self-Efficacy in Clinical Performance scale

AIM

This paper describes the development and testing of the Self-Efficacy in Clinical Performance (SECP) instrument for nursing students.

BACKGROUND

Accurate measurement of self-efficacy can be used to predict nursing students' clinical performance. The literature review indicated there is no existing self-efficacy in clinical performance instrument for Iranian nursing students.

METHODS

To clarify the concept of self-efficacy in clinical performance, 28 semi-structured interviews and three focus groups were conducted. A self-efficacy framework with well-developed theoretical constructs was formed. A review of literature and content analysis of the interview transcripts identified subscales and items to be included in the instrument. Then, a methodological design was used. The SECP was developed into 69 Likert-format items, which were evaluated by 20 nursing experts in the form of content validity index. The scale's validity and reliability were tested in a randomized sample of 207 final year nursing students.

FINDINGS

The final scale consists of four dimensions with 37 items. The overall scale internal reliability had alpha = 0.96; the dimensions Cronbach's alpha ranged from 0.90 to 0.92. Test-retest reliability with a 2-week time interval was: r = 0.94. In addition, concurrent validity was obtained (r = 0.73, P = 0.01).

CONCLUSIONS

The SECP has demonstrated evidence of content validity, construct validity, concurrent validity, internal consistency reliability and stability. Statistical analysis provided an objective tool for assessing nursing students' self-efficacy in clinical performance. It may have been fruitful to further test the instrument with students from other years of their education.